Art therapy is an intervention method that traditionally has drawn from psychoanalytic theory for its framework and procedures. A breadth of current art therapies, informed by a variety of theoretical paradigms, share a common procedure that uses creative art as a method for promoting expression and healing. Modern art therapists apply a procedure of creative art therapy that is appropriate to the psychosocial characteristics and psychological needs of their clients. As applied specifically to traumatized children, art therapy often (but not exclusively) includes the development of a therapist–client relationship through the creation of art, frequently coupled with storytelling (Coleman & Farris-Dufrene, 1996; Moschini, 2005 and Simonds, 1994). During the initial therapeutic sessions, a piece of art is completed. During this phase, the role of the therapist is to facilitate the creation of the art by providing appropriate tools (artistic media) and encouragement. When working with children, pencil drawing, coloring, painting, and clay are the most common media. As the sessions progress, the child might be asked to tell a story about his or her piece of artwork and the therapist facilitates the interpretation of that story. As the story unfolds, fantasy and reality are teased apart, leading to self-discovery and cathartic release, and the child is assisted in coping with the reality of the trauma and the accompanying emotions (Avstreih & Brown, 1979; St. Thomas & Johnson, 2002).
Although the practice of art therapy has been in existence for many years, until very recently, the efficacy of art therapy has not been empirically addressed (Reynolds, Nabors, & Quinlan, 2000). One reason cited for the absence of efficacy research is a lack of art therapists trained in experimental research methods (Tibbetts, 1995) and a historical lack of doctoral-level clinical psychologists trained in art therapy (Wadeson, 1995). Another obstacle to pursuing efficacy research is difficulties inherent in measuring outcome variables. Some art therapists maintain that the outcomes of interest to them, which tend to be abstract psychological constructs, may not be adequately measured by empirical methods (e.g., self-actualization) (Wadeson, 1995 and Wolf, 1995).
Despite these obstacles, several art therapists are pursing empirical efficacy research. A recent review uncovered five published randomized controlled clinical trials, four controlled (nonrandomized) clinical trials, and another eight single group (with no control group) studies that tested the efficacy of art therapy (Reynolds et al., 2000). Reynolds et al. explicated several experimental methods that could be employed to study the efficacy of art therapy. Furthermore, the authors noted a variety of outcome measures effectively used, which included measuring symptom reduction and overt behaviors, as well as abstract psychological constructs. For example, Fryrear (1988, cited in Reynolds et al., 2000), measured self-actualization, while several other studies measured constructions such as self-esteem. The studies Reynolds, et al. reviewed were quite diverse in sample demographics, art therapy media, length of therapy, and outcomes measured. Moreover, they varied with regard to the amount of information the researchers provided. Consequently, the authors of this review concluded that, although art therapy appears to demonstrate efficacy, in some cases the results were mixed.
In conclusion, Reynolds et al. (2000) called for more focused research in this area, specifically mentioning efficacy evaluation when art therapy is used to treat children who have experienced trauma. This gap in the literature is particularly unfortunate because many art therapists believe that the process of art therapy is especially successful when it is used with their youngest clients, because children are more willing to partake in imaginative articulation than adults (Avidar, 1995, Clements, 1996 and Davis, 1989; Kozlowska & Hanney, 2001; Pifalo, 2002 and Prager, 1995; St. Thomas & Johnson, 2002).
Sample demographics from the studies relevant to this review are displayed in Table 1. Using art therapy as a treatment method for childhood trauma was the focus of this study and the nature of the trauma these children experienced was categorized. The breadth of the traumatic events covered by the literature included childhood physical and sexual abuse, exposure to the violence of war, the World Trade Center 9-11 terrorist attacks, exposure to gun violence within a community, and grief following the loss of a loved one. Seventeen percent of the studies included samples of children who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR; American Psychiatric Association, 2000) diagnostic criteria for post-traumatic stress disorder. Fifty percent of the studies included samples of children who were not specifically diagnosed with a disorder but who had experienced some specified form of trauma (e.g., physical abuse, sexual abuse, or grief). Thirty-three percent of the studies included samples of children who had experienced trauma but the nature of the traumatic experience was unspecified or unclear in the research report.
