In addition to making, I have an interest in interactions between art, mental health, creativity, and art therapies, with an emphasis on how art therapies may be better understood and funded to be more effective in the future.  In exploring these issues, my background in engineering and quantitative sciences steers me to take a systems approach that may provide a good foundation for better shared understanding in the future between art therapy stakeholders with disparate viewpoints.  In what follows, I briefly review art, mental health, creativity, and art therapies via a small number of recent references.  After noting linkages between these topics resulting in a small network, I suggest that all have gaps concerning language, knowledge and emotions, that can be addressed through inclusion of additional topics within the network.  I further suggest that this enhanced network could provide a basis for developing better quality evidence for art therapy efficacy and funding through better sharing of knowledge and understanding between stakeholders.


In what follows, I use ‘viewpoint’ in a specific way - a viewpoint is held by anyone who interacts with- or participates in a system.  A viewpoint has two parts – a model and a narrative.  The model is those parts of the system that the viewpoint interacts with.  The narrative describes how the viewpoint uses its model to provide the interaction or participation.  For example, the following ART section identifies at least 10 different viewpoints.



Amongst other things, the philosophy of art is concerned with its origin and reason.  Davis [1] considers two alternative theories - biological evolution and cultural invention.  The biological approach claims that art is a consequence of evolution driven by intrinsic value to makers and viewers.  This is evidenced by its occurrence in many forms throughout the world, over tens of thousands of years.  Alternatively, cultural invention claims that art arose in 18th & 19th century western society, driven by technological and social change, along with emergence of philosophical theories concerning aesthetics largely recycled from ancient Greece.


Another philosophical issue concerns what art is or may be.  Aesthetic functionalism suggests that something is art if it generates an emotional response in the viewer that makes them feel that it is art.  Institutional theory focuses on social factors suggesting that something is art if it is created by an artist using processes accepted as valid in the artworld.  Alternatively, Historicism suggests that something is art if it can be related to artistic predecessors, perhaps through the art making process or through emotional response of the viewer.  Whilst each has elements of truth, each also has caveats.  Each is a model associated with a different viewpoint.


Formulation of art philosophy and associated definitions typically takes place through observation and interpretation outside of the art making process.  Interpretation of the artist’s efforts has ebbed and flowed over several centuries between manual labourer and inspired genius. As discussed in [2], the rise of Modern Art in the 19th century saw artists taking the initiative and emphasising the technical and intellectual complexities of the art making process.  This introduces the need to consider the psychology of art making and how individuals engage with its results [3].  In art making, cognitive psychology addresses the basis for development of artists’ knowledge, experience and skill, whilst emotion plays a significant role in steering their application, aiming to achieve the artist’s creative intent.  Art making is rarely linear, needing continued interaction between creativity and practical work to keep on track or recognise the need or opportunity to take the work in a direction that feels more important to the artist.  Of particular relevance to art therapy, as discussed in [4], much of this, starting with the initial creative idea or insight, has been explained from a psychoanalytical viewpoint.  As with any other viewpoint, this involves a model that provides valuable insights, but does not tell the whole story [5].



For several decades mental illnesses have been defined by Chapter 5 of the WHO International Classification of Diseases (ICD) [6] and the Diagnostic and Statistical Manual of Mental Disorders (DSM) [7].  Most clients arrive in art therapy as a consequence of practitioner decision making guided by these documents.  Revision of DSM from edition 4 to 5 met with significant wide-ranging criticism [8].  Many of the criticisms relate to the specification of arbitrary classification boundaries that are open to manipulation by commercial, political and cultural influences.  This also includes the difference between mental illness and normality.  In contrast, Gallon [9] proposes that mental problems arise from interactions between our biology, psychological experience and social environment and that these problems fall more naturally along nine dimensions, or types, rather than within discrete categories.  Along with problem states, each dimension includes the concept of ‘normal’.  This approach appears to offer a more fundamental and robust conceptual framework for evidence-based practice, consensus between practitioners and reliability of interventions.



