Art Therapy Program for Children and Adults with Visual Impairments
In this module, art therapists, educators, and parents will find a discussion of art therapy and its application to people, especially children, with visual impairments and other disabilities. Also covered here are practical considerations for creating a safe therapy environment, the materials and techniques that may be used, as well as how to find an art therapist. We have also included checklists and agendas, troubleshooting and funding tips.
- Creating a Safe Therapy Space
- Materials and Techniques of Art Therapy
- Art Therapy for Children with Multiple Disabilities
- For Art Therapists
- For Parents
- For Educators
- How to Find an Art Therapist
- Sample Agenda
- Meeting with Parents
- Troubleshooting Tips
- Funding Strategies! Low Cost. No Cost.
- Fact Sheet: Psychology of Art Therapy
Contributors and Reviewers:
Jennifer Drower received her BFA in sculpture/drawing from SUNY, College at Purchase and her MA in art therapy from New York University. She specializes in child art therapy, with much of her work focusing on children with disabilities. She is the art therapist at Once Upon a River, an alternative treatment center for children with autism, sensory impairments, multiple disabilities, ADHD/ADD and depression. She is a consultant for Art Beyond Sight, The Museum of Modern Art in New York and ARC in Greenwich, CT. Previously, she served on the faculty of the Graduate Art Therapy programs at New York University and The School of Visual Arts, and as the art therapist at The Jewish Guild for the Blind’s Guild School and Early Intervention/Preschool program.
Laura Buonomo has been working as an art therapist for the School, the Early Intervention and the Preschool Programs at the Jewish Guild for the Blind in New York City since 2002. Prior to joining the Guild, Ms. Buonomo worked for Caring at Columbia, a mental health school-based program funded by the New York State Psychiatric Institute at Columbia University, as well as for the after school program at the Henry Street Settlement in New York. Ms. Buonomo received her MA in Art Therapy from NYU and her BFA from the Academia di Belle Arti di Roma in Italy where she was born and raised. Ms. Buonomo lives in Brooklyn with her husband and son.
Julie Szarowski-Cox graduated from Nazareth College of Rochester in 2001 with a Master’s degree in Art Therapy. She worked at Genesee County Mental Health Clinic from 2001 to 2005, specializing in working with children and families with mental illness. In 2005, she joined the Albright-Knox Art Gallery’s education department as the Matter at Hand/ ADA coordinator. Her work involves providing tours and art activities for various special needs populations as well as consulting with the Gallery regarding improving accessibility.
Tami Herzog, Art Therapist and Adjunct Professor at New York University Graduate Art Therapy Program
Frequently Asked Questions (FAQs)
What is Art Therapy?
Art Therapy uses art-making materials and techniques to facilitate the process through which a person is able to develop or enhance the sense of self. It is based on the belief that the creative process mirrors the self, and is healing and life-enhancing. Through the process of art making with an art therapist, one can increase self-awareness, cope with stress and traumatic experiences, develop motor skills, and enhance cognitive abilities.
In cases of children with disabilities, it is not uncommon that the individual never had the chance to develop a clear sense of self, or he or she may have difficulty differentiating him or herself from the environment. In that case, the goal of art therapy would be to do whatever is necessary to encourage that process to happen.
- How does a child with disabilities develop a sense of self?
The process of developing a concept of “self” is complex and lifelong, and begins as an infant. One of an infant’s first tentative attempts to interact with his world is the smile. This early developmental milestone is termed the “social smile.” The child smiles at its caregivers, and elicits a return smile. This event is important for two reasons. First, the infant has an experience of being “mirrored” by the caregiver. The caregiver reflects back to the infant what he or she just did, and the infant gains great pleasure from it; this pleasure encourages the infant to continue smiling at the sight of the “mirroring” caregiver. Second, this interaction is one of the first experiences an infant has that establishes an environment separate from his or her own body and helps develop a positive sense of self. If that return smile is forthcoming, the “social smile” develops into playful behavior, which is one of the forerunners of a healthy interaction between child and world. If the return smile is not forthcoming, the original social smile of the infant disappears, and the child “gives up,” so to say, interacting.
The failure to distinguish oneself from the environment is common in children with disabilities, and especially with children who are blind, because the self-development process involves a significant amount of very early interaction with caregivers, interaction that is disrupted by the disability. Most adult humans find an infant’s smile alluring, captivating, and they cannot help responding to it with a smile of their own. That is true whether the smile comes from a sighted or a blind child. But a blind child cannot see the adult’s response smile! A child who is blind does not recognize the response it receives from the outside world, and it therefore reacts as though there were no response; it reacts by withdrawing its own social smile. In this way, a blind child raised by very loving caretakers can exhibit the same signs of social non-integration as a child raised without human interaction.
What’s the difference between Art Therapy and traditional art classes?
Educational art-making programs assume a healthy, well-adjusted individual, and they provide their participants with the means to self-expression. Practically speaking, the goal of such education programs is to teach participants how to make art and the different mediums available for doing so. The emphasis is on imparting as much knowledge as possible to as many people as possible, which is why traditional art education is generally done in groups.
Art therapy is more clinical in nature, and involves setting goals and measuring progress. Art therapy is called for when the client is experiencing emotional and/or behavioral difficulties that are impairing his or her ability to function to his or her fullest potential. Sometimes people who suffer severe emotional distress are afraid or unwilling to reveal themselves through art, in which case the art therapy would focus on creating a safe environment where the individual begins to trust the space and therapist enough to begin expressing him or herself. As stated earlier, sometimes an individual never had the chance to develop a clear sense of self; this is especially true in cases of children with disabilities. In that case, the goal of art therapy would be to do whatever is necessary to encourage that process to happen.
The focus of art therapy begins with helping the client enter into his or her creative space. This can only be done through the process of making art. The healing power of art therapy lies within the act of making art. The art-product or “art-worthy” object is not the focus of this work. The object is important as the final, concrete expression of the self, and is vital, as it is a “mirror” or reinforcement of the creator’s sense of self. The process of creating art and the products that follow will work together to develop this sense of self over the course of treatment. For this reason, art therapy, as opposed to art eudcation, has no curriculum. What is done depends entirely on the child’s experience of being psychologically held, which is determined by what the child needs.
When should art therapy start?
