Humanistic and developmental art therapy

1. Introduction

Version followed: the grouping used in Rubin & Van Den Berg (eds.), Approaches to Art Therapy, 3rd ed. (Routledge, 2016). Its Part III "Humanistic Approaches" has chapters by Bruce Moon (humanism in action), Janie Rhyne (Gestalt art therapy), Natalie Rogers (person-centred expressive arts therapy) and Chilton & Wilkinson (positive art therapy). Its Part VII has Ch. 22 "Developmental Art Therapy" by Susan Aach-Feldman and Carole Kunkle-Miller. Procedures here come from these sources: Mala Betensky's phenomenological method (book 1995; demonstration film), Natalie Rogers' own articles, Williams & Wood's Developmental Art Therapy in the Classroom (2nd ed., 2010, Developmental Therapy Institute; 1st ed. 1977 titled Developmental Art Therapy), Lowenfeld & Brittain's stage sequence as applied in developmental art therapy, and Kagin's media dimension variables from the Expressive Therapies Continuum (ETC). Only the 2016 chapter list is drawn on, not the chapter texts. Anything credited to Rhyne, Moon, Chilton & Wilkinson or Aach-Feldman & Kunkle-Miller beyond chapter titles is therefore marked [uncertain]. [source: Routledge 3rd-ed. contents page; Mercyhurst catalogue record]

What it is. "Humanistic and developmental art therapy" is an umbrella for two families of approach, not a single manualised therapy.

Humanistic art therapy covers person-centred, phenomenological, Gestalt and existential work. The client makes art in an accepting relationship and is treated as the authority on what the image means. Change is held to come from the creative process itself: expressing and staying with feelings, seeing one's own image freshly, and self-directed meaning-making. Rogers sums it up as "The creative process is healing." [source: Rogers 2010, psychotherapy.net] Betensky combined art, phenomenology and gestalt psychology. In her method the client makes the artwork, then looks at it as an entity in its own right, then shares what is seen. [source: JKP book page; psychotherapy.net Betensky film page]
Developmental art therapy starts from where a person is developmentally: sensory, motor, cognitive, social and emotional. Art materials, task structure and group demands are then graded so that each experience succeeds and builds the next skill. Change comes from graded mastery and from art activities that carry "social, intellectual, perceptual-motor and emotional growth" lesson by lesson. [source: combinedbook description of Williams & Wood 2010; Wingender 1981 abstract; Wikipedia ETC page]

Professional frame.

UK: "art therapist" and "art psychotherapist" are titles protected by the HCPC. The route is an approved master's programme. The professional body is BAAT.
US: the credentials are ATR / ATR-BC through ATCB, with AATA as the professional association.
Person-centred expressive arts: training is through expressive-arts programmes, with IEATA registration (REAT) as the multimodal route. Rogers ran it as a long experiential training, for example four ten-day sessions over two years in Norway, and said facilitator qualities are best learned by first experiencing them. [source: Rogers, Self & Society; Rogers 2010]
Williams & Wood: their developmental art therapy comes from the Developmental Therapy Institute, Athens, Georgia. [source: Mercyhurst record]

A psychotherapist without art-therapy training can use art materials inside their own modality. They should not call this art therapy, should not use art for assessment, and should not run regressive or sensory-level work with severely impaired clients. [synthesis]

