Bringing Art (Therapy) to Life: An Interview with Judith Rubin

Judith Aron Rubin: People get caught up in trying to define it, but it’s simple in my mind. Art Therapy is using an art form, in my case, the visual arts, to help people through therapy. And yes, there are many variations; but in its essence, it’s art plus therapy. 

JR: As it turns out, and I guess we all know that we don’t start out having words as infants, but we do start out having visual experiences. Other art forms like movement, drama, and music also depend on some of the other basic sensory inputs babies have. So, these are simply ways we learn early on of taking in information about the world and then expressing experience.

To not take advantage of these natural and inborn languages in trying to help people get better seems almost foolish. Cooing, babbling, dramatizing, pretending, and making marks seem universal in higher primates. When given art materials to make marks, chimpanzees and apes like to draw and paint. So, it’s a natural activity that can be used to help people — another avenue to reach people and to help them find out about themselves.  

JR: That’s one way of looking at the value in people expressing themselves freely like free associating with words. Free association and images is actually quite fun. And you can do it with mental images. You don’t have to draw or paint them. And in fact, there were a lot of psychologists in the 60s and 70s and 80s who were quite interested in mental imagery as a way of understanding, but also helping people.

JR: Because they can get in touch with things that they are unable to articulate in words. It’s obvious with people who are not very verbal, or who are communicating to us through a second language, or who have hearing or expression problems. But it’s also very helpful with people who intellectualize, who use words defensively to cover up. They’re not aware that they’re doing that, but that happens. Creating something visually, or moving or dramatizing, are all ways of cutting through those defenses, allowing something to become part of someone’s awareness that they couldn’t otherwise access.

JR: Yeah, it’s interesting because using art in therapy seems to help people not only get to a kind of awareness or insight, but also to feelings that they aren’t aware of that are often evoked by using art material or seeing what they’ve created with the material. This can be incredibly powerful. 

JR: I do. That was 1967 — three years before the American Art Therapy Association was formed. You’re right that it was in the the beginning years, and that was exciting. Actually, it was fun. I feel lucky to have entered the field at a time when it was essentially unformed. It was about ideas and passionate people. But there hadn’t been any kind of intellectual framework developed yet.

JR: I not only remember the image, I remember the little girl who came into the art room in her wheelchair. I remember watching her create it and thinking, “God, this kid is not only not retarded, she’s saying something that needs to be expressed.”

JR: Yes. We were assessing children in a place then called the Home for Crippled Children, meaning it was all children with disabilities, some of whom were residents and some of whom came during the day. They had about 200 kids and had invited me to start a pilot art program because they had never offered art for the children. I met with the coordinators who presented me with a list of 10 eligible children. I remember saying, “only 10 out of all these children?!”

They were so anxious about what these kids could or could not do, so they picked only the 10 highest functioning children with the most mobility and fine motor skills. I asked if it would be alright if we assessed everybody, which they agreed to. As a result of this assessment and this drawing, this little girl was moved back into the classroom that she had been taken out of.   

JR: Oh, sure. Many patients and adults too. Except for children. Most children don’t say that. But adolescents? Adults? Sure, but then you explain.

JR: It happens developmentally around puberty, where they become much more self-conscious in the general sense about the way they look, the way they move, the way they dress and how they draw. They become self-critical. It isn’t simply their artistic talent or lack of it, because until a certain age, most kids are un-self-consciously able to create.

There are little children of all ages who are blocked, who are unable to play. These children really need creative arts therapy because it’s a kind of play therapy. I think the creative arts therapists in their training, in their experience, are used to helping people who can’t create, to be able to create, if that makes any sense. It’s part of the job.  

JR: It is a big question. With different age groups, you present it in a different way, so I’ll just stick to art therapy for the moment because that’s what I know best. But, as I said, older children, adolescents, and particularly adults are inhibited. You explain that this isn’t about being an artist.

In fact, artists are some of the hardest patients in art therapy because they’re so aware and self-conscious about their art, and they want to make it pretty, good, and attractive. But that’s not the purpose of art in therapy. The purpose essentially is to help people express and find themselves.   

JR: I believe you can. It’s an issue, a political issue within the field, because it’s been difficult for art therapists to be recognized as clinicians. But in actuality, the training is at least as rigorous, if not more so than the training that LMFT’s and social workers and other masters-level clinicians receive. I believe it’s at least as good as, if not better than, the training that mental health counselors get. And many people go on for PhD’s these days in art therapy or related fields like psychology, which actually is what I did my doctorate in. So, I’m licensed as a psychologist, although I don’t think of myself as primarily that.

There’s some anxiety about sharing techniques and activities with people who aren’t trained in the art form or who don’t know how to help people to use clay or the paint or whatever, and may not understand what they’re unleashing. The truth is that you can get to buried material that can be quite disruptive unless you know what you’re doing as a clinician or therapist. That’s the political aspect of helping others to use art. But I personally believe that everybody should be incorporating it. I wrote a book called, Artful Therapy for Non Art Therapists.   

