A Theory-based Approach to Art Therapy

Art therapy literature is often based either on practice in a specific setting, art
material or population, or if taking a more theoretical focus, on illustrative case
studies.This book provides a theory-based approach to research, teaching, and prac-
tising art therapy, including verbal and art-based techniques, settings, art processes
and analyses, and the principles of supervision, evaluation, and research. It also offers
an overview and discussion of how the different orientations of psychological and
social theories are interpreted and implemented by art therapy.
The book provides an integrative perspective that anchors methodology within
a rigorous theoretical background. Focusing on three sub-groups of dynamic,
humanistic and systemic-social theories, each chapter outlines the central concepts
of varying sub-theories within a general heading, and their interpretation from an
art therapy perspective. Ephrat Huss explores the respective and shifting roles of art,
client, and therapist through each theory, demonstrating the practical implications
for creating a coherent intervention that informs all parts of the setting, therapy,
client evaluation, and supervision.
A Theory-based Approach to Art Therapy draws on the latest research in the field and
will be a valuable text for art therapy theorists, educators, students and researchers,
as well as for other social practitioners interested in understanding how to integrate
art into their practice.

Ephrat Huss is Senior Lecturer at Ben-Gurion University, Israel, and Chair of the
Arts in Social Practice MA specialization. Before this, she worked for many years
as a supervising art therapist, family therapist, and social worker before turning to
research, and still strongly believes in the connection between theory and practice.
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A Theory-based Approach to
Art Therapy

Implications for teaching, research, and

practice

Ephrat Huss
First published 2015
by Routledge
27 Church Road, Hove, East Sussex, BN3 2FA
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor and Francis Group, an informa business
© 2015 E. Huss
The right of E. Huss to be identified as author of this work has been asserted by her in
accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or
reproduced or utilized in any form or by any electronic,
mechanical, or other means, now known or hereafter
invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identification and explanation without intent to infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloguing in Publication data
Huss, Ephrat, author.
A theory-based approach to art therapy : implications for teaching,
research and practice / Ephrat Huss.
p. ; cm.
Includes bibliographical references and index.
I. Title.
[DNLM: 1. Art Therapy. 2. Psychological Theory. WM 450.5.A8]
RC489.A7
616.89′1656–dc23 2014042487

ISBN: 978-0-415-72544-6 (hbk)

ISBN: 978-1-315-85681-0 (ebk)
Typeset in Bembo
by Out of House Publishing
Contents

List of figures vii

List of tables viii

Introduction 1
Introduction to the case study 8

SECTION 1: ART THERAPY ACCORDING TO THEORY 19

A Art as decoding the unconscious: introduction to art
therapy through dynamic theory 21

1 Art as a path to the unconscious: art therapy and psychodynamic

theory 23
2 Art as relationships: art therapy and object relations 32
3 Art as the ego: art therapy and ego psychology 39
4 Culturally contextualized art as healing on a preconscious
level: art therapy and Jung 44
Summary of dynamic theories 50

B Art as a path to the self through unconditional

acceptance: introduction to humanistic theories 53
5 Art as a path to the self: art therapy and humanistic theories 55
6 Art as experience: art therapy and gestalt 63
7 Art as development: art therapy and developmental theories 68
8 Art as telling and retelling: art therapy and narrative theory 75
vi Contents

9 Art as the positive: art therapy and positive psychology 81

Summary of humanistic theories 88

C Art as transforming systems, society, the present, and

the future: art through systemic theories 93
10 Art as showing the system: art therapy and systemic theory 95
11 Art as claiming space: art therapy and empowerment 101
12 Art as a space to fight: art therapy and social theories 109
13 Art as cultural values: art therapy and culture 116
Summary of systemic theories 122

S ECTI O N 2: A RT – S E T T IN G S – P O P UL ATIONS : PU LLING

I T TO GET H E R T H RO UG H T HE O RY 125

14 Doing the art: setting–process–interpretation 127

15 Individual, family, group, and community 139
16 Deconstructing populations 148
17 Evaluation, supervision, and research 158

