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Art Making as a Mental Health Recovery Tool for Change

and Coping
Theresa Van Lith
Published online: 24 Mar 2015.

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To cite this article: Theresa Van Lith (2015) Art Making as a Mental Health Recovery Tool for Change and Coping, Art Therapy:
Journal of the American Art Therapy Association, 32:1, 5-12, DOI: 10.1080/07421656.2015.992826

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articles
Art Making as a Mental Health Recovery Tool for Change
and Coping

Theresa Van Lith

Abstract and meaning from the artworks they created (Patterson,

The intrinsic benets of art making may be implicated in
how and why people with mental illness turn to art therapy to
aid their recovery. In this longitudinal multiple case study
adult participants (N D 12) with severe and ongoing mental
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Debate, Anju, Waller, & Crawford, 2011). This result is in
keeping with the view of mental health recovery as an ongo-
ing process whereby therapeutic benets need to be intrinsi-
cally and intuitively experienced for long-term change to

occur (Deegan, 1988, 2005). The intrinsic benets of art

illness were recruited through their involvement in diverse making, therefore, may be implicated in how and why peo-
community mental health art therapy programs. An ple with mental illness turn to art therapy to aid their
interpretive phenomenological data analysis revealed that recovery.
participants utilized art making as a change mechanism and Art therapists value artistic expression as a manifesta-
coping tool that encouraged development of exible and tion of deeper or hidden psychological needs and as a means
adaptable approaches toward overcoming barriers in their for accessing personal and cultural history not available
recovery process. through verbal means alone (Karkou & Sanderson, 2006).
A collaboratively written article by an art therapist and for-
mer mental health service user demonstrated how artwork
Introduction can embody multiple perceived mental states as it becomes
a relational subject rather than an inanimate object to its
Mental health recovery requires a thoughtful and sensi-
maker (Melliar & Br uhka, 2010). Through reections on
tive relationship between practitioners and the consumers
the various contexts in which artwork was created and then
they serve. Ideally the relationship is built on mutual
viewed (within therapy, in the studio, and via an exhibi-
respect, openness, honesty, and trust (Jacobson &
tion), the authors agreed that the power of the clients art-
Greenley, 2001). This attitude involves practitioners
work shifted from context to context as new insights
adopting a role that places emphasis on helping the cli-
continuously emerged. In this example an aesthetic
ent build skills and encouraging connections with sup-
response to the artwork occurred because the client and
port networks such as peer support groups (Davidson,
therapist put themselves in a relationship with it. It is as
Harding, & Spaniol, 2005). Additionally, practitioners
though the artwork itself developed an emotive state with
work beyond making sure basic needs are met by equip-
which they could engage, similar to an empathetic response
ping clients with the knowledge, insights, resources, and
(J. Green, 2009). In another account by a mental health
information that will assist them in making informed
service user, Kathy (pseudonym) wrote that the process of
choices about their lives (Onken, Dumont, Ridgway,
looking at these paintings is like reading a book of my
Dornan, & Ralph, 2002).
story (Learmonth & Gibson, 2010, p. 55). However, this
Art therapists who adopt a mental health recovery
avowal is not the same as the suggestion that what one sees
framework tend to perceive their role as that of a guide
in an artwork is simply a reection of the artists mental
(Van Lith, Fenner, & Schoeld, 2009); many disregard the
state. Kathy experienced her narrative in fragments, like
title of therapist altogether because of its connotations of an
pieces of a puzzle; the art images were catalysts for an
expert having authority over clients (Vick & Sexton-Radek,
emerging coherence of self.
2008). A recent British survey of art therapists working in
The notion of artistic sensibility, as explained by art
mental health settings found that the majority of respond-
therapist Thompson (2009), extends the above concepts in
ents used a nondirective approach that encouraged clients
relation to how art making empowers people living with
to express their feelings and derive their own understanding
mental illness. Art making offers potential integration of
aesthetic qualities toward the self and others through a
Editors Note: Theresa Van Lith is Assistant Professor of Art process of becoming aware of ones artistic identity
Therapy in the Department of Art Education at Florida Univer-
sity, Tallahassee, FL. Correspondence concerning this article may
(Thompson, 2009). This in turn strengthens a persons
be addressed to the author at tvanlith@fsu.edu emotional and cognitive processes by infusing them with
5
 6 ART THERAPY FOR RECOVERY
recovered internal and external parts of the self. As a fur-
ther consequence, artistic self-exploration saturates the
image with meaning so that previously inaccessible and
fragmented parts of the self nd a place to become known.
Thus, people with mental illness may reduce their sense of
stigmatization by recovering a fractured part of self-
identity.
In a critical review of research my colleagues and I
found that art-based practices in mental health care are par-
ticularly benecial for psychological and social aspects of