2. Framework

A. Humanistic session arc (Betensky; Rogers)

Within-session phases (Betensky). Her film describes three phases. [source: psychotherapy.net film page]
1. Doing: making the art, with stress on the client's relationship with the materials and the process.
2. Analysing: looking at the finished product as an entity, led by the question "What do you see?"
3. Sharing: talking it through.
- Other accounts give Betensky a longer sequence, with a warm-up on the materials and a separate step of setting the picture at a distance before looking. This is [uncertain].
Multimodal sequence (Rogers' "Creative Connection"). One art form stimulates the next. The usual order is movement with awareness, then drawing or painting the feeling, then freewriting straight away. Structured movement first builds a body "vocabulary". Guided experiences in art, fantasy and writing deepen inner exploration. [source: Rogers, Self & Society; Rogers 2010]
Course length and format. No session count is given in the sources. Betensky's film shows the same client at ages 10 and 15, which points to long-term, intermittent work. Rogers worked with individuals, groups and residential trainings. [source: film page; Rogers]
- A typical individual session is 50–60 minutes: about 10 minutes check-in and media choice, 25–35 minutes making, 10–15 minutes looking and sharing. Groups need 90–120 minutes. [synthesis]

B. Developmental progression (Williams & Wood)

The chapter sequence of the 2010 book lays out the stage progression. [source: Mercyhurst contents] The stage names follow Mary Wood's Developmental Therapy model; matching them to the chapters is my reading. [uncertain]

Stage	Focus	Goal
1	Responding to the art environment with pleasure	Sensory engagement, trust in the room and the adult
2	Responding to art materials with success	Mastering tools and materials, completing simple tasks
3	Learning skills for successful participation in group art projects	Turn-taking, sharing materials, following group rules
4	Valuing individual artwork and contributions to group projects	Pride in one's own work, recognising others' work

Further chapters cover a "sublime material" (which material is not stated in the record), exhibiting work, "art as therapy" and "art as development". [source: Mercyhurst contents; contents beyond titles [uncertain]]

Format: classroom groups, from early childhood to the teens. [source: combinedbook]
Moving between stages: not given in the sources. Move on once the client reliably meets the current stage's goals across several sessions with little adult help, and drop back a stage when stressed. This follows the general Developmental Therapy logic. [synthesis/uncertain]

C. Developmental level of art expression (Lowenfeld & Brittain, as used by developmental art therapists)

Stages: scribbling, preschematic, schematic and gang age. Developmental art therapists use "structured and unstructured art exercises that mirror the developmental stages", including with adults who have intellectual disability. [source: Wingender 1981 abstract]
Media dimension variables (Kagin, ETC): task complexity, task structure and media properties. Each can be changed on its own to shift the client's level of functioning: kinesthetic/sensory, perceptual/affective, cognitive/symbolic, creative. [source: Wikipedia ETC page, citing Kagin & Lusebrink 1978]
Phases of a developmental course: assess the current level of art expression; work at that level until success is reliable; then add one step of complexity or structure at a time. [synthesis]

3. Guiding principles

Humanistic [source: Rogers 2010; Rogers, Self & Society; Betensky film page; JKP page]

Everyone is creative; the process heals. Never grade skill. Offer media as invitations, not tests.
Process matters as much as product; not a "pretty" picture. Don't praise or correct how the work looks. Respond to the experience.
Worth, dignity and capacity for self-direction. The client chooses media, subject and pace. Offer choices rather than prescriptions.
No art-based diagnosis or interpretation by the therapist. Rogers states that humanistic expressive therapy does not use art to diagnose or "treat". Meaning comes from the client's own account of the image.
Empathy, congruence, deep listening. Reflect what the client says and shows. Don't rush to reassure. Let grief and tears be present.
Feelings are energy to channel into art. Invite strong emotion into the material (movement, colour, line) rather than only talking about it.
One art form feeds the next (the Creative Connection). If a client is stuck in one mode, change modality: movement, then image, then words.
Structure is compatible with person-centredness. You may give exercises, but hold them lightly and let the client change or refuse them. Unstructured groups are not neutral either.
Look before explaining (Betensky). Ask what is seen on the page before asking what it means, and keep the client's attention on the visible work.
Directive and kind (Betensky). Her stance was active: encouraging observation, putting things into words, choice, narrative and imagining change. [source: film page]

Developmental [source: combinedbook; Mercyhurst contents; Wingender abstract; ETC page; synthesis where marked]

