Art Therapy: A Proposal for Inclusion in School Settings

Art Therapy is a term that has been used to describe widely varying practices in education, rehabilitation, and psychotherapy. Essentially, Art Therapy is the therapeutic use of art making to promote healing and growth in a professional relationship. Art Therapists are Masters-level professionals who have extensive knowledge of, and are able to practice, counseling theories and techniques with people of all ages, in a variety of settings including schools.

Functions of the Art Therapist
The responsibility of an Art or Expressive Therapist within a school setting is to help students express and contain their internal conflicts, while facilitating their ability to implement change (Frostig & Essix, 1998). School Art Therapists collaborate with the teaching and counseling staff as well as parents, to establish treatment goals and objectives that are appropriate within a school system. They offer both individual and group counseling. Art Therapy in schools is generally used for special education students who have difficulty in the setting as a result of learning disabilities, behavior disorders, emotional disturbances, or physical handicaps which impair gross and fine motor control. An initial AT assessment is a primary part of this process, in which a student’s strengths and weaknesses are explored. To further describe this process, it is useful to discuss the typical development of children’s drawing skills.

Developmental aspects of children’s drawings
In 1947 Victor Lowenfeld published the book Creative and Mental Growth in which he connected intellectual growth, psychosocial stages of development, and six stages of development in children’s drawings. Cross-sectional studies conducted by Kellogg (1970) also support the conclusion that children progress in drawing through different stages that fall into predictable age groups as follows:

Scribble Stage
The scribbling stage appears at about eighteen months to two years of age. According to most researchers, this scribble is not just aimless motion created at random by the child, but demonstrates an awareness of pattern and growing hand-eye coordination. (Silk & Thomas, 1990; Lowenfeld & Brittain, 1987)

Soon after children start scribbling, they will start to name what it was they drew after they have finished drawing it. Around two years of age, children will sometimes label their drawing before they have started working on it, but if the drawing looks like something else to them, they may just change the label. Their scribbles progressively become more recognizable and separate shapes appear on the same page. At around three and a half years, children begin incorporating details like fingers on hands. (Silk & Thomas, 1990; Lowenfeld & Brittain, 1987)

“Pre-Schematic” Stage
The next stage of drawing, identified by Lowenfeld as the “Pre-Schematic” stage, typically occurs between four and seven years. In the emergence of this stage, children may draw a human figure with a circle and two dangling lines for legs. Sometimes they include a rectangular shape for trunks of bodies, and often little marks inside the circle to represent facial features. This tadpole schema is used for animals as well as people. Drawings at this level are often described as symbolic realism because a child is perfectly happy with a simple symbol of an object. (Silk & Thomas, 1990; Lowenfeld & Brittain, 1987)

“Schematic” Stage
The “Schematic” stage of drawing generally occurs at ages 7-9. Some characteristics that commonly occur in this stage are indicative of what the child is thinking versus what is actually seen by the child. An interesting phenomenon that occurs in many children’s drawings during this stage is called “x-ray drawing”. In these, a child will draw things that aren’t really visible in life. A good example of this is a man on a horse with both legs showing, even though we would really only see one. Pregnant women are often shown with a visible baby in their abdomens. Details like hands, fingers, and clothing are added with greater and greater frequency. (Silk & Thomas, 1990) As they progress further, overlapped objects, such as a tree partially obscured by the edge of a house, also emerge. The farther away something is, the smaller it will be portrayed, regardless of the real relationship in size between the objects. This indicates a growing comprehension of perspective. In many cases, children have begun using one-point perspective. (Silk & Thomas, 1990; Lowenfeld & Brittain, 1987)

“Dawning Realism” Stage
Around the age of nine or ten, children’s drawings become increasingly standardized. An emphasis on depicting how things really look can begin to frustrate them. This is referred to as the “Gang Age” or “Dawning Realism.” Children will often bring comic strip figures or commercial logos into their drawings and it is at this point that many children lose interest in drawing, as they become dissatisfied with their results. Adults often draw at this level or slightly below because this is where they ended their art education.