Art therapy can start with a child as young as six months, and may be initiated when parents or doctors first notice that an infant has lost the social smile. At this point, of course, therapy will not be focused on creating an art project. It is, rather, focused on making the child aware of the fact that there is a separation between him and the outside world: his skin.
How long should art therapy last?
Art therapy is usually done in one-hour sessions, twice a week, although it is possible to do it once a week, as well. With infants the process can be quite short, as much of the therapy is to teach the parents. With older children it is rarely less than a year and sometimes sessions are necessary for a substantially longer period.
What are some basic considerations when doing art therapy with a client with disabilities?
- The art therapist’s first goal is to build a trusting therapeutic relationship. Allow the client or child to lead the art therapy experience. One goal of art therapy is to provide a safe space in which the client can explore his relationship with the environment; the development of this relationship should not be forced. Often these clients, especially children, will be tactile defensive, or afraid of new sensations. If a client is tactilely sensitive, do not pressure or physically compel him to engage with new materials, even if it is clear that he will grow quickly accustomed to the materials, and enjoy himself after a few minutes. Thrusting a client’s hand into material he is afraid of communicates that he has no control over his environment, and thus that it is not a safe place.
- It is very important that the client be thoroughly familiar with the environment and materials before being asked to engage with them creatively. That process may be accomplished in just one session or might take as long as a few weeks. Introduce the client to the studio space – making sure, of course that the entire studio is completely safe for the client’s exploration. Bring the client around the entire studio, explaining where you are and in what relation you are to other parts of the room. For example, “Now we are at the sink. The door is to your left. To your left is the art table. Let’s go there now…” Repeat this at the beginning of every session until the client is familiar with the studio.
- The set-up of the room’s needs should be carefully considered, with materials easy to organize and access: all painting materials in one area, all paper in another, clay in an area with tools, etc.
- If anything in the room changes, the client must know prior to entering, and then she should be guided through the studio again.
- It’s good to have others’ art displayed (with clients’ permission). It can be very encouraging for a client to touch the artwork if he or she cannot see it.
How does one do art therapy with an infant?
Art therapy with an infant is focused on tactile experience. Materials include water, sand, beads, hand lotion, paper, and other pre-art materials that produce different sensations when rubbed against the skin. The first step is to get the child used to the environment. The therapist should never initiate a process that causes the child distress, even with the rationalization that the child will grow accustomed to it and enjoy it. Art therapy is about creating a safe place for personal growth and development, and one of the most important parts is the relationship the therapist builds with the child.
The parents of a very young child are always welcome in the therapy room, as a substantial part of the process takes the form of teaching parents how to provide the needed stimulation.
What is the process of art therapy for children with disabilities?
The first step in therapy is to get the child comfortable with the space in which therapy will take place. This process can take anywhere from one session to a few weeks, or even, months. Each material is introduced and thoroughly explored by both therapist and child. In the example of paper, the therapist might roll a long sheet of mural paper over the floor and have the child feel it, fold it, crumple it, tear it, lie on it, roll himself up in it, and generally experience it in all the ways it can be experienced. The process could also be repeated with shredded paper. This encourages kinesthetic activity, and explores how the body moves in space, in addition to familiarizing the child with the material.
Many older children who are blind or have multiple disabilities struggle with the same issue of self-differentiation as the infants, although obviously at a different level. The first step of art therapy with these children is to get them used to different sensations and bring them to the realization that those sensations represent something outside of themselves, something they can choose to experience or choose not to.
For that reason, therapy with a child in this stage will resemble therapy with an infant. Often these children will be tactile defensive, or afraid of new sensations. In that case, the therapist must accustom the child slowly and carefully. The step of becoming used to the materials in the studio can be a lengthy process. The therapist will start with pre-art materials, such as shaving cream, and encourage the child to touch it. If the child is afraid, the therapist will put the child’s hand on her own, and her own hands over material, playing with it and describing it to the child. Note that for a child who is particularly tactile sensitive, introducing material to his feet first is often the least threatening and the easiest way in, therefore exploration of the pre-art material will have a greater chance of success (most children are more open to this because their feet are being touched daily in their process of getting dressed). Over time, the child will become curious, and move his fingers down between those of the therapist to touch the material, and, eventually, put his own hands in fully to play with the material.
Play is the first step of therapy – it is a demonstration of creativity that will soon manifest itself in art. When the child is ready to move beyond playing with the materials, the therapist begins to show him traditional methods of making art: molding clay, tactile drawing, papier-mâché, collage, and so on. Still, the emphasis is never on the finished product: it is always on the process. The process of making art is the process of reproducing an image of oneself. This replays the early experience of being mirrored by the caregiver, which helped the person develop a positive sense of self. In this act of creation, which comes solely from the artist, the experience of being mirrored is repeated and the sense of self is further developed.
How is the process of art therapy different for adults who have experienced sight loss later in life?
For people who lose sight as adults, the process of beginning art therapy is often quite similar to that of older children who have experienced sight loss. The initial step is to help the client feel comfortable in the therapy space. This process, as with younger clients, may happen quickly, or it may take days, weeks, or months. It may be useful to initially speak with the client outside of the therapy room to understand any anxieties, expectations, and prior experience the client has had not only with art, also but with the new skills required to accommodate the loss of sight, including tactile sensitivity, mobility and orientation skills. This dialogue will be vital as the therapist and client decide together how to proceed. Keep in mind, though, that the plan may need to change, and that this is in no way a set back for the client, or the therapist.
Most adults who are experiencing sight loss have been exposed to various art materials or different tactile stimuli; thus working through tactile defensiveness may be abbreviated, but it is not completely unnecessary. Prior tactile experiences may seem unfamiliar as the sensory input is processed through different parts of the brain. Again, a client should never be forced to experience a material.
Revisit with the client his earlier experiences with art. For many adults, the last art experience will have been in high school or earlier. There may be fears or assumptions about whether they are capable of making “art.” Often, adults can be much more concerned with the product and lack confidence in their artistic abilities. In these cases, the art therapist will need to work with the client to focus more on the process and reduce his or her anxiety.
It is useful to go through the various art mediums if your client has not had a lot of art-making experience. Introduce basic art education concepts so that the client can understand the creative possibilities of different materials. It is important, though, that the therapist remain open to how the client wants to use the material, even if it isn’t in the fashion in which it was meant to be used. Remember, exploration and playing is still a vital part of the therapy. Maintaining a safe space includes acceptance of any and all creations. As the client feels more and more comfortable, the therapeutic alliance will deepen, and the creative possibilities are endless.
