Art Therapy


Edited by: David Edwards & Paul Wilkins

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    To my family, far and near


    The Creative Therapies in Practice series, edited by Paul Wilkins introduces and explores a range of arts therapies, providing trainees and practitioners alike with a comprehensive overview of theory and practice. Drawing on case material to demonstrate the methods and techniques involved, the books are lively and informative introductions to using the creative arts in therapeutic practice.

    Books in the series:

    Psychodrama Paul Wilkins

    Dance Movement Therapy Bonnie Meekums

    Music Therapy Rachel Darnley-Smith and Helen M Patey

    An Introduction to Dramatherapy Dorothy Langley

    About the Author

    David Edwards qualified as an art therapist in 1982, having trained at Goldsmiths College, University of London. Since qualifying he has worked in a range of clinical and educational settings and has lectured and published widely in the field of art therapy. He is currently employed as the Clinical Manager at Share Psychotherapy Agency in Sheffield. David also works privately as an art therapist, clinical supervisor and UKCP-registered psychodynamic psychotherapist.


    When I sat down to write the preface for the first edition of this book in November 2003, I did not anticipate how much the profession of art therapy would develop over the following decade. While much of the historical and theoretical material included in the first edition of this book remains relevant and has been retained, things have moved on apace so far as training, practice, research and the regulation of the art therapy profession are concerned. The economic, social and political context in which art therapy is now practised within the UK has also changed significantly over the past ten years. This edition aims to update the reader regarding these developments and their impact on art therapy. As a consequence, Chapters 5, 6 and 7 have been substantially revised.

    In common with its predecessor, this second edition of Art Therapy aims to provide a clearly written, accessible and informative introduction to art therapy in a style that does not assume prior knowledge of the discipline. To assist this I have made a number of modifications to the way in which the book is now organised. First, I have invited a small number of practising art therapists to contribute new material at those points in the book where my own clinical experienced proved to be a particular limitation. I have also added a glossary of terms to help readers unfamiliar with the language of therapeutic work, art therapy and the history of art. Finally, because the profession has expanded so quickly outside the UK, and believing I could no longer offer an up-to-date commentary on these developments, I have omitted the chapter providing an international perspective on art therapy.

    While I hope this book will be of relevance to practising art therapists in the UK and elsewhere, it has been written primarily for students, therapists and academics in related disciplines, prospective clients and anyone who may be interested in exploring the potential of art therapy to promote their own personal growth.

    There are a number of people I wish to thank for their contributions to the second edition of this book. First, I wish to express my gratitude to those individuals who have contributed to this edition either through providing additional material or through reading and commenting on the text. My thanks, therefore, go to Susan Allaker, Michael Atkins, Will Crane, Barrie Damarell, Carmen Edwards, Peter Gurney, Val Huet, Dale Kitchen, Julie Leeson, Jana Sanford, Professor Joy Schaverien, Nick Stein and Dr Chris Wood. I should also like to thank my editors at Sage, Alice Oven and Kate Wharton, for their patience, understanding and help in shaping this book.

  • Glossary of Terms

    Note: all URLs provided below were last accessed on 28/05/2013, unless otherwise stated.

    act out/acting out:

    ‘an activity that can be interpreted as a substitute for remembering past events. The essence of the concept is the replacement of thought by action’ (Rycroft, 1979: 1).

    active imagination:

    a means of establishing an active dialogue between the conscious and unconscious mind developed by Carl Jung (Jung, 1997). As a process active imagination involves working imaginatively with stories, dreams and images.

    Adamson, Edward

    (1911–1996): pioneer art therapist and a founder member of the British Association of Art Therapists. Adamson also helped establish one of the first art therapy training course in the UK in St Albans. The Adamson Collection is comprised of over 5,000 paintings, drawings, sculpture and ceramics produced by patients. The collection is currently housed at Lambeth Hospital, South London.


    generally understood to refer to the nature and appreciation of beauty, especially in relation to art (Stecker, 2010).


    the precursor of modern chemistry, alchemy was practiced in much of the ancient and medieval world. Alchemy was of particular interest to Carl Jung who saw it as a symbolic representation of the process of individuation (Jung, 1969, Vol. 13).

    American Art Therapy Association (AATA):

    a not-for-profit organisation that sets educational, professional, and ethical standards for its members and strives to educate and disseminate information about art therapy to the public in the USA. Further information can be found at www.american


    the term used to describe a person undergoing psychoanalysis.

    analytical psychology/Jungian psychology:

    the school of psychology derived from the theories of the Swiss psychiatrist Carl Jung. In practice, analytical psychology is based on the idea of a self-regulating psyche and is primarily concerned with achieving psychological wholeness through integrating those unconscious forces and motivations that underlie human behaviour. Terms such as ‘individuation’, ‘archetype’, ‘complex’, ‘extrovert’ and ‘introvert’ are all derived from analytical psychology and have become part of everyday speech (Fordham, 1973; Samuels et al., 1986).


    in analytical psychology, the anima and animus are understood to be archetypes of the collective unconscious. The anima finds expression as a feminine, inner personality in the unconscious of the male, whereas in the unconscious of the female the animus is expressed as a masculine inner personality.


    a term loosely applied to the work and ideas of R.D. Laing (1970, 1975), Thomas Szasz (1974, 1977) and Basaglia et al. (1987), amongst others, each of whom was critical of the assumptions and practices mainstream of orthodox psychiatry.


    a feeling of acute apprehension or agitation in response to a real or imagined danger.


    in Jungian theory, archetypes are, like the instincts, the inherited part of the psyche and belong to the collective unconscious (Fordham, 1973).


    the word used in everyday speech to describe both the expression or application of skill and imagination through the making of objects – e.g. paintings or sculptures (Graham-Dixon, 2008) – and an appraisal of such objects; see aesthetics.

