According to the 'What is Art Therapy?' brochure from the website of (BAAT - British Association of Art Therapists),
“Art therapy is a form of psychotherapy that uses art media as its primary mode of communication. It is practised by qualified, registered Art Therapists who work with children, young people, adults and the elderly. Clients who can use art therapy may have a wide range of difficulties, disabilities or diagnoses. These include, for example, emotional, behavioral or mental health problems, learning or physical disabilities, life-limiting conditions, brain-injury or neurological conditions and physical illness. Art therapy may be provided for groups, or for individuals, depending on clients’ needs. It is not a recreational activity or an art lesson, although the sessions can be enjoyable. Clients do not need to have any previous experience or expertise in art.”
The American Art Therapy Association describes it this way:
"(a)rt therapy is the therapeutic use of art making, within a professional relationship, by people who experience illness, trauma or challenges in living, and by people who seek personal development. Through creating art and reflecting on the art products and processes, people can increase awareness of self and others cope with symptoms, stress and traumatic experiences; enhance cognitive abilities; and enjoy the life-affirming pleasures of making art."
"Art therapy is a mental health profession that uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behaviour, reduce stress, increase self-esteem and self-awareness, and achieve insight. Art therapy integrates the fields of human development, visual art (drawing, painting, sculpture, and other art forms), and the creative process with models of counseling and psychotherapy."
Art therapy is a relatively young therapeutic discipline. It first began around the mid-20th century, arising independently in English-speaking and European countries. In England as in the U.S., the roots of art therapy lie mainly in art education, the practice of art, and developmental psychology.
According to David Edwards, an art therapist in Britain, “(n)umerous and often conflicting definitions of art therapy have been advanced since the term, and later the profession, first emerged in the late 1940s (Waller and Gilroy, 1978).” Edwards states, “in the UK, the artist Adrian Hill is generally acknowledged to have been the first person to use the term ‘art therapy’ to describe the therapeutic application of image making. For Hill, who had discovered the therapeutic benefits of drawing and painting while recovering from tuberculosis, the value of art therapy lay in ‘completely engrossing the mind (as well as the fingers) … [and in] releasing the creative energy of the frequently inhibited patient’ (Hill, 1948: 101–102). This, Hill suggested, enabled the patient to ‘build up a strong defence against his misfortunes’ (Hill, 1948: 103).” Art therapy began when Hill, recovering from tuberculosis in a sanatorium, suggested artistic work to his fellow inpatients. That began his artistic work with patients, which was documented in 1945 in his book, Art Versus Illness.
The artist Edward Adamson (1911-1996), recently demobilised after WW2, joined Adrian Hill to extend Hill’s work to the British long stay mental hospitals. Adamson started his work at Netherne Hospital in Surrey in 1946 and continued until his retirement in 1981. Adamson established an open art studio, allowing people to come and paint – a radical act when those detained in the 'asylums' were living in bleak conditions, profoundly excluded from society, with minimum dignity, autonomy, or even personal possessions. He continued to work alone with hundreds of people for 35 years. He and his life partner and collaborator, John Timlin (b 1930), published Art as Healing, their book on his work and the Adamson Collection, in 1984. His importance in the history of British art therapy is widely accepted, though by the end of his career his point of view was seen as at odds with the evolving psycho-dynamic era in art therapy and his practice as personal to him. Adamson saw that people recovered – ‘healed’, in his terms – through the act of expressing themselves through art. The act of creating was all that mattered and not influencing, distorting or impinging on self-expression the therapist’s primary concern. He saw the space where he worked as an art studio, and himself an artist “somewhere in between” the clinical staff and the patients. He encouraged 'free expression' by letting people come to paint or sculpt without comment or judgment by him. He abhorred psychological interpretation, which he dismissed as ‘the therapist’s own projections’ onto the work. Such views did not endear him to the emerging art therapy profession. His working style has been termed 'non-interventionist' by Hogan and is not a practice that would probably be recognised as part of contemporary art therapy. By keeping all the work done in his daily, progressive art studios over 35 years, Adamson collected an estimated 100,000 works - of which 6,000 by over a hundred people survive as the Adamson Collection (at Lambeth Hospital in South London between 1997 and 2012; and currently almost all re-located to the Wellcome Library in anticipation of a securer future in several international institutions). He exhibited work from the Collection from 1947 on, and internationally until his death in 1996. Adamson believed that exhibiting the Collection educated the public about the creativity and humanity of those with mental illness: "Adamson was an educator, who saw the socio-cultural intervention of showing these people’s works to the public who had excluded them - and showing it as an important contribution to their culture - as a way to change public opinion”. There is debate about whether work should be shown – there are questions about the creator's consent, confidentiality, capacity, and intention and whether these works are always clinical records or can be considered outsider art.
