Atlas›Domain VIII · Creative & expressive arts therapies›Guide 016
Guide VIII-016

Accompanied and solution-oriented painting (Egger)

Bettina Egger, Jörg Merz1965Zurich, Switzerland
A 23 · L 38 · M 3917 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Solution-oriented painting therapy (Lösungsorientierte Maltherapie, LOM®) as set out by Bettina Egger and Jörg Merz in Lösungsorientierte Maltherapie: Wie Bilder Emotionen steuern (Hogrefe 2013; 2nd unchanged ed. 2024), taught at the Institut für Humanistische Kunsttherapie (IHK), Zürich, and by LOM® international with Alanus University; and Egger's accompanied painting (begleitetes Malen), published in its later form as Person-oriented painting therapy (Personenorientierte Maltherapie, POM; Egger & Hartmann 2017). The two Hogrefe books are cited here through secondary sources, and their full procedures are not verified. [uncertain] Confirmed in sources: the IHK course structure (provider portrait); the LOM® international/Alanus certificate structure and its 0–10 ratings at start and end; the 1980 origin and the 1995 start of teaching given in the Riner & Merz review; the image rules and directive starts that Ostertag & Podszun attribute to Egger's approach as described in Egger & Hartmann 2017; and the focusing step names and Egger 2001 quotations in Maaß & Naderer-Klinkovsky 2017. LOM procedural detail comes mainly from a 2024 thesis that cites Egger & Merz closely (Lang 2024). [uncertain: where a detail rests only on these secondary sources, it is tagged]

What it is. These are two related painting-therapy methods from one Zürich tradition. Bettina Egger (born 1943) trained with Arno Stern in Paris. She opened a painting studio (Malatelier) in Zürich in 1965 and co-founded the IHK with Robert Wirz in 1978. [source: Ostertag & Podszun 2020; Lang 2024] (1) Accompanied / person-oriented painting (POM). The client paints with the hands in bright paint on paper. The therapist does not interpret the picture psychologically or judge it artistically, but works directly with the image, the painting process and the relationship. The aim is to clarify thoughts and feelings in a mindful process that slows impulsive reactions and builds compassion towards self and others. [source: Hogrefe POM page; IHK listing] (2) Solution-oriented painting (LOM). Egger, an art therapist, and Merz, a psychologist and psychotherapist, developed LOM from about 1980–83, after watching hundreds of painting processes. [source: Riner & Merz review; Lang 2024; the two give different dates, see uncertain] LOM is more structured. The client paints a simple, realistic metaphor, or the image they actually saw, for a specific problem, and corrects it by set rules until it is "right". The image is never interpreted.

How change happens. LOM's core idea is Eindruck statt Ausdruck: impression rather than expression. Its authors hold that changing the picture changes the emotion. The painting process itself is the therapy, and the therapist only accompanies it. [source: Lang 2024, citing Egger & Merz 2013] The aim is not a cognitive solution. A burdensome inner image is replaced by a clear, undisturbed one. [source: Riner & Merz review] The authors explain this with neuroscience as they read it. Simple, clear images are processed by the amygdala as harmless. The slow, calm movement of painting works against fear. Repeatedly activated new images can overwrite old ones, because memories are modifiable each time they are recalled (they cite LeDoux and Hüther). [source: Lang 2024] Treat this as the developers' explanatory model, not as established mechanism. [uncertain] In POM, change is described as clarification through the felt, mindful painting process in a protective, non-evaluating relationship that draws on Rogers. [source: Hogrefe POM page; Maaß & Naderer-Klinkovsky 2017]

Professional frame. In Switzerland, IHK runs three method courses: POM, LOM, and work-oriented painting and design therapy, which combines POM and LOM in clinical or institutional settings. Each is 9 blocks of 2.5 days over about 15 months, with 170 contact hours. LOM adds 20 hours of supervision, POM a self-awareness/teaching-therapy internship, and the work-oriented module 250 hours of practical training. Together they form IHK's method training towards the Swiss Higher Federal Professional Examination in Art Therapy, run under OdA ARTECURA. IHK is also recognised by GPK, the professional association for creative psychotherapy and art therapy. [source: IHK listing] LOM® international also runs a university continuing-education certificate in LOM® with Alanus University (Germany), with Dr Bettina Egger and Cora Egger among the staff: an introductory course and five modules (metaphors, distressing images, relationships, working with trauma, working with systems), 95 contact hours plus 190 hours of self-study (11.5 ECTS), mostly online with one in-person week. [source: Alanus programme page] LOM® is a registered trademark. In Germany it is practised by art therapists and Heilpraktiker (Psychotherapie) in an "LOM-Netzwerk Deutschland". [source: Nordkurier; therapie.de profile] The LOM training is offered to art therapists, psychotherapists and physicians. [source: Lang 2024] Elsewhere, LOM is not a regulated profession of its own. In the UK the title "art therapist" is protected (HCPC registration via a BAAT-recognised master's). In the US the credential is ATR-BC via ATCB. [synthesis] Do not use the LOM trauma and memory-image procedures, or present yourself as offering LOM®, without IHK or LOM training and supervision. A psychotherapist without that training can use the general stance (no interpretation, metaphor questions) only as an adjunct inside their own licensed practice. [synthesis]

