Art Therapy

Description, benefits, techniques, research findings, session structure, certification, suggestions for social work.

Four sections follow:

1.      Background Material that provides the context for the topic

2.      Suggestions for Practice

3.      A list of References

4.      Appendix: Research findings from Gray (2022)

Feedback welcome!

Background Material

Definition / Description

Art therapy is the use of art making within a professional therapeutic relationship. It is a form of psychotherapy adaptable for use with various client groups ranging across the entire lifespan. The power of art therapy is in its capacity utilise the nonverbal processes of art-making to help people express and integrate their life experiences (Walsh, 2012). The American Art Therapy Association defines art therapy as a mental health profession in which clients, facilitated by the art therapist, use art and the creative process to explore emotional conflicts, foster self-awareness, manage behavior and addictions, develop social skills and increase self-esteem. The association goes on to say, the goal is to improve or restore a client’s functioning and his or her sense of personal well-being (Gall et al., 2015).

People have been relying on the arts for communication, self-expression, and healing for thousands of years. Art therapy is a tool therapists use to help clients explore their emotions, understand conflicts or feelings that are causing them distress, and help them find resolutions to those issues.  Clients are encouraged to put their inner thoughts and emotions into a tangible, external form through a creative process conducted in a safe and supportive environment, without fear of judgment or criticism.  This can help to promote emotional healing, reduce stress and anxiety, and develop a deeper understanding of one’s own thoughts and behaviours (Cherry, 2024; Feeney, 2024; Thinkahead, 2023). 

Art therapy, like other expressive arts therapy, such as dance therapy or music therapy, draws on creativity.  The underlying concept in art therapy is to better enable clients to understand and respond to their emotions and thoughts by using a new perspective.  Art therapy is a technique rooted in the idea that creative expression can foster healing and mental wellbeing (Cherry, 2024; Feeney, 2024; Thinkahead, 2023).

Art therapy has the unique ability to unlock emotional expression by facilitating nonverbal communication. This is especially useful in cases where traditional psychotherapy has been ineffectual. Art and art making are inherently perceptually and sensory based and involve the brain and the body in ways that verbal language does not.   The art therapist follows both the process of creation and the resulting artwork and engages withs the client on struggles experienced with social relationships, low self-esteem, or other sources of emotional or psychological pain. The objective is to improve confidence, cope with addictive behavior, lower anxiety, and restore effective social functioning (Flynn, 2019).

Benefits

Art therapy can be used to treat a wide range of mental health disorders and psychological distress. In many cases, it might be used in conjunction with other psychotherapy techniques such as group therapy or cognitive-behavioral therapy (CBT).  Clients who have experienced emotional trauma, physical violence, domestic abuse, anxiety, depression, and other psychological issues can benefit from expressing themselves creatively.  Some conditions that art therapy may be used to treat include:

•       Addiction

•       Aging-related issues

•       Anxiety

•       Cancer

•       Depression

•       Dementia

•       Eating disorders

•       Emotional difficulties

•       Family or relationship problems

•       Grief and loss

•       Medical conditions

•       Obsessive Compulsive Disorder (OCD) and perfectionism

•       Psychological symptoms associated with other medical issues

•       Post-traumatic stress disorder (PTSD)

•       Psychosocial issues

•       Relationship issues

•       Self-harm

•       Stress

•       Substance use disorder (Cherry, 2024; Thinkahead, 2023).

Some specific situations in which art therapy might be utilized include:

•       Adults experiencing severe stress

•       Children experiencing behavioral or social problems at school or at home

•       Children or adults who have experienced a traumatic event

•       Children with learning disabilities

•       Individuals living with a brain injury

•       People experiencing mental health problems (Cherry, 2024; Thinkahead, 2023).

Potential Negative Effects

Art therapy is not for everyone.  While high levels of creativity or artistic ability aren't necessary for art therapy to be successful, many adults who believe they are not creative or artistic might be resistant or sceptical of the process. Also, art therapy is not effective for all types of mental health conditions, e.g. schizophrenia (Cherry, 2024).  Furthermore, art therapy, like other forms of therapy, can have negative effects.  It can result in:

• Higher levels of stress or anxiety

• Surfacing emotions without effectively processing them

• Difficulty coping if therapy is abruptly terminated.

If art therapy is ineffective, it means that the patient's issues cannot be fully addressed. This often increases the patient's distress and may even make a patient resistant to other, better-suited forms of therapy.  Patients with serious mental health conditions should consider adding art therapy to their treatment rather than using only art therapy (Feeney, 2024).

