Hi, everyone. I wrote this study guide before I took the exam in November 2024. I passed on the first attempt, so this outline did some good. I have been a subject-matter expert for ATCB exams since early 2025. To avoid a conflict of interest, I will not be providing any updates to this document. However, please feel free to add information or resources to this document, and I will clean up the format and credit the contributors. Best, Shayla Hayward-Lundy, LPAT, ATR-BC

THEORETICAL APPROACHES

Attachment Theory: Developed by John Bowlby and further expanded by Mary Ainsworth, posits that early relationships with caregivers profoundly influence an individual's emotional and social development. It suggests that the quality of these early attachments shapes one's expectations in future relationships, impacting how they form connections, seek support, and regulate emotions throughout their lifespan. This theory has implications for understanding psychological well-being and informs therapeutic approaches, particularly in contexts related to relationships and attachment patterns.

Behavioral Theory: Cognitive Behavioral Therapy (CBT) is a widely used psychotherapeutic approach that focuses on identifying and changing negative thought patterns and behaviors to improve mental well-being. Acceptance and Commitment Therapy (ACT) emphasizes accepting complex thoughts and feelings while committing to actions aligned with one's values, aiming to enhance psychological flexibility and resilience. Behavioral Therapy targets specific behaviors, employing reinforcement and punishment to modify maladaptive patterns. At the same time, Dialectical Behavior Therapy (DBT) combines elements of CBT with mindfulness and acceptance strategies to address emotional dysregulation and improve interpersonal skills, particularly for individuals with borderline personality disorder.

Developmental Approaches: A framework that examines how individuals grow, change, and develop psychologically and emotionally throughout their lives. It emphasizes the importance of understanding the stages and milestones individuals typically pass through and how these experiences can impact their thoughts, feelings, and behaviors. This theory helps counselors gain insights into clients' unique developmental journeys, enabling them to provide tailored support and interventions to facilitate healthy growth and personal well-being.

Erikson's Theory: Focuses on the psychological and social challenges individuals face at different stages of life. It emphasizes the importance of successfully navigating these developmental tasks, such as trust vs. mistrust in infancy or identity vs. role confusion in adolescence, for healthy psychological development.
Piaget's Cognitive Developmental Theory: This theory examines how individuals construct knowledge and understanding through stages of cognitive development. It emphasizes the processes of assimilation and accommodation, highlighting the importance of cognitive growth in problem-solving and adapting to one's environment.
Kohlberg's Moral Development Theory: Outlines the stages of moral reasoning that individuals progress through. It asserts that moral thinking evolves from focusing on self-interest to considering broader ethical principles, providing insights into how individuals grapple with ethical dilemmas.

Environmental/Ecotherapy Approaches: Centered around the belief that human well-being is intricately connected to the natural world. These approaches utilize the healing power of nature to promote mental and emotional health. Ecotherapy encompasses a range of techniques, including outdoor activities, wilderness experiences, and practices that foster a deeper connection to the environment. By immersing individuals in natural settings and encouraging a mindful appreciation of the natural world, ecotherapy aims to alleviate stress, enhance well-being, and nurture a sense of ecological interconnectedness, ultimately contributing to improved mental and emotional health.

Expressive Therapies Continuum: A framework developed by Sandra Graves-Alcorn and Vija Lusebrink that helps therapists understand and utilize various forms of artistic expression to communicate and heal. It outlines various creative modalities, from simple kinesthetic movements to more complex, symbolically rich art forms. It provides a structured way to tailor therapeutic interventions to individuals' unique needs and abilities. By considering this continuum, therapists can effectively harness the power of art, movement, and other expressive media to promote self-discovery, emotional processing, and psychological growth.

Family Systems Theory: Pioneered by Murray Bowen, views families as interconnected systems where each member's behavior and emotions are interdependent and influence the functioning of the whole unit. It emphasizes the importance of understanding the dynamics, roles, and communication patterns within families and how multigenerational patterns can impact individual behavior and relationships. The theory explores and addresses issues within families by examining the systemic context in which they arise, rather than focusing solely on individual members.

