Remedial-education art therapy (Menzen)

1. Introduction

Version followed: Karl-Heinz Menzen's method systematisation in Grundlagen der Kunsttherapie (Ernst Reinhardt/UTB; the 5th ed. 2021 reading sample, the full table of contents of an earlier edition and a review of the 3rd ed. 2009). Status: the reading sample confirms the core rationale, the tactile-contrast examples, the hemisphere observations and the modified ROT (Sections 1 and 3, A1, A5, A6); it gives no phase model, no session counts and no step-by-step procedures. The childhood-places map (A7) is traced to Menzen 2008, pp. 63–65, through the SWAIP summary. Menzen's original monograph Heilpädagogische Kunsttherapie (Lambertus, Freiburg, 1994, 184 pp., ISBN 3-7841-0717-6) and Kunsttherapie in der Förder- und Heilpädagogik: Neurobiologische Grundlagen (Winter, 2017) have no public preview, so whatever procedures they contain are [uncertain]. No published step-by-step protocol was found: all "Steps" in Section 4 and the level-transition criteria in Section 2 are the writer's synthesis [synthesis]; a few steps now draw on the Deutsche Alzheimer Gesellschaft's descriptions of Validation and reminiscence work (A7, A8). A later, separate framework under the same name by Ruth Hampe and Monika Wigger (Heilpädagogische Kunsttherapie, Kohlhammer 2020) is mentioned only for orientation and is not the version followed.

What it is. Heilpädagogische (remedial-education / special-needs) Kunsttherapie is not a single manualised therapy. In Menzen's account it is one of six historical approaches (Ansätze) from which art therapy grew: the "heilpädagogisch-rehabilitative Ansatz", alongside the art-psychological, art-pedagogical, occupational-therapy, creative/design-therapy (Gestaltungstherapie) and depth-psychological approaches [source: Menzen 2021 reading sample, ToC; socialnet review]. Menzen traces it in three stages: around 1860 (Deinhardt and the Georgens, framed around disorders of the senses and of partial performance), around 1920 (holistic and Gestalt psychology) and from around 1990 (neurological orientation); he notes it became a discipline within academic special education in the late 1990s, with a curriculum set in 1998 [source: Menzen 2021 reading sample]. Practically, it is the art-therapeutic support of people with intellectual, learning, sensory, motor and social-behavioural impairments, hyperactivity, and acquired brain impairment (stroke, traumatic brain injury, dementia) [source: Menzen 2021 reading sample].

How change happens (core idea). Menzen grounds the approach in perception: graded aesthetic material experience is meant to reconstruct and compensate the early-childhood sensory situations that were missed or damaged, and to rebuild Gestalt (whole-form) perception, so that support is holistic rather than purely sensory. In his paraphrased words, the therapeutic process proceeds in pictorial steps that are "psychologisch und physiologisch angemessen" (psychologically and physiologically appropriate). The aim he names is re-appropriation ("Wiederaneignungsarbeit") of spatial, temporal and action structures, together with widening the field of perception; after brain injury a distorted body schema can be rebuilt [source: Menzen 2021 reading sample, section on the heilpädagogisch-rehabilitative approach, re-checked]. In brain-injured clients, lost functions must be reorganised through image-making; in his socialnet entry Menzen describes neurological work as rebuilding perception, feeling and action functions by pictorially synchronising impressions and actions, and work with people with disabilities as resource-oriented, drawing on pre-verbal and pre-symbolic abilities (perceiving colour, form, rhythm, melody) together with emotional relational offers [source: Menzen, socialnet Lexikon "Kunsttherapie", 2019].

2. Framework

Menzen does not publish a fixed phase model or session count for this approach in the available material. The 2021 reading sample says only that therapy proceeds "in bildnerischen, psychologisch und physiologisch angemessenen Schritten" and does not name or order these steps. Its "drei großen Schübe" (around 1860, around 1920, from around 1990) are historical stages of the field, not therapy phases [source: Menzen 2021 reading sample]. Whether the 1994 monograph or the 2008 dementia book contains a phase model is not known [uncertain]. What he does publish is a method ladder: four method families, each paired with a practice chapter, which in clinical use work as levels of support you choose between and move up through [source: Menzen 2021 ToC, Parts II and III; ordering-as-progression is synthesis]:

Format. Individual, group, family and mother–child settings; mostly complementary to medical, rehabilitative or educational care, and also used in diagnostics and medical rehabilitation [source: Menzen, socialnet 2019]. Menzen describes art-therapy practice as project work in his practice chapter on sensory promotion [source: Menzen ToC, "Exkurs: Kunsttherapeutische Praxis als Projektarbeit"] [uncertain: named only]. In dementia care, the secondary literature describes the heilpädagogisch approach as working with visual, motor and tactile stimuli, with each session's structure kept the same to give security [source: Ganß 2009, pp. 178 f., as cited in Ellermann's BA thesis, TH OWL; Ganß not drawn on; not specific to Menzen].

Session count and length. Not stated in the sources, including the 2021 reading sample [uncertain]. Working assumption [synthesis]: in disability and dementia settings, short (20–45 min), frequent (1–3 per week) sessions over months, with the same opening, middle and closing each time; in neurological rehabilitation, sessions fitted into the rehab team's plan (in Germany delegated under OPS/KTL with a physician or psychologist supervising [source: Menzen, socialnet 2019]).

Criteria for moving between levels [synthesis; not stated in the sources]:

• Level 1 → 2: the client tolerates and actively seeks material contact, shows differentiated responses (prefers, refuses, repeats), and begins to make marks or shapes intentionally.
• Level 2 → 3: the client can recognise and complete simple wholes (closing a form, matching parts) and orients to the page/space; marks begin to carry meaning or naming.
• Level 3 → 4: the client produces representational or symbolic images, can talk or play around them, and has enough stability for biographical or conflict material.
• Move down a level whenever fatigue, disorientation, agitation or regression appears; levels are not a one-way ladder.

3. Guiding principles

• Perception before meaning — start where the client's perceptual functioning is, not with interpretation [source: Menzen 2021 reading sample].
• Compensation of early experience — offer, in graded form, the sensory situations the client missed (warm/cold, firm/soft, wet/dry) [source: Menzen 2021 reading sample].
• Holistic Gestalt orientation — aim at whole-form perception and experience, not isolated sensory drills [source: Menzen 2021 reading sample].
• Psychologically and physiologically appropriate steps — pace and grade tasks to the client's nervous system and emotional tolerance [source: Menzen 2021 reading sample].
• Resource orientation — build on what remains (pre-verbal, pre-symbolic capacities) rather than on deficits [source: Menzen, socialnet 2019].
• Relationship as the frame — the material offer is always also an emotional relational offer [source: Menzen, socialnet 2019].
• Non-verbal first, verbal reflection after — in practice: let the client work in the medium; talk only as much as they can use [source: Menzen, socialnet 2019].
• Complementary, not replacing — art therapy supports medical, educational and rehabilitative measures; in practice: coordinate with the team and never present it as a substitute for medical care [source: Menzen, socialnet 2019].
• Participation and reintegration — goals are tied to self-esteem, tension reduction, emotional openness, coping and social participation [source: Menzen, socialnet 2019].
• Haptic activity is especially effective with confused elderly people — in practice: favour drawing, building and modelling over looking and talking [source: SWAIP summary of Menzen 2008].
• Neurologically informed observation — read the image as information about functioning (e.g. fragmented image-making after right-hemisphere damage; impaired detail and sequencing after left-hemisphere damage), not as a diagnosis [source: Menzen 2021 reading sample; use limits are synthesis].
• Aesthetic socialisation / enculturation — in practice: connect the client to everyday aesthetics and culture (e.g. public murals), not only to private expression [source: Menzen ToC, Part II.3].
• Form matters, not only content — Menzen's outlook moves from the primacy of image content toward the autonomy of form and formal process; in practice: attend to how the client handles material and form as much as to what they depict [source: Menzen ToC, Part II.6.4].

• Re-appropriation of space, time and action: in practice, choose tasks that rebuild orientation in space (page, table, room), order in time (before and after, repetition) and purposeful action (plan, do, see the result), and widen the field of perception step by step [source: Menzen 2021 reading sample, "Wiederaneignungsarbeit von Raum-, Zeit- und Handlungsstrukturen"].

