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425
In an era where students face increasing and ever- changing mental health needs, school-
based art therapy can provide an essential service. School shootings, terrorist attacks,
gang violence, and political unrest permeate school walls, disrupting students’ academic
and/or social performance. ese adverse large- scale events exacerbate the chronic
stress that paralyze young people, oen developmentally ill equipped to mitigate such
insurmountable stress. Teachers and administrators are oen the rst to notice prob-
lematic symptoms, and schools can oer a safe, familiar environment for students to
receive treatment. Cultivating creativity in students helps them develop skills to man-
age the complex issues they encounter (Robinson, 2015). e New York University Art
erapy in Schools Program, developed in 1997, provides school- based art therapy
treatment for general education students who struggle with emotional and behavioral
challenges. It features a tri- part model of intervention that supports students, teachers,
and parents in their home communities.
Need for Mental Health Treatment
Between 13% and 20% of children in the U.S. have been diagnosed with a mental health
disorder (Centers for Disease Control, 2013). According to the National Alliance on
Mental Illness (NAMI, 2018), 50% of all lifetime cases of mental illness begins by age
14. One in every four to ve adolescents met the criteria for a mental disorder with
severe lifetime impairment (Merikangas etal., 2010). Inpatient admissions for mental
health and substance abuse treatment increased by 18% between 2013 and 2017, with
a rise of 39% in spending (Health Care Cost Institute, 2019). Amood disorder was
the most common diagnosis for inpatient hospitalization for young people aged 1 to
17years between 1997 and 2011, increasing over that time period by 66% for those
covered by Medicaid and 88% for the uninsured (Pfuntner, Wier,& Stocks, 2013).
In total, childhood mental disorders in the U.S. cost $247billion each year (Perou etal.,
2013).
Lack of access to aordable treatment has a long- term negative eect, but many com-
munities are unable to provide sucient outpatient mental healthcare. Challenges in
accessing treatment stem from both structural and attitudinal factors, including costs,
insurance restrictions, limited availability, and cultural beliefs and stigmas (Campo,
Bridge,& Fontanella, 2015). In a 2017 study by Gallo etal., only 63% of those seeking
22
School- Based Art erapy
Filling the Void
MARYGRACE BERBERIAN
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
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426 • Marygrace Berberian
psychiatric treatment were able to schedule an appointment upon calling a clinic, and
19% of those unable to schedule were not provided with a referral for other resources.
Most referrals were thwarted by the necessity of multiple calls, administrative paper-
work, and several intake appointments before receiving care. It is therefore unsurprising
that 50% of children ages 8 to 15years who have a mental health condition do not
receive treatment. Among young people in poverty, fewer than 15% receive services,
and even fewer complete treatment (Kataoka, Zhang,& Wells, 2002). Poverty oen
adds other attitudinal concerns that hinder treatment, including self- blame, mistrust of
the inequitable healthcare system, and fears of having a child who is diagnosed with a
mental illness removed from the caregiver (Hodgkinson, Godoy, Beers,& Lewin, 2017).
Mental health services may also be a “mismatch” for community members; care that
does not adapt to cultural needs by providing attuned sta or interventions results in
decreased treatment acceptance and delity (Ijadi- Maghsoodi etal., 2017, p.225).
Poverty- related distress is consistently linked to poor mental health outcomes (San-
tiago, Kaltman,& Miranda, 2013). In a nationally representative sample, the lack of
neighborhood resources, interpersonal support, and community and school safety were
positively associated with current diagnosed mental disorders in young people aged 6
to 17years (Dahal, Swahn,& Hayat, 2018). Stiman etal. (2010) suggested a public
health approach to pediatric mental health is most appropriate, noting that “strengths
and problems of children and adolescents are based upon interactions between their
internal genetic/ biological predispositions, as well as their family, community, school,
and societal environments” (p.120).
Schools are more oen becoming the sole providers of mental health support for
children (Berberian, 2017). Areport by the Citizens’ Committee for Children of New
York (2013) advocated for more aordable, school- based mental health treatment, as
New York city agencies can serve only 12% of school- aged children who need men-
tal health treatment. Nationally, schools were found to be an “ideal place to leverage
evidence- based mental health knowledge and make a transformative impact on the
mental health landscape of this country” (Child Mind Institute, 2016, p.1). Eective
interventions within the school setting can address students’ underlying issues, reducing
or eliminating the need for special education services and clearing a path for academic
learning. Mental health issues and the associated negative social and educational out-
comes drive priorities for eective solutions (Murphy, Abel, Hoover, Jellinek,& Fazel,
2017).
Unaddressed mental health needs lead to negative outcomes in school performance
(Child Mind Institute, 2016). When mental health symptoms emerge even in rst grade,
academic performance can diminish within two years (Murphy etal., 2014). Normative
stress associated with later transitions to middle school resulted in substantial academic
failure and behavioral risk for sixth grade students (Lane, Oakes, Carter,& Messenger,
2015). Students challenged by mental health issues struggle academically and achieve
lower levels of educational attainment (McLeod, Uemura,& Rohrman, 2012). Alterna-
tively, emotion regulation was positively associated academic success, productivity, and
achievement scores (Graziano, Reavis, Keane,& Calkins, 2007).
