What is art therapy and how does it work?

Art therapy is a clinical and depth-psychological practice that uses the making of images — painting, drawing, sculpting, movement, music, sandplay — as the primary medium of therapeutic work, rather than verbal exchange alone. Its premise is that the psyche speaks first in images, and that giving those images physical form is itself a transformative act, not merely a preparation for talking about them.

The theoretical ground runs deep. Hillman (1983) argues that images are the psyche — not representations of it, not symptoms pointing beyond themselves, but the thing itself:

Soul-making is also described as imaging, that is, seeing or hearing by means of an imagining that sees through an event to its image. Imaging means releasing events from their literal understanding into a mythical appreciation.

From this vantage, art therapy is not decoration applied to psychotherapy. It is the psyche doing what it already does — making images — but now with conscious participation and a container. The art object becomes what Hillman elsewhere calls a "worked soul": something that has been plowed through, hammered out, given density and weight. Dream-work and image-work share the same logic: both convert the raw material of experience into soul-matter.

How it works in practice depends on which theoretical lineage is operating, but several mechanisms recur across traditions.

The first is bottom-up processing. Trauma and intense affect are often stored in the body before they reach language. Haeyen (2024) describes how creative arts therapies begin with sensing bodily signals — the felt texture of clay, the rhythm of percussion, the pressure of a brush stroke — which creates space for emotional and cognitive meaning-making that verbal approaches cannot always reach. The body is engaged first; interpretation follows, if it comes at all. This is why art therapy is particularly significant in trauma work: the implicit, embodied experience of trauma often defies narrative expression, and the sensory-based, action-oriented artforms provide a different portal.

The second mechanism is containment through form. The sandtray, the canvas, the lump of clay — these are bounded spaces. Dora Kalff, who developed sandplay therapy from Lowenfeld's World Technique and integrated it with Jungian symbol interpretation, called this the "free and protected space": the client is free to create whatever emerges, while the physical and relational container holds what might otherwise be overwhelming. The limitation of the tray is not a restriction on the psyche but a vessel for it.

The third is the image as interlocutor. Jung's practice of active imagination — which underlies much of what art therapy inherits — treats the figures and forms that emerge in creative work as autonomous presences to be engaged, not decoded. Johnson (1986) documents this vividly: a woman in dialogue with an inner figure discovers not a symbol to be interpreted but a being with its own needs, its own history of being "locked up," its own demands on her life. The art object externalizes what was interior and makes it available for genuine encounter. As Jung observed, the German betrachten — to look at — means also to make pregnant: concentrated attention activates the image, which then begins to shift and multiply.

The fourth is the therapeutic relationship itself. Haeyen (2024) draws on polyvagal theory to describe how co-regulation between therapist and client — synchronized rhythm, shared attention, the prosody of a calm voice — activates the ventral vagal state that makes genuine creative engagement possible. The nervous system needs to register safety before the psyche will risk expression.

What art therapy is not is a system of symbol translation. The image of a dark figure in clay is not a code for repressed aggression; the sandtray scene with a wall around the central figure is not a diagnostic checklist. Woodman (1993) puts it plainly: soul work is an act of the imagination, and the soul lives on metaphor — not on the reduction of metaphor to its supposed referent. The art object is the thing itself, not a pointer to something more real behind it.

This is where the depth-psychological tradition parts company with more behaviorally oriented art therapy models. For Hillman, for Woodman, for the Jungian lineage that runs through Kalff and Johnson, the image is not a symptom to be resolved but a presence to be honored. The work is not to get past the image to the underlying issue; the work is the image, and the soul is made in the making.

  • active imagination — Jung's method of conscious engagement with autonomous psychic figures
  • soul-making — Hillman's term for the craft of deepening psychic life through image and imagination
  • James Hillman — portrait of the founder of archetypal psychology
  • Marion Woodman — Jungian analyst whose work on the body, addiction, and the feminine informs much of depth-oriented art therapy

Sources Cited

  • Hillman, James, 1983, Archetypal Psychology: A Brief Account
  • Haeyen, Suzanne, 2024, A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma
  • Johnson, Robert A., 1986, Inner Work: Using Dreams and Active Imagination for Personal Growth
  • Woodman, Marion, 1993, Conscious Femininity: Interviews With Marion Woodman
  • Roesler, Christian, 2019, Sandplay therapy: An overview of theory, applications and evidence base