4. Intervention inventory

How to read this inventory. The interventions below are those Menzen names in his method and practice chapters [source: Menzen 2021 reading sample and full ToC]. The available sources give their names, aims, materials and target groups but not Menzen's own step-by-step text, which sits in the practice chapters (Part III) and in the 1994 and 2008 monographs [uncertain]. The reading sample names the modified ROT without steps and lists basal stimulation, Validation, Mäeutik and image/memory work only in its contents. No published step-by-step protocol was found, so all "Steps" are the writer's synthesis [synthesis], built from the named aim, material and population; they are not Menzen's wording. All example language is (illustrative).

Professional frame before you start. In Germany and Austria art therapy is not a state-regulated profession and is not covered by the Psychotherapists Act; training runs through bachelor's/master's programmes and further-education courses, and the professional landscape is organised under the BAG Künstlerische Therapien (founded 2008), with member bodies including the DFKGT, DAGTP, BVAKT and DGKT; in hospitals and rehab it is delegated under OPS/KTL with a physician or psychologist supervising [source: Menzen, socialnet 2019]. Heilpädagogik is a separate trained profession and a training orientation within art therapy [source: Menzen, socialnet 2019]. Outside German-speaking countries use the local route (e.g. UK: HCPC registration as art therapist, BAAT; US: ATCB credential, AATA) [synthesis]. Do not run basal stimulation with people with profound disabilities, neurological rehabilitation work, or trauma-focused design therapy without art-therapy training and the treating team's involvement [synthesis]. A psychotherapist without that training can use the stance, the material-choice principles and receptive work within their own scope, and refer for the rest [synthesis].

Materials and physical safety [synthesis]: use non-toxic, food-safe-rated paints and pigments in powder-free or pre-wetted form (dry pigment and clay dust must not be inhaled — mix wet, wipe surfaces wet, never sweep dry clay); wallpaper paste should be fungicide-free (many commercial pastes contain fungicides; use plain starch or flour-and-water paste if clients may mouth material); check allergies (latex, wheat in flour paste); for clients who mouth or swallow, offer only edible-safe materials and stay within arm's reach; no sharp tools without one-to-one supervision; warm/cold stimuli at skin-safe temperatures tested on your own inner wrist first; clean hands and surfaces after wet work; seated work and clear floor space for wheelchair users and fall-risk elderly clients.

A. Sensory compensation and promotion (Sinneskompensation und Sinnesförderung)

A1. Basal (aesthetic) stimulation with material contrasts

• Purpose / when: To stimulate the client's basic perceptual activity when perception itself is limited (profound intellectual disability, late dementia, early post-stroke or TBI). Menzen says basic perceptual activities should be stimulated basally, with tactile contrasts such as warm/cold, firm/soft, wet/dry as his examples [source: Menzen 2021 reading sample, re-checked]; he lists "(Ästhetisch-)Basale Stimulation" among methods for dementia rehabilitation [source: Menzen 2021 ToC]. Basale Stimulation as a concept comes from outside art therapy: special-education method handbooks list it as "Basale Stimulation nach Fröhlich" [source: ToC of Methoden und Konzepte in der Heilpädagogik, Kohlhammer]. Menzen adapts it aesthetically; the details of his adaptation are not drawn on [uncertain].
• Steps [synthesis]: (1) With carers, list sensory likes, dislikes, sensitivities and medical restrictions. (2) Prepare 2–3 contrasting material pairs (e.g. warm damp cloth vs cool smooth stone; soft wool vs firm wooden block; wet clay vs dry sand). (3) Announce each contact in words and with a consistent pre-touch cue (e.g. touching the forearm first), then offer the material near the hand and let the client move toward it; guide the hand only with permission and lightly from underneath. (4) Offer one quality at a time, pause, watch the response, then the contrast. (5) Repeat the same sequence across sessions so it becomes recognisable; add a mark-making step (e.g. pressing a coloured, wet sponge onto paper) once contact is tolerated. (6) End with the same closing ritual each time.
• Example language (illustrative): "Here is something warm … and now something cool." "You pulled your hand back. We'll leave that one."
• Watch for: startle, grimacing, breath-holding, increased muscle tone or withdrawal = too much or unwanted; stop. Working signs: orienting toward the material, reaching, repeating a movement, calmer breathing, choice behaviour across sessions. Document responses session to session.