Feminist theory: A framework that acknowledges and addresses the impact of gender-based inequalities and power dynamics on mental health. It recognizes that social, cultural, and political factors significantly influence individuals' experiences, particularly in relation to gender. Feminist counseling approaches aim to empower clients, promote self-determination, challenge oppressive norms, and foster a sense of agency in navigating and transcending gender-related challenges.

Social justice approaches in counseling: To address systemic inequalities and advocate for fairness, equity, and inclusivity in the context of mental health and well-being. These approaches recognize that societal structures and policies can contribute to psychological distress, particularly for marginalized and underrepresented groups. Counselors employing social justice perspectives work to raise awareness of systemic issues, challenge discriminatory practices, and promote social change to create more just and inclusive environments for their clients.

Socially-engaged Practice in Counseling: An approach involving the counselor in community-based efforts and social activism. It extends beyond individual therapy sessions and incorporates advocacy, education, and direct involvement in community initiatives. This approach recognizes the broader societal context in which individuals live and seeks to empower clients within the therapy room and their communities. It emphasizes collaborative efforts to address systemic issues and promote positive change for individuals and their larger social environments.

Humanistic Approaches: A framework that emphasizes each individual's inherent worth, potential, and capacity for self-determination. It views humans as inherently good and capable of personal growth and self-realization.

Adlerian: A humanistic approach founded by Alfred Adler that focuses on understanding an individual's unique perceptions and subjective experiences. It strongly emphasizes the individual's social context and their striving for a sense of belonging and significance. The therapist collaborates with the client to explore their goals, beliefs, and lifestyle choices, fostering a sense of self-worth and facilitating positive personal growth.
Existential: A humanistic approach that explores the fundamental questions of human existence, such as freedom, responsibility, meaning, and mortality. It encourages clients to confront the realities of life and grapple with existential concerns. Therapists help individuals explore their values, choices, and the ultimate purpose they assign to their lives, ultimately aiding them in finding a sense of authenticity and meaning.
Gestalt: Founded by Fritz Perls, is an experiential and present-focused approach that emphasizes awareness and integration of one's thoughts, feelings, and actions. It encourages clients to become fully present in the "here and now" and to take responsibility for their experiences. Through techniques such as role-playing and empty-chair exercises, clients are guided to explore their emotions, conflicts, and unresolved issues to achieve greater self-awareness and personal integration.
Spiritual or Transpersonal: is a humanistic approach that acknowledges the spiritual dimension of human experience. It explores consciousness, transcendence, and the search for meaning and purpose beyond individual existence. This approach may incorporate practices such as meditation, mindfulness, and exploration of altered states of consciousness. It aims to help individuals connect with their deeper spiritual selves and experience a sense of oneness with the universe.

Stages of Change (SOC) / Transtheoretical Model (TTM): The Stages of Change model is a psychological framework that describes the process individuals go through when changing behavior. It identifies five stages: pre-contemplation (not yet considering change), Contemplation (considering change), Preparation (preparing for change), Action (actively making change), and Maintenance (sustaining change over time). The model recognizes that change is a dynamic process and that individuals may cycle through these stages multiple times before achieving lasting change.

Motivational Interviewing (MI): A client-centered counseling approach that aims to elicit and strengthen a person's motivation and commitment to change behavior. It involves collaborative conversations in which the therapist helps the client explore their ambivalence about change, resolve any internal conflicts, and ultimately move towards making positive, sustainable changes in their lives.

Psychodynamic Approaches: Based on the belief that unconscious thoughts and emotions significantly influence behavior. These approaches aim to explore and understand the deep-seated psychological processes that impact a person's thoughts, feelings, and behaviors. They often involve techniques such as free association, dream analysis, and exploration of early childhood experiences to uncover unconscious conflicts and promote self-awareness.

Psychoanalytic Therapy: Origin of the psychodynamic theory, developed by Sigmund Freud. It delves into the unconscious mind to bring unresolved conflicts and repressed feelings to conscious awareness. The therapist helps the client gain insight into their unconscious motivations, defense mechanisms, and early experiences. The goal is to alleviate emotional distress and promote psychological growth.
Jungian Therapy (Analytical Psychology): Jungian therapy, founded by Carl Jung, emphasizes the exploration of the collective unconscious and archetypes. It delves into the deeper layers of the psyche, exploring symbolic imagery, dreams, and myths to gain insight into the individual's unique journey toward self-realization and wholeness. It also considers integrating the conscious and unconscious aspects of the self.
Internal Family Systems (IFS): A contemporary psychodynamic approach developed by Richard Schwartz. It posits that within each individual there are multiple sub-personalities, or "parts," that contribute to one's sense of self. IFS aims to help individuals understand, communicate with, and harmonize these various parts, promoting a more balanced and integrated sense of self. It emphasizes the importance of self-leadership and compassion towards one's internal dynamics.

