Art psychotherapy

1. Introduction

Version followed: UK art psychotherapy (psychodynamic and relational) as BAAT defines it and the HCPC regulates it. Group procedures follow the group art therapy guidelines of the MATISSE trial (Crawford et al. 2010), which draw on Edwards, Waller and Gilroy, Killick and BAAT guidance. Two documented adaptations are added and labelled: mentalization-informed art psychotherapy (Parkinson, Cole and Trevelyan 2024; BAAT Insight 2025) and the Dutch "opposites" protocol for personality disorders (Haeyen et al. 2022). Schaverien's analytical concepts are included only as far as the sources describe them.

Art psychotherapy is a profession with several theoretical orientations, not a single manualised therapy. No treatment manual is cited even in the main UK trial [source: Crawford et al. 2010]. BAAT describes it as "an established form of psychotherapy, delivered by trained art therapists". Art-making is the main mode of expression, used alongside talking, and helps with experiences that are hard to put into words. The stated aims are to reduce distress and to build insight, self-compassion, agency and self-worth [source: BAAT, What is art therapy?].

Core idea of change. Two things are held to do the work: making art, and the three-way relationship between therapist, client and image [source: Crawford et al. 2010]. The picture can "hold the transference". Feelings the client cannot yet bear can be carried by the image and worked on there [source: Schaverien, as reviewed in Self & Society; Schaverien 1999]. In groups, members' relationships with each other are also explored, in both conscious and unconscious terms [source: Crawford et al. 2010]. Later variants describe change in mentalizing terms: making inner states visible so that client and therapist can attend to them together and think about them [source: BAAT Insight 2025; Parkinson et al. 2024].

Professional frame. In the UK, "art therapist" and "art psychotherapist" are protected titles, and every practitioner must be on the HCPC register. The mandatory qualification is an HCPC-approved MA or MSc in Art Therapy or Art Psychotherapy, taken over 2 years full-time or 3 years part-time. There are no approved evening or distance-learning routes, and full BAAT membership follows HCPC registration [source: BAAT 2022 Training leaflet; BAAT, What is art therapy?]. Elsewhere, national bodies regulate the profession (for example AATA and the ATCB credential in the USA) [uncertain]. A psychotherapist without this training must not call their work art therapy or art psychotherapy. They may use art-making only as an adjunct within their own modality and competence. BAAT also limits practitioners to the assessment methods they were trained and supervised in [source: BAAT Code of Ethics 2019 s.2.3, 3.1–3.2] [synthesis for non-art-therapist use].

2. Framework

No staged phase model with formal transition criteria is described in the primary sources drawn on [uncertain]. The documented course of therapy and the formats are as follows.

Course of therapy

Referral and risk review. Get and read the referral and any risk assessment before the client joins [source: Crawford et al. 2010, Table 2].
Pre-therapy meeting. Meet the person once, individually or in a small group, before they start. Explain the aims, boundaries and expectations [source: Crawford et al. 2010].
Consent and contract. Get informed consent, given verbally and in writing, and record it in the notes. Explain benefits, risks (including that the client may feel worse at first) and alternatives, including NICE-recommended treatments. Agree a written contract covering start date, expected length, frequency, boundaries and the limits of confidentiality [source: BAAT Code of Ethics 2019 s.7, 12].
Working phase. Hold regular sessions of art-making and talking. Group conflict, lateness and changes are explored rather than managed [source: Crawford et al. 2010, Table 3].
Ending. Agree with the client what happens to the accumulated images. Waller gives a whole chapter to ending a group and what to do with the images and objects [source: Waller 2015, contents; BAAT Code s.14] [uncertain: chapter text].

