Art therapy

Art therapy is one of several types of therapy in the expressive therapy category. It uses various artistic methods within the process of therapy in order to allow people to express themselves and then look at the underlying messages in their artwork to resolve psychological difficulties.

Development of Art Therapy

Art has been used for expression since the beginning of humanity. Prehistoric man used art to record events, and artists have long expressed man's outer and inner world since its inception. Art therapy has taken the innate therapeutic ability of art and turned it into a form of healing.

Art is also seen as a form of communication, and because of this, therapists began to see that art could be used as a way for individuals to gain better insight into topics that may be too difficult to discuss verbally.

While art in psychiatric therapy can be dated back to the 1700s, it was not until the 1940s that research began to study the effects of art on psychotherapy. The first graduate program in art therapy was offered at Drexel University in the late 1960s, with New York University following soon after. Edith Kramer and Margaret Naumburg were two of the first pioneers of art therapy. Both taught professional classes in New York, and Kramer founded the NYU graduate program.

Art therapy became more widespread in the latter half of the 1900s and was commonplace by 2000. It has grown into a respected and well-developed profession worldwide.

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Art Therapy Techniques

The goal of art therapy is to use the process of creation to analyze and process emotions to understand themselves clearly.

Because this goal can be accomplished in many ways, there are a variety of techniques available for the art therapist to use with clients like:

• Making a collage
• Coloring
• Simply doodling
• Drawing
• Finger painting
• Painting
• Photography
• Sculpting
• Working with clay

The benefit of having so many options is that while one medium may be uncomfortable to the client due to their perceived lack of artistic ability, there are others that seem less artistically demanding to begin with, like collages and photography. Some clients may enjoy the tactile nature of working with clay or finger painting. For others, this may be unpleasant, and they might enjoy less ‘messy’ forms like drawing or coloring. The art therapist is only limited by their own imagination in the ways to adapt to each client’s needs.

What to expect as you begin art therapy

Similar to talk therapy, the process begins with the therapist and client sitting down to discuss goals and how to identify those goals are met. The therapist will introduce the process of art therapy, which typically includes getting rid of any ideas the client may have that they need to be particularly creative or artistic to benefit.

When the client understands the process and goals are set, then the client will typically choose which medium (drawing, sculpture, painting, etc.) they wish to use. The therapist will then guide the client through the planned activity, which may include asking questions or directing the client in a direction they believe may be beneficial (e.g., a specific subject or theme for the project).

Afterward, the client and therapist will discuss emotions, themes in the creative project, and any concerns the client has. After each project, the therapist and client will either plan for the next session or plan for the client to do some work on their own prior to the next session, depending on the progress and goals of each individual client.

Effectiveness of art therapy

Art therapy has been proven to be effective across all age groups and a wide range of medical and psychiatric disorders. In 2010, researchers Sarah Slayton, Jeanne D’Archer, and Frances Kaplan reviewed a wide range of studies regarding art therapy and published the results of their meta-analysis in the journal Art Therapy. Their results showed that art therapy was an effective intervention and could be used with children with emotional disturbance, individuals suffering from chronic illness, and various mental health disorders, including personality disorders. 

Art therapy can improve self-esteem, awareness, coping skills, and aid in resolving conflict related to emotions and behavior struggles. The production of art affects the brain in different areas than talk therapy and may help many individuals channel and express their feelings in unique ways.

Downsides of art therapy

While individuals do not need high levels of creative talent or ability to benefit from art therapy, this belief often holds some people back. Individuals may be self-conscious about their skills or be so focused on perceived criticism that they are unable to focus on the therapeutic process.

It is important that prospective clients and therapists work together to develop a trusting relationship if this kind of reluctance occurs.

Additionally, because therapy is never a one-size-fits-all proposition, the client and therapist should have a conversation about a number of important details including: 

• Experience with your specific mental health disorder or concern

• What mediums the therapist uses 

• And if the client is comfortable with those, and what to expect

Remember that therapy isn’t like seeing a medical provider. Therapists can’t take your blood and “prescribe” the perfect thing to fit your disorder. The therapist and client have to get to know one another and learn to work together. I typically tell individuals to give a therapist a minimum of three sessions before they quit unless the therapist does something particularly offensive or upsetting and a remedy can’t be found. This rule of thumb is especially important for art therapy as it can be a complex process.

Insurance coding for art therapy

Art therapy doesn’t currently have a specific CPT code for use. However, because art projects could be considered similar to other ‘tools’ that therapists use, like games, then some therapists bill under regular coding 90837/34/32. At the same time, others use code 90899 for Other Psychiatric Services or Procedures to report psychiatric services or procedures that do not have a specific code. In the notes, therapists should indicate information referring to specific art techniques used and the client's response to the treatment.

Some specific insurance companies have their own billing codes to designate expressive therapies, including art therapy. Always consult information received upon credentialing with specific insurance boards for best billing practices.

If used in medical settings such as occupational therapy, G0176 is a valid 2022 HCPCS code for activity therapy, such as music, dance, art, or play therapies that are not recreational in nature but are related to the treatment of a patient’s mental health diagnosis. Sessions must be a minimum of 45 minutes to qualify for this.

Art therapy tools

The tools of art therapy are as varied as the tools in the art world. Therapists will need to provide a wide range of mediums for individuals based on comfort levels. This may range from magazines to make collage clippings to a wide variety of paint brushes and types of paint. 

Therapists may want to use giant rolls of butcher paper to complete large tracings and murals or a variety of canvases in different backgrounds and sizes.

Some art therapists may focus on expressive skills like photography or just sketching. The choice is really in the hands of the therapist and client, but this type of therapy certainly has the most diverse tools.