Atlas›Domain VIII · Creative & expressive arts therapies›Guide 025
Guide VIII-025

Origami, sumi-e and kintsugi-inspired art practices

Japan
A 28 · L 39 · M 3315 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: no single founder, manual or institute exists for this entry. It is a loose cluster of art-therapy and arts-in-health practices that borrow three Japanese art forms. For kintsugi this guide follows two published versions: Espino's (2026) single-session Kintsugi-ACT workshop and Princer's (2022) three-part kintsugi-influenced directive (create, destroy, repair). It also uses the Broken Bowl Project as a school and counselling variant. For origami it follows the graded folding protocol in Salsabila, Witdiawati & Sari (2025), which they adapted from Huimin & Li (2023), plus Tanaka's (2009) crane folding exercise and the NHS community workshop model at Mersey Care. For sumi-e (Japanese ink painting) no published clinical protocol was found, so items 4.11–4.14 are my own [synthesis]. [source: Espino 2026; Princer 2022; Mirabella, Broken Bowl Project; Salsabila et al. 2025; Tanaka 2009; Mersey Care 2026]

Status of sources. Confirmed: the Princer (2022) record (author, the three-part directive, eleven interview questions, millennial participants, qualitative analysis); the Santos & Maciel (2026) citation and abstract details; Espino's statement that her workshop deliberately left out a breaking step; and urushi allergy and curing facts from a Japanese kintsugi supplier. Not verified [uncertain]: the full procedures of Princer and of Santos & Maciel, so neither's detailed steps are given. No published clinical protocol for sumi-e was found; the closest published sources are Wu et al. (2024, abstract), on Chinese freehand brushwork for retired older adults, and an action-research study of sumi-e-inspired, mindfulness-based ink work in secondary-school art education (Pinelo Páez 2019), which is educational, not clinical.

What it is. These are client-made art practices used inside art therapy, or as structured arts activities in health settings:

  • Kintsugi-inspired work: mending a broken object, or an artwork that has been broken or torn, so that the repair stays visible. Traditional kintsugi used lacquer and gold. Clinical versions use modern substitutes such as epoxy with metallic powder or paint, gesso and paint on paper mâché, or paper and gold pen. [source: Espino 2026; Mirabella]
  • Origami: paper folding, graded from simple to more complex models, done alone or in a group, sometimes repeated many times (for example 1,000 cranes). [source: Salsabila et al. 2025; Tanaka 2009]
  • Sumi-e: black-ink brush painting in which a stroke cannot be undone. It is close to Chinese freehand brushwork, which Wu et al. (2024) propose as art therapy for retired older adults. [source: Wu et al. 2024 abstract] Pinelo Páez (2019) used sumi-e-inspired ink work with mindfulness routines in secondary-school art education. [source: Pinelo Páez 2019] [uncertain: no published art-therapy protocol for sumi-e itself was found]

How change is thought to happen.

  • Kintsugi: the authors present the visible repair as a lived metaphor. Breakage and damage are acknowledged, not hidden, and the mended whole carries meaning. Espino maps the mending steps onto ACT's psychological flexibility processes. Participants in that study reported "mending aspects of themselves" as well as the pot, along with reflection, mindfulness, values clarification, connection and resilience. Princer targets self-forgiveness and resilience in young adults who carry shame and guilt. [source: Espino 2026; Princer 2022]
  • Origami: the proposed mechanisms are repeated, sequenced folding, which trains attention, working memory, planning, spatial reasoning and hand-eye coordination, plus mastery and social contact. Its stated benefits are present-moment focus, calm, confidence, belonging, and relief from boredom in hospital. [source: Salsabila et al. 2025; Mersey Care 2026] Tanaka adds that folding for a seriously ill loved one gives caregivers a way to overcome powerlessness, express love, take a positive distraction, relax, and feel community support. [source: Tanaka 2009]
  • Sumi-e: an attentional and acceptance mechanism is inferred. Preparing the ink and making one irreversible stroke at a time asks for slowed, present-focused attention and tolerance of imperfection. [synthesis: no published clinical source] Pinelo Páez (2019) set out the hypothesis that sumi-e-inspired ink work can support bodily and emotional awareness, self-regulation and resilience, and paired the single, unretouched stroke with mindfulness concepts; the study is educational and reports qualitative observations, not outcomes. [source: Pinelo Páez 2019]

Status. None of these is a regulated therapy of its own. The kintsugi studies are master's theses and one uncontrolled pre/post study. Santos & Maciel (2026) tested a technique called "Kintsugi", developed by the corresponding author, with 200 adults aged 18–70. They assessed participants before and about two months after (roughly 4–6 sessions) with a semi-structured interview, the Hamilton Anxiety Scale and a French-language psychological well-being scale (EMMBEP). They report lower anxiety and higher well-being, with no control group. Their procedure is not drawn on here [uncertain]. The origami evidence is a single nursing case study and community reports. [source: Espino 2026; Princer 2022; Santos & Maciel 2026 abstract; Salsabila et al. 2025] [uncertain: Espino cites the technique as "Santos & Costa (2025)". A PubMed Central record titled "Kintsugi, Mending with Gold - A Psychotherapeutic Technique" also exists; whether it is an earlier version is unconfirmed]

2. Framework

Professional frame.