JR: That’s a whole chapter in a book, and a bit hard to put into words. One way is to help it be a non-threatening activity, because a blank piece of paper is pretty threatening to most adults. What has worked for me is to give people choices, to have options. I’ll say something like, “You can use clay, or you can use chalk; or if you prefer to use markers or colored pencils, that’s fine. You can use a little piece of paper or a big piece of paper, whatever suits you.”

I think giving people choices is one way to help them overcome some of the inhibitions around using art in therapy. It’s about explaining to an adult or adolescent that this is a way of getting at stuff that we might not otherwise be able to get at by talking. Another way is to ask people what they remember about their dreams, because dreams contain many visual images, so in a sense, they are already thinking as an artist.   

JR: These can range anywhere from open-ended to a starter. A starter is an easy and non-threatening way to begin because it doesn’t push the person in one direction or another. You can put a blot of paint on paper, fold it, and then ask the person what it reminds them of. People also like to doodle or make squiggles, so you can ask them to do that with their eyes closed and then look at it, and then turn it around as you ask them, “what does this remind you of?”

Each time, it’s like a Rorschach as you ask them what they see. You can get a lot of projective material from this very simple exercise. Then you can say, “OK, now take all the other colors and make it look like what you saw in it.” Because it starts with the scribble that doesn’t require people to think of making something realistic, they’re liberated.   

JR: Yes, because just starting with a line or a shape doesn’t give you much. But when people start to develop an image, they can begin to see something, like an image in the clouds. That’s another common experience that you can remind people of to let them know that they don’t have to be an artist to be artistic. Or you can give them clay to fiddle around with and then ask them similar questions to those you asked about the doodle, squiggle, or ink blot.

JR: That’s fascinating because he’s not the first person I’ve heard that about. I think it’s uncommon that people who were mostly word people begin to pay attention to sounds, images, and the nonverbal when they get older. 

JR: Well, let me give you another kind of example of helping people get started, one that’s very valid, and a bit different from that other making-and-creating exercise. We used to have more magazines for selecting and cutting out pictures to paste into a collage. You certainly don’t have to be an artist to do that. You just find the images you like — or even just projectively looking at postcards or small reproductions of artwork and saying something like, “pick the one you like or the one you don’t like and let’s talk about that.” You can use art as a stimulus and find non-threatening ways of helping people to get started creating. 

JR: If it’s a grown-up, you have to listen to them first. You don’t throw the art at them right away unless they say, “I’ve come because I want art therapy,” which sometimes happens, right? 

JR: But if they’ve been in verbal therapy and they’ve hit a block and they hear somebody say, “Oh, you can past this in art therapy,” they might then ask you, “Can I do some artwork?” But most of the time, people want to tell you what’s troubling first. You know, you don’t even have to ask, why are you here? They tell you pretty fast while they’re here.

And so, you listen to that and sometimes you can say, “could you make a picture about that?” or, “what color would that be?” or, “what shape would that be, that issue you’re talking about?” or, “if that person was a color or a shape, what would they be?” In other words, there are many ways of hooking into what they’ve talked about and asking them to think of it visually. And then you might say, would you like to make some art to see if that would help us?

When I had adults in private practice, I would give them a choice of working at the table or the easel, or while sitting looking at me, in which case I would give them a sketchbook and they would sketch. I didn’t have to look at what they were sketching.

Sometimes, they want you to see it and sometimes they don’t. There’s a million different ways and I think one of the advantages of being in different positional relationships is also interesting. It’s not something you do in therapy as often, although some people like August Aichhorn went for walks with his patients. Some people do, but mostly people are sitting looking at each other, and if you’re an analyst, they’re not looking at you. But anyway, in the creative arts, there’s much more flexibility about how you are in space with one another.  

JR: I worked in a psychiatric hospital and child guidance center for many, many years, which were part of the University of Pittsburgh psychiatry training program where we trained a lot of social workers, psychologists, and psychiatrists. We discovered that the best way to train people was to get them involved in doing something themselves, even briefly, and then talking to their colleagues about how to use it in their work — just to get a feel for it making something and talking about it. This is the most powerful tool to convince people that it’s useful. 

JR: Same thing with art. I heard this again before the association was founded, from the woman who started art therapy at NIMH, which was one of the earliest places where they were trying it out. She said that whenever you train the staff, to make sure you get them working with materials. That way they will understand what you’re trying to tell them. And I think that’s why I started making films. There’s a limit to what you can tell or say about the arts in therapy with words.

I want to go back to the question you asked earlier about how to help people connect what they’ve done with what’s important to them. You need to be very open and explicit about that. In fact, you can get farther if you work with the symbol, rather than making or asking for any kind of obvious connection, like, “tell me a story about that picture, or what do you think is happening in the picture?”

