Photo credit: Kate Rheinheimer

Art supplies decorated with flower petals. Art therapy is a form of therapy that often goes overlooked because of it’s creative nature.

Passionately streaking a paintbrush across a large canvas. Gently molding a soft piece of clay into a masterpiece. Mindlessly sketching while listening to your favorite artist. Most people may think of these activities as hobbies or art class projects, but these expressive practices are also used as forms of mental health care in the field of art therapy.

The American Art Therapy Association defines art therapy as “a mental health profession that enriches the lives of individuals, families and communities through active art-making, creative process, applied psychological theory and human experience.”

An important distinction to make is between the profession of art therapy and creative therapy programs. Art therapy is provided by a licensed art therapist, focused on visual arts and is rooted in psychology, while creative therapy is a more general term for the healing benefits of artistic practices, and can also encompass performing arts.  The organization Portraits of Hope utilizes creative therapy to uplift pediatric hospital patients and showcase their artwork to the greater world. It was founded in 1995 by Ed Massey and Bernie Massey. Ed Massey said that because their organization involves animal therapy and live music in addition to art therapy, he doesn’t limit his program to a singular definition. 

“We call it creative therapy because we’re not art therapists, so we don’t want to take that title,” Ed Massey said. “We can let other people define it the way they like, but it’s very engaging, very hands-on.”

Although many hospitals now implement art therapy as a form of care, the field is relatively new, and programs like the one at Children’s Hospital Los Angeles are still in developing stages, according to Nicole Albers. Albers is a specialist in pediatric art therapy and the director of art therapy at Children’s Hospital Los Angeles. Just as there is a shortage of other mental health professionals, the demand for art therapists continues to grow. Because art therapy has only recently become more widespread, many misconceptions exist about the field Albers said.

“We get called the ‘arts and crafts ladies’,” Albers said. “People forget the therapy part of the word.” 

In addition to the misconception that art therapists are the same as art teachers, many also assume that anyone can provide art therapy. Not only do these assumptions impact treatment, but nonprofessional interpretations of art produced in therapy sessions can also hinder the healing process.

“If a kid is drawing a flower, a nurse might come in and be like, ‘Oh my god, so pretty.’ And they think it means happiness. But then when you talk to the kid, it could be a representation of their pain,” Albers said. “People might misperceive the art and put their own content on it, as opposed to knowing what the person is thinking. The meaning lies with the maker.”

Art therapy is especially effective for children and senior citizens because it provides a way to nonverbally express oneself. Because of this, many children’s hospitals and elderly facilities have art or creative therapy programs to create enrichment and provide mental health treatment. 

“The thing I love about art therapy is you can communicate without words. Sometimes it’s hard to talk about what’s happening, especially here at the hospital, and it’s easier to make art, so we can let the art do the talking for us … It’s a way to share your story and share your voice and have an open space for somebody to witness, hear you and to validate your experiences,” Albers said. 

Most art therapy exercises fall into the category of directive or nondirective. In a directive exercise, the therapist leads the activity, whereas, in a non-directive one, it is patient-led. Albers said art therapists are trained to quickly asses the needs of a patient depending on the day.

Albers said. “If I have a kid who’s about to go home, I might fold the paper in three and say, ‘What did life look like before the hospital, what did it look like in the hospital and what is it going to look like when you go home?’ It’s a directive that I’m providing because we’re aimed at a certain clinical goal for that day. So it can be super wild, kid-led, and then it can also be more contained and structured.”

Another tool utilized by art therapists is the media continuum which lists art materials and their therapeutic impacts. It can aid art therapists in selecting an appropriate medium for treatment. This scale ranges from materials that create precise lines and shapes, like a colored pencil, to materials with more variation and less structure, like clay or watercolor. Each art supply has the ability to illicit a wide range of emotional responses from patients and lend itself to different therapeutic exercises.

“When I first meet a kid, I’m over on the structured side because I need to assess how they are. As you notice the need to express more, you can move towards the looser side of the continuum and different feelings will come up,”Albers said. “The way you would express yourself with a colored pencil will look different than the way you express yourself with an oil pastel or a watercolor … What we find with some people is the looser side is not comfortable, and it’s not emotionally safe because they’re not contained. So art therapists have training to know the difference between what a colored pencil could do and what a watercolor could do and when to of move in those different spaces.” 

Although she doesn’t work in art therapy, Hannah Kremin, a visual arts teacher at Archer, believes that working with clay and sculpture allows for the most emotional expression due to its sensory nature.

“I really love something tactile,” Kremin said. “Clay is extremely therapeutic, because you can see your physical touch in the material. There’s something really beautiful about that connection to your body in the material.”

In addition to material selection, another important aspect of art therapy is providing a safe and judgement-free space for the patient, according to Albers. Trust and openness are essential, she said. A barrier to giving this kind of care is perfectionism. Albers has noticed that when people are high-performing artists or have had their creations judged in the past, there is usually initial hesitance to engage in treatment.

“I like to say we’re just going to let the art be itself,” Albers said. “Kids that are super high-quality artists [are], used to making a finished product. Art therapy is too radical for them because I’m saying, ‘It doesn’t matter what it looks like. It’s the process of making it.'” 

Similarly to psychotherapy and cognitive therapy, art therapy is used to clinically treat and manage mental health conditions like ADHD, depression, anxiety and PTSD. However, in a hospital setting, art therapy can have different applications. It has been shown to be effective at pain management. Albers recalls treating a patient with sickle cell anemia — an incredibly painful condition — whose doctor needed to lower her dose of pain medication. Prior to their session, the patient rated her pain as a 12 out of 10; however, after producing artwork that represented her wish of lessening her pain, her perceived pain level reduced to an eight out of 10.

Portraits of Hope provides their creative therapy services to the Braille Institute. The organization pairs children from local middle schools with children who have vision impairments to work on art projects. Massey said the activity of creating art encourages the formation of social connections that might not have otherwise existed.

“Some can see, some can’t see. But they work together. They get their hands together, they start working together on the panels and they talk about social things like any other kid would that’s in middle school,” Massey said. “So we love seeing the connectivity between the kids in the schools, the social service programs, after school programs, the hospitals. It all connects, and it’s really beautiful.”

According to Albers, art therapy can be applied to everyone’s life even without access to a professional art therapist. Albers believes that daily visual art exercises can inspire gratitude in anyone. The therapeutic qualities of artistic expression are widely recognized, and one can experience them by reaching for a paintbrush or pencil instead of a phone when feeling emotionally distressed.

“Making space for yourself, to allow yourself to be imaginative, to dream and to have creative thought is so important because it’s a way of checking in with yourself and tapping into what makes you you, and I think a big part of that is your creative interest and your imagination and your thoughts,” Kremin said. “No matter what the output is, if anyone can just make time for themselves in the day, even if that’s sitting on the bus and looking out the window and daydreaming about the things you enjoy or might want to create one day, it allows you to get to know yourself a little bit better, and be mindful. It opens up your world, in a slow way, or in a really big way.”

In the audio clip below, Ed Massey, the founder of Portraits of Hope, talks about the emotional impacts that creative therapy has on pediatric hospital patients.