A2. Elementary forms (Fröbel-type materials)

• Purpose / when: Menzen presents Fröbel's play materials — balls, discs, cuboids, columns — as tools through which a person learns the world [source: Menzen 2021 reading sample]. Use with clients at an early stage of form and object perception.
• Steps [synthesis]: (1) Offer one large, graspable ball; let the client hold, roll, drop and retrieve it. (2) Introduce a contrasting form (cube or disc) and let the client explore difference (rolls vs stays). (3) Pair the object with a trace: roll an ink-coated ball across paper, press a disc into clay, print a block. (4) Later, sort forms or match objects to their prints.
• Example language (illustrative): "This one rolls away. This one stays." "Can you find the one that made this mark?"
• Watch for: objects small enough to swallow (avoid); working = spontaneous comparing, choosing, linking object and trace.

A3. Material projects with paste, pigments and clay (people with intellectual disabilities)

• Purpose / when: Menzen's practice chapter describes projects with Kleister (paste), Farbpigmente (pigments) and Ton (clay) with people with intellectual disabilities [source: Menzen ToC Part III.1] [uncertain: named only]. Use for basal sensory experience that leaves a visible product.
• Steps [synthesis]: (1) Paste: cover a large table with paper; let the client spread plain paste with hands or a wide brush; when tolerated, sprinkle or drip colour into it so hand movement produces colour traces; lay a second sheet on top and lift for a print. (2) Pigments: use pre-mixed, wet pigment or pigment already stirred into paste (no loose powder); offer one strong colour at a time, then two to mix. (3) Clay: start with soft, slightly warm, moist clay; press, poke, roll, pat; leave fingerprints; later form a simple shape (ball, coil, bowl). (4) Keep products, photograph them with the client and show the sequence over weeks.
• Example language (illustrative): "Your hand made this blue path." "Push — look, your thumb is in the clay."
• Watch for: mouthing, wiping on face or eyes, tactile defensiveness (offer tools, gloves or a barrier sheet), overstimulation from too many colours. Working = longer engagement, deliberate movement, recognition of own product.

A4. Art therapy as project work

• Purpose / when: Menzen includes an excursus on art-therapeutic practice as project work within the sensory-promotion practice chapter [source: Menzen ToC Part III.1] [uncertain: named only]. Use when a group or institution can sustain a shared product over weeks.
• Steps [synthesis]: (1) Agree a shared, concrete product with clients and staff (e.g. a large paste-and-pigment wall panel, a clay garden). (2) Break it into sensory-level tasks each participant can do. (3) Fix a weekly rhythm and a visible progress record. (4) Close with a showing to the group or institution.
• Example language (illustrative): "This week everyone adds their colour to the big sheet."
• Watch for: product pressure overriding individual pacing; the project serves the clients, not the institution's display needs.

A5. Sensory promotion after stroke, TBI and in Alzheimer's disease

• Purpose / when: Menzen describes art-therapeutic sensory promotion with stroke, Alzheimer's and TBI patients and frames brain-injury work as reorganising lost functions [source: Menzen 2021 reading sample and ToC]. Always as an adjunct within the neurological or geriatric team's plan [source: Menzen, socialnet 2019 — complementary use].
• Steps [synthesis]: (1) Get from the team the deficits (neglect, aphasia, apraxia, hemiparesis, visual field loss) and any precautions. (2) Position materials in the intact visual field first; later move them gradually toward the affected side. (3) Use thick crayons, large paper fixed to the table, and one-step tasks (trace, fill, press). (4) Link a sensation with an action and its visible result ("feel – move – see"). (5) Repeat and grade; record what the client can do unaided.
• Observation aid: Menzen notes that right-hemisphere damage tends to show as fragmented image-making and left-hemisphere damage as impaired detail and sequencing [source: Menzen 2021 reading sample]. Use this only to adapt tasks and share observations with the team; it is not a neurological diagnosis [synthesis].
• Example language (illustrative): "Let's start here where you can see it well." "Feel the edge of the paper with your fingers, then draw along it."
• Watch for: fatigue (stop early), frustration at lost skills (lower demand, praise process), catastrophic reactions in aphasia; working = longer attention, crossing toward the neglected side, more complete forms.

