How Art Therapy Can Work-A Case Study

Along with many art therapists, I sometimes struggle to articulate exactly how art therapy works. In response to this question recently posed by Cathy Malchiodi, I am going to attempt to explain it via a case study. Details have been changed to protect the identity of the client, who has since passed away.

Many years ago, I worked extensively in nursing homes. One resident was in the late stages of an illness that was greatly exacerbated by his diet. Many battles ensued between him and nursing staff over his constant intake of food that worsened his condition. The attending psychiatrist asked me to work with him to address this problem. I imagined that our work would focus on his body image (as he was morbidly obese), his declining health and the struggles with nursing staff.

This case ended up being a lesson for me in person-centered planning. He had no interest whatsoever in focusing on what I considered to be the primary problems. He was, however, very interested in painting even though he had never done it before. During our first session, he pulled out a book of postcards that depicted various nature scenes on the West Coast. The time he spent living in that part of the country was the happiest time of his life and he wanted to capture these images in paint. I brought him a set of acrylic paint, some brushes and paper and we were off and running.

Over the course of time, nursing staff started to notice that he was quite gifted as a painter. He painted all weekend instead of eating all of his favorite snacks. Nurses checked in to admire what he was working on instead of to scold him for what he was eating. A few even commissioned works from him. While he painted, he reminisced about his time on the West Coast and his younger days.

We never spoke of his diet, his weight, his battles with nursing staff. We talked about line, shape, form, color, harmony, and composition. I listened while he told me of adventures from his youth, his life and loves. I accompanied him on his journey. By the time he was discharged from the nursing home, his relationship with the staff was a positive one and his diet had improved.

So how did art therapy work in this case? Art became a healthy coping skill, allowing this client to engage in a positive activity to manage his feelings, rather than burying them in food. It became a conduit in his relationships with others, allowing them to see his strengths rather than focusing on his deficits. Art was the language that joined us together in our relationship. He benefited from the time and attention I gave him and from my willingness to follow him where he needed to go in therapy.

This case was a good lesson for me. I had to let go of my ideas about what this client needed and not impose my treatment priorities on him. And guess what? He found exactly what he needed.


What This Art Therapist Does Not Do

I get a lot of hits to my blog from people searching on the topic of “a day in the life of an art therapist” and “what does an art therapist do?” I want to add to this conversation by telling you what I as an art therapist do NOT do.

I do NOT analyze your artwork  seeking out clues to your psyche.

I do NOT interpret imagery in your artwork to fit my theory about you.

I do NOT tell you what kind of artwork to make, as though to prescribe a cure.

I do NOT diagnose you based only on your artwork.

I do NOT share your artwork with anyone except other providers at the site, as it is confidential healthcare information.

I do NOT reveal your name or other identifying information if you have given me explicit written permission to share your artwork.

Here are some things I DO:

Provide you with the materials, space, instruction and time to create the artwork you want to make.

Support you in exploring the  imagery, themes and content of your work.

Give suggestions if you feel you are stuck in your artwork or want to explore something further.

Walk with you on your healing journey of the heart.

There are many misconceptions about what art therapists are and what they do. I won’t even go into the whole debate about “arts and healing” vs. “art therapy.” Art therapists are trained clinicians, yes clinicians, who have had years of schooling and internships to better assist our clients in exploring their challenges and struggles. Call it what you want, but I proudly call it Art Therapy.

I have my degree, now what?

It’s that time again. New art therapists are walking the stage, collecting their diplomas and wondering what the heck they are going to do next. Especially at a time when it seems like there are no jobs of any kind out there, how does one find an art therapy job? Given the time and money invested in getting a master’s degree, frustration and pressure can rise as the job search goes on.

Here is my advice. You are most likely not going to find the job of your dreams straight out of school. What you will be able to find is a job that will help you get your clinical license and your art therapy credentials so that down the road you can get the job of your dreams. Don’t be afraid to hold out for a little while until you can find a job that suits your needs in terms of benefits, clinical experience and supervision. You are probably aware by now that a huge salary is not coming your way but don’t be afraid to negotiate and find something that suits your needs. No need to undersell yourself.

There are many ways of working as an art therapist. One is to land a full-time job. Inquire about what type of supervision you will be able to receive. You may be able to find someone within the agency who can give you the supervision hours you need for your license. This is a huge job benefit and will save you a great deal of money. Don’t be afraid to apply for jobs that are not explicitly art therapy jobs. A clinical position at an agency can be a foot in the door and you can market your additional skills as an art therapist. They may not have known they were looking for an art therapist until you showed up! My first job was at a mental health agency as an elder services clinician. They did not hire me specifically as an art therapist but were happy to have me work as one. There was someone in the agency who was an ATR and LMHC who provided my supervision. It was a win-win because the supervision was on the clock for both of us and I did not have to pay for outside supervision. Within 2 years I had my credentials and moved on to another job.