Positive Psychology: Positive psychology is a branch of psychology that focuses on the study and cultivation of positive emotions, strengths, and well-being in individuals and communities. It seeks to understand and promote the factors that contribute to a fulfilling and flourishing life, emphasizing gratitude, resilience, optimism, and purpose. Positive psychology aims to enhance mental health, improve overall life satisfaction, and foster greater human potential and achievement. It encourages practices and interventions that empower individuals to lead happier, more meaningful lives.

Solution-Focused Therapy: A goal-oriented approach to counseling that emphasizes finding practical solutions to current problems rather than dwelling on past issues or analyzing their origins. It centers on the client's strengths, resources, and abilities to promote positive change. Therapists use questions and techniques that help clients envision their desired future and identify small, manageable steps toward achieving their goals. This brief, solution-focused approach aims to instill hope, build confidence, and empower clients to take proactive steps toward a more satisfying and fulfilling life.

Somatic Approaches: A therapeutic focus on the body's physical sensations, movements, and experiences to promote emotional healing and psychological well-being. These approaches recognize the intricate connection between the mind and body, understanding that emotional issues can manifest physically and vice versa. Techniques may include mindfulness practices, breathwork, body-awareness exercises, and somatic experiencing, all aimed at helping clients deepen their awareness and integrate their bodily experiences for healing and self-discovery. This approach is particularly effective for individuals dealing with trauma, stress, anxiety, and other issues where the body's response plays a significant role.

Systems Theory: A framework that views individuals as part of larger interconnected systems, such as families, communities, or societies. It posits that problems and behaviors cannot be fully understood in isolation but must be examined in the context of these broader systems. This approach emphasizes the reciprocal influence between individuals and their environments, highlighting how changes in one part of the system can impact the entire system. By examining these systemic dynamics, counselors aim to facilitate positive change and promote healthier functioning at the individual and broader social levels.

Trauma-Informed Therapy: An Approach that recognizes and responds to the widespread impact of trauma on individuals' mental, emotional, and physical well-being. It involves creating a safe and supportive therapeutic environment, understanding the effects of trauma on the brain and behavior, and integrating trauma-sensitive techniques to promote healing and resilience. This approach is crucial for empowering individuals who have experienced trauma to regain a sense of control and rebuild their lives.

Maslow's Hierarchy of Needs:

Defense Mechanisms: Psychological defense mechanisms are unconscious strategies individuals use to protect themselves from anxiety, stress, or uncomfortable thoughts. In people with mental health diagnoses, these defense mechanisms can be more pronounced or maladaptive, contributing to or exacerbating their symptoms.

