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Art Therapy
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Outcome Studies on the Efficacy of Art Therapy: A
Review of Findings
Sarah C. Slayton MA, ATR-BC a , Jeanne D'Archer MA, ATR-BC a & Frances Kaplan DA, ATR-BC
a
a Marylhurst University, Marylhurst, OR
Available online: 22 Apr 2011
To cite this article: Sarah C. Slayton MA, ATR-BC, Jeanne D'Archer MA, ATR-BC & Frances Kaplan DA, ATR-BC (2010): Outcome
Studies on the Efficacy of Art Therapy: A Review of Findings, Art Therapy, 27:3, 108-118
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Art Therapy: Journal of the American Art Therapy Association, 27(3) pp. 108-118 © AATA, Inc. 2010
Outcome Studies on the Efficacy of Art Therapy:
A Review of Findings
Sarah C. Slayton, Jeanne D’Archer, and Frances Kaplan, Marylhurst, OR
articles
Abstract
In response to a review by Reynolds, Nabors, and
Quinlan (2000) of the art therapy literature prior to 1999,
this review article identifies studies from 1999–2007 that
measured outcomes of art therapy effectiveness with all ages
of clinical and nonclinical populations. Although numerous
studies blend art therapy with other modalities, this review is
limited to studies that isolate art therapy as the specific inter-
vention. The results of this review suggest that there is a small
body of quantifiable data to support the claim that art ther-
apy is effective in treating a variety of symptoms, age groups,
and disorders.
Introduction
As we near the end of the first decade of the 21st cen-
tury, our intuitive skills as people, art therapist clinicians,
and artists continue to affirm that art making helps clients
and patients—and us. Yet there is a need for evidence that
this is so. Because it serves to treat major mental illnesses
and transient but serious symptoms of trauma, as well as
providing a response to the consequences of social prob-
lems, art therapy is needed as much as it ever has been, if
not more. One can imagine, for example, that the effects of
war, the implications of complex trauma, neurological
impairments from traumatic brain injuries, and the emer-
gence of new addictive substances have created greater
mental health challenges than in previous generations.
Clinicians practicing in the United States for several
decades often comment that their clients’ problems have
increased in severity in the past 5 to 10 years (E. Bagley,
personal communication, June, 2008; C. Turner, personal
communication, September, 2008). Given these dilem-
mas, it is ever more important that art therapists produce
evidence to support our intuitive knowledge that art heals.
With this goal in mind, the authors of this paper
sought to continue where Reynolds, Nabors, and Quinlan
(2000) left off in their review of art therapy effectiveness
studies in the literature prior to 1999, from which they
identified 17 studies that met their inclusion criteria. These
criteria were that the studies assessed the impact of art ther-
apy on a measurable outcome and also assessed the impact
of treatment on a sample or treatment group. Reynolds et
al. also attempted to identify any outcome trends that
could be associated with various research study designs and
to discuss their implications.
The earliest studies included in the report were White
and Allen’s 1971 school-based study on the role of art in
counseling on the development of self-concept, and Silver
and Lavin’s 1977 study on the use of art in the evaluation
and development of cognitive skills. Both of these studies
were published in educational journals. Reynolds et al.
(2000) also identified the first research study published in
an art therapy journal (Chin et al., 1980), which docu-
mented a significant change in self-esteem in underserved
adolescents. However, this and many of the other studies
discussed by Reynolds et al. combined art therapy with
other interventions, making it impossible to determine the
actual effect of the art therapy intervention itself as the
agent for positive change. Additionally, many of the stud-
ies reviewed did not provide detailed descriptions of the art
therapy intervention. In their report, Reynolds et al. noted
an overall lack of standardization and reporting in the lit-
erature on outcome studies.
These predicaments—and the fact that there are only
a couple of decades of research documenting some support
for art therapy—were put forth by Reynolds et al. in 2000
as motivation for more focused research in this area. We
believe that this call has led to some gains in the years since
their review. Our intention was to compile a review of
recent outcome studies so that art therapy students, clini-
cians, and readers may access the data and assess the
strength and relevancy of the data in accordance with their
respective needs.