Formats documented

Long-term group (MATISSE, psychosis). Weekly 90-minute sessions for up to 12 months, with no more than 8 active members. Led by an HCPC-registered art therapist with a co-facilitator. Monthly group supervision and a fidelity proforma after each session [source: Crawford et al. 2010].
Interactive group (Waller). Combines the change factors of interactive group psychotherapy with those of art therapy. Short-term versions and versions for children and adolescents exist [source: Waller 2015, publisher page] [uncertain: session structure].
Short themed group (Haeyen et al. 2022). Four weekly sessions of 1–1.5 hours, about 9 participants, each session built around a pair of opposites. Delivered inside a multidisciplinary outpatient programme for personality disorders.
Mentalization-informed psychoeducational course (Parkinson et al. 2024). Ten weekly 2-hour sessions, co-led by an art psychotherapist and a psychiatric registrar, held in a community art studio, for an Early Intervention in Psychosis service. Adapted from a 12-session MBT introductory programme. Topics: mentalizing, basic emotions, attachment, mentalizing culture (held in a gallery), anxiety, trauma, depression and compassion; a "What is psychosis?" session was added on later courses.
Individual work. Session length and number are not specified in the sources [uncertain]. Agree them in the contract.

Within-session sequence. In the psychoeducational model each session runs: display last week's work and recall the topic, then introduce the new topic with images, then set an art exercise, then look at the work together, then reflect and ask each other questions [source: Parkinson et al. 2024]. In open groups, free making and verbal exploration are combined flexibly [source: Crawford et al. 2010].

When to deepen

Start at a safe, empathic and validating level. Move to more activating work, such as exploring feelings or interpersonal dynamics, only once the person is steady. Return to validation when arousal rises [source: Parkinson et al. 2024].
Moving from private making to putting work on the wall for shared looking is a significant step. Let the client choose when to take it rather than requiring it [source: Parkinson et al. 2024].
Opposite-based tasks need a group that can tolerate discomfort. The therapist balances confrontation with comfort [source: Haeyen et al. 2022].

3. Guiding principles

No art skill is needed. Say so at the outset and judge nothing on aesthetics [source: BAAT].
Process over product. Treat "bad" drawings as fine and praise engagement, not results [source: Parkinson et al. 2024].
The triangular relationship. Attend to the client, the image, and how each relates to you; the image is a third presence in the room [source: Crawford et al. 2010; Gazit et al. 2021].
The image can hold the transference. Notice what the picture is made to carry, such as an intolerable feeling, a magical charge, or a message aimed at you, before putting it into words [source: Schaverien via Self & Society review].
A setting that can contain. The room and the routine must be able to "bear and contain" fragmented or unintegrated states. Keep them stable [source: Killick via Self & Society review].
Free choice of materials and spontaneous expression. Have a range of materials available and invite free use unless a structured protocol is being followed [source: Crawford et al. 2010].
Supportive by default. Lead with empathy and encouragement. Offer symbolic interpretations rarely and think them through in supervision first [source: Crawford et al. 2010].
Here and now first. Links to history or mental state can be offered, but the main focus is present experience in the room [source: Crawford et al. 2010].
Protect acutely psychotic material. With an acutely unwell person, handle the content of their images with great sensitivity, or leave it alone [source: Crawford et al. 2010].
Explore behaviour, don't just manage it. Lateness and conflict are material to be understood through the artwork, the group process and life events [source: Crawford et al. 2010, Table 3].
Reliability. If the therapist cannot attend, cancel the session rather than send cover, and give space to talk about the change. Small signs of keeping people in mind, such as reminder texts and a way to text back, build trust [source: Crawford et al. 2010; Parkinson et al. 2024].
The not-knowing stance (mentalizing variants). Be curious about what an image means to its maker; don't tell them what it means [source: Parkinson et al. 2024].
Active collaboration (mentalizing variants). Think about the artwork actively with the client rather than waiting passively for insight [source: BAAT Insight 2025].
Balance confrontation and soothing. Pair every stretching task with a way to settle afterwards [source: Haeyen et al. 2022].
The client owns the artwork. Name and date every piece and store it safely. Agree with the client what happens to it [source: BAAT Code s.14].
Written consent before images are reused. Get written consent before photographing work for display, research, teaching or exhibition. Never profit from sales [source: BAAT Code s.15].
Limits of confidentiality. Information belongs to the treatment team, and safeguarding can override confidentiality. Tell clients this at the start [source: BAAT Code s.10].
Cultural awareness. Consider how culture, faith, gender, sexuality, age, education and disability shape both the work and its assessment [source: BAAT Code s.7].
Safe space and materials. Provide a private room with ventilation, light and running water, and know how toxic each material is [source: BAAT Code s.13.1].
Stay within competence and under supervision. Use only methods you were trained in, and get supervision that follows BAAT guidelines [source: BAAT Code s.3–4].
Images are not diagnostic proof. Never read abuse or a disorder from a picture. Explore with the client and follow safeguarding procedures for what is said or otherwise evidenced [synthesis, consistent with BAAT Code s.3.2].