Huss and Sela-Amit (2018) have similar concerns.  They warn that the arts may not be suitable for all clients.  Asking someone who might feel that she or he has failed in life to create art even though she or he is not an artist might be experienced as yet another area of failure. Furthermore, asking a grown person who is not an artist to draw or use another form of art might be experienced as infantilizing and therefore disrespectful. Clients might also fear that their art will be used to diagnose them because the arts can indeed become legal proof of psychiatric, illegal, or abusive behavior.  Additionally, social workers might not have the skills to guide clients to create aesthetically pleasing and effectively communicative art products

Techniques

Art therapy techniques and goals can vary depending on the needs and preferences of each individual client.  Art therapists work collaboratively with their clients to develop a plan that meets their unique needs and goals.

• Free drawing or painting               Clients are encouraged to create whatever they feel compelled to express, without a specific prompt or direction.

• Guided drawing or painting         The therapist provides a prompt or theme to help clients focus their artwork. This can be helpful for clients who have difficulty expressing themselves or need a starting point.

• Collage         Clients cut out images from magazines or other sources and arrange them on a page to create a visual representation of their thoughts or feelings.

• Clay or sculpture               Clients use clay or other materials to create a three-dimensional representation of their emotions or experiences.

• Sand play              Clients use a tray of sand and miniature figurines to create a scene that represents their thoughts or emotions.  This technique is often used with children.

• Metaphor and symbolism              Therapists may ask clients to explore the metaphors or symbols in their artwork to gain insight into their feelings or experiences.  For example, a client might draw a tree with deep roots to represent their feelings of stability and security.

• Visual Journaling               Involves creating a visual diary or journal using a variety of art materials.  It helps individuals to process their emotions and experiences through creative expression.

• Mindfulness-Based Art Therapy            Combines mindfulness practices with art therapy to promote relaxation, emotional regulation, and self-awareness.

• Narrative Art Therapy    This technique involves creating a visual story using art materials. This can be helpful in exploring personal narratives and promoting self-expression.

• Expressive Art Therapy            Involves integrating multiple forms of creative expression, such as drawing, writing, movement, and music, to facilitate self-expression and exploration.

• Play-based Art therapy           Combines play and art to help children express their emotions and thoughts. It allows them to engage in a non-threatening and enjoyable activity while exploring their inner feelings.  This type of therapy encourages creativity, imagination, and self-expression, and can be a valuable tool for children who have experienced trauma or are struggling with emotional or behavioural issues.  Through play-based art therapy, children can develop coping skills and a sense of control over their lives, while building trusting relationships with their therapist (Thinkahead, 2023).

Research Evidence

While research suggests that art therapy may be beneficial, some of the findings on its effectiveness are mixed. Studies are often small and inconclusive, so further research is needed to explore how and when art therapy may be most beneficial (Cherry, 2024).  However, studies have shown that art therapy can help many mental health conditions that relate to mood, such as anxiety and depression, trauma, low self-esteem, and similar disorders. It is also effective for people with a serious health condition, such as cancer, and for people working to develop effective coping skills, including prison inmates. Art therapy can help people who are experiencing physical pain during hospitalization. It can be effective for post-traumatic stress disorder.  The evidence of effectiveness for serious mental health conditions is promising but limited,  possibly because art therapy is relatively new (Feeney, 2024).

A 2018 study with a group of adolescents (n = 37, age range 6 to 16, mean age 14.4 years) used surveys to gauge enjoyment and usefulness of a variety of creative activities groups and verbal psychotherapy groups.  Young people rated the creative activities and games group (54.05%) and the art therapy group (48.95%) as the two most enjoyable groups. Young people also expressed their dislike for verbal psychotherapy groups (43.24%), finding these ‘boring’, ‘unhelpful’, or ‘confronting’ relative to other modalities in the programme.  Art therapy was reported to be the most helpful group overall (45.65%), and was the only group which was reported as both enjoyable and helpful by nearly half of all respondents. The authors suggest that using creative arts-based elements has potential to enhance consistent engagement in adolescent groups, something fundamental to their effectiveness as these groups generating interest and build rapport with the therapist (Versitano et al., 2024).