To identify how far the field has come since the 2000
study, we undertook a systematic review of the academic
journals in the field of art therapy (Art Therapy: Journal of
108
Editor’s Note: Sarah C. Slayton, MA, ATR-BC, Jeanne
D’Archer, MA, ATR-BC, and Frances Kaplan, DA, ATR-BC,
are associate faculty members in the Art Therapy Counseling
Department of Marylhurst University, Marylhurst, OR.
Correspondence concerning this article may be addressed to the
first author at sslayton@marylhurst.edu
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109
the American Art Therapy Association, The Arts in
Psychotherapy, The Canadian Journal of Art Therapy, The
International Journal of Art Therapy). We also searched for
outcome studies using art therapy treatment in the related
fields of creativity, psychology, psychiatry, counseling,
education, nursing, and medicine. Our search included
abstracts and full text articles from the databases
PsycINFO, Medline/PubMed, CINAHL, ERIC, EMBASE,
Genamia JournalSeek, and Sagepub using these specific
keywords: art therapy, treatment outcomes, measurement,
psychological assessment, and outcomes. We reviewed pub-
lished research from January of 1999 through December of
2007. Like Reynolds et al. (2000), we considered studies of
all age populations. We used the following inclusion crite-
ria, the first two of which were also utilized by Reynolds
and his colleagues: (a) studies had to assess the impact of
art therapy on a measurable outcome, (b) studies had to
measure the impact of treatment on a sample or treatment
group, and (c) studies had to utilize art therapy as meas-
ured distinctly and separately from other treatment inter-
vention factors (i.e., participants used visual art media and
were facilitated by an art therapist or qualified clinician).
At first glance, we found numerous reports of outcome
studies. However, many studies that have been conducted
since 1999 will not be discussed here because they com-
bined art therapy interventions with other expressive arts
(such as video, dance, movement, theater, writing, and
music) or with other types of treatment interventions. We
also omitted studies that did not utilize interventions or
activities facilitated by a trained art therapist or qualified
clinician (such as studies in which the participants did art
activities on their own).
Our analysis led to the identification of four useful
categories of art therapy outcome studies: (a) thorough and
detailed qualitative studies, (b) single-subject pre/posttest
designs, (c) designs using control and treatment groups
without random assignment, and (d) controlled clinical tri-
als with randomized assignment to groups.
Qualitative Studies
In a useful qualitative study, the researcher can
describe nuances of the intervention that cannot be
described as readily in other types of studies. Table 1 iden-
tifies qualitative studies published since 1999 that offer evi-
dence as to whether or not art therapy addressed the ther-
apeutic or developmental needs of participants. The stud-
ies by Ball (2002) and Hosea (2006), for example, provid-
ed in-depth discussions of attachment needs in their pop-
ulations in the context of the therapeutic setting. Despite
their examination of two different populations—clinical
and nonclinical—both authors offered astute discussions
on the complexities of attachment utilizing the ideas of
Stern (1985) as applied through art therapy treatment.
Ball’s (2002) small (N= 5) but detailed long-term
study of severely emotionally disturbed children who partic-
ipated in 50 sessions of individual art therapy provided evi-
dence that art therapy treatment was a successful interven-
tion for these children and suggested that art therapy may
be an effective treatment for the population. Both the child
clients and the therapist were able to identify moments of
change and growth during the art therapy process. Children
with severe emotional disturbance can be particularly chal-
lenging to treat, with disrupted attachment seen as a wide-
spread and complex clinical dilemma; thus, Ball’s study
may be applicable in asserting individual art therapy as an
effective intervention for this population.
Although the participants in Hosea’s (2006) study did
not present with clinical disorders, her study (N= 12) pro-
vided valuable data regarding interactions between the
mothers and toddlers in her painting group. As measured
by videos of sessions and interviews with mothers, partici-
pants reported the specific benefits of containment provided
by the therapist, emotional expression as allowed by the qual-
ity of the art medium (paint), and the physical proximity
required by the activity (the closeness of painting together)
that literally and emotionally connected the dyads.
Smeijsters and Cleven (2006) examined art therapy in
forensic settings with adults in the Netherlands and
Germany. After collecting art and detailed reports from
eight art therapists working with this population, the
researchers found evidence that art therapy enables resist-
ant clients in forensic settings to change their cognitive dis-
tortions. This finding may be important for a population
whose “thinking errors” are a common treatment focus.
