The Basis of Psychotherapy Through Art
Giora Carmi ATR-BC, LCAT
Creative arts therapists know that making art in any of its modalities helps people
feel good about themselves and, many times, heals them from mental suffering. But
most of us do not know clearly enough how it works and why it heals. I am proposing
that when we understand deeply how artmaking helps, we can use art more effectively
and we may find that using the arts for healing can work even better and faster than
other more standard modalities of psychotherapy.
Healing is the dissolution of mental structures, which prevent us from seeing reality
the way it is, and prevent our intuition and creativity from acting on this reality.
When such a mental structure dissolves it no longer stands in the way of intuition,
and allows it direct interaction with reality. This is healing. Healing activates
development. Being in development is the healthy state.
Mental Health and Psychological Development
Continuous development is not usually thought of as connected to mental health,
but it is.
Although psychological development may start before birth, it is clearly active from
the moment the baby is born, and ideally should continue to be active throughout
her life. If at some time, in some area, her development stops, from that moment
on her mental health is compromised. It does not necessarily mean that she is or
will become severely ill: she can be uninterested, bored, disappointed or even depressed;
she may feel that life is no longer meaningful. If she is lucky, this unhappiness
will motivate her to seek a way back to development. But if significant development
ceases for a long enough time she may become severely mentally ill.
Usually we speak of development as being in a process of moving through steps that
a person is expected to accomplish at certain ages. In this case, and in my work
in general, I consider development from the point of view of how it happens when
it does and what its effect is on mental health.
Development is the result of successful interaction between a person’s intuition
and her environment.
How development happens healthily
When a baby suffers she cries. She does not have any previous experiences that teach
her this behavior. She did not read theories or stories. She did not get advice from
anyone. The notion of crying arises spontaneously in her and she cries. For a baby
there is no separation between the arising of an idea and the doing. This is the
baby’s intuition in action. Intuition comes from a deep state and sees all the knowledge
we have plus the reality we are in, and finds the best way to act.
As a result of the crying, the good-enough mother or father in the house comes to
the baby and spontaneously knows how to do what is necessary. The parent gives the
baby acceptance of her suffering and love that is not dependent on anything. He also
provides a practical solution to eliminate the cause of distress. All of this comes
from the parent’s intuition. When we love, intuition is likely to come through.
Why development is so important
Thus the baby’s intuitive crying is successful. If this happens repeatedly, the baby
starts to know what to do when she suffers. She finds a practical and effective connection
to her new surroundings: they become comprehensible, accessible and communicable.
She is not completely helpless any more. At the same time, because the baby acted
upon her spontaneous impetus to cry, which resulted in a successful resolution to
her suffering, the baby starts to trust these messages that arise spontaneously from
inside of her. We can say, in other words, that the baby is developing trust in her
intuition. Because of these two ingredients, success and then trust, the whole event
is a successful step in the baby's development.
From this example we can see that development happens when there is discomfort and
the intuition is allowed to respond to it directly, without the interference of
As long as the baby keeps this openness, which allows her intuition to act on discordant
circumstances, she will continue to develop throughout her life. This is the mentally
healthy state of being.
How development can fail and what happens when it does
The first years of life are the most important for creating trust in intuition. If
the parents are not good enough, do not respond or their response is sufficiently
inadequate, the baby will not be successful when she tries to connect her intuition
with her reality. She will not develop trust in her intuition. Since her intuition
has lead to negative results, she will not listen to it. The intuition will still
want to come but the baby will make an effort to reject it. With repetition, this
rejection of intuition becomes a permanent inner structure.
Without the guidance of intuition, the baby will create unhealthy ways of responding
to her environment: ways, which are not authentic; not satisfying and do not result
in development. Her development has been blocked. This is a mentally unhealthy state
Blockages are always self-built.
To better understand this we will look at one aspect of the traditional method of
training baby elephants in India. The goal of the trainer here is to teach the elephant
to stay in place.