  • Therapy use (working with breakage, shame, guilt, trauma or grief through art): this belongs to a trained art therapist or a psychotherapist with art-therapy training. In the UK, art therapists are regulated by HCPC, with BAAT as the professional body. In the US, the bodies are AATA and the ATCB credential. Other countries have national art-therapy associations. [synthesis; registration rules uncertain]
  • Activity use: origami and ink-painting groups can be run by artists or tutors as arts-in-health activity. At Mersey Care the origami workshops are led by an origami tutor and arts facilitator, not a therapist. [source: Mersey Care 2026]
  • Destruction steps: do not use breaking, tearing or destroying directives without art-therapy training and established rapport. The Broken Bowl write-up says to use it only after rapport is established. [source: Mirabella] [synthesis: the training requirement]

Kintsugi strand: phases.

  • Phase A, Engage and frame (part of session 1).
    • Goal: introduce the kintsugi idea of honouring breakage and repair, agree on aims, and check safety and materials.
    • Move on when the client understands the task, freely consents (including to any breaking), and is not in acute crisis. [source: Espino 2026, framing; synthesis, criteria]
  • Phase B, Make or choose the object.
    • Princer: the client creates an artwork. Broken Bowl: the client makes a bowl, painting the outside as they see themselves and writing hidden aspects of themselves inside. Espino: participants mend ceramic ware that is already broken. Her design deliberately left out breaking as a step, unlike Princer's. [source: Princer 2022; Mirabella; Espino 2026] [uncertain: who broke Espino's ware, and what ware it was, are in her methods chapter, which is not verified here]
  • Phase C, Break or acknowledge the break.
    • Options: the client destroys their own artwork (Princer), breaks the bowl (Broken Bowl), or, in my safer variant, works with a piece that is already broken.
    • Goal: contact with damage or loss at a level the client can tolerate. [source: Princer 2022; Mirabella] [synthesis: the pre-broken option]
  • Phase D, Repair.
    • The client reassembles the pieces with visible, often gold, seams. In Princer's version they may instead make something new from the pieces.
    • Espino links each part of the work to an ACT process: sanding edges to acceptance, sorting and test-assembling pieces to defusion, stepping back to view the whole to self-as-context, attention while mending to present moment, the repair's meaning to values, and finishing to committed action. [source: Espino 2026; Princer 2022]
  • Phase E, Reflect and close.
    • Run a structured reflection or interview (Princer used eleven short questions), link the work to the client's life, and decide how the object is kept. [source: Princer 2022] [synthesis: the closing steps]
  • Session count and format:
    • Espino: a single 2.5-hour nonclinical group workshop for adults.
    • Santos & Maciel: about 4–6 sessions over about two months between assessments. The abstract does not say whether sessions were individual or group. [source: Santos & Maciel 2026 abstract] [uncertain: full text not verified]
    • Real epoxy curing usually needs a second session. Traditional urushi needs humid curing: a few days to a week per coat, and about 2–3 months for a full repair. [source: Espino 2026; TSUGU TSUGU beginner's guide] [synthesis: the second session]

Origami strand: graded protocol.

  • Salsabila et al. (2025) ran six 30-minute individual sessions in the morning, two per model: airplane, then boat, then rabbit. Rest days fell between models, and the MMSE was given before and after.
  • Each session ran in this order:
    • repeat reality orientation;
    • the facilitator demonstrates the model three times;
    • the client folds with guidance;
    • the client tries an unassisted recall.
  • A printed step guide supported practice between sessions.
  • Move to the next model after two sessions, or once the client can recall most of the steps without help (in the case, 6 of 8 steps for the airplane). [source: Salsabila et al. 2025]
  • Group and community format: small groups at a table working on a shared task, with tutor guidance and peer encouragement, starting from simple models such as butterflies or hearts. [source: Mersey Care 2026]
  • Crane folding exercise: a group folds 1,000 cranes for a seriously ill loved one. [source: Tanaka 2009] [uncertain: Tanaka's session structure is not in the abstract]

Sumi-e strand. No published clinical phase model was found. Suggested structure: 6–8 weekly sessions of 45–60 minutes, moving from grounding and ink preparation, to basic strokes, to simple subjects, to free expression, each session closing with reflection. [synthesis: the writer's structure, not from a clinical source] In school art education, Pinelo Páez (2019) organised units into perception (looking at inspiring images), production and written reflection, and opened each session with a short mindful routine (gentle joint mobility, attention to breathing, a bell rung by the students in turn). [source: Pinelo Páez 2019, educational setting]