[10] provides a very broad starting point for exploring creativity with good links to deeper material.  I have particular experience of creativity in engineering and sculpture. Creativity in engineering is concerned with problem solving, aiming to achieve novelty and value in terms of cost, efficiency and market share.  Strong focus is placed on divergent and convergent thinking, along with the need for appropriate emotions and a conducive environment [11]. From a neurological viewpoint, divergent and convergent thinking take place via networks of different brain regions [3], with divergent thinking exploring novelty and convergent thinking assessing the value of this novelty.  In contrast to relatively formulaic approaches in engineering, creativity in art making is concerned with interpretation and can take many forms [4], but also relies on emotions and the interplay between divergent and convergent thinking, hence reliance on similar neurological activity.


The value of creativity in engineering is easy to perceive, e.g. availability of new consumer products, consequently, value can be measured in technological and financial terms.  Value of creativity in art is more subtle.  “isms” are clear indicators of creative pulses, typically spawning new artistic communities.  Also, as shown in [12] it is possible to calculate creativity networks spanning centuries amongst individual artists that demonstrate longer term value through influences on personal technique and practice.  In art therapy, creativity is required of both the client in producing their artwork and practitioner in its interpretation.



Jones [13] provides a recent comprehensive review of arts-based therapies using many examples of current practice to demonstrate its benefits.  He also highlights the significant lack of good quality statistical evidence of these benefits needed by national funders to establish arts-based therapies as a mainstream treatment option.  This is supported, for example, by particular investigations such as [14, 15] and an over-arching review [16] which provides valuable insight into various reasons for current evidence quality, including the use of multiple terminology for techniques and processes.  Such linguistic issues - semantic and syntactic problems – are symptomatic of unmediated knowledge silos or schools of thought and multiple viewpoints.  Allied to Jones’s review of practice,  Huss [17] provides a viewpoint in which practice is situated in a categorisation of psychoanalysis themes.  This appears to be a valuable starting point for establishing a coherent knowledge base from which investigations can be designed to deliver statistically valid evidence of art therapy efficacy.



Art therapy has significant potential for growth as a community-based treatment option, with a growing body of evidence indicating that it provides beneficial results for many.  However, from the viewpoint of potential funding bodies, this evidence is of scientifically poor quality.  Many of the topics reviewed in previous sections have a bearing on this and may potentially contribute to improved progress based on several common factors.  Each topic:


  • Contributes various forms of value to society
  • Has a relationship with the others, forming a small network as shown in fig.1
  • Has a body of research at the conscious and neurological levels but lacks some form of mediating middle ground.
  • Has an emotional element but lacks a coherent or structured approach for documenting how emotions arise and their influence.
  • Can be considered as a viewpoint on being human.
  • Has multiple viewpoints within it, associated with a wide range of differences, including interests, perceived importance, processes and terminology.




There are several observations at different levels of detail concerning art therapy:


Determination of cause and effect

The subjective nature of DSM and IDC, both requiring practitioner interpretation along with varying personal and professional experience of diagnosing practitioners, leads to a significant element of subjective client assessment.  In other words, practitioners can hold potentially significantly different viewpoints of clients, possibly leading to significant changes to prescribed treatment [18].  Art therapy practice seems to follow a similar trajectory to mental health diagnosis in that cause, effect and progress through therapy also rely on the perceptions of therapy practitioners steered by their individual experience and expertise.  As an alternative to DSM and IDC, Gallon’s dimensional approach [9] provides opportunity to locate clients within a more objective well-defined state space.  Given such a state space, with current reliance on individual practitioner experience and expertise, diagnoses and art therapies would still be subjective but less arbitrary.   However, further in the future, the adoption of a state space definition of mental health could provide a significantly more objective framework for inclusion of various novel forms of assistive technologies and assessments that could inform practitioner decision making, diagnosis and treatment including art therapy.


Considering the art element of art therapy, artwork creation, explanation and  interpretation involve creativity, language, knowledge and emotion.  Created artwork, or the interpretation of prior art, is an externalised model of the client’s subjective state, experience and emotions.  Treating this model as part of a viewpoint, the detail of the explanation or interpretation is the associated narrative within the client’s viewpoint of themselves.  In parallel, the practitioner’s interpretation and guidance are part of the narrative within their psychoanalysis viewpoint.


Whilst modern psychoanalysis has resulted from long standing efforts to develop interpretive viewpoints on mental condition, it appears to step from unconscious influences to their conscious recognition with little consideration of how this happens within the client’s mind.  Regardless of how these influences are neurologically encoded, their rise to consciousness appears to involve language and emotion.