References 166
Index 176
List of figures

A1, A2, A3 and A4: Shoshana’s drawings 9

B1, B2, B3, B4: Rina’s drawings 11
C1, C2, C3, C4: Sharon’s drawings 14
D1, D2, D3: Avital’s drawings 16
1.1 Dynamic theories: setting, process, and interpretation 22
5.1 Humanistic theories: setting, process, and interpretation 54
10.1 Social theories: setting, process, and interpretation 94
14.1 Art therapy settings according to dynamic, humanistic, and
social theories 130
14.2 Process according to dynamic, humanistic, and social theories 135
14.3 Interpretation of art according to dynamic, humanistic, and
social theories 137
15.1 Using systemic and social theories with individuals 140
15.2 Using dynamic, humanistic, and social theories with families 142
15.3 Using dynamic and humanistic theories within groups and
communities 146
16.1 Interactions between individual and social factors 149
16.2 Using art to address psychological or ‘nature’ oriented problems 152
16.3 Using art to address social or ‘nurture’ related problems 155
List of tables

4.1 Dynamic theories: content, composition, and role of therapist 50

4.2 Comparison of dynamic theories 51
9.1 Humanistic theories: content, composition, and role of therapist 87
9.2 Summary of humanistic art therapy 89
9.3 Summary of humanistic theories 91
13.1 Summary of the role of art interpretation according to social theory 123
13.2 Social theories: content, composition, and role of therapist 124
Introduction

In general, art therapists and all social practitioners tend to be bored by theory: indeed,
theory sounds like a nice pursuit for academics and writers, but social practitioners
with a client appearing at the door on the hour don’t have time to delve into the-
oretical issues. Theory and practice are often experienced as two disconnected areas:
‘practice knowledge’ is different from theoretical knowledge. In art therapy specific-
ally, theory is therefore often viewed with suspicion as something that is external to
art therapy, coming from psychology, from art, or from a place that distances art from
therapy, or therapy from art. There is much debate around the relative power of ‘art’
versus ‘therapy’; as in the ‘art as psychotherapy’ versus ‘art as therapy’ debate, which
becomes an effort to prove to the holders of psychological theory that art provides
therapeutic results. Conversely, the other direction is to prove to the art sides that art
is in itself healing: sometimes this includes sweeping declarations that art is above or
beyond, or does not need ‘theory’.
The claim of this book is that art therapy must base itself clearly within theor-
etical frames. While theory is never absolute truth, it is a vital and evolving set of
ideas about how to make the pain of living in the world more bearable. It is a set
of assumptions about what is a problem, and what is a solution, at a given place
and time in history. Each psychological theory – dynamic, object relations, ego
psychology, humanistic, existential, gestalt, narrative mind-body, cognitive behav-
iour therapy (CBT), systemic empowerment, social change, and cultural theories,
to name a few – has a conception of what is a problem, what is a solution, and
what is the role of art in relation to the theory of therapy. This provides a base for
understanding the relationship of art to therapy, and for understanding how to use
art within therapy. Theory defines the role of art within art therapy as inherent,
rather than as randomly based on the techniques the therapist likes most, or what
worked best with the last client, or on general ‘recipes’ according to generalizations
about the client type, or the problem type. A theoretical understanding of how art
is conceptualized within each theory enables it to be used coherently and profes-
sionally, as well as in the most flexible manner, because the core assumptions of
the theory can be translated in many ways, while still creating unity between the
therapeutic contract, setting, evaluation, supervision, and art use, that all correlate
through the basic assumptions of the theory. This enables the art therapist to be
2 Introduction