    Art Brut:

    French term meaning ‘raw art’, first used by the French artist Jean Dubuffet to describe art created outside the boundaries of official culture; especially art made by asylum inmates. The English equivalent of Art Brut is Outsider Art (Maclagan, 2009; Maizels, 1996, 2009; Rhodes, 2000).

    arts in health/arts and health:

    both terms refer to ‘arts activities that take place within the health care environment, providing new access and participation opportunities for artists, patients, health service staff and visitors’ (

    art psychotherapist/art therapist:

    both titles are used interchangeably in the art therapy literature and in clinical practice. In the UK both titles are protected by law;

    Art Therapists Practice Research Network (ATPRN):

    a UK-wide group of practising art therapists who collaborate on practice-led research and evaluation ventures. Further information can be found at

    arts therapies/arts therapists:

    generic terms used to describe qualified and HCPC registered art, music or drama therapists;


    refers to the emotional bond, the enduring psychological connectedness established between human beings. Attachment theory is the theory that the emotional bonds formed with our primary caregivers during infancy shapes the way we relate to others throughout later life and that the absence of such bonds may lead to a range of mental health problems (Holmes, 2001). It was first developed by the British psychoanalyst John Bowlby (1907–1990) (Bowlby, 1971) and the American-born developmental psychologist Mary Ainsworth (1913– 1999) (Ainsworth et al., 1979).

    attacks on linking:

    first introduced into the psychoanalytic literature by Wilfred Bion (1897–1979) (Bion, 1959), the term refers to the psychological process understood to be operative in psychosis – destructive attacks are directed against all links between objects. Such attacks are essentially an attack on thinking; internally through dissociation and externally through projective identification.

    autistic spectrum:

    the term used to describe a range of conditions and developmental disorders, including autism and Asperger syndrome. These disorders are typically characterised by impaired social interaction and communication difficulties.

    Barnes, Mary

    (1923–2001): a psychiatric cause célèbre in the 1960s through her involvement with R.D. Laing and the anti-psychiatry movement and through her paintings, which were later exhibited throughout Britain, Europe and North America.

    Beck, Aaron Temkin

    (1921–): widely recognised as a pioneer of cognitive behavioural therapy (CBT) (Beck, 1991), Beck is an American psychiatrist and a professor emeritus in the Department of Psychiatry at the University of Pennsylvania.

    Bleuler, Eugen

    (1857–1939): Swiss psychiatrist best known for his contributions to the understanding of mental illness and for first using the term ‘schizophrenia’.


    boundaries delineate what is, and what is not, acceptable within the therapeutic relationship. Their purpose is to establish a safe and reliable space within which art therapy might take place. This is sometimes referred to in the literature as the therapeutic frame (Gray, 1994). Boundaries define expectations regarding the behaviour of both the therapists and client in art therapy; for example, that sessions will begin and end on time and that the client's artwork will remain with the art therapist until therapy is concluded. The term ‘boundaries’ can also refer to ‘elements of the image in [art] therapy, which appear as barriers, edges or encapsulations’ (Ambridge in Wood, 2011b: 37).

    British Association of Art Therapists (BAAT):

    the professional organisation for art therapists in the United Kingdom. Further information can be obtained from


    a dance form developed in postwar Japan which rejects Eastern and Western dance conventions, expressing intense emotions through slow, controlled and sometimes distorted movements.

    Cassirer, Ernst

    (1874–1945): German philosopher and one of the leading twentieth-century proponents of idealism. Cassirer argued that man is a ‘symbolic animal’ who creates a world of symbolic meaning and that symbolic representation is a crucial function of human understanding.

    Champernowne, Irene

    (1901–1976): an influential Jungian analyst who, along with her husband Gilbert, founded and ran the Withymead Centre, a therapeutic community for the healing arts in Devon, England from 1942 until the late 1960s. See Champernowne, 1971, 1983; Hogan, 2001 (Chapter 9); Stevens, 1986 and Waller, 1991 (Chapter 7) for further information on Champernowne's life and work.