Around the same time as Hill and Adamson, Margaret Naumburg, a psychologist in the U.S.A., also began to use the term “art therapy” to describe her work. Naumburg’s model of art therapy based its methods on:
“Releasing the unconscious by means of spontaneous art expression; it has its roots in the transference relation between patient and therapist and on the encouragement of free association. It is closely allied to psychoanalytic theory … Treatment depends on the development of the transference relation and on a continuous effort to obtain the patient’s own interpretation of his symbolic designs … The images produced are a form of communication between patient and therapist; they constitute symbolic speech.”
U.S. pioneers Margaret Naumburg and Dr. Edith Kramer started working in art therapy at around the same time as Hill. In the late 1940s, Margaret Naumburg pioneered “psychodynamic art therapy.”, while Edith Kramer developed art therapy out of artistic practice.
Dr. Edith Kramer, ATR-BC, HLM, was born in Vienna, Austria, where she studied art, drawing, sculpture and painting as part of the Bauhaus movement. After arriving in the United States in 1938 as a refugee, she became a U.S. citizen in 1944 and continued to pursue the practice of art. Dr. Kramer was founder of the graduate program at New York University and Adjunct Professor of Art Therapy in the university's Graduate Art Therapy Program from 1973 to 2005. During that time, from 1972 to 2000, she was also Assistant Professor in the Graduate Art Therapy Program at George Washington University in Washington, D.C.
Edith Kramer received an honorary doctorate in 1996 from Norwich University in Northfield, Vermont. Currently, Dr. Kramer is Adjunct Associate Professor at George Washington University where she teaches a Psychodynamic Processes course. She maintains a studio where she paints, etches, and sculpts and specializes in art therapy with children and adolescents. The American Art Therapy Association gave Dr. Kramer the award of "Honorary Life Member,” a mark of highest esteem.
Art therapy and outsider art
The relation between the terms Art Therapy and Outsider Art has been debated in many academic discussions, especially in regard to the practical application of both professions. The term 'Art Brut' was first coined by French artist Jean Dubuffet to describe art created outside the boundaries of official culture. Dubuffet used the term 'Art brut' to focus on artistic practice by insane-asylum patients. The English translation Outsider Art was first used by art critic Roger Cardinal in 1972 .
Both terms have been criticized because of their social and personal impact on both patients and artists. Art therapy professionals have been accused of not putting enough emphasis on the artistic value and meaning of the artist's works, considering them only from a medical perspective. This led to the misconception of the whole outsider art practice, while addressing therapeutical issues within the field of aesthetical discussion. Outsider Art, on the contrary, has been negatively judged because of the labeling of the artists' work, i.e. the equation artist = genius = insane. Moreover, the business-related issues on the term outsider art carry some misunderstandings. While the Outsider Artist is part of a specific Art System, which can add a positive value to both the artist's work as well as his personal development, it can also imprison him within the boundaries of the system itself.
As a mental health profession, art therapy is employed in many clinical and other settings with diverse populations. Art therapy can be found in non-clinical settings, as well as in art studios and in creativity development workshops. Closely related in practice to marriage and family therapists and mental health counselors, U.S. art therapists are licensed under various titles, depending upon their individual qualifications and the type of licenses available in a given state. Art therapists may hold licenses as art therapists, creative arts therapists, marriage and family therapists, counselors of various types, psychologists, nurse practitioners, social workers, occupational therapists, or rehabilitation therapists. Art therapists may have received advanced degrees in art therapy or in a related field such as psychology in which case they would have to obtain post-master's or post-doctorate certification as an art therapist. Art therapists who meet credentialing requirements set by the national credentialing body, the Art Therapy Credentials Board (ATCB), initially become Registered (ATR), then Board-certified (ATR-BC), after which they may go on to earn the supervisory credential, Art Therapy Certified Supervisor (ATCS). Art therapists work with populations of all ages and with a wide variety of disorders and diseases. Art therapists provide services to children, adolescents, and adults, whether as individuals, couples, families, or groups.
