Like essential frontline workers, art therapists have been toiling nonstop during the pandemic. Having usually treated patients in psychiatric hospitals and mental health clinics, they shifted to practicing online, making art virtually with clients marooned at home. In August 2020, the American Art Therapy Association released a coronavirus impact report documenting how Covid-19 had disrupted mental health care at a time when it was desperately needed: 92 percent of the art therapists surveyed said their clients experienced anxiety due to isolation and the pandemic threat. Financial pressure and increased family responsibilities, like home schooling and safeguarding the health of loved ones, ranked highest among their patients’ causes of stress. Meanwhile, a new dynamic sprang up overnight, with clinicians and clients suddenly “in” each other’s homes—privy to personal space, accidentally meeting pets or family members—a situation that would normally constitute a flagrant breach of ethical boundaries. For art therapists, conducting sessions online presents additional roadblocks. It’s harder to view the art-making process through a screen, and the art materials that a patient happens to have on hand limit possibilities. In response, many therapists shifted to graphics programs such as Procreate so clients could paint on their iPads.
All in all, the struggles of the pandemic revealed the fundamentally cathartic value of making things. Arts and crafts experienced a surge in popularity over the last year and a half. Publications including the New York Times, the Washington Post, and Smithsonian magazine have chronicled the boom in hands-on hobbies like sewing, crochet, and flower pressing.
Experts aren’t surprised that people intuitively gravitated toward creative expression during a period of extreme uncertainty. At one end of the spectrum, drawing, crafting, and sculpting on one’s own have therapeutic benefits in general. Many studies have documented a positive physiological response to both aesthetic and tactile experiences, whether walking down the halls of a hospital painted in bright colors or working with clay in a ceramics class. In one instance, a 2017 Drexel University experiment measured blood flow in various areas of participants’ brains while they completed a series of simple art-making tasks. Among the findings were that doodling or coloring in a mandala activated parts of the brain related to pleasurable activities and a sense of reward. Of course, people are drawn to make art for subjective reasons, says Juliet King, who holds dual appointments as an associate professor of art therapy at George Washington University and an adjunct associate professor of neurology at the Indiana University School of Medicine, where she cofounded a program for art therapy in neuroscience and medicine. “When we create, we have a symbol,” she notes. “We have an objective way of saying we are here.” Dina Schapiro, assistant chairperson of Pratt Institute’s Creative Arts Therapy department similarly reflects on the therapeutic benefits of simply making art: “It gives us peace and calm. It creates rhythm. It separates time and space. That’s all really important.”
At the other end of the spectrum is working with an art therapist in a clinical practice. Trained as psychotherapists, King explained, practitioners use the creative process and symbolic communication to facilitate treatment. Guided by specialized clinicians, patients work in artistic mediums to express their thoughts and tap into regions of the psyche that are often not consciously accessible.
The clinical practice of art therapy is far from new, its inauguration dating to the 1940s and generally attributed to the American psychologist Margaret Naumburg, also known for founding the first Montessori school in the United States. Working at the New York State Psychiatric Institute, Naumburg asked patients to draw with paint or chalk pastels on large sheets of paper, then prompted them to talk about their artwork and its symbolic imagery. Since then, research has shown that art therapy can be beneficial in an array of contexts. Over the years, the therapeutic approach has been used in prisons to address mental health issues and as a tool of rehabilitation. Art therapy programs in the Los Angeles Unified School District and among refugees from Burma in North Carolina have helped traumatized children and adolescents who are unable to verbalize their feelings.
Treatment protocols are flexible and patient-dependent: two art therapists may choose different artistic mediums to treat the same mental health condition. The core principle, however, is always based on a therapeutic response to those materials, the theory being that particular mediums evoke particular types of emotional expression. Although this aspect of art therapy is not yet scientifically proven, King said, the hypothesis is that mediums such as watercolors tend to elicit a primarily sensorimotor or feeling-based response, whereas colored pencils or collage generally provoke a strong cognitive or thinking-based reaction. Pastel chalks are messy and break easily, which can create anxiety for those who need greater control in their life. On the other hand, cutting and arranging magazine images can provide structure and precision for clients who need such support. “Clinicians are warned against using art therapy techniques without having the training to understand how the materials and interventions work together,” King cautioned. “If someone were to work with a client [who] ‘opened up’ through a watercolor, it might become dangerous for the client, who might become overwhelmed and flooded in the process.” While patients need never have taken an art class, clinicians are required to complete basic coursework in drawing, painting, and sculpture. “Formal art training is necessary for art therapists to learn how to manipulate media, and understand composition and technique,” Deborah Elkis-Abuhoff, associate professor and director of Hofstra University’s Creative Arts Therapy Counseling program, wrote in an email. “This helps the art therapist to have a baseline of understanding when working with a client.”