    Champernowne Trust:

    founded in 1969 by Irene Champernowne, the Champernowne Trust is a mental health and educational charity that promotes emotional health through Jungian psychotherapy and the creative arts. Further information can be found at

    Cižek, Franz

    (1865–1946): best known as a teacher and reformer of art education. He is credited with beginning the Child Art Movement with the founding of the juvenile art classes he ran in Vienna from 1897. Malvern (1995: 267) writes of Cižek, ‘What he rejected was the conventional and academic notion of the teacher as the possessor of some wisdom to be transmitted to the child whose mind was, as it were, a “tabula rasa” awaiting the inspiration of prior and predetermined knowledge. In particular his teaching methods emphasized working from imagination and memory’.

    clinical notes:

    the official record of the clinical work an art therapist has undertaken with a client.

    clinical supervision:

    a form of professional support and learning that involves a range of tasks; from the provision of emotional support through to experiential learning, along with much in between. Supervision may be arranged on a group or individual basis (Schaverien and Case, 2007).

    clinical supervisor:

    clinical supervisors have responsibility for helping the supervisee maintain and develop their professional competence and the quality of the services provided to clients.

    code of ethics:

    the purpose of a code of ethics is to publicly articulate agreed standards of conduct, professional judgement and integrity. Copies of the BAAT Code of Ethics and the supporting Principles of Professional Practice and Guidelines can be downloaded from

    cognitive behavioural therapy

    (CBT): a popular form of psychotherapy developed by Aaron Beck. CBT works by challenging the way people think and the ways in which this affects how they feel and how they behave (Trower et al., 2011).

    collective unconscious:

    in Jungian psychology, a part of the unconscious mind, incorporating inherited memories, instincts, and experiences common to all mankind.


    a term found in the psychoanalytic literature to describe a pattern of unconscious thoughts, memories, perceptions and impulses organised around a common theme.

    concrete thinking:

    the tendency to think literally and rigidly, rather than metaphorically and abstractly.

    consultant psychiatrist:

    a senior psychiatrist who has reached the top of their profession.


    according to the UK Department of Health code of practice on Confidentiality in the NHS (DoH, 2003),

    A duty of confidence arises when one person discloses information to another (e.g. patient to clinician) in circumstances where it is reasonable to expect that the information will be held in confidence.

    Confidentiality is also a legal obligation that is derived from case law and a responsibility established within professional codes of conduct ().


    the provision of a relationship in which heightened emotional states such as acute anxiety might be experienced and responded to appropriately and thoughtfully.

    continuing professional development

    (CPD): defined by the HCPC as ‘a range of learning activities through which health and care professionals maintain and develop throughout their career to ensure that they retain their capacity to practice safely, effectively and legally within their evolving scope of practice’ ( In order to retain their registration with HCPC, art therapists must, amongst other things, maintain a continuous, up-to-date and accurate record of their CPD activities; demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice; ensure that their CPD has contributed to the quality of their practice and service delivery and that this benefits the service user.


    defined by Laplanche and Pontalis (1988: 92) as ‘The whole of the analyst's unconscious reactions to the individual analysand, especially to the analysand's own transference’.

    Cunningham Dax, Eric

    (1908–2008): British-born psychiatrist who, while Medical Superintendent at the Netherne Hospital between 1946 and 1951 introduced the use of art for treatment and the diagnosis of mental illness (Cunningham Dax, 1953). The Cunningham Dax Collection is located on the campus of the University of Melbourne, Australia, and contains some 15,000 artworks by individuals who have experienced mental illness.

    dead metaphors:

    metaphors where the associations are lost or unknown; e.g. the saying ‘mad as a hatter’, which originates in the symptoms of St. Vitus' dance and other irrational behaviour displayed by hat makers as a result of mercury poisoning.

    defence mechanisms:

    unconscious mental processes that exist in order to protect the self from psychological conflict or pain.


    in everyday speech the word depression is used to describe a range of experiences from feeling low in mood through to utter despondency and dejection (Gilbert, 2000; Leader, 2009; Rowe, 1978, 1984; Wolpert, 1999). More formally, the World Health Organisation define depression as,

    A common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. ( accessed 22.06.13).

    depressive position:

    first introduced into the psychoanalytic literature by Melanie Klein, the depressive position, as defined by Rycroft (1979: 32),

    is reached by the infant (or by the patient in analysis) when he [or, presumably, she] realises that both his love and hate are directed towards the same object – the mother – becomes aware of his ambivalence and is concerned to protect her from his hate and to make reparation for what damage he imagines he has done.


    separating or splitting off memories or thoughts from consciousness.

    Dix, Dorothea

    (1802–1887): American activist, best known for her pioneering work in the field of mental health. Horrified at the abusive conditions in which the mentally ill were kept, Dix was an early campaigner for the building of modern hospitals for the treatment of the mentally ill.


    to draw or scribble absent-mindedly. See Maclagan (2013) for an exploration of the history and significance of this marginalised form of drawing and its relevance to art therapy.


    originally developed in the 1920s by the American psychologist Florence Goodenough (, the Draw-A-Person-Test is a drawing-based psychological test used to evaluate children and adolescents for a variety of purposes (Oster and Crone, 2004). The test involves the administrator requesting that the child complete three individual drawings of a man, a woman and themselves, on separate pieces of paper.


    the therapeutic value of exploring and interpreting dreams begins, arguably, in 1899 with the publication of The Interpretation of Dreams (Freud, 1980). For Freud, dreams function primarily as a form of wish-fulfillment. Jung held a very different view to Freud, arguing that they expressed the nature of the dreamer's inner world through the language of symbols, images and metaphor. Influenced more by Jung than by Freud, art therapists tend to view dreams as a point of departure in the process of self-discovery and meaning making through the creation of dream-related images; see, for example, Ambridge in Wood, 2011b; La Nave, 2010; Moon, 2007; Schaverien, 2002).


    due for publication in May 2013, DSM-5 is the planned fifth edition of the American Psychiatric Association's Diagnostic andStatistical Manual of Mental Disorders ( It aims to provide an agreed, common language and standard criteria for the classification of mental disorders.