the recovery process (Van Lith, Schoeld, & Fenner,
2013). Specically, self-discovery and self-expression, along
with social relationships and social identity, were the most
evident contributions of art-based programs. Self-discovery
is dened as the development of an open-minded awareness
that enables insightful and reective thinking to be explored
with associated emotions, which expands the selfs sense of
possibility (Engle, 1997; Franks & Whitaker, 2007). In
contrast self-expression involves the release of tensions and
unresolved feelings that impact an individuals ability to
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maintain a functioning lifestyle (Greenwood, Leach,
Lucock, & Noble, 2007). For example, Greenwoods
(2011) case study found that over the course of 6 years of
art therapy the continuous use of self-expression allowed a
client to resolve deeply entrenched attachment issues.
Reported changes remained 3 years post art therapy. Green-
wood posited that long-term change was due to the clients
focused engagement and processing of repressed feelings,
which altered implicit memory and helped to reform new
neural pathways.
Relationship building through art making also occurs
when clients in mental health care engage with others in
art-based group therapy (B. L. Green, Wehling, & Talsky,
1987; Korlin, Nyback, & Goldberg, 2000). The nonverbal
component of art making assists with human relating and
communication processes in indirect ways (P. B. Allen,
2008; Czamanski-Cohen, 2010; Feen-Calligan, Washing-
ton, & Moxley, 2008). For example, clients often work on
their own while also making art alongside others (McNeilly,
2006). This combination of individual and communal
focus can lead to informal and safe social relating, allowing
even for small communications (e.g., I like your drawing)
that validate the maker. A social identity may form through
feeling a sense of belonging to a particular group. For many
clients this experience helps overcome stigma and discrimi-
natory beliefs that impact their sense of identity (Howells
& Zelnik, 2009).
I sought to contribute to the evidence base in my
study by examining in-depth a sample of clients lived
experience of art making during their mental health
recovery. One early nding was that art making added a
spiritual aspect that intersected with the clinical, personal,
self-care, social, occupational, and contextual elements of
recovery and provided a sense of transcendence beyond
ones mental illness (Van Lith, 2014). For the distinctly
different purposes of this article, I will present results
from the study that contribute evidence of how art mak-
ing may help clients as a tool for change and coping in
their recovery from mental illness.
Method
Participants and Setting
Participants were recruited after human subjects review
and approval was received from the university and the two
collaborating psychosocial rehabilitation organizations
involved in the study. As detailed in a previous publication
(Van Lith, 2014), selection criteria were that the partici-
pants were actively engaged in their program of recovery,
were satisfactorily managing their mental illness, and were
well enough to consent to participation in the study. The
study comprised twelve participants: ve men and seven
women. Their ages ranged from early 20s to late 50s.
Length of participation in mental health care services
ranged from 5 years to more than 10 years. The partici-
pants had ongoing and severe levels of mental health issues;
however, their diagnoses were not specically identied in
the study. This decision followed the mental health recov-
ery principle that requires one to look beyond diagnosis to
focus on personal growth (Anthony, 1993; Deegan, 1988,
2005). Participants had widely different degrees of interest
and experience in art making, ranging from no interest in
art before the onset of illness to regularly creating and
exhibiting artworks. In order for participants to be able to
locate themselves in any research publication they were
asked to create their own pseudonyms.
Procedures
A longitudinal, multiple case study was used as the
study design. Data collection involved three interviews with
each of the 12 participants at 6-month intervals over the
course of 1 year. Each of the three interviews began by ask-
ing the participant to complete a recovery assessment (Ridg-
way, 2005) followed by an open-ended conversation. The
interview focused on the participants experience of art
making and engaging in symbolic meaning making, which
was facilitated by reecting with the investigator on art-
works completed in an art therapy program during the pre-
vious 6 months. Betenskys (1995) phenomenological
approach based in symbolic art expression and Barrys
(1996) application of symbolic constructivism were used to
frame the interviews (Table 1). Each interview lasted
approximately 1.5 hours.
After all of the interviews were completed and tran-
scribed, an interpretative phenomenological analysis was
conducted that involved several iterations of analysis that
moved from description to interpretation in order to draw
out themes (Smith & Dunworth, 2003; Smith, Flowers, &
Larkin, 2009). This method incorporates feelings, physical
responses, and other behavioral phenomena present in the
accounts in addition to words. Therefore, participant valida-
tion was necessary to ensure that the thematic analysis stayed
true to their experiences. Each participant reviewed and veri-
ed the analysis from the rst two interviews prior to the
third interview, and again at the completion of the study.
Participants endorsed the themes and descriptive evidence
from their interviews, as discussed in the following sections.
 VAN LITH 7