Other psychological factors in working with this audience might include the process of accepting and learning to live with sight loss. Early work done to establish trust in therapeutic relationship will encourage dialogue, which may or may not play a larger role in the therapy process for adults, depending on the client’s preferences. Finally, you might want to coordinate your efforts with other professionals working with the client, i.e., those helping with developing mobility skills, tactile sensitivity, and braille literacy.
Creating a Safe Therapy Space
A Safe Emotional Space
One of the most important aspects of helping a child who has low or no vision feel safe in the art therapy studio is the establishment of a positive therapeutic alliance that will create and support a safe emotional space for that child. It is useful to keep in mind this three-step progression when working with children or clients with disabilities.
Step 1: Follow the child (or client)
First, the therapist will meet the child where she is, both emotionally and physically, learn her language and “follow the client” as she leads the therapeutic process. This phase of the therapy is crucial because it is here that the child can experience full, non-judgmental acceptance. In this step, the therapist’s goal is not to change behavior – whether it be self-stimulating body movements, vocalizations that are not understood by the therapist or other professionals , or little or no behavior at all – but to communicate to the child that she is completely accepted. At this point, very little art will be made; meaningful interactions with art materials are more likely to occur later when a solid foundation of meaningful interactions between therapist and child is established.
It is vital that the therapist listen generously; every word, sound or movement the child offers is a meaningful gesture, and it is the therapist’s job to figure out what it all means to the child. Part of this process entails the therapists mirroring, or replicating, all of the communications put forth by the child. If she is rocking in a certain motion, stand close and rock the same way as you describe what it feels like. If she is vocalizing, repeat these vocalizations right back, trying not to alter them in any way. By doing this, you are communicating in her language and letting her know that who she is very important to you; that you want to know her. Question yourself: Why this movement, but not that one? Why this sound? What does it mean to this particular child? This complete attunement will be felt by the child, letting her know that you are totally present for her and, over time, you will come to understand what she is “saying.”
Step 2: Walk beside the child (or client)
At this point, a trusting therapeutic relationship should have been established; the therapist has begun to learn the client’s personal language and a general idea of the client’s needs. Now, the therapist will “walk beside the child,” introducing new experiences and learning more about the client’s needs. During this phase, the therapist still does not ask the child to work towards goals set out by the therapist, but tries to learn even more about the person. At this point the therapist will be able to ask, either literally or figuratively through body language, if the client is interested in exploring some art materials. This is never forced upon the client, and the client has the final say in the matter. “Walking along side” may mean sitting on the floor and reading a story, massaging the child’s hands and feet with lotion (this is an excellent precursor to tactile exploration of materials), going for a walk in a familiar place, or talking and playing a game. Again, it is vital that the therapist not move too fast or begin the exploration of art or pre-art materials too soon. It is during this phase that the therapist has the potential to learn a great deal about where the child is most open to new experiences. He may be most receptive to tactile experiences with his hands, his arms or elbows, or his feet. During this period, the therapist and child play together as the therapist continues to follow cues provided by the child. Both child and therapist are still getting to know each other, and the therapist continues to communicate that the child will not be asked to, nor put in the position of doing, touching, or experiencing something he is not ready or willing to do.
Step 3: Invite the child in
In the third stage of develop of the therapeutic relationship, the therapist invites the child to explore new materials. It is at this point that tactile defensiveness is addressed. Typically, tactile exploration begins with a dry material such as sand, cornstarch, or shredded paper, followed by wet materials; a tray with warm water with bubbles is a good first wet material because it is often something with which the child is familiar. To introduce a new material, the therapist may place her hands in the material, and ask the child to put her hands on top of the therapist’s hands (or on top of the arm, far away from the material) as the therapist explores the material. The therapist describes the experience, both of the material and of movement. Slowly, sometimes after many sessions, the child is invited to move her hand(s) down farther on the therapist’s arm or hand. Then, the child is invited to put one finger in the material, and is reassured that she can stop at any time. Each step of the process is explained before beginning the exploration. Note that for a child who is particularly tactile sensitive, introducing material to his feet first is often the least threatening way in, therefore exploration of the pre-art material will have a greater chance of success. (Most children are more open to this because their feet are being touched daily in their process of getting dressed.) Remember, even simply putting one finger or toe in an art or pre-art material may be tremendous progress for a child who has been fearful or anxious about tactile stimulation.
It is essential to stress that it does not matter how brief this experience may be; nor does it matter if the child wants to or can touch the material at this point in her therapy. Something that should never be done is taking the control away from the child, i.e., putting the child’s hands or feet into a material without the child’s consent. Doing this creates a situation where the moment of impact with the material becomes traumatic, and the relationship will be compromised. At this point, the therapist is still learning a tremendous amount about the client. Even if it appears no progress is being made, don’t become discouraged. There is so much happening on the emotional/psychological level that may not yet be visible. Once the therapeutic relationship and the creation of a safe emotional space is established a child can feel that he or she is accepted and feels safe enough to begin the exploration of new materials. From this exploration, play begins and, ultimately, creative expression emerges.
A Safe Physical Space: The Art Therapy Room
It is very important to have a self-contained art therapy room. This will be the physical space where the client comes to understand as his or her area for free exploration. It does not change from session to session. The room he or she leaves will be the same room returned to: the same materials are still where they have always been, the furniture is the same, the sink is in the same place, even the smells and sounds are the same. Providing this, especially for a child with disabilities, is vital as it gives a sense of control and security in his or her environment.
As noted earlier, a client new to the space should always be taken on a tour of the entire room. This should be done at the beginning of each session until he or she is comfortable and familiar with the room.
Tips for Room Set-up:
- Organize materials so that all the supplies needed to work in a particular medium or technique are together: i.e., paints, brushes and supports or clay and tools should be easily accessed with minimal need to navigate different spaces in the room.
- Tables and chairs should positioned so the therapist can comfortably access younger clients either by sitting across from or behind them. The children should be seated at the table so they have adequate workspace. Remember, the younger the child, the more room he or she will need to comfortably explore materials and create art.
- Young children need larger paper because they are in the kinesthetic stage of development; they are all about movement as they begin to master their gross motor skills. As the children develop and begin to work on fine motor skills, they will be able to use smaller paper.