Start where the person is. Match the task to the client's developmental level of art expression, not to their age.
Pleasure, then success, then group skill, then valuing. Don't ask a client for group collaboration before they can enjoy and manage the materials.
Every lesson carries growth goals. Plan each activity with an explicit social, cognitive, perceptual-motor and emotional aim.
Grade the media dimensions. Change one variable at a time (structure, complexity, material resistance) to move a client up or down a level.
Engineer success. Design tasks that can be finished, and step in before frustration turns into failure. [synthesis]
Value the work publicly. Exhibiting and recognising work builds identity, with the client's consent. [source: contents title; method [uncertain]]

4. Intervention inventory

This inventory lists the interventions named in the sources. Where the sources only name an activity, the step-by-step detail is my own and is marked [synthesis]. Wording marked (illustrative) is mine.

Materials and space safety (applies to all items) [synthesis]

Use non-toxic, certified art materials (for example AP-labelled). No solvent-based paints, aerosols or fixatives in the room.
Use wet-clay methods and wet clean-up. Never sweep dry clay dust.
Count scissors, craft knives and wire in and out, and keep them supervised.
Ask about latex, food and wheat allergies (play dough contains wheat). Watch for pica or mouthing in clients with intellectual disability or young children.
For movement exercises: clear floor space, non-slip surfaces, a chair option, and no pairing of people with very different mobility without adaptation.
Artwork is confidential clinical material. Agree storage, return and display with the client.

Humanistic

4.1 Free choice of media and open art-making ("doing" phase)

Purpose: to start a self-directed process. Betensky stresses the client's relationship with the materials and the process. Rogers invites doodling, painting or playing with colour without concern for the result. Use it at the start of most humanistic sessions. [source: Betensky film page; Rogers 2010]
Steps [synthesis]:
1. Set out a limited, visible range of materials: crayons or oil pastels, chalk pastels, tempera, clay and collage.
2. Invite the client to touch and try materials before choosing.
3. Leave the subject open, or offer one theme in the client's own words.
4. Stay present and quiet while they work. Reflect only if invited, or if the client seems lost.
5. Time-check five minutes before the end of making.
Example language (illustrative): "Take a moment with the materials. Try any of them and see which one wants to be used today. There's no right way to do this."
Watch for:
- Paralysis or "I can't draw". Rogers notes some people were discouraged by childhood art training; see 5.2.
- Rushing to finish, or making the work look "nice" for you.
- It is working when the client becomes absorbed and makes choices without checking with you.

4.2 Phenomenological looking: "What do you see?" (analysing phase)

Purpose: to let the client see their own product as an entity, notice what is actually there, and find meaning from it rather than from theory. This is the core of Betensky's method; she uses the question "What do you see?" repeatedly. [source: Betensky film page; JKP page] Use it after the art-making in most sessions.
Steps:
1. When the client says the work is finished, place it where you can both see it. Betensky's distancing step is [uncertain]. Propping the picture up and stepping back is my [synthesis].
2. Ask what they see.
3. Keep them describing visible features (lines, shapes, colours, placement, empty areas) before any explanation.
4. Follow with questions about how the parts relate and what stands out.
5. Only then ask what it reminds them of, or how it connects to their life.
- Steps 3–5 are [synthesis], consistent with Betensky's focus on formal components and on encouraging observation and putting things into words. [source: JKP page Part II; film page]
Example language: "What do you see?" [Betensky, film page]. Then, illustrative: "Tell me about this part here." / "What's happening between the red shape and the empty space?" / "Looking at it now, what do you notice that you didn't while you were making it?"
Watch for:
- Jumping straight to an explanation ("it's just my house"). Return gently to looking.
- Asking you for an interpretation. Hand the question back.
- It is working when the client notices something new, surprises themselves, or links a visual feature to a feeling in their own words.