Art erapy in Schools
e pioneers of the art therapy profession formed their visions within the context of
art education. In her groundbreaking work at the Wiltwyck School for Boys, Edith
Kramer (1958) demonstrated the importance of her work as a skilled artist, teacher, and
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
children and adolescents. Retrieved from http://ebookcentral.proquest.com
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School- Based Art erapy • 427
therapist. In 1964, Margaret Naumburg, Edith Kramer, Rawley Silver, and Elinor Ulman
presented their innovative work with children at the Ninth Symposium on Creative
Arts Education, which was titled “Creativity for the Exceptional Individual” (Syracuse
Herald- Journal, July27, 1964). Lowenfeld later contributed greatly to this forum with
his lectures, “Art Education erapy” (Lowenfeld& Michael, 1982; Silver, 1986). Janet
Bush (1997), an innovator in school- based art therapy, suggested that school- based
art therapists can “meet the challenge of twenty rst century by upgrading programs
designed to assist youngsters at risk in their climb toward academic and emotional
reconstruction” (p.16).
e landmark adoption of the federal Education of All Handicapped Children Act
of 1975, updated as the Individuals with Disabilities Education Act (IDEA) in 1990,
mandated best practices for children with special needs. In 1997, related services,
including therapeutic recreation and counseling were outlined in the IDEA (Sec. 602,
paragraph22). Subsequent documentation by the Oce of Special Education and
Rehabilitative Services (OSERS) in the U.S. Department of Education (2006, 2008,
2011) specied the following clarications for Regulations for Part B of the (IDEA)
(34CFR §300.34):
Related services can include artistic and cultural services that are therapeutic in
nature, regardless of whether the IDEA or the Part B regulations identify the thera-
peutic service as a related service. e Department’s long- standing interpretation is
that the list of related services in the IDEA and the Part B regulations is not exhaus-
tive and may include other developmental, corrective, or supportive services (such
as artistic and cultural programs, art, music, and dance therapy), if they are required
to assist a child with a disability to benet from special education in order for the
child to receive FAPE [Free Appropriate PublicEducation]. As is true regarding
consideration of any related service for a child with a disability under Part B of the
IDEA, the members of the child’s IEP Team (which include the parents, school o-
cials, and whenever appropriate, the child with a disability) must make individual
determinations in light of each child’s unique abilities and needs about whether an
artistic or cultural service such as music therapy is required to assist the child to
benet from special education. (2011, p.22)
e more recent Every Student Succeeds Act of 2015 advocated for “specialized instruc-
tional support personnel” (SISP) including social workers, psychologists, and related
service providers to be part of the comprehensive program to meet student needs. e
inclusion of school- based art therapists as SISPs is regulated on the state level (Potash&
Sutherland, 2016).
Research supports the use of art therapy in schools to help students overcome a vari-
ety of academic, social, and emotional challenges. In the U.S., school- based initiatives
have demonstrated substantial positive outcomes: improved self- concept (Rosal,
McCulloch- Vislisel, & Neece, 1997); improved social interaction and cooperation
(Boldt & Brooks, 2006; Coakley, 1997; Zi, Pierce, & Johanson, 2012); increased
problem- solving abilities (Pfeier, 1994; Fish, Dingee,& Neumann, 2000; Gibbons,
2010); increased self- competency and self- esteem (Garibaldi, 1995; Kay& Wolf, 2017;
Sitzer& Stockwell, 2015); improved academic performance (Darrell& Wheeler, 1984;
Wallin& Durr, 2002; Zi, Ivers,& Shaw, 2016); and decreased disruptive behaviors
(Coakley, 1997; Guzder, Paisley, Robertson- Hickling, & Hickling, 2013; Epp, 2008;
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
children and adolescents. Retrieved from http://ebookcentral.proquest.com
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428 • Marygrace Berberian
Freilich& Schectman, 2010; Froeschle & Riney, 2008; Spier, 2010). Other research
has shown that the sense of safety and agency established by creative arts therapies in
educational settings enables children to thrive (Landgarten, Tasem, Junge,& Watson,
1978; Bornmann, Mitelman,& Beer, 2007; Wahl- Alexander, 2015). Arecent system-
atic review of more global, controlled studies in school- based art therapy noted positive
outcomes for students struggling with classroom behavior, oppositional deant disor-
der, separation anxiety disorder, and issues relating to locus of control and self- concept
(McDonald& Drey, 2018). Art- making in schools supports resiliency, as the provision
of pleasure and safety is coupled with the discovery of the potential to adapt, cope, and
thrive (Dunn- Snow& D’Amelio, 2000).