3. Guiding principles

  1. Visible repair over concealment. Treat the cracks as part of the story, not a defect to hide. In practice, invite the client to make the seams prominent and to say what they mean. [source: Espino 2026; Princer 2022]
  2. Metaphor offered, never imposed. Let the client decide what the break stands for, or that it stands for nothing. Do not tell them their trauma is "golden". [synthesis]
  3. Rapport before destruction. Only introduce breaking or tearing once the alliance is solid. [source: Mirabella]
  4. Choice about breaking. Espino questions deliberate breaking. Offer real alternatives (already-broken ware, tearing paper, or no breaking) and accept a refusal without comment. [source: Espino 2026, critique] [synthesis: the alternatives]
  5. Process over product; no pressure for perfection. Praise effort and attention, not neat folds. Normalise trembling hands and crooked results. [source: Mersey Care 2026]
  6. Graded challenge and errorless support. Start with the simplest model, demonstrate several times, give help with fine details, and keep a printed guide. Increase difficulty only when recall improves. [source: Salsabila et al. 2025]
  7. Repetition as anchor. Repeated folds or strokes give the mind a steady focus. Use repetition deliberately when thoughts are racing, and comment on the calm it brings. [source: Mersey Care 2026]
  8. Mindful attention to the hands. Keep bringing attention back to the material, breath and the stroke or fold now. [source: Espino 2026, present-moment mapping] [synthesis: for sumi-e]
  9. Link making to values and action. End the repair work by naming what matters and one next step. [source: Espino 2026]
  10. Connection and giving. Folded pieces can be gifts, and group folding builds belonging. Use gifting and shared tasks for isolated clients and caregivers. [source: Mersey Care 2026; Tanaka 2009]
  11. Care for the caregiver. Offer folding projects to relatives of seriously ill people as self-care, not only to patients. [source: Tanaka 2009]
  12. Cultural respect and attribution. Present kintsugi, origami and sumi-e as Japanese art traditions, with Zen associations for ink painting attributed to that tradition. Do not claim spiritual or medical effects. Name the source culture and where possible learn from or credit Japanese practitioners. [synthesis]
  13. Artwork is not diagnostic. No validated diagnostic manual exists for these products. Never read a crack, a messy fold or a heavy stroke as evidence of abuse or disorder. [synthesis]
  14. Safety of materials first. Choose materials for the setting and the risk level: no shards or solvents where there is self-harm risk. [synthesis]

4. Intervention inventory

This inventory covers the interventions described in the sources cited. Steps marked [synthesis] are my practical filling-in where the sources give only an outline. All example language is my own (illustrative) wording.

Materials and physical safety (applies to all kintsugi items) [synthesis unless tagged]

  • Urushi lacquer (traditional kintsugi): urushi contains urushiol, the allergen in poison ivy. Raw or not-quite-cured lacquer, the mixed pastes, tools, sanding dust and sanding water can all cause a contact rash that appears days after exposure: itching, redness, blisters and pain, lasting weeks. Airborne reactions are rare but possible, and lacquer transfers to door handles, desks and bedding. A Japanese supplier flags extra caution for people allergic to mango, latex, cashew, pistachio or ginkgo. Suppliers advise rubber gloves, long sleeves and tied-back hair; wiping lacquer off skin with vegetable oil before it hardens; and seeing a doctor for any reaction, urgently for the face or eyes. They describe fully cured urushi as non-allergenic. [source: TSUGU TSUGU urushi-rash column and beginner's guide; a commercial supplier, not a clinical source] Clinical rule: do not use raw urushi in sessions. Use non-toxic substitutes: paper with gold pen or gold paint, gesso and paint on paper mâché (as in the Broken Bowl Project), or air-dry clay. Keep epoxy with metallic powder, the modern method Espino describes, for low-risk adult settings, with the precautions below. [source: Espino 2026; Mirabella] [synthesis: the clinical rule]
  • Epoxy: two-part epoxy is a skin and eye irritant and sensitiser. Use nitrile gloves and ventilation, and keep it away from eyes and mouth.
  • Metallic powders: fine mica or metallic powders should not be inhaled. Mix them into the adhesive away from airflow, or use gold paint pens instead.
  • Ceramic shards: these are sharp.
    • Break inside a cloth bag or between towels, wearing safety glasses.
    • Count the pieces in and out, and sweep up with a dustpan, not hands.
    • On inpatient, forensic or self-harm-risk units, do not use ceramics or blades. Substitute paper mâché bowls (as in the Broken Bowl Project), torn paper, card or air-dry clay. [source: Mirabella, paper mâché bowl]
  • Modern materials: Espino notes that modern kintsugi typically uses epoxy resin with metallic powders, foils or paints. [source: Espino 2026]

