The Arts in Psychotherapy 34 (2007) 256–262
A review of research and methods used to establish art therapy
as an effective treatment method for traumatized children
Leslie G. Eaton, Ph.D. ∗ , Kimberly L. Doherty, B.S.,
Rebekah M. Widrick, B.A.
State University of New York College at Cortland, Cortland, NY, United States
Abstract
Art therapy uses creative expression to provide individuals with a safe outlet for expressing thoughts and emotions to successfully
facilitate recovery from psychological distress. The present study reviews the efficacy of art therapy as a method for treating
traumatized children. Published, peer-reviewed literature that focused exclusively on the use of art therapy for treating children
who had experienced a traumatic event was included in this review. This study found that art therapy was used successfully in a
variety of contexts as a treatment regimen for traumatized children. Several methodological and statistical issues are discussed and
suggestions for future research are provided in this review.
© 2007 Elsevier Inc. All rights reserved.
Keywords: Art therapy; Trauma; Children; Methodology; Review
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; 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
∗ Corresponding author. Tel.: +1 607 753 2079.
E-mail address:
[email protected] (L.G. Eaton).
0197-4556/$ – see front matter © 2007 Elsevier Inc. All rights reserved.
doi:10.1016/j.aip.2007.03.001
L.G. Eaton et al. / The Arts in Psychotherapy 34 (2007) 256–262 257
interest to them, which tend to be abstract psychological constructs, may not be adequately measured by empirical
methods (e.g., self-actualization) (Wadeson, 1995; 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. expli-
cated 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 behav-
iors, 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; Davis, 1989; Kozlowska & Hanney, 2001; Pifalo, 2002; Prager, 1995; St.
Thomas & Johnson, 2002).
The literature review
The present study is a review of the published research concentrating on the efficacy of art therapy as a treatment
regime for traumatized children. The purpose of this review is to provide a summary of the existing literature and to
provide suggestions for future research aimed at closing the gap in the efficacy studies identified by Reynolds et al.
(2000). To obtain the most complete snapshot of the state of the literature, our review will include both quantitative
and qualitative research.
Literature search procedure
The articles used in this review were identified by an OCLC FirstSearch PsychInfo search conducted on August 30,
2005. Keywords “art and therapy,” “children,” “trauma,” in “English,” and in “peer reviewed journal” were selected.
These search terms narrowed the list of articles to those of interest (studies of art therapy used to treat conditions of
childhood trauma) and those that have already been screened for quality by the peer review process. This search yielded
a total of 26 articles. On August 1, 2006 a second search, using OCLC FirstSearch PsychInfo, included a combination
of keywords used previously, in a process that limited the search to “art therapy” as a subject, “emotional trauma” as
a subject, and children as a keyword. These multiple search criteria were used in an effort to obtain and include the
maximum number of articles possible.
Categorization and coding of article content
The articles were obtained and categorized in terms of the demographics of the sample, the research methodology,
and the non-statistical and/or statistical findings. Fifty-three percent of the 26 articles could not be used because they
were studies that used multiple therapeutic approaches or studies that focused on outcomes for someone other than the
child (e.g., the art therapist himself or herself, as opposed to the efficacy of art therapy as a therapeutic method1 , or the
parents of the child).
1 When conducting an empirical literature review, such as a meta-analysis, it is common to find that many articles are excluded for various
methodological reasons (Rosenthal, 1991). In this case, there were two major reasons some articles were excluded—either because the focus was
on therapist training rather than on client improvement or because more than one therapeutic approach was used. When more than one therapeutic
approach was used, it was impossible to determine if client improvement was due to art therapy, some other therapeutic approach (such as play
therapy, for example), or to the unique contribution of both approaches. In the present study, the question asked pertained to client improvement as
a result of the exclusive delivery of art therapy.