A Typical Art Therapy Assessment
Typically, an Art Therapy assessment involves the therapist’s giving the client a series of five or six art tasks, using a variety of media. These tasks relate to the student’s perception of self, his or her family, and school, or other aspects of their environment. These drawings and the student’s behavior while approaching this task are then evaluated along with developmental, family, and academic history. It is important to note that children’s progress in drawing differs significantly across the cultural spectrum. A person who uses art as an assessment tool needs to be familiar with the art children are exposed to and the culture they are from, before making an evaluation.

Because children’s drawings can be segmented into specific stages, it is possible to distinguish when a child is specifically behind age level, or in rare cases such as with certain types of autism, significantly ahead. In the case of learning disabled children whose intelligence may not be fully measured on standardized tests, it is sometimes found that they have significantly advanced creative and visual intelligence in drawing tasks. (Silver, 2001) Those students may benefit from a visual component to enhance learning.

How Deviations from the Norm may Appear
Many children will express internal conflicts with variations in drawing style and developmental level. Low self-image is often expressed in drawings in which the child draws himself in a regressed manner, but other objects and people in the composition will be drawn at a more age-appropriate level. A domineering parent may be expressed much larger in comparison to the other family members. Often, family divisions as seen by the child will show up in the way he or she groups the members in a drawing. For example, drawings in which body parts such as arms or legs are left out, when the child is known to be capable of appropriate representation, can be indicative of denial. Another variation is having the appendages drawn too small to be of any use, and may symbolize the child’s feeling of powerlessness about the events happening around him or her. A depressed child may choose to use only a pencil, and make a minimal amount of investment. Children who have ADHD will often use heavy scribbling, and might portray themselves incredibly small in a classroom but normal sized on a playground.

There is no Art Therapy manual that provides a concrete key on how to interpret drawings; however, a perceptive individual with an art background and knowledge of clinical principles is able to interpret the subliminal messages children express in their work.

Bridget: Art Therapy in Action
The following case illustrates some basic principles of Art Therapy practice. Bridget was a five-year-old girl who attended a small kindergarten class, which consisted of a blend of “normal students” and students with special needs. She was referred to Art Therapy by her mother and teacher because of her screaming fits during transitions of any type and her oppositional behavior at school and at home. Bridget lived with her mother and two older siblings, one of whom was prone to violent outbursts towards the family. Before she was born, her father had been removed from the home molesting her siblings.

Bridget’s Initial Assessment
During the initial assessment, I asked Bridget to draw a picture of herself. She responded by drawing a very small circle. She then drew her mother around the circle, and stated “This is me inside my mom’s belly. She is pregnant”. The overall figure is very small, isolated, and ungrounded (Figure 1). Behaviorally, she alternated between acting out and seeking physical contact and approval, reminiscent of a 2 year-old’s “Separation-Individuation” process.

Figure 1. Bridget’s Initial Self-image

Her background history described her as functioning at the emotional level of a three-year-old, based on her mother’s report of what she had been told by an early intervention program and her own experiences with Bridget. Her teacher, however, reported that she performed within the expected range on academic tasks. All five artworks she did for me during this assessment reflected an age appropriate pre-schematic level of development, confirming her teacher’s assessment of Bridget’s cognitive development. The theme of her drawings, however, suggested to me that she was in the midst of the psychosocial task of “Individuation”, which is normally achieved around three years of age. I felt that her drawing in Figure 1 in particular, portrayed her sense of self as still merged with the identity of her mother.

My first objective was to support Bridget’s development of a schema of self that was separate from her mother. Emphasis was placed on her forming an opinion about things, such as her favorite color. Her mother supported this by offering simple choices when possible at home where either choice was correct. In her early treatment, Bridget avoided conversation and preferred to sing phrases repetitively that related to her process or her relationship with me.

During this initial stage of treatment, she showed a low tolerance for frustration and had tantrums frequently. To help her learn problem-solving skills, art tasks were broken down to simple shapes that she then could combine to form a schema of a person. She would eventually learn that mistakes in one element did not mean the whole piece had to be destroyed.

Bridget’s Progress: Two Steps Forward
During the middle phase of treatment, Bridget stated “I want to draw a picture”, and used this time to draw a picture of herself. She said “This is me in my beautiful dress”. (Figure 2)

Figure 2. My Beautiful Dress

She easily drew this more advanced, individualized representation of herself, and displayed none of the frustration that had been evident during previous sessions.

As an afterthought, she began an image of her mom, stating “She is small because she is far away.” This represented a precocious leap in graphic development because she verbalized a beginning understanding of perspective. It also graphically expressed a successful separation from her mother. Through this image, she expressed pride in herself as an individual while, at the same time, sadness that her mother was far away. The finished picture presented an honest portrayal of a young girl in a beautiful dress.

When she mastered the ability to represent herself in drawings, my treatment approach expanded to include a broader range of symbols, which increased her ability to express herself graphically. She responded to this with an increase in her verbal expression as well. She progressively became more talkative about her family and began making reports about her brother’s physical violence towards her and her sister. She displayed little emotion while talking about her brother; however she made physical complaints, such as “My neck is bad and my stomach hurts.”

I conducted a projective test to see if she would express emotion graphically that she was not expressing facially or verbally. The test I used was the Rawley-Silver’s (1987) “Draw a Story” (DAS). This test is administered by providing the student with 14 different stimulus cards. The student is told to select two pictures, and then draw and narrate a story based on those subjects. The responses are rated for emotional content, and assigned numerical values.

Is This A Step Back?
Bridget’s themes were self-destructive. She drew and narrated two images. For the first (Figure 3), she drew a regressed princess who stabbed herself with a knife and died.

   Figure 3. Suicidal Princess


In the second (Figure 4), she drew the princess in a tornado, and stated “She is screaming because she is in a tornado and she will die.”

Figure 4. Princess in a Tornado

Because her behavior outside of session was continuing to improve, I felt she had established enough trust in me to use our session time to channel her inner turmoil that had always been present. This increase in her ability to discuss her family dynamics coincided with an increase in frustration tolerance for risk-taking and accepting perceived imperfections in her artwork.

Treatment Conclusion: Bridget’s Next Steps
Near the end of treatment, she made this engaging drawing of a neighborhood cat walking upstairs to go into a house. (Figure 5).

  Figure 5. Neighborhood Cat

She cheerfully drew the image and displayed no frustration over any element within the drawing. She talked about how she liked the cat. The image does contain an environment and tells a story on its own, which demonstrates a clear progression into the next developmental stage of drawing.

I believe this expressive therapy was extremely helpful for Bridget because she began treatment in a primarily non-verbal mode. She was able to use the process in combination with the structure provided by her teacher to achieve greater individuation. She also learned to use the art process to express her inner turmoil in a safe way with an adult, and this enabled her to behave more appropriately in the school setting. By the end of the school term, she was well within the expected range of academic progress. Her psychological problems were so severe, however, that it was clear she would need continued help.

Data I collected helped clarify her problems, and the severity of those problems. The support she received from me and her teachers enabled her creative strengths to compensate for her emotional deficits. She did achieve significant developmental goals and a resulting sense of competence. Without that support, she may have continued to experience lowered self-esteem and a feeling of failure.

Why did creating art help Bridget?
The theories about why children play are much the same as why they draw, in that the child wishes to be grownup and in control. In this sense, drawing gives children a sense of mastery over the media, as well as the objects and situations they represent in their pictures. (Silk & Thomas, 1990). As a matter of fact, most people of any age have the ability to act out what they feel through play and art. They also have an ability to step out of these activities, to reflect on them, and to create new ideas that lead to healing (Dyer-Friedman & Sanders, 1997; Rubin, 1978). By creating a healthier image to represent herself, Bridget was then able to become more mature in her behavior.