A6. Modified reality orientation training (ROT) with images

• Purpose / when: Menzen describes a "modifizierten Realitäts-Orientierungs-Training (ROT)" used on neurology wards with stroke, accident and Alzheimer patients [source: Menzen 2021 reading sample, re-checked]. The reading sample does not give the modifications or any steps, and how the 2008 dementia book modifies ROT is not known [uncertain].
• Steps [synthesis]: (1) Begin each session with a shared, image-based orientation board the client helps make (day, season, place, who is here), e.g. painting the season's colours or gluing a picture of today's weather. (2) Keep it gentle and non-testing; offer information rather than quizzing. (3) Return to it at the end.
• Example language (illustrative): "It's autumn — the leaves outside are turning. Shall we pick autumn colours for today?"
• Watch for: in moderate–severe dementia, correcting the person's reality can distress; switch to a validating stance (A8) when orientation work causes agitation [synthesis].

A7. Image and memory work: the childhood-places map

• Purpose / when: Menzen lists "Bild- und Erinnerungsarbeit" among dementia methods [source: Menzen 2021 ToC]. In Kunsttherapie mit altersverwirrten Menschen (2nd ed. 2008) he explains memory loss in dementia neurologically as a loss of the continuum of time and space (pp. 53–59) and develops methods meant to activate neural connections. In one of them (pp. 63–65) a group jointly reconstructs a city map of the places of their childhood, which prompts storytelling as memories come back; haptic activities (drawing, building, modelling) are described as especially effective [source: SWAIP summary of Menzen 2008, pp. 53–70]. Connert (2019, Forum für Kunsttherapien 47(1), 8–11) describes using Menzen's method of supporting the reconstruction of childhood places to stimulate emotional memory in very old people with dementia [source: SWAIP]. No German method name (such as "Kindheitslandkarte") appears in the sources used; "childhood-places map" is a descriptive label [uncertain]. The summaries give no group size, materials or session sequence, so the Steps below are [synthesis]. The Deutsche Alzheimer Gesellschaft describes reminiscence work (Erinnerungstherapie) as individual or group conversation about earlier experiences, prompted by pictures, stories, music or everyday objects, and notes that childhood and youth memories often last long after short-term memory fails [source: Deutsche Alzheimer Gesellschaft, Infoblatt 6, 2016].
• Steps [synthesis]: (1) Small group (4–6), large paper on the table. (2) Start with an anchor everyone knows (a river, main street, church, school). (3) Each person places and draws, builds or models "their" place (home, school, shop, playground) and adds a detail. (4) Invite stories about the place; the therapist writes short labels the person dictates. (5) Add to the same map over several sessions; keep it displayed.
• Example language (illustrative): "Where did you live as a child — near the river or up the hill?" "What could you smell walking to school?"
• Watch for: painful memories (war, loss, displacement) surfacing — slow down, acknowledge, offer a safer place on the map; competing or correcting between members. Working = spontaneous storytelling, members linking to each other's places, recognisably richer detail.

A8. Validation and maieutics within art-therapy sessions

• Purpose / when: Menzen lists Validation and Mäeutik alongside basal stimulation, ROT and image/memory work as dementia-rehabilitation methods that art therapy works with [source: Menzen 2021 ToC]. These are separate methods developed outside art therapy; special-education method handbooks list "Validation nach Feil" and "Integrative Validation nach Richard" as distinct approaches [source: ToC of Methoden und Konzepte in der Heilpädagogik, Kohlhammer]. How Menzen combines them with image-making is not described in the available sources [uncertain].
• Steps [synthesis]: Accept and reflect the feeling behind what the person says or depicts rather than correcting facts (the Deutsche Alzheimer Gesellschaft describes the validating stance as accepting that people with dementia live in their own world and not constantly correcting them [source: Deutsche Alzheimer Gesellschaft, Infoblatt 6, 2016]); let the image carry the conversation; refer staff to formal training in those methods.
• Example language (illustrative): "Your mother's kitchen — it sounds like a warm place."
• Watch for: do not claim to deliver Validation or maieutic care without the respective training.