more professional, not because they are more insightful or sensitive than the client,
or because art is inherently healing (otherwise all artists would be healthy), but
because they are professionals following a theoretical frame that makes sense of the
client’s problem and solution, and of how art can help reach this solution.This book
will show that, paradoxically, taking time to weave theory more inherently into art
therapy is not limiting to creativity, but rather enables a broader and more flexible
base for art within therapy.
There are many books within art therapy that describe different art activities,
often directed for use with specific populations (Abraham, 2001; Arrington, 2001;
Buchalter, 2009; Cary and Rubin, 2006; Case and Daley, 1990; Docktor, 1994;
Dubowski and Evans, 2001; Gil, 2006; Kalmanowitz and Lloyd, 2005; Liebmann,
1994; Linesch 1993; Magniant and Freeman, 2004; Malchiodi, 1997, 1999, 2007;
Meekums, 2000; Meijer-Degen, 2006; Miller, 1996; Moschino, 2005; Murphy, 2001;
Rogers, 2007; Safran, 2002; Spring, 2001; Steinbach, 1997; Stepney, 2001; Wadeson,
2000; White, 2007; Zammit, 2001).
While these books are invaluable for art therapy, the concept of using art accord-
ing to a specific ‘population’ is itself problematic because it provides a static def-
inition of clients according to the single parameter of their presenting problem.
Additionally all types of problems that define populations are conceptualized dif-
ferently according to different theories. For example, if addiction is understood
as an illness, art will be used to self-regulate the system, but if addiction is under-
stood as a defence against traumatic memories, then art will be used to raise the
repressed experience into consciousness. Understanding the type of problem – and
thus populations – differs according to the theoretical glasses.
Art therapy books can also be organized according to individual, group, or com-
munity settings (Allen, 1995; Betinsky, 1995; Case and Daley, 1990; Docktor, 1994;
Henley, 2003; Jones, 2005; Moon, 2002; 2008; Rappaport, 2008; Rogers, 1993;
Rubin, 2001; Wadeson, 2000). However, this is also problematic because, as shown
in the first section, all theories can be used in all settings; therefore settings are not
prescriptive of a single type of art intervention.
Another division of art therapy books is that of general teaching; however, these
do not always break down the theory or examples into a set of transparent assump-
tions about art use (Allen, 1995; Ball, 2002; Betinsky, 1995; Campbell, 1999a; Hogan
and Coulter, 2014; Horowitz and Epstein, 2009; Malchiodi, 2007; Moon, 2003;
Rubin, 1999; Wadeson, 2000).
Not all of the above divisions define the theoretical assumptions behind the art
activities suggested. This creates a danger that the question they answer becomes,
‘What should I do with the art?’ rather than the question, ‘How do I address the
problem – and the solution I have identified according to the theoretical glasses that
I have committed to – through the art?’
In sum, the claim of this book is that a good understanding of the array of the-
oretical assumptions in different therapeutic standpoints will, in fact, enable much
more choice and richness in art practice than by adhering to a few familiar art
activities or general assumptions. These assumptions could be defined as ‘absolute
 Introduction 3

truth’: for example, that art expresses the unconscious, or that art is relaxing, or
that art is good for one, without understanding the theory from which this idea
emerged, or its implications for all parts of the therapy. Often, in the public sector,
where therapists and clients do not choose but are allocated to one another, the
theoretical orientation of the art therapist is not elucidated to the client. The claim
of this book is that theory needs to be elucidated and intensified within art therapy
training and practice. A clear theoretical base ensures that the ‘doing’ of art in art
therapy emerges coherently from theory, and synchronizes the role of the therapist
with the problem and with the solution.
At the same time, in order to create a ‘tool box’ of theoretical orientations, it
is important to reduce the absolute power of the most popular theory because, as
stated above, no theory is absolute truth, but rather is a historical and social con-
struct based in a particular location and moment in history. Therapeutic theories
in this book are defined as a type of symbolic creation – just like religion, politics,
and art, to name a few areas of social creation. All types of therapy aim to help deal
with problems in the context of a set of cultural norms and socio-cultural realities.
This context and historical moment are paradoxically what created the problem,
but also the context within which the solution must be found. In other words,
similar to art, cultural and religious theories of therapy is a hermeneutic, creative,
and evolving construct that aims to ‘heal’ or to balance the individual within a
given social reality. This includes scientific, humanistic, and social constructs that
help people process and react to the complex shifting and often painful realities of
their society at a specific time. In terms of art, they are an expression of and also
a reaction to a socio-geographic and cultural reality; they aim to both strengthen,
but also to balance, or counteract this reality in order to enable the adjustment of
the system to a constantly evolving reality. This understanding demystifies theory
and enables the therapist to choose the right theory for the social context, popula-
tion setting, and therapist, and to shift between theories and even use them simul-
taneously within the same intervention when needed – assuming they are clearly
understood at the start.
To exemplify: most problems can be understood through exploring early child-
hood conflicts and through defence mechanisms used against pain. This takes art
as a path to the unconscious, and as an expression of such defence mechanisms
(dynamic) most problems can be understood in terms of a person’s potential for
self-actualization and ability to create meaning out of one’s life, using art as a path-
way not to the unconscious but to the evolving authentic self (humanistic). Most
problems can be analysed in terms of faulty cognitions and ensuing lack of self-
regulation, understanding art as a way to envisage solutions and to self-regulate the
mind-body connection (CBT and positive psychology). Most problems can also be
understood through the roles the clients take within their social systems – under-
standing art as a space to explore, communicate, and symbolically change these roles
and divisions of space (systemic). Most problems are the result of a lack of power
and resources within the social world. Thus, from this stance, art helps these suffer-
ers visualize their lack of power and social marginalization, becoming instead the
4 Introduction