2. Framework

LOM course of therapy [source: Lang 2024 citing Egger & Merz 2013, unless tagged]

  1. Assessment and goal (session 1). A standardised interview covers when and where the problem occurs, what would show it is solved, the body reactions and feelings that come with it, how the client thinks about themselves in the situation, and how they would like to think. The client builds their own rating scales for the burden. These are rated at the start, at the end and at follow-up. Physical symptoms must already have been medically examined. LOM supports medical care and does not replace it.
  2. Choosing the entry route. The route depends on the problem:
    • a feeling or symptom: a metaphor question (form, flower, fruit, animal)
    • a whole situation: an animal or landscape metaphor
    • a trauma: the exact image seen at that moment, then memory images in chronological order, then a rescue image
    • a relationship: a portrait of the other person, a return metaphor and a gift image
    • a dream: one static close-up image
  3. Painting and correction phase. The first image that comes is painted standing at the wall, with the non-dominant hand (fingers or hand) on large paper, about 70 × 100 cm. Pastel on A3 is an alternative. The therapist checks the image against the LOM rules (realism, healthy state, simplicity, context) and the client corrects it until it is "right".
  4. Checking. Distress ratings and the "positive cognition" are checked at intervals. [source: Lang 2024, discussion]
  5. Ending and follow-up. Ending is judged by symptom change, the scales and the positive cognition. Follow-up ratings are taken.

Number of sessions: from a few pictures to several dozen. The process makes "before and after" visible, and the ending becomes tangible. [source: Nordkurier, practitioner U. Jünger] LOM® international describes LOM work as based on standardised assessments, with success rated from 0 to 10 at the start and end of the process; it gives no session count. [source: Alanus programme page] For person-oriented studio painting, a painting process usually runs beyond the time frame of a single therapy hour. [source: Maaß & Naderer-Klinkovsky 2017] A typical LOM session length and total number of sessions were not found in any source opened. [uncertain] Trauma work may not suit short-term therapy. [source: Lang 2024]

When to move on: an image is finished when it is "right". Signs are that the client is in living contact with it, the matching body reaction or symptom eases, and the rating drops. If contact fades, the image needs correction before moving on. Once an image is right, the change is said to last without repeated work. [source: Lang 2024] Expect temporary inner "chaos" while new material settles; it is to be tolerated, not treated as failure. [source: Lang 2024 citing Egger 1995]

POM / accompanied painting format. This is open-ended individual or small-group work in a painting studio. The client paints with the hands and the therapist talks with them during and about the painting; the therapeutic conversation and hand painting are what Egger added to Arno Stern's studio model. [source: Hogrefe POM page; Ostertag & Podszun 2020] IHK describes POM as working directly with picture, process and relationship. [source: IHK listing] Person-centred practitioners in Innsbruck who draw on Egger (Maaß & Naderer-Klinkovsky 2017) map the painting process onto Gendlin's focusing steps, named as „Freiraum schaffen“ (clearing a space), felt sense, „der Griff“ (the handle, which shows itself as a sensory reality in the picture) and felt shift, with a "big shift" in their case example. This is their own adaptation, not Egger's scheme and not a published POM phase model. [source: Maaß & Naderer-Klinkovsky 2017] Use it, if at all, as a descriptive map rather than as criteria for moving on. [synthesis] No session count is published in the sources. [uncertain] Studio painting processes often run longer than one therapy hour. [source: Maaß & Naderer-Klinkovsky 2017]

Combined use. IHK's work-oriented module combines POM and LOM in one therapy process in clinics and institutions. [source: IHK listing] A practical sequence is POM-style open painting to build safety and contact with the medium, then LOM for a defined problem once the goal and scales are set. [synthesis]

3. Guiding principles

LOM [source: Lang 2024 citing Egger & Merz 2013, unless tagged]