B. Form-perception disorders and Gestalt reconstruction (Gestaltrekonstruktion)

B1. Orientation support in neurological disorders

• Purpose / when: Menzen treats Gestalt reconstruction as a route to orientation and perceptual training and has a practice section on orientation support in neurological disorders [source: Menzen 2021 reading sample and ToC]. Use when clients cannot organise space, page or sequence (after brain injury, in dementia).
• Steps [synthesis]: (1) Give the page a clear frame (taped border, coloured edge) and a fixed start point. (2) Use one-figure-on-ground tasks: one strong shape on a plain background. (3) Build from the frame inward: border → large shape → detail. (4) Keep the room, seating and material layout identical each session.
• Example language (illustrative): "Here is the edge of your picture. Let's start at this corner."
• Watch for: visual clutter (remove extra materials); working = the client finds the page edge and start point unaided, organises marks within the frame.

B2. Gestalt-perception exercises with disoriented people

• Purpose / when: Menzen's practice chapter contains practical exercises for Gestalt perception with disoriented people, grounded in his account of form, wholeness and Gestalt and its neurological basis [source: Menzen ToC Part II.2 and III.2; review mentions "perception exercises for disoriented people"] [uncertain: exercises not described].
• Steps [synthesis]: (1) Closing forms: offer an incomplete simple outline (circle with a gap, house missing its roof) and invite completion. (2) Part–whole: tear a simple coloured shape into 2–4 pieces and reassemble it on paper. (3) Matching: match cut shapes to their outlines. (4) Familiar wholes: trace and colour an everyday object (cup, leaf) placed on the paper. Grade from 2 to more pieces only when success is reliable.
• Example language (illustrative): "Something is missing here — what would make it whole?"
• Watch for: tasks that feel like testing or school (frame them as making, not scoring); shame at failure — always end on a success. Working = faster, more confident completion; transfer to spontaneous drawing.

C. Developmental compensation and aesthetic socialisation

C1. Choosing aesthetic materials and colours

• Purpose / when: Menzen gives practical notes on aesthetic material and on the choice of colours for developmental support, and the review notes practical tips on choosing materials for different groups [source: Menzen ToC III.3; socialnet review] [uncertain: named only].
• Steps [synthesis]: (1) Match resistance of material to the client's control: fluid materials (finger paint, wet paste) loosen and regress; firm materials (pencil, wax crayon, wood) structure and contain. (2) For anxious or chaotic clients start with structuring materials and limited palettes; for rigid, over-controlled clients introduce fluid ones gradually. (3) Offer real choice between 2–3 options, which is itself a developmental step.
• Example language (illustrative): "Would you like the firm crayons or the soft paints today?"
• Watch for: regression or loss of control with fluid media (switch to firmer media); colour preferences are personal and cultural — do not apply fixed colour meanings.

C2. Children's drawings as a developmental record

• Purpose / when: Menzen uses a four-year-old's drawings as a practice example of developmental constitution through images [source: Menzen ToC II.3.1, III.3] [uncertain: named only]. Use to follow a child's developmental steps over time and to pitch tasks.
• Steps [synthesis]: (1) Keep all drawings dated in a folder. (2) Note developmental features (scribble → closed forms → tadpole figures → base lines and scenes) and match next tasks to the next step. (3) Review the series with the child and, where appropriate, carers.
• Example language (illustrative): "Tell me about your picture." (not "What is it?")
• Watch for: Drawings are not diagnostic evidence of abuse or disorder; no validated manual supports reading abuse from children's art in this approach [synthesis]. If a child discloses something in words while drawing, follow safeguarding procedure (see Section 5).

C3. Murals with adolescents (identity work)

• Purpose / when: Menzen uses young people's wall paintings as identity work and as an example of everyday aesthetics, cultural reconstruction and enculturation as tasks of art therapy [source: socialnet review; Menzen ToC II.3.2–3.3, III.3]. Use with adolescents whose identity and belonging are fragile or contested.
• Steps [synthesis]: (1) Secure a legal wall or large boards and permission. (2) Group develops themes and sketches; each member has a visible part. (3) Transfer and paint together, with roles (design, outline, colour). (4) Hold a public showing and a reflective closing talk about what the wall says about them.
• Example language (illustrative): "If people walk past this wall, what should they know about you?"
• Watch for: ladder and height safety, ventilation with spray paints (prefer brushes and water-based paint), gang or hate symbols (agree rules beforehand), exclusion within the group. Working = ownership, cooperation, pride, talk about self.