4.3 Formal-element observation: line, shape, colour

Purpose: to use the formal components of the image as a way into experience. Part II of Betensky's book covers line, shape and colour as formal components. [source: JKP page] Use it when content is guarded or the client is very verbal and intellectualising.
Steps [synthesis]:
1. Ask the client to pick one element: a line, a colour or a shape.
2. Ask them to describe its quality: speed, weight, direction, temperature.
3. Ask whether that quality is familiar in their body or their life.
Example language (illustrative): "Pick one line that catches your eye. How would you describe it: fast, heavy, hesitant?"
Watch for:
- Treat formal qualities as the client's material, not as diagnostic signs.
- It is working when descriptions of the line or colour shift into descriptions of feelings.

4.4 Scribble drawing

Purpose: a low-skill, projective starting point that brings out spontaneous imagery. Betensky devotes a part of her book to symbolic expression through the scribble, including a classification system, diagnostic possibilities and eating-disorder case studies. [source: JKP page] Her scribble procedure and classification are not drawn on. [uncertain]
Steps [synthesis, a common generic form]:
1. A loose warm-up movement of the arm.
2. A continuous scribble on paper.
3. Turn the page and look for an image in it.
4. Develop the image with colour.
5. Phenomenological looking (4.2).
Example language (illustrative): "Let the crayon wander, without planning. Now turn the paper around. Does anything start to appear?"
Watch for:
- Never use scribble content as diagnostic evidence beyond what a validated manual supports.
- It is working when an image emerges that the client relates to.

4.5 Sharing and client-led meaning-making (sharing phase)

Purpose: to put the experience into words and integrate it. The meaning comes from the client's own explanation, received with empathy. Betensky encouraged the client to build a narrative and to imagine and create change. [source: film page; Rogers 2010]
Steps [synthesis]:
1. Invite the client to tell the story of the piece, or of making it.
2. Reflect what you hear: content and feeling.
3. Ask what the image might need, or what would change it.
4. Optionally offer a new sheet to draw the change.
5. Agree what the client wants to keep or take forward.
Example language (illustrative): "If this picture could tell its story, how would it go?" / "Is there anything this picture needs?" / "You said the figure is alone and tired. That sounds like a heavy place to be."
Watch for:
- Your own interpretations creeping in; offer them as a question, or not at all.
- It is working when the client takes ownership ("I see that I always...") and begins imagining alternatives.

4.6 The Creative Connection sequence: movement, then art, then writing

Purpose: to let one art form stimulate the next, freeing feeling and reaching deeper material. This is Rogers' signature method. [source: Rogers 2010; Self & Society] Use it when talking or single-medium work has stalled, or with groups.
Steps:
1. Brief structured movement with awareness, attending to the body and feelings.
2. Move straight to colour, line or form to express what came up.
3. Freewrite straight after, without editing, for several minutes.
4. Read the writing, look at the image, share.
- The order and the immediacy follow the sources. Timings are [synthesis].
Example language (illustrative): "Stand or sit however is comfortable. Let your body move with whatever you're feeling, even if that's very small movements. ... Now, without talking, go to the paper and let the colour carry that feeling. ... Now write whatever comes, without stopping to correct it."
Watch for:
- Fall risk and self-consciousness in movement. Offer seated options and permission to keep eyes open.
- Rogers notes this work can reach "primitive, child and shadow" aspects; see 5.3.
- It is working when the writing flows freely (Rogers reports it sometimes becomes poetry) and the client links the three products.

4.7 Building a movement vocabulary

Purpose: structured movement exercises that build a "vocabulary" so clients can express themselves through their bodies. They are a precondition for 4.6. [source: Self & Society] The specific exercises are not given in the sources. [uncertain]
Steps [synthesis]:
1. Explore a few movement qualities in turn: fast/slow, heavy/light, contracted/expanded.
2. Name each quality after trying it.
3. Invite the client to choose the quality that fits today's feeling.
Example language (illustrative): "Try moving very slowly... now quickly. Which feels more like today?"
Watch for:
- Trauma-related body shame or dissociation; offer opt-outs.
- It is working when clients start using movement qualities spontaneously as a language.