  • Impression, not expression. You are building a new, calming image, not draining feeling onto paper.
  • No interpretation. Never read meaning into colours, shapes or content. The only questions are whether the image matches what was seen, and whether it is healthy and simple.
  • Do not paint the fear. Use neutral metaphors or the concretely seen image, never an illustration of the anxiety itself. Jünger's words: "Wir malen nicht die Angst" (we don't paint the fear). [source: Nordkurier]
  • Metaphor, not symbol. The metaphor is a stand-alone picture that resonates with the problem, set in a meaningful background. It is not a sign that stands for something else.
  • Realism. A tree must look like a tree. Abstraction and decorative detail weaken or reverse the effect. Check that sizes are realistic and colours "normal". [source: also Ostertag & Podszun 2020]
  • Whole situation. For a situation, the metaphor shows the whole scene, not one person in it.
  • No wishful editing. Do not change the image to look the way the client wishes; change it only to be accurate and healthy.
  • Healthy form. Paint metaphors in their healthiest state. Wilting or damaged subjects strengthen negative feeling.
  • Repair damage. Injured bodies and broken objects in an image are restored.
  • Simplicity. Simple, general images are what the brain takes in, so keep forms simple and colours clear. [source: also Nordkurier]
  • Opaque, not transparent. Opaque painting had effects and transparent painting did not. Size, gaze direction, perspective, distance and loving attention to the picture also mattered. [source: Riner & Merz review]
  • Context last. Time of day, season and place are added after the main motif.
  • Living contact. The image must touch the client. When that contact goes, correct the image. Egger writes that making contact takes fractions of a second. [source: Lang 2024]
  • Non-dominant hand, standing, hands on paper. This gives direct, unrehearsed contact with the image. [source: Lang 2024; Nordkurier]
  • Self-efficacy. The client makes the changes and builds control and responsibility. No painting skill is needed, and the method suits any age. [source: therapie.de profile]
  • Adjunct to medicine. LOM never replaces medical treatment. [source: Lang 2024]
  • Children may make mistakes. Let children experiment without pressure to perform. [source: Riner & Merz review]

POM / accompanied painting

  • Protect the picture. Shield it from evaluation by others, and sometimes from the painter's own attacks on it. [source: Maaß & Naderer-Klinkovsky 2017, on Egger]
  • No interpretation, psychological or artistic. [source: Hogrefe POM page]
  • Midwife for the picture. Egger calls her work „Hebammenarbeit für das Bild“ (midwifery for the picture), serving mainly the pictures and painting processes rather than the painters. Help the picture come into being; do not steer the person. [source: Maaß & Naderer-Klinkovsky 2017, quoting Egger 2001, p. 14]
  • Stance limits action. You may intervene directly in the image. Your stance, not a rulebook, sets how far. [source: Maaß & Naderer-Klinkovsky 2017, citing Egger 2001, p. 14]
  • Play with the image. For Egger, working with the picture means engaging with it playfully: turning, extending, overpainting and trying things out. [source: Maaß & Naderer-Klinkovsky 2017, citing Egger 2001, p. 14]
  • Person-centred relationship. Trust, empathy and Rogers' view that the source of evaluation lies in the person. [source: Ostertag & Podszun 2020; Maaß & Naderer-Klinkovsky 2017]
  • Mindful slowness. Painting with the hands slows the client so they feel rather than act on impulse. The aim is compassion towards self and others. [source: Hogrefe POM page]
  • Firm image rules in Egger's own approach. Ostertag & Podszun describe Egger's person-oriented method (Egger & Hartmann 2017) as having firm rules: colours placed side by side, nothing painted over until the picture's uniqueness is clear, proportions and colours checked for realism, and the therapist intervening when a rule is broken. They note an unresolved tension with Rogers' non-directive stance. [source: Ostertag & Podszun 2020] Maaß & Naderer-Klinkovsky instead describe overpainting by the painter's inner sense of fit; the two accounts differ. [uncertain]
  • Process over product. [source: Maaß & Naderer-Klinkovsky 2017]
  • Not diagnostic. Neither method uses pictures as projective or diagnostic evidence. Do not draw clinical or forensic conclusions (for example about abuse) from a picture made in either method. [synthesis, consistent with the no-interpretation stance in all sources]

4. Intervention inventory

Unless tagged otherwise, LOM items come from Lang 2024 citing Egger & Merz 2013. Example language is illustrative unless quoted. Step detail beyond what sources state is marked [synthesis].