Despite the proven benets and legislative advances, only a few states oer sustain-
able, district- implemented art therapy services for general education students (Amer-
ican Art erapy Association, 2011). In most other instances, programs for general
education students rely on time- limited grants. Gonzalez- Dolginko (2018) advocated
for the dissemination of evidence- based data of clinical school- based art therapy to
overcome the bureaucratic impediments to widespread expansion.
Most mental disorders are diagnosed when children reach school age (National
Academies of Sciences, Engineering,& Medicine, 2015). Disruptive, impulsive students
who tend to externalize their distress generally receive attention that points to the need
for treatment. Students who tend to internalize behaviors (e.g., depressive symptoms)
oen take longer to attract notice in classroom settings. When academic performance
declines or maladaptive behaviors surface, underlying causative factors are revealed.
rough art therapy, students disclose hidden trauma, including domestic violence or
abuse, that has led to destructive behaviors such as substance abuse, sex work, eating
disorders, and self- harm. School- based art therapy helps students organize the chaos of
their internal worlds and their oen less- than- favorable realities.
e school experience can promote mental health by molding, teaching, and eval-
uating prociencies for skill building and interpersonal relations (Mallin, Walker,&
Levin, 2013). Schools, an integral resource in the social ecology of resilience, “initi-
ate meaningful resource- provision, reciprocate in contextually- relevant ways when
children negotiate for supports, and advocate for life- worlds that prioritize children’s
well- being” (eron, 2016, p.88). School- based art therapy helps students cope with
the psychological distress that impedes academic performance and healthy social-
emotional development. Community and familial stressors can evoke overwhelming
feelings of powerlessness, which can intensify in academic settings that demand focus
on cognitive tasks. Empowered with a sense of agency, struggling students can nd
solace in the school day. ey can discover strengths that have been concealed by feel-
ings of “not being good enough” due to academic failures, social isolation, and lack
of validation. Academic support was associated with greater executive functioning and
increased global cortical thickness in the brain (Piccolo, Merz,& Noble, 2018).
Positive early childhood experiences are particularly crucial for immigrant-
background students. Students in immigrant families make up 25% of the U.S. popula-
tion ages zero to eight and even larger proportions in many states and localities (Park,
McHugh,& Katsiacas, 2016). e U.S. foreign- born population reached 43.7million
in 2016, nearly tripling to 13.5% from 4.7% in 1970 (Lopez, Bialik,& Radford, 2018).
As schools strive to meet students’ academic, sociocultural, psychological, and phys-
ical needs, those from immigrant backgrounds face the added burden of acute and
chronic adversity. Suarez- Orozco etal. (2012) noted that “loss and separation from
country of origin, family members, familiar customs and traditions; changes in social
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
children and adolescents. Retrieved from http://ebookcentral.proquest.com
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School- Based Art erapy • 429
class and/or socioeconomic status; exposure to a new physical environment and the
need to navigate unfamiliar cultural contexts” can serve as catalysts for psychological
distress (p.7). is lack of connectedness can result in adjustment issues, diculties
with attachment, and social isolation. Negative social, psychological, and educational
outcomes for immigrant- background students leads to heightened vulnerabilities and
poor educational and life outcomes (Cherng, Sanzone,& Ahram, 2017). Academic chal-
lenges are more prevalent in students living in poverty (Cortina, 2014). Further, dispro-
portionality—the higher rates of referral for special education services for students in
marginalized racial groups—has been documented in schools for more than 40years
(KramarczukVoulgarides, Fergus,& King- orius, 2017).
Direct connections have found between participation in the arts and increased self-
esteem; participants reported a feeling of being part of something larger, an ability to
nd deeper meaning in life, an increased capacity to build social relationships, and an
enhanced self- awareness (Martin etal., 2013).Young people form and revise their iden-
tities based on armation and feedback from others in their circles (McGann, 2006).
Art therapy increases self- awareness and the concept of self in the context of the group,
culture, and/or society (Kalmanowitz& Ho, 2016). For immigrant- background stu-
dents, creative expression promotes the safe disclosure of loss, separation, and trauma
in the assimilation process (Rousseau, Lacroix, Bagilishya,& Heusch, 2003). e use
of metaphor and symbol in visual expression aids negotiation of conicted cultural
values for immigrant- background students (Berberian, 2015). Aschool- based protocol
for creative expression can aid the exploration and integration of identity for students
displaced from their countries of origin (Beauregard, Papazian- Zohrabian,& Rous-
seau, 2017).
Art therapy can be more readily accepted by students in a school setting, where a
sense of safety and support has already been established (Cortina& Fazel, 2014). e
school- based art therapist builds trust quickly with students and families. High visibility
in the school building enables the art therapist to become a familiar, trustworthy xture
of support. Factors of predictability and consistency ground students in a sense of safety
for healing in school- based treatment (Field, 2016). Perry and Szalavitz (2017) consid-
ered schools a controlled, predictable environment for traumatized children to better
regulate their sensitized and overreactive systems. Student perceptions of school con-
nectedness are associated with improved emotional health (Kidger, Araya, Donovan,&
Gunnell, 2012). Positive perceptions of the school climate (La Salle, Wang, Parris,&
Brown, 2017) and school connectedness (Marraccini& Brier, 2017) were also associated
with reduced suicidal thoughts and behaviors by students.