Opportunities for Process augmentation

Language, emotions, creativity and viewpoints have all featured in the previous sections in various crucial ways.  However, in simply accepting their natural and essential occurrence, their multiple roles seem highly underestimated and in need of deeper investigation. 


  • Language

Relational Frame Theory (RFT) [19] appears prominent amongst theories of language development because, firstly, its descriptive power has been demonstrated in many different contexts including various mental health therapies.  Secondly, RFT offers scope for testing and validation through computational modelling.  As a psychological theory of human language, RFT was originally demonstrated through its explanation of language development and knowledge acquisition in infants, proposing that repeated use of relating and framing [19] leads to the accumulation of knowledge and language as a mental network that grows throughout individual human life.  Speculatively, perhaps what becomes conscious in psychoanalysis is actually encoded within an RFT network and kept hidden by emotional factors?


  • Emotion – Two tools are relevant.

The cognitive structure of emotions or OCC model, after its developers [20], proposes that emotions are reactions of some intensity to some perspective on the world.  Emotional cognition can be realised in different related forms as different affective reactions: experienced internally, reflected in behaviour or labelled and communicated through various forms of language.  In contrast to the familiar use of language to label emotions, the OCC model proposes that emotion types can be clustered into smaller classes of related types based on three eliciting conditions or stimuli: Events, Agents and Objects.  For any individual, the intensity of an experienced emotion depends on their goals, interests and beliefs which together provide a context for appraising or assessing the effect of some stimulus.  Goals, interests and beliefs form a fluid network of motivations and actions that can take place over various timescales and change due to experience.  In providing a structured approach to linking cause and effect, OCC has relevance to both diagnosis and subsequent therapy processes.


Nummenmaa et al [21] demonstrate an interesting psychophysiological software tool that enables reporting of distinct physiological responses to various experienced emotions.  The tool presents the user with stimuli, e.g. words, stories, videos and facial expressions, and allows the user to shade areas of body silhouettes that feel more or less activated in response to each stimulus. Statistically significant results were obtained from a cohort of several hundred users from European and Asian cultures.  This appears to be a potentially powerful approach to client self-realisation and a new communication mode  between client and practitioner.


  • Creativity

Art therapy depends on the creativity of both client and practitioner.  Clients exercise creative insight in recognising and organising what they want to express or say; organising and controlling communication mechanisms; assimilating and reacting to guidance and suggestion from practitioner.  All of these involve interactions between language, emotions and viewpoints.


Practitioner creativity is concerned with intellectual and manual processes involving use of professional and personal knowledge and experience, along with expansion of knowledge and experience to accommodate changes in the wider context of art therapy.  Huss presents this latter point well [22], appearing to align a future version of art therapy with the state space viewpoint for diagnosis exemplified by Gallon [9].


Creativity also plays a large part in practitioners’ interpretation of client artwork.  Again, this relies on professional and personal knowledge and experience leading to subjective interpretation processes [23, 24].  Artwork interpretation appears to offer a particularly valuable opportunity for the development and adoption of various assistive technologies.  The core process of recognising semantic content in artwork is amenable to image processing techniques such as [25, 26, 12].  Assistive technologies can also be developed for wider aspects of therapy, including computational psycholinguistics [27] for analysing language and vocal intonation, both reflecting dominant emotions.


All of these technologies deliver objective data that can be used individually or in combination to influence practitioner interpretation. The objective nature of this data also offers the possibility of more accurately tracking individual client progress and amassing accurate population data.  In the future, this would be a significant body of objective evidence to demonstrate the scientific efficacy of art therapy.


  • Viewpoints

Viewpoint Analysis was originally developed as a software engineering tool and has been more recently generalised by me and others to be applicable to any system as a novel basis for knowledge curation. Viewpoint Analysis is valuable to art therapy because it can help to identify and document what art therapy means in the minds of different stakeholders, such as schools of thought, individual practitioners, clients, prescribers, funders, general public, etc.  Each viewpoint involves a model, representing that part of art therapy that is relevant to the stakeholder, along with a narrative that documents how the stakeholder interacts with their model.  Comparing models and narratives from different viewpoints helps to identify gaps and overlaps, creating opportunities for developing better shared knowledge and understanding between stakeholders.