    Dubuffet, Jean

    (1901–1985): French-born artist and collector.

    duty of care:

    a legal obligation imposed on an individual requiring that they adhere to a standard of reasonable care while performing any act that could potentially harm others.


    in psychoanalysis the term ‘ego’ is used to define the part of the mind that mediates between the conscious and the unconscious and which is responsible for reality testing and a sense of personal identity. The ego is one of the three parts of the psychic apparatus described by Freud in his structural model of the psyche; see also superego and id.

    electroconvulsive therapy

    (ECT): a controversial form of psychiatric treatment involving electrically induced seizures in anesthetised patients for therapeutic effect.

    evidence-based practice

    (EBP): EBP requires the clinician/therapist to identify and systematically evaluate the most current and valid research findings and use these to inform their work with patients or clients.


    an artistic movement originating in Germany at the beginning of the twentieth century. Refers to forms of art in which the external reality has been reshaped in order to express the artist's inner feelings or thoughts about it (Bassie, 2008; Dube, 1972).

    free association:

    Laplanche and Pontalis (1988: 169) define free association as the

    Method according to which voice must be given to all thoughts without exception which enter the mind, whether such thoughts are based upon a specific element (word, number, dream-image or any kind of idea at all) or produced spontaneously.

    Free association is based on the premise that all lines of thought lead to what is significant and that resistance to unconscious thoughts or feelings entering consciousness is minimised by relaxation.

    Freud, Sigmund

    (1856–1939): born in Freiberg, then a part of the Austro-Hungarian Empire (today a part of the Czech Republic), Sigmund Freud was the founder of psychoanalysis.

    Freudian slip:

    also known as parapraxis: a slip of the tongue or pen due to influence of an unconscious wish or conflict.

    General Practitioner

    (GP): a non-specialist doctor who attends to the everyday medical needs of individuals within a particular community or locality.

    graphic indicators:

    recurring themes or features of an image of particular concern or interest to the viewer. The term tends to be found most commonly in the art therapy literature concerned with sexual abuse, violence or neglect (Allen and Tussey, 2012; Sidun and Rosenthal, 1987; Trowbridge, 1995).

    group psychotherapy:

    generic term used to describe any form of psychotherapy – including art therapy – delivered in a group format.

    Health and Care Professions Council

    (HCPC): an independent, UK-wide regulatory body responsible for setting and maintaining standards of sixteen health professions, including arts therapists, occupational therapists, social workers (in England), speech and language therapists and practitioner psychologists.

    heuristic research:

    research grounded in the personal experience, particularly the trial and error experience, of the researcher (see Moustakas, 1990).

    Hill, Adrian

    (1895–1977): British-born artist, author, educator, broadcaster and pioneering art therapist.


    when using the House-Tree-Person test the client is asked to draw a picture of a house, a tree, and a person and then asked to tell a story related to each picture. The H-T-P is based on the belief that what the client paints or draws will reflect aspects of the personality that might be otherwise unavailable to consciousness or for assessment (see Buck, 1992; Wenck, 1970).

    human potential movement:

    emerging out of the ‘humanistic psychology’ developed by Abraham Maslow (1908–1970) in the 1940s and 1950s, the term was first used to describe the humanistic psychotherapies that became popular in the 1960s and early 1970s in the USA. These psychotherapies were founded on the belief that through fully developing their potential, humans can experience an exceptional quality of life filled with happiness, creativity and self-actualisation.


    part of Freud's psychic apparatus, the id is the unorganised part of the personality structure that contains our instinctual drives. The id is driven by the pleasure principle and strives for the immediate gratification of all desires, wants and needs irrespective of the demands of external reality.


    in philosophy, idealism is the term used to identify the group of philosophies which assert that reality, or reality as we can know it, is fundamentally mentally constructed.

    Improving Access to Psychological Therapies

    (IAPT): introduced in 2008, and delivered through the NHS, the government-sponsored IAPT programme is designed to increase access to NICE approved, evidenced-based psychological therapies for individuals experiencing depression and anxiety.


    derived from the work of Jung, the term ‘individuation’ describes the process of psychological integration, the aim of which is that of becoming an individual.

    informed consent:

    the process by which a patient, client or research participant is made aware of the nature of the proposed treatment or procedure, possible alternatives, along with the potential risks and benefits of the treatment or procedure. For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.


    in contemporary usage the word ‘insanity’ is most commonly used informally to describe some form of psychological instability; see madness, mental illness and lunacy.

    institutionalisation/institutional syndrome:

    both terms refer to the deficits in social and life skills which a person develops as a consequence of spending a significant amount of time living in institutions such as psychiatric hospitals, care homes or in prison where a lack of independence and responsibility is the norm.


    the act of interpreting or explaining the meaning of something. In the arts, an interpretation articulates an understanding of a work of art such as a painting, poem, performance or piece of music.