The baby elephant is tied to a strong tree using a strong rope. Intuitively he tries
and tries to escape but cannot. He struggles painfully yet unsuccessfully for several
weeks. This causes unbearable mental suffering which eventually leads the elephant
to reject or block his intuition to escape. Thus a new mental structure has been
The strong tree and strong rope are no longer necessary. Years later, when the elephant
is huge and powerful, even a string tied to a bush will keep him in place. The natural
or intuitive idea of escaping will not even occur to him. It is blocked by his belief
or mental structure, which also blocks his ability to see the reality of his situation.
We human beings are the same with our inability to see things the way they are. Instead
we see the world through our mental structures, structures that we have created which,
by definition, block our intuition.
Let us take the example of a person who, as a child, is criticized for everything
he does. This leads him to mistrust his intuition. So without internal guidance to
fulfill his needs, he comes to rely on others. In order to secure what he perceives
is critical help, he learns to manipulate these others. When he eventually encounters
negative reaction to this, he develops patterns of behavior to hide his manipulations,
such as false charm or helplessness.
This appearance of charm or helplessness is what walks into the therapist’ office.
He is there because these behaviors do not work well and do not create happiness.
If the therapist does not see through him immediately, she must start a difficult
and often tedious job, working like an archeologist. She will have to start with
these various defensive layers, penetrate them to find the manipulative layer and
only then come to those wrong underlying beliefs of needing help and of being worthless.
Eventually this should bring the therapy at last to the blocking of intuition with
the fear that accompanies it. She now arrives at the critical task of dissolving
the block. This will set his intuition free and restore the patient to his own development.
Amazing as it may seem, we art therapists do not have to go through these layers.
When this same person comes to art therapy, we do not study his charming or helpless
behavior. His sense of being worthless and his habitual blocking of his intuition
can be seen clearly in his first artwork, if indeed we know how to read it. Using
the method described below, we can help the patient dissolve these old habitual mental
blocks and become free to use his intuition again. The manipulative and defensive
habits will collapse on their own, as soon as they are not needed. This is one of
the reasons why using art, when we know how to do it, can be so direct, and even
Knowing how to read mental structures in the artwork depends on special talent and
great openness, which can be learned by practice. Openness means that there are fewer
mental structures in the therapist’s mind, and therefore his intuition has direct
access to the patient’s art.
Mental structures, or beliefs, are thoughts that occur again and again to prevent
intuition from coming into our consciousness. Their existence of depends on the fear
of being traumatized again if we let our intuition express itself. Closing the gate
of intuition becomes a habitual pattern.
As with many other habitual thoughts or mental structures, like how to button a button,
how to sit, how to chew, etc., it becomes hidden. A thing that we do many times becomes
a pattern of thinking and doing, which we do not need to reconfigure every time we
use it. As such, this pattern of thought can do its work without our attention and
awareness. We can chew without being aware of how we do it. We can tie our shoes
while being absorbed in thinking about something else. Our hidden mental structures
move our fingers. In the same way we close the gates of intuition, not knowing that
we do it.
Almost everything we think is motivated by our hidden beliefs. So if we try to dissolve
a mental structure by thinking about it or about ways to dissolve it, we will not
be able to do it. This hidden belief, acting out of a sense of danger, will motivate
our thoughts to move away from any real possibility of dissolving it.
Even if we know intellectually that we are afraid of opening the gate, we still cannot.
In order for mental structures to dissolve the patient needs to experience and act
from a state deeper than that of patterned thinking.
As Albert Einstein once said, we cannot solve a problem by using the same system
that caused it.
Let us look now at what it means to go to a deeper experiential state and why it
When we are awake it looks as if we are in the same, waking state all the time. But
the truth is we can enter different states, depending on what we do.
1. The unrelaxed state.
It may sound shocking, but the state we are in for most of our waking time is the
state of being motivated by our mental structures. Something happens in our environment,
and before we even have time to think about it, our mental structures determine how
we will react. They decide for us whether we will like what happen, dislike or not
care at all. Based on these attitudes we will act.
This is different from what a baby will do. For a baby every situation is fresh.