- Table easels should be available because clients with certain vision impairments can see vertical work surfaces better than horizontal ones.
- It is also helpful to have at least two separate areas where mural paper can be hung. Often a child may not want to work at the table and having a large drawing or painting area, such as mural paper hung on the wall, encourages continued play and creativity. TIP: It is also helpful to have one of these areas near the sink. During clean up, you can have the children make handprints (if they’ve been painting, their hands are sure to be full of paint) on the mural paper while you are washing the hands of another child. Not only does a child delight in seeing multi-colored prints of his or her hands, it also removes a lot of excess paint, so by the time it’s that child’s turn to wash there isn’t as much paint to wash off, making clean-up less stressful on both the therapist and the child.
- For people using wheelchairs: Provide adequate room for the therapist to move around the chair with ease, as well as ease in moving the chair in and around the room. Additionally, there needs to be enough room to safely take the child out of the wheelchair. You will need to elicit the help of the physical therapist to ensure you have the right equipment (mats, booster seats, etc.) and training in how to correctly remove the client from the chair. Learn how to position the client on or in the adaptive equipment being used and then safely return him or her to the chair.
Materials and Techniques of Art Therapy
One goal of art therapy is to learn to be creative in the world, not just in the art studio. Through exploration and play begins the understanding of potential of materials. This process also helps the client, especially children with disabilities, understand that it is safe to touch and interact with the world, and that this interaction is pleasurable and rewarding.
Basic organizing points:
- Label materials, including crayons, adhesives, tapes, markers, paints (with color names), and parts of the room, such as the doors and supply cabinets, with Braille and large-print labels.
- Begin with pre-art materials. Explore textures and the potential of different materials. This helps clients overcome the tactile defensiveness that is frequently found in children with disabilities, including visual impairment, autism, or developmental disabilities. A common way to begin is with hand cream.
- Progress from dry to wet materials, and from large- to small-scale exploration.
- Thoroughly explore the creative potential of each material. For example, glue is not only an adhesive, but also a texture, and way of making a mark.
- Allow clients to be messy and use materials in unorthodox ways, as long as everyone in the room is safe.
- Slow progress is okay.
- Be flexible.
This material has limitless potential. Here are some ways to use paper.
- Shredded paper can provide a multi-sensory experience. Ask students to explore the sound, texture, smell, and weight of the paper, and how they can move their hands and body in and out and through the material.
- Mural paper can be explored on a large scale. It can be hit, crumpled, made into a tent, etc. Again explore the multi-sensory experience: sound, texture, surface temperature, etc.
- Toilet tissue rolls. Unroll paper around classroom,
- Color cellophane rolls
- Tissue paper
- Any paper of other textures and weight to which you have access.
As a result of the above exploration, when the client is then given a small piece of paper on a table top, in a more traditional art media format, he will be familiar with the material’s potential; this familiarity fosters security and creativity.
These are the more traditional art materials. Graphite, crayons, markers, charcoal, and craypas. Explore the tactile sensations created by these materials.
Glue. Begin with glue alone. Have the client observe how it changes as it dries, on paper and on one’s hands, i.e., it shrinks and hardens. Having experienced the change with you, the client understands that this experience will not hurt him, and that unfamiliar sensations are okay. If in the creation of a collage, the client completes her work with glue alone, that is okay. It is essential that the client has ownership and control of entire process.
Masking Tape. Can be used to create lines/designs.
Collage Materials: paper, string, seeds, beads,
Begin with Pre-art Materials:
Water, bubbles and water, sand, sand and water, cornstarch, cornstarch with water, shaving cream, hand cream, wet paper, or paper pulp.
There is an enormous variety of paint; explore as many types as you can. Fingerpaint, watercolor, tempera; use a variety of implements to manipulate the paint: sponges, brushes, hands, sticks, etc.
Texture will be important. Add sand, beads, or other textural media (available in art supply stores) to paint to make it more tactile.
Introducing Color: Paint media offer the opportunity to introduce color concepts. For those who have some vision or who lost their vision later in life, color may have expressive significance. Introducing color also gives an opportunity for decision-making. Texture and consistency of the paint can be used to differentiate the different colors. It will be essential to keep careful records of the recipes for each color, and label each paint accurately with braille labels. Begin with two colors. After the paint has dried, have the client re-experience the work. Describe the colors as he moves his hand over his marks; include input as to the directionality of the mark in relation to the page as well as to other marks.
Clay. Generally, this is left for last because many children have had very little exposure to earth clay, as opposed to Play-doh and other man made modeling materials. Earth clays are preferred because they are more natural and responsive, and hold shape, imprints and other marks better. Man-made or synthetic materials often do not maintain their shape once dried; they crumble, shrink, or warp.
It is important to approach the material slowly and to assure children that they can wash their hands whenever they feel the need. Often children associate earth clays with dirt or mud and are apprehensive to touch it. It also has a strange sensation as it dries on the hands, again, something children may not have experienced before. There may be fear that it won’t wash off and that their hands may not return to their normal feeling state. It can be helpful to initially roll slabs of clay for the children and let them explore it with clay tools, feeling the textures and marks they have made. From here, direct contact with clay may be much easier. Also, keep the consistency of the clay stable: if it gets too wet it becomes slippery and very difficult to work with, which can create frustration. Once the child becomes accustomed to the feel of earth clay, building techniques can be demonstrated.
Art Therapist Jennifer Drower explains and demonstrates the value of art making activities for young people with vision loss.
Art Therapy for Children with Multiple Disabilities
By Laura Buonomo
Art therapy for children with multiple disabilities is designed to help each child’s overall development and learning. This treatment is helpful to children with a variety of problems including Brain-injuries, Down Syndrome, Autism and Cerebral Palsy. Children with multiple disabilities may experience some degree of difficulty receiving and utilizing information from the world around them. For example, they may be visually and/or hearing impaired and they may have diminished perceptions. It might be difficult for them to filter or screen out information from the outside world; for example, they may be overly sensitive to tactile or sound stimulation. They may have low muscular tone, limited mobility or none at all; or they may have minimal problems moving around and receiving information and instructions, but be unable to process and put in sequence what they receive.
Two Main Functioning Areas
Individual functioning is generally measured in these two main areas: receptive and expressive. The receptive area consists of the visual, auditory, olfactory, and tactile functions; the expressive area by mobility, hand control, and language.