    Jones, Alfred Ernest

    (1879–1958): British neurologist and psychoanalyst, perhaps best known for being Freud's ‘official’ biographer (Jones, 1993).

    Jung, Carl Gustav

    (1875–1961): Swiss-born psychiatrist and founder of analytical psychology.

    Kinetic Family Drawing:

    widely used projective test employed to understand and assess the perspectives of children and adolescents on their families (Burns and Kaufman, 1970, 1972).

    Klein, Melanie

    (1882–1960): an original and controversial psychoanalyst. After Freud, Klein has arguably been the most influential figure within psychoanalysis in Britain.

    Kraepelin, Emil

    (1856–1926): German psychiatrist widely credited as being the founder of modern psychiatry.

    Kramer, Edith

    (1916–): Austrian-born art therapist, widely acknowledged as one of the key figures in the development of art therapy in the USA.

    Laing, Ronald David

    (1927–1989): controversial Scottish psychiatrist, writer and key figure in the anti-psychiatry movement (Laing, 1970, 1975; Laing and Esterson, 1964).

    learning disabilities/disability:

    Valuing People, the 2001 White Paper on the health and social care of people with learning disabilities (Department of Health, 2001), includes the following definition of learning disabilities.

    Learning disability includes the presence of a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with; a reduced ability to cope independently (impaired social functioning); which started before adulthood, with a lasting effect on development.


    term used in psychoanalytic theory to describe the energy or force derived from instinctual biological drives. In early Freudian theory its usage was restricted to the sex drive, but was later extended to include all expressions of pleasure and love.

    Lombroso, Cesare

    (1835–1909): Italian doctor and criminologist famed largely for his theory of innate criminality.


    see madness.


    generic term used to describe a range of behaviour deemed abnormal or deviant (Porter, 2002; Scull, 2011). Related words include mental illness, lunacy and insanity.


    ancient Sanskrit word meaning magic circle. Mandalas are found in the art of many religious traditions where they are employed in the service of personal growth and spiritual transformation.

    mental handicap:

    see learning disability.

    mental health:

    refers to psychological or emotional wellbeing.

    Mental Health Act 1983/2007:

    the law in England and Wales that covers the care and treatment of individuals with a ‘mental disorder’; including their compulsory admission to hospital and treatment without consent (unofficially known as ‘sectioning’ or being ‘sectioned’).

    mental illness (mental disorder):

    term generally used when a person experiences significant changes in their thinking, feeling and/or behaviour. These changes need to be severe enough to significantly influence how the person functions or to cause distress to them.


    thought of as a form of imaginative mental activity that enables us to ‘see ourselves as others see us, and others as they see themselves’ ( The concept is most often encountered in relation to work with people with personality disorders; see, for example, Bateman and Fonagy, 2006. See also Springham et al. (2012) for a discussion of the application of this concept in art therapy.

    Menzies Lyth, Isabel

    (1917–2008): distinguished psychoanalyst and social scientist whose work on the ways in which anxiety shapes the behaviour of organisations and the individuals who work in them (Menzies Lyth, 1988 and 1989) remains influential in the field of organisational psychology. See organisational dynamics.


    figure of speech in which a word or phrase is applied to something to which it is not literally applicable (e.g. ‘food for thought’); a thing symbolic of something else.

    Miller, Alice

    (1923–2010): Polish-born psychologist and author, best known for her work on the abuse of children.

    Milner, Marion

    (1900–1998): British psychoanalyst and author who has exercised a significant if often unacknowledged influence on development of art therapy (Edwards, 2001).

    moral treatment:

    developed during the 1800s by William Tuke and Philippe Pinel amongst others, moral treatment sought to replace the medical treatments used in the asylums of the period such as bloodletting, purging and physical restraint with more humane forms of care.

    multi-disciplinary team:

    found in health care organisations such as the NHS, a multi-disciplinary team consists of a group of professionals from one or more clinical disciplines who together make decisions regarding recommended treatment of individual patients or clients.


    psychological condition characterised by excessive self-preoccupation (self-love) and a lack of concern or empathy for others (Holmes, 2001; Morrison, 1986).

    National Health Service

    (NHS): formally launched on 5 July 1948 by the then minister of health, Aneurin Bevan, the NHS was created out of the ideal that good health care should be based on clinical need not ability to pay and that it should be free to all at the point of delivery.

    National Institute for Health and Care Excellence

    (NICE): provides guidance, sets quality standards and manages a national database to improve people's health and prevent and treat ill health;

    Naumberg, Margaret

    (1890–1983): a key figure in advancing the development of art therapy in the United States. ‘Naumberg was the first to delineate art therapy as a separate profession and a distinct form of psychotherapy’ (Junge and Asawa, 1994: 22).

    Netherne Hospital:

    a psychiatric hospital in Hooley in the county of Surrey, England, where Edward Adamson worked from 1946–81. During this period Adamson established five art therapy studios and a purpose-built gallery at the hospital.


    a form of emotional problem in which emotional distress or unconscious conflicts find expression through physiological or psychological – ‘neurotic’ – disturbances.


    term meaning characteristic of, or affected by, neurosis; as in ‘neurotic disorder’ or ‘neurotic symptoms’. Symptoms of neurotic disorders include anxiety, depression, obsessional behaviour.