4.8 Freewriting after art or movement

Purpose: to capture unedited material while it is fresh. [source: Rogers 2010; Self & Society]
Steps [synthesis]:
1. Set a short time.
2. Keep the pen moving, with no correcting.
3. Start from the image or the body sensation.
4. Choose whether to read aloud.
Example language (illustrative): "Start with 'This picture says...' and keep going."
Watch for:
- Literacy difficulties: offer dictation or single words.
- It is working when the text holds feeling words rather than commentary.

4.9 Art journal and dream journal

Purpose: to continue the process between sessions. Rogers describes doodling, painting or playing with colour in an art journal, and dream journaling to find patterns and symbols. [source: Rogers 2010]
Steps [synthesis]:
1. Agree a small, low-pressure practice: a few minutes of colour after waking or before sleep, or noting dream images.
2. Bring the journal to sessions only if the client wishes.
3. Explore recurring images with 4.2.
Example language (illustrative): "This is just for you. If you'd like to bring something in, we can look at it together."
Watch for:
- Nightmares or trauma intrusions increasing. Pause dream work and stabilise.
- It is working when the client notices recurring patterns themselves.

4.10 "Melting and Growing" (group or pair)

Purpose: an embodied group exercise about collapse and growth, translated into art. [source: Rogers 2010]
Steps:
1. Partners take turns: one moves through melting and growing while the other watches.
2. Each then translates the experience into art.
3. The pair shares. [source: Rogers 2010; sharing step is [synthesis]]
Example language (illustrative): "When you're ready, let your body slowly melt toward the floor, as far as is comfortable, then slowly grow back up. Your partner simply watches with care."
Watch for:
- Falls and joint strain: offer a chair version.
- Feeling exposed while watched.
- The exercise as described is observation, not touch. If any physical contact is added, get explicit consent first and give an easy opt-out. Never sexual or genital touch. [synthesis]
- It is working when the art captures the felt contrast and sparks discussion of personal "melting" and "growing".

4.11 Guided imagery or fantasy followed by art

Purpose: to explore the inner world through imagery and then give it form. Rogers lists guided experiences in art, fantasy and writing. [source: Self & Society] The scripts are not given in the sources. [uncertain]
Steps [synthesis]:
1. A short grounding.
2. An open-ended imagery prompt (a path, a place, an object) with the eyes open or closed.
3. Return and re-orient to the room.
4. Draw what was found.
5. Look and share (4.2, 4.5).
Example language (illustrative): "Let an image of a place come to mind, any place. Notice what's there. ... Bring your attention back to the room, feel your feet. Now draw what you found."
Watch for:
- Dissociation and intrusive images in trauma clients. Keep eyes-open options and a clear re-orientation.
- It is working when the client can describe the image and stays regulated.

4.12 Sound and vocal expression

Purpose: to widen the expressive channels within the Creative Connection. [source: Rogers 2010]
Steps [synthesis]:
1. Breath.
2. A hum or a single sound for a feeling.
3. Draw the sound.
Example language (illustrative): "If that feeling had a sound, what would it be?"
Watch for:
- Embarrassment.
- Noise levels in shared buildings.

4.13 Empathic reflection of process and image (the stance as intervention)

Purpose: to provide the acceptance and understanding Rogers sees as what makes healing possible, especially with painful feelings. [source: Rogers 2010; Self & Society]
Steps [synthesis]:
1. Name what you observe in the process ("you pressed hard here").
2. Reflect the feeling the client expresses.
3. Tolerate silence and tears without rushing to comfort.
4. Check your understanding.
Example language (illustrative): "It looks like that took a lot of force. Is that right?" / "I don't need to fix this; I'm here with you in it."
Watch for:
- Your own urge to reassure or advise.
- It is working when the client goes deeper rather than closing down.