4. Intervention inventory

The inventory has three parts. Part A covers the core procedures of UK art psychotherapy. Part B covers the structured "opposites" exercises (Haeyen et al. 2022). Part C covers mentalization-informed procedures (Parkinson et al. 2024; BAAT Insight 2025). All example language is the author's own unless it is quoted and cited.

Part A. Core art psychotherapy procedures

A1. Pre-therapy meeting and engagement

Purpose: Orient the client, reduce fear of joining, and check suitability and risk [source: Crawford et al. 2010, Table 2].
Steps:
1. Read the referral and risk assessment.
2. Invite the person by letter or phone, giving the place and start time.
3. Meet once, individually or in a small group.
4. Explain the aims, boundaries (time, confidentiality, artwork stays in the room) and expectations.
5. Show the room and the materials.
6. Agree what happens if they miss sessions.
7. Keep in contact by phone and post, and with the care team [source: Crawford et al. 2010].
Example language (illustrative): "You don't need to be good at art. People use the materials to show things that are hard to say. We look at what you make together, and only talk about what you want to."
Watch for: Fear of being judged on skill, and confusion with an art class. If the person attends the first session, engagement is working.

A2. Contracting and informed consent

Purpose: A legal and ethical base for the work, and a frame the client can rely on [source: BAAT Code s.7, 12].
Steps:
1. Give information both verbally and in writing. Use an interpreter or signer if needed.
2. Cover benefits, risks (including possibly feeling worse at first) and alternatives, including NICE-recommended treatments.
3. Agree the start date, expected length, frequency and boundaries in writing.
4. State the limits of confidentiality, including that information is shared with the treatment team.
5. Ask now for any written consent to photograph or reuse artwork, for example for research [source: BAAT Code s.15].
6. Record consent in the notes.
Example language (illustrative): "Sometimes people feel stirred up for a while before things feel better. If that happens, tell me and we'll go at your pace."
Watch for: Consent given under pressure from the ward or family. Capacity issues. Cultural factors affecting the client's understanding.

A3. Preparing the room and materials

Purpose: A stable, safe and private studio-therapy space that can contain the work [source: BAAT Code s.13.1; Killick via review; Waller 2015, ch. "Practical matters: materials and rooms"].
Steps:
1. Use a private room with heating, ventilation, light, running water and furniture that meets health and safety standards.
2. Lay out a consistent range of materials, for example paint, pastels, pencils, collage, clay and different papers [source: Crawford et al. 2010: "a range of art materials"].
3. Know the hazards and toxicity of each material.
4. Arrange lockable storage for each client's work.
5. Set up the room the same way every session.
Watch for: Solvent-based or toxic products and aerosols. Dry clay dust (wet-clean surfaces; don't sweep dry) [synthesis]. Sharp tools such as blades and scissors with people at risk of self-harm: count them out and back in, or remove them, according to the service's ligature and sharps policy [synthesis].

A4. Free (non-directive) art-making

Purpose: The core activity. The client expresses themselves freely and spontaneously with materials of their choosing [source: Crawford et al. 2010].
Steps:
1. Invite the client to use whatever materials they like, with no set subject.
2. Let silence and making take as long as they need.
3. Stay present and attentive without hovering.
4. Note the choice of materials, the order of making, any hesitations or destruction, and how much space the image takes.
5. Leave time to look and talk before the end. How long depends on the client and is not standardised [uncertain].
Example language (illustrative): "Use anything here, in whatever way you like. There's no right thing to make."
Watch for: Paralysis in front of a blank page (see section 5). Copying, or making for the therapist. Over time, more personal and spontaneous imagery and easier talk about it suggest the work is deepening [synthesis].

