The expression of feelings in visual form has a long history, as ancient cave paintings attest. In the 19th century, Rudolf Steiner advocated the role of art in healing when developing anthroposophy. In the early 20th century, Carl Jung and Sigmund Freud ascribed to visual images the ability to reflect a patient's subconscious state, while other psychoanalysts, such as Anna Freud and Melanie Klein, later emphasized the value of creative art in childhood development.

 

In the UK, art therapy developed in the 1940s, when artist Adrian Hill began to work informally with sanatorium patients. The British Association of Art Therapists was established in 1963, and there are now about 1,000 practitioners. A postgraduate Diploma of Art Therapy was recognized by the National Health Service in 1982, and art therapists were state-registered in 1997.

Patients are encouraged to express their feelings using materials such as paint, clay, crayons, and fabric, or even magazines from which they can make a collage. They are not expected to produce a "good" work of art, but simply to give two- or three­dimensional expression to threatening or confused emotions. The act of releasing such emotions in the safe confines of the practitioner's consulting room is considered healing in itself, since the patient is able to overcome fear of self-expression and gain confidence and self-esteem. Thoughts and emotions often surface visually in a work of art long before they might appear verbally in a conventional "talk" therapy, allowing issues to be addressed at a relatively early stage. Socially unacceptable emotions, such as jealousy or rage, can also be unearthed and confronted without fear of criticism.

 

Many people cope with mental and emotional problems by repressing them, mistakenly believing that they are taking firm control over their lives. In the early stages of art therapy, the challenge for such patients is to relinquish control sufficiently to create a therapeutically useful image. Often, destructive impulses must be expressed before creativity and psychological insights can follow. Some patients need to make a mess, or to work carefully on an image only to destroy it, in order to achieve a breakthrough.

 

A further benefit of art therapy is that the work produced may contain symbols that can be interpreted by the practitioner, much as dreams may be analyzed in psychoanalysis. Art therapy differs from psychoanalysis, however, in that it is the patient who takes the lead in interpretation, not the practitioner. Art therapists believe that the individual holds the key to the symbols he or she produces, with the practitioner playing a supporting or guiding role.

Extensive casework in North America, the UK, and Europe since the late 1980s has demonstrated the value of art therapy for a wide range of emotional and psychological disturbances, including psychotic illnesses, severe learning difficulties, eating disorders, and alcohol and drug abuse. Areas now being explored include relief from AIDS, Alzheimer's disease, and terminal illness.

MEDICAL OPINION

 

Art therapy is extensively used in hospitals, prisons, and other institutions in the treatment of psychological disorders and addictions. Most psychiatrists and doctors accept its role in treating learning difficulties and exploring the profound inner conflicts that arise when a life ­threatening disease is diagnosed.

Before therapy begins, the practitioner assesses your condition. Many patients, especially in the UK and Australia, may have been referred by a medical doctor. If this is the case, the practitioner reviews any notes or background information resulting from your previous treatment. He asks about your emotional problems, your life situation, and your expectations from therapy. You in turn should take this opportunity to ask any questions you may have about the approach.

 

During a session, the practitioner avoids guiding you in an intrusive manner. He may respond to what you produce with questions and comments, in order to stimulate interpretation and further development. Unexpected and disturbing images and associations may be made in the process, and the practitioner will help you explore the meanings uncovered and feelings that arise. If you are having difficulty with a particular medium, he may suggest changing to another or working with it in a different way.

 

Adult therapy sessions usually take place once a week and are 60-90 minutes long; children's sessions may last 30 minutes. A minimum of six months' treatment is advised. Sessions may be one-to-one, or may take the form of group therapy, involving about 8-10 people. When working with a group, the practitioner might suggest theme-based exercises using dreams, relaxation, and visualization techniques.

 

Art therapy is sometimes practiced, in hospitals to supplement conventional psychotherapy. Up to three quarters of practitioners work in social services, prisons, and educational institutions. Some also work in private practice.