4.14 Gestalt-oriented image work [synthesis; Rhyne chapter]

Purpose: to increase present-moment awareness and ownership. Janie Rhyne's Gestalt art therapy is a chapter of the version followed, but her procedures are not drawn on. [uncertain]
Steps: the following are generic Gestalt-informed practices, not attributed to Rhyne. [synthesis]
1. Describe the image in the present tense and first person ("I am a dark circle...").
2. Optionally hold a short dialogue between two parts of the picture.
3. Notice what is felt in the body while doing this.
Example language (illustrative): "Try speaking as the circle: 'I am...'. What does it say?"
Watch for:
- Can be intense. Don't use it with fragile, psychotic or acutely traumatised clients until they are stable.
- Stop if the client becomes flooded.

Developmental

4.15 Assessing developmental level of art expression (Lowenfeld & Brittain stages)

Purpose: to find the client's current level so tasks can be matched to it. Developmental art therapists use the Lowenfeld & Brittain sequence (scribbling, preschematic, schematic, gang age), including with adults who have intellectual disability. [source: Wingender 1981 abstract] Use it at intake and periodically afterwards.
Steps [synthesis]:
1. Over two or three sessions, offer one unstructured task (free drawing) and one simple structured task (for example "draw a person" or "draw your home").
2. Note the stage features: controlled or uncontrolled scribble; first representational symbols; stable schemas with a baseline; increasing realism and peer-focused themes.
3. Also note tool grip, use of space, ability to name the work, and how long the client stays with a task.
4. Record the observations descriptively.
Example language (illustrative): "Today I'd like to see how you like to use the crayons. Make anything you want."
Watch for:
- These stages are descriptive developmental norms, not a standardised test. Don't use them to diagnose disorder or as evidence of abuse. Allow for cultural differences in drawing conventions and for motor impairment. [synthesis]
- It is working when you can name a level that predicts which tasks the client can succeed at.

4.16 Stage 1 (Williams & Wood): responding to the art environment with pleasure

Purpose: to build trust and sensory enjoyment in the art room. This is for children or adults who withdraw, are severely impaired or are very young. [source: Mercyhurst contents chapter title; content [synthesis]]
Steps [synthesis]:
1. Use a predictable routine: the same start ritual and the same place.
2. Offer highly sensory, forgiving materials, such as finger paint, play dough, large crayons and textured paper.
3. The adult models enjoyment, names sensations simply, and gives no demands for a product.
4. Keep sessions short.
5. End with a predictable closing.
Example language (illustrative): "Squishy! Look, the blue is spreading."
Watch for:
- Sensory overload: noise, smells, sticky textures. Offer tools (sponges, brushes) for clients who dislike direct touch.
- Mouthing of materials.
- It is working when the client approaches the materials and the adult willingly.

4.17 Stage 2: responding to art materials with success

Purpose: mastery of tools and simple processes, completing short tasks, and accurate praise of effort. [source: chapter title; content [synthesis]]
Steps [synthesis]:
1. Break each task into small steps: fold, cut on a thick line, glue, place.
2. Demonstrate each step.
3. Hand-over-hand only with consent and only if needed; fade it quickly.
4. Give choices between two options.
5. Make sure the product can be completed in the session.
6. Name the specific skill the client used.
Example language (illustrative): "You cut right along the line. You did that yourself."
Watch for:
- Frustration with resistive or fiddly materials. Simplify before failure happens.
- It is working when the client tries steps independently and asks for materials.

4.18 Stage 3: learning skills for group art projects

Purpose: turn-taking, sharing materials, following simple group rules and contributing to a joint piece. [source: chapter title; content [synthesis]]
Steps [synthesis]:
1. Start with parallel work on a shared surface, each person in their own section.
2. Then shared materials with clear turn rules.
3. Then a joint mural with assigned roles.
4. State a few positive rules before starting and reinforce them during the work.
Example language (illustrative): "This corner is yours, this one is Sam's. When you need the green, ask Sam."
Watch for:
- Conflicts over materials. Duplicate key items early on.
- It is working when clients negotiate with peers without adult help.