C4. Individual work with an over-adapted child or a socially refusing adolescent

• Purpose / when: Menzen presents cases of work with an over-adapted girl and a socially withdrawing adolescent [source: Menzen ToC III.3] [uncertain: named only].
• Steps [synthesis]: Over-adapted child: offer permission for mess and imperfection (large paper, fluid media), avoid praise for neatness, follow the child's lead. Refusing adolescent: low-demand presence, adult-grade materials, allow just looking or doodling, accept refusal without sanction, follow interests (graffiti, comics, photography).
• Example language (illustrative): "Here it's fine to make a mess." / "You can just sit, or try the markers — your call."
• Watch for: the child pleasing the therapist rather than exploring; adolescent testing limits. Working = more spontaneous marks, initiative, return to sessions.

C5. Group work

• Purpose / when: Menzen gives notes for group work in his developmental practice chapter [source: Menzen ToC III.3, "Exkurs: Anmerkungen für die Gruppenarbeit"] [uncertain: named only].
• Steps [synthesis]: Fixed opening and closing; own workspace for each member; individual task first, then shared product (joint picture, mural); short round of showing; rules on respect for others' work.
• Watch for: dominance, damage to others' work, contagion of agitation.

D. Depth psychology, biographical narration and design therapy

D1. Depth-psychological image use and biographical narration

• Purpose / when: Menzen includes depth-psychological use of images, aesthetic production in psychiatry and psychoanalytic developmental research, with the case of a narcissistically disturbed boy [source: Menzen ToC II.4, III.4; socialnet review]. Use only once the client can symbolise and tolerate reflection (Level 4).
• Steps [synthesis]: free or themed image-making; then invite the client to tell the image's story; attend to transference and countertransference; link images over time into a biographical narrative.
• Example language (illustrative): "If this picture could talk, what would it say?"
• Watch for: requires psychodynamic training and supervision; avoid interpretations the client cannot use.

D2. Design therapy (Gestaltungstherapie) with traumatised clients

• Purpose / when: Menzen describes design-therapy procedures for people with PTSD and cases of a traumatised boy and a traumatised, phobic young woman [source: Menzen ToC II.5.4, III.5] [uncertain: named only].
• Steps [synthesis]: stabilisation first (safe-place image, containers, resource images); only then, with consent and in graded steps, give form to trauma-related material, always ending with a stabilising image.
• Watch for: this is exposure-adjacent: screen for dissociation and current threat, agree a stop signal, never push depiction of trauma content; trauma-specific training required.

D3. Receptive art therapy (working with existing artworks)

• Purpose / when: In later work Menzen and Franzen describe receptive art therapy: the client engages with an existing artwork, resonates with it empathically, and the image's symbolic content becomes a therapeutic resource [source: Franzen & Menzen 2022 reading sample; MTK review]. Useful when making images is impossible or overwhelming.
• Steps [synthesis]: choose 2–3 reproductions with care for the client's history; let the client choose one; slow looking; ask what they notice, feel, would change; optionally respond with own image.
• Example language (illustrative): "Take your time with it. Where does your eye go first?"
• Watch for: images that trigger (violence, loss); your own motives for choosing an image.

5. Handling problems

The available Menzen sources do not contain a problem-handling section. Everything below is [synthesis] built on the principles in Section 3 (graded steps, resource orientation, relationship, complementary use) unless a source is given.