Setting and materials. Use large paper sheets (about 70 × 100 cm) fixed to a wall at standing height. Pastel chalk on A3 is the alternative for clients who cannot stand or for short sessions. [source: Lang 2024] In POM, the client paints with the hands in bright paint on paper. [source: Hogrefe POM page] Stern-derived studios use thick gouache that can be painted over, and a central table where colours are fetched. [source: Maaß & Naderer-Klinkovsky 2017] Rolling materials trolleys are used on wards. [source: Widmer review] Safety [synthesis]:

  • Use non-toxic, water-based paints labelled safe for skin, because clients paint with bare hands. Ask about skin allergies and eczema, and keep gloves, a sink and towels ready.
  • Pastel chalk makes dust. Prefer oil pastels or dustless chalk for clients with asthma, and wipe surfaces damp.
  • Keep floors dry (paint spills cause slips). Have a chair at hand for clients who tire standing, and give room around the wall for clients with balance problems or in palliative care.

LOM 1. Structured intake interview and goal

  • Purpose / when: at the start of every LOM process, to define one workable problem and what "solved" would look like.
  • Steps:
    1. Ask when and where the problem occurs.
    2. Ask what would show it is solved.
    3. Ask which body reactions and feelings accompany it.
    4. Ask how the client thinks about themselves in the situation, and how they would like to think: the target or positive cognition. [source: Lang 2024]
    5. Confirm that any physical symptoms have been medically examined. [source: Lang 2024]
    6. Choose one problem to start with. Complex, overlapping problems need more time. [source: Lang 2024; ordering is synthesis]
  • Example language (illustrative): "When does it hit you most, and where are you then?" "What would you notice first if this were solved?" "What happens in your body?" "What do you tell yourself about yourself in that moment, and what would you rather be able to think?"
  • Watch for: vague or global goals; narrow them to one situation. Clients who do not want to give up the symptom completely may not benefit, so explore that ambivalence first. [source: Lang 2024]

LOM 2. Self-made distress scales and positive-cognition check

  • Purpose / when: to track change at the start, end and follow-up. [source: Lang 2024; Alanus programme page]
  • Steps:
    1. With the client, define one or more scales in their own words, such as fear in the lift or tension in the shoulders. LOM® international describes the assessments as standardised and rates success from 0 to 10. [source: Alanus programme page] Which end of the scale means "worst" is not stated in the available sources. [uncertain]
    2. Rate before painting.
    3. Rate again after the image is right and at follow-up. [source: Lang 2024]
    4. Recheck how believable the positive cognition feels at intervals. [source: Lang 2024, discussion; exact procedure not described there; uncertain]
  • Example language (illustrative): "On your own scale from 0 to 10, where is it right now?" "Thinking of the situation now, how true does 'I can manage' feel?"
  • Watch for: a falling rating together with an easing of the body reaction is the expected sign the image is working.

LOM 3. Metaphor question for a feeling or symptom

  • Purpose / when: to work on emotions, symptoms, thought patterns or wishes without painting the problem itself. [source: Lang 2024; therapie.de profile]
  • Steps:
    1. Ask the client what the feeling would be if it were a geometric form, a flower, a fruit or an animal. [source: Lang 2024]
    2. Accept the first image that appears; do not debate or replace it.
    3. Ask the client to paint it with the non-dominant hand, in its healthiest form, realistically sized and coloured, and in a fitting setting.
    4. Correct by the rules (see LOM 6) until it is right.
  • Example language (illustrative): "If this tightness were a fruit, what fruit would it be? Take the first one that comes." "If your wish to go home were a flower, which flower?" (The flower-for-a-wish question is from Widmer's palliative work.) [source: Widmer review]
  • Watch for:
    • Clients offering a symbol (a heart, a question mark) instead of a picturable thing; ask what it would be as a real object or creature. [synthesis from metaphor-not-symbol rule]
    • Over-decorated images; simplify.
    • Signs of contact: a pause, a breath, a change in face. [synthesis]

LOM 4. Situation metaphor (animal or landscape)

  • Purpose / when: when the burden is a whole situation, such as a team, a family or a conflict. [source: Lang 2024]
  • Steps:
    1. Ask what the situation would look like if it were an animal or a landscape.
    2. Make sure the metaphor shows the whole situation, not one participant; otherwise it turns into a symbol.
    3. Paint it realistically and healthy, then add the context (time of day, season, place). [source: Lang 2024]
  • Example language (illustrative): "If the whole situation at work were a landscape, what landscape would it be?"
  • Watch for: the client painting only the "villain"; bring the frame back to the whole scene.