    Northfield Hospital:

    located near Birmingham, England and best known for the pioneering work in the treatment of neurotic disorders among army personnel between 1942 and 1948.


    Charles Rycroft (1979: 100) defines the word object as,

    That towards which action or desire is directed; that which the subject requires in order to achieve instinctual satisfaction; that to which the subject relates himself.

    In the psychoanalytic literature the word object appears alone, and in numerous compound forms, such as .

    object relations/object-relationship:

    what is usually being referred to when we speak of ‘object-relationships’ is an ‘inter-relationship’. That is, a relationship ‘involving not only the way the subject constitutes his objects but also the way these objects shape his actions’ (Laplanche and Pontalis 1985: 278).

    object-relations theory:

    As Greenberg and Mitchell (1983: 11–12) comment,

    The term ‘object relations theory’, in its broadest sense, refers to attempts within psychoanalysis to … confront the potentially confounding observation that people live simultaneously in an external and an internal world, and that the relationship between the two ranges from the most fluid intermingling to the most rigid separation.

    organisational dynamics:

    term used to describe the psychological processes – particularly unconscious processes – active in organisations and which might be said to have an impact, negative or positive, on the way they function (Obholzer and Roberts, 1997). See also Menzies Lyth.

    Outsider Art:

    term first used by the art critic Roger Cardinal (Cardinal, 1972) as the English equivalent of Art Brut. With the passage of time the term has been applied increasingly loosely to the work of any artist who is untrained, has a disability (mental or physical) or is socially excluded irrespective of its quality (Maclagan, 2009; Maizels, 2009, Rhodes, 2000).


    refers in everyday language to the social face a person presents to others. In the psychology of Carl Jung, this mask or façade is designed to impress others while also concealing a person's true nature (see also Samuels et al., 1986).

    personality disorder:

    DSM-IV defines a personality disorder as ‘an enduring pattern of inner experience and behaviour that differs markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment’ (

    Personnel Memorandum PM82/6:

    Published in 1982, this Memorandum provided the first ‘official’ definition of an art therapist in the UK and marked an important step in establishing art therapy as a profession.


    see unconscious phantasy.

    Pinel, Philippe

    (1745–1826): French physician and psychiatrist, best known for challenging the view that lunacy (mental illness) was the result of demonic possession and introducing a more humane approach to the care and treatment of psychiatric patients.


    The Concise Oxford English Dictionary defines the verb ‘play’ as ‘to engage in games or other activities for enjoyment rather than for a serious or practical purpose’. For many art therapists play is central to the therapeutic process because it provides a means for safely expressing troubling feelings or conflicts. Youell (2008: 122) uses the word ‘playful’ to describe ‘a state of mind in which an individual can think flexibly, take risks with ideas (or interactions), and allow creative thoughts to emerge … Playfulness happens in a relationship; it is a two-person phenomenon. We can be playful alone but only if we have had the experience of being playful with another’.

    pleasure principle:

    term used to describe in psychoanalytic theory the human tendency to seek pleasure and avoid emotional pain in order to satisfy biological and psychological needs.

    post-traumatic stress disorder

    (PTSD): disorder that may emerge months or sometimes years after a traumatic experience.

    primary care:

    services provided by GP practices, dental practices, community pharmacies and high street optometrists. These services typically provide the first point of contact with the NHS.

    primary process thinking:

    in psychoanalytic theory, primary process thinking is derived from the id and is characterised by illogical, disorganised forms of thinking wherein thought and action are synonymous. Primary process thinking is preverbal and dreamlike in nature.


    has several meanings in relation to art, culture and human development. In contemporary use, it tends to be used when referring to the first or earliest form of its kind, as characteristic of an early state of human development or as unaffected by civilizing influences.

    Prinzhorn, Hans

    (1886–1933): German psychiatrist and art historian, best known for his book ‘Bildnerei der Geistenkranken’ (The Artistry of the Mentally Ill), first published in 1922 (Prinzhorn, 1995). The Prinzhorn Collection is based at the University Psychiatric Hospital in Heidelberg, Germany and in its present form consists of over five thousand pieces of art, mainly drawings, paintings, collages, textiles, sculptures and writing. The museum has also accumulated works from other institutions in Germany, France, Austria, Switzerland, Italy, Poland and Japan.

    private sector:

    the part of the national economy that is not under direct government control. This includes private health care and a wide variety of alternative and complementary treatments. See also public sector and third sector.

    process notes:

    as defined by the BAAT the term ‘process notes’ refers to ‘writing done by therapists in order for them to process the psychological content of sessions’ (BAAT, 2009a: 11).

    professional autonomy:

    refers to the freedom art therapists have to exercise their professional judgement once they are qualified and registered with the HCPC.

    professional indemnity insurance:

    insurance that protects art therapists practising privately from any civil claim made against them arising from their professional activities. From October 2013 all registered health care professionals will be required to hold appropriate professional indemnity insurance as a condition of their registration with the Health and Care Professions Council.


    defence mechanism that involves getting rid of uncomfortable inner thoughts and feelings by expelling (projecting) them on to other people.

    projective identification:

    term first introduced into the psychoanalytic literature by Melanie Klein. A psychological defence that involves evoking in someone else aspects of the self that one cannot bear.


    used in contemporary psychology to describe the whole of the human mind, in both its conscious, and unconscious aspects.

    psychiatric art:

    generic term applied to describe artefacts produced by psychiatric patients.


    a medically trained doctor who specialises in the diagnosis and treatment of mental illness.


    psychiatry is a medical field concerned with the diagnosis, treatment and prevention of mental illness (Burns, 2006).