4.1 Kintsugi-ACT mending workshop (Espino 2026)

  • Purpose: to teach and live ACT's psychological flexibility processes through hands-on modern kintsugi. Suits nonclinical adults, or adults in ACT-informed therapy dealing with loss, setbacks, self-criticism or change. Format: a single 2.5-hour group session. [source: Espino 2026]
  • Steps:
    1. Introduce the history and philosophy of kintsugi, and ACT in plain language. [source: Espino 2026, framing]
    2. Give each participant an already-broken ceramic piece. Espino's design deliberately left out breaking as a step, unlike Princer's. [source: Espino 2026] [uncertain: who broke the ware, and what ware it was, are in the methods chapter, which is not verified here]
    3. Acceptance: the participant examines the break and does the effortful prep, such as sanding the edges. Invite them to notice resistance and frustration and make room for them. [source: Espino 2026, mapping]
    4. Defusion: sort and dry-fit the pieces before any glue goes on. Notice thoughts such as "it will never fit" as thoughts. [source: Espino 2026, mapping] [synthesis: the example thought]
    5. Present moment: apply the adhesive and gold along the seams slowly, with attention on hands, breath and texture. [source: Espino 2026, mapping]
    6. Self-as-context: step back and look at the whole object, not only the cracks. [source: Espino 2026, mapping]
    7. Values: each participant names what the repair means to them. [source: Espino 2026, mapping]
    8. Committed action: finish the mend, then name one action in their own life that the repair stands for. [source: Espino 2026, mapping] [synthesis: the life-action step]
    9. Share in pairs or the whole group, and agree when to collect pieces after curing. [synthesis]
  • Example language (illustrative):
    • "Before we glue anything, just hold the pieces. What do you notice in your body as you look at the break?"
    • "Your mind may say this is a mess. See if you can let that thought sit here while your hands keep working."
    • "Step back. What do you see when you take in the whole bowl, not only the cracks?"
  • Watch for:
    • frustration with pieces that will not fit, which can echo hopelessness;
    • perfectionism;
    • grief surfacing.
    • Signs it is working: participants link mending to their own lives (Espino's participants spoke of "mending aspects of themselves"), and they report reflection, mindfulness, values clarity and connection. [source: Espino 2026]

4.2 Create–destroy–repair directive (Princer 2022)

  • Purpose: to promote self-forgiveness and resilience in young adults with shame and guilt, using destroyed artwork. Princer tested the directive with millennials and analysed their experiences qualitatively. She frames kintsugi as repairing pottery with lacquer and honouring the scars, and notes that little art therapy literature addresses using destroyed art. [source: Princer 2022, Dominican Scholar record; full text not drawn on]
  • Steps:
    1. The client makes an artwork, for example one representing themselves or the thing they feel shame or guilt about. [source: Princer 2022, "create artwork"] [synthesis: the theme prompt]
    2. The client destroys it in a way they choose and that is safe, such as tearing, cutting or crumpling paper, or breaking a clay piece in a bag. [source: Princer 2022, "destroy it"] [synthesis: the methods]
    3. The client uses the pieces either to repair the original, with visible seams in the kintsugi spirit, or to create something new. [source: Princer 2022]
    4. Run a structured reflection. Princer used eleven short interview questions, whose wording is [uncertain]; the themes to cover are what was destroyed, what it felt like, what the repair or new piece means, and what it says about forgiving oneself. [source: Princer 2022] [synthesis: the themes]
    5. Agree what happens to the piece: keep it, photograph it, or store it in the therapy room. [synthesis]
  • Example language (illustrative):
    • "You decide how to take it apart, and you can stop at any point."
    • "Now you have the pieces. Would you like to mend it, or make something new?"
    • "What is it like to look at something that was broken and is now held together?"
  • Watch for:
    • destruction that turns into self-punishment, rage or dissociation (pause, ground, slow down);
    • shame spikes after the destruction step.
    • Signs it is working: expressions of resilience and self-forgiveness. Princer reports qualitatively that the directive evoked both. [source: Princer 2022]

4.3 Broken Bowl Project

  • Purpose: a cognitive or client-centred kintsugi-based directive. The bowl represents the person and the many experiences they hold. Breaking and mending conveys that life can damage us and we can put ourselves back together. Used in counselling and school contexts. [source: Mirabella, citing Smestad 2018]
  • Steps:
    1. The client makes a bowl from paper mâché, newspaper, fabric or similar. [source: Mirabella]
    2. Coat the inside and outside with gesso so the paint adheres. [source: Mirabella]
    3. Decorate the outside to show how the client sees themselves, and write words for hidden parts of themselves on the inside. Watercolour and permanent marker are typical. [source: Mirabella]
    4. Allow drying time, which usually means the next session. [synthesis]
    5. The client breaks the bowl and puts it back together. Using glue and gold paint or tape on the seams is my suggested kintsugi finish. [source: Mirabella, break and rebuild] [synthesis: the finishing]
    6. Reflect on what was shown outside and what hidden inside, what broke first, and what the mended bowl now holds. [synthesis]
  • Example language (illustrative):
    • "On the outside, show the you other people see. On the inside, put things you usually keep hidden."
    • "Looking at the mended bowl, what is it able to hold now?"
  • Watch for: this should come only after positive rapport. [source: Mirabella] With children, have a school counsellor or therapist supervise the breaking step. Hidden-inside words may disclose risk or abuse, so follow safeguarding procedures (see section 5). [synthesis]