In 2022 Gray summarised the research around art therapies that was published between 2013 and 2021 finding several large scale reports have been produced which demonstrate the usefulness of creative arts therapy to improve both mental and physical health. These include an entire edition of the peer-reviewed journal, Frontiers in Psychology dedicated to the matter, a systemic literature review by Hu, et al. (n=413), evidence provided in the largest report of its kind by the World Health Organisation (WHO), the Oxford textbook of creative arts, health and wellbeing and a systematic literature review (n=78) published by the Psychotherapy and Counselling Federation of Australia (PACFA).

• Hu, et al., 2021  Art therapy affords opportunity for non-verbal expression and develops safe spaces for intrapersonal and interpersonal connection. It demonstrates positive outcomes in cancer treatment, autism, dementia, and cognitive impairment.  Positive outcomes, including reduction of distress and suffering, have also been demonstrated with mental health concerns such as depression and anxiety, particularly when articulating experiences can be challenging.   

• THE WHO REPORT (2019)            This report, the largest review taken regarding the impact of arts on health and wellbeing, showed the arts (in all modalities) have a significant impact on health and wellbeing at different stages across the lifespan and across a variety of physical and mental health conditions.  

• PACFA REVIEW (2013)   The Psychotherapy and Counselling Federation of Australia (PACFA) undertook a literature review (2013) pertaining to the effectiveness of expressive art therapies. The review focused on quantitative research with rigorous selection criteria (n=281 articles with exclusion of n=203 to ensure robust data: review n=78). 

  • Key findings demonstrate the efficacy of art therapy for a range of physical conditions including cancer, managing terminal illness, asthma, dementia, and children diagnosed with autism spectrum disorder

  • Key findings demonstrate the efficacy of art therapy for a range of mental health conditions including depression, emotional eating, anxiety, and stress

  • Art therapy demonstrates positive outcomes in mental health, asthma and assisting with emotional management pertaining to breast cancer

  • Dance/movement therapies demonstrated positive outcomes for people managing schizophrenia, cancer, depression, stress, emotional eating and dementia

  • Drama therapy provided sound outcomes for assisting school students with behavioural problems and emotional self-regulation.

Gray (2022) lists the results of specific studies into the efficacy of art therapy in a number of areas across physical health (specifically cancer, cognition and chronic pain), mental health (specifically depression, anxiety, stress and trauma), and with children and young people in school environments.  More detail about the results of these studies can be found in the Appendix that follows the References section.

Another review of quantitative studies measuring outcomes in the art therapy field from 2000 to 2017 (Regev & Cohne-Yatziv, 2018) came to conclusions similar to the Gray study in the areas of cancer and mental health.  While noting that CBT was the most effective for clients coping with schizophrenia, the study also found promising evidence for the use of art therapy for prison inmates and the elderly.  The authors qualify their conclusions by noting that the number of studies addressing each population is small and differ in many aspects but, nevertheless, see the emergence of such studies as an encouraging sign.  

Art Therapy Sessions

Art therapy can take place in  a variety of settings; it does not require a person to be artistic.  It is not an ‘art class’, i.e. it is not focused on creating a specific finished product; rather, art therapy is more about letting clients focus on their inner experience.  Clients are encouraged to create art that expresses their inner world more than making something that is an expression of the outer world (Cherry, 2024; Thinkahead, 2023).

Clients can engage with an art therapist in a one-on-one session or as part of a group.  One-on-one sessions are typically held weekly or fortnightly and are for clients who want to commit to more consistent art therapy sessions.  A group program can consist of weekly one-hour sessions for a limited time.

During the first few sessions, art therapists will likely ask the client about health background as well as current concerns and goals. After explaining the goal of art therapy, therapists may also suggest a few themes to begin exploring via drawing, painting, sculpting, or another medium.  They will ensure clients realise they do not have to think of themselves as creative or artistic to benefit.  During a session, the art therapist works with clients to understand what is causing them distress. The therapist may ask questions about the art and how it makes the client feel. For example: What were you thinking while doing the art?  Did you notice a change of mood from when you started to when you finished? Did the artwork stir any memories? The therapist will discuss the results, both the work of art and what the client felt.  The session will conclude with planning for another session, or for the client to work on their own (Cherry, 2024; Feeney, 2034).

