Art Therapy: A Creative Alternative to Talk Therapy
Art Therapy – What is it?
Art Therapy is both a therapeutic approach and a mental health and human services profession. As a therapeutic approach, art therapy uses the creative process and active art making to enrich the social emotional lives of individuals, groups, and families of all ages. It applies psychological theory and human experience within a psychotherapeutic relationship to address a wide range of mental health related concerns such as cognitive and sensory-motor functioning, self-esteem and self-awareness, emotional regulation and resilience, insight development, social skills enhancement, and conflict resolution and reduction (American Art Therapy Association, 2017).
Who becomes an Art Therapist?
A registered art therapist has completed a master’s degree and post graduate training, practicum, and clinical supervision. The recognized certification for Art Therapists is an ATR, which stands for Registered Art Therapist. Like other disciplines in mental health, Art Therapists must undergo continuing education in ethics and scope of practice as well as ongoing supervision after completing their formal educational training. They work in a wide range of settings, including hospitals, community mental health, and private practice, with a variety of different populations and mental health needs.
Art Therapy and the Triune Brain:
At the NC Center for Resiliency, we utilize and draw from experiential approaches such as art therapy due to their compatibility with somatic treatments. Somatic approaches, as the name suggests, focus on functions of the body and use the body as a resource for psychological healing and regulation of the autonomic nervous system, which regulates bodily functions that include our fight, flight, freeze survival responses. Unlike traditional “talk” therapy, which tends to focus on words and cognition, somatic therapists highlight sensation, a “felt sense”, and gross motor movements, which are manifestations of the autonomic nervous system. Because art therapy uses the creative process, which can be spontaneous, it allows for access to parts of the brain that may not be immediately accessible through language.
To understand this latter point, it may be helpful to briefly highlight neuroscientist Paul Maclean’s concept and term the “triune brain.“ While Dr. Maclean’s term is a highly simplistic conception of how the brain functions, it is a helpful concept for a lay audience because it distinguishes between the “top, middle, and bottom” parts of the brain and describes the general purpose those areas of the brain serve in terms of human behavior, physiological functioning, and emotional experience, expression, and processing.
Take the neocortex for example. Located literally at the top of the brain, the neocortex is responsible for organizing our cognition, thought, and executive functioning. Treatments attempting to change cognitions and thoughts, such as Cognitive Behavioral Therapy (CBT), are referred to as “top down” treatments, because they target functions of the neocortex. From this treatment approach, by supporting Clients to change their thinking (e.g., cognitions), they can begin to change the feelings and behaviors those thoughts produce. This approach primarily uses talking to accomplish this task, which is why it is one of the most commonly referenced form of “talk therapy.”
From a somatic perspective, change cannot be limited to thoughts if they are informed by functions of the brainstem or the “bottom” part of the triune brain. The brainstem controls and influences automatic bodily functions, such as our heart rate and breathing. Thankfully, we don’t have to “think” in order to breath, we just do it. In other words, when dysfunctional thinking is the result of an automatic, nonconscious function of the body, changing one’s thoughts about it may not be enough to promote healing.
For example, individuals with panic disorder are commonly frightened by changes in their breath as an indication of a potential panic attack. Simply changing their beliefs about the panic may change the cognitive reaction to the panic attack but does not necessarily address the nervous system response to whatever in the environment is triggering the change in breathing initially. By using somatic interventions, Clients are better equipped to shift their breathing before thoughts and beliefs are triggered in the “top” part of the brain. Thus, relying solely on the “top,” cognitive, portion of the brain is considered insufficient from a somatic perspective, because the brainstem is in operation and responding to our environment before we may have thought something about our physiology. Moreover, many individuals coming to therapy cognitively “know” they are not under threat when they are having a panic attack, or logically understand that whatever danger they endured in the past has ended. Nevertheless, they still feel terrified, disconnected from experience, or confused.
It is in this circumstance that art therapy becomes very helpful, because it is experiential and process oriented, which is inherently a “bottom” up approach. The art therapist’s ability to attend not only to what one thinks about their creative process related to experiences, emotions, and perceptions, but also to foster an embodied and somatically enlivening creative process can activate the brainstem in ways that may not be accessible from purely talking about those experiences, emotions, and perceptions. Of course, there are times when a cognitive approach is certainly warranted with some Clients, and perhaps even preferred by them.