• Stuck client (no engagement, no change over weeks): step down one level (Section 2) — often the task is above current perceptual or developmental capacity. Reduce choice to two options, shorten sessions, change material resistance (C1), and check with the team for medical causes (pain, medication changes, infection, hearing or vision loss).
• Refusal and resistance: accept refusal without sanction; in disability and dementia settings refusal is often communication (overload, pain, fear). Offer presence and a low-demand option (watching, holding a material), try another time of day, and ask carers what the person usually signals with this behaviour.
• Sensory overwhelm or agitation: stop the stimulus, reduce to one calm material or none, lower voice and light, offer a known closing ritual. Next time: fewer stimuli, longer pauses, start from the last tolerated step. Never use restraint to complete an activity.
• Catastrophic reactions and shame at lost abilities (stroke, dementia): reduce demand immediately, take responsibility ("that was a hard task I gave you"), finish with something certain to succeed; avoid school-like testing.
• Non-adherence / irregular attendance: in institutions, attendance often depends on staff; agree fixed times, a named staff contact and a short shared record of each session; for outpatient children, agree with carers how sessions fit into the family's week.
• Rupture: acknowledge your part plainly, return to what the client enjoyed, and re-negotiate the material and pace. With non-verbal clients, read rupture from withdrawal and repair through consistent, predictable sessions.
• Over-interpretation risk: do not read diagnoses, abuse or hidden meanings into images, play or material handling. Menzen's hemisphere observations (A5) are aids for adapting tasks, not diagnostic tests [source for observation: Menzen 2021 reading sample; limit is synthesis].
• Children and young people — safeguarding, consent and assent: obtain consent from those with parental responsibility and the child's own assent at an age-appropriate level, and renew assent when tasks change; involve parents or carers in goals and reviews; if a child discloses harm or you have reasonable concern, follow your local child-protection procedure and mandatory-reporting duties (e.g. in Germany § 8a SGB VIII procedures with the youth welfare office; elsewhere your jurisdiction's equivalent) and do not investigate through the artwork.
• Adults lacking capacity (severe disability, dementia): follow the applicable capacity or guardianship law, best-interests decision-making and the person's expressed wishes (including non-verbal signals of refusal); record how consent was established.
• Touch: basal stimulation and hand-guiding involve touch. Ask or cue before every contact, offer the material rather than taking the hand, allow withdrawal at any time, respect cultural and trauma-related sensitivities, have a second staff member present where policy requires, and never touch intimate areas.
• Retraumatisation in design therapy (D2): stop if dissociation, flashbacks or panic appear; ground (name objects, feel feet and chair, cool water), put the image away in a folder or container, and end with a resource image. Do not resume trauma-related work until the client is stabilised and has consented again.
• Suicidal or self-harm content in images or talk: treat it as you would in verbal therapy: ask directly, assess risk with your service's standard procedure, involve the responsible clinician, safety-plan, and remove access to sharp tools in the session if risk is current.
• Institutional pressure for display products: keep therapeutic work private unless the client consents; separate project or exhibition work (A4, C3) from individual therapeutic images.
• Material hazards in practice: a client mouths paste or clay → switch to edible-safe materials and inform staff; dust or spray → wet methods and ventilation; allergic reaction → stop, wash, follow first-aid procedure.
• Scope limits: if you are a psychotherapist without art-therapy or Heilpädagogik training, use receptive work, simple material choice and the stance; refer for basal stimulation, neurological rehabilitation work and trauma-focused design therapy. Art therapy here is always complementary to, never a replacement for, medical, nursing or rehabilitative treatment [source: Menzen, socialnet 2019].

Sources

Pages consulted:

• Menzen, K.-H.: Grundlagen der Kunsttherapie, 5th ed. 2021, reading sample (Ernst Reinhardt / UTB, e-bookshelf)
• Table of contents of Menzen, Grundlagen der Kunsttherapie (lehmanns.ch)
• Table of contents of Menzen, Grundlagen der Kunsttherapie, earlier edition (lehmanns.ch)
• Niederreiter, L. (2009): Review of Menzen, Grundlagen der Kunsttherapie, 3rd ed. (socialnet Rezensionen)
• Menzen, K.-H. (2019): Kunsttherapie (socialnet Lexikon)
• edudoc.ch record: Menzen, Heilpädagogische Kunsttherapie, Lambertus 1994
• Franzen, G. & Menzen, K.-H. (Eds.) (2022): Rezeptive Kunsttherapie, reading sample
• Review of Rezeptive Kunsttherapie, Musik-, Tanz- & Kunsttherapie
• Franzen, G. (2022): Laudatio for Karl-Heinz Menzen's 80th birthday (SFU)
• SWAIP: entry on Menzen, Art therapy with people confused by age
• Table of contents of Hampe & Wigger, Heilpädagogische Kunsttherapie (Kohlhammer 2020, hugendubel)
• Skoobe: Hampe & Wigger, Heilpädagogische Kunsttherapie (2020)

Further pages consulