Foundations of Visual Arts Therapy

Presentation

Visual arts therapy is a discipline that harnesses the artistic creation process as a tool for psychological care. It does not aim to produce an aesthetically pleasing work but uses painting, drawing, sculpting, collage, and other visual media to allow the patient to express what cannot be put into words. The therapist accompanies the person through their creative process, observing gestures, material choices, hesitations, and impulses — all valuable clues to the patient's inner world.

This approach is based on a fundamental principle: the therapeutic triangle. Unlike verbal psychotherapy where the relationship is dual (patient/therapist), art therapy introduces a third element — the artwork — that serves as mediator. The created object becomes a transitional space in the Winnicottian sense, a safe place to project emotions, conflicts, and desires without confronting them directly. This triangulation reduces anxiety linked to direct confrontation with the therapist and opens a creative play space conducive to change.

History and Evolution

Modern art therapy was born in the 1940s, although the link between art and healing has been recognized since antiquity. In 1942, British artist Adrian Hill, hospitalized for tuberculosis, discovered the therapeutic virtues of drawing and painting during his convalescence. He published Art Versus Illness in 1945 and coined the term "art therapy."

In the United States, two founding figures developed complementary approaches. Margaret Naumburg (1890-1983), a psychoanalyst and educator, considered art as a tool for diagnosis and exploration of the unconscious. Her approach, called "art psychotherapy," favored interpretation of the artwork. Edith Kramer (1916-2014), an Austrian-born artist and educator, proposed a different vision: the creative process itself is therapeutic, regardless of interpretation. Sublimation — the transformation of drives into creation — constitutes the central healing mechanism. Her approach, called "art as therapy," emphasizes engagement in the creative act.

Core Principles

• Process over product: the goal is not to create a beautiful work but to engage in an inner transformation process. The therapist values the journey, attempts, erasures, and revisions as much as the final result
• The therapeutic triangle: the patient/artwork/therapist relationship forms the fundamental framework. The artwork serves as mediator, mirror, and container for emotions
• No aesthetic judgment: no artistic skill is required. The therapist never judges the aesthetic quality of the production
• The containing framework: the studio, session duration, proposed materials, and group rules constitute a secure framework allowing expression without overflow
• Giving form: giving concrete shape to internal experience (anxiety, anger, sadness) allows containment, observation, and transformation

Therapeutic Mechanisms

• Symbolization: the patient translates internal experience into image, form, and color. This passage from inner to outer world enables distancing and gradual elaboration
• Sublimation: a central Freudian concept in art therapy — the transformation of a drive or painful affect into socially valued creation
• Projection: the patient projects elements of their inner world onto the artwork — emotions, conflicts, representations. The artwork becomes a revealing mirror
• Catharsis: emotional release through artistic expression allows purging of accumulated affects
• Containment: the artwork functions as a container in Bion's sense. Chaotic emotions are received, contained, and transformed by the creative process

Typical Session

A visual arts therapy session generally lasts 45 minutes to 1.5 hours, individually or in groups of 3 to 8 participants:

1. Welcome and setup (5-10 min): the therapist welcomes the patient, presents available materials, and allows a brief verbal exchange to assess emotional state
2. Theme or prompt (5 min): the therapist may suggest a theme, technique, or leave the patient in free creation
3. Creation time (20-50 min): the patient creates at their own pace while the therapist observes and accompanies discreetly
4. Discussion time (10-20 min): the patient is invited (without obligation) to talk about their creation and feelings during the process
5. Cleanup and closure (5 min): tidying is part of the therapeutic ritual. Works are stored in a personal portfolio, marking the journey traveled

Contraindications

• Acute unstabilized psychosis (risk of flooding by unconscious material mobilized through creation)
• Severe dissociative state (regression induced by the creative process may worsen dissociation)
• Categorical refusal by the patient (art therapy requires minimal voluntary engagement)
• Allergy or sensitivity to materials used (solvents, pigments, latex) — material adaptation is then necessary
• Caution with patients having severe narcissistic issues: confrontation with imperfect production may be experienced as an unbearable wound