Another way of working is to pick up per diem and fee for service work. It is sometimes necessary or desirable to do this in addition to a full-time job. Many sites do not have the funding to hire a full-time art therapist but are able to bring someone in for a few hours a week. It is worth it to pursue these positions because it could turn into something more and you are networking as well. Fee for service work is tricky because if the client doesn’t show up, you don’t get paid. Paperwork is done on your own time and it can be significant. Travel time is often not reimbursed. However, it is a good way to gain experience and supplement your income. You often can work in a wide range of settings and with diverse populations as well. I have worked in homeless shelters, schools, nursing homes, clients’ homes, hospitals, adolescent group homes and elder housing as a fee for service clinician. I loved working in so many different settings. The work was interesting and I gained a great deal of experience.

My final piece of advice: Network. Network. Network. Massage every connection you have. Stay in touch with supervisors, professors and fellow students. Join online groups. Attend conferences and workshops. Print up some business cards and give them to everyone you meet. I found my current job through a former professor. My previous job was found through a former supervisor. People hear about positions all the time and you have to keep your name and face in front of them. Hang in there. Working as an art therapist is possible. It is not always easy and I have certainly had my share of struggles so I won’t sugarcoat the challenges we face in the job market. But it can be done. Best wishes to you on your journey.

A Matter of Degrees

I am often asked what one has to do to become an art therapist. I am going to tackle this question from two points today: the personal qualities one must have and the credentials and degrees that are needed to practice.

To be an art therapist, or any kind of therapist, in my opinion one must have  a level of compassion for others. You must have a tolerance for hearing painful stories and knowing that people are still living in difficult situations. You must be patient. Change does not happen overnight for anyone and it cannot be forced. You must be humble. Therapists do not have the secret to a happy life and cannot dictate what will be meaningful and important to others.  You must be hopeful. If you don’t believe that a person can change and grow, they won’t believe it either. When someone is in the depths of despair, you have to hold onto hope for them. You must be willing to face heartbreak, yours and the clients. You must be willing to educate others about your work. Art therapy is still unknown to many, and you will constantly be explaining your work to others. You must be able to use yourself as a tool. By this I mean you are able to hold onto other ‘s pain, let them bounce their feelings off of you, attend to your own internal responses, and reflect back to them from a place of honesty, compassion, and non-judgement.  You must have a level of self-knowledge. This doesn’t mean that your own life is all worked out and perfect. I know plenty of therapists and we all have our own daily struggles. But you must be  willing to look closely at yourself and your own actions and feelings so that you are responding to clients, not simply reacting.

Credentials and insurance reimbursement vary widely depending on where you live, so I am just going to talk about my decisions regarding degrees. My undergraduate degree was a Bachelor of Fine Arts with a minor in Psychology. There was no such thing as a bachelor’s degree in Art Therapy when I was an undergrad. I am glad I got a broader degree because I was exposed to the full liberal and fine arts education as opposed to a narrow specialization. It was important for me to consider all of my options and not lock into anything at the beginning of my higher education. I chose to specialize when I got to graduate school and have a Master’s in Art Therapy. Now the question is whether to get a PhD.

When I was in high school, I dreamed of getting a PhD. Instead of writing out my imagined married name, I wrote out my name with a string of letters after it. Now, I feel very differently about it. I want to have a PhD, I just don’t want to get one. There are a few PhD programs in Expressive Therapies, but the purpose of them seems to be to prepare you for a life in academia and research. This is not the direction I want to go. Anyway, I am already teaching and don’t need a PhD to do research or publish. A PsyD interests me, but again I don’t think it would further my career in a way that I would want. I would have to do some full-time internships, and how would I do that and still work? I also don’t need it to bill insurance, as my current credential of Licensed Mental Health Counselor allows me to do that.

The bottom line, as often happens, is money. If I won the lottery, I might consider going back to school. As it stands, I can’t work and go to school and the degree options available to me won’t further my career in any substantial way. The debt I  would incur would offset any potential increase in salary.

So what  is my advice to the person interested in becoming an art therapist? Get as many credits as you can in art and psychology as an undergrad. Find out what the requirements are to practice where you live. The credentials and ability to bill insurance vary widely. Get  whatever credentials you can related to art therapy.  Get whatever clinical license you can in your area. Get a Master’s Degree. You won’t be able to get any credentials without it. It is hard work to attain all of these, believe me, I know. But it will likely set you up to practice at both agencies and independently.  And most importantly, don’t give up. Connect with everyone you can in person and  on-line to buoy you on your journey.

The work of art

Vocational arts display at the Statehouse

I lead a double life as an artist. I have my “work art” and my “art art.” Let me tell you a bit about the “work art.” As an art therapist in a rehab program, I run a vocational arts program. Now this might seem like a contradiction to some. As an art therapist, my role is to encourage the free expression of thought and emotion via the art materials. As a vocational arts coach, my role is to teach people how to make specific salable items using particular materials. I may very well work with someone in an art therapy group in the morning  and work with that same person in the vocational arts program in the afternoon.