A5. Looking at and talking about the image together

Purpose: To put image-held experience into words, and to use the triangular relationship [source: BAAT; Crawford et al. 2010; Gazit et al. 2021].
Steps:
1. Ask whether the client would like to look at the piece with you.
2. Agree where to place it, side by side and at a distance, so you look at it together rather than at the client.
3. Ask the maker what they notice and what it was like to make.
4. Offer your observations tentatively, for example about colour, placement or what is missing.
5. Follow the client's associations; don't impose meaning.
6. Accept a choice not to talk about it.
Example language (illustrative): "Shall we put it over there and look at it together?" "What stands out to you now that it's finished?" "I notice this corner is left empty. I wonder about that."
Watch for: Interpretations the client experiences as intrusion or being "read". It is working when the client brings their own associations and can tolerate a second view.

A6. Linking the image to the here and now, mental state or history

Purpose: To connect what appears in the art to current feelings, group events or life history [source: Crawford et al. 2010].
Steps:
1. Start with the present: how the client felt while making the piece and how they feel looking at it.
2. If it fits, link it to what is happening in the group or in their life this week.
3. Offer links to history only occasionally, and as questions.
4. With acutely psychotic clients, avoid exploring content. Stay with the experience of making and with safety [source: Crawford et al. 2010].
Example language (illustrative): "You started with dark colours today, after we talked about the break. I wonder if those are connected."
Watch for: Rising disorganisation or distress. If you see it, drop back to supportive, concrete talk.

A7. Working with the image as carrier of the transference (analytical approach)

Purpose: To understand how the picture holds feelings and relationships, especially with clients who are not ready for purely verbal work. Schaverien presents her analytical approach for psychotic and borderline patients, children, and people in psychiatric settings [source: Schaverien 1999, publisher description].
Concepts as the sources describe them:
- The picture "holds the transference".
- Scapegoat transference: attributes and states, including otherwise intolerable affect, are unconsciously transferred into a picture or object, which comes to embody them.
- Talisman: the "empowered picture" to which the patient gives magical properties.
- The embodied image: "the life in the picture".
- With psychotic patients, the art object can act as a transactional object between patient and therapist, and words written on pictures can reflect the transference [source: Self & Society review of Killick & Schaverien 1997; Schaverien 1999, contents].
- The full technical guidance, including any staged handling of the picture or its disposal, is not drawn on [uncertain].
Steps [synthesis from the concepts above]:
1. Treat a charged image with care. Keep it safe, and ask before handling or moving it.
2. Notice your own response to the image (countertransference).
3. Notice what the client does with the image: hides it, destroys it, wants it kept or wants it taken away.
4. Take your hypotheses to supervision before voicing them [source: Crawford et al. 2010 for the supervision step].
5. When the client is ready, wonder aloud about what the picture is carrying.
Example language (illustrative): "It seems this picture is holding a lot of the anger right now. Shall we keep it safe here until you want to look at it again?"
Watch for: Wishes to destroy a piece or remove it immediately. Treat these as meaningful and agree on them; don't refuse automatically [source: BAAT Code s.14 on case-by-case decisions] [synthesis]. Requires analytic training and supervision.

A8. Exploring group process through the artwork (interactive group)

Purpose: To use relationships between members, conscious and unconscious, as material for change [source: Crawford et al. 2010; Waller 2015].
Steps:
1. Notice patterns in the room: lateness, conflict, sub-groups, scapegoating, splitting.
2. Explore their meaning rather than redirecting to the task.
3. Look at how they show in the images: shared themes, images of the group, the same colours or symbols appearing across members.
4. Invite members to comment on each other's work and reactions.
5. Link what happens to group events such as new members, breaks or endings.
- Waller's case chapters cover the unwilling participant, images of the group, catharsis, power and domination in clay workshops, splitting, symbolic expression of anger, and scapegoating. Their procedures are not drawn on [source: Waller 2015, contents] [uncertain].
Example language (illustrative): "Several of you have drawn walls or fences today, and we have someone new joining. What do people make of that?"
Watch for: Scapegoating of one member. Interpretations that feel shaming. It is working when members begin to name their reactions to each other directly.