The remaining qualitative studies listed in Table 1
cover a range of populations, including incarcerated women
dealing with loss, children with family issues, women diag-
nosed with lupus, and elders suffering from dementia.
According to the authors of these reports, all the art therapy
interventions under study yielded benefits for their respec-
tive participants.
Quantitative Studies
Single-Subject Pre/Posttest Design
As was found by Reynolds et al. (2000), the single-
subject pre/posttest design appears to be the most prevalent
design used in art therapy outcomes research, with 13 stud-
ies falling into this category. Most of these studies (identi-
fied in Table 2) involved participants from a single treat-
ment group, although some utilized a single case (N= 1)
design. Because they lack control groups, the shortcoming
of these studies is that they measure change but cannot
conclusively determine if it is the result of the treatment
(Leedy & Ormrod, 2005). Other limitations in the studies
reviewed include small sample sizes, short duration of
treatment, modification of standardized measures, and use
of art therapy in combination with verbal and other non-
expressive therapies. Nonetheless, as Gilroy (2006) noted
regarding the cumulative findings of quantitative studies,
when viewed as a group the cumulative findings of these
studies suggest positive change.
The studies in this category implemented a wide range
of interventions, involved numerous populations, and used
various measurement tools. Although each study should be
evaluated on its own merits, we note two studies in partic-
SLAYTON / D’ARCHER / KAPLAN
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ular that had statistically significant findings with larger
sample groups. Pifalo’s (2006) follow-up to her pilot study
(2002) demonstrated that cognitive–behavioral art therapy
was successful in addressing trauma symptoms in child and
adolescent victims of sexual abuse. Saunders and Saunders
(2000) conducted a long-term study of a relatively large
sample (N= 94) of children and adolescents who were at
risk for long-term behavioral problems. Their evidence
suggests that art therapy not only helped diminish behav-
ioral problems to a statistically significant degree but also
allowed for a stronger relationship with the therapist. The
researchers measured eye contact and other nuances of the
therapeutic relationship while simultaneously measuring
numerous behavioral problems. They found that the latter
decreased in accordance with the clients attending art ther-
apy sessions and getting to know their therapist over time.
Control Treatment Group Without
Random Assignment
The category with the fewest number of studies was the
control treatment group with random assignment. Table 3
identifies four studies that compared participants in an art
110 OUTCOME STUDIES ON THE EFFICACY OF ART THERAPY
Size
Author (N) Population Intervention Time Tool(s)/Measures Results
Ball 5 Emotionally dis- Individual art One year Art therapist Both client and
(2002) turbed young chil- therapy (drawing, (50 interviews, art therapist
dren with attach- painting, sewing) sessions) coded were able to
ment disorder in a information identify positive
residential setting change/growth
Ferszt, 8 Incarcerated Weekly art 8 weeks Post-group 7 of 8 clients
Hayes, adult women therapy group client interviews described having
DeFedele, who had a positive experience
& Horn experienced and a safe place to
(2004) the death of a explore grief or
loved one during feelings deemed
incarceration unacceptable in a
prison setting
Gersch & 5 10-year-old School-based One year Post-treatment All children reported
Sao Joao children with group art therapy focus group that art therapy
Goncalves family issues, (exact intervention interviews with specifically helped
(2006) grief, and not explained) children them to better cope
various stressors with feelings
Hosea 12 Mothers and Weekly painting 8 weeks Video taped Paint and color
(2006) toddlers group sessions, interviews brought dyads closer;
of mothers, viewing the videos
qualitative analysis was seen by mothers
as important
Nowicka- 38 Adult women Group art therapy; Not Qualitative Drawing was seen
Sauer with Lupus “draw the disease” specified analyses of cases as an advantage over
(2007) directive to reveal the verbal interviewing
psychological alone
lives of the patients
Seifert & 7 Adults (ages Twice weekly 3 years Formal elements Details in drawings
Baker 83–89) with activities group of artwork decline but symmetry
(2002) Alzheimer’s using drawing analyzed and persists long into the
disease/dementia recorded disease; clients desire
symmetry and benefit
from symmetry
Smeijsters * Adults in Use of media (paint- Not Detailed reports All 7 problem areas
& Cleven forensic ing, stone work, specified submitted by were successfully
(2006) institutions and more) to create art therapists on addressed by art
metaphors for frus- 7 problem areas therapy; decrease in
tration tolerance cognitive distortions
* Unspecified; data collected from 8 art therapists
TABLE 1 Qualitative Studies
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111
SLAYTON / D’ARCHER / KAPLAN