Using their evaluative and psychotherapy skills, art therapists choose materials and interventions appropriate to their clients’ needs and design sessions to achieve therapeutic goals and objectives. They use the creative process to help their clients increase insight, cope with stress, work through traumatic experiences, increase cognitive, memory and neurosensory abilities, improve interpersonal relationships and achieve greater self-fulfillment. Many art therapists draw upon images from resources such as ARAS (Archive for Research in Archetypal Symbolism) to incorporate historical art and symbols into their work with patients. Depending on the state, province, or country, the term "art therapist" may be reserved for those who are professionals trained in both art and therapy and hold a master or doctoral degree in art therapy or certification in art therapy, obtained after a graduate degree in a related field. Other professionals, such as mental health counselors, social workers, psychologists, and play therapists combine art therapy methods with basic psychotherapeutic modalities in their treatment. Assessing elements in artwork can help therapists understand how well a client is in-taking information.
Pediatric trauma patients
The efficiency of treatment interventions for post traumatic disorder in children have not been researched upon extensively. Linda Chapman and fellow psychologists have, however, researched the effectiveness of art therapy on pediatric trauma patients. Early in the research, analysis showed that there were no significant reductions in PTSD (post traumatic stress disorder) symptoms between the patients and the control group. However, acute stress disorder symptoms were reduced for the children who received the art therapy intervention.
Another use that is becoming more prevalent is aiding in the recovery of eating disorders. There are a few reasons why this type of treatment is helpful when treating eating disorders. One reason is the ease of communicating deep issues non-verbally. In many cases people use food restriction as a way to gain control and divert attention from a much deeper problem in their lives. These deeper issues are in most cases so hard to deal with that the use of art, pictures, and movement can provide needed insight. The way this works is through the interpretation of the things that the patient has drawn. There are many things to look for when interpreting art work. Not only do you look at what is on the paper and the symbolism in that, attention also needs to be paid what is not there, the things that people omit from a work can be just as informative. The placement of each part of the art work will provide insight. Art therapy also allows the individual to play a vital role in recovery as well as track their progress. A third reason is that it helps to build a more aware and healthy relationship with the individual’s body. One major way art therapy helps with this is through a technique called Body image tracing. Body image tracing is where a patients compare the outline of how the perceive their body to a true out line of their body. Because of these reasons art therapy has been a useful and quite successful tool in many venues, including out and in-patient treatment facilities, hospitals, schools, and private practices.
Improvement of Depression and Locus of Control in Prison Inmates
A 2009 study of prison inmates done by David Gussak discovered that art therapy aided in the improvement of mood within prison inmates. It is believed that prison inmates experience an external locus of control and as such feel they do not control their lives and subsequently experience a higher instance of depression and overall poor mood. Art therapy however was proven by David Gussak to assist inmates to shift their locus of control from an external to internal and thus allow inmates to feel they had some control over themselves. This feeling of control led to improvement of mood and the associated depression within the inmate population.
It should be noted that art therapy was found by Gussak to be more helpful in improving the mood of female inmates than male inmates, this however is not necessarily a completely conclusive result and requires further study.
The purpose of art therapy is essentially one of healing. Art therapy can be successfully applied to clients with physical, mental or emotional problems, diseases and disorders. Any type of visual art and art medium can be employed within the therapeutic process, including painting, drawing, sculpting, and photography. Art therapy stands in contrast with other kinds of creative or expressive arts therapies that use dance, music or drama. One of the major differences between art therapy and other forms of communication is that most other forms of communication elicit the use of words or language as a means of communication. Studies have demonstrated the efficacy of art therapy, as applied to clients with memory loss due to Alzheimer’s and other diseases; stroke residuals; cognitive functioning; traumatic brain injury; post-traumatic stress disorder (PTSD); depression; dealing with chronic illness; and aging.