4.4 Kintsugi-inspired ceramic mask-making (Michener 2022, as cited)

  • Purpose: Espino cites this as kintsugi-inspired ceramic mask-making with people who have addictive behaviours, and notes that it emphasises catharsis. [source: Espino 2026, citing Michener 2022]
  • Steps: [uncertain: Michener's procedure. I give no steps beyond this: make a mask, break or crack it, and repair it with visible seams.]
  • Watch for: the material-safety notes above apply. In addiction services, check whether solvents or adhesives are a misuse risk. [synthesis]

4.5 Kintsugi as verbal metaphor, without making

  • Purpose: to use the kintsugi image in talk therapy for trauma recovery and identity rebuilding when making art is not possible. Espino cites Randazzo & Ammari (2025) and Scherb (2018) as metaphor-only uses. [source: Espino 2026, citing these]
  • Steps: [synthesis]
    1. Show an image of a kintsugi-mended bowl.
    2. Ask what the client notices.
    3. Invite parallels with their life only if they want to explore them.
    4. Return to the image later in therapy to mark progress.
  • Example language (illustrative): "Some menders make the repair stand out in gold rather than hide it. Does anything in that fit or not fit for you?"
  • Watch for: a client who feels pressured into a "growth" story. Accept "it doesn't fit". [synthesis]

4.6 Kintsugi psychotherapeutic technique (Santos & Maciel 2026)

  • Purpose: a psychotherapy tool called "Kintsugi", developed by the corresponding author (Santos). It was tested with 200 adults aged 18–70 over about 4–6 sessions (about two months), with anxiety measured by the Hamilton Anxiety Scale and well-being by EMMBEP. The authors report falls in anxiety and rises in well-being regardless of age or gender. This was an uncontrolled pre/post study. [source: Santos & Maciel 2026, abstract; Medical Research Archives 14(6), doi 10.18103/mra.2026.0270]
  • Steps: [uncertain: the full procedure is not verified here, so no steps are given. The abstract does not say whether a physical object is broken or mended. Read the open-access article before using it.]

4.7 Paper kintsugi (low-risk variant) [synthesis]

  • Purpose: a version with no shards and no adhesives hazard, for children, inpatient units and online sessions.
  • Steps:
    1. The client draws or paints an image of themselves or a situation on thick paper.
    2. They tear it into a few pieces.
    3. They glue it onto backing card, leaving gaps.
    4. They fill the gaps with gold or metallic pen or paint.
    5. Reflect on the image as it now stands.
  • Example language (illustrative): "Leave the gaps showing, and let the gold mark where it came apart."
  • Watch for: the same signs as 4.2. This is my adaptation, not a published protocol.

4.8 Graded origami cognitive-motor training (Salsabila, Witdiawati & Sari 2025)

  • Purpose: to support orientation, attention, recall, fine motor skill and confidence in older adults with mild cognitive impairment. This is an adjunct to medical and nursing care, not a treatment for dementia. [source: Salsabila et al. 2025]
  • Steps:
    1. Measure baseline cognition with a standard screen. The case used the MMSE and SPMSQ; licensed screens should be used as their publishers require. [source: Salsabila et al. 2025]
    2. Run six 30-minute sessions at a fixed time of day, after breakfast in the case. Use two sessions per model, going from airplane to boat to rabbit, with a rest day between models. [source: Salsabila et al. 2025]
    3. Open each session with reality orientation: the day, date, place and the names of people present. [source: Salsabila et al. 2025]
    4. Demonstrate the whole model three times, step by step. [source: Salsabila et al. 2025]
    5. The client folds while you guide them, and you help with fine details. In the case, the facilitator drew the rabbit's eyes and nose. [source: Salsabila et al. 2025]
    6. Close with an unassisted recall attempt. Record how many steps the client completes alone; in the case, airplane recall went from 3 to 6 of 8 steps. [source: Salsabila et al. 2025]
    7. Give a printed step guide for practice between sessions. [source: Salsabila et al. 2025]
    8. Re-measure cognition at the end. [source: Salsabila et al. 2025]
  • Example language (illustrative):
    • "Today is Tuesday, and we're in the lounge. Watch me fold it once, twice, three times, then it's your turn."
    • "Now try it from memory. Take your time, and I'll only help if you ask."
  • Watch for:
    • frustration or shame at forgetting: reduce the steps and praise what was recalled;
    • visual or arthritic limits: use larger, thicker paper;
    • fatigue.
    • Signs it is working: recall of more steps, better orientation, enthusiasm, and other residents joining in. The case reported all of these, with the MMSE score rising from 18 to 22, a single uncontrolled case. [source: Salsabila et al. 2025]