    Rycroft (1979: 129–30) provides two definitions for psychoanalysis. First, that it is ‘the form of treatment of the neuroses invented by Freud in 1890s and elaborated since then by himself, his disciples and followers’. Second, that it is the term used to describe and define ‘the psychological theories of the origin of the neuroses and (later) of general mental development formulated by Freud, his disciples and followers concurrently with the invention and elaboration of psychoanalytical treatment’.


    ‘any person who has received a training in psychoanalysis at a recognised psychoanalytical institute and who practices psychoanalytical treatment’ (Rycroft, 1979: 130).

    psychoanalytic literature/theory:

    refers to the ideas and concepts that underlie and inform psychoanalysis and psychodynamic psychotherapy.

    Psycho-Analytic Play Technique:

    developed by Melanie Klein. In her consulting room, children had access to play materials such as water, pencils, paper and paints in addition to his or her own set of toys, including small wooden human figures in two sizes, a train, a car and so on. How the child played with these toys was carefully observed and interpreted; ‘it was by approaching the play of the child in a way similar to Freud's interpretation of dreams that I found I could get access to the child's unconscious' (Klein in Mitchell, 1986: 51–2).

    psychodynamic psychotherapy:

    based on psychoanalytic theory, a form of psychotherapy aimed at exploring the underlying thought processes and conflicts causing emotional distress (Jacobs, 1993). See Lidmila, 1996 for a thoughtful discussion concerning the contested nature of this term.


    term used to describe the study, diagnosis and/or treatment of mental illness.


    type of mental health problem or mental illness involving the severe disruption of perception, thinking, emotion and behaviour; a consequence of which is that the sufferer may lose contact with external reality.


    also called neurosurgery for mental disorder (NMD) ( Psychosurgery is the term used to describe the use of surgery to treat severe psychological or behavioural problems.


    form of psychological therapy or treatment aimed at alleviating psychological problems and which involves a particular kind of conversation and relationship between a trained professional and a client, patient, family, couple, or group (Clarkson and Pokorny, 1994; Feltham and Horton, 2012).


    person who practices psychotherapy.


    see psychosis.

    public sector/statutory sector:

    the part of a nation's economy that consists of state-owned institutions and services provided by local authorities.

    randomised controlled trials

    (RCTs): an experimental procedure designed to test the effectiveness of a new medication or a new therapeutic procedure. In an RCT participants (patients) are randomly allocated to receive one or other of the alternative treatments under study. Therapeutic outcomes are then compared. See also evidence-based practice.

    record keeping:

    see clinical notes and process notes.

    Recovery Movement:

    generic term used to describe a range of approaches to supporting an individual's recovery from mental illness or substance misuse (Davidson et al., 2011; Nilson and Nyland, 2008).

    Red Book:

    a 205-page manuscript written by Carl Jung between approximately 1914 and 1930 (Jung, 2009). During the period Jung worked on the Red Book he developed some of his most enduring theories including those concerning archetypes, the collective unconscious, and individuation.


    the psychological process whereby unconscious feelings of guilt are alleviated through acts intended to repair, restore or recreate internal objects that, in phantasy, have been damaged or destroyed. Introduced to the psychoanalytic literature by Melanie Klein.

    Reil, Johann

    (1759–1813): German doctor credited with first using the term ‘psychiatry’. Reil was also innovative in his approach to the welfare and treatment of the insane and was among the first to incorporate the use of occupation, art and drama in therapy (Casson, 2001; Ellenberger, 1994).


    the essence of repression, as defined by Freud, ‘lies simply in turning something [i.e. unpleasant, instinct based, thoughts, images, memories] away and keeping it at a distance, from consciousness’ (Freud, 1975, SE, X: 250).


    a phenomenon occurring in art therapy groups where ‘members often unknowingly influence one another and synchronously produce images with similarities’ (Richardson in Wood, 2011b: 201).

    Richardson, Marion

    (1892–1946): British art educationalist who pioneered the development of a child-centred approach to the teaching of art which largely dispensed with instruction and promoted the use of the memory, visual imagination and self-expression rather than copying nature.

    Rogers, Carl

    (1902–1987): psychologist and founder of the humanistic psychology movement.


    an artistic, literary, and intellectual movement that emerged in Europe towards the end of the eighteenth century (Ferber, 2010). As a cultural movement Romanticism arose in response to the rationalism and physical materialism of the Enlightenment.

    Rycroft, Charles

    (1914–1998): British psychoanalyst and the author of several popular books on psychoanalysis, the best known of which is A Critical Dictionary of Psychoanalysis (Rycroft, 1979; Pearson, 2004).


    a person or group blamed or punished for the sins of others and made to suffer in their place.


    defined by the Royal College of Psychiatrists as ‘a mental disorder which affects thinking, feeling and behaviour’ ( See also psychosis.

    secondary care:

    term used to describe the health services provided by medical and non-medical specialists who do not typically have first contact with patients.

    secondary process thinking:

    introduced into psychoanalysis by Freud, secondary process thinking refers to mental activity controlled by the ego that is logical thinking and influenced by external reality. See also primary process thinking.