Even if it is the same person who appears again and again, smiling at her, for the
baby it is always new and fascinating. The baby still does not have mental structures
and does not have this problem.
In the unrelaxed state we are not relaxed. The mental structures are always involved
with some kind of self protection. In most cases it is not related to a trauma, but
to a softer experience of rejection that caused us to block our intuition. Nevertheless
there is an effort made, according to circumstances, to block our intuition and save
oursleves from the rejection, which our mental structures expect. In other words,
we are not safe all the time, and as a result this state is not calm. We may behave
calmly, while in this state, but it will be external, learned, and not real.
When a person in this state starts his participation in art therapy sessions, in
many cases he will tend to choose an uncontroversial subject, like flowers or a landscape.
The person is unsure about the therapist's reaction, so he tries to do something
that most people accept. This is like behaving calmly while feeling a bit afraid.
If a patient had a stronger hurt than the usual, and his blocking of his intuition
comes with greater fear, he will, many times, look for an even safer subject to draw
or paint, that is even more removed from his emotions. He may draw a flag or write
his name or a slogan and decorate it. These are only examples but I am sure that
many art therapists met with some versions of them. These are subjects that the patient
had drawn before, and therefore knows how to make them. He wants to make sure that
he will not be criticized and hurt by the therapist.
It is clear that in both cases, in spite of the difference, the artwork is being
created by the person's mental structures. The patient believes that he needs those
structures to protect himself. Therefore it is impossible, when working in this way,
to dissolve mental structures. As an example, if a patient in a drug-rehabilitation
program writes the slogan "Say No To Drugs!" You can be almost sure that he will
take drugs in the future, because he does not do anything about his mental structures
and he will not change.
2. The Concentrated State.
The patient enters this state when his interest in his artmaking absorbs him more
than his self-concern. He discovers, as he paints, how colors look next to each other,
what textures are made, how the placement of lines or shapes in the art change his
feelings, or any of the experiences that can be had while making art. Every patient
may discover different things, but the common and significant issue is that the interest
in the art itself takes away the focus from self-concern, and as a result the mental
structures start relaxing. Thus the unrelaxed state changes into the concentrated
Some patients can enter this state without any guidance. A lot of art in the world
is created in this state.
Without guidance, the patient will move between this state, the unrelaxed state and
maybe, sometimes, venture into the next, even more relaxed state. His mental structures
are more relaxed than in the first state, but they are still active, and the patient
feels the need to go back to them every now and then and make sure he is safe. If
you look at his art, you will see some artworks that are more open, free and daring,
and some that are driven by the search for security.
Talent does not matter from this perspective. This state can even be seen in some
professional artists. When they have some success with a certain style of work, many
of them keep working in the same style to make sure they will get a good response
again. This is when they start feeling stuck, because they are driven by their mental
structures and not their curiosity.
3. The relaxed state
The guidance of the therapist is crucial if we want the patient to progress to the
next state and feel safe enough to be in it for a long time. The third state is like
being absorbed in a dream. It is being in the third state and making art while being
in it, which starts making changes in the patient's mental structures. Specifically
what is being dealt with is the mental structure that shows itself at the time of
artmaking. This structure becomes more flexible, more open to variations and eventually
To enter the third state, or the dream state, it is not enough to be concentrated
on the art. The patient must concentrate in a special way.
He has to forgo any aim, (like making a drawing that will look as something in reality).
By forgoing any goal the patient lets himself be guided in his artmaking by intuition.
He has to concentrate on the step that he is in the process of making. This helps
calm the mental structure even more than before, as mental structures are always
concerned with future results.
The patient has to look for guidance in his own sense of beauty, so that every step,
as it is being made, is guided by what he finds experientially, at the moment, to
be what will make his art beautiful, by his standards. Tuning in to his personal
sense of beauty will also inform the patient about when the artwork is finished.
The patient can also search for guidance in his feeling of being truthful, in being
playful and in deep curiosity. All of these guiding principles cannot be based on
previous knowledge, or on logic, because they can only be experienced, at the moment
By relying solely on this inner experiential observation, and having no goal, the
patient calls on his intuition to act. Beauty never relies on mental structures,
and the same is true for truthfulness, playfulness and deep curiosity. Since the
mental structures are not used in any way at this time, they relax completely, and
the intuitive work flows better and better. Thus the patient has entered the relaxed,
dream like, state.
Beauty, truthfulness, playfulness and curiosity become combined.
This reflects itself in the artwork, which, naturally, becomes truthful, beautiful,
playful and full of curiosity.
The concentrated state, in terms of relaxation, is like the state of shallow sleep.
The relaxed state is similar to the state of dreaming while being asleep. The ease
of coming up with ideas, which happens in this state, is parallel to the ease of
movement of the dreams, when they are not obstructed by mental structures.
There are two crucial characteristics of this state:
1. The view, while in this state is unobstructed by mental structures, and therefore
we can say that it is clear and direct. This clear view includes both the inner world
of mental structures and the outer world of reality. When the patient creates art
in this state, his outer reality, which is being seen clearly at this state, is his
2. In this state there is a general tendency to support life and development. This
is why, across cultures and centuries, people benefited from looking at their dream
material, with the help of healers and therapists. When the mental structures stop
deciding for us how to react, this supportive tendency of the relaxed state is what
moves our thoughts and actions. This is intuitive action.
There are deeper states than this and they bring more benefits to those who enter
them. But for the purposes of this article it is enough, in the therapy, to enter
the relaxed state, for intuition to start doing its healing work.
What the art therapist has to do
The therapist’s work has basically three aspects, and it keeps being so all through
The first aspect is teaching the method of artmaking as described before, and correcting
mistakes in the way the patient works, so that the patient will steadily deepen his
concentration and let his intuition do the art.
The second is helping the patient become aware of what appears in his art as expression
of his mental structures. Also, to help the patient see that a mental structure has
dissolved, and how his art changes as a result.
The third is to completely accept, unconditionally and without judgement, all the
aspects of the patient’s personality, including all his mental structures, fears,
shame, self-loathing and whatever shows itself in the therapy. In order to do this
the therapist must have a much wider view of development than that of the patient.
The first aspect puts the patient on his path of healing. The second encourages the
patient to explore and go forward, guided by his intuition. The third aspect creates
the patient’s trust that he is safe to explore, so he can stay longer in the flow
of the relaxed state and experience growth.
An example of the process
A teen-age girl with a problem of recurring depressions starts her art therapy sessions.
The therapist teaches her the method.
The girl starts experimenting with techniques and with having no goal, concentrating
on the present step only, and doing every step of the artwork, as an exploration
of her personal sense of beauty.
The therapist shows her the places in her art where her intuition acted and the places
where she was not attuned to it. She starts seeing the difference. The therapist
asks her to remember how she felt when doing the different parts. She starts becoming
aware that when she is guided by her intuition she feels right, flowing, truthful,
and very curious, though not in control in the usual way. She does not know what
will be created in her art, but it feels meaningful when it is done.
The patient’s intuition starts to flow. In the following two sessions she goes deeper
and deeper into the relaxed state.
In the next session the expression of a mental structure appears very clearly. In
the relaxed state, her intuition clearly sees one of her mental structures and senses
the openness and acceptance by the therapist. Out of its tendency to support development,
her intuition brings onto the paper what it sees. Because of acting out of support
and clear seeing, intuition will only bring out to the patient’s view, what she can
handle. This makes this method of working very safe.
The patient makes a series of black heavy strips, which cover smaller stripes of
many colors. The therapist tells her it feels as if these black strips hold down
the stripes of color.
In the next artwork there is more focus on the issue, and things start moving. There
is only one black stripe, covering colored stripes, but the color stripes have become
bigger, so it is harder for the black stripe to hold them down. There are scratches
in the black, through which the colors can be seen. The therapist tells her what
he sees. This is a conversation between the therapist’s intuition and the patient’s
intuition. The patient’s intuition starts knowing that there will be acceptance of
what will come out.
In the next artwork, which happens in the next session, the black breaks to small
pieces, which are scattered all over the picture, and the colors appear as very vibrant
squiggly lines on top of the black pieces.
The therapist says only that the colors came to be on top now, that they are very
much alive and that the black is breaking to pieces.
In the next artwork only small parts of the black remain and they seem to be falling
off the page, while the colors start playing all over the artwork. This is what the
therapist describes to the patient.
There is no black in the next art. Only colors. But there is no structure either.
The therapist knows at this point that a mental structure has dissolved, and there
is nothing yet to replace it. The best thing to do is to continue working with the
same guiding principles, and he encourages the patient to do it.
In the next artwork the patient draws herself crying. This is an expression of relief,
and it is being accepted as relief by the therapist. This is a point of departure
from that mental structure. In the next artwork a more complex structure appears
on the paper, with more sense of flow, and the next mental structure to be dealt
with will soon appear.
In this way it goes on. Every time an expression of a mental structure disappears
from the art, the life of the patient in her world changes too. The change may require
repetitions but eventually the freedom from that mental structure will become permanent.
What does the therapist need to know
Working in the way described above, the therapist does not need to know everything
that can happen in the process. He needs to know, from his own experience, how trust
in intuition, coupled with wide openness and awareness of what happens, create development
in the most natural way.
In order to know it the therapist must go through a training that creates this openness
and trust in intuition. He must have dissolved many of his mental structures, so
that they will not stand in the way of his seeing. Being open like this, he will
see what aspects of the art are intuitive, and what, in the artwork, describes a
mental structure. And most importantly, the therapist will know for sure, how the
process works, and that everybody, when they dissolve their mental structures, become
freer and more satisfied with their life.
What is art therapy?
Art making is not art therapy. The difference is very meaningful, but confusion and
ignorance about art therapy are rife and its reputation somewhat dubious.
Art therapy has finally become a licensed psychotherapy in New York State. It is
now officially recognized as parallel in status to the other, more traditional, psychotherapies.
As such it is reimbursable by most big private health insurance companies.
Clarification is definitely called for.
Not that art therapy is unknown. Nor is it that art therapists are not doing good
work. Lately there has been a flood of articles about the power and benefits of art
therapy in magazines, newspapers and journals all over the country and the world.
It's a hot topic. Readers of this magazine may have come across some of these articles.
The problem is that descriptions of what art therapists actually do and why it helps
are either ill-informed or just not good enough.
One of the biggest mistakes is to equate art therapy with art making.
I think everybody accepts that making art can be good for you. A wonderful example
appeared recently in a documentary on PBS about an open studio project in a hospital
upstate. A professional artist with a crusading ambition to help patients was given
a big space and a big budget. Easels and artist quality materials were bought. The
studio opened and was made available for many hours daily. Patients were encouraged
to come and make art.
A number of patients came. Some of them started to spend many hours every day in
the studio. It helped all of them cope with their hospital stay and for a few of
them it was a life changing experience. Those, for whom it was life changing, were
people with real talent. They had not pursued careers as artists before their hospitalization,
but the illness or injury which brought them to the hospital, and made it impossible
for them to continue doing the work that they did before, made them ready for change.
Now, given the opportunity to experience making art regularly, some of them decided
to become artists. No doubt this is a good thing. But it is not art therapy.
Another example would be to look at your own lives as artists, or people who enjoy
art witnessing in any form. As long as you are making or experiencing art, you become
curious, you come alive, your inner world is touched, you experience beauty and you
are more then OK. But again, this is not art therapy.
Indeed art therapists agree that making art per se is good. They use this beneficial
state as the foundation for good therapy.
Let us look at the benefits of making art.
Many of the articles written lately refer to these benefits: Having a good time and
enjoying the process of artmaking; the chance to turn one's attention away from suffering
(I am not sure that this is a therapeutic benefit at all); having a sense of accomplishment
when the work turns out to his or her satisfaction; becoming calm and satisfied;
being able to express and communicate content that is hard to express otherwise.
The last of these benefits can become therapeutic. The participation of a good, sensitive,
and deeply knowing witness can turn this expression, of the otherwise inexpressible,
into therapy. But this is already beyond just making art.
As an art therapist I find it necessary to term the benefits of artmaking differently.
Here are a few examples:
- One turns inward at last - instead of trying to pursue his happiness outside, which
- One develops the ability to consider the overall composition, which allows for a
wider and wiser view, instead of getting lost in separate details.
- One learns that his own creativity can be the source of satisfaction, which means
that HE or SHE is a worthy person and HIS or HER life is meaningful.
All these do come automatically from just making art, if you do it long enough. They
can be enhanced immeasurably, so that they happen quicker and in a deeper way, with
the presence of a good art therapist.
SO WHAT IS ART THERAPY?
How do art therapists use artmaking in a way that is so uniquely effective?
I would like to give an example from nature. This is justified, because the process
of healing is basically a natural process, in which people let go of what stops them
from being happy, and come back to the way they can be, which is their innate happiness.
The sun shines every day and sends its warmth and benefits to the earth non-stop.
It is always there and always shining.
If there is a tree, the light of the sun falls on the tree, which in turn casts its
shadow on a part of the earth, blocking the sun's light. Some plants cannot grow
in this shadow. If you want to plant something that needs light you had better know
the map of where the shadow falls.
Like the sun outside which always shines, we have an inner source of happiness that
always shines. Every one of us has it. It is always there and always shines. But
we too have things that block the light and cast shadows. These blocks are our habitual
inhibiting thought patterns, or inner conflicts. The more thought patterns we have,
the more difficult it is for that inner light to shine through.
This inner light comes out as creativity. Not only in art, but in everything that
we do. Creativity here means a fresh, authentic and truthful response to everything.
When art therapists start working with a person, the first thing they do is to help
this person find his/her way to let creativity come through. What for artists is
an inborn gift is not inaccessible for all others. Everybody can be taught how to
tap into his or her creative source. This serves as the basic condition for what
When the inner light finds its way to the paper or the canvas, the inner conflicts
or thought patterns, which stand in the way, cast their shadows on the artwork.
An art therapist is trained to see these shadows in people's art. His next duty is
to help the client see them too. This role, of helping the client become aware of
his or her inner workings, is best done through the arts. Nothing can shine the inner
light into the outside world like any of the arts. But art therapy has an important
advantage over almost all the other arts. The results of the light and the shadows
remain fixed to the paper or the canvas and visible for as long as we want to look
at them. We can go back to what was expressed long ago, when it is meaningful to
do so and it is very helpful. We can find repeated patterns and tendencies. In all
other therapeutic modalities, except for writing and poetry, (and lately, video),
the testimony of inner life disappears as soon as it is done.
The culmination of the process is when the therapist guides the patient through the
release of these inner inhibiting thought patterns and emotions. Again, there is
nothing that so easily enables this process of releasing better than artmaking.
In the hands of a good art therapist, artmaking becomes the good foundation for the
therapy, the instrument of discovery and one of the best and strongest ways to easily
When even one of the shadow-casting inner-thought-patterns is eliminated, more of
the inner light comes through, and the client becomes more authentic, his or her
life becomes more meaningful naturally and he or she becomes happier.
Artmaking then becomes a very good way to experience and express wellbeing, which
is also very important, until the next problem shows itself in the art.
This was a general description of art therapy. There is one more important thing
It used to be that psychotherapists specialized in one or several diagnoses, and
based their work on specialized learning and the experience that they have accumulated
in their specific areas. It is still that way in most cases. But the more modern
modalities of therapy are universal and this may be the direction therapy is going.
The process of healing through art therapy is a universal process too. Problems that
people have are varied and numerous. But the principles of how problems are created
and how to discover and release them are the same. Every problem that people suffer
from will show itself in their art, and, in the presence of a good art therapist,
will be released.