Art therapy

Art therapy is a form of expressive therapy that uses art materials, such as paints, chalk and markers. Art therapy combines traditional psychotherapeutic theories and techniques with an understanding of the psychological aspects of the creative process, especially the affective properties of the different art materials.

As a mental health profession, art therapy is employed in many clinical settings with diverse populations. Art therapy can be found in non-clinical settings as well, such as in art studios and in workshops that focus on creativity development. Art therapists work with children, adolescents, and adults and provide services to individuals, couples, families, groups, and communities.

According to the American Art Therapy Association, art therapy is based on the belief that the creative process of art is both healing and life-enhancing. Art therapists use the creative process and the issues that come up during art therapy to help their clients increase insight and judgment, cope better with stress, work through traumatic experiences, increase cognitive abilities, have better relationships with family and friends, and to just be able to enjoy the life-affirming pleasures of the creative experience. The term art therapist is reserved for those that are professionals trained in both art and therapy and hold a master's degree in art therapy or a related field.

Purpose of Art Therapy
The purpose of art therapy is much the same as in any other psychotherapeutic modality: to improve or maintain mental health and emotional well-being. But whereas some of the other expressive therapies utilize the performing arts for expressive purposes, art therapy generally utilizes drawing, painting, sculpture, photography, and other forms of visual art expression. For that reason art therapists are trained to recognize the nonverbal symbols and metaphors that are communicated within the creative process, symbols and metaphors which might be difficult to express in words or in other modalities. By helping their clients to discover what underlying thoughts and feelings are being communicated in the artwork and what it means to them, it is hoped that clients will not only gain insight and judgment, but perhaps develop a better understanding of themselves and the way they relate to the people around them. According to Ed Beeson, "Art therapists stress that it is not their job to interpret or read meaning into patients' art." (2006)

Art-Based Assessments
There are many psychological assessments that utilize artmaking to analyze various types of mental functioning (Betts, 2005). Art therapists are trained to administer and interpret a number of these assessments, most of which rely on simple directives and a standardized array of art materials (Malchiodi 1998, 2003; Betts 2005). The first drawing assessment for psychological purposes was created in 1906 by German psychiatrist Fritz Mohr (Malchiodi 1998). In 1926, researcher Florence Goodenough created a drawing test to measure the intelligence in children called the Draw–A–Man Test (Malchiodi 1998). The key to interpreting the Draw-A-Man Test was that the more details a child incorporated into the drawing, the more intelligent they were (Malchiodi). Goodenough and other researchers realized the test had just as much to do with personality as it did intelligence (Malchiodi). Several other psychiatric art assessments were created in the 1940s, and have been used ever since (Malchiodi 1998). Notwithstanding, many art therapists eschew diagnostic testing and indeed some writers (Hogan 1997) question the validity of therapists making interpretative assumptions. Below are a few of the most common art therapy assessments:

The Diagnostic Drawing Series (DDS)
The Diagnostic Drawing Series is an art therapy assessment that assesses for a range of major psychiatric disorders. (Malchiodi 1998). There are three parts to the DDS (Malchiodi 1998). In the first part, the patient is asked to draw any picture using colored chalk pastels on an 18x24 inch piece of paper (Malchiodi 1998). Then they are asked to draw a tree in the second part. In the last part of the test, the patient is asked to show how they are feeling using lines, shapes, and colors (Malchiodi 1998). The series of pictures are interpreted based on a combination of many different factors, such as use of color, amount of blending, and placement of the images on the paper.

The Mandala Assessment Research Instrument (MARI)
In this assessment, a person is asked to select a card from a deck with different mandalas; designs enclosed in a geometric shape, and then must choose a color from a set of colored cards (Malchiodi 1998). The person is then asked to draw the mandala from the card they choose with an oil pastel of the color of their choice (Malchiodi 1998). The artist is then asked to explain if there were any meanings, experiences, or related information related to the mandala they drew (Malchiodi 1998). This test is based on the beliefs of Joan Kellogg, who sees a reoccurring correlation between the images, pattern and shapes in the mandalas that people draw and the personalities of the artists (Malchiodi 1998). This test assesses and gives clues to a person's psychological progressions and their current psychological condition (Malchiodi 1998).

House–Tree–Person (HTP)
In this assessment, the patient is asked to draw a picture with a house, a tree, and a person in it (Malchiodi 1998). After the patient has finished the drawing, the therapist asks questions like, "How old is the person in your drawing? What is he or she doing?  What is the house made of?  What is the weather in this picture?" (Malchiodi 1998). This is a projective assessment and the house, the tree, and person in the drawing represent different aspects of the artist and the way the artist feels about him or herself (Malchiodi 1998).

Board Certification and Registration
In the United States, art therapists may become Registered (ATR) and Board Certified (ATR-BC). For more information on these credentials, art therapists in the US should contact the Art Therapy Credentials Board (ATCB) at www.atcb.org. A Code of Professional Practice, a 17 page document summarizing the standards of practice for professional art therapists. The ATCB Code of Professional Practice is comprised of five main categories; General Ethical Principles, Independent Practitioner, Eligibility for Credentials, Standards of Conduct, and Disciplinary Procedures (ATCB 2005).