A typical session
Malchiodi (2006) provides an example of what an art therapy session involves and how it is different from an art class. "In most art therapy sessions, the focus is on your inner experience—your feelings, perceptions, and imagination. While art therapy may involve learning skills or art techniques, the emphasis is generally first on developing and expressing images that come from inside the person, rather than those he or she sees in the outside world. And while some traditional art classes may ask you to paint or draw from your imagination, in art therapy, your inner world of images, feelings, thoughts, and ideas are always of primary importance to the experience.
Therapy comes from the Greek word therapeia, which means 'to be attentive to.' This meaning underscores the art therapy process in two ways. In most cases, a skilled professional attends to the individual who is making the art. This person’s guidance is key to the therapeutic process. This supportive relationship is necessary to guide the art-making experience and to help the individual find meaning through it along the way. It helps the individual trust themselves more.
The other important aspect is the attendance of the individual to his or her own personal process of making art and to giving the art product personal meaning—i.e., finding a story, description, or meaning for the art. Very few therapies depend as much on the active participation of the individual (p. 24)." In art therapy, the art therapist facilitates the person's exploration of both materials and narratives about art products created during a session.
Art therapy can take place in a variety of different settings, as therapists each have their own preferred methods of constructing therapy, and a range of intended goals depending upon the client’s case. Renowned art therapist, Dr. Ellen G Horovitz, describes the breadth of tasks and roles art therapists might have to assume, “My responsibilities vary from job to job. It is wholly different when one works as a consultant or in an agency as opposed to private practice. In private practice, it becomes more complex and far reaching. If you are the primary therapist then your responsibilities can swing from the spectrum of social work to the primary care of the patient. This includes dovetailing with physicians, judges, family members, and sometimes even community members that might be important in the caretaking of the individual.” Some art therapists find it vital for the progression of the therapy and the therapeutic relationship, to ensure that each session with a client occurs in the same space and at the same time, from week to week, a similar notion of psychology in general. Additionally, art therapy is offered on either the individual or group level depending on which is better for the individual based upon assessment.
Art therapy is also prevalent in schools as a means of therapeutic tools for children because of their interest in art and creativity as a means of expression. Art therapy can benefit children with a variety of issues, such as learning disabilities, speech and language disorders, behavioral disorders, and other emotional disturbances that might be hindering a child’s learning. Similar to other psychologists that work in schools, art therapists should be able to diagnose the problems facing their student clients, and individualize treatment and interventions. Art therapists work closely with teachers and parents, in order to implement and carry out their therapy strategies.
People always search for some escape from illness and it has been found that art is one of the more common methods. Art and the creative process can aid many illnesses (cancer, heart disease, influenza, etc.). People can escape the emotional effects of illness through art making and many creative methods.
Hospitals have started studying the influence of arts on patient care and found that participants in art programs have better vitals and less complications sleeping. Artistic influence doesn't need to be participation in a program, but studies have found that a landscape picture in a hospital room had reduced need for narcotic pain killers and less time in recovery at the hospital.
Art therapy has been shown to help students ages 11 to 18 with autism spectrum disorder to increase their social skills. There was improvement in assertion scores, and hyperactivity scores and internalizing behavior (harming oneself) significantly decreased with art therapy sessions.
Art classes also can have a therapeutic effect on retired people’s well-being. Retired participants who regularly took art classes were interviewed about their previous art class participation. They felt that painting gave a sense of satisfaction and achievement with their many free hours. It also boosted confidence (from noticing improvement over time in their paintings), productivity, and offered an opportunity for participants to be encouraged to discuss art with others.
Art therapists have conducted studies to understand why some cancer patients turned to art making as a coping mechanism and a tool to creating a positive identity outside of being a cancer patient. Women in the study participated in different art programs ranging from pottery and card making to drawing and painting. The programs helped them regain an identity outside of having cancer, lessened emotional pain of their on-going fight with cancer, and also giving them hope for the future.
Studies have also shown how the emotional distress of cancer patients has been reduced when utilizing the creative process. The women made drawings of themselves throughout the treatment process while also doing yoga and meditating; these actions combined helped to alleviate some symptoms.