Size
Author (N) Population Intervention Time Tool(s)/Measures Results
Franks & 5 Adults diagnosed Weekly group 9 months Clinical Outcome Statistically signifi-
Whitaker with personality art psychotherapy and Routine Evalu- cant reduction in
(2007) disorders ation, Brief Symptom mean score on
Inventory, and the PSDI; reduction of
Positive Symptom symptoms; observed
Distress Index (PSDI) improvements
Gunter 4 Children and Individual art 2 or 3 Analysis of themes Engagement in
(2000) adolescents therapy using the sessions depicted in the squiggle game
undergoing “squiggle game” squiggles compared and with therapist
bone marrow (Winnicott, 1971) with stress reactions decreased stress
transplants reactions
Gussak 48 Incarcerated Group art 8 groups Person Picking an Statistically
(2004) adult men therapy Apple from a Tree significant
(PPAT); Formal Ele- improvements
ments Art Therapy in behavioral
Scale (FEATS); Likert functioning
Scale on interpersonal and mood
interactions and
compliance with rules
Hamre 161 Patients with Anthroposophic 15 sessions SF-36 Health Survey; Significant improve-
et al. chronic diseases art therapy (median) KINDL Questionnaire ments with respect
(2007) (ages 5–71) for Measuring Health- to disease, symp-
Related Quality of toms; mental scores
Life in Children and were shown and
Adolescents maintained
Kearns * 5-year-old boy Art therapy with 10 weeks SI traits assessment Child’s artwork and
(2004) with sensory a rotation of questionnaire; behavior became
integration (SI) media choices Touch Inventory closer to age-
difficulties for Elementary Aged appropriate; greatest
Children; FEATS pre- improvement
and posttest; teacher in behavior followed
rated behavior reports easel painting
Pachalska 14 Children and Art therapy 4 months Standard neuro- Statistically signifi-
et al. adolescents integrated with psychological tests cant improvements
(2001) with cerebral logopedic for speech fluency; in speech intelligibil-
palsy and severe therapy Auditory Dysarthria ity, volume, tempo,
dysarthria Scale fluency, and control
of pauses
Pifalo * Girls and young Structured group 10 weeks Briere’s Trauma Statistically signifi-
(2002) women who had art therapy in Symptom Checklist cant reductions on
been sexually three groups for Children 3 TSCC Anxiety,
abused (ages 8–17) separated by age (TSCC) PTSD, and
dissociation scales
Pifalo 41 Children and Group art therapy 8 weeks Briere’s TSCC Statistically signifi-
(2006) young adults who integrated with cant reduction on 9
had been sexually cognitive– of 10 clinical TSCC
abused (ages 8–16) behavioral therapy subscales
in three groups
separated by age
* Unspecified
TABLE 2 Pre/Posttest Studies
(Table 2 continued on next page)
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112 OUTCOME STUDIES ON THE EFFICACY OF ART THERAPY
TABLE 2 Pre/Posttest Studies (continued)
Size
Author (N) Population Intervention Time Tool(s)/Measures Results
Ponteri 4 Mothers with Group art therapy 8 weeks Mother/child drawing Self-assessments indi-
(2001) mother depression that scored with adapted cated more positive
/child affected their FEATS; Interaction self-image; mother/
pairs parenting Rating Scale; Mother child drawings
Questionnaire; showed improve-
Maternal Self-Report ments; Interaction
Inventory (Short Rating Scale indicated
Form) half of the mothers
had integrated the
gains indicated on
self-reports
Pounsett, 3 Adults with Individual art One year Play Observation Statistically signifi-
Parker, learning and therapy and Emotional cant improvements
Hawtin, developmental Rating System for all clients in
& Collins disorders modified by most areas, including
(2006) authors affective, attention,
and level of acuity
Sacchett, 7 Stroke patients Individual art 12 weeks Generative Drawing Improved ability to
Byng, with severe therapy using Test; interviews; communicate and
Marshall, aphasia drawing for Pragmatics Profile of make recognizable
& Pound communication Everyday Communi- drawings
(1999) cation Skills in Adults
Saunders 94 Outpatient Individual art 3 years Checklists that rated Significant findings
& emotionally therapy 14 presenting problems in success of art ther-
Saunders and behaviorally and 24 symptomatic apy overall; severity
(2000) disturbed behaviors; Initial of 23 of 24 behaviors
children and Therapeutic Relation- decreased; significant
teens ship (ITR) rating correlation of sessions
(ages 2–16) attended and higher
ITR score
Wallace- 19 7th- and 8th- Group art inter- 10 Pre/post assessment No statistically
DiGarbo grade students vention program sessions and 6 month follow up significant changes
& Hill exhibiting using mural over 6 of family/school/peer were found; trend
(2006) truancy making and weeks relationships, deviancy, toward positive
journaling and attitude factors; changes seen at 6
psychological profile month follow up
therapy group with another group of participants who were
not receiving art therapy. These quasi-experimental designs
offer more rigorous indicators of cause and effect than sin-
gle-subject pre/posttest designs but they are still limited in
that the control and treatment groups may not be fully
equivalent (Leedy & Ormrod, 2005).