Engagement in creative expression, through its spontaneous exploration of varied
materials, proves benecial for students. In art therapy, students unpack the burdens of
intrapsychic and external stressors. In this relationship of secured, attuned witnessing,
the student repairs, re- creates, and restores the experiences of loss, victimization, and
deprivation. Art therapy interventions address gaps in a student’s emergent develop-
ment by supporting fundamental demands: to be seen, cared for, and celebrated.
e NYU Art erapy in Schools Program
In 1997, New York University (NYU) piloted two public- school- based art therapy pro-
grams in New York City. is initiative, one of the few in the nation, proved to be an eec-
tive modality for general education students struggling with emotional and behavioral
challenges. Following the attacks of September11, 2001, the New York City Department
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
children and adolescents. Retrieved from http://ebookcentral.proquest.com
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Copyright © 2019. Routledge. All rights reserved.
430 • Marygrace Berberian
of Education invited expansion of art therapy to schools in the city’s Chinatown (Ber-
berian, 2015). e nonverbal, metaphorical intervention of art therapy was found to be
culturally aligned with Chinese values. In the years that followed, post- 9/11 federal and
local funding and private donors enabled the Art erapy in Schools program to con-
tinue to serve struggling students in New York City. As a proactive, preventative service,
the NYU Art erapy in Schools Program has established a model of intervention for
general education students challenged by emotional and behavioral diculties.
School- based art therapy services provide accessible, free, long- term treatment for
students. As students are a “captive” audience in the school milieu, treatment attendance
is higher than in outpatient community treatment. Treatment at the school level enables
the art therapists to serve as the central point of connection and communication for
students, teachers, and parents, allowing for a comprehensive and accurate perspective
on progress and impediments. e structure and benets of school- based art therapy
services are comparable to outpatient mental health programs. Treatment is trauma
informed and involves case management to address student needs holistically.
In the Art erapy in Schools Program, students are referred for services by teach-
ers, parents, and even the students themselves through the Pupil Intervention Commit-
tee (PIC), which includes the art therapist, school counselor, psychologist, and social
worker, among other related service providers at the school. As the program gains buy- in
from the students and their families, school- based art therapy has become the most
referred intervention to support mental health in the participating schools. All services
are labeled “art therapy” rather than “expressive arts” or other names oered to avoid
the feared stigma associated with mental health intervention. If the services are called
“art therapy,” students feel permitted to present issues of intense psychological distress
to their teachers. e student may not feel able to present issues of self- harm, abuse, or
domestic violence to an “expressive arts” teacher. Labeling the intervention as “therapy”
also cultivates a willingness to receive mental health services in the future if warranted.
Once a referral is made, the art therapist discreetly observes the student in the class-
room setting, where the challenges of managing academic and social engagement can
be understood. Aparent or legal guardian gives consent for the student to participate.
e art therapist conducts an intake interview to discuss the student’s strengths and
developmental stressors and to articulate treatment goals. In the rst session of treat-
ment, the art therapist discusses condentiality and shares the reasons for referral with
the student. Weekly art therapy services are held for individuals, dyads, and groups for
the academic year, providing a continuum of long- term care. Students of all grade levels
generally respond enthusiastically to the additional support of school- based art ther-
apy. For 45 minutes in the school day, students feel seen, heard, and supported through
art therapy interventions. Teachers nd the students less anxious, more positive, and
better equipped to engage in academic learning when they return to class aer sched-
uled sessions. Classmates oen request art therapy services as they observe the pos-
itive changes in participants and hear stories of their experiences. Aside from a very
few cases, there has been no refusal or stigma associated with school- based art therapy
participation. Teachers and parents are engaged regularly to share feedback about prog-
ress. e art therapist oen serves as mediator between the student, teacher, and parent,
managing the parties’ diering expectations. e art therapist can also help cultivate
more social and emotional support in the school environment when familial stressors
are exacerbated.
School- based art therapists can be “rst responders,” proactively solving problems
through prompt assessment and intervention. Field (2016) wrote that trauma- informed
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
children and adolescents. Retrieved from http://ebookcentral.proquest.com
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School- Based Art erapy • 431
approaches in school settings change the response to disruptive or disengaged students,
examining the underlying causes rather than the presenting symptoms. e following
vignettes describe instances in which students’ artwork reected underlying conicts.
Immediate Assessment and Responses for Students
Lina: ACase Vignette
During a group for students with behavioral concerns, Lina, a female, cisgender Latinx
student, worked diligently on a clay mask. e directive was to create a mask of an imag-
inary creature, composed of human, animal, and/or fantasy qualities. Lina, however,
opted to create a gure in her own likeness (Figure22.1A). She was obese and relied on
articial means to beautify herself, with chemically treated hair, a full face of makeup,
and synthetic nails. For three sessions, she carefully rolled thin coils of clay to apply as
eyelashes to her mask. Lina seemed to rely on elaborate cosmetic enhancements to con-
ceal the emptiness she felt inside.
On the back of the mask, Lina depicted the character’s inner state by writing “Heart
Less” and painting a sword- like object piercing a heart (Figure22.1B). During the group
discussion, Lina courageously jumped out of metaphor to describe how she had felt
heartless when she encountered her birth mother, overtly high on a substance, while
walking to school with her friends. She was both mortied and devastated by her moth-
er’s behavior. With Lina’s knowledge and permission, the school- based art therapist
contacted Lina’s grandmother, her legal guardian, to alert her about Lina’s feelings and
experiences. Subsequently, Lina was able to receive more support through individual art
therapy sessions.
Wei: ACase Vignette
School- based art therapy provides opportunities for disclosure when a child is in immi-
nent danger. During an individual session early in treatment, Wei, a cisgender male
11- year- old from a Chinese immigrant family, created a drawing of a child being beaten
and beating himself (Figure22.2).
With contusions protruding from his head, the gure holds a stick that reads “Eat
my poo poo.” e seemingly same gure (dressed in identical clothes) is also beating his
Figure 22.1A, 22.1B Lina’s mask
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
children and adolescents. Retrieved from http://ebookcentral.proquest.com
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432 • Marygrace Berberian
own bare buttocks. Agure drawn to the right has reddened eyes and lines radiating
from her outstretched hand, suggesting she is the perpetrator. e art therapist was able
to rst use metaphor and then ask more direct questions about the motivation behind
the drawings. Wei disclosed abuse at the hands of his female caretaker. Child protective
services were called immediately.
Maya: ACase Vignette
In another case of neglect, Maya, a 14- year- old Latinx female cisgender student who
had a trusting relationship with her art therapist, arrived at the start of the school day
to report inappropriate touching by her mother’s live- in boyfriend. Immediately, child
protection was called. Upon investigation by caseworkers, Maya’s mother was asked to
either remove her boyfriend from the home or nd alternative guardianship for Maya.
e mother chose the latter, and Maya was sent to live with her aunt. In the art therapy
session held immediately aer her removal, Maya created this image with watercolor
paint (Figure22.3).
“IHate You Mom!” are the dominant words on the page. She also wrote, “Why do
you do this to me?” and “You ruined my life” and used the word “hate” repeatedly. While
Maya was surely angered by her mother’s choice to side with her boyfriend over her
daughter, the emoji face signals sadness. Also, the meticulous execution of lettering with
a watercolor- saturated brush demonstrates a signicant level of control. e duality of
anger and sadness is also evident in the mix of red and blue colors. Maya was able to
receive individual, school- based art therapy in conjunction with the treatment provided
by child protective services for the remainder of the school year.
Figure 22.2 Wei’s disclosure drawing
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
children and adolescents. Retrieved from http://ebookcentral.proquest.com
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School- Based Art erapy • 433
For the student living with chronic adversity, the responsiveness of a caring adult
through long- term connectedness or relational continuity is an essential protective factor
for health (Perry& Szalavitz, 2017). Siegel (1999) described a human need for “contin-
gent communication” acquired through developing relationships, connecting with oth-
ers, receiving aective attunement, and gaining a sense of coherence within the internal
processes of the mind (p.298). School- based art therapists provide a continuum of care
in the school environment, wholly supporting students through the expected disruptions
of grade changes and less predictable crises that pervade families and communities.
Immediate Assessment and Response for the Greater School Community
School- based art therapy addresses a broad range of challenges, including anxiety and
depression stemming from both acute trauma and chronic issues of abuse, family con-
icts, academic problems, identity formation, transitory living, addiction, and social
Figure 22.3 Maya’s drawing about her mother
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
children and adolescents. Retrieved from http://ebookcentral.proquest.com
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434 • Marygrace Berberian
pressures. As described, school- based art therapy has been eective as a central mental
health intervention, synthesizing the perspectives of the student, parent, and teacher.
e establishment of art therapy services in the school building also allows for an imme-
diate response when terrorizing events aect a community. Aquick response is critical
to preventing erroneous beliefs from becoming attached to the traumatic experience
(James, 1989; Newgrass& Schonfeld, 2015). For example, the immediate processing of
the 9/11 attacks with students corrected their misapprehension that many buildings fell,
a notion derived from seeing footage repeated on news media.
Eective practices for communal engagement in art therapy include frameworks
centered on empowerment, social justice, cultural considerations, and community rela-
tionships (Ottermiller& Awais, 2016). School- wide therapeutic intervention can reduce
the isolation and fear caused by collective trauma. Community- based art therapy has
been found to be an eective intervention for collective trauma to alleviate symptoms
of psychological stress (Decosimo& Boland, 2017), increase self- ecacy (Ho, Lai, Lo,
Nan,& Pon, 2017), mobilize support (Slone, Shoshani,& Lobel, 2013), oer interper-
sonal connection, and promote posttraumatic growth (Mohr, 2014).