4.9 Crane folding exercise (senbazuru) for a seriously ill loved one (Tanaka 2009)

  • Purpose: a group of caregivers, friends or family fold 1,000 origami cranes for a seriously ill person. It is offered as self-care for caregivers. Tanaka's themes were: overcoming powerlessness, a gesture of love and support, positive distraction, relaxation, teamwork and community support, and healing power. [source: Tanaka 2009]
  • Steps: [synthesis: Tanaka's abstract gives no session structure]
    1. Agree the purpose and the recipient, and check that the ill person or family would welcome the cranes.
    2. Teach the crane in a group until everyone can fold one on their own.
    3. Share out a target number per person, and run regular folding circles in person or online.
    4. Hold a reflection round in each circle, on what each person is folding for and how they are holding up.
    5. String and present the cranes.
    6. Hold a closing session, and plan what happens if the person dies before completion: finish them as a memorial, or stop.
  • Example language (illustrative): "While your hands fold, you might hold in mind what you wish for them, and what you need for yourself."
  • Watch for:
    • pressure to finish becoming a burden or a magical bargain about recovery;
    • grief, if the illness progresses.
    • The Japanese folk custom of 1,000 cranes should be credited to its culture. [synthesis] [uncertain: no source is cited on the custom's history]

4.10 Origami wellbeing group (Mersey Care and Origami Pulse model)

  • Purpose: an arts-in-health group for hospital inpatients and for staff wellbeing. It aims at present-moment focus, calm, confidence, belonging, and relief from boredom and isolation. It is run by an origami tutor and arts facilitator, not as therapy. [source: Mersey Care 2026]
  • Steps:
    1. Seat a small group at a table with any paper, including recycled flyers or magazines. [source: Mersey Care 2026]
    2. Start with a simple model such as a butterfly or heart. [source: Mersey Care 2026]
    3. Have the tutor demonstrate and guide while participants encourage each other, share tips and celebrate progress. [source: Mersey Care 2026]
    4. Invite participants to give finished pieces as small gifts. [source: Mersey Care 2026]
    5. A psychotherapist can refer clients into such a group, or co-run it and keep any therapeutic processing for individual sessions. [synthesis]
  • Example language: "Stress is released into the paper with each fold" is Dr Lizzie Burns's phrasing, quoted in Mersey Care 2026. Illustrative: "Wobbly folds are fine. Your hands are learning."
  • Watch for:
    • trembling hands and self-criticism: stress that there is no pressure for perfection [source: Mersey Care 2026];
    • choking risk from small folded pieces for people with severe dementia or small children [synthesis].
    • Signs it is working: quieter racing thoughts, conversation, a sense of belonging. [source: Mersey Care 2026]

Sumi-e items 4.11–4.14 are the writer's synthesis, not a published clinical method. No published art-therapy or clinical protocol for sumi-e or ink painting was found. The closest sources are Wu et al. (2024), who propose Chinese freehand brushwork as art therapy for retired older adults (abstract), and Pinelo Páez (2019), an action-research study in a Madrid secondary school (198 students in the first two years) that combined sumi-e-inspired ink activities with mindfulness routines. Its activities are educational, not therapy; where one is used below (4.14a) it is tagged. Items 4.11–4.14 adapt general art-therapy and mindfulness practice to ink-brush materials. They are not attributed to any founder, school or study. Use them only as optional exercises within your own trained practice, and treat the steps as suggestions. [synthesis]

4.11 Ink grinding and setup as a grounding ritual (sumi-e) [synthesis: no clinical source]

  • Purpose: to slow down and arrive in the session, for anxious or hyperaroused clients.
  • Steps:
    1. Set out the brush, an ink stick and inkstone (or bottled ink), a water dropper, absorbent paper and a felt underlay.
    2. The client adds a few drops of water and grinds the ink slowly in circles, at whatever unhurried pace suits them.
    3. Ask them to notice the sound, smell and darkening of the ink.
  • Example language (illustrative): "Take your time with each circle of the ink stick. There's no hurry."
  • Watch for: restlessness, and stop if it turns into a chore. Ink stains clothes. Use non-toxic ink and keep it away from mouths. Signs it is working: slower breathing and speech. This item is the writer's adaptation, not from a clinical protocol.