You can instead ask them questions like, “If you were that person, what would you be thinking? What would happen next? What do you think happened before?” You get them to elaborate on whatever image they’ve created, and then after you’ve explored what they can understand creatively from their own creation, imaginatively, then you say, “gee, so what do you think this has to do with you?” or, “Does this have anything to do with you?  

JR: Interpreting what their drawing means is an old myth about how art therapists tell the patient what their work means.

JR: Exactly! It’s a similar myth. Making the connection themselves is certainly necessary and helpful with older clients and adolescents. I’m not always necessarily explicit with children if you see progress.

JR: For sure. Once they learn that it’s something connected with them, you don’t need to ask those questions. They just become curious.

JR: That’s the other thing. The woman who told me to never try to teach psychiatrists without materials, believed, after decades of doing it, that the first drawing is usually a self- representation, even if people don’t realize it. That may never have been tested, and I’m not sure I agree, but it’s often true. 

JR: I was indeed. I was becoming an art therapist while also becoming a child development expert. Fred and I both had the same teacher at the Child Development Center where we worked with the same children. We were colleagues, and students, and workers at the same time. One day he came to me and said, “I’m going to be doing this television program next year and I’d like you to be on it.”

I remember saying that I didn’t know anything about being a television performer. He said, “that’s why I want you to be on it, because I don’t want performers — I want real people.” I initially said no because I was going to have another baby and take some time off to nurse. Fred said, “oh, you can nurse before and after the tapings.” He was a little pushy, but I continued to refuse until he said, “don’t you have a grandmother in New Jersey?”

When I told him that I did, he said, “well, the show is going to be shown in New Jersey” — it was only going to be shown on the eastern seaboard in the first couple of years. Then he said, “well, it’s going to be shown twice a day in New Jersey and your grandmother in the nursing home can see you.” I finally and was on about once a month for three years. It was an interesting experience.   

JR: I learned how to adlib (laughs). No, I learned how to figure out what he wanted me to have children do that was related to the theme of his program. But I guess that reminds me that being an art therapist means that you really have to be flexible and creative and figure out ways to work in different environments with whatever sort of person or group you’re confronted with.

I ended up liking doing the shows because it was fun and because I was learning a lot. Around the time I was taping shows with him, I was starting a pilot program at the School for the Blind in Pittsburgh. These were the multiple handicapped blind children, or premature blind babies as they were called at the time. They were being saved in incubators on neonatal units where they had better equipment. They were premature babies who had more than one disability. They were different from “normal” blind children.

Sadly, there was a lot of hostility around introducing art with these children — similar to the situation at the Home for Crippled Children, but even more so, because they already had an art program, and said, “oh, you’ll never be able to do anything. These kids won’t be able to do anything.” Of course, it turned out they were. I assessed each child, and of course, they had to be different for blind children. We used a lot of sensory materials. I said to Fred, “nobody’s ever going to believe how creative these kids are. They are amazing. But there’s such skepticism about them. Even in the school with people who know blind children.”

He said, “well, you’ll have to make a movie. I said that I didn’t know anything about making a movie, and he said, “well, you must know somebody with a camera.” That was our conversation. I said that I would ask the people at Children’s Hospital who were already making slides of artwork. They had just gotten a black-and-white 16mm camera and said, “We’d love to go to the school for the blind. We don’t have sound, but we’d love to do it.” It was all very spontaneous, and that was my first film.

Although I hadn’t yet written my first book — I had written articles, one with the director for the Journal of Education for the Blind who said you couldn’t really convey in words how creative these children were. You had to see it. He was right! With seven volunteers, we started a seven-week pilot program, in which we incorporated the artwork with the children. So, we shot on a 16mm and edited on an old Moviola. That was old-fashioned filmmaking, which was fun. That was a new creative process for me, putting the images, sounds, and narration together.  

JR: It was a powerful learning experience, and one that people responded to so emotionally and intellectually, from which they started programs with children like these. It made a difference. I was convinced, and I did get into filmmaking as a way of teaching.

JR: It was for me, as I’m sure it was for you too; it’s another creative process. I found editing films that I created, one of which was about Fred Rogers and his teachings, to be great fun. I would have a hard time separating from it to do my wifely, motherly duties. Putting together image and sound was a way of teaching. Having written a bunch of books, it was a completely different teaching process.

JR: Well, I think for non-art therapists, one of the films that might be most helpful is about children who grieve. I’m trying to remember the title now.

JR: It was made in Canada. I got it because I gave a talk at the Toronto Art Therapy Institute where a guy came up to me and said, “I just made a film about people doing art therapy and music therapy; are you interested in seeing it?” He turned out to be a successful documentary filmmaker, but most of the people in that film doing the work were psychologists and social workers. There were also a few art and music therapists who used very clever kinds of instructions to help children deal with the loss of a parent or a sibling. But it was more structured than what I was describing that I would do.