A review of 12 studies investigating the use of art therapy in cancer patients by Wood, Molassiotis, and Payne (2010) investigated the symptoms of emotional, social, physical, global functioning, and spiritual controls of cancer patients. They found that art therapy can improve the process of psychological readjustment to the change, loss, and uncertainty associated with surviving cancer. It was also suggested that art therapy can provide a sense of “meaning making” because of the physical act of creating the art. When given five individual sessions of art therapy once per week, art therapy was shown to be useful for personal empowerment by helping the cancer patients understand their own boundaries in relation to the needs of other people. In turn, those who had art therapy treatment felt more connected to others and found social interaction more enjoyable than individuals who did not receive art therapy treatment. Furthermore, art therapy improved motivation levels, abilities to discuss emotional and physical health, general well-being, and increased global quality of life in cancer patients.
Art therapy has been used in a variety of traumatic experiences, including disaster relief and crisis intervention. Art therapists have worked with children, adolescents and adults after natural and manmade disasters, encouraging them to make art in response to their experiences. Some suggested strategies for working with victims of disaster include: assessing for distress or post traumatic stress disorder (PTSD), normalizing feelings, modeling coping skills, promoting relaxation skills, establishing a social support network, and increasing a sense of security and stability 
Art therapy and other creative, humanistic intervention strategies are becoming popular methods for working with life-threatened patient and for working with the family members of patients who die- particularly bereaved children. Art therapy stimulates the conscious and unconscious expression of the mourning process in adult and child patients. Children are at greater psychological risk because their grief is less overt and can occur months or even years after the death. Group therapy is used to provide social sanction for the expression of that grief and to promote adaptive mourning responses.
Art therapy may be a beneficial treatment for incarcerated women. A residential substance abuse program called New Beginnings in a detention facility has used art therapy as a means of treatment for incarcerated women. The therapy sessions were weekly and lasted 2 hours. During the first 15 minutes of the art therapy session, the topic of therapy was discussed. The topics were self-esteem, fear, self-defeating behaviors, treatment goals, barriers for recovery, and self-sabotage. The clients then worked on an exercise relating to the topic for 45 minutes in tables of four. Exploring deeper thoughts, positive reinforcement and feedback, confidence building, and clarification of thinking were encouraged by the art therapist. The clients were resistant at first, claiming “I can’t draw.” However, they began to share their works and offer insight on other inmates’ work after one or two sessions. Group cohesion increased after the inmates began expressing different perspectives on their work and others. Simple art media was offered, to ensure that the clean-up process and technique of the materials was not difficult or intimidating. Art therapy in the program was used to help clients recognize their defense mechanisms that conceal their fear or inadequacy or to create a sense of safety and peace, increase confidence, express feelings verbally, and identify feelings. Therefore, art therapy can be used as a tool in incarceration settings with women for mental health and substance abuse.
Distraction from sadness using art therapy may be a better alternative than venting sadness. Two studies by Drake and Winner (2012) published from the American Psychological Association compared venting (expressing negative feelings) and distraction (expressing something that is not related to negative feelings) in one study. To distract oneself, the participants were told to draw something unrelated to a sad film they had watched. The participants who had vented were told to draw something related to the film. In study 2, the participants were told to think of a sad event and were put into the venting, distraction, or sitting conditions. The sitting condition allowed the passage of time to be evaluated. In study 1, the distraction method in which the participants drew something unrelated to the sad film significantly improved negative mood compared to the venting condition. In study 2, the distraction method in which the participants drew a house (something unrelated to the sad event), had significantly improved negative mood compared to venting (drawing the sad event) or the sitting condition (sat quietly for 10 minutes). Therefore art therapy could be beneficial to people suffering from depressive moods through a way of distraction rather than venting.
Art therapy has also been used to develop problem resolution and emotional regulation skills in children.
As an approach to problem solving
Congdon (1990) discusses art therapy’s benefits in terms outside the traditional approaches within the clinical world of therapists purporting that art therapy should be used not just to help treat mental illness but as a tool to help individuals solve problems in day to day to living.