Art therapy can be used as a component of behavioral modification and social skills training for clients with disorders like autism, ADHD, OCD, and ODD. Through creative expression and exploration of symbols, art therapy allows clients to communicate feelings, develop problem-solving skills, and increase self-esteem - helping to reduce negative behaviors. Consistency, clear expectations, and positive reinforcement are important to effective treatment, in combination with therapies like art therapy, CBT, and behavior modification. A case example is provided of a client who showed improved emotional regulation and communication through long-term art therapy.

1. Art Therapy and Behavioral Modification
Shannon Halligan, L-CAT
Licensed Creative Arts Therapist

2. Task: Identify 2-3 symbols that are recurrent for you.
Think about what symbols/images appear in your life:
Circles/spirals
Flowers/Nature
Water/Air/Fire/Earth
Animals/Creatures
Objects (knots, crosses, keys, labyrinth, etc.)
Colors/Numbers/Letters
Express those symbols artistically with drawing or
sketching them.

3. Think about their associations to
emotions/experiences/meanings in your life.
Ask yourself, what meaning to these symbols have
for me? How can I explore further how they
help/comfort/interest me in my life?

4. Every single person in this room has recurrent images and
themes that show up in their lives.
These images do not have to be in the form of artwork, but
can come about in other forms; such as jewelry, tattoos,
items in your home, photos you choose/take, clothing style,
color choices, patterns, etc.
Art Therapy works in a similar way in that the art you
create, is a reflection of the artist who created it.

5. Art Therapy can include exploration of the images and
themes that are re-current for the client.
Symbols can be threatening or calming or have deeper
meaning. An art therapist facilitates the process of helping
a client understand their own artwork.
More information/resources:
1000 Symbols: What Shapes Mean in Art & Myth
by Rowena Shepherd (Author) , Rupert Shepherd (Au

6. What is Art Therapy?
Art Therapy uses the creative process of art making to improve and
enhance the physical, mental and emotional well-being of
individuals of all ages.
It is based on the belief that the creative process involved in artistic
self-expression helps people to resolve conflicts and problems,
develop interpersonal skills, manage behavior, reduce stress,
increase self-esteem and self-awareness, and achieve insight.

7. Improve communication
Improve social skills
Improve gross and fine motor coordination (clay: strength, gross motor,
muscular development.)
Resolve conflicts and problems
Develop/improve sense of self
Manage behavior, reduce frequency of negative behaviors
Create new patterns of learning (Nisenson, 2008)
Increase self-esteem and awareness

8. Art Therapy isn’t just for children or those with special needs.
Art Therapy can be utilized for a wide range of client populations.
One does not need to have any artistic talent to “do” art therapy.
Art therapy is not about creating “a pretty picture”; often art expresses difficult
and/or negative emotions and experiences. By expressing these experiences, a
client can heal from trauma, illness and better manage symptoms.

9. In cases of Autism, Asperger’s, OCD, ADHD.
Often Art Therapy is recommended in addition to applied behavior
analysis, behavior modification strategies, occupational therapy,
sensory integration therapy, CBT (Cognitive-Behavioral-Therapy),
etc.
Positive behavior reinforcement. Not punishment for negative
reinforcement, as this increases anxiety, hostility and anger.

10. Symptoms of ADHD and ODD can be decreased by utilizing art therapy as a
treatment method.
Oppositional behavior: Art Therapy can promote positive communication,
increased ability to express their feelings, thoughts and ideas.
Often, children and young adults who are oppositional have a difficult time
expressing themselves and communicating clearly, which leads to frustration,
anger and defiance.
The solution to defiance in children is not for adults to gain more control, but for
children to learn how to regulate their emotions and behavior so that they feel in
control of themselves, their own choices, and outcomes.

11. The goal of treatment planning and therapy/counseling, is
not to completely eliminate/”get over” their diagnosis or
disorder.
The goal is to reduce symptoms, make them more
manageable, learn coping strategies, increase ability to
problem solve, increase ability to regulate emotions and
behavior.

12. An effective treatment plan for a client with ADHD, ADD, ODD, and related disorders must
include:
Consistency
Clear expectations
Limit setting, replace negative behavior with positive behavior.
Example: “We cannot throw the paint, but we can use or fingers or brush to put it on the paper.”
Clients with these behaviors, are often told NO repeatedly, an effective treatment but set clear
limits but allow for some more positive/replacement behaviors to be expressed.
Positive behavior reinforcement.
Parent Coaching: consistency, schedules, limit-setting, reward system/token system.
This can be achieved by a number of therapies, including Art Therapy, CBT, DBT, and behavior
modification.

13. Art Therapy is not about teaching art techniques, however, it can help a client
build skills that can translate to other arenas of life.
Such as, art can teach how to follow 1-2 step directions, planning, pacing, time
management, and promote gross and fine motor development.
It can also build confidence, self-esteem and a sense of accomplishment, which
are all positive qualities that will reduce negative, impulsive and and anti-social
behaviors.

14. Jason is a 10 year old male, in the 5th, grade, who has been diagnosed with
Cerebral Palsy, ADHD, hearing loss, and Generalized anxiety disorder. He is
verbal, with a strong vocabulary, but struggles to express his feelings clearly or
understand his own emotions.
His symptoms include a lack of self-esteem, negative self statements and some
self-harm behaviors, anger outbursts
Verbal therapy has not been successful in the past due to his limited ability to
communicate/express himself, as well as lack of insight.

15. Jason’s treatment plan includes:
A sign skills coach: teacher aide works 1:1 with him to promote use of sign-language as an additional form
of communication.
Sensory based therapies, art therapy, Jason seeks out sensory experiences to calm and learn to self-
soothe.
Sensory experiences: clay, fingerpaint, tactile materials, goop, etc.
He began art therapy treatment at age 8, when he was experiencing frequent anger outbursts at school and
home, becoming overwhelmed by demands or tasks at school, and making frequent negative statements
about self, such as, “no one likes me” or “I can’t do it”.
Consistent, supportive parenting. Parents worked closely with therapist, school and support staff to
reinforce positive behaviors, teach skills, have a reward system for desired rewards (motivation).

16. Jason has attended individual art therapy bi-weekly for 2 years and has shown the following progress:
Increased planning, ability to follow multi-step directions, complete projects.
In early sessions, he would jump from one activity to another, not completing any one task, and easily
become frustrated when things did not go as he wanted.
Ability to self-regulate his emotions and give himself time to calm down.
Use communication strategies to let others know how he is feeling.
Examples: Feeling Buddies, Feeling cards/charts, sign language, “I“statements, etc.
Regulate his emotions and behavior when a project does not go as planned, he does not melt down or have
outbursts but works with therapist to come up with a way to problem solve and try a new way.
Is able to express himself and his ideas artistically, is proud of his creations and eager to share them with
others.
*Play Therapy: Allowed him to express aggressive thoughts and impulses in a safe way. Play fighting,
Ninjas, Guns, etc. Parents had previously not allowed any sort of “play fighting” at home.
[Book: Why Children Need Monsters by Gerard Jones.]

17. “But if I reward my child, am I going to have to reward him/her for every
little thing they ever do?”
The answer is NO. Reward systems/token systems are designed to motivate children toward more positive
behavior and its rewards (verbal praise, privileges, accomplishments, recognition, etc.)
Eventually, the child will show the positive behavior without the reward.
As adults, we reward ourselves all the time, that doesn’t mean we need a constant immediate reward to get
to work daily, manage our lives, etc. Example: “If I get all these notes done, I am going to go get more
coffee.”
It teaches children life skills in that they can have the self discipline to accomplish a less desirable task,
(homework, etc.) so that they can enjoy a desired reward (more time on the computer, time with friends,
etc.)
Improves behavior for groups and families, so that there is less family discord.

18. Art therapy as a component to social skills training may increase the
willingness of children to participate because art is an activity that they
find acceptable. (Epp, 2008; Naumburg, 2001)
 Art therapy allows children to solve problems visually and offers a non-
threatening way to deal with rejection. (Freilich, R., & Shectman, Z.,
2010)
Art has the potential to assist special needs children in communicating
with others and to obtain confidence in their own ideas. (Balke, 1997;
Germain, 2008)
 By allowing students more freedom and accountability when making art
in the classroom, teachers can promote self-worth as an artist and foster
self-esteem at the same time. (Rufo, 2011; Viza, 2005; Taylor, 2005 )
Some of the most commonly mentioned benefits of art therapy are self-
esteem, self-expression, problem solving, and conflict resolution.
(Bagilishya et al., 2005).

19. Art Therapy can be utilized in a variety of other disorders.
Art can externalize trauma and emotions, so that it allows a client to
express trauma in a safe way.
Imagery and artwork can tap into unconscious material that verbal
discussion/dialogue sometimes cannot.
Art Therapy can help a client with anxiety/depression by exploration
of experiences so that a client can better understand the source,
triggers and characteristics of their disorder.
Art Therapy can promote coping skills, problem-solving, and
symptom reduction.

20. Insight is not needed for art therapy or other therapies to be successful in
treatment.
Facilitating insight is part of the therapist’s job! Client often come to therapy
because they lack adequate insight to understanding their own challenges.
Clients can learn to develop insight, when given opportunity to process their
experiences in therapy. It does not have to be just verbal discussion of
experiences, but this processing can be done via artwork/creative therapies.
*Especially useful with children and those with limit verbal/cognitive abilities.

21. Resistance, resistance, resistance!
Art can get around resistance when other methods have failed.
Art work reflects so much about the artist, simply creating it can give a therapist
much information about a client.
Art Therapists are trained to interpret artwork and explore its meanings and
implications about clients. Do not attempt to “analyze” artwork without proper
training. You can look for incongruencies in artwork, recurrent themes/symbols,
changes/improvements in art-making, time invested, details, ideas, emotions,
etc.
Judgements of good/bad/pretty/nice etc are not a part of art therapy. Anticipated
judgement of art work is often what creates resistance. A client who already
feels poorly does not want their artwork judged.

22. Example: a 22-year old female client with Asperger’s often has vivid dreams.
Part of her therapy is to draw/re-create her dreams in her artwork, discuss
images and recurrent themes. The client is able to identify emotions that are
often represented in her dreams.
Storms: Anxiety, Depression (“the dark beast”), loss of control/fear of
abandonment are common themes in her dreams. When she is under stress,
she will notice that “the storm dreams are back”. Important people and
relationships recur in her dreams. When she is stable and/or happier, her
dreams are more pleasant and imaginative vs. scary and threatening.

24. Questions?
Comments?
Resource List