A9. Themes or projects within an interactive group

Purpose: To give structure or a shared focus, for example in short-term groups, groups for children or groups of anxious members. A theme can also arise spontaneously from the group [source: Waller 2015, contents].
Steps [uncertain: Waller's procedure; structure taken from Haeyen 2022 and Parkinson 2024]:
1. Offer a broad theme connected to the group's current process.
2. Allow the theme to be interpreted freely.
3. Follow with shared looking and discussion.
4. When a theme emerges unprompted across several images, name it and let it become the focus.
Example language (illustrative): "Today you might like to make something about how the group feels at the moment. Take it any way you want."
Watch for: Themes that are too directive or too intense for the group's stage.

A10. Group painting

Purpose: A shared image that makes the group's developmental processes, territory and cooperation visible [source: Waller 2015, contents: "Developmental processes in a group painting"; Haeyen et al. 2022].
Steps:
1. Put one large sheet on a table or the floor.
2. Invite everyone to paint on it, with or without a theme.
3. Watch for boundaries, invasions, collaboration and the empty spaces.
4. Afterwards, ask members to describe their experience of the shared space. (For a structured version, see B4.)
Example language (illustrative): "What was it like when someone painted next to, or over, your part?"
Watch for: Distress when one person paints over another's area. Explore it gently as group material.

A11. Managing artwork through therapy and at the ending

Purpose: To protect the client's work as part of the therapy and to honour the client's ownership [source: BAAT Code s.14; Waller 2015, ch. "Ending the group: what to do with the images and objects"].
Steps:
1. Name and date every piece.
2. Store it in the therapy space during therapy.
3. Decide case by case on requests to take work home.
4. Toward the end, review the accumulated work with the client. Agree whether they keep each piece, whether it is stored, or how it is disposed of.
5. If storage is limited, photograph the work with the client's consent.
6. Keep written records according to the employer's policy.
Example language (illustrative): "We have a few weeks left. Shall we look back through your folder together and decide what you'd like to do with each piece?"
Watch for: A review of the work can stir grief or pride. Leave time for it.

A12. Session recording and fidelity

Purpose: Keep track of the work and support supervision [source: Crawford et al. 2010].
Steps: After each group, record its structure, content, attendance, any boundary breaches and how they were handled, the main verbal content, and the materials used. Bring these records to supervision; MATISSE held supervision monthly.
Watch for: Drift into an activity group, meaning no exploration of feelings or process (see section 5).

Part B. Structured "opposites" exercises (Haeyen et al. 2022)

These four exercises come from a four-session group for outpatients with cluster B and/or C personality disorders, delivered inside a multidisciplinary programme. Each session lasts 1–1.5 hours with about 9 participants. The therapist balances confrontation with comfort, and initial discomfort is framed as a necessary step [source: Haeyen et al. 2022].

B1. Line drawing (session 1)

Purpose: Make current feelings and their opposites visible and bring them together.
Steps:
1. Draw lines that follow what you feel right now.
2. Exaggerate those lines.
3. Turn your attention to the opposite feeling and draw that.
4. Combine both drawings into one meaningful picture. Participants may tear the paper and glue pieces together into one whole.
5. Discuss the result.
Example language (illustrative): "Let your hand follow what you feel now. Then make it bigger. Now, what would the opposite feeling look like?"
Watch for: Some participants felt worse after this first session. Check how people are before they leave.

B2. Mask inside out (session 2)

Purpose: Show the inner self and the face shown to the world side by side.
Steps:
1. Open with a short guided imagery exercise that directs attention inward. Its script is not published in the paper [uncertain].
2. Each participant paints a mask as a symbolic self-portrait: inner feelings on the inside, outward presentation on the outside.
3. Reflect together. The message to reinforce is that it is acceptable to show inner feelings.
Example language (illustrative): "On the inside, paint what you feel but rarely show. On the outside, paint what others usually see."
Watch for: Shame about revealing the inside. Allow partial disclosure.