    Segal, Hanna

    (1918–2011): British psychoanalyst, former president of the British Psychoanalytical Society and a leading follower of Melanie Klein (Segal, 1978).

    Simon, Rita

    (1921–2008): founder member and former president of the Northern Ireland Group for Art as Therapy (NIGAT) and the BAAT.


    psychological defence mechanism involving separating the ‘bad’ part of an object or person from the good part in order to keep the ‘good’ object or person uncorrupted.

    Standards of Proficiency:

    defined by the HCPC (2007) as ‘the professional standards which every registrant must meet in order to become registered, and must continue to meet in order to maintain their registration’.


    Laplanche and Pontalis (1988: 431) define ‘sublimation’ as the ‘process postulated by Freud to account for human activities which have no apparent connection with sexuality but which are assumed to be motivated by the force of the sexual instinct. The main types of activity described by Freud as sublimated are artistic creation and intellectual inquiry’. What distinguishes sublimation from other defence mechanisms is its social value.

    substance misuse:

    substances such as alcohol, solvents and drugs (including prescription drugs) consumed for the purpose of intoxication, or in sport for performance enhancement, the consequences of which may include ‘social, psychological, physical or legal problems’ (


    a twentieth-century movement, strongly influenced by the ideas of Freud, which sought to release the creative potential of the unconscious mind through the illogical juxtaposition of words and images.


    one of the three parts of the psychic apparatus defined in Freud's structural model of the psyche (Freud, 1975, Volume XIX). The superego functions as the critical, moralising part of the mind; acting, in effect, as what is better known as the conscience (Roth, 2001).


    representation or attribution of meaning through the use of symbols (Archive for Research in Archetypal Symbolism, 2010; Battistini, 2005; Bruce-Mitford, 2008; Jung, 1978). A symbol represents one thing, such as an object, idea or feeling, by linking it with something else.

    Szasz, Thomas

    (1920–2012): born in Budapest, Hungary, Dr Szasz is best known as a trenchant critic of the moral and scientific foundations of psychiatry.

    tabula rasa:

    in English the term means ‘blank slate’ and is generally used to refer to the mind – particularly the mind of a child – before it receives the impressions gained from experience.


    an object, typically an inscribed ring or stone, believed to possess supernatural or magical powers.

    therapeutic community:

    term used to describe a participative, group-based and usually residential approach to treating long-term psychological problems.

    therapeutic relationship:

    term used to describe the totality of the interpersonal relationship between the therapist and client.

    third sector:

    term used to distinguish the voluntary, community or not-for-profit (charity) sectors from public sector and the private sector.

    trade union movement:

    an organisation of workers who have come together to achieve a common goal, such as improved working conditions.

    transcendent function:

    term derived from the work of Carl Jung and Analytical Psychology. The transcendent function connects the real to the imaginary, the rational to the irrational and consciousness to the unconscious and it is through a process of engaging with the transcendent function that a person may cultivate the psychological growth required for individuation (Miller, 2004).


    within psychoanalysis, ‘the transference is acknowledged to be the terrain on which all the basic problems of a given analysis play themselves out: the establishment, modalities, interpretation and resolution of the transference are in fact what define the cure’ (Laplanche and Pontalis, 1988: 455). While this is not so for art therapy, working with transference phenomena is, for many art therapists, an important aspect of their practice (see, for example, Schaverien, 1982, 1996, 1998, 2005a and b). See also countertransference.

    transitional object:

    refers to any material object such as a soft toy or a piece of cloth, for example, to which the developing infant attributes value and importance.


    (psychological): a form of damage to the mind as a consequence of a sudden, often violent traumatic event. See also post-traumatic stress disorder (PTSD).

    Tuke, William

    (1732–1822): an early pioneer of a more humane approach to the treatment of the insane than was common in the eighteenth century. Tuke is perhaps best known for founding the York Retreat, a religious asylum for the care of the mentally ill in 1796 (Charland, 2007).


    usually used to refer, in art therapy, to ‘all those contents [of the mind] that are not present in the field of consciousness at a given moment’ (Laplanche and Pontalis, 1988: 474).

    unconscious phantasy:

    as defined by Hinshelwood (1991: 32), unconscious phantasies are, ‘the mental representation of those somatic events in the body which comprise the instincts, and are physical sensations interpreted as relationships with objects that cause those sensations’.

    visual metaphors:

    the use of an image of one thing to represent something else. See also metaphor.

    Waller, Diane

    OBE: a key figure in the development of art therapy from the late 1960s onwards.

    Winnicott, Donald Woods

    (1896–1971): English paediatrician and psychoanalyst best known for his theories concerning the importance of play and transitional objects in infant development (Abram, 2007; Jacobs, 1995; Phillips, 1988; Winnicott, 1971, 1980).

    Wolff, Toni

    (1888–1953): Swiss analyst and close associate of Carl Jung. Wolff is credited with helping Jung define some of his best-known concepts including anima, animus, and persona (Champernowne, 1983).


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