Marine Corps Staff Sgt. Anthony Mannino performs art therapy with guidance from Adrienne Stamper, art therapy intern as part of his traumatic brain injury treatment and recovery at the National Intrepid Center of Excellence in Bethesda, Md., March 1, 2016. Photo by Marvin Lynchard. Courtesy the United States Department of Defense.
On Wednesday morning, Second Lady Karen Pence held a press conference at Florida State University to outline how and why she will promote art therapy in the United States during her time in the White House. Her platform, officially known as Art Therapy: Healing with the HeART, aims to help Americans understand and access the benefits of art therapy and to stimulate interest among young people to pursue careers in the field.
“From children with cancer to struggling teens to grieving families to people with autism, to military service members experiencing Post Traumatic Stress Disorder to those with eating disorders…art therapy is changing lives and it is saving lives,” Pence said. A longtime art educator and painter, the Second Lady has been involved in art therapy initiatives for over a decade, working first with Tracy’s Kids, a D.C.-based nonprofit that administers art therapy to children with cancer, and later, steering fundraising efforts to bring art therapists to an Indiana children’s hospital.
Over the next three years, Pence aims to increase awareness and advocate for more research in art therapy by traveling to programs across the U.S. and abroad and meeting with stakeholders. (However, not every member of the profession is comfortable working in tandem with the current administration.)
“This attention is absolutely unprecedented,” says Dr. Donna Betts, president of the board of the American Art Therapy Association (AATA), who is a practicing art therapist and an associate professor in the art therapy program at George Washington University. “In this country, there has never been any national figurehead that has drawn this much attention to art therapy.”
In light of the announcement, and the potential impact the initiative could have on the field, we spoke with Betts to learn what art therapy is, exactly, and how it exists in the United States.
What is art therapy?
AATA defines art therapy as “a regulated, integrative mental health and human services profession,” which “uniquely promotes the ability to unlock emotional expression by facilitating non-verbal as well as verbal communication.”
The first of Pence’s three goals in her initiative is “to elevate the profession so that people understand that art therapy is a mental health profession, and not arts and crafts.” Confusion surrounding what art therapy is, and what it is not, is a frequent hurdle, Betts affirms.
“A lot of mental health professionals—social workers, counselors, psychologists—will have art materials in their offices; sometimes a psychologist will have a patient make a drawing. That's fine, but that's not art therapy,” Betts explains. “What’s important to distinguish is that in our profession, our students and professionals have had the requisite, in-depth training in understanding the implications and the power of different art materials and the artmaking process.”
Karen Pence participating in an art session in Puerto Rico. Courtesy of the White House.
And while sitting at home and dabbling with watercolors may feel therapeutic, that’s not art therapy either. Art therapy requires a client, a trained therapist, and the art itself.
Betts notes that qualified practitioners have expertise in both psychological theory and artmaking. They are prepared for scenarios where a patient may express that they’d prefer not to make art that day, in which case “the session becomes more of a psychotherapeutic experience,” Betts explains, “where we may just talk about whatever is bothering the client.”
An inclusive and expansive field, art therapy has been used in diverse settings to help individuals and groups work towards greater emotional, physical, and mental wellness. In the U.S., according to AATA, art therapists work at hospitals, schools, veterans’ clinics, psychiatric and rehabilitation facilities, community clinics, crisis centers, forensic institutions, senior communities, museums, and in private practices. It’s proven useful for communities in the aftermath of devastating natural disasters or terrorism, as well as prison inmates and those suffering from dementia and Alzheimer’s, to name a few. Research has illustrated art therapy’s efficacy in various scenarios: from improving mood among healthy adults, to helping troubled youth stay in school, to contributing to better physical well-being among HIV and AIDS patients.
Individuals looking to find and access an art therapist near them can do so through AATA’s website and those of its state chapters (not every state has a chapter due to the small number of art therapists in some states). Additionally, the website of the Art Therapy Credentials Board can be used to seek out art therapists and check their credentials.
What happens during an art therapy session?
Betts warns that due to the wide range of people that art therapists work with, and thus the variety of treatment goals, there is no formulaic approach to art therapy. She notes that there are, however, shared techniques that individual art therapists employ.
One example she gives is working in a small group setting with three children with autism, where the main treatment goal was to improve socialization. Betts employed a mural exercise with them, which required them to work together on a large sheet of paper. “They had to learn how to be cooperative, how to communicate, all through the process of creating a mural.” A secondary benefit of the exercise was that it helped the children learn how to use new materials, addressing “social-emotional goals, fine motor control, and sensory motor goals.”
Certain populations call for an entirely different approach. Betts gives the example of working with a group of people with eating disorders, primarily young women, which requires a more in-depth art psychotherapy approach. “They are very intelligent and intellectualize their problems,” she explains. “To be able to work with that population effectively you really do need to have a skillset that enables you to not only encourage patients to engage in artmaking as a vehicle for communication, but also to really be able to deal with some very serious issues related to trauma, anxiety, suicide, and depression.”
Army Staff Sgt. Jonathan Meadows and Jackie Biggs discuss a painting during an art therapy session at Fort Belvoir Community Hospital's traumatic brain injury clinic at Fort Belvoir, Va., Dec. 19, 2014.Photo by Marc Barnes. Courtesy the United States Department of Defense.