4.19 Stage 4: valuing individual artwork and contributions to group projects

Purpose: to build self-worth and appreciation of others through recognising one's own and others' work. [source: chapter title; content [synthesis]]
Steps [synthesis]:
1. A short sharing circle after making.
2. Each person names one thing they like in their own work and one in a peer's.
3. Build group decisions about a joint piece.
Example language (illustrative): "What part of your picture are you proudest of? What do you notice in Maya's?"
Watch for:
- Put-downs: teach and model specific, kind comments.
- It is working when clients spontaneously comment on peers' work.

4.20 Exhibiting work ("Developmental art therapy on exhibit")

Purpose: public valuing of work. It appears as a chapter of the 2010 book; their procedure is not drawn on. [source: Mercyhurst contents; [uncertain]]
Steps [synthesis]:
1. Get consent and assent for each piece.
2. The client chooses the pieces and the titles.
3. Use first names or no names.
4. Never show work that holds disclosures or personal clinical content.
Example language (illustrative): "Would you like this one in the hallway show? It's completely your choice."
Watch for:
- Confidentiality.
- Disappointment if the work is not chosen.

4.21 Structured and unstructured exercises graded to developmental stage

Purpose: to alternate free and structured tasks matched to the client's stage, and to move them forward. [source: Wingender 1981 abstract] Wingender also studied copying tendencies and the "need of symbolism" in adults with intellectual disability; her specific exercises are not drawn on. [uncertain]
Steps [synthesis]:
1. Pair each structured task (a template, a theme, a step-by-step) with a free task.
2. When copying or stereotyped repetition dominates, keep the familiar schema but vary one element (colour, size, setting) and invite a personal addition.
Example language (illustrative): "You've made a great house again. What could be in the garden this time?"
Watch for:
- Copying can be a coping strategy. Don't ban it; extend it gradually.
- It is working when personal symbols appear.

4.22 Grading the media dimension variables (Kagin; ETC)

Purpose: to shift a client's level of functioning by changing task complexity, task structure or media properties one at a time. [source: Wikipedia ETC page, citing Kagin & Lusebrink 1978]
Steps:
1. Identify the client's current or preferred level from process and product.
2. To move down toward kinesthetic/sensory work (for regulation, preverbal material or young children), use simpler tasks and more sensory media.
3. For perceptual/affective work (identifying emotions, seeing things anew), use expressive colour and form.
4. To move up toward cognitive/symbolic work (planning, problem-solving), add structure and steps.
5. Change one variable at a time.
- The level uses follow the source; the steps are [synthesis].
Example language (illustrative): "Let's try the clay instead of the pencil today and just see what your hands want to do."
Watch for:
- Very fluid or highly sensory media can disorganise some clients. Lusebrink's level descriptions note K/S work may access extreme emotions. [source: ETC page]
- It is working when the client's functioning shifts in the intended direction within the session.
- Note: the ETC is often given its own entry. It is included here only as the media-grading tool developmental art therapists use.

5. Handling problems

The sources give almost no explicit troubleshooting. Except where a source is cited, everything below is [synthesis] consistent with the stated principles.

5.1 Stuck client (repetitive images, "nothing comes")

Switch modality. Rogers' principle that one art form stimulates the next fits here: go from talk to movement, then to colour (4.6). [source: Rogers]
Or switch the material along the media dimensions: a fluid material for a rigid client, a structured one for a diffuse client (4.22).
Return to pure looking (4.2) rather than pushing for meaning.

5.2 "I can't draw" / performance anxiety

Rogers links art blocks to childhood discouragement and stresses that art here is not about a "pretty" picture. [source: Rogers 2010]
Respond by:
- offering scribble (4.4), non-dominant hand or eyes-closed drawing, collage or clay;
- doing a few minutes of parallel art-making yourself, if that fits your frame;
- never praising or criticising skill.