Hartz and Thick’s (2005) study of incarcerated adoles-
cent girls not only supported the claim that art therapy is
beneficial for this population but also illustrated the charac-
teristic functions of both art psychotherapy and art as ther-
apy—the two original theoretical orientations of the field.
Although they work in slightly different ways, both art psy-
chotherapy and art as therapy are effective in addressing
self-esteem, which is a core issue with this population. Self-
esteem can be related to all populations (Franklin, 1992).
Franklin (1992) proposed that art making may function as
a metaphor for the construction of the self or for building
core levels of self-esteem. The study by Hartz and Thick
may provide empirical support for Franklin’s theory, as well
as validate what Naumburg (1966) and Kramer (1958) for-
mulated long ago.
Clinical Trials With Random Assignment
of Groups
Our search yielded 11 studies that had fully experi-
mental designs with random assignment of groups (Table
4). Although small, it was encouraging to find a growing
number in the category of experimental designs, which is
the most widely applicable and effective study design for
determining outcomes, according to Leedy and Ormrod
(2005). One such study was conducted by Lyshak-Stelzer,
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Singer, St. John, and Chemtob (2007). As with Pifalo’s
(2002, 2006) studies mentioned earlier, these researchers
were concerned with the impact of traumatic events on
young people in need of mental health services. Lyshak-
Stelzer et al. implemented a trauma-focused art therapy
group with hospitalized adolescents who were being treat-
ed for posttraumatic stress disorder. The results indicated
statistically significant symptom reduction for the adoles-
cents who were in the trauma-focused art therapy group.
Additionally, daily milieu records indicated a trend that
there would be a likelihood of fewer behavioral incidents
and seclusions, despite “a concern among some clinicians
that directly addressing trauma-related memories and reac-
tions could be clinically destabilizing” (Lyshak-Stelzer et
al., 2007, p. 164).
Although the duration of treatment was short, Puig,
Min Lee, Goodwin, and Sherrard (2006) conducted a well-
designed study of 39 women with breast cancer who were
randomly assigned to groups; members of the experimental
group (n= 20) received art therapy for 4 weeks and members
of the control group (n= 19) were offered art therapy after
4 weeks. Puig et al.’s purpose was to determine if emotional
expression and spiritual functioning would be improved
with art therapy. Although the results did not show statisti-
cally significant improvements in emotional expression and
spiritual functioning specifically, the Profile of Mood States
(McNair, Lorr, & Droppelman, 1971) yielded clinically sig-
nificant improvements on four of the six scales of psycholog-
ical well-being assessed: anger/hostility, confusion/bewilder-
ment, depression/ dejection, and tension/anxiety.
Addressing the growing need for treatment in the area
of gerontology, Rusted, Sheppard, and Waller (2006) con-
ducted a study in which they concluded:
The use of art therapy for people with dementia provided
clear evidence of positive and durable benefits to aspects of
mental alertness, sociability, and physical and social engage-
ment in clients with moderate and severe dementia. These
changes were quantitatively and qualitatively different from
the pattern of effects achieved in the parallel program of
recreational activity. (p. 531)
These authors provided in-depth discussion of quanti-
tative and qualitative results, as well as an analysis of limi-
tations in their study, all of which may encourage other
researchers to strengthen their outcome study designs.