Denial: refusing to accept reality or facts, blocking external events from awareness to avoid emotional distress. Example: a person struggling with alcohol dependence may deny having a drinking problem, even after repeated issues at work or in relationships due to drinking. They might say, “I don’t have a problem. I can stop anytime I want.”
Repressions: unconsciously pushing distressing memories or thoughts out of awareness. Example: Someone with PTSD may repress memories of a traumatic event, such as an assault or accident. They may not consciously remember the event, but it manifests through nightmares, flashbacks, or hypervigilance.
Projection: when people attribute their unacceptable thoughts or feelings to others. Example: A person with paranoia might project their own fears or insecurities onto others, believing that others are out to get them or are being untrustworthy, when in fact these are their own deep-seated fears.
Displacement: transferring feelings from the original source of distress onto a safer, more acceptable target. Example: A person who is angry at their boss but cannot express it may go home and take out their frustration on their spouse or children, showing irritability or outbursts toward them.
Rationalization: explaining an unacceptable behavior or feeling rationally or logically, avoiding the true reasons for the behavior. Example: A person with bulimia might rationalize purging after binge eating by telling themselves that it’s a necessary way to “balance” overeating, or that it’s the only way to stay in control of their weight.
Regression: when an individual reverts to an earlier stage of development in response to stress or conflict. Example: When faced with intense emotional stress, a person with BPD may regress to childlike behaviors, such as throwing temper tantrums, becoming overly dependent on others, or acting out in self-destructive ways.
Reaction Formation: behaving in a way that is opposite to one’s true feelings because those feelings are socially or personally unacceptable. Example: Someone with OCD who has intrusive violent thoughts may engage in excessively kind or gentle behaviors to counteract the anxiety provoked by these thoughts, or a person with depression who makes people laugh and is outwardly positive.
Sublimation: channeling unacceptable impulses into more acceptable or socially valued activities. Example: A person with bipolar disorder who feels an impulse toward risky sexual behavior or substance use during manic episodes may sublimate this energy by engaging in intense physical activity like marathon running or creative projects like painting or writing.
Intellectualization: focusing on facts, logic, and abstract reasoning to avoid dealing with emotional content. Example: A person dealing with depression after a significant loss may intellectualize their feelings by analyzing the stages of grief, focusing on the scientific aspects of death, and avoiding any emotional processing of the loss.
Dissociation: a person disconnects from their thoughts, feelings, memories, or sense of identity. Example: Someone with DID may experience episodes where they feel detached from their thoughts and identity, sometimes even developing distinct identities (alters) to deal with traumatic or stressful situations that their primary personality cannot cope with.
Undoing: an attempt to reverse or undo a thought or behavior that is deemed unacceptable by engaging in the opposite behavior. Example: A person with OCD may engage in repetitive rituals (e.g., handwashing) to “undo” an intrusive thought of contamination, trying to negate the anxiety and perceived harm associated with that thought.
Splitting: the tendency to view people or situations as all good or all bad, with no middle ground. Example: A person with BPD may view a loved one as perfect one moment and as terrible the next if the loved one disappoints them in some way. This inability to integrate a person's positive and negative aspects leads to intense, unstable relationships.
Acting Out: engaging in destructive or risky behaviors as a way of expressing feelings that are otherwise difficult to verbalize. Example: A child with conduct disorder may act out by engaging in fights, stealing, or breaking rules to express underlying anger, frustration, or a need for attention that they are unable to communicate verbally.
Fantasy: retreating into an imaginary world to escape painful realities. For example, someone with schizoid personality disorder might retreat into elaborate fantasy worlds as a way to avoid social interaction or emotional connection with others, living more in their imagination than in reality.
Compartmentalization: the process of separating conflicting thoughts, behaviors, or emotions into separate mental compartments to avoid the distress that arises from their coexistence.Example: A person with antisocial traits might compartmentalize their behavior by engaging in unethical or criminal activities without feeling guilt, while maintaining a facade of normalcy or responsibility in other aspects of life.

Lowenfeld's Stages of Artistic Development:

FACILITATE TREATMENT

Apply general interviewing skills

Reflective statements
Summarizing
Nonverbal communication
Demonstrate empathy and validation
Establish a therapeutic relationship
Timing, session closure

Conduct comprehensive intake and ongoing evaluations.

Biopsychosocial information, including demographics, reason for referral/presenting problems, mental health history, and substance use history
Mental status exam

Collaborate with the client to formulate and modify the treatment plan and goals.

Document all communications with clients and treatment team members.

Facilitate the art therapy sessions:

Introduce the art therapy process
Knowledge of and justification for media and material use
Appropriate and safe media and materials based on clients’ communication/developmental level/learning styles and evolving treatment needs. As well as maintain a physically safe environment regarding art materials.

Adaptive art materials and tools
Store and lock hazardous materials
Use non-toxic materials
Count and label materials

Utilize concepts of fine arts and art history
Use art therapy skills to facilitate the expression and exploration of feelings, thoughts, and behaviors.

Witnessing
Intention setting
Art directives
Encourage reflection and connection of symbols to personal, cultural, and historical contexts.