Opportunities for integration

The tools discussed above for language, emotions, creativity and viewpoints all have commonality in terms of their network structure, offering the possibility of their integration, fig.2.  Morrell [23] has explored some of these integration issues, supported by evidence for the need of a more rational objective theory of art therapy expressed from a range of viewpoints.  Springham [28] also identifies needs and opportunities for a more thorough scientific grounding that recognises the importance of multiple viewpoints and the need for interdisciplinary common ground. 






This note highlights several topics that can be explored to better understand and possibly develop art therapy processes and practice in the future.  Each topic is concerned with capturing objective data that can contribute to practitioner decision making and, in the longer term, contribute to the development of stronger scientific evidence for the efficacy of art therapy.




  1. Davis, S., “The Philosophy of Art”, ISBN 978-1-119-09165-3, 2016
  2. Grant, K., “All About Process”, ISBN 978-0-271-07745-1, 2017
  3. Mather, G., “The Psychology of Art”, ISBN 978-0-367-60993-1, 2021
  4. Townsend, P., “Creative States of Mind – Psychoanalysis and the Artist’s Process”, ISBN 978-0-367-14614-6, 2019
  6. “Diagnostic and management guidelines for mental disorders in primary care : ICD-10. Chapter 5, Primary care version”, ISBN 088-9-37148-2, 1996
  7. “Diagnostic and Statistical Manual of Mental Disorders”, ISBN 978-0-890-42555-8, 2013
  9. Gallon, R., L., “Nine Dimensions of Madness”, ISBN 978-1-58394-926-9, 2015
  11. Cropley, D. H., “Creativity in Engineering - Novel Solutions to Complex Problems”, ISBN 978-0-12-800225-4, 2015
  12. Elgammal, A., Saleh, B., “Quantifying Creativity in Art Networks”, arXiv:1506.00711v1 [cs.AI] 2 Jun 2015
  13. Jones, P., “The Arts Therapies – A Revolution in Healthcare”, ISBN978-1-138-62131-9, 2021
  14. Deshmukh, S. R., et al, “Art therapy for people with dementia”,
  15. Wigham, S., et al, “Using Arts-Based Therapies to Improve Mental Health for Children and Young People with Physical Health Long-Term Conditions: A Systematic Review of Effectiveness”, Frontiers in Psychology,, 2020
  16. “Reviewing art therapy research: a constructive critique”, 2015
  17. Huss, E., “A Theory-based Approach to Art Therapy”, ISBN 978-0-415-72544-6, 2017
  18. Pickersgill, M., “What is psychiatry? Co-producing complexity in mental health”, Soc Theory Health 10, 328–347,, 2012
  19. Dymond, S, Roche, B. (Eds.), “Advances in Relational Frame Theory – Research and Application”, ISBN 978-1-608-82447-2, 2013
  20. Ortony, A., et al, “The Cognitive Structure of Emotions”, ISBN 978-0-521-38664-7, 1994
  21. Nummenmaa, L., et al, “Bodily maps of emotions”, PNAS January 14, 2014 111 (2) 646-651;
  22. Huss, E., “The relationship between figure and background: Towards a new theory of a social prism for analyzing the mechanisms of art in therapy”, ATOL: Art Therapy OnLine, 8 (1) © 2017
  23. Morrell, M., “Signs and Symbols: Art and Language in Art Therapy”, Journal of Clinical Art Therapy, 1(1), 25-32, retrieved from:, 2011
  24. Curtis, E. K., “Understanding Client Imagery in Art Therapy”, Journal of Clinical Art Therapy, 1(1), 9-15, 2011
  25. Torresani, L., et al, “Efficient object category recognition using classemes”, ECCV, 2010.
  26. Oliva, A., Torralba, A., “Modeling the shape of the scene: A holistic representation of the spatial envelope”, International Journal of Computer Vision, 42:145–175, 2001.
  27. Schuller, B., Batliner, A., “Computational Paralinguistics: emotion, affect and personality in speech and language processing”, ISBN 978-1-119-97136-8, 2014
  28. Springham, N., “Description as social construction in UK art therapy research”, International Journal of Art Therapy, 21:3, 104-115, DOI: 10.1080/17454832.2016.1220399, 2016