power holders (empowerment and social change). Most problems include an elem-
ent of conflict and negotiation, where art becomes a distanced transitional space
within which to explore conflict.
As an example, let us take the story of Joseph’s coat of many colours (Huss,
2009b). Joseph is one of 12 brothers, 10 of whom are his half-brothers born to four
different mothers. Joseph’s own mother, Rachel, died giving birth to a younger
brother. Joseph was his father’s favourite son and, consequently, his brothers’ most-
hated sibling, who threw him into a pit. Joseph’s most treasured possession was a
coloured coat, a gift from his father, which he wore at all times [Genesis, 37:3].
How can art work with this object, the coat of many colours, through different
theories? From a dynamic perspective, the coloured coat could be understood as
a transitional object – or in object relations terms, as a metaphor for Joseph’s nar-
cissistic compensation for lack of a mother object. From a Jungian perspective, the
coat is a kind of mandala, or expression of self; and the pit into which his brothers
threw him, can be understood as his meeting with his ‘shadow’. From a humanistic
perspective, the coat is a metaphor for a young man trying to define his specific
‘colours’ and holding on to his holistic potential. From a narrative perspective, the
coat is a symbol that gives him strength to continue in face of his brothers’ rejec-
tion. From a CBT perspective, it is a visualization that enables him to hold on to
a vision of a brighter future. From a systemic perspective, the coat is an expression
of a role within the family system. From a socio-cultural perspective, the coat is an
accepted sign of bestowing the social role of leader of the family on to the most
suitable child, in the face of competition over who will lead the family; the embroi-
dery shows specific roles according to shape and colour, as in a uniform; and the
coat is a cultural way of visually signifying social responsibility to others as well as
dominance – as, indeed, Joseph does in the end save the family.
Each of these understandings of Joseph’s coat signifies a different meaning for
the visual symbol of the colourful coat and may be developed within further art
work within the therapy (such as modulating the grandiose brightness of the coat,
exploring the meanings of each colour within the coat, or creating coats for others
in the family). No single understanding of the colourful coat is the ‘truth’, and
neither is total lack of understanding the truth; rather, each theory may have a
moment in the therapy when it becomes most relevant. For example, the moment
that the brothers decide to throw him in the pit, or the advent of famine that
leads the family to Egypt, clearly demands systemic and social intervention, rather
than a dynamic exploration of the past. It may therefore be better to explore his
inner world during the times when Joseph is in the pit or in an Egyptian prison.
If he is sold into slavery, perhaps a social intervention is what is needed to enable
powerholders to release him. If he is wandering around a little lost in his colour-
ful coat, maybe a dynamic or humanistic theory can be used. Often, theories are
combined by starting to work on childhood, then to integrate a family approach, to
continue to work on negative cognitions as well as on resiliences and to integrate
social understandings of the problem. The usefulness of art for the expression of an
 Introduction 5

integrative therapeutic stance is that they can all be anchored within the same art
work (Huss et al., 2012a).
Each of the above theories is created within a specific social historical and cul-
tural reality and is constantly evolving within that reality. For example, Freud’s libid-
inal energy theories can be understood as influenced by the industrial revolution
that illustrated the theories of repressed energy (Gerken, 2001; Schultz and Schultz,
2011). Similarly, the secularization of society and the rise of science and rational
thought versus religion intensified the need to resolve moral and social conflicts
internally – between the id (self) and the superego (society) rather than relying on
an external religious locus of control, as in the past (Gay, 1989; Leary, 1994).
Within the humanistic theory that followed the dynamic theory after the two world
wars, focus on the individual subjective self became relevant in the context of the lack
of faith in collective systems, such as the state, and in objective systems, such as ‘sci-
ence’. Art became process-oriented, and individualized creativity was a highly valued
activity in education. Similarly, the current shift to short-term and measurable therapy
corresponds to the needs of the neo-capitalist market to prove financially viable quick
positive outcomes. Developments in science define art as a type of neurological rather
than hermeneutic activity and aim to measure its impact on the body.
The above examples are, of course, stereotypical generalizations, but their aim is
to demonstrate how theories of therapy and art are created within specific finan-
cial and social contexts – and as such are not absolute truths, but ways that people
aim to deal with the present reality. Similarly, the concept of beauty in art is con-
stantly evolving, from harmony to interest, to challenge, to cognition, etc., accord-
ing to the role that art plays in society at a given time and place (Hills, 2001). Art
can be understood as a universal act with deep universal ‘archetypes’ or common
denominators of humanity. Alternatively, it is an expression of cultural norms; or,
art is a way to fight cultural norms. Additionally, it may be understood as a discrete
aesthetic language disconnected from social issues (Rose, 2011). Art can be located
within religion (with a spiritual component), within ethnicity, within education,
within therapy, or within culture. It can be an expression of the reality of different
groups, ranging from the elitist to marginalized sectors of society (Huss, 2009b,
2011, 2012a, 2012b). These ‘cultural versus universal’ or ‘crafts versus art’ or ‘process
versus product’ dichotomies can be broken down into varying roles of art emerging
from the theory within which it is used. From this, therefore, art can have many
different roles within art therapy.
In sum, the first point made above, was the importance of theories; the second,
was that while theories are so important, it is also necessary to understand them
not as an absolute reality, but as a creative type of problem solving within a spe-
cific context. The third point is that in accordance with the first two theories, each
theory is also a constantly evolving interpretation of itself and understands the role
of art differently within therapy. From this, art therapists can utilize different uses
of art according to different theories, rather than according to different activities,
materials, or populations.
6 Introduction

Organization of the book

The first section of the book will first outline a set of theories in detail, including:
dynamic, Jung, object relations, ego psychology, humanistic, gestalt, narrative, mind-
body CBT, systemic, empowerment, and social change theories.These roughly div-
ide into dynamic, humanistic, and social-systemic theories. Each of these three
general categories will have its own summary, showing how the conceptions and
uses of art and of the therapist shift within the theoretical epistemology. These are
not inclusive of all theories used in art therapy, but rather aim to show how to trans-
late a theory into practical art therapy.
Each chapter will have the following components:

• contribution of the theory to art therapy

• the theory
• problems as defined by the theory
• the solutions as defined by the theory
• the social context
• macro applications
• role of art in this theory
• dynamic art therapy
• role of the art therapist
• evaluation
• art evaluation
• supervision
• research
• critique of the theory
• central concepts exemplified through case study
• working the theory: art therapy skills and techniques
• verbal techniques
• visual techniques: art setting, process, and interpretation
• overall skills to practise
• art-based skills to practise.

It is important to state here that these are this author’s interpretations of the the-
ory and are not presumed to be the only single way to interpret the theory, or to
encompass all that has been written about art therapy from each perspective, or to
include all of the theories outlined in art therapy. The art therapy literature in each
field is extensive, constantly growing and evolving even while writing this book.
Thus, the art therapy literature in this book is by no means the most encompassing
or the most important literature, but rather is used to exemplify the integrative the-
oretical standpoint outlined in this book.
Each chapter will be illustrated using a case study of a group of women who
experienced sexual abuse in childhood. The reason for using the same case study
is to demonstrate how the same art work can be understood through different
 Introduction 7

theories. The case study will be introduced before the theories, and will be sum-
marized at the end of the introduction.