One exercise Betts employs with this latter group is the bridge drawing exercise. “Think of a bridge as a powerful metaphor for change or transition—after all, we are constantly in a state of change and flux,” she explains. “I invite them to create a bridge going from one place to another place.” Often, her clients will draw their life with an eating disorder, which tends to be dark and bleak, on one side of the bridge. On the other is a depiction of their life in recovery, which is decidedly optimistic. Betts uses these drawings to check in with her patients in sessions thereafter, to help them locate where they are on that path to healing.
“We do a lot of work, as art therapists, on a very symbolic and metaphorical level,” she explains. But she emphasizes that they do not analyze or diagnose the artwork, in a Freudian sense. “We are facilitators, we are there to witness the art process, we are there to help guide the patients in uncovering what they are communicating through the art.”
What is the state of art therapy in the U.S.?
“Throughout the world right now, art therapy is definitely the most well-developed in the United States and the United Kingdom,” Betts explains. The field has hit a new level of maturity in recent years, she says, adding that she often has meetings, facilitated through the State Department, to discuss art therapy with foreign officials.
Betts notes that, as with any mental health practice, the main difference between art therapy in the U.K. and the U.S. is that in the U.K., art therapy and other mental health professions are overseen by the federal government, through the Health & Care Professions Council (the HCPC), whereas in the U.S., it’s governed on the state level. In this sense, she continues, art therapy is more nationally stable in the U.K.
“I would say given the fact that art therapy began as a formal profession around 50 to 60 years ago in the U.S. (and also simultaneously in the United Kingdom), if you look at it from a developmental perspective, now we’re kind of in our late adolescence. Mrs. Pence is lifting up our field right at a time when we really are in a stage of rapid growth.”
Karen Pence at the National Museum of the Marine Corps. Photo by Staff Sgt. Jen S. Martinez. Courtesy of the U.S. Marine Corps.
How do you become an art therapist in the U.S.?
At present, to become a Registered Art Therapist (ATR) in the U.S., one must complete a master’s degree in the field—AATA recognizes 35 graduate masters programs across the country—and earn credentials from the Art Therapy Credentials Board (ATCB). At time of writing, the ATCB reports that there are 5,968 active, credentialed art therapists in the U.S.
To be accepted into a graduate program in art therapy, students must have completed undergraduate coursework in both psychology and studio art. Graduate coursework includes a range of studio-related classes as well as psychological theory and technique, and students must also complete 700 clinical supervised hours in internships during the program. After graduation, students go on to attain their credentials through the ATCB, which requires them to seek supervision for another 1,000 hours of clinical work. Once they’re working, art therapists must earn continuing education credits—through activities like attending conferences—in order to retain their status.
On top of ATCB credentials, 12 states currently offer formal licensing for art therapists. Betts says that it’s among AATA’s top priorities to increase this number, noting that licensing efforts are crucial in order to have a regulatory body protect the field. “Ten to twenty years ago, when the profession was younger, art therapists had to rely on a number of different creative ways to be able to practice and that often entailed having to get a license in another profession, which is complicated,” she explains. “The importance of having a license is to protect the public from harm.”
Photo by Save the Children Canada via Flickr.
One of the few prominent, national art therapy programs in the U.S. is the National Endowment of the Arts initiative Creative Forces, which is a collaboration with the Departments of Defense and Veterans Affairs, and various state arts agencies. The program, established in 2011, pays for the salaries of art therapists, music therapists, and dance therapists who are hired to work in facilities for veterans across the country. The program has been implemented at 12 sites thus far, after originating at the National Intrepid Center of Excellence (NICoE) at Walter Reed Military Medical Center in Bethesda, Maryland.
Art therapy is also felt nationwide through emergency relief and natural disaster recovery. In the wake of devastating and traumatic events, volunteer art therapists partner with organizations like the Red Cross and Save the Children to work with affected communities, following first-responder efforts.
What does the field of art therapy need?
Betts and AATA have been involved in Pence’s initiative over the past few months, including a brainstorm session in May where the Second Lady gathered leaders of the field. “She wanted expert input on how to best promote art therapy,” Betts explains. “We informed her of our critical priorities as the leading association for art therapy in this country, regarding the need for more resources for research, the need for increased public awareness, and absolutely to bring more people into the profession.” Betts affirms that the approach Pence rolled out to the public on Wednesday “definitely dovetails with our critical priorities at AATA.”
“The public awareness piece is really huge, just to get it in front of people,” Betts says. “We’ve already seen it help in small ways and now that it’s been officially launched, with the rollout, I do think it will continue.”
More research, Betts says, is crucial in order to learn more about the efficacy of art therapy. “There is some evidence-based research, but we need more of it to demonstrate with certainty that art therapy works and how it works and why it works,” she says. She nods to neuroscience research being conducted at NICoE. “We’re trying to bring in the neuroscience aspect to help further understand what happens in the brain when someone’s engaged with art therapy, which will then help explain exactly how and why it is beneficial.”
There are other considerations for AATA in the near future. “One of our priorities is to increase the number of practitioners—which would mean more opportunity for people to see art therapists,” Betts says, “but also a critical priority is to increase diversity within the profession.” She notes that the field is, at the moment, predominantly white and female. “We’d like to see more men in the profession, but we would also like to see more ethnic and age diversity.”
AATA will continue to work with Pence in enacting the art therapy platform. “We are bound by our mission to advance the profession,” Betts says, “we will continue to help to make sure that it’s done the right way.”