Three Main Activities – How Children Learn
What does a typical child do with the information the world constantly provides? He receives information through the senses (in-put), processes it (categorizing, prioritizing, interpreting, etc.), stores it in memory, and finally utilizes it in behavior (output). In other words the output is a sort of mirror image of the input.
Children learn through movement, sensory experiences and correlated perceptions, a perception being a mental image or representation of what is perceived. The art therapist intervenes by magnifying and targeting stimuli to foster the child’s in-take, and by creating opportunities for children to move independently and to get involved in a variety of activities (out-put).
Part of the art therapy process will involve practicing important functions, such as imitation and delayed imitation. Delayed imitation occurs when a child imitates without having the model right in front of him. Being able to do so implies generating a mental image of what is imitated, thereby creating a representation of what he has observed and wants to see happening again. Art therapy addresses the expressions of our being human, not just scribbles, drawings, or sculptures, but also other expressions of our senses and perceptions, as represented by body language and behavior in general.
Getting Enough Information and Enough Practice
When a child appears lethargic and inattentive to sounds, even though it is ascertained that he/she can hear, or is visually inattentive, although in possession of functional residual vision, he/she may not be receiving enough information from the outside world. In fact, children with multiple disabilities require a lot of in-put for out-put to occur. Accordingly, they need to be exposed to increased stimuli and repetition for them to re-act, practice, and learn. Targeted stimulation art therapy provides experiences of different degrees of complexity, from movement to thought, from the concrete to the symbolic. Modalities range from sensory stimulation, to providing opportunities to manipulate, compare, and categorize information, to utilizing such information creatively in play and art making.
How does an art therapist get started?
The art therapist formulates an Initial Evaluation of the child’s global functioning based on observation of the child, interviews with family members, and review of the available medical and psychosocial information, as well as from information gathered from teachers and other therapists working with the child. It is necessary to determine what abilities the child has been able to develop, regardless of his chronological age, because this will clearly determine the course that art therapy will take. For example, is the child ambulatory? What hand functions does he have? Is he at the stage of grasp reflex or can he let go of objects voluntarily?
If the child is not ambulatory, has not developed whole hand grasp or the release reflex, chances are that he/she may have not progressed to the point of awareness of the outside world. This is a crucial piece of information because in these cases intervention will be directed and concentrated mainly on the child’s body – the focus of the child’s interest and source of enjoyment.
Identify Preferences or Sensory Profile
Defining a sensory profile with a clear indication of the child’s preferences increases the chance that the child will be motivated to respond and become engaged. For example, a child might dread art projects involving glue or clay because the tactile stimulation caused by these substances is interpreted by his nervous system as a sensory assault. For example, a child who cannot tolerate having his hands sticky with glue might start by making collages using stickers, either sparkling or made of foam, in bright colors and distinctive shapes. Once the child has become invested in making collages, he will be more amenable to trying pre-glued shapes that adhere to paper by wetting the back with a sponge or a brush. From here to using actual glue is not a huge step. However it might take a long time to get to this point. You will be surprised how much easier it is for the child to get his fingertips sticky once he has experienced the pleasure of independently making something to like and be proud of!
Another child might show marked preference for auditory versus tactile in-put. In this case the art therapist might initiate interactions singing to the child or offering art games along with familiar songs. For example, she might play a Music Together or a Putumayo Songs CD and engage the child in gestures relating to the song’s lyrics. Once the child has become familiar with the music the therapist can replace the lyrics with others more consistent with art activities. One of the children I see in my practice loves the song “The Singing Bear.” Over time we have replaced the original words with “The Painting Bear.” This is how it goes: “Painting bear, painting bear, paint a little bit with me, painting bear, painting bear, paint a little dot with me. Painted high, painted low, paint it up all around the page. Painting bear, painting bear, painting is all you care.”
A plan is based on the principle that children will be met where they are at developmentally, and build on their existing abilities, step by step. Let’s take, for example, the first hypothetical case mentioned, a child who is non ambulatory, has not developed hand control and, therefore, is presumably only dimly aware of the outside world. In such a case the art therapist will help the child perform nonreflexive, simple and repetitive movements centered on the child’s own body. The art therapist’s objective is to help the child feel his body, practice actions, and perceive the immediate surrounding.
The art therapist first intervenes by amplifying the in-put the child receives ,for example, from hand movements. The art therapist will help the child move his fingers and encourage the child to touch parts of his own body; she might place the child’s fingers in shallow trays containing pre-art materials such as water of different temperatures, lotion, corn meal, or foam-paint, facilitating his explorative movements. Subsequently, movements can be encouraged using other parts of the child’s body in similar activities by placing him on a mat on the floor.
In the case of a child with insufficient hand control due to low muscular tone the art therapist will intervene by adapting art materials to the child’s particular needs. For example, she might insert the crayon into a Velcro holder that will be tied to the child’s hand and wrist. Initially with hand-over-hand assistance the child will have a chance to experience the pleasure of scribbling freely on paper, possibly for the first time. The same holder can be used with a brush to paint. Gradually, the therapist will withhold support until the child is able to draw or paint independently.
Naturally during any activity other external factors contribute to the child’s sensory stimulation, such as the therapist’s tone of voice, intonation, and volume, the therapist’s body language, the light in the room, and the sounds coming from the larger environment. The therapist will monitor as much as possible all the stimuli presumably reaching the child by paying close attention to the child’s responses, however minimal they might be.
Activities such as those described above will be done for increasingly longer periods of time, with varying degrees of intensity regarding pressure, temperatures, textures and sounds, or complexity, in order to excite the child’s senses, solicit his interest and keep his attention. This “excitement,” as well as the activity that follows, is for the child as necessary as food. Without stimulation the child’s brain does not function nor develop. With little stimulation the child’s brain starves. Ultimately, the child would die just as he would die without food.
Goals and Building Blocks
There are a whole range of art therapy goals for physical, cognitive, and emotional development, in both the social and the personal spheres. Each goal or set of goals includes many steps that I call “building blocks.” Examples of general goals are being able to maintain attention, to try new activities, to manipulate and explore new materials, to participate in group art projects, etc. The building blocks necessary to obtain a goal in these areas include: to increase body awareness, to experiment with self-initiated mobility, to decrease self stimulation behaviors, to improve hand/eye or hand/sound coordination, etc. Once a specific goal is attained, the art therapy intervention will shift to a succeeding series of steps toward a new goal.