B3. Big and small self (session 3)

Purpose: Explore how strong and vulnerable parts of the self relate to each other.
Steps:
1. Make two clay figures, one for the big self and one for the little self.
2. Arrange them in different positions: facing each other, one behind the other, far apart, close together.
3. Notice what each arrangement feels like.
4. Discuss.
Example language (illustrative): "Try putting the small one in front. What changes?"
Watch for: Self-criticism. Work toward a dialogue between the parts.

B4. Controlled and free group paintings (session 4)

Purpose: Work with holding on versus letting go, and with control versus freedom, in a group.
Steps:
1. Split the group in two, each half with a large sheet.
2. One half paints in a controlled way and the other paints freely, for 20 minutes.
3. Swap sheets. Each half continues in the style already set on the sheet it receives.
4. Reflect on the experience.
Example language (illustrative): "What was it like to carry on a style that isn't your usual one?"
Watch for: Perfectionism, fear of failure and performance pressure at first. Fear of losing control or doing it wrong can block movement between the two styles.
Session measures used in the study: PANAS, two DERS subscales, VAS mood scales and SERATS. These are research measures, not part of the clinical method [source: Haeyen et al. 2022].

Part C. Mentalization-informed art psychotherapy procedures

This approach is credited to Neil Springham's foundational adult work, with frameworks by Havsteen-Franklin and the ostensive-communication theory of Springham and Huet (2018). It is explicitly more structured and collaborative than traditional non-directive art therapy [source: BAAT Insight 2025]. The procedures below come from the Early Intervention in Psychosis course [source: Parkinson et al. 2024] unless stated otherwise. Formal MBT training is advisable [synthesis].

C1. Dough warm-up (first session)

Purpose: Introduce the materials and the group members in a low-pressure, playful way.
Steps:
1. Hand out soft dough.
2. Set a simple structured task, for example a small object that introduces you. The exact task is not specified in the source [uncertain].
3. Share briefly.
Example language (illustrative): "Make something quick that tells us one thing about you. Nobody's judging."
Watch for: Withdrawal. Keep it light.

C2. Observational drawing of a familiar object

Purpose: Separate assumptions from what you actually see. This practises the not-knowing stance.
Steps:
1. Each person takes an object from a pocket or bag.
2. They draw it as though seeing it for the first time.
3. Discuss what they noticed that they had not seen before.
Example language (illustrative): "Draw your keys as if you'd never seen keys before."
Watch for: Frustration with drawing ability. Reaffirm that process matters more than product.

C3. Display and shared looking (joint attention)

Purpose: Move from private making to shared viewing, so people can compare how they see their own work with how others see it.
Steps:
1. Display the previous week's work on walls or chairs.
2. Use it to recall the last topic.
3. Invite people, without pressure, to put new work on the wall.
4. Look at it as a group.
Example language (illustrative): "Would anyone like to put theirs up so we can look together?"
Watch for: Choosing to display is a significant step, so don't force it.

C4. Mentalizing questions and reframing praise

Purpose: Replace certain judgements, including praise, with curiosity about the maker's mind.
Steps:
1. The maker reflects on their piece first.
2. Peers ask open questions about the maker's experience. The source contrasts "What was it like to paint that bit?" with "Wow that's really good!"
3. When praise comes, the therapist turns it into curiosity: they say what drew them to the piece and invite the maker to say more.
Example language (illustrative): "I'm trying to work out what pulls me to this part. Can you tell us more about it?"
Watch for: Interpretations made with certainty, such as "You were clearly angry". Model tentativeness instead.

C5. Therapists make and display their own art

Purpose: Model self-reflection, open a non-verbal dialogue, and move from observer to participant.
Steps: Co-therapists make work during the exercise and display it alongside the group's.
Watch for: Therapist self-disclosure that pulls focus. Keep it modest [synthesis].

C6. Rebalancing the mentalizing dimensions

Purpose: Help someone stuck in overthinking (cognitive pole) reconnect with affect.
Steps: Invite curiosity about the feeling in the making: the pressure of the mark, the pace, the chosen colour.
Example language (illustrative): "Leave the meaning for a moment. What did it feel like to press that hard?"

