The healing power of art

Therapists who use creative outlets to help patients process trauma seek licensure

THE YOUNG GIRL had endured bullying and been called ugly. She was told she had a unibrow by one of her male classmates.

At her therapist’s office, she was “withdrawn and disengaged.” She refused to finish a self-portrait she had started the previous week, instead picking up another piece of paper and painting two eyes and a single eyebrow floating alone in a sea of blue. The place where the mouth would be was covered in a green swath.

The therapist, Stephanie Burks-Pelland, who is based in Beverly, said her client’s interaction with art was revealing.

“She didn’t want to mess up her self-portrait and was feeling out of control. She couldn’t go there,” said Burks-Pelland. “It was so telling to me as a therapist to be able to assess what she was really going through.”

Burks-Pelland is a licensed mental health counselor, but the session with her young client was not only tapping skills from that training, it drew heavily on her additional background as a certified art therapist.

An emerging field in the world of mental health care, art therapy, which advocates say can be especially helpful for those who have experienced trauma, is looking to establish a firmer foundation in Massachusetts.

Many mental health counselors use art as part of their practice, and they can obtain certification from the Art Therapy Credentials Board, a national nonprofit founded 50 years ago to support development of the art therapy profession. But now art therapy practitioners are pushing legislation on Beacon Hill to establish state licensing of art therapists, a move that would increase their professional standing, allow them to bill through insurance companies, and make their services more widely accessible to low-income families.

Map showing art therapist licensure across states.

Christine Hultgren Ryan, who convinced Sen. Diana DiZoglio of Methuen to file the legislation, said she wants to see art therapy recognized as a profession. “Establishing guidelines and regulations to ensure practitioners are sharing their services and are properly trained is important,” said Hultgren Ryan, who works as a school adjustment counselor in Ipswich.

Hultgren Ryan said her two-year master’s program in art therapy and counseling at the College of New Rochelle in New York was rigorous training. She worked in a mental health facility for adolescent males when conducting her required internship and practicum, and is now registered with the Art Therapy Credentials Board.

Art therapists often combine their methods with traditional psychotherapy, which revolves around discussion with clients. Art therapy can be especially useful with patients who are having difficulty articulating the issues they are dealing with, allowing them to reveal their feelings without saying anything.

Burks-Pelland said art therapy is particularly helpful for sexual assault and human trafficking victims. She has volunteered at the Boston Area Rape Crisis Center, and spent time with sexual assault victims in emergency rooms. She said those types of patients need to deal with the trauma they experienced but typically don’t want to keep reliving it.

“I told a survivor that she wouldn’t need to recount her story to me,” said Burks-Pelland. “I said, ‘We’re going to start with the art.’”

Art therapy uses a range of visual art materials, including painting, sculpture, and collaging, to help clients explore trauma and other problems. The psychological undertones of the art can help decode feelings. Certain media, like collage or markers, are recommended for sexual assault victims who need to feel in control of their surroundings, as opposed to mediums like paint, which are more fluid.

Burks-Pelland said she had a patient who had been sexually assaulted create a collage of herself. She and the patient then discussed what the collage said about how she viewed her body and herself. It was a way to start a discussion and “begin the process of healing,” Burks-Pelland said.

A “body work” collage created by a victim of sexual assault during an art therapy session.

According to an essay on the American Art Therapy Association’s site, one Chelsea clinician’s patient was a 14-year-old boy who had crossed the US-Mexico border three years earlier as an unaccompanied minor to avoid gang violence. He was detained and kept in detention centers. He and his art therapist processed his trauma by collaborating on a quilt.

Over time, he told her of the cold in the detention center. He described how he watched other children who were exposed to frightening things, how he wrapped his own sweater around another shivering little boy, how his remaining mementos from Central America were taken away, and how he felt stripped of dignity.

The teen created a secret pouch within the blanket to hold his belongings. The final portion of the blanket was brightly colored, in memory of his grandmother who sent him off the US to be safe.

Although the field of art therapy has existed since the 1950s, it has taken decades for states to figure out methods of licensure and embrace the idea of certifying therapists. Six states currently license art therapists and more than a dozen others are moving toward doing so.