5.3 Overwhelm, flooding, regression

Rogers notes the process can touch primitive, child and shadow aspects. [source: Self & Society] Lusebrink associates K/S work with extreme emotions. [source: ETC page]
Respond by:
- stopping the making;
- grounding (feet, breath, naming five things in the room);
- turning the image over or moving it away;
- shifting to a structured, cognitive task (copying a simple pattern, ordering colours).
End with orientation to time and place.
For trauma clients: avoid open guided imagery (4.11), dream work (4.9) and Gestalt dialogue (4.14) until the client is stable.
If the client has psychosis or dissociative disorders, prefer structured, reality-based tasks.

5.4 Resistance or refusal to make art

Honour self-direction: making art is an invitation [source: Rogers].
Offer:
- talking while handling material;
- a very small, time-limited task;
- choosing a postcard image rather than making one.
Explore the refusal empathically.
Rogers names a tension between giving instructions and staying client-centred. Reduce structure when it feels coercive, and add it when an open frame leaves the client lost. [source: Self & Society]

5.5 Client wants interpretation, or you feel the pull to interpret

Hand meaning back (4.2, 4.5).
If you hold a hypothesis, offer it tentatively as something you notice, and accept rejection.
Never present formal features or content as diagnostic. Guttmann & Regev (2004) note that the phenomenological approach lacks operational terminology. Treat "readings" of images as hypotheses only. [source: Haifa CRIS abstract]

5.6 Non-adherence with journaling between sessions

Make it optional and very small.
Treat a blank journal as information, not failure.
Offer a phone photo of a doodle as the bare minimum.

5.7 Ruptures

Typical triggers:
- an artwork damaged or lost;
- a careless comment on the work;
- display without consent;
- a directive that felt like a test.
Repair:
- acknowledge specifically and apologise;
- restore control (the client decides what happens to the work);
- offer to remake or repair the piece together if wanted.
Store work securely and consistently.

5.8 Developmental-specific problems

Frustration or meltdown on a task: the task was above the client's level. Drop a stage or simplify one media variable (4.22), and finish on success.
Perseveration and copying: extend rather than forbid (4.21).
Destructive behaviour with materials: limit how much material is available, set simple rules beforehand, and move to safer media.
Group conflict: go back to parallel work (4.18).
Plateau: check whether the goals need changing rather than pushing the stage.

5.9 Children and young people

Get parent or carer consent and the child's own assent, and re-check assent when introducing new media or body work.
Agree what is shared with parents or school: themes, not the artwork, unless the child agrees.
Safeguarding: a drawing alone is not evidence of abuse. Disclosures, statements or behaviour indicating risk are what trigger local safeguarding and mandatory-reporting procedures.
- Record verbatim what the child said, keep the artwork securely as part of the record, and do not question leadingly through the image.
For classroom work: coordinate with teachers on goals and on confidentiality limits.

5.10 Risk and self-harm themes in images or writing

Take any imagery or writing about death or self-harm seriously. Ask directly about current thoughts, intent and plans, using standard risk assessment.
Follow your service's safety-planning and escalation procedures. Discuss means safety (removing or securely storing means) where relevant.
Do not treat an image alone as proof either of risk or of safety.

5.11 Cultural and spiritual framing

Rogers links the inner core to "the essence of all beings" and integrates the spiritual dimension. [source: Rogers 2010] Present this as her humanistic view, not as fact. Respect clients' own religious meanings of images and colours.
Use culturally familiar materials and imagery.

5.12 Scope limits

Refer to, or work alongside, a registered art therapist when you want:

art-based assessment;
severe developmental or neurological impairment;
long-term regressive or sensory-level work;
groups using movement-based Creative Connection sequences, unless you have had the experiential training.

Sources

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