C7. Pressing pause and giving distance

Purpose: Practise stepping back from a situation or an image when arousal rises. Some participants used this at home.
Steps:
1. Stop the activity.
2. Step back physically from the work.
3. Notice your state.
4. Return only when ready. The steps are inferred from the source's brief description [synthesis].
Example language (illustrative): "Let's press pause. Step back from the table and just notice what's happening inside."

C8. Naming bodily sensations and "detective work" (children)

Purpose: Link bodily arousal to emotion, and look for clues to thoughts and feelings in the artwork. Child-friendly art therapy journals support this [source: BAAT Insight 2025, McDonald's primary-school work].
Steps:
1. Notice a body sign aloud. The source reports a therapist asking a child "is your heart beating really hard?"
2. Offer a way to understand what is happening.
3. Then look at the drawing together for clues, like detectives.
Watch for: Over-reading clues. Present these as shared guesses, not facts.

C9. Photography, journalling and collaborative reflection (adult groups)

Purpose: Structured practice of mentalizing, with the group as a "training ground" [source: BAAT Insight 2025, Chilvers].
Steps: The procedure is not detailed in the source [uncertain]. Use these media as prompts for shared reflection.

C10. Gallery or museum session

Purpose: Practise mentalizing through looking at, drawing and talking about other people's art, using joint attention.
Steps:
1. Hold one session at a local gallery.
2. Look at works together, draw from them, and compare readings. An earlier session compared readings of projected portraits.
Watch for: Access and anxiety in public spaces. Plan travel.

C11. Audio-Image Recordings (review at the end)

Purpose: Consolidate learning and give participants a record of their work.
Steps:
1. Each participant chooses 2–3 works.
2. They are interviewed about them by a therapist or a peer using a set template.
3. The interviews are edited into short films that participants keep.
4. Get explicit consent for recording [source: BAAT Code s.15].
Watch for: Participants often chose images of psychotic experiences. Prepare to discuss psychosis openly.