Following the attacks of September11, the author led school- wide interventions to
help New York City public school students process their responses to the destruction
and continuing fear of terrorist threats (Berberian, 2003, 2006, 2015; Levy, Berberian,
Brigmon, Gonzalez,& Koepfer, 2002). At downtown schools, the anniversaries of Sep-
tember11 were also dicult to endure. Anniversaries trigger collective emotional and
cognitive reactions to the communal loss, as well as more individual experiences of grief
and unpredictability. Pervasive fears were exacerbated by the continual threats of terror-
ism that plagued New York and other areas of the world. e concurrent start of the new
academic term in early September added to the anxiety in the shared space of the school
building. Examples of school- wide interventions follow.
Second Anniversary of September11
As part of a school- wide art therapy initiative, a school in downtown New York created
a Memorial Garden of Hope to commemorate the second anniversary of September11.
e art therapists developed a plan for coordinated classroom discussions in which stu-
dents could share their thoughts and hopes for New York and people around the world.
Because teachers in post- disaster communities oen struggle with the intense emotions
of students amidst their own grief (Ho, Potash, Lo& Wong, 2014), the art therapists
distributed guidelines with scripted prompts for engagement. To create the garden, stu-
dents were invited to draw or write their thoughts and expressions of hope on cardboard
fence pieces. Teachers engaged in separate workshops to create owers to honor the lives
lost. is structured intervention provided concrete guidelines for the teacher facilita-
tors, allowing the project to include all 900 students. It was also an opportunity to glob-
ally assess students. Teachers identied students who struggled in the discussions and
art- making that followed. In its culmination, the installation of the fence in the school
lobby became a testament of solidarity and safety in the school building, less than half a
mile from Ground Zero (Figure22.4).
Fifth Anniversary of September11
For the h anniversary, at a time of much global unrest, students, faculty, and sta at
a downtown middle school were empowered to share their wishes for the future in a
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
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School- Based Art erapy • 435
project titled Weaving Peace. School art therapists and counselors led small- group dis-
cussions, inviting students to reect on the events of September11 and consider their
aspirations for the future by drawing and writing them on long strips of paper. By artic-
ulating these intentions, students were able to take action and feel less passive and help-
less (Figure22.5A).
e intentions covered a wide spectrum, from the political to the poignant:
I wish they’d nd Osama... I wish for a happy life for my mommy... I wish the
world would never come to an end... I wish that our leaders would be a model for
peace, not violence... I wish no one would die... I wish that no one will attack
the U.S. again so it would be safer... I wish that they would build new buildings
and that the terrorists would not bomb them down... I wish that Bush would just
stop the war... I wish to get into a good high school... I wish that the NYPD don’t
lose anymore ocers... I wish the replacement towers are destruction proof and
Figure 22.4 Anniversary school- wide Memorial Garden of Hope
Figure 22.5A, 22.5B Anniversary school- wide weaving
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
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436 • Marygrace Berberian
they should stay that way forever... I wish Iraq won’t attack us... I wish for lots of
money for my family... I wish to make my mom proud... I wish to get a college
degree... I wish my dad to live a longer life from cancer... I wish to become a
scientist... I wish for better economic conditions.... I am wishing the dust didn’t
hurt my grandpa... I wish Igot taller... I wish they saved more people... I wish
my grandpa didn’t die, so Iwould get to know more about him... I wish there were
no more suicide bombers... I wish to have more friends this year... I wish Ihad
my uncle still in my sight—RIP Uncle Jay... I wish for no more homework... I
wish everything didn’t go wrong... I wish for one million more wishes.
ese strips were then woven through satin ribbons stretched across large 5’ × 6’
wooden stretcher frames (Figure22.5B). e resulting fabric of running words and
images expressed a collective voice imagining new possibilities. Intentions were inter-
twined and strengthened by solidarity.
Response After the New York 2017 Terrorist Attack
On Halloween in 2017, a terrorist drove a rented truck down a bike lane on the west side
of New York City, killing 8 people and injuring 11. Public school students in the school-
yard witnessed the attack and police activity that followed. Students were rushed back
into the building and remained in lockdown for hours. Following the incident, parents
and teachers observed students struggling to feel safe at both school and home. As the
school was located near Ground Zero, school- based art therapy had been put in place
aer the September11 attacks. School administrators, having seen the positive eects
of the post- 9/11 art therapy intervention, requested it to help cope with the aermath
of the 2017 incident.
Art therapists and graduate art therapy students conducted classroom workshops to
meet with students and assess their coping. In structured art therapy workshops, stu-
dents identied coping strategies to manage their thoughts and feelings. ey created
art using the metaphor of trees, taking inspiration from trees’ resiliency and the strong
roots that help them withstand storms. Students engaged in movement, writing, and
art exercises to identify inner strengths. Figure22.6A depicts the leaf of a student who
Figure 22.6A, 22.6B, 22.6C School- wide response to terrorist attack
Berberian, M., & Davis, B. (Eds.). (2019). Art therapy practices for resilient youth : A strengths-based approach to at-promise
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School- Based Art erapy • 437
wrote, “When Ifeel stressed Iusually sing to myself because that is something Ilove to
do. Ialso like to run in place.” In another example, a child used pencil to carefully link
puzzle pieces as she sorted through the things that brought her control and comfort.