Table 1 Sample Interview Questions

Interview Interview Questions

First interview Can you tell me about your experience with art making and how you
came to use art making in your recovery?
First, second, and What kinds of art making have you been doing in the last 6 months?
third interviews Can you tell me about your art-making experience in the last 6 months?
What aspects have been the most helpful/unhelpful?
In what way has art making played a role in your mental health recovery
in the last 6 months?
Can you give me examples of some experiences?
What aspects of the art-making context have been most helpful/non-
helpful in the last 6 months?
What aspects of the art program that you attend have you found to be
helpful/unhelpful in the last 6 months?
Second and third interviews Have there been any signicant changes in your life since we last met?
Third interview What are your future plans for art making?
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Results self-destructive energies. Another participant, Sean,

explained that he used art to challenge core things within
Data analysis resulted in four themes that, taken together, himself, saying that his artwork was part of the develop-
illuminate how art making was used by the participants to ment of who I am and how I feel about myself. Had he
cope with mental illness and served as a change mechanism in not created certain artworks, Sean asserted, he would not be
the recovery process. The four themes were: (a) I connect where he is today. As a result of his internal work, he saw
with my inner self and elicit new insights through art, (b) I that selling his artworks would disrupt his sense of self,
strive to develop and gain a sense of achievement through art, like selling my nger.
(c) I use art as my motivational force when unwell, and (d) Kathryn recounted a similar processing of her experi-
I transcend to a psychologically safe place through art. ence through art making, explaining that she wanted to
show there was trauma . . . that it was being stitched up
(Figure 1). For her, the stitching up process took time to
Connection to Inner Self
repair her self and throughout such a time she found there
With respect to the theme I connect with my inner
self and elicit new insights through art, several participants
described how they create a connection to their inner self
through immersion in the creative process. Sam (all names
used in this article are pseudonyms) referred to the experi-
ence of immersion as a meditative process, which works
like a mindfulness or a dialectical behavior therapy exer-
cise. Kathryn explained: I nd that no matter what else is
going on, especially stresses in my life, which can include
so-called mental health issues, when I am here doing art
nothing else exists. Alex took a slightly different stance,
stating I just sort of let it ow without censoring myself; I
dont sort of judge what comes out of my [drawing] pen.
Becoming immersed involved what Sam called a fol-
low your nose process that takes her into a place where
[art] evolves on its own. Kathryn saw such immersion as a
connection to her unconscious self where ideas just come
and then they disappear. She remarked that as a result
some bits really form my expression, particularly when I
am expressing things that I am not conscious of.
Once participants were immersed in their creative pro-
cess they were able to resolve inner conicts or problem
solve. For example, Sam found that becoming completely
absorbed in art making provided her with relief from her
demons. Sams unique insight was that she created art Figure 1. Stitching Up Trauma by Kathryn (Acrylic on
not just to be distracted but also to actually diminish her canvas, 30 cm x 30 cm)
 8 ART THERAPY FOR RECOVERY

was something very exposing about it. Expressing these

kinds of internal experiences through art making had wider
implications that extended to how the participants commu-
nicated to others. Clare found that she could use her art-
works to communicate with her therapists and doctors. She
reected: In the end I realized I was helping myself by
sharing more. So it was I who was going to benet from
telling them all about it and a lot changed.

Developing a Sense of Achievement

According to the participants, developmental progres-

sion, expressed in the theme I strive to develop and gain a
sense of achievement through art, involved constant rene-
ment and input from others. Paul, Sean, James, Lori, and
Louise described certain benets as a result of engaging in
the conscious planning and preparation involved in the cre-
ative process. Such an intellectual practice required estab-
lishing their own ground rules before art production and
using problem solving along the way. Conceptual thinking
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as well as physical restructuring of artistic elements in a