A quilt made by a Central American teenager who experienced trauma as an unaccompanied minor being held in immigrant detention.

The biggest roadblock art therapists face is insurer reimbursement. Insurers cover art therapy if it’s provided in a broader hospital setting – Massachusetts General Hospital, for example, employs art therapists – but not if it’s provided by an individual practitioner. As a result, most art therapists in Massachusetts are also licensed mental health counselors, a designation that can make them eligible for insurance reimbursements.

Burks-Pelland said her sessions are covered by Blue Cross Blue Shield of Massachusetts, but only because she is a licensed mental health counselor. If she were only an art therapist, her patients would have to pay entirely out of pocket, which can cost hundreds of dollars per session.

As of late January, there were 6,851 licensed mental health counselors in Massachusetts, but there’s no way to determine how many of them practice art therapy. The New England Art Therapy Association is connected to at least 70 art therapists in Massachusetts.

The proposal in the Legislature would lump professional art therapists in with other mental health care providers, including mental health counselors, clinical social workers, and marriage and family therapists.

Katie Racanelli, president of the New England Art Therapy Association, says the organization hasn’t heard yet of any pushback against the bill to create an art therapy licensing designation in Massachusetts.

Lesley University graduates 45 to 50 students each year from a master’s program that teaches the principles of art therapy along with the education requirements needed to gain licensure as a mental health counselor.

Meet the Author

Sarah Betancourt

Reporter, CommonWealth magazine

About Sarah Betancourt

Sarah Betancourt is a bilingual journalist reporting across New England. Prior to joining Commonwealth, Sarah was a reporter for The Associated Press in Boston, and a correspondent with The Boston Globe and The Guardian. She has written about immigration, social justice, and health policy for outlets like NBC, The Boston Institute for Nonprofit Journalism, and the New York Law Journal. Sarah has reported stories such as a national look at teacher shortages, how databases are used by police departments to procure information on immigrants, and uncovered the spread of an infectious disease in children at a family detention center. She has covered the State House, local and national politics, crime and general assignment.

Sarah received a 2018 Investigative Reporters and Editors Award for her role in the ProPublica/NPR story, “They Got Hurt at Work and Then They Got Deported,” which explored how Florida employers and insurance companies were getting out of paying workers compensation benefits by using a state law to ensure injured undocumented workers were arrested or deported. Sarah attended Emerson College for a Bachelor’s Degree in Political Communication, and Columbia University for a fellowship and Master’s degree with the Stabile Center for Investigative Journalism.

About Sarah Betancourt

Sarah Betancourt is a bilingual journalist reporting across New England. Prior to joining Commonwealth, Sarah was a reporter for The Associated Press in Boston, and a correspondent with The Boston Globe and The Guardian. She has written about immigration, social justice, and health policy for outlets like NBC, The Boston Institute for Nonprofit Journalism, and the New York Law Journal. Sarah has reported stories such as a national look at teacher shortages, how databases are used by police departments to procure information on immigrants, and uncovered the spread of an infectious disease in children at a family detention center. She has covered the State House, local and national politics, crime and general assignment.

Sarah received a 2018 Investigative Reporters and Editors Award for her role in the ProPublica/NPR story, “They Got Hurt at Work and Then They Got Deported,” which explored how Florida employers and insurance companies were getting out of paying workers compensation benefits by using a state law to ensure injured undocumented workers were arrested or deported. Sarah attended Emerson College for a Bachelor’s Degree in Political Communication, and Columbia University for a fellowship and Master’s degree with the Stabile Center for Investigative Journalism.

“There are few jobs listed as art therapist jobs,” said Michaela Kirby, the interim director of the expressive therapies division at Lesley. “They’re often for licensed, eligible clinicians. In a way, that agency that hires our students is getting a twofer – someone trained as a licensed counselor who can also do art therapy.”

Kirby thinks licensing art therapists would improve the quality of services provided using the approach. “Right now there’s no title protection,” she said. “Anyone can call themselves an art therapist. Licensure means you have to be trained in this.”