LOM 5. Adding context: background, time, season, place

  • Purpose / when: once the main motif stands, to embed it in a meaningful background. [source: Lang 2024]
  • Steps: ask where the motif is, what time of day and season it is, and what surrounds it. Paint the context opaquely around the motif. [source: Lang 2024; opaque from Riner & Merz review]
  • Example language (illustrative): "Where is this horse standing? What time of day is it, and what season?"
  • Watch for: a motif floating on blank paper often feels unsettled to clients; the setting usually settles it. [synthesis]

LOM 6. Rule check and correction (realism, colour, size, opacity, gaze, distance)

  • Purpose / when: throughout painting, whenever the image departs from the rules or contact with it fades. [source: Lang 2024; Ostertag & Podszun 2020; Riner & Merz review]
  • Steps:
    1. Check that sizes are realistic and colours "normal". [source: Lang 2024; Ostertag & Podszun 2020 describe the same realism check in Egger's person-oriented approach]
    2. Check that the paint is opaque, not transparent. [source: Riner & Merz review]
    3. Attend to the size of animals, gaze direction, perspective and distance, all of which the developers observed to change the effect. [source: Riner & Merz review] Which way to change each is not specified in the available sources. [uncertain]
    4. When a rule is broken, ask about it rather than ordering a change. Ostertag & Podszun's example, from Egger's approach as described in Egger & Hartmann 2017, is „Was ist passiert, dass die Wiese violett ist?“ (what happened that the meadow is violet?). [source: Ostertag & Podszun 2020]
    5. Let the client make the change. Do not edit towards a wish or your own taste. [source: Lang 2024]
  • Example language (illustrative): "What has happened that the meadow is violet?" "How big is this dog next to the house in real life?" "Is it see-through, or would it really cover what is behind it?"
  • Watch for: the directive rule-checking can feel like correction or criticism. Ostertag & Podszun note the tension with Rogers' non-directive stance. Ask with curiosity and warmth. [source: Ostertag & Podszun 2020; wording synthesis]

LOM 7. Healthy-state and repair painting

  • Purpose / when: whenever a motif appears damaged, rotting, wilted, injured or broken. [source: Lang 2024]
  • Steps:
    1. Notice the damage.
    2. Ask the client how it looks when it is whole and healthy.
    3. Have them paint it restored, so body parts are uninjured and objects intact. [source: Lang 2024]
  • Example language (illustrative): "How does this apple look when it's fresh?" "Show the arm as it is when it's healed."
  • Watch for: relief or a softer body reaction when the repair lands. If the client resists repairing, the image may not yet fit what they saw; return to accuracy. [synthesis]

LOM 8. Trauma sequence: seen image, memory images, rescue image

  • Purpose / when: after a single traumatic event, once the client is stable and the therapy is not short-term. [source: Lang 2024] Requires LOM training. [synthesis]
  • Steps [source: Lang 2024]:
    1. Ask what exactly the client saw at that moment, the concrete visual image, not the feeling.
    2. Paint it simply and realistically.
    3. Paint memory images in chronological order.
    4. Paint a rescue image (rettendes Bild) of the situation after the event, when it was over.
  • Example language (illustrative): "Just what you saw, from where you stood. What was in front of you?" "And then? What did you see next?" "Now paint the moment when it was over."
  • Watch for:
    • Rising arousal, dissociation or flashback. Slow down, stay with the concrete visual detail, and keep the end point (the rescue image) in view. [synthesis]
    • Do not start a trauma sequence you cannot finish in that session or the next. [synthesis]
    • Reconcile with the 'do not paint the fear' rule: the seen scene is painted, the emotion is not illustrated. How the two published statements fit together is the author's inference. [uncertain]

LOM 9. Relationship work: portrait, return metaphor, gift image

  • Purpose / when: for relationship conflicts and burdens with a specific person. [source: Lang 2024]
  • Steps [source: Lang 2024]:
    1. Paint a portrait of the other person.
    2. Return what belongs to them by painting a metaphor matched in size, colour and placement. The source does not say exactly where on the portrait it goes. [uncertain]
    3. Paint a gift image: an object the other person would enjoy, painted on the upper body of the portrait.
  • Example language (illustrative): "Paint them as they look." "What do you still carry that belongs to them? What would it be as an object, and how big?" "What would they be glad to receive?"
  • Watch for: the gift image can be hard with someone who harmed the client. Do not press it in abuse contexts; check safety and readiness first. [synthesis]

LOM 10. Dream image

  • Purpose / when: for recurring or distressing dreams, including nightmares. [source: Lang 2024; Riner & Merz Hogrefe page lists nightmares]
  • Steps:
    1. Pick one static, close-up image seen in the dream, from one fixed viewpoint. Movement cannot be painted.
    2. Leave out what was only sensed but not seen.
    3. Paint and correct by the rules. [source: Lang 2024]
  • Example language (illustrative): "Stop the dream at one moment. What do you see right in front of you?"
  • Watch for: clients narrating whole dream plots; bring them back to a single frame.