Art therapists can meet the needs of these Clients by using interventions that are more precise, such as pencil or pen. An art therapist may also draw on what is called the “expressive therapies continuum” to assess whether a person who prefers a more precise approach has the preference due to comfort or due to limited access to additional creative processes, such as emotional/affective ones or kinesthetic/sensory ones.
For Clients more comfortable expressing themselves without words, orienting toward symbolic and cognitive creative processes can feel natural and very helpful in negotiating their mental health needs. Additionally, if a Client is looking to expand their experience of self and their expression, an art therapist may invite the Client to use paint or watercolors which are “looser” and allow for more access to affective and perceptual creative processes. As the Client is ready to explore spontaneity and perhaps expand and understand their perceptual and sensory experience, creative processes can included shaving cream, foams, and clay as mediums to explore sensory experiences related to touch or scented mediums to elicit smell in the Client’s exploratory process.
Over the course of treatment utilizing art therapy, Clients will find they now have more access to the entire continuum of experience rather than just functions of the brainstem or neocortex. From a self-regulation-based perspective, this integration is essential. After all the heart of somatic treatment is to increase a Client’s capacity to regulate their autonomic nervous system. Art therapy is one way to do so which is why many somatic approaches, such as Sensorimotor Psychotherapy, Eye Movement Desensitization and Reprocessing, or Somatic Experiencing, draw from art therapy techniques to support regulation in any given treatment.
The Vagus Nerve and the Use of Creative Techniques:
What do we mean “self-regulation?” Simply, we mean the ability to control functions of the autonomic nervous system, which as mentioned previously, controls our fight-flight-freeze responses. Stephen Porges, PhD conceptualized a theory called “The Polyvagal Theory” to explain the role of the vagus nerve in this process. The vagus nerve is connected to our brainstem and travels down the spine all the way to our digestive system. Rather than just focusing solely on the brainstem, polyvagal theory explains how our fight-flight-freeze response is often nonvoluntary and nonconscious.
Porges’ theory also explains how mammals feel when they are not in a state of fight, flight or freeze. In this state, we feel safe and secure, and have access to playfulness, energy, and desire social connection. This state is ideally our baseline, but when we feel threatened or in danger, we move into a fight-flight response that allows us to defend ourselves. Importantly, when we are unable to fight or flee a situation, we are prone to freeze or “shut down.” This later defense is considered a last resort because it uses the most amount of energy and is only utilized when there is a perception of being trapped or unable to escape. Through this understanding of the nervous system, interventions that support Clients to come out of freeze are essential. The theory proposed by Porges’ provides a good explanation as to why purely cognitive approaches are ineffective for those whose symptoms are driven by a stuck “freeze” or fight/flight response, because changing their thoughts does not address issues related to brainstem and vagal responses.
One of the most prominent Clinicians utilizing the polyvagal theory in Clinical practice today is Deb Dana, LCSW. She recently released an important book highlighting the use of the Polyvagal theory in clinical practice and does intensive trainings throughout the world on the topic. In her most recent book, she outlines numerous incredibly relevant uses of artistic mediums to support self-regulation. Music, the use of colored markers and paints, images or access to nature, and mindful movement all can increase a Client’s sense of safety and ability to return to a state of safety and social connection (Dana, 2018). When we can reach these states, we know that we are no longer “stuck” in a fight, flight, freeze response. Art therapy can be one critical way to support Clients to get “unstuck” because it’s harder to disconnect and freeze when one is actively listening to music or mindfully engaging in coloring. Additionally, the creative process itself may also create space for symbolic representations of safety and regulation which could be more comprehensible to Clients who are “stuck” in a freeze response and do not resonate with words that convey safety or attempt to “convince” a Client they are safe through rationale or logic.
As you can see from the information outlined above, art therapy and other creative interventions can be powerful tools in therapy to support Clients. Where words may be a useful tool in many cases, there are often situations and circumstances when Clients are unable to access them due to responding predominantly to information from the lower part of the brain, rather than the neocortex. Such Clients struggle in therapies which rely solely on talking, especially when they are unable to feel safe due to fear-based responses for which they do not have words, but are reacting to very real physiological responses, nonetheless. At the NC Center for Resiliency, we support and highlight treatments that use creative processes and artistic modalities due to their tremendous ability to support Clients in finding a sense of safety when words have been found to be insufficient.
Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, New York, NY: W.W. Norton & Company