Students listed their sources of strength, including relationships with relatives and pets
and activities such as fencing, eld hockey, and working with technology (Figure22.6B).
e drawings were compiled into an installation of ten ceiling- height trees that show-
cased the strength of the school community (Figure22.6C). e students were able to
express their own strengths and learn adaptive coping skills from their peers. Teachers
were also inspired by the imaginative ways students found solace in the face of commu-
nity violence.
Students who exhibited more diculties were invited to join long- term art therapy
groups for the remainder of the academic year. For many, the terror and unpredictabil-
ity of the attack triggered past experiences of trauma and loss. Parents also engaged in
workshops led by art therapy sta to help manage symptoms at home. e school- based
art therapy services rearmed the building as a safe, supportive place.
A sense of belonging is the strongest motivation to develop interpersonal relation-
ships and seek group membership (Field, 2016). ese structured school- wide initia-
tives expressed and normalized the feelings of fear and uncertainty while amplifying the
hope held by the community.
Parental Involvement
For families in distress, parental involvement is a critical component to successful ther-
apeutic outcomes. Positive parental engagement in children’s mental health treatment is
a key factor in the quality and eectiveness of care (Haine- Schlagel& Walsh, 2015). Par-
ents are more likely to accept art therapy services within the familiar school setting, as
they trust school sta to aid in their children’s development. During communal trauma,
schools can bring community members together, re- establish routines, organize aid, and
distribute information (Ho etal., 2014). In post- disaster recovery and resilience build-
ing, community support of the kind oered by schools is sought more oen than mental
health interventions (Hanbury& Indart, 2013).
For children aected by war, terrorism, and conict, school- based intervention has
been shown to help families, as strong correlations were found between parental and
child psychopathology (Slone& Mann, 2016). Arecent meta- analysis of published fam-
ily/parent training programs concluded that early intervention reduces behavior prob-
lems (Piquero etal., 2016). Extensive research indicates children with PTSD are largely
aected by parental behavior (Yumbul, Wieling,& Celik, 2017; Vincent, 2009). Aisen-
berg and Ell (2005) related these ndings to interdependent coping theory, whereby
parental behavior aects children’s emotional and cognitive responses to an event and
subsequently to the parents’ actions. e parents and children ultimately relate in a
reciprocal and interdependent manner. In circumstances where parents have survived
chronic traumatization, their fears are oen transmitted or shared with their children,
resulting in transgenerational trauma (Violence Policy Center, 2017). Additionally,
adversities secondary to the traumatic event, such as homelessness and poverty, have a
great impact on families and impair children’s adaptation and development (Sriskanda-
rajah, Neuner,& Catani, 2015).
In acute mental health treatment of young people, the clinician must actively sup-
port the parents. Mishne (2001) noted that “parents oen know what they should do,
and what they want to, but they may be paralyzed by internal or external inhibitions”
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438 • Marygrace Berberian
(p.63–64). Art- based parental training has been shown to be eective in parent- child
art psychotherapy (Gavron& Mayseless, 2018; Regev& Snir, 2014; Snir& Regev, 2018).
Art- based parental training can eectively examine underlying fears, wishes, and con-
icts through the artistic process (Shamri Zeevi, Regev,& Guttmann, 2018).
School- based art therapists lead parenting workshops based on the tenets of art
therapy: creative processes and metaphors (Figure22.7). Parents in familial distress
oen experience feelings of shame and failure. Art- making can diminish their anxiety
about expressing their concerns. Metaphors are widely used in the parenting skills pro-
gram, as they help to normalize struggles. In one workshop, parents painted owerpots
while discussing how best to support developing children. Some parents acknowledged
wishing to hold their children close, almost smothering any chance for growth, while
others explored their experiences of giving their children too much freedom and too
little guidance. Parents were encouraged to engage their children in a planting activity
in which they could talk about needs and preferences in their shared relationships. Soil
and seeds were distributed along with talking points for children at each age level. e
painted pot with its growing plant would also serve as a visual reminder to parents about
topics discussed during the training, suggesting optimal development requires constant
monitoring and care.
Art Therapy Support for School Staff
Grant support following the September11 attacks allowed for art therapy groups for
teachers and sta. e mental health of teachers is oen neglected in school- based
programs that address community trauma (Ho, Potash, Wong, 204). Just as children
Figure 22.7 Art therapy workshops for parents
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School- Based Art erapy • 439
respond to the functioning of their caregivers, student behaviors reect all that is emit-
ted both verbally and nonverbally by educators. Adistressed teacher cannot facilitate
harmonious learning. Ideally, the enduring presence of the teacher in the life of a stu-
dent develops through a sustained relationship that negotiates expectations with fair-
ness, trust, and care (Song, Doll,& Marth, 2013).