LOM 11. Feeling-colour start with the unpractised hand (from Egger's person-oriented approach)

  • Purpose / when: a direct opening instruction, useful when no metaphor comes yet. Ostertag & Podszun give it as one of the directive starts in Egger's person-oriented method (Egger & Hartmann 2017), so it belongs to POM; using it as an LOM opener is an adaptation. [source: Ostertag & Podszun 2020; LOM use synthesis]
  • Steps:
    1. The client chooses a colour for a current feeling.
    2. They apply it slowly with the unpractised hand.
    3. They change colour when the feeling changes. [source: Ostertag & Podszun 2020]
    4. Place colours side by side rather than over one another until the picture's uniqueness has become clear. [source: Ostertag & Podszun 2020]
  • Example language (illustrative): "Pick a colour for what you feel right now, and use your other hand. Go slowly. When the feeling shifts, change colour."
  • Watch for: pace. Slow, calm movement is what the LOM authors credit with settling arousal. [source: Lang 2024]

LOM 12. Children and adolescents (4–18)

  • Purpose / when: for anger, nightmares, school anxiety, parental separation, cyberbullying, eating problems and identity questions. [source: Hogrefe Riner & Merz page]
  • Steps:
    1. In the published case of an 8-year-old with sleep problems and school fear, the therapist asks what the fear would be if it became an animal. The child names a bat and gives it a name.
    2. The child paints it.
    3. A frightening image (the mother's frightened face) is later transformed: the child paints a toy fire engine into the picture.
    4. Let children experiment and make mistakes without pressure to perform. [source: Riner & Merz review] The book's full procedure is not verified here. [uncertain]
  • Example language (illustrative): "If your fear were an animal, what animal would it be? Does it have a name?"
  • Watch for:
    • Get parent or carer consent and child assent. Agree with carers what you will share. [synthesis]
    • Safeguarding: content in a picture is not evidence of abuse. A disclosure made in words, or clear safety concerns, follows your local mandatory-reporting procedure. [synthesis]

LOM 13. Palliative-care adaptations (Widmer, after LOM)

  • Purpose / when: for ward patients who are physically limited or near the end of life. The focus is the patient's own concern, dignity and quality of life. Esther Widmer works after LOM, and her book includes a conversation with Egger. [source: Widmer review] These are one practitioner's adaptations, not core LOM. [uncertain]
  • Steps [source: Widmer review; Widmer table of contents, which lists chapters on painting by dictation (Malen nach Diktat), intuition and mirroring, and primal forms]:
    • Painting by dictation (Malen nach Diktat). The patient chooses theme, colours and additions, and the therapist paints in front of them.
    • Partial participation. The patient adds what they can, for example the dots on a ladybird, with support.
    • Metaphor questions for wishes and feelings (for example, which flower a wish to go home would be).
    • Favourite-colour picture. Built around the patient's favourite colour; it can bring back biographical memories.
    • Primal forms (Urformen). Line, cross, square, circle and spiral on small cards. The patient arranges them into a "life panorama" that can open talk about breaks and conflicts. Urformen des Malens is also the title of a 2015 Egger book, and Widmer's book has a chapter on a painter and the primal forms. [source: Widmer table of contents] How Egger's book uses the forms is not verified here. [uncertain]
    • Pictures as gifts and memory bridges. Relatives may paint with the patient, and pictures may be given to them.
    • Simple, clear forms and a slow, calm rhythm, described as stabilising.
    • Close every session properly, because work is often unfinished.
  • Example language (illustrative): "Tell me what to paint and I'll be your hand. Which colour first?"
  • Watch for: fatigue, and grief at lost skills (for example in former artists). Keep sessions short and always close the picture. [source: Widmer review; brevity synthesis]

POM 1. Accompanied hand painting (basic session)