Observe and process the art production and use of material

Color, line, shading, size
Perspective
Symbols and metaphors
Material selection and use
Respond appropriately to images that suggest violence or other risk factors

Maintain an appropriate pace for art therapy
Observe and respond to the dynamics of the session

Affect
Behavior
Rate of speech
Verbal and nonverbal communication
Interpersonal interactions

Facilitate the conclusion of the art therapy process within the session
Provide crisis intervention (depending on the situation)

Gather information
Empathy and active listening
Offer grounding to calm physiological responses
Solution-focused, alternatives, planning
Safety Plan

If a group session, manage the group dynamics.

Collaborative group rules established
Group check-in
Individual check-in or creative support as the group works
The artist speaks about work before the group responds, encourages observations and questions rather than value-based statements
Ensure all group members have an opportunity to share and/or respond

Promote client understanding of the art process and attainment of treatment goals
Refer to other treatment providers as needed

Need written and signed release forms

Routinely evaluate clients’ progress and the efficacy of the art therapy process.

Understand current Diagnostic and Statistical Manual diagnoses

ADMINISTER AND EVALUATE ART THERAPY AND ART-BASED ASSESSMENTS

Determine the need for, select, and administer the appropriate art therapy and art-based assessment (linked to client goals)

Write and evaluate art therapy and art-based assessment reports.

Understand and administer art therapy and art-based assessments:

Belief Art Therapy Assessment (BATA): Assess a client's spiritual dimension and how a belief or disbelief in God impacts functioning within self, family, and society. Initial verbal interview, two art directives, and post-assessment interview.
Bird’s Nest Drawing (BND): Draw a bird's nest. The drawing is analyzed to gain insights into the person's feelings about home, nurturing, and safety. One sheet of blank, white 8.5 x 11 paper, 10-color pack of fine-point markers.
Bridge Drawing: Participants are instructed to draw a bridge. This assessment can be used to gain insights into the individual's perception of connection, transition, and progress in their life. 8 ½ X 11 blank, white paper; drawing utensils of choice.
Cognitive Art Therapy Assessment (CATA): This assessment can be used as a pre- and post-test. An open-ended, nondirective art assessment identifies changes in development and cognition, observes formal qualities in artwork, and identifies subject matter and client attitude during assessment. Low stress for the client, the client is usually unaware of the assessment, and uses Lowenfield development scoring standards. This information was added in Nov 2025 by Kelsey Paparo, ATR-P
Diagnostic Drawing Series (DDS): A series of 3 drawings: make a picture using these materials, draw a picture of a tree, and make a picture of how you're feeling using lines, shapes, and colors. Flat-sided chalk pastels, 18x24”, 70lb white drawing paper. Designed to be worked on a table
Draw-A-Person-In-The-Rain (DAP): Participants are instructed to draw a person standing in the rain. This assessment can reveal emotions, coping mechanisms, and attitudes towards adversity. One 8.5 x 11 piece of blank, white paper, and two #2 graphite pencils with working erasers.
Draw-A-Story (DAS): Creating a story based on a given stimulus drawing. This assessment helps in understanding a person's cognitive and emotional processes, as well as their problem-solving abilities.
Face Stimulus Assessment (FSA): Participants are asked to draw a face. The drawing is analyzed for facial features, expressions, and other elements to gain insights into emotional and social aspects. The FSA consists of three pieces of white 8.5” x 11” paper: Picture 1 contains a standardized image of a human face; Picture 2 contains only a face outline; and Picture 3 is a blank page. A standard packet of 8 Crayola markers and a packet of 8 Crayola Multicultural markers.

Formal Elements Art Therapy Scale (FEATS): a structured assessment that evaluates the formal elements of an artwork, such as color, form, and composition. It helps in understanding the individual's artistic expression and preferences.
Kinetic Drawings (KFD, K-H-T-P, KSD): These assessments involve drawing dynamic scenes, such as a family, house-tree-person, or school, in motion. They provide insights into a person's perceptions of relationships, environment, and personal dynamics.plain white paper (8 ½ X 11); #2 pencil.
Family Art Evaluation: Hana Kwiatkowska’s assessment involves family members creating art together: a free picture, a picture of your family, an abstract family portrait, a picture started with a scribble, and a joint family scribble. It aims to explore family dynamics, communication patterns, and relationships through the collaborative art-making process.
Levick Emotional and Cognitive Evaluation and Assessment Method (LECATA): LECATA is a comprehensive tool for evaluating emotions and cognition through art-making. It assesses emotional expression, coping strategies, and cognitive functioning.
Mandala Assessment Research Instrument (MARI): MARI involves creating a mandala, which is then analyzed for its symbolic content. Examines “12 lifeforces”. It provides insights into an individual's unconscious thoughts, emotions, and inner conflicts from a Jungian perspective.
Person Picking an Apple from a Tree (PPAT): Participants are asked to draw a person picking an apple from a tree. This assessment can reveal attitudes toward growth, achievement, and fulfillment.
Road Drawing: Participants are instructed to draw a road or path. This assessment can provide insights into a person's sense of direction, goals, and life journey.
Silver Drawing Test (SDT): Participants draw a picture of a tree. The drawing is analyzed for psychological content related to personal growth, emotional stability, and interpersonal relationships.

PROFESSIONAL PRACTICE AND ETHICAL RESPONSIBILITIES

Abide by the ATCB Code of Ethics, Practice and Disciplinary Procedures
Comply with the Health Insurance Portability and Accountability Act (HIPAA)

Release of PHI for providers and referrals
HIPAA-compliant communication, telehealth, and EMR platforms

Review and obtain informed consent, release of information, and other forms, which should be signed and copied for both the patient and the therapist

Informed consent
Confidentiality
Limits of confidentiality
Mandated Reporting
Private practice fee structure and sliding scale
Inpatient and residential length of stay based on insurance
No Surprises Act (Good Faith Estimates) 2023

Document art therapy products

Label and store in a locked drawer, cabinet, or office
Photographs are in an encrypted and locked folder
Do not throw away patient art (I have heard it can last up to 5 years?)

Document sessions and progress

Treatment plans
Progress notes
Other PHI records

Document supervision sessions
Engage in Cultural Responsiveness

Continuing education courses
Research related to the client
Engage in activism
Engage in personal art-making
Participate in peer consultation and supervision related to cultural humility

Evaluate the risk of harm to self and/or others

Assess risk, gather information, stabilize, safety plan, higher level of care
Duty to warn
Protocol dependent on the site
Military active duty: Local police if the client is off base, military installation/base police if the client is on base for immediate danger to self or others

Knowledge of supervision models
Guide ethical research practices
Provide supervision and consultation
Seek supervision and consultation
Utilize reflective art-making processes

PROFESSIONAL DEVELOPMENT AND RESEARCH

Gather, review, and interpret research literature and apply it to practice

Learn new techniques or media relevant to the client population/setting
Pursue additional resources when necessary
Research best practices for client/population needs

Prepare research for publication
Guide ethical research practice
Understand and conduct qualitative research

Interviews
Focus groups
Written responses on surveys

Understand and conduct quantitative research

Experimental designs
Developing or distributing measures
Measurable data on surveys

ADMINISTRATIVE FUNCTIONS AND PROGRAM MANAGEMENT

Conduct programmatic needs assessments/program evaluation

Prepare for external program accreditation review and audit
Prepare necessary reports for agencies/collaborating professionals/funding sources

Consult with other agencies/organizations

Maintain knowledge of community resources and referral sources

Provide appropriate physical space and ensure that universal precautions are utilized in the work environment

Proper ventilation
Lighting
Access to water
Access to restrooms
ADA Accessibility
Hazardous materials and disposal
Purchasing non-toxic materials
Cleaning supplies and areas
First aid kits
Body fluid protocol

Learn new techniques or media relevant to the client population/setting
Orchestrate programming that supports the work setting

Fundraising
Ethical art shows and exhibitions
Weekly schedules

Organize non-art therapy activities for clients

Field trips
Outdoor time

Participate in administrative meetings, case presentations, and clinical team meetings
Provide community outreach, staff trainings, and in-services

CONTINUED: ADMINISTRATIVE FUNCTIONS AND PROGRAM MANAGEMENT

ADDED BY JO CARPENTER, LPAT-A, ATR ON JAN 2025

Professional role within organizations

Art therapists function as integrated professionals within systems, not only as clinicians in therapy sessions.
This role applies across clinics, schools, hospitals, community programs, nonprofits, and staffed private practices.
Competence is demonstrated through safety, collaboration, organization, and ethical responsibility.