In the NYU program, teachers engaged in weekly group art therapy sessions at
lunchtime. e sessions oered teachers the chance to decompress, refuel, and restore
balance. With bag lunches in tow, teachers would enter the nonjudgmental space of the
art therapy room and nd comfort and community while creating art (Figure22.8).
Immersion in the creative process permitted candid dialogue about struggles in the
classroom and personal challenges outside of school. With collective agreements of con-
dentiality, the art therapy room psychically held expressions of anxiety, frustration,
rage, grief, relief, and joy associated with the demands of life and teaching complex
students. e art therapist balanced the roles of facilitating clinician and collegial peer
when prompting further introspection and oering guidance. Each year, the educators
participated in an exhibition of their selected works.
Art therapy- based professional development for teachers enables consistent sta
engagement. e art therapists lead workshops and trainings to better equip sta to
understand students’ artistic development and learn how art- making can improve class-
room performance.
Recommendations
On the macro level, the American Art erapy Association (AATA), the National Alli-
ance of Specialized Instructional Support Personnel (NASISP), and school- based art
therapists tirelessly advocate for the implementation of art therapy in public schools
Figure 22.8 Teachers creating during lunchtime art therapy groups
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children and adolescents. Retrieved from http://ebookcentral.proquest.com
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440 • Marygrace Berberian
across the U.S. School- based art therapists are encouraged to showcase the merits of
the profession through parent workshops, professional development, and school- wide
initiatives. Testimonials by art therapists, school mental health sta, and teachers at city
and state hearings on public education help to raise the prole of school- based art ther-
apy. As letters from constituents can inuence government ocials, the NYU program
distributed sample letters to school communities to support the expansion of art therapy
in New York State public schools.
On the micro level, the school art therapist must remain mindful when establishing
a new role on the faculty. To initiate programming in a school or district, it is most
eective to partner school- based art therapy services with a university or community-
based organization; this capitalizes on the trust the institutions have already established.
Generous eort should be invested in cultivating relationships with other school mental
health practitioners to show that art therapy would complement rather than compete
with existing services.
e art therapist can provide in- service trainings for sta. It is best to not to disguise
art therapy services by calling them some other name in an attempt to avoid stigma
associated with mental health interventions. Practitioners should share information
about the scope and goals of art therapy with parents and teachers. Clinicians must
also maintain guidelines for condentiality; well- intentioned teachers and parents may
be curious about the content of art therapy sessions, assuming the art reveals hidden
answers. Art created in art therapy should be considered part of the treatment record
and protected by HIPAA standards. It is helpful to engage both the parent and teacher
in the student’s treatment through a cooperative relationship.
As a mediator between parents and teachers, the school art therapist may have to
negotiate conict. While open lines of communication can help to support the student
in need, the demands of each party can be contradictory and overwhelming. e push
and pull of each side forces a great amount of negotiation and limit setting. Oen this
mediating role requires that the school art therapist confront both parents and teachers
and challenge their decisions about the student’s well- being. While the problems can
oen feel insurmountable, the rewards are evident in positive student outcomes.
e intimacy and condentiality of art therapy treatment can be novel in school
environments, which oen showcase student achievement. Art created in sessions
should be considered with great sensitivity and only displayed when requested by the
students. In cases of expressively volatile work, the art therapist will need to confer
with the student to discuss the potential vulnerabilities of having classmates view art
created in sessions.
Full awareness of the academic culture is critical for the school- based art therapist.
Administrators, teachers, and even parents may focus heavily on school performance.
School personnel may prioritize academic success at all costs, which diers from the
more holistic goals of the school art therapist. e therapist can respectfully oer psy-
choeducation to advocate for modications in the classroom when social and emotional
impediments are identied. By aligning with the classroom teacher, the school art ther-
apist can devise classroom interventions that support academic performance while also
cultivating emotional resilience.
Conclusion
Schools were originally established to teach. e work of educators in public schools has
widened to include more than academics. Issues from home and social environments
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children and adolescents. Retrieved from http://ebookcentral.proquest.com
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School- Based Art erapy • 441
oen impede a child’s academic performance. In order to learn, children may need help
with their cognitive, behavioral, emotional, or social problems. Building capacity for
resiliency in students requires attention to psychological well- being and interpersonal
skills. School- based art therapy provides immediate, accessible intervention to address
the acute and chronic stressors that impede the development of students. e NYU Art
erapy in Schools Program oers a model to support students as soon as mental health
symptoms are noticed, cultivating collaboration between the student, teacher, and par-
ent. Schools, as familiar and trusted centers in the community, are also well- equipped
to deliver communal interventions when mass violence occurs. Structured, community-
based art therapy interventions provide a venue for collective expression, normalizing
responses, and identifying those in need of more intensive care. As students continue to
face adversity in their families and communities, school art therapy cultivates creative
solutions, providing a renewed sense of agency and resolution. Greater expansion of
school art therapy in public education can help to address growing mental health needs.
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