The second section of the book aims to model how to think of specific issues or areas in
art therapy, through different theoretical lenses. The various areas include:
Chapter 14 Art setting and materials, processes, and interpretation.
Chapter 15 Settings, from micro to macro, that is, working with individuals, fam-
ilies, groups, and communities.
Chapter 16 Working with different populations, including inherent problems,
(such as physical mental and emotional disabilities) and environmen-
tal problems (such as trauma, abuse, and transitions).
Chapter 17 Evaluation, supervision and research of art therapy.
Readers may either delve into a specific theory in the first section or use an over-
view of the issue that most concerns them. The aim of the second section is to
model how considerations of working with a specific population, setting, mater-
ial, or supervision can be conceptualized dynamically through different theories,
rather than statically. For example, working with an autistic client can be concep-
tualized statically as a population A – that demands intervention B – or can be
conceptualized in many ways according to different theories. The aim is thus to
demonstrate how to choose and shift between theories, and how to utilize them to
enlarge understanding and choice within specific art therapy settings, populations,
and interactions. The systematic analysis of discrete elements of art therapy such
as population, through different theories, raises interesting questions about basic
assumptions of art therapy that are discussed in these chapters.
Introduction to the case study

In the first section of the book, the central concepts of each theory will be exempli-
fied with images from the following case study of an art therapy group of sexually
abused women.
The case study of these women has been outlined in further detail in a previous
publication (Huss, 2010).The aim here is to illustrate central concepts in all of the
theories, demonstrating how the same images can be analysed through each.
The women in the case study signed consent forms to have their art work pre-
sented under false names and with no identifying features. The original research
using these images underwent the university ethics committee.

The following is an outline of each of the four women whose

images are presented
A) Shoshana was sexually abused as a child over a few years by a relative. Furthermore,
as a religious girl, it was expected in her culture that she should become preg-
nant immediately after her marriage, but when this failed Shoshana learnt that
she and her husband were in need of special medical treatment to assist them. She
experienced the gyneacological treatments as an additional ‘invasion of her body’.
Shoshana was ambivalent about pregnancy in general, although she very much
wanted children. This ambivalence was not culturally acceptable and she could not
talk about it with her family or husband. She decided over the year of being with
the art therapy group, that she would put off having a baby until she felt more com-
fortable about it.
Over time, her images became more flexible and colourful and the black centre
that she called ‘the blackness’, identified as her sexual abuse and womb, was replaced
by an image of the baby that she wanted. After a year she decided to start medical
treatment to become pregnant.
Figure A1 was her first image, and she called it ‘blackness’. ‘I don’t have words to
describe my image, I can only draw blackness.’
Figure A2 was her second image, showing squares with a ‘black’ centre that she
defined as ‘the blackness’. Shoshana added the words of a popular song about how
unjust the world is on top of the coloured squares.
 Introduction to the case study 9

Figure A1 Shoshana’s drawings

Figure A2
10 Introduction to the case study

Figure A3

Figure A3 is another image with a black centre. Shohsana stated that the colours
have become a view of hills that she loves and that give her comfort.
Figure A4 was drawn towards the end of the group and includes coloured squares
around the centre with a baby, instead of a black shape.This was when Shoshana
decided to start fertility treatment.
B) Rina is a Russian immigrant who was sexually abused by a relative when she
was young. The relative continued to live at home and Rina would present either
a ‘tough’ tomboy facade, or an exaggeratedly female stance. Within the group she
often told stories of situations of intense danger with men that she encountered,
but was emotionally disconnected from these stories.The present concerns that she
raised in the group included her uncertainty about staying in her job as a security
guard. Rina’s images were often split into black and white, or half images (see fig-
ures B1 and B2). Over time her pictures became more integrated and softer, and
she left her ‘tough’ job and her ‘tough’ boyfriend.
Figure B1 is an image divided by black and colour. ‘This is life – black or a sunny
beach.’
Figure B2 is an image of a woman without a face, also split in half. ‘I feel like this
woman sometimes, split into two.’
Figure B3 is a doodle incorporating shadows and light. ‘Here I just let myself draw,
a doodle, but it has a blacker area and a lighter area, although it’s more integrated.’
 Introduction to the case study 11

Figure A4

Figure B1 Rina’s drawings