Art therapy researchers describe multiple paths for addressing emotional challenges. One 1990 study by art therapists Kathryn Cox and Karen Price outlines how fast-drying tempera paint on paper helped treat adolescent clients with substance addictions. The researchers designed a program where patients met as a group twice per week for 45-minute sessions in which they were asked to draw an incident that occurred during the time they were drinking or abusing drugs. The therapists selected tempera paint specifically because it is more difficult to use than pencils or markers, paralleling the unmanageability of addiction. The art experience was meant to reflect the core concept of unmanageability from the first of the Alcoholics Anonymous twelve steps to recovery. In a 1995 paper, art therapist Holly Feen-Calligan described a different approach to working with clients in an addiction recovery program, asking them instead to draw with their eyes shut or with their nondominant hand. Here, the goal was to abandon a preconceived idea of how things should look and allow expressive images to spring forth from a less structured inner place.
Art therapy has proven particularly successful for clients suffering post-traumatic stress disorder. For nearly two decades, US military personnel have been mobilized to fight a global war on terror, exposing millions of combat soldiers to physical and psychological danger, often resulting in either traumatic brain injury or PTSD. In a 2015 TED talk, art therapist Melissa Walker of the National Intrepid Center of Excellence at Walter Reed National Military Medical Center described how crafting papier-mâché masks allows service members to express emotional war injuries through a harrowing avatar. At their initial session, service members receive a blank papier-mâché mask to decorate for two hours, and are told thereby to explore part of themselves or their emotional trauma; she finds veterans often return to work more on their masks in their spare time. “Mask making is a useful way to explore identity, as it allows for an objective and distanced approach to expressing and eventually discussing self,” King said. The success of the approach stems from a purposeful mix of subject matter—buried feelings of alienation, grief, loss—and material selection. “Working with papier-mâché in this capacity is about allowing materials to transform over time,” Schapiro, who specializes in clients with eating disorders, explained. “You have a dry and flaky material that gets wet and heavy, and then with some time, dries and then hardens. It’s a metamorphosis of materials that requires our egos to tolerate change and be patient.” Papier-mâché is also forgiving, she adds: it can always be repaired, even once dry, and it’s simple to clean up, “which can often create ease when dealing with uncomfortable feelings that arise.”
In this field, making art is a broad concept that doesn’t require a cache of professional art supplies, formal art training, or a sophisticated sense of composition. In fact, art therapists sometimes use an expressive exercise called the “scribble chase,” in which client and therapist use different watercolor markers and a large sheet of paper; as the therapist begins drawing a line, the client
is encouraged to “chase” it with their marker. Once the sheet is covered, the practitioner prompts the client to find images within the scribble and construct a story from the pictures or scene they see within the abstraction. Art therapists have also begun to embrace virtual reality, conducting sessions with headsets and remote controls to create 3D images in a virtual space. “Every art therapist has a slightly different way of working and introducing art media,” explains psychologist Cathy A. Malchiodi, founder and executive director of the Trauma-Informed Practices and Expressive Arts Therapy Institute. She often treats highly traumatized victims of assault and witnesses to violence. “Many people need to acquire a sort of visual language in the early stages of art therapy, as they may not have engaged in art-making since childhood,” Dr. Malchiodi said. “I might ask them to make a gesture or even try to make a sound like a sigh, and then use colors, shapes, and lines to show me what that looks like. Over time, most people start to become comfortable with media, just like learning a new language.”
Lately, many people have learned the therapeutic value of art-making at home on their own. As the world emerges from a long, dark pause and emotional needs rapidly adapt, drawing, sewing, and collaging at the kitchen table may continue to help individuals process and punctuate their daily reality. When asked if people will find making art so therapeutic once daily life recalibrates, Schapiro answered, “what I know in my heart is that we’re never going to be the same. There’s no way of going back, because we can’t. It’s going to have to be different. Now what we want to do with that difference depends on how much healing we experienced and how much awareness we gained from the experience of coping creatively with ourselves and the people we love.”
This article appears in the September/October 2021 issue, pp. 34–36.