Programmatic assessment and evaluation

Identify unmet needs within the organization or client population.
Evaluate whether programs are effective and aligned with goals.
Use feedback and outcome data to make informed improvements.

Consultation and collaboration

Coordinate care with schools, hospitals, social service agencies, and community partners.
Share relevant information appropriately to support clients.
Participate in interdisciplinary problem solving.

Health and safety practices

Apply universal precautions to prevent infection and injury.
Use protective equipment when body fluids are present.
Clean shared materials and dispose of sharp tools properly.
Follow OSHA and infection control standards.

Professional development and competence

Stay current with techniques and media relevant to the population served.
Adapt approaches to meet cultural, developmental, or trauma-related needs.
Engage in continuing education to maintain professional competence.

Program support and coordination

Help organize activities that support the mission of the setting.
Assist with scheduling, exhibitions, fundraisers, or program visibility.
Advocate for the value of art therapy within the organization.

Client enrichment activities

Plan non-therapy activities that support client engagement and growth.
Organize field trips, workshops, or community-based experiences.
Maintain ethical boundaries between enrichment and therapy services.

Administrative and clinical participation

Attend administrative meetings and clinical team discussions.
Contribute to case presentations and treatment planning.
Communicate clearly and professionally with colleagues.

Physical environment management

Ensure therapy spaces are safe, accessible, and functional.
Monitor ventilation, lighting, and access to water for art materials.
Address environmental risks that could affect client safety.

Outreach, education, and advocacy

Provide community outreach and education about art therapy.
Offer staff trainings and in-service presentations.
Support organizational understanding of trauma-informed and ethical practice.

DISTINGUISHING FEATURES NOTED IN ARTWORK

ADDED NOV 2025 BY KELSEY PAPARO, ATR-P, ADAPTED FROM BARBARA COOPER’S STUDY GUIDE

Schizophrenia
Imagery resembling hallucinations, distorted body parts, unusual or mismatched facial expressions, transparent figures, geometric patterns, unusual color choices, fragmentation, disrupted spatial orientation, weak figure and ground relationships, excessive detail, regression, labeling, and written words or numbers. Themes often include depersonalization, alienation, or religiosity.
Depression
Somber or dark colors, minimal color use, minimal detail, few ideas, signs of low energy, unmoving or frozen figures, images of obstacles or confinement such as pits or corners, night scenes, and references to death or suicidality.
Bipolar Disorder (Manic Phase)
Vivid color, weakened composition, distorted figures, careless or impulsive execution, minimal detail, strong movement, expanded or crowded pages, euphoric themes, sexual imagery, religious imagery, and grandiose content.
Obsessive-Compulsive Disorder
Sparse color, rigid or highly controlled organization, limited emotional expression, and intense focus on detail.
Paranoia
Rigid, geometric, or symmetrical forms, cryptic or idiosyncratic symbols, and repeated images of eyes or watching.
Borderline Personality Disorder
Disorganized or unbalanced compositions, themes of splitting and emptiness, strong emotional expression, and negative self-images. Black and red often appear more prominently.
Antisocial Personality Disorder
Symbols of aggression or hostility, such as snakes, knives, or guns.
-Organic Mental Disorders
Irregular size or form, broken or shaky lines, one-sided drawings often seen after stroke, difficulty closing shapes such as circles, perseveration, and unusual or distorted human figures.
Anorexia
Hesitation to begin drawing, reluctance to reveal the self, light or sketchy lines, controlled execution, minimal color use, restricted affect, and occasional imagery of mushrooms associated with unsafe or contaminated food.
Bulimia
Impulsive use of materials, taking more supplies than needed, a greater likelihood of making a mess, and imagery that reflects bingeing and purging. Symbolic references to past sexual trauma may sometimes appear.
Dissociative Identity Disorder
Overlaps with features seen in Schizophrenia and Borderline presentations. Common themes include fragmentation of the self, puzzle-like or divided body images, maps or metaphors that represent alter systems, frequent child alters, barriers or dividing lines, chaotic scenes, trance-like imagery, and depictions of an internalized abusive part of the self that may be connected to suicidal or harmful thoughts.