ATR-BC Exam Prep: CBT and ACT in Art Therapy
One of the most effective ways for me to comprehend and remember information is through writing. I was often excited when assigned an essay in school! Because of how much I am already writing, I have decided to share what I am currently reviewing as I prepare for my board certification exam!
This week I reviewed CBT, ACT, and attachment theory. I will save attachment theory for more related theories, to create a more cohesive blog post.
Cognitive Behavioral Therapy (CBT) Art Therapy
Cognitive behavioral therapy focuses on current issues that are affecting the client. While a brief history is collected, the therapist focuses on collaborating with the client to identify and address unhelpful thoughts, behaviors, and coping mechanisms, replacing them with helpful ones. This approach focuses on insight into the present in order to equip the client to better handle stressors.
Therapists challenge clients to face fears directly through role playing, action plans, learning and applying calming techniques, and changing limiting beliefs about self, others, and life. This can be amplified through art making, as the visual nature of images may allow clients to face their fears in the therapy room before outside of it. Art making can also include art-based calming and mindfulness techniques that can equip the client with tools to feel empowered when facing fears.
CBT prioritizes insight about current thinking patterns over past experiences, focusing on identifying distorted thinking about themselves and others. The therapist may assist the client in reframing thinking patterns and assigning homework such as ‘thought logs’. Certain other techniques may be taught such as ANTs to PETs and locus of control. Art therapy can be effective in gaining insight into how the client currently may view an issue, or even view themselves.
CBT therapists believe that teaching these skills can instill empowerment in the client, as the goal is for the client to no longer need the therapist to continue changing thought patterns. Art therapy directives such as problem solving development, shield of strength, personal superhero, and vision boards may be applied.
Figureheads such as Dr. Aaron Beck and Elbert Ellis are seen as initiators of CBT in the 1950s and 60s. They focussed on the connection between unhelpful thinking and negative emotions, as well as challenging irrational beliefs.
Acceptance Commitment Therapy (ACT) Art Therapy
Acceptance Commitment Therapy is considered a third-wave behavioral therapy, and combines well with art therapy due to similar inherent values. ACT views thoughts and emotions as valuable for observation, with both therapist and client collaborating to view them objectively and curiously. While others see discomfort as something to treat or avoid, ACT sees it as part of the human experience to be accepted. ACT asserts that avoidance of discomfort is counterproductive, and worsens issues, while making choices in accordance with values is the best way to engage in a deeply enriching life.
ACT has six primary processes that are done in therapy, each easily compatible with art therapy. First is acceptance. This is achieved through processes of non-judgement, naming, and cultivating curiosity about all thoughts and emotions that come up. Clients are encouraged to not try to alter or change thoughts. In art therapy, emotions and perspectives can be both revealed and expressed visually, and the client can practice non-judgment through the way they engage with the art they created about those internal experiences.
Second, ACT encourages ‘cognitive diffusion’, a process that allows for enough distance to observe one’s thoughts and feelings without being consumed by them. This works in conjunction and prepares the client for the third process of mindfulness. In art making, sensory and affective components can connect the client to the present moment in powerful and confrontational ways, which can assist the client’s ability to stay connected outside of therapy. In cognitive diffusion, the thought/feeling is externalized as outside of the self, and may assist with this process. The fourth process is ‘self as context’, which is further development of the observing self, the self that is able to provide the space of non-judgement, mindful awareness, and distance. This ‘self’ can be further developed in art making through symbolism, and visual expression and representation of the self.
The final processes are value identification and committed action in accordance with values. This includes empowerment to choose and behave in alignment with one’s own values instead of making choices aimed at pain avoidance or adherence to the values of others. The committed action is formed out of these values and practically involves goal-setting, exposure processes, and skill building.
Within the context of the therapeutic relationship, ACT requires the therapist to adhere to their own values and committed action, as well as approach the space with acceptance and non-judgement. Art therapists by nature are committed to their value of creativity, creative thinking, and observation of experiences. This fundamentally forms the relationship with the client around the core principles of ACT. Furthermore, both art therapists and ACT therapists value cognitive flexibility and creative thinking. Art making increases the ability to engage in cognitive flexibility, as well as facilitates complex and powerful meaning-making of all life experiences.