JR: There’s another film from Canada which I think is inspiring. It’s called “A Brush with Life.” It shows some of the work at a Canadian hospital that had a good art therapy program. It also follows a little bit of a case study of this one woman, who I believe was probably borderline and was having terrible problem. You see her laying down talking to her analyst, but you also see her painting. You also see her in and out of the hospital, and you get a sense of how art played a big role in her recovery. As a case study, it’s inspiring.

I also think that of the two films you decided to distribute, “Art Therapy Has Many Faces,” is a good introduction to the field and is still used a lot. Many people have made subtitles in different languages because it’s an overview and provides a nice history. The other one, “Creative Healing in Mental Health,” shows different art and drama techniques that anybody can use with people of different ages.   

JR: To inspire others to explore art therapy, I offer what Fred Rogers said to me about being on television — “Try it, you’ll like it. You’ll be surprised that you’ll find something of value in it.” Maybe start out with mental imagery by saying, “Is there an image that goes with that thought, or that statement, or that idea? After all, mental imagery is something that’s going on all the time and we don’t always paint it, right?!

JR: That’s the beautiful thing about art. Whenever I’ve done a workshop with any group, whether it’s teaching or therapy or some combination of the two, the consensus is to use materials in a non-threatening way that are likely to come out looking pretty.

They suggested oil-based clay in different colors — plasticine, which you can get at the drugstore. It’s about fiddling around, warming it up, shaping it without even thinking about what you’re making, or picking three colors, and making something out of it. It’s a kind of doodling it, which reduces anxiety. And when you ask people to place what they’ve made in front of them, it’s as true with clay as it is with doodling, if you haven’t given the topic.

The uniqueness of each person is so dramatically illustrated — it’s incredible. As a side thought, I used to be an art teacher, so for a while I taught some art education classes to people working in elementary and secondary education. I would go to visit them to see how they were doing. For the teachers who were really good at it, their children’s work was engaging and unique. The teachers who were imposing, either consciously or unconsciously, or had their own aesthetic, had children whose work was very similar to each other’s.  

JR: In the early days of art therapy, there was a great hunger for that kind of diagnosis derived from a patient’s artwork. Can you tell this is schizo or manic depressive? And of course, it turned out you couldn’t. Projective drawings were very big in psychology. Maybe you don’t know because maybe it was before you studied.

JR: The Rorschach is different because you’re projecting onto an ambiguous stimulus.

JR:  This is my problem with what I call the acronym generation; the art therapists who are now certified in EMDR and CBT. Many of the young art therapists are learning these specific approaches, and they tend to use terms like directive art therapy, which makes me shudder, but that’s a common term. To me, it’s kind of anti-creative, but giving people a theme or a task that’s not bad. Inviting is OK, prompting even, but response art is very tricky. That’s one of the hazards in art therapy, that you have to train the therapists not to project their own ideas onto what they’re seeing, and to know themselves well enough so that they can separate their perception from what is actually being said or created by the client. 

JR: Same idea. Response art has wonderful potential to do good, just like AI, but there are hazards as well.

JR: I’m not sure who started the term, but Barb Fish recently did her dissertation on it, and it’s become very popular. I’m currently helping my friend, Millie Chapin, a fabulous artist, to sell her artwork online through a mutual friend. A lot of art therapists are actively practicing artists. She worked with Kohut and actually became a self-psychologist who then developed an interesting technique.

She would talk to the patient for a while to find out what was going on, and then she’d say, “Okay, let’s draw about that. I’ll draw and you draw and then we’ll talk.” It was her response to whatever the person told her and then they would talk about both drawings together. When she first had the idea, I remembered commenting that I thought it was dangerous for people who didn’t know themselves as well as she knew herself. But this technique has been embraced by many art therapists because they love using their artist-selves as part of what’s happening. So, it’s not always responding in the sense of actually responding to what somebody’s talked about. That’s Natalie’s technique.    

JR: Yes! It’s literally working alongside, which can be quite helpful. I did some of that while I was working with groups of children to inspire a kind of Pied Piper kind of thing. I call that the Pied Piper Effect, because I would start working with the material then they would all start wanting to work with the material. It has an impact when the therapist becomes an important person in the process. And no matter how they try to pretend that they are on equal footing, and that the activity is a collaborative process, clients hope the clinician knows a heck of a lot more than they do.

JR: Well, I hope so, too, and that they look at the titles and trailers. It’s much like choosing the art material because there are case studies. There’s work with individuals, groups, families, and couples. So, for me to choose for somebody else what they should watch when you asked earlier, “what stands out,” is hard for me too, because I think it has to appeal to them, and then they’ll get something from us.

JR: Thank you, Victor, for asking.