The Arts and Social Work

Flynn (2019) suggests that social work and art have a common connection through their connection to creativity.  Social work can be considered primarily subjective in nature, drawing on creativity in much the same way as creating art does as the basis for giving organized meaning to the experience of their clients.  In other words, the act of creativity is central to the “work” of social workers and lies at the heart of social workers’ ability to imagine their client’s world.  A social worker’s skill rests in the degree to which the worker is effective in using language that communicates a subjective understanding of the client.  The social worker is not just a critic understanding the meaning and expression of others, but an artist giving expression to her or his own understanding in a way that others will value. 

Other authors also offer thoughts on the place of the arts in social work.  Huss and Sela-Amit (2018) suggest the arts have much to offer social work clients in terms of exploring and understanding the person in context.  When used skilfully by social workers, the arts can contribute to client resilience and empowerment. One example might be when a social worker discusses with his or her client the strengths depicted in their artwork.  The authors also suggest that shifting to visual language can result in power being transferred to the client, as it enables the client to better define the problem in symbolic, narrative and visual form rather than the worker using what can be abstract psychological and social concepts.

Regev & Cohne-Yatziv, in their 2018 review, were struck by the large number of articles which appeared to present interventions in the field of art therapy, but in fact were conducted by non-certified art therapists or were restricted to a therapeutic intervention of a single session in a manner that would not be considered therapy. The authors suggest there is a need to define, clarify and specify what art therapy is and what it is not, and specifically to clarify that this type of therapy must be composed of ongoing sessions and be conducted by a certified art therapist who meets the criteria defined for the profession.  Following this theme, Klammer (2017) distinguishes between expressive arts facilitators and art therapists. 

Art facilitators, who might be intuitive/expressive artists, counsellors, academics, psychologists, social workers, teachers, nurses, and other helping professionals, provide a space for people to experiment with spontaneous art, poetry, dance, sculpture, music and more. Critiques are never made about the aesthetics or meaning of the art. Participants are invited to express their honest thoughts and emotions, as they relate to their creative self-expression, in an atmosphere of unconditional acceptance.  Expressive arts facilitators that do not have therapy training tend to focus on providing strength-based, hope-inducing directives and do not offer therapy. Therapy involves working with a therapy professional to resolve problematic behaviours, beliefs, feelings, relationship issues, and/or somatic responses and is the domain of art therapists who are trained in both art and therapy. 

Art therapists are knowledgeable about human development, psychological theories, clinical practice, spiritual, multicultural and artistic traditions, and the healing potential of art. They use art in treatment, assessment, and research, and provide consultations to allied professionals.  Art therapists work with people of all ages: individuals, couples, families, groups, and communities. They provide services, individually and as part of clinical teams, in settings that include mental health, rehabilitation, medical and forensic institutions; community outreach programs; wellness centres; schools; nursing homes; corporate structures; open studios and independent practices.

Art Therapy Certification

Some mental health professionals will add art therapy activities and other creative approaches to supplement traditional talk therapy.  Art Therapy certification is not needed to use these methods, but it is needed to claim status as an art therapist speciality. To obtain art therapy certification, one must become a provisional registered art therapist or a registered art therapist (ATR).  To become an ATR, a person must have a master's degree (including an internship and practicum) in art therapy or a related field, coursework in art therapy, and be currently practicing independently as an art therapist (Feeney, 2024).  This appears to be consistent across Australia, the UK and the USA.  For example, Google AI suggests the following:

• To become a qualified art therapist in Australia, you typically need a master's degree in Art Therapy, which includes at least 750 hours of supervised clinical placement, and registration with ANZACATA (Australian, New Zealand and Asian Creative Arts Therapies Association). 

• To become a registered art therapist in the UK, you need to complete a postgraduate qualification (typically a master's degree) in art therapy or art psychotherapy, approved by the Health and Care Professions Council (HCPC), and then register with them.

• To become a certified art therapist in the US, you typically need a master's degree in art therapy or a related field, complete the required coursework and supervised clinical hours, and pass the national Art Therapy Credentials Board (ATCB) examination to become a Registered Art Therapist-Board Certified (ATR-BC). 

Suggestions for Practice

Jackson (2015) provides a rationale for including art in social work practice.

There's no human endeavour that can't be improved with a little creativity, and social work is no exception. Social work is also an art, and it is imperative for social workers to recognize their clients' unique history, strengths, and culture. The arts offer the means to reach and validate clients by allowing them to tell their stories in a variety of ways. This is a respectful and strengths-based approach.

While social workers can draw upon any number of talk therapy techniques to help their clients, there are times when talk isn't helpful or can't be summoned. In such cases, the arts—visual art, music, dance and movement, drama, and poetry—can open a back door to the psyche, drawing from individuals that which they cannot yet put into words, thus catalysing subsequent therapeutic conversations. The creative arts offer social work clients a nonverbal way of expressing themselves and communicating their needs—cognitive, behavioural and affective.

In addition to facilitating communication, the arts also help clients forge relationships. Creative arts therapies are wonderful starting grounds for building a verbal and nonverbal trusting relationship between a client and therapist and, in group therapy, between members of the group. Working together on a project creates connections that gently allow clients to reveal parts of themselves to others for a richer interpersonal knowledge.

Any of the creative arts modalities may be used as a primary form of therapy or an adjunct to other modalities to improve the physical, cognitive, and psychosocial well-being of individuals with psychiatric disorders, developmental disabilities, neurological diseases, physical disabilities, and medical conditions, and may be practiced in the entire spectrum of therapeutic settings.

Becoming a certified art therapist requires additional study at master’s level and, after a period of supervised clinical placement, registration with an Art Therapist Association.  As art therapy is a specialised psychotherapy not usually included in social work education, social workers who intend to use art, or other creative arts therapies, as their primary way of practising with clients, should qualify as an accredited art therapist. 

However, there appears to be a place for social workers who are personally comfortable with the creative arts to utilise them in their practice as a means of building rapport, relieving the stress some clients may feel when required to engage in verbal interactions with a therapist, and to highlight a clients strengths.  Using art may be particularly useful when supporting children.

This aspect of the social work role is referred to as that of an arts facilitator (Klemmer, 2017), or as art as therapy (as opposed to ‘art in therapy’) by Gray (2015).   Drawing is the main focus in the art as therapy approach where clients may describe how the drawing relates to their life, providing a springboard to explore further themes and addressing the issue at hand.  Using an ‘art in therapy’ approach involves delving deeply into the unconscious message behind the drawing using various psychotherapy techniques. 

As an art facilitator, social workers can use art as a way of enabling some clients to more easily and clearly express their thoughts and emotions.  It can be used to enable nonverbal communication, to build rapport between worker and client, and enable the worker to gain a more comprehensive understanding of the client and her or his issues as well as highlight the client’s strengths.  Creating art could form part of the initial assessment (BPSS) process used by social workers and inform the plan of action ultimately discussed with the client.  Points similar to this are made in the Background Material section above.  For example:

• Discussing artwork can be used to highlight the strengths of a client as a way of opening up discussion of other  issues facing the client.

• The shift to visual language can transfer power to the client as it enables the client to define the problem.

• While using art in one’s practise may not be suitable for all clients, the worker may find one of the many art techniques that are available that a client is comfortable in using so communication can move from verbal to nonverbal.

In summary: if attracted to using art as a medium for working with clients, becoming accredited as an art therapist would seem to be the appropriate way.  However, there appears to be a place for social workers who are personally comfortable with art to utilise art-making in their practice as a means of building rapport, enabling the client to more easily describe and discuss their situation, and in work with children.

References

Cherry, K. (2024). What is art therapy?  Verywell mind.  https://www.verywellmind.com/what-is-art-therapy-2795755

Feeney, A. (2024). What is art therapy?  https://www.psychology.org/resources/what-is-art-therapy/

Flynn, M. L. (2019). Art and the social work profession: Shall ever the twain meet?  Research on Social Work Practice, 29(6), 687-692.  doi: 10.1177/1049731519863109

Gall, D. J., Jordan, Z., & Stern C. (2015). Effectiveness and meaningfulness of art therapy as a tool for healthy aging: A comprehensive systematic review protocol.  JBI Database of Systematic Reviews and Implementation Reports, 13(3), 3 – 17.  doi: 10.11124/jbisrir-2015-1840

Gray, D. (2022). The proven efficacy of creative arts therapies: What the literature tells us. The Australian, New Zealand and Asia Creative Arts Therapies Association (ANZACATA). Melbourne, Australia.  https://anzacata.org/home

Gray, R.  (2015). The art of healing and healing in art therapy.  InPsych, 37(3).  https://psychology.org.au/inpsych/2015/june/gray#

Huss, E., & Sela-Amit, M. (2018). Art in social work: Do we really need it?  Research on Social Work Practice, 29(6), 721-726.  doi: 10.1177/1049731517745995