Discussion
Art therapist researchers have emphasized for some
time that structured inquiry should be a priority in our
work (Kaplan, 1998; Levick, 1983; Rosal, 1989; Silver &
Lavin, 1977; Wadeson, 1978). In comparison to many sci-
Size
Author (N) Population Intervention Time Tool(s)/Measures Results
Bar-Sela, 60 Adult cancer Weekly individual 4 sessions Hospital Anxiety Statistically significant
Atid, patients art therapy with an and Depression improvements in
Danos, anthroposophic Scale; Brief depression and fatigue
Gabay, & philosophy; Fatigue Inventory in intervention group;
Epelbaum watercolor painting no change in anxiety
(2007) between groups
Favara- 32 Children with Group art therapy * Information not Art therapy appeared
Scacco, leukemia available to promote more
Smirne, (ages 2–14) cooperative behavior
Schiliro, during painful
& Di medical interventions
Cataldo
(2001)
Hartz 31 Adolescent Art as therapy 1–1.5 Self-Perception Statistically signifi-
& Thick girls convicted groups compared years Profile for Adoles- cant gains on 6 of 8
(2005) of felonies in with art psycho- cents; Hartz Art self-esteem domains
a correctional therapy groups Therapy Self-Esteem
setting Questionnaire
Italia, 65 Doctors and Group A (medical * Maslach Burnout Group B had
Favara- nurses who personnel on an adult Inventory significantly
Scacco, work with oncology unit) had no decreased burnout
Di Cataldo, oncology art therapy; Group B after art therapy
& Russo patients (medical personnel on interventions
(2008) a child oncology unit)
had art therapy
* Information not available
TABLE 3 Studies With Control Group and No Random Assignment
SLAYTON / D’ARCHER / KAPLAN 113
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Size
Author (N) Population Intervention Time Tool(s)/Measures Results
Chapman, 85 Children and 31 patients received One 60- UCLA PTSD Index, No significant differ-
Knudson, adolescents the Chapman Art minute Child, Adolescent ences found overall;
Ladakakos, (ages 7–17) Therapy Treatment session and Parent however, CATTI
Morabito, diagnosed with Intervention Versions; PTSD group showed fewer
& posttraumatic (CATTI); 27 Diagnostic Scale; DSM-IV PTSD
Schreier stress disorder received standard Family Environ- criteria C (avoidance)
(2001) and hospitalized hospital care; 27 did ment Scale; symptoms at 1 week
for average of not present with Nursing Checklist and sustained at
4.4 days PTSD symptoms 1 month
Curry & 84 Undergraduate After anxiety was One 20 State Anxiety Coloring mandalas
Kasser students induced, participants minute Inventory and plaid patterns
(2005) either colored a coloring decreased anxiety to
prepared mandala, activity below baseline; free
colored a complex session coloring did not
plaid pattern, relieve any anxiety
or freely colored
De Petrillo 62 Undergraduate After a negative mood One Affect Grid rated Mood improved for
& Winner students (art was induced, partici- session both the images participants who
(2005) majors and pants either created of tragedy and made art regardless
non-art majors) a drawing about their the activity of their majors
feelings or copied
geometric shapes
Gussak 29 Incarcerated Group art 8 PPAT/FEATS; Significant improve-
(2006) adult men therapy sessions Beck Depression ments in symptoms
Inventory Short of depression
Form (BDI-II) on the BDI-II
Henderson 36 Undergraduate Experimental group One BDI-II; State-Trait Experimental group
Mascaro, students drew 3 mandalas drawing Anxiety Inventory; had more severe
& Rosen screened for with symbols to per day Spiritual Meaning trauma symptoms
(2007) trauma history represent distressing for 3 con- Scale; Pennebaker before study than
and symptoms events; control group secutive Inventory of Limbic control group but
created 3 drawings days Languidness less severe symptoms
from a still life one month later
Lyshak- 29 Inpatient Experimental 2 years UCLA PTSD Statistically significant
Stelzer, adolescents group received Reaction Index; reduction in trauma
Singer, diagnosed with trauma-focused milieu behavioral symptoms in the
St. John, & posttraumatic group art therapy; expectations experimental group;
Chemtob stress disorder control group also a trend in the
(2007) received “treatment reduction of behavioral
as usual” art activities incidents and seclusions
Pizarro 45 Undergraduate One experimental Two 60- General Health Significant health
(2004) students group (“write-stress”) minute Questionnaire; benefits for the write-
wrote about stressful sessions Global Measure stress group but not
events; one experi- of Perceived Stress; the art-stress group;
mental group Physical Symptoms art-stress group most
(“art-stress”) drew Inventory; Short often reported
about stressful events; Version of the enjoying the sessions
control group drew Profile of Mood and were most likely
from a still life Scale; Participant to continue treat-
Satisfaction Survey ment over any other
TABLE 4 Clinical Trials With Random Assignment
OUTCOME STUDIES ON THE EFFICACY OF ART THERAPY
114
(Table 4 continued on next page)
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entific fields, the body of studies in art therapy that has
accumulated since its inception is minimal.
The results of these 35 studies provide varying degrees
of support that art therapy does work. Compared to 10
years ago when Reynolds et al. (2000) found only 17 studies
that met the criteria in their review, the fact that there are
35 studies in our review provides clear evidence of improve-
ment. Although most of the studies do not meet the highest
standard in efficacy research, they do serve to add support
to the few that do. As Gilroy (2006) remarked:
Quantitative research of all kinds is usually replicated and
therein lies its strength. Repetition either highlights erro-
neous results or confirms true results. The findings of several
small experiments can be combined to produce the strong,
composite, critical mass of outcome research…that can be
represented in systematic reviews. (p. 119)
Reynolds et al. (2000) felt that they could only state,
“in the few studies that have been performed, art therapy
appears to be effective, but not usually more effective than
the standard therapy” (p. 211). Even though much more
research is needed, we found that a small body of studies
now exists in which art therapy as a treatment modality has
been isolated, measured, and shown to be statistically sig-
nificant in improving a variety of symptoms for a variety of
people with different ages. The range of participants repre-
sented in our survey of studies was broad; it included
young children, elders, and all ages in between. A range of
treatment settings also was represented, including schools,
outpatient clinics, day treatment centers, residential homes
and treatment centers, hospitals, correctional facilities, and
nonclinical settings. Undoubtedly there are populations
not represented in these studies that could be addressed in
future research.
It should be noted that we were able to cite studies
from the journals of various clinical disciplines as well as
from art therapy journals, indicating that there is growing
Size
Author (N) Population Intervention Time Tool(s)/Measures Results
Puig, 39 Adult women Experimental group 4 sessions Profile of Moods Statistically significant
Min Lee, with stage I received group art over 4 (POM) scale improvement on 5
Goodwin, or II breast therapy; control weeks POM subscales
& Sherrard cancer group received
(2006) delayed treatment
4 weeks later
Regev & 109 Elementary One experimental One Piers-Harris Children’s No demographic
Guttman school group received session Self-Concept Scale; differences found
(2005) children art instruction; one Intellectual Achieve- between 4 groups;
experimental group ment Responsibility free art activity and
received games; Questionnaire; games had some
control group Children’s Sense of impact in the statis-
received art therapy Coherence Scale; tical analysis of
Loneliness and self-concept and
Social Dissatisfaction responsibility
Questionnaire
Richard- 90 Outpatient Experimental group 12 Scale of the No significance in
son, Jones, adults diag- received group art sessions Assessment of 6 of 7 outcome
Evans, nosed with therapy based on Negative Symptoms measures; the SANA
Stevens, schizophrenia Waller (1993); con- (SANA) yielded significant
& Rowe trol group received incremental benefit
(2007) regular psychiatric for the art therapy
care (no art therapy) group
Rusted, 45 Older adults Experimental group 40 weeks Mini Mental Status Clear evidence of
Sheppard, with dementia received group art Exam; National Adult positive and durable
& Waller in day and therapy; control Reading Test; Cornell benefits in mental
(2006) residential group received Scale and Dementia; alertness, sociability,
treatment non-art activities Multi Observational and physical and
Scale for the Elderly; social engagement
Rivermead Behavioral for the art therapy
Memory Test; Test group
of Everyday Attention;
Benton Fluency Task;
Bond-Lader Mood
Scale
TABLE 4 Clinical Trials With Random Assignment (continued)
SLAYTON / D’ARCHER / KAPLAN 115
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support for art therapy. This contrasts with earlier reviews
of art therapy effectiveness by Burleigh and Beutler (1997)
and Reynolds et al. (2000). They found very little evidence
to support art therapy as a means of improving behavior
problems in children. Of the 35 studies in our review 10
years later, 14 included child subjects (ages 12 years and
under) and 12 included adolescent subjects (ages 13–18
years). A variety of mental health, developmental, and med-
ical patient groups are represented in our review and many
include behavior problem profiles. We now have some evi-
dence that art therapy can lead to positive treatment out-
comes for these populations (Ball, 2002; Lyshak-Stelzer et
al., 2007; Pifalo, 2002, 2006; Regev & Guttmann, 2005;
Saunders & Saunders, 2000).