There is no doubt in my mind that the artwork done as part of the vocational arts program is expressive and that creating it is therapeutic. But this is a very different ball of wax from art therapy and I am not going to tackle the topic of the goals of art therapy today. The goals of the vocational arts program differ in some significant ways from the art therapy program. In the vocational art program, clients are taught how to use particular materials and employ craftsmanship and design skills. They are involved in every aspect of the business, from working events to ordering materials. They are paid for all of their efforts. The program aims to develop strong vocational skills to prepare clients for their return to the community. They learn to plan their work time, complete tasks, keep an orderly work space, interact effectively with their co-workers, and engage with the public.

There are two main benefits to this program. One is that people working in the program have fun. Yes, fun. We enjoy our work and enjoy each other. The other is that the clients learn transferable skills. I don’t expect that many of them will set up their own crafting business upon discharge from the hospital. But the skills they learn in this program apply to any type of work situation. The work group has grown close, a rarity in the hospital environment. They support and encourage each other and ooh and ahh over each others’ work. Some clients work alone on their items and some work closely with me to create their pieces. As long as it stays fun, we will keep on with the “work” of art.

So, what exactly does an art therapist do?

There are some really delicious things about the work of an art therapist.  Art making every day, time in the studio, contact with art materials, watching people grow and learn through the creative process.  Yesterday I even got to have the “I am not an artist” conversation with a client while they were making a beautiful silk scarf.  I run groups, train students, order materials, coordinate a vocational arts program and work on special projects.

I work in the open studio model.  Open studio is a little different from traditional art therapy.  Instead of giving a directive to a group, each person works on their own self-directed art work.  The therapist typically makes art alongside the clients.   The processing of the art work is much more organic in that the conversations arise naturally rather than the typical “go-around” where each person shares something about their work.  It sounds easy, but it’s not.  The therapist is still attending to each member of the group and keeping the group process going while encouraging clients to interact with each other.  The therapist makes their own art not to share with the group necessarily, but to model art making as a purposeful, meaningful and useful activity.

In addition to my responsibilities as an art therapist, I have a variety of other tasks to tend to.  Depending on where you are working, you may have some similar duties.  I think it’s important for art therapists in training to understand that we are quite often called upon to do many things besides work in the studio.  It is the nature of the system and it actually makes you more valuable to have a variety of skills.   I make staff assignments, close down our restaurant, drive the van, organize trips, run the laminating machine, coordinate a meeting, sit on a treatment team, organize the library and generally jump in wherever I am needed to keep our boat afloat.

So I think the question really is “What doesn’t an art therapist do?”  Given our sometimes fragile status in the work place due to our eligibility for licensure and perceived value as clinicians , I think it is important to not only be trained as an art therapist but to have a broad skill set and be willing and able to use it.  And yes we get called on to do things that are art-related but not necessarily art therapy e.g holiday decorations, etc.  Just do it, help out and don’t get too hung up on the whole “I am a therapist, not a decorator” thing.  You are an artist and your expertise is called upon in many ways.  Be a team player in all aspects of your job.  It helps with how art therapists are perceived, it helps the clients and it helps you.

So, that’s a typical day in the life of this art therapist.  What does your typical day look like?  What are you called upon to do?  What model do you work from?

Art Therapy: An Elevator Speech

The Question.  It’s inevitable.  “So, what do you do?” Depending on the circumstances, I may answer that I am an artist, a teacher or an art therapist.  While I am extremely proud of being an art therapist, I have sometimes been a little hesitant to share this.   My fear (and this is well-founded) is that the person will start to tell me about their personal problems.  But let’s assume that this person is genuinely interested in what art therapy is all about.   How can I explain my life work in 3 minutes?

While I hesitate to define art therapy against anything, I will.  Let me tell you what art therapy is not. It is not reading inkblots.  It is not interpreting drawings.  It is not about coloring and doing “cut and paste.”  Let me tell you what art therapy is. It is a profession practiced by highly trained individuals with graduate degrees and clinical licenses.  Art therapists are both fine artists and trained mental health professionals.  Art therapy draws (pun somewhat intended) on strengths, on the the drive to create and on the human need for community.  Art therapy uses the creative process to heal.  Whether it is a Sudanese child drawing an image of the attacks on their village, or a victim of domestic violence making a collage about her traumatic home life, or a person with an eating disorder drawing a self-portrait reflecting their  body image, art therapy has the power to capture their experiences and communicate it to another.   Another.  A trained other who has the clinical experience to hold the emotion being expressed and help the person process it and heal from their pain.

“So, what do you do?”  I proudly answer “I am an art therapist.”

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