Jackson, K. (2015). Beyond talk: Creative arts therapies in social work.  Social Work Today, 15(2), 22.  https://www.socialworktoday.com/archive/051815p22.shtml 

Klammer, S. (2017).  What is expressive arts facilitation?  https://intuitivecreativity.typepad.com/expressiveartinspirations/2017/10/differences-between-expressive-arts-facilitation-and-art-therapy.html 

Regev, D., & Cohne-Yatziv, L. (2018).  Effectiveness of art therapy with adult clints in 2018: What progress has been made?  Frontiers in Psychology, 9, 1531.  doi: 10.3389/fpsyg.2018.01531

Thinkahead.  (2023).  Art therapy.  https://www.thinkahead.com.au/individuals-children-families/art-therapy/

Versitano, S., Butler, G., & Perkes, I. (2024). Art and other group therapies with adolescents in inpatient mental health care.  International Journal of Art therapy, 29(2), 80-87.  https://doi.org/10.1080/17454832.2023.2217891 

Walsh, D. (2012). A sense-able approach to art therapy: Promoting engagement for a child with developmental difficulties.  Australia and New Zealand Journal of Art Therapy, 7(1), 26-41.  https://www.jocat-online.org/ex-mixed-methods

Appendix

Gray, D. (2022). The proven efficacy of creative arts therapies: What the literature tells us. The Australian, New Zealand and Asia Creative Arts Therapies Association (ANZACATA). Melbourne, Australia.  https://anzacata.org/home

What the Literature Tells us

Art Therapy research literature suggests the following outcomes for clients who engage in art therapy with a certified art therapist.

Physical health

Cancer treatment

Significant improvement in social connection and support which has been demonstrated in other studies to improve wellbeing and emotional health in cancer sufferers.

Increased ability to cope with a variety of psychological symptoms.

Art therapy provided opportunities for expression and communication, resulting in a reduction of both psychological and physical symptoms.

Decrease in anxiety and tiredness levels, in levels of drowsiness and in anxiety.

Cognition

Positive outcomes for development of executive functioning, social awareness, and engagement with others.  Improvement in abilities of creativity and imagination.

Art therapy improves the following: overall visual-cognitive skills, visual exploration strategies and general motor functioning.

Art therapy was found to improve the ability to engage others and have assertiveness in social encounters.

Chronic pain

Drawing had positive impact on pain levels, resilience development and other psychosocial factors.  Significant results in the areas of pain, depression, anxiety, experiences of helplessness and improvementin relationships.

Mental health

Depression

Findings suggest short-term art therapy may be a beneficial treatment for women experiencing mild depression and stress-related symptoms.

Significant reduction of symptoms in art therapy participants compared to control group and this finding supported at six-month follow-up.  Significant improvements in suicidal ideation comparative to baseline

Anxiety

Our review confidently supports art therapy as a highly effective intervention for anxiety, depression and fatigue.

Using mindfulness-based art therapy showed improvements across psychological symptoms of anxiety and depression and also physical fatigue.  Results demonstrated engaging with art therapy to be positive for both quality of life and wellbeing outcomes

Stress

Art therapy had positive effect and decreased stress levels of participants.

Group art therapy reduced stress levels and increased quality of life for participants.  Results remained statistically significant at four-week follow-up.

Trauma

Art therapy was helpful for veterans in processing trauma.  Participants who engaged with art therapy experienced improvements in depression, anxiety, and significant improvements in overall general quality of life.  Participants also experienced improvements in self-image and cognitive functioning (being able to combine ideas, represent stories as basics for effective cognition and creativity)

Art therapy is beneficial in PTSD recovery, demonstrating: ability to process trauma and improvements in self-image.

Children and young people

School environments

A statistically significant improvement for social, emotional, and behavioural difficulties was found.

Art therapies assisted with emotional expression, bonding and relationships, empathy and optimism.

Significant improvements in sleep, and emotional and behavioural health.

Results demonstrate significant improvement in emotional health.

Some effect on reduction in challenging behaviours.

Both children and teachers considered art therapy to assist with classroom engagement and learning.

Art therapy was helpful in both peer and teacher–student relationships.

Creating safe spaces, designed to be social, fun, and engaging, is recommended to promote coping strategies and self-expression.

Encouraged sense of fun, connection, and safety for those involved.

Results demonstrated significant effects on inattention (i.e. lower inattention scores post-test) with the drawing group.

Creative art therapy interventions improve child wellbeing with results supported at three, six and twelve-month follow-up.