Medical Art Therapy vs.
Hospital Arts
Medical Art Therapy Course
copyright Tracy Councill, 2010
Lecture #3
Do you see what I see?
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Art therapists do not have a monopoly on art materials in any setting.
Social workers, play therapists, counselors and other professionals often
use art materials with clients.
Hospital artist programs are many and varied—perhaps more common
than medical art therapy programs. The Society for the Arts in Healthcare
promotes many uses of the creative process in hospitals, including passive
programs such as exhibits and performances, and programs that engage
patients with artists at bedside or in the clinic.
Drawing the distinctions between art therapists and other artists in
medical settings is a difficult but critical question for our field.
What distinguishes Art Therapy from
other ways of using art to help people?
An observer might regard this art therapy session as a kid
just having fun with a caring adult. That’s part of it, but what
is really going on here?
The Art Therapist’s Skills
Unlike most artists in hospitals, Art Therapists are trained in:
• Cognitive and social development
• Behavioral assessment and management
• Clinical assessment, enabling them to recognize and advise the
medical team when there are mental health concerns that go
beyond adjustment to illness
• Techniques for resolving trauma, managing anxiety, relieving pain
• Therapeutic boundaries
• Boundaries may be an especially important skill that the art
therapist brings to the medical team. Many doctors and nurses
do not receive training in this area, and they may have trouble
advising patients and families and managing the psychosocial
aspects of care because they may become too closely allied or
remain too distant from patients and families.
Invisible Structure
• Much medical art therapy is done in settings that are not very
private. In a clinic or infusion center, much of what is said and
created at the art table is visible to everyone in the area. In a hospital
room, family members, visitors, and healthcare professionals must
be included, excluded or managed in some way before the therapy
can begin.
• Medical art therapists must work to maintain a safe environment by
encouraging patients to participate, and by teaching patients, family
members and healthcare providers to value open-ended creative
work without judging and questioning.
• Everything the art therapist says or does contributes to the safety of
the art therapy space. Patience, humor, empathy, and humility give
the medical art therapist the poise to teach patients, families and
caregivers about art therapy—and the ability to recognize when
therapeutic work is not possible at the moment.
Why even try to make art therapy
work in the hospital?
• With so many obstacles, why try to make it work? Why
not just refer patients to art therapy in the community?
• Jessie James, the famous outlaw, was once asked why he
robbed banks. He is said to have replied, “Because that’s
where the money is.”
• Art therapy in the medical setting is worth trying because
that is where the patients are! A chronic illness tends to
take over the life of the patient and his/her family—they
spend hours and hours at the hospital, and any time they
have away must be spent earning a living and caring for
the everyday business of life. Most would not participate
in traditional therapy, but they engage readily in a
hospital-based program.
Clients as Teachers
• The medical environment is inherently alienating to many patients
and family members. Care providers often do not realize that the
language and customs of medicine are strange to patients and
families.
• Shirley Riley provides a helpful framework for approaching patient
art:
– The therapist can step into the [individual’s] drawings and let
him/her teach the meaning of the visual narrative. The art is a
form of personal externalization, an extension of oneself, a visible
projection of thoughts or feelings. When the art is accepted,
honored, and validated by the therapist, the creator is . . . equally
accepted, honored and validated. . .When the problem or anxiety
has been externalized . . . in a drawing, it is the perfect time to
confront the problem-laden behavior and still validate the worth
of the creator. (Riley, 1997, p.2)
– Though medical patients may not be in the hospital to confront
problem behaviors, they may find that they need help developing
new strategies for managing stress and anxiety
Defining Ourselves
In the Tracy’s Kids Art Therapy Programs:
• Art therapists serve as integrated members of the
multidisciplinary treatment team.
• Open studio programs in clinics and infusion centers
invite open-ended creation, facilitated by trained art
therapists.
– Most visiting artists teach a specific skill or medium, often in a
directive, product-oriented way.
• Art therapists are skilled at listening for metaphoric
expression in art and in recognizing content expressed in
the art process itself.
• Therapeutic goals are often formulated first by the art
therapists, and related to patients and families through
the therapeutic work itself.
The Therapeutic Agreement
• The Tracy’s Kids programs are designed to become part
of the environment of care at the hospitals and clinics
where we work.
• Since we work with children, we have a Parental
Permission Form, which we ask parents of all clinic kids
to read and sign. The form describes the objectives and
methods of our program, and allows parents to decide if
they wish their children to participate.
• We have never had a parent refuse permission for art
therapy services.
• We use the opportunity of gaining permission to educate
parents about how we can help their children.
Excerpt from our Permission Form
How can we help?
“Our Open Studio and bedside Art Therapy programs offer
opportunities for kids to respond creatively to the challenges of
illness and treatment. They are ‘built in’ to the clinic and hospital
experience, so no appointment is necessary. Your child may wonder
why he or she got sick, and have other worries about the meaning of
a serious illness. Creative work with other patients and the Art
Therapists can help kids work on these concerns. We can help your
child cope with anxiety about medical procedures, swallowing pills,
sleep problems, and adjustment after diagnosis and treatment. We
also offer education and support with transitions such as returning
to school, ending treatment, and going home after a long
hospitalization. Feel free to call your art therapist to let her know of
any specific problems your child may have. . .”
Patient Art Exhibits to Educate the
Hospital Community
• The tension between what is public and private in the hospital
community is inherent in hospital-based art therapy programs.
• Respectfully exhibiting patient artwork, with appropriate permission
and release, can be a very effective way to get your message out to
the hospital community.
• Lombardi’s annual art shows grew into group installations around a
medium or theme—each individual’s expression being strengthened
by the power of the art show as a whole.
• For the past two years we have had group shows of work from all
four Tracy’s Kids programs at a professional art gallery in downtown
DC. In 2008 we launched the International Art Exchange Exhibit of
work by young people in the US and the Middle East, which is
presently touring the Middle East.
• The following slides relate some of the issues we encountered as we
began showing patient artwork in the hospital.
The Problem of Artistic Quality
•An art show from an art therapy program is
different than a traditional art show.
•In preparation for our first show, the curators
of the Cancer Center’s exhibit program
encouraged me to impose artistic standards on
the kids’ art: a direct conflict with my
commitment to include every child who wanted
to participate. I was passionate about giving
patients artistic control. They felt that showing a
toddler’s paint scribble alongside a teenager’s
realistic rendering diminished the older child’s
accomplishment. We did not agree, but we
stayed in conversation.
Censorship: Metaphor vs.
Literalism
• A piece of art was removed from one exhibit because it
represented a five-year old’s chemotherapy as a gun—a
weapon in his fight against cancer. I fought for my young
patient’s freedom of expression, but the cancer center
administration removed the work. They felt any
depiction of a weapon condoned violence.
• Both my young patient and I found it confusing that folks
at the cancer center had taught him to think of his
treatment as a battle and his chemo a weapon, but they
objected to the metaphor when he expressed it.
Never Forget: Art is Powerful
• I find that I have not always understood the meaning our
patients’ art would have for others at the cancer center:
• “Who We Are” was a collection of 57 life-size self-portrait
sculptures. The kids represented themselves ice skating,
doing karate, riding skateboards, as mermaids, explorers
and sea creatures!
• One of the adult oncologists was so appalled by the kids’
art that he spent an entire week trying to shut down the
show! It was a reminder that art—even children’s art—
can be powerful and we don’t always know the effect it
will have on other people.
The Children as Leaders
• On the strength of the Pediatric Art Therapy Program, I
began to advocate expanding art therapy to the adult
patients. To try out the idea, we placed a graduate art
therapy intern on the adult service.
• Lombardi eventually decided to implement a broader
Arts and Humanities Program in 2001, under the
direction of Nancy Morgan. It is a hospital arts program,
not an art therapy program, but our art therapists
collaborate on projects from time to time, particularly
using art to support staff development and coping.
• From time to time our art therapists work with adult
patients, or children of adult patients, when it is felt that
the hospital artist’s capability is not sufficient.
Full Circle: Art Therapy vs.
Hospital Arts
• Art Therapy in medicine is different from hospital arts
programs. Hospital arts programs typically include
exhibits, performances and a variety of art forms—music,
dance, movement, writing, as well as visual art. Their
goals are more general than those of a hospital art
therapy program, but the two types of programs need not
conflict.
• The expertise of the medical art therapist opens the door
to healing and support in a way that art-making by itself
does not, but it is up to the art therapist to define her
distinctive role and advocate for the effectiveness of her
work.