General Ethical Principles
One topic covered in this section describes the responsibility art therapist have to their patients (ATCB 2005). According to the ATCB, art therapists must strive to advance the wellness of their clients, respect the rights of the client, and make sure they are providing a useful service (2005). They cannot discriminate against patient whatsoever, and may never desert or neglect patients receiving therapy (2005). Art therapist must fully explain to their patients what their expectations of the patients will be at the outset of the professional relationship between the two (ATCB 2005). Art therapists should continue therapy with a patient only if the client is benefiting from the therapy (ATCB 2005). It's against the principles established by the ATCB for art therapist to have patients only for financial reasons (ATCB 2005).

Another topic of this section discuses the competency and integrity art therapist must possess (ATCB 2005). The ATCB states art therapist must be professionally proficient and have integrity (2005). Art therapist must keep up dated on new developments in art therapy. They are only supposed to treat cases in which they are qualified as established by their training, education, and experience (ATCB 2005). They are not allowed to treat patients currently seeing another therapist without the other therapist's permission (ATCB 2005). Art therapist must observe patient confidentiality (ATCB 2005).

Other topics covered in this section discuss other responsibilities of art therapists. This responsibilities include, “responsibility to students and supervisees, responsibility to research participants, responsibility to the profession” (ATCB 2005). This section also establishes the rules by which art therapists must follow when making financial arrangements and when they chose to advertise their service (ATCB 2005)

Independent Practitioner
Independent practitioners are art therapists who are practicing independently or responsible for the service they are providing to paying clients. This section covers the credentials for independent practitioners.

Independent practitioners must provide a safe and functional environment to conduct art therapy sessions (ATCB 2005). According to ATCB, "this includes but is not limited to: proper ventilation, adequate lighting, access to water supply, knowledge of hazards or toxicity of art materials and the effort need to safeguard the health of clients, storage space for art projects and secured areas for any hazardous materials, monitored use of sharp objects, allowance for privacy and confidentiality, and compliance with any other health and safety requirements according to state and federal agencies which regulate comparable businesses" (2005).

This section also establishes the standards for independent practitioners to follow when dealing with financial arrangements (ATCB 2005). Basically it states that the art therapist must provide a straight forward contract to the payer of the therapy sessions (ATCB 2005). It also states that the art therapist must not deceive the payers or exploit clients financially (ATCB 2005).

The last topics this section sets standards for address treatment planning and documentation (ATCB 2005). Art therapists must provide a treatment plan that assists the patients to reach or maintain the highest level of quality of life and functioning (ATCB 2005). This involves using the clients’ strengths to help them reach their goals and address their needs (ATCB 2005). Art therapists are also required to record and take notes that reflect the proceedings of the events of therapy sessions (ATCB 2005). According to ATCB, the following is the minimum of which must be documented: “the current goals of any treatment plan, verbal content of art therapy sessions relevant to client behavior and goals, artistic expression relevant to client behavior and goals, changes (or lack of change) in affect, thought process, and behavior, suicidal or homicidal intent or ideation” (2005) and a summary of the "clients response to treatment and future treatment recommendations" (2005).

Eligibility for Credentials
This section of the ATCB Code of Professional Practice outlines the process by which art therapy students receive their credentials. It discusses the standards for eligibility and describes the application process. It also states that the ATCB certificates are the property of the ATCB and that any art therapist who loses their certificate and still claim to have ATCB credentials can be punished legally. It also discusses the procedure to follow when accused of wrong doing related to art therapy. Lastly, it discusses the wrong doings related to art therapy that therapists can be convicted for with a felony or another criminal conviction. These wrong doings include rape, sexual abuse, assault, battery, prostitution, or the sale of controlled substances to patients.

Standards of Conduct
This section of the ATCB Code of Professional Practice addresses in detail confidentiality, use of clients’ artwork, professional relationships, and grounds for discipline (ATCB 2005).

Art therapists are permitted to disclosing information about the clients’ therapy sessions. This includes “all verbal and/or artistic expression occurring within a client-therapist relationship” (ATCB 2005). Art therapist are only allowed to release confidential information if they have explicit written consent by the patient of if the therapist has reason to believe the patient needs immediate help to address a severe danger to the patients life (ATCB 2005). Also, therapists are not allowed to publish or display any of the patients work without the expressed written consent of the patient (ATCB 2005).

The standards of a professional relationship between art therapists and clients are covered in this section. Within a professional relationship, art therapists are banned from engaging in exploitative relationships with current and former patients, students, inters trainees, supervisors, or co-workers (ATCB 2005). The ATCB defines an exploitative relationship as anything involving sexual intimacy, romance, or borrowing or loaning money (ATCB 2005). Within professional relationships, therapists are to do what they feel is best in the clients interest, shall not advance a professional relationship for their own benefit, and shall not steer their patients in the wrong direction (ATCB 2005).

The breaking of any of the standards established in this section is grounds for discipline (ATCB 2005).

Disciplinary Procedures
The content contained in this section of the ATCB Code of Professional Practice specifically discusses in legal and technical detail the entire disciplinary procedures for wrong doings in art therapy (2005). Main topics covered in this section cover: “submission of allegations, procedures of the Disciplinary Hearing Committees, sanctions, release of information, waivers, reconsideration of eligibility and reinstatement of credentials, deadlines, bias, prejudice, and impartiality” (ATCB 2005).