4.12 Single-stroke and basic-stroke practice [synthesis: no clinical source]

  • Purpose: to build tolerance of strokes that cannot be erased or corrected, and to give a focused attentional task. This suits perfectionism, self-criticism and rumination. [synthesis] Pinelo Páez (2019) links the single, unretouched stroke of ink painting to mindfulness concepts. [source: Pinelo Páez 2019, educational]
  • Steps:
    1. Demonstrate how to hold the brush upright and how to load it with ink.
    2. The client paints repeated lines, dots and the gradation from light to dark ink on cheap paper.
    3. Agree a rule: no correcting or overpainting. The next stroke goes on a fresh sheet.
    4. Choose one sheet to keep, and name what the client likes in it.
  • Example language (illustrative): "Once the brush has touched the paper, that stroke is done. We let it be and make the next one."
  • Watch for: harsh self-judgement. Reframe the aim as attention, not beauty. Signs it is working: the client relaxes into imperfect marks and criticises less.

4.13 Ensō circle practice [synthesis: no clinical source]

  • Purpose: to paint a single-movement circle as a repeated, present-moment exercise. The ensō belongs to Zen ink-brush tradition, and its spiritual meaning is that tradition's own. No clinical source describes it; Pinelo Páez (2019) discusses the ensō only as a symbol, not as an exercise. [uncertain]
  • Steps:
    1. The client settles at the paper with the loaded brush, breathing normally.
    2. They paint one circle in a single movement.
    3. They repeat this on several sheets.
    4. Compare the circles without ranking them, and ask what the client noticed in each.
  • Example language (illustrative): "Just one circle, one movement. Whatever shape it takes is today's circle."
  • Watch for: a client who reads spiritual claims into it, or feels it imposes a religious frame. Offer it as a simple art exercise. Do not use it with clients who object to religious associations.

4.14 Simple-subject brush painting (bamboo, orchid, grass, stones) [synthesis: no clinical source]

  • Purpose: to build mastery and expression with few strokes and plenty of empty space. Wu et al. (2024) propose the related Chinese freehand brushwork as art therapy for retired older adults. [source: Wu et al. 2024 abstract] Pinelo Páez (2019) describes the four traditional motifs (bamboo, orchid, chrysanthemum, plum) as the basis of sumi-e-inspired classroom work. [source: Pinelo Páez 2019]
  • Steps:
    1. Demonstrate a simple subject in three to five strokes.
    2. The client copies it, then varies it.
    3. Invite them to leave empty space on purpose.
    4. The client adds a title or a short line of writing.
    5. Reflect on what the empty space and the strokes hold.
  • Example language (illustrative): "What would you like to leave unpainted?"
  • Watch for: frustration at a skill gap. Keep subjects very simple and avoid copy-perfect standards. Check for hand pain in older adults. Signs it is working: absorption and pride in the work.

4.14a "Inner bamboo" and modulated strokes: emotion-linked ink exercises (educational source)

  • Purpose / when: to build awareness of present emotions through simple ink motifs, for clients who can tolerate looking at their feelings through an image. Pinelo Páez (2019) describes these as classroom activities for emotional awareness and self-regulation with young adolescents; they are not a clinical protocol. [source: Pinelo Páez 2019, pp. 83–84]
  • Steps: (1) Inner bamboo: the person paints bamboo whose features (a single stem or a group, young or grown, in sun or storm) match how they feel now. (2) Conscious self-portrait: a few simple strokes express present emotions, with no attempt at likeness. (3) Modulated painting: with the brush kept on the paper, the person shifts gradually from one emotion to its opposite in both mind and gesture. (4) Close with written or spoken reflection on what each technique brought up. [source: Pinelo Páez 2019, pp. 83–85] [synthesis: use in therapy, step order]
  • Example language (illustrative): "If your bamboo showed how today feels, what would it look like: one stalk or many, young or old, still or in wind?"
  • What to watch for: in the school study, too little structure drained energy and too much caused frustration, and some students found the opening breathing routine a waste of time. [source: Pinelo Páez 2019, pp. 77, 91] In therapy, the shift to an opposite emotion can stir strong feeling; keep it optional, stay with the client, and use the overwhelm steps in section 5. [synthesis]

4.15 Closing reflection and handling of the artwork (all strands) [synthesis]

  • Purpose: to consolidate meaning and contain feelings at the end of a session.
  • Steps:
    1. Title the piece.
    2. Name one word for how the client feels now.
    3. Decide where the work goes: home, therapy-room storage, a photograph, or a planned disposal ritual.
    4. Note one link to the client's week.
  • Example language (illustrative): "If this piece could say one thing to you, what would it be?"
  • Watch for: reluctance to leave the work, or urges to destroy it after the session. Agree on safe storage.

5. Handling problems

The sources say almost nothing about problems. Apart from the tagged exceptions, everything in this section is my own [synthesis].