5. Handling problems

Blank mind, or can't start. In mentalizing terms, heightened arousal is linked to difficulty expressing oneself and a "blank mind". Pause the making and share experiences with the aim of validating, not solving. Offer a material the person finds safe [source: Parkinson et al. 2024]. Also offer a small, bounded start: a scribble, tearing paper, or a single colour [synthesis].
"I can't draw", perfectionism, fear of failure. Restate that no skill is needed [source: BAAT]. Treat "bad" drawings as acceptable, and have the therapist make work alongside [source: Parkinson et al. 2024]. Expect performance pressure at first in group tasks [source: Haeyen et al. 2022].
Reluctant or unwilling participants. Waller gives a chapter to the unwilling participant [source: Waller 2015, contents] [uncertain: content]. Allow sitting without making. Invite rather than insist. Treat the reluctance as material [synthesis].
Lateness. Explore the reasons and the feelings about the group. Don't just remind people of the start time [source: Crawford et al. 2010, Table 3].
Conflict with you or peers. Explore it through the artwork, the group process and life events [source: Crawford et al. 2010]. If agitation escalates, de-escalate; ask the person to leave the room if needed. Inform the care coordinator and record the incident. Decide in supervision whether they should miss further sessions [source: Crawford et al. 2010, Table 2].
Overwhelm after confrontational tasks. Opposite-based work can heighten emotionality and self-criticism, and some participants felt worse [source: Haeyen et al. 2022]. Pair each such task with a soothing element. Leave time to settle. Check each person's state before they leave, and have a plan for between sessions [synthesis].
Psychotic material emerging. Handle the content of images from acutely psychotic participants with great sensitivity, or avoid it [source: Crawford et al. 2010]. Participants may want to talk about psychosis itself; a dedicated psychoeducation session helped [source: Parkinson et al. 2024].
Deteriorating mental state. Encourage contact with the care coordinator or psychiatrist, and ask consent to contact them. If decline continues, contact them even without consent after discussing with your supervisor and checking the risk plan [source: Crawford et al. 2010, Table 2].
Suicidal or self-harm content in an image. Ask directly about current thoughts and plans. Follow your service's standard risk assessment and safety-planning procedure. Discuss safe storage or removal of means within that plan, and involve the care team. Don't treat an image as a risk verdict either way [synthesis].
Self-harm with materials. Use the sharps and ligature protocols listed in A3. Supervise blades. Review which materials are available to each person against their risk assessment [synthesis].
Non-attendance and drop-out. Use clinical judgement to decide when someone has left, then write to confirm that their place is closed. Keep in contact by phone and post with the person and their care team to support engagement [source: Crawford et al. 2010].
Therapist absence or change. Cancel rather than send cover, and give as much notice as possible. Give space to explore feelings about the change. For a longer absence, involve your supervisor and find a replacement [source: Crawford et al. 2010].
Ruptures, such as feeling misread by an interpretation. Name the misattunement. Return to the client's own view of the image, and go back to the not-knowing stance [synthesis, consistent with Parkinson et al. 2024]. The bond component of the alliance early in therapy predicted later responses to art materials in a simulation study, so attend to the alliance early [source: Gazit et al. 2021].
Drift into an activity or art class. Signs: no exploration of feelings, interpersonal process or images. Check your session records in supervision. What distinguishes art therapy is exploration, not diversion [source: Crawford et al. 2010].
Requests to take artwork home, or to destroy it. Decide case by case with the client, who owns the work. Explore what the request means first [source: BAAT Code s.14; synthesis on exploring meaning].
Requests to exhibit or post artwork online. Get specific written consent and explain how the work will be used. Never profit from it [source: BAAT Code s.15]. Discuss the risk of identifying the client [synthesis].
Assessment and projective readings. BAAT limits practitioners to assessment methods they were trained and supervised in [source: BAAT Code s.3.2]. The sources do not support any validated diagnostic reading of art psychotherapy images [uncertain]. Never present a drawing as evidence of abuse or disorder [synthesis].
Disclosures and safeguarding (children and young people). Follow child safeguarding policy, which the law requires. In private practice, explain at intake your duty to report risk of harm to a child or of violence to others. Involve parents or carers in planning and reviews where possible. Keep a minor's confidentiality where possible, and don't share material with parents if that would harm the therapy or put the child at further risk [source: BAAT Code s.10–11, 24.1]. Get assent from the child as well as parental consent, and adapt materials and session length to the child's age [synthesis].
Touch. The BAAT Code does not address touch [source: BAAT Code 2019]. Help with materials, such as steadying a board or guiding a hand, only with explicit consent each time and a clear opt-out. Never touch sexually [synthesis].
Cultural and religious imagery. Explore what an image means to the maker. Don't apply your own symbolic system. Respect sacred forms and don't ask the client to reproduce ceremonial art [synthesis, consistent with BAAT Code s.7].
Your own countertransference to disturbing images. Use regular clinical supervision that follows BAAT guidelines, and don't practise if your own state could affect the work [source: BAAT Code s.4, 9.1].
Materials hazards. Know the toxicity of every material and ventilate the room [source: BAAT Code s.13.1]. Prefer water-based, non-toxic products. Wet-clean clay dust. Check for allergies, for example to latex or certain clays [synthesis].

Sources

Further reading (not drawn on beyond publisher descriptions)

Schaverien, J. (1992; JKP ed. 1999). The Revealing Image: Analytical Art Psychotherapy in Theory and Practice. Jessica Kingsley.
Killick, K. & Schaverien, J. (eds) (1997). Art, Psychotherapy and Psychosis. Routledge.
Waller, D. (2015). Group Interactive Art Therapy: Its Use in Training and Treatment (2nd ed.). Routledge.
Edwards, D. Art Therapy (Creative Therapies in Practice), and Waller, D. & Gilroy, A. (eds) Art Therapy: A Handbook. Both cited by Crawford et al. 2010 [uncertain].
Case, C. & Dalley, T. The Handbook of Art Therapy. Routledge [uncertain].

Not covered: Schaverien's distinction between embodied and diagrammatic images and any staged handling of the picture; Edwards' and Case & Dalley's session technique; US (AATA/ATCB) credentials [uncertain].

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