Within this small body of outcomes studies, several of
the complications that historically have been found in art
therapy research continue to exist. There is a lack of stan-
dardized reporting and utilization of control groups, and a
tendency to use anecdotal case material to demonstrate
treatment outcomes rather than measured results. Often,
poor or only vague descriptions of the treatment interven-
tions are provided, which makes it difficult or impossible
to determine the study procedures. Finally, studies that
mix interventions prevent an examination of which inter-
vention led to the changes reported.
Conclusion
As artists and people with life experience, we intuitive-
ly know that art therapy works. On any given day we may
feel that “of course it was the art therapy” that allowed a
client to make a certain improvement. Our perception
rules out other possibilities when art therapy fits as the best
solution for a client or worked in the same way for another
client. Thus, it is essential to provide evidence of the effi-
cacy of our treatment of choice. There are many people
invested in the outcome of the treatment of given clients;
most importantly, the clients themselves need to know that
the art therapy treatment they are being offered has been
shown to mitigate the challenges they face.
Given the complicated clinical dilemmas of the 21st
century, at times it can feel discouraging to work in the art
therapy field without a reminder that what we are doing not
only has meaning but also makes tangible headway in the
areas where our clients are suffering. In the midst of com-
pleting this review of outcomes research, the authors were
encouraged by the fact that two clinical settings in our com-
munity consider art therapy, at least preliminarily, to be an
“evidence-based” treatment. One is a secure program for
adolescent males who have been adjudicated for sexual
offenses. This program has recognized the value of nonver-
bal and metaphorical processes inherent in art therapy in
working with these youth, many of whom suffer from the
kinds of complex trauma and the cognitive distortions that
Smeijsters and Cleven (2006) described in their study.
During a recent site audit, the individual and group art ther-
apy interventions provided by graduate student interns at
the site were recognized as concrete evidence of progress
toward the specific treatment goals of identifying safe coping
skills and improving social skills. This treatment program
relies on evidence-based treatment outcomes for funding,
so we were very encouraged to learn of this development
(K. K. Doolittle, personal communication, March, 2008).
The second development in our local community
came from a day treatment and residential program that
serves elderly adults with medical, mental health, and cog-
nitive impairments. This agency is interested in writing a
grant for art therapy services based on the following ration-
ale by Dale (2008):
Preliminary examination of the data indicates that partici-
pants using [art therapy] make less phone calls to medical
and mental health providers; require fewer referrals to med-
ical specialists; have a decreased number of somatic symp-
toms and complaints; and reduce their utilization of medical
and mental health services. (p. 2)
Although we believe that art therapists have the same
challenges we have always had in art therapy research—to
be more standardized and more precise, to do more fully
experimental designs, and to replicate studies—there
seems to be positive movement in the field of art therapy,
and ultimately, toward the well-being of our clients and
patients. Since 2007, which was the end date for the stud-
ies in our review, several new studies have been conducted.
Continued improvement in our field will be accomplished
by evaluating outcome studies that have emerged since
2008 and by conducting larger-scale effectiveness studies in
the future. Our review is a small contribution to the ongo-
ing clarification of how art therapy helps with various chal-
lenges and what components of the art therapeutic
encounter lead to positive outcomes.
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