  • Overwhelm or flashback at the breaking step:
    • Stop the activity.
    • Put the pieces out of sight in a bag or box.
    • Ground the client: feet, breath, name objects in the room.
    • Offer the choice to resume with the pre-broken or paper variant (4.7), or to stop for the day.
    • Screen beforehand. For clients with recent trauma, dissociation or high self-harm risk, avoid destruction steps and choose repair-only or metaphor-only work (4.5).
  • Destruction escalating into rage or self-punishment:
    • Set limits beforehand: one safe method, in a bag, with an agreed stopping point.
    • If violence or self-directed aggression appears, end the step and process the feeling verbally.
  • Self-harm and sharp-object risk:
    • No ceramics, blades, glass or solvents on inpatient, forensic or self-harm-risk units. Use paper mâché (as in the Broken Bowl Project [source: Mirabella]), card, tissue paper or air-dry clay.
    • Count the materials in and out.
    • If the client discloses suicidal thoughts during reflection, carry out a standard risk assessment and safety planning under your service protocol.
  • "It won't fit" despair (kintsugi) or "I can't do it" (origami, sumi-e):
    • Make the task smaller: fewer pieces, a simpler model, one stroke.
    • Help with fine details, as the case study facilitator did [source: Salsabila et al. 2025].
    • Notice the thought as a thought, in the ACT spirit of 4.1 [source: Espino 2026, defusion mapping].
    • Normalise imperfect results [source: Mersey Care 2026].
  • Perfectionism:
    • Use cheap paper and a no-corrections rule (4.12).
    • Set a time limit.
    • Compare several attempts without ranking them.
  • Metaphor resistance ("this is just a pot"):
    • Accept it. Treat the work as a mindful craft activity and do not push for meaning.
    • Clients may find the "beautiful scars" message invalidating when they are in acute pain. Name that some damage does not feel golden.
  • Toxic positivity or spiritual bypass:
    • Avoid framing trauma as a gift.
    • Leave room for anger and grief. Repair does not mean the harm was acceptable.
  • Cultural appropriation concerns:
    • Credit the Japanese origins.
    • Do not use terms such as Zen or wabi-sabi as therapeutic claims.
    • Invite Japanese and East Asian clients to share their own meanings, or to decline the practice.
    • Do not present ensō or Zen meanings as fact (rule VIII(f)).
  • Non-adherence and home practice:
    • Keep home tasks tiny: one fold, one stroke, a printed guide [source: Salsabila et al. 2025].
    • Review any home practice without shaming.
  • Ruptures:
    • Sometimes a client feels the therapist pushed them into breaking, or judged their work.
    • Name it, apologise for your part, and return control of the materials to the client.
  • Grief in the crane project when the loved one deteriorates or dies:
    • Plan alternatives beforehand: memorial completion, or stopping.
    • Refer to bereavement support.
  • Cognitive impairment (4.8):
    • Watch for shame at forgetting, and celebrate what was recalled.
    • Keep sessions short and at a fixed time.
    • Coordinate with nursing and medical care. This is an adjunct only [source: Salsabila et al. 2025, adjunct framing].
    • Do not read the MMSE change from a single case as evidence of treatment effect.
  • Children and young people:
    • Get assent from the child and consent from a parent or carer.
    • Use paper mâché or paper variants and have adults handle any breaking.
    • Words written "inside" the bowl (4.3) may disclose abuse or risk. Follow mandatory reporting and safeguarding procedures.
    • Do not interpret artwork as evidence of abuse.
    • Keep sessions short, demonstrate concretely, and use simple models.
  • Physical limits (tremor, arthritis, low vision):
    • Use larger, thicker paper and thick brushes.
    • Pre-crease folds and give extra demonstration.
  • Allergy and material reactions:
    • Stop and wash with soap and water.
    • Seek medical advice for eye contact with epoxy or for a rash.
    • Never use raw urushi lacquer clinically. A urushi rash can appear days after contact, so ask about any new rash at the next session. Suppliers advise wiping lacquer off the skin with vegetable oil before it hardens, and seeing a doctor for any reaction, especially on the face or eyes. [source: TSUGU TSUGU urushi-rash column]
  • Boundary drift in arts-in-health groups:
    • When an origami or ink group led by a tutor uncovers distress, refer the participant to the therapist instead of processing it in the group [source: Mersey Care 2026 for the tutor-led model].

Sources

Sources

Cited via the sources above

  • Huimin & Li (2023), creative origami training for MCI (via Salsabila et al.).
  • Michener (2022), kintsugi ceramic mask-making for addictive behaviours.
  • Randazzo & Ammari (2025), kintsugi metaphor for trauma survivors.
  • Scherb (2018), kintsugi metaphor in trauma therapy training.
  • Backos (2022), ACT and art therapy.
  • (All via Espino 2026, except Huimin & Li.)
  • Smestad, L. (2018), The School Counselor's Life (image credit via Mirabella).
  • No published clinical source on sumi-e was found; the published uses are fine-art and education studies, the closest being Pinelo Páez (2019). Items 4.11–4.14 therefore stay as the writer's [synthesis].
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