Sample Technique: Using a Light Box with Children with Visual Impairments
Children with visual and additional impairments require specific interventions, including the use of optical devices, in order to facilitate development. A visually impaired child, for example, will not show any interest in drawing and painting unless she has been gradually exposed to such activities in ways that take into consideration her disability.
If the child for whatever reason has not learned to utilize effectively her senses, including residual vision, to decode the world around, she will have difficulties with concept development and symbolic operations. For example, a visually impaired school-age child who typically would have mastered the functional use of a variety of objects and materials, might hold a brush from the bristles rather than from the handle, or attempt to glue a piece of paper using the side without the glue. Because vision is the activity mostly responsible for integration of functions, practicing the use of residual vision results in enhanced use of all other senses, and thus to a better understanding of self and the world around.
I have found that drawing and painting over a surface lit from behind greatly enhances the child's visual interest. This activity motivates the child to practice with new media and explore new concepts, which in turn may bring forth development in cognitive, emotional, and social areas.
The light box is generally utilized by therapists to exercise the child's visual perception through structured activities with preexisting sets of shapes and colors. While these receptive activities are important for the child's growth, art therapy's main focus is on expressive abilities – to help the child make something on his own utilizing individually tailored media. The most viable format is the unstructured session, as it best allows the therapist to follow the child's cues. This facilitates the child's spontaneous involvement. Use of vision is encouraged in conjunction with all other senses – touch, smell, hearing, and balance.
As with any other activity the light box must be utilized in ways that are meaningful to the individual child. An activity is meaningful when it emerges from the child's unique responses to a specific situation, in this case, the source of light. For example, if the child's impairment is such that his behavior is extremely rigid and his psychomotor understanding undifferentiated, or at best, elementary, a therapist might start by showing the light box as a sound object and tap on its surface to invite the child's attention. Once the child has familiarized herself with the box, the therapist might move on to other, more complex activities. However, whether the child will want to touch and engage with the light box, master the concept of the light switch, and how quickly she will learn to use it to paint and draw, will in part depend on the child's degree of tactile selectiveness and current general development. Exploring the light box and utilizing it as a sound board for a variety of independent or interactive sound games might be all the child can do. This would be a great advance for a tactile-defensive child who probably started out as functionally rigid and socially withdrawn. For children with less severe disabilities a brief introduction to the light box might propel them into the world of symbols.
The following are some of the activities that I have designed with much help from the children at the Guild School:
- Spend time helping the child familiarize with the light box. Touch the smooth surface of the light box while describing it, inviting the child to do the same. The therapist may point to different aspects of the light box, such as the size, the shape, and the parts it is made of, including the on off switch. Encourage the child to explore this object and to operate it independently.
- The therapist will model for the student and turn the light on and off. This might appear as a magic trick to the child, and therefore help gather momentum in getting her attention. If the child shows only interest in using the switch, the therapist will allow plenty of time for the activity, even over the course of several sessions.
- The therapist can show the child a variety of shapes cut out from colored Plexiglas (specialty stores will cut it according to specifications), and encourage the child to place them on the light box and organize them in different configurations. Basic geometric shapes of different dimension can be assembled in ways that range from the random to the representational to allow for development. For example, one large yellow square, one large red triangle, and one long thin green rectangle can make a variety of abstract images, but together can also form a yellow house with a red roof over a green meadow. The shapes will also prompt other behaviors. For example, the child might enjoy taking all the shapes in and out of a box along with the light box game. The therapist can provide a box without a lid and then one with a lid to help the child practice different hand movements. Shape and color matching, and sorting games may also unfold.
- Using a marker or a paint-marker with hand-over-hand assistance, the therapist might show the child how to make a mark directly on the light box screen. The therapist can start with a dot and progress through single, multiple, and curved lines, withdrawing help when the child signals her readiness to work independently. Occasionally I have drawn a smiley face on the lighted screen prompting a surprised smiled by the child. Eventually a turn-taking drawing game may unfold, which supports the child's overall inclination to social interaction.
- The therapist might place a piece of light weight paper over the screen of the light box and see whether the child can initiate any work with markers, crayons, paint markers, or with paint and brushes. Initially the therapist might offer a choice between two media. The child might scribble and independently discover that when the paper is removed from the light box the paper retains the scribble. Or she might need help to make the connection as the scribble might become too faint for the child to see once it is removed from the light box. The therapist and the child can also paint directly on the light box and use a moist sponge to clean the surface. A child, especially a younger child, might greatly enjoy painting and wiping the paint off as she is more inclined to appreciate painting for its kynesthetic than for its symbolic characteristics. The art process, including the use of paint, water, and a sponge, offers the child infinite opportunities to practice important psychomotor activities that with time and practice may evolve into increasingly more complex mental activities.
Once the dynamics implicit in drawing and painting are established, it may become possible for some children to draw and paint without the light box. This suggests that vision improves with practice, but more to the point, that vision helps integrate other functions, such as psychomotor and, thereby, emotional and cognitive functions. In fact, before the light box was introduced not only did the child not perceive by sight enough to be able to draw, she did not perceive mentally the idea of drawing – Just like when we say: "Oh, I see now!" and we mean: "I understand now!", so the child can finally say: "Oh I see now what drawing is about!"
For Art Therapists
Most of the general principles of art therapy apply to clients with visual impairments. Considerations for the visually impaired include:
Orientation to Therapy Space
The initial goal is developing the therapeutic alliance. This relationship is one based on trust; the client needs to feel safe in the therapy room, both physically and emotionally. (For more, see Creating a Safe Therapy Space.) To achieve this, the setup of the room must remain constant, and the therapist needs to take a tour of the room with the client in order to familiarize the client to furniture, sink, and art material placement. This may need to be repeated for the first few session until the client indicates he or she is comfortable. If any changes have been made, the client should be informed prior to entering the room, and then upon entering, the therapist should take a tour of the room with the client in order to point out the changes.
Often clients with disabilities will be tactile defensive, or afraid of new sensations. In that case, the therapist must accustom the child slowly and carefully. The step of becoming used to the materials in the studio can be a lengthy process. The therapist will start with pre-art materials, such as shaving cream, and encourage the client to touch it. If a child is afraid, the therapist will put the child’s hand on her own, and her own hands over material, playing with it and describing it to the child. Over time, the child will become curious, and move his fingers down between those of the therapist to touch the material, and, eventually, put his own hands in fully to play with the material. Adults may or may not be comfortable with this technique.
It is essential that the client always determine the pace and maintain control of the exploration for the material. Never force the experience. While it might take longer, this is crucial for building a trusting therapeutic relationship. For on building this relationship, see Creating a Safe Emotional Space.
Art therapist Jennifer Drower describes her approach for parents beginning an art therapy program with their children:
Parents play an important role in the art therapy process, especially for young children with disabilities. They provide support and observations, continue stimulating the child’s development and learning processes. Art therapy is part of a larger approach of meeting the needs of the child with disabilities.
Introduction and Initial Evaluation
It is vital that parents understand what the art therapist will be doing with their children, how it will be done, and why. With very young children (birth-2), I invite parents into the therapy room. This will help the child feel safer, and will teach parents how they can work with their child and what sort of milestones (or lack thereof) their child may achieve while out of the therapy room. It is also an excellent way for parents to better understand the therapy rationale.
Initially parents fill out a brief questionnaire describing their child’s strengths and weakness, and the goals they have for their child. During my evaluation of the child, I explain what I am looking for at every step of the process. In the therapy room I track tactile tolerance, general visual information, such as tracking, face response, startle response, and engagement with surrounding environment, such as exploring, opening arms to reach or feel something, and signs of separation anxiety.
If the child is very young, parents are encouraged to stay through the duration of the session, which last about 30 minutes or until the child’s saturation point is reached. With children, 3 years old and up, it is better if the parents do not come into the therapy room. This is important because the therapeutic alliance needs to begin immediately and is often hindered by the presence of a parent. Prior to the beginning my work with their child I explain to parents what their child and I will be doing, my estimated time of progression, and how I handle a child who becomes very upset, cannot stop crying, or becomes very angry. I also write an initial evaluation and bi-yearly evaluations where parents get a copy
A Fearful Child
Often a child is afraid when coming into a strange place with an unfamiliar person. I always introduce myself to the child, sign my name in his or her palm (if that is their mode of communication), and allow the child to feel my hands and explore my face as I describe what he is feeling, such as eye color, nose, mouth, neck, and hair – color, length, and whether curly or straight.
I also bring the child on a tour of the room. I explain that this is a room where he can explore, touch, play with anything here, and that he is in control unless the he or I are in danger of being hurt.
During therapy if a child becomes afraid I initially ask what he is afraid of and may suggest certain things if the child cannot express or verbalize the fear. If the child is afraid of a material being used, such as sand, shaving cream, or paint, I will sit behind him or her to provide physical and emotional containment by placing my arms around the child, without touching closely – it’s not a hug. I’ll talk about what the material is, place my hands in it, talk about how it feels, and then ask the child if she would like to put her hands or hand on my arm. I continually tell the child I will not make her touch the material, that she controls the speed and depth of exploration. If the child doesn’t want to put hand on my arm, I reassure her saying, ”I can see you’re not ready to touch my arm. That’s okay, I’m just going to keep my hand in [the material] and talk about what it feels like…” After a few minutes, I ask her to try again. If no, I repeat above. If yes, I verbally praise her action, observing, “You are very brave to…” or “That’s great you’ve….” I avoid comments that praise her person, like “good girl,” because this type of comment implies that she may have the potential to be a “bad girl.”
I continue in this fashion until the child’s hand has independently made it down to rest on top of my hand. I slowly open one finger and invariably the child slips a finger between the space and begins to explore with me. Eventually the child is playing in the material with me and then without me. She has had control of the experience and that takes away the fear, usually of the unknown.
Traditional Art Classes vs. Art Therapy
As stated earlier in the FAQ’s section, in traditional art classes, there is a focus on the product or the work: how to fabricate a product or simulate a particular technique. In contrast, art therapy focuses on the process of exploring the world, and in the act of creation, discovering a sense of self, and supporting the definition of a true self. The development of self goes back to the mirroring process; all marks created by the child are an affirmation of self. Through the process, the child explores cause and effect through play, and explores uniqueness and difference. From this play, emerges creativity.
Basic Classroom Practices:
- Encourage and support all types of exploration of art and pre-art materials.
- Make sure your art materials are non-toxic because many children with sensory impairments often explore with their mouth in addition to their hands, feet, arms, and legs.
- Give authentic, specific praise. Rather than saying: “That’s a pretty flower.” Say “What a wonderful flower. I see lots of different colors and look at all the different textures you created, too!” Children hear how pretty or beautiful or good something they made is all the time. It becomes meaningless because it is said to all the others in the class. When you’re specific to that child’s art, he or she knows you are really looking, really paying attention
- Display as much art as possible. Children love to have a say in where their art is to be displayed, so ask!
- Celebrate all the art! Allow parents and family members to participate in the art-making process by sending work home, and encouraging children to discuss the process with their family.
The process of artmaking is essential. Encourage choices and decision making. Resist the urge to make the art piece yours, or to make it conform to a predetermined goal or product. Don’t tell the child where to place glue, collage items, which colors to use, etc. Avoid projects with rigid instructions and limited choice making.
Allow the child to determine when the process is complete. If a child is making a collage using cardboard, glue, feathers, beads, let her explore and play in the materials. If, at the end of the session, she’s removed all the items from the board, leaving only glue, recognize this as her art piece, to be displayed and sent home as a final product. Don’t add items to make it “look like art,” or feel pressured to make it something it’s not.
How to Find an Art Therapist
In the United States art therapy had its beginnings as a distinct field in the 1940s. However, it has only recently gained wider recognition. Some ways to find an art therapist include:
- Contact a local college or university with an art therapy program, and request a referral.
- Ask your child’s physician: pediatricians are increasingly aware of art therapy programs.
- Contact professional organizations, such as American Art Therapy Association (AATA) and state chapters of AATA, www.arttherapy.org/.
- Art Therapy Credentials Board has a Registry and Certificant list for therapists in the US (by state), Canada and at the international level,
When contacting an art therapist, don’t be afraid to ask questions. Some you may want to ask are:
- Have you worked with people/children with disabilities? What is the range of your experience? Have you work with children with visual impairments?
- What is a typical session like with [a person with similar circumstances as your child, i.e., visual impairments or additional disabilities]?
If you like what you hear, ask to meet him or her or schedule a visit to the art therapy room. You can read our description, Practical Considerations: Create a Therapy Space, for ideas of what to expect within the room.
Orientation Meeting with Parents
Orientation to room
Therapist’s background: education, experience, and theoretical/philosophical model for work with children with disabilities
Description of evaluation and assessment process
Review parental questionnaire:
Medical history: diagnosis, medication, etc.
Development skills – strengths and weakness: (specific) such as: opening drawers, doors, dressing
Socialization skills: family history, separation anxiety, etc.
Previous art experiences
Parental goals and wishes for the child
Parental expectation of time period to meet goals
General Methods and Strategies
Address tactile defensiveness
Explore range of pre-art and art materials
Discover preferences among materials
Encourage play and freedom of expression
Facilitate creativity, which helps to develop self-concept
Schedule Initial Evaluation.
Initial goals and strategies. These may change during later sessions. Parents will be notified of any changes in goals or strategies.
Checklist: Art Therapy Program for Children and Adults with Visual Impairments
- Purchase materials
- Set up space
- Establish funding
- Meet with students, outline goals
- Meet with parents
- Contact forms for participants
- Release forms
The following list of materials is not comprehensive, but should give an idea of the range of possibilities. Be creative.
bathroom tissue rolls
colored masking tape
packing materials: peanuts, bubble wrap
paper: shredded, large sheets and rolls, tissue paper
water with bubbles
white glue (Elmer’s)
hot glue and glue gun
microcrystalline wax and tools
raised-line drawing boards
wire: chicken wire, and different weights
wood pieces and scraps
Allow child/client to lead the art therapy experience.
- Do not be discouraged if progress is slow. If the client is initially hesitant, continue by exploring material yourself, describing the experience. Allow the client to touch your hands as you explore material; eventually the client will touch material at edges and then begin more fully exploring material.
- Keep open, respectful communication with client, child and paernts. Listen generously
- Develop classroom guidelines. Express them positively, rather than as a list of don’ts. If possible, allow the students to generate the rules, while emphasizing safety. This conveys that you value their opinion, and avoids making the assumption that the students will behave negatively.
Funding Strategies! Low Cost. No Cost.
- If you can only buy one thing: buy a roll of mural paper. You can use it on the walls for protection and another safe space for exploration. Paper can also be manipulated in many ways: shredded, cut, wet, torn, and wrinkled. In large sheets, it can create a space to crawl in, out, and through.
- Where to get cheap materials: Supermarkets, lumberyards, home improvement stores, flower shops, decorating and craft shops. Yard sales and thrift shops are also good sources.
- Go to any store manager, owner, vendor, or supplier you can find, explain what you do and ask if they have any material, even leftover or discarded materials that they could donate. It helps to have a business card with your organization’s name on it.
- Let it be known in your school, neighborhood, and organization that you can use just about anything. Soon, everyone will check with you before throwing materials out.
Fact Sheet: Psychology of Art Therapy
Over one hundred years ago, a number of European writers described the spontaneous art done by patients in mental hospitals. This seemingly irrepressible urge to make art out of any available materials confirms the compelling power of artistic expression to reveal inner experience. It was because art making provided a means of expression for those who were often uncommunicative that art therapy came to be developed as one of the helping professions.
Art therapy is defined as a human service profession that uses art media, images, the creative process, and patient/client responses to the created products as reflections of an individual's development, abilities, personality, interests, concerns, and conflicts. Art therapy practice is based on knowledge of human developmental and psychological theories that are implemented in the full spectrum of models of assessment and treatment, including educational, psychodynamic, cognitive, transpersonal, and other therapeutic means of reconciling emotional conflicts, fostering self-awareness, developing social skills, managing behavior, solving problems, reducing anxiety, aiding reality orientation, and increasing self-esteem.
Art therapy as a separate field developed simultaneously in England and the United States. Margaret Naumburg is considered its founder in this country. An educator and psychotherapist who started the Walden School in New York City, Naumburg wrote several books on art therapy and its applications with psychiatric patients in the 1940s and 1950s. Her sister, Florence Cane, modified principles from art education for use with children. At the same time, artists (including some who were conscientious objectors during World War II) were volunteers in mental hospitals. They eventually convinced psychiatrists of the contributions art therapy could make to treating the most difficult patients.
Theories from psychoanalysis and art education are the foundations for the two poles of the field which are termed art psychotherapy and art as therapy. Whether the therapeutic process is inherent in talking about a work of art and in expressing oneself or in the specific act of creation has been a subject of considerable debate. Most art therapists find that they draw from both approaches, modifying what they do or emphasize according to the population with which they are working.
The first journal in the field was published in 1961 as the Bulletin of Art Therapy (now the American Journal of Art Therapy). The American Art Therapy Association (AATA), founded in 1969, is the national professional organization; it sponsors annual conferences and regional symposia, approves training programs, and publishes the journal Art Therapy. The first graduate degrees in the field were awarded in the 1970s. Today, there are undergraduate introductory courses and preparatory programs in colleges across the country ,as well as 27 master's programs approved by AATA.
Art therapy is an effective treatment for the developmentally, medically, educationally, socially, or psychologically impaired; it is practiced in mental health, rehabilitation, medical, educational, and forensic institutions. Populations of all ages, races, and ethnic backgrounds are served by art therapists in individual, couples, family, and group therapy formats.
Educational, professional and ethical standards for art therapists are regulated by the American Art Therapy Association. The Art Therapy Credentials Board, an independent organization, grants post-graduate Registration (A.T.R.) after reviewing documentation of completion of graduate education and post-graduate supervised experience. The Registered Art Therapist who successfully completes the written examination administered by the Art Therapy Credentials Board is qualified as Board Certified (A.T.R.-BC), a credential requiring maintenance through continuing education credits. Many states also require that art therapists be licensed by the state.
Research in art therapy has included studying the influence of depression on the content of drawings, the use of art to assess cognitive skills, the correlation of psychiatric diagnosis and formal variables in art, and the effect of art therapy interventions as measured by single-case designs.
Taken from: http://www.nccata.org
For further information contact:
The American Art Therapy Association
1202 Allanson Road
Mundelein, IL 60060
Telephone: 847/ 949-6064 ; Fax: 847/ 566-4580