Winnicott (1965) placed emphasis on “Transitional Space,” which is the distance children travel to explore new terrain before returning to their caregiver. The relationship between the therapist and child will mimic the transitional space the child has established with their primary caregiver. Winnicott also placed emphasis on a “Transitional Object,” which is usually a favorite toy to which children attribute characteristics of their primary caregiver. This transitional object is used by children to self-soothe when they are separated from their caregivers or during other transitions that cause anxiety. This process is linked to children’s growing creativity and their future ability to use play as a coping strategy.

Art products produced by a student during treatment can be used in much the same manner as transitional objects. The child learns to trust another person who is not the primary caregiver, can use the art process as a means of self-soothing, and can form an attachment in the context of the therapeutic relationship (Robins, 1987). In Bridget’s case, she was able to form an attachment to me, and then practice separation from me by taking progressively responsibility in her art process.

Conclusion: The Need for Expanded Art Therapy Involvement in Schools
The inclusion of Expressive Art Therapies in the school system is slowly increasing, as it becomes necessary to meet the rising needs of students who require more clinical assistance than can typically be provided by a teacher in a large classroom setting. Children entering the schools today face challenging problems that place them at risk for failure, and for many, school is the only place they are exposed to structure and safety. For others, the complex task of learning may be complicated by neurological deficits that cause learning disorders. These children are often rejected by their peers and can then suffer secondary symptoms of low self-esteem, depression, or acting-out behavior as a result of a primary learning disorder. As more schools begin providing services “in house,” these services can be much less costly than paying for education in specialized treatment centers.

Additional information about Art Therapy can be obtained from the American Art Therapy Association on the WWW at:


Dyer-Freidman, J, & Sanders, M. (1997) Child abuse. In H. Steiner (Ed.), Treating school-age children. (pp.189-214). San Francisco: Josey Bass Publishers.

Frostig, K. & Essix, M. (1998). Expressive arts therapies in schools: A supervision and program development guide. Springfield, Illinois: Charles C. Thomas.

Kellogg, R. (1970). Analyzing children’s art. Palo Alto, CA: National Press Books.

Kramer, E. (1993). Art as therapy with children. Chicago: Magnolia Street Publishers.

Lowenfeld, V. & Brittain, W. (1987) Creative and mental growth. New York: MacMillan Publishing Company.

Robins, A. (1987). ‘An object relations approach’ in J. A. Rubin. (ed.) Approaches to art therapy. Levittown: Brunner/Mazel.

Rubin, J. (1978). Child art therapy. New York: Van Nostrand Reinhold.

Silver, R. (2001). Art as language access to thoughts and emotions through stimulus drawings. Philadelphia: Brunner-Routledge.

Silver, R. (1987). Draw a story: Screening for depression and age or gender differences. Sarasota: Ablin Press Distributors.

Winnicott, D. (1965). The family and individual development. London: Routledge.

Silk, A. & Thomas G.V. (1990). An Introduction to the Psychology of Children’s Drawings. Washington Square, NY: New York University Press.  

About the Author:

  Eve Jarboe is a Masters of Art Therapy graduate from Marylhurst University, Oregon.  During her University programs in Oregon and Nebraska, she volunteered and worked in therapy-based roles in geriatric, crisis prevention, and school settings. She comes by her art interests “honestly” – her whole family is involved in the art process. She obtained her BA in Studio Arts from the University of Nebraska, Omaha prior to moving to Oregon. Eve currently resides in Lake Oswego, Oregon with her husband, a two-year old son, and three non-artistic and confused cats.  She may be reached by email at:

© September 2002 New Horizons for Learning

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