  • Purpose / when: to clarify thoughts and feelings in an open, non-directive process, to build mindful contact with feelings instead of impulsive reaction, and to develop compassion for self and others. [source: Hogrefe POM page]
  • Steps:
    1. Arrival. The client chooses a place at the wall and fixes the sheet; Maaß & Naderer-Klinkovsky's question is how the client wants to hang their sheet. [source: Maaß & Naderer-Klinkovsky 2017]
    2. Paint with the hands in bright paint. [source: Hogrefe POM page]
    3. Talk with the client during and about the painting, taking up only what they perceive or offer. [source: Ostertag & Podszun 2020; Maaß & Naderer-Klinkovsky 2017]
    4. The finished picture stays in the studio and is never destroyed. This is a rule of Maaß & Naderer-Klinkovsky's own Innsbruck studio (MaPo), with no interpretation and painting in company without group process; Egger helped shape these principles, but they are not attributed to her directly. [source: Maaß & Naderer-Klinkovsky 2017]
  • Example language (illustrative): "How do you want to hang your sheet today?" "How is it right now, standing in front of it?" "What do you notice in this part?"
  • Watch for: slowing breath and absorption as the client settles into the process. Share your own impressions only if asked. [source: Maaß & Naderer-Klinkovsky 2017]

POM 2. Direct work on the emerging picture

  • Purpose / when: when the picture no longer feels right to the painter and the process stalls. [source: Maaß & Naderer-Klinkovsky 2017, on Egger's practice]
  • Steps:
    1. Discuss the picture while it is being painted.
    2. Turn it, extend it by adding paper, or paint over parts by the painter's inner sense of fit, until it feels coherent ("stimmig"). [source: Maaß & Naderer-Klinkovsky 2017]
    3. The therapist's stance sets the limit on how far to intervene. [source: same]
  • Example language (illustrative): "Does it feel right as it is, or is something off?" "Would it help to give it more room, with another sheet here?" "What if you turned it round?"
  • Watch for: a felt release, often a deep breath, when the picture "fits". Do not push your own aesthetic. [source: Maaß & Naderer-Klinkovsky 2017]

POM 3. Creating distance and space (focusing-informed adaptation)

  • Purpose / when: when the content is too arousing, or so distant that interest fades. The aim is a tolerable level of arousal. [source: Maaß & Naderer-Klinkovsky 2017] This is a person-centred focusing adaptation that draws on Egger, not Egger's own published procedure. [uncertain]
  • Steps [source: same]:
    1. Look at parts of the picture separately (partialising).
    2. Shift between foreground and background, or change the direction of gaze.
    3. Step back from the picture or come closer.
    4. Leave the room and come back.
    5. Temporarily cover parts of the picture.
    6. "Play" with the image.
  • Example language (illustrative): "Let's step back two paces and look from here." "Shall we cover this corner for a moment?"
  • Watch for: settling arousal and returning curiosity.

POM 4. Protecting the picture

  • Purpose / when: throughout. It is most needed when the painter devalues the picture ("it's hideous"), wants to destroy it, or fills it with repeated "villains". [source: Maaß & Naderer-Klinkovsky 2017]
  • Steps:
    1. Do not evaluate the picture and do not allow others to.
    2. Shield it from the painter's own attacks: suggest pausing or changing distance instead of destroying it.
    3. Look for a detour that lets the painter approach the picture again. [source: Maaß & Naderer-Klinkovsky 2017]
  • Example language (illustrative): "We don't throw pictures away here. Let it rest, and we'll see how it looks from over there."
  • Watch for: shame. Pictures often show more than intended, and outside evaluation hurts. [source: Maaß & Naderer-Klinkovsky 2017]

No further named LOM techniques (for example protection, resource or timeline images) are described in the available sources, so none are listed here. LOM® international says the procedure rests on three fundamental interventions, practised in its introductory seminar, but the programme page does not name them. Its modules cover metaphors, distressing images, relationships, trauma and working with systems. [source: Alanus programme page] Whether the three are the metaphor, distressing-image and relationship procedures (LOM 3–4, 8–9 here) is an inference. Working with systems (families, teams) is a training topic with no published procedure in the available sources. [uncertain]

5. Handling problems

Sourced guidance

  • "I can't paint" or "I don't know what to paint". Safety comes first, from an accepting atmosphere that does not judge. [source: Maaß & Naderer-Klinkovsky 2017] In LOM, tell the client no skill is needed, then use a concrete metaphor question (LOM 3) or the feeling-colour start (LOM 11). [source: therapie.de profile; Ostertag & Podszun 2020]
  • Stuck process: repetition, devaluing, "villains", wanting to destroy the picture. Give more intensive accompaniment that restores space, and find a detour back to the picture (POM 3 and POM 4). [source: Maaß & Naderer-Klinkovsky 2017] In LOM, ask whether the image breaks a rule (realism, damage, symbol instead of metaphor, decoration) and correct it. [source: Lang 2024]
  • Image loses its effect or contact fades. Correct the image and simplify. [source: Lang 2024]
  • Overwhelm (too much arousal) or detachment (too much distance). Adjust distance until arousal is tolerable. [source: Maaß & Naderer-Klinkovsky 2017] Keep forms simple and the painting rhythm slow. [source: Lang 2024; Widmer review]
  • Temporary inner chaos after a change. Prepare the client in advance that unrest can follow a change and is expected. [source: Lang 2024 citing Egger 1995]
  • Slow progress. Possible causes are mistakes, wrong timing or overlapping problems. These need more time, and some clients take a long time before they can let the image touch them. New insights may take long to become routine. [source: Lang 2024]
  • Ambivalence about losing the symptom. Clients who cannot or will not fully let go of a symptom may not benefit. Explore this before painting. [source: Lang 2024]
  • Physical symptoms. Require medical examination first, and never present LOM as replacing medical care. [source: Lang 2024]
  • Palliative patients. If they cannot paint, use painting by dictation or partial participation. Always close the session, because work may end unfinished. [source: Widmer review]

Own synthesis (not in sources)

  • Directiveness as rupture. Rule-checking ("why is the meadow violet?") can feel like being corrected. If the client bristles, name it, explain the rule's purpose in one sentence, and give them the choice whether to change the image. Repair the relationship before you continue. [synthesis]
  • Dissociation or flashback during the trauma sequence. Stop painting. Ground the client: feet on the floor, describe the room, cold water, wash the paint off the hands. If it is safe, return later to painting the rescue image so the session does not end on the worst moment. Screen beforehand for dissociative disorders, current unsafe circumstances, active substance misuse and acute suicidality, and stabilise first. Do not do trauma sequences in groups. [synthesis]
  • Non-adherence and missed sessions. The available sources describe no homework in LOM. If you suggest looking at the finished picture between sessions, keep it optional. [synthesis; uncertain whether LOM uses between-session tasks]
  • Suicide and self-harm risk. If it emerges, the painting pauses. Do a standard risk assessment, safety planning and, where relevant, lethal-means counselling (safe storage or removal). Liaise with medical care. [synthesis]
  • Eating disorders. Riner & Merz list eating problems as a children's indication. Use LOM only alongside medical monitoring and a specialist eating-disorder team. Use no body-weight images or targets. [source for indication: Hogrefe Riner & Merz page; rest synthesis]
  • Children. Keep sessions short and let the child choose the hand. Involve parents in the goal (LOM 1) without letting them direct the images. Follow safeguarding and mandatory-reporting duties on verbal disclosures or observed risk. Never treat a picture as evidence of abuse. [synthesis]
  • Touch. In both methods the client touches the paint; the therapist does not need to touch the client. Do not guide a client's hand without explicit consent and an easy way to opt out, and be cautious with trauma survivors. In painting by dictation, the therapist paints and does not move the patient's hand. [synthesis]
  • Cultural meaning of colours and animals. Realism rules ("normal" colours) may clash with culturally meaningful colours or animals. Ask what the image looks like in the client's own world before correcting it. [synthesis]
  • Using these methods without training. Do not run LOM trauma, relationship or dream procedures without IHK or LOM training and supervision. If you are untrained, refer to a trained LOM or art therapist, or work alongside one. [synthesis]

Sources

Sources

Books cited

  • Egger, B., & Merz, J. (2013; 2nd unchanged ed. 2024). Lösungsorientierte Maltherapie: Wie Bilder Emotionen steuern. Bern/Göttingen: Hogrefe.
  • Egger, B., & Hartmann, U. (2017). Personenorientierte Maltherapie: Wie der Malprozess Gedanken und Gefühle klären kann. Bern: Hogrefe.
  • Riner, S., & Merz, J. (2025). Lösungsorientierte Maltherapie mit Kindern und Jugendlichen: Wie Bilder Entwicklungsschritte ermöglichen. Hogrefe.
  • Widmer, E. (2019). Mitten im Leben bis zum Schluss. Kunsttherapie in der Palliative Care. Zürich: rüffer & rub.
  • Egger, B. (2015). Urformen des Malens. Earlier Egger titles: Bilder verstehen (1998 ed.), Der gemalte Schrei (2001 ed.).

Conflicts in the sources: LOM's origin is dated 1980 in the Riner & Merz review, which also says it has been taught to art therapists and psychosocial professionals since 1995, and 1983 in Lang. Lang gives the start of LOM training as both 1988 and 1995. The review supports 1995 for teaching to professionals; what 1988 refers to is unresolved. [uncertain] On overpainting, Ostertag & Podszun's account of Egger's rules (nothing painted over until the picture is clear) differs from Maaß & Naderer-Klinkovsky's (overpainting by inner sense of fit). [uncertain]

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