piece was necessary to enable ideas to become fully realized.
In their striving to express themselves, the participants
noted being driven to see their achievements develop in an
aesthetic form. Sean explained: I guess sometimes it was
hard to see where it was going. . . . But at every step we
took a picture and I was able to show people what I was
doing; so that was really exciting.
Concentration was an important part of the participants Figure 2. Unforgiving Indian Ink by Louise (Acrylic and
art making as well as attentiveness to their symptoms. For ink on canvas, 30 cm x 42 cm)
example, Louise noted how she persevered through her
symptomatic ashbacks. She used permanent ink (Figure 2), will be good run or bad run. Although Paul gradually
despite her awareness that it was an unforgiving material made less art over the yearlong study, he attributed this
and was something she wanted to master in order to over- change to being healthier and added, I realize I will con-
come her shaking hands. She explained: My hands were tinue to do art in my life, because it motivates me.
doing something different [than] what my mind wanted. The participants experiences also indicated that the
She shared that she thought to herself, you are going to varying qualities of art media and their own trust in art
have to do something and decided that every time her hands making enabled them to direct how and when they could
shook she would make that shaking into something creative. use it for their recovery. For example, Clare noted that the
Because the participants were very proud of their com- purpose of art making changed for her over the course of
pleted artworks, these often took on a life of their own. For
Louise, this idea was reected in her references to artworks
as characters; for Paul, the living qualities of his relationship
to his artworks were seen in his emotional reactions to
them. They were like a prize to show off to people. Paul
saw his artworks as a notable accomplishment that indicated
both improvements in his art style and in his progress
toward recovery.

Motivational Force When Unwell

The theme I use art as my motivational force when

unwell is exemplied by the experiences of Paul, Richard,
and Clare who valued that they could turn to art making
whenever needed. For example, Paul recalled a time when
he had been particularly unwell and art became a driving
force for him (Figure 3). He stated, I needed to get
involved and just keep drawing, like running a race. Like its Figure 3. Feeling Like a Storm by Paul (Acrylic on
madness, running a race, you just go on doing it, whether it paper, 42 cm x 30 cm)
 VAN LITH
the study. She gradually moved from a personal and intro-
spective approach to her art toward an emphasis on its phys-
icality and aesthetic expressiveness.
Psychologically Safe Space
Mia, Louise, and Richard identied that art making
entailed going to a psychologically safe place. The theme I
transcend to a psychologically safe space through art ini-
tially entailed for Mia a process of being absorbed in a sense
of safety that provided a reprieve from her symptoms of
ashback (Figure 4). As she explained, art making takes
me away to a better place, where I dont worry about the
everyday problems and makes me feel better about myself.
Participants also described feeling greater comfort from hav-
ing depicted the image of the safe space, and feeling a sense
of belonging as a result.
Discussion
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The four themes from art therapy client accounts
depicted above describe how art making served as a change
mechanism in twelve peoples mental health recovery with
impacts on both intrapersonal and interpersonal levels.
Additionally, art making served as a coping strategy that
participants were able to adapt to suit their individual needs
for the betterment of their mental health.
The participants accounts indicate that art making
involves a series of stages that moved them toward a deep
level of concentration. Thus art making fostered implicit
changes through intrapersonal awareness. Siegal (2007,
2010) referred to this process as intrapersonal attunement in
which one is focused on the present and becomes self-aware
without judgment. Creative energy and information move
and become integrated between the mind, body, and social
relatedness. Siegal (2009) regarded attunement as key to
developing a vital and resilient sense of self. Similarly, the
concept of ow theory (Cskszentmihalyi, 1990, 1996) sug-
gests that when a persons feelings, intentions, and thoughts
Figure 4. A Safe and Spiritual Place by Mia (Acrylic on
canvas, 84 cm x 59 cm)
9
are focused on a goal, resulting harmony or coherence ena-
bles the self to grow. Thus, it is possible that when the par-
ticipants immersed themselves in art making they did not
experience a loss of awareness but rather felt a heightened
state of conscious wakefulness (Cskszentmihalyi, 1990).
Once participants were immersed in art making, they
reported being able to resolve inner conicts or to problem
solve. Completed artworks were then seen as containing
truth and knowledge, and as if they were mirror fragments
of the artists internal selves (Learmonth & Gibson, 2010).
As a consequence of the authenticity evoked, participants
saw these artworks as both precious and unique representa-
tions of the changes within themselves.
Sams experience of making art to gain relief from her
demons offers insight into how art can reduce symptoms.
The use of art making as a form of symptom reduction is
by no means a new concept (e.g., B. L. Green et al., 1987;
Richardson, Jones, Evans, Stevens, & Rowe, 2007), and
some research has suggested that goal-directed activities
may reduce the frequency and duration of hallucinations
(H. A. Allen, Halperin, & Friend, 1985; Fogel, 1996).
However, in this case Sam went further in that she made
art not solely for temporary relief. She was able to actually
diminish her self-destructive energies that she perceived as
voices embedded within herself. She believed that ignoring
them would not be enough and instead expressed her
demons to expose them.
It is also important to note that some individuals who
are in acute states may be too overwhelmed to create, and
therefore the deep level of concentration required can be
harmful (Springham, 2008; Woods & Springham, 2011).
In the case of Sam, who had participated in an art therapy
program for several years, art therapy equipped her with the
self-knowledge of when and how art making could be of
benet to her recovery.
Another component of art making as a change mecha-
nism is the greater relational awareness of the participants.
Both the artwork itself and descriptions of it enabled poten-
tial identities to emerge for the participants. Artistic sensi-
bility was drawn out from describing artworks with
increasing familiarity (Thompson, 2009). Participants
became aware of their artistry by integrating aesthetic quali-
ties into their artworks in ways that others could under-
stand. As they reected on their artworks, they became
aware of the works emotive qualities, which resonated with
their experiences (J. Green, 2009). Rather than a raw and
untranslated version of the self, their art reected emerging
self-coherence (Learmonth & Gibson, 2010).
Some participants used art making to project their ideal
selves or personied their artworks to give them a life of
their own. Art making also fostered exploration and testing
of particular parts of the self. Additionally, the process of
reecting on the same artwork at different points in time
shifted perceptions and allowed new self-insights to emerge.
Thus, the artwork likely contained a self-representation of a
shifting, emergent sense of self. This changing mental state,
embodied in the artwork, became particularly evident when
viewed in different contexts (Melliar & Br uhka, 2010). For
example, Sean initially placed an art piece in the lounge of
 10 ART THERAPY FOR RECOVERY
the rehabilitation facility where he was living at the time.
Sean used this artwork to communicate how his changing
self was like a rebirth. Another resident interpreted the
depiction of depression in Seans artwork and related it to
his own experience, which in turn helped him to under-
stand Sean. When Sean moved to his own house, he placed
his artwork in the living room where it often became a focus
of discussion about the changes he was making.
Art making in this study was found to be an important
coping tool in addition to being a mechanism for change.
Trust in the creative process helped participants deal with
stressors and gave them a means to bounce back. Coping
strategies that are culturally and personally relevant are inte-
gral to developing resilience against external and internally
perceived pressures (Wong & Wong, 2006). This usage
of the art-making process was self-determined and self-
designed as the participants sought mastery and acquired
control of materials, thereby helping to manage themselves.
Participants recognized a certain level of stress that was
comfortable for them; however, when an issue became out
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of control they increasingly developed over time an auto-
matic tendency for restoration through art making. As in
homeostasis, art making was used to maintain internal equi-
librium by reexively adjusting to a changing situation
(Arnheim, 1971). Participants initially reached for any art
materials at hand and guided themselves intuitively in the
process thereafter. For example, Paul turned to art to
drive him when he was unwell. His use of art making to
cope could be viewed as an act of autopoiesis or self-creation
involving an inherent capacity to self-organize and to be
self-aware (Cullinan, 2011, p. 79). Autopoiesis for Paul
seemed to be an intrinsically motivating action that is also
a surrendering to what is taking place (Knill, Levine, &
Levine, 2005, p. 42) in order to cope with an issue that was
making him unwell.
Art making also intimately revealed what was needed in
order to move forward. As such, it involved an intuitive pro-
cess of reaching inward toward that which was urgently seek-
ing to be expressed. For Kathryn, the imagery of waterholes
in her artwork communicated a desire for getting replenish-
ment along the way. Within her art she found resting places
where she could stop, gain sustenance, and then decide on
the next path to take before continuing on her journey.
Growth and stimulation in all of the participants expe-
riences suggested that art making served as more than
homeostasis and a source of maintenance. According to Arn-
heim (1971), engagement in art making involves staying
present with chaos as diverse elements are brought together
to create new forms. The more the participants practiced
and engaged in art making, the more they gained a greater
awareness of their own wisdom. Some saw their artworks as
reections of inner knowledge captured in time; others saw
their artworks as a process of piecing fragments of self-iden-
tity together to discover new ways forward. Ultimately, each
of these participants saw that engaging in art making awak-
ened a new authenticity (Woods & Springham, 2011) bring-
ing forth alternative possibilities for the future.
In conclusion, this study contributes to the evidence
base of art therapy with regards to its benets in mental
health recovery. The research suggests that art making in
art therapy acted as both a mechanism for change and for
coping, which produced internal shifts in the recovery pro-
cess through the expression, restoration, and gradual attain-
ment of a new authentic self. As a result, clients with
mental illness may nd art making particularly benecial in
the search for a more exible and adaptable approach to
address the barriers to recovery.
Acknowledgments
This article is based on a doctoral dissertation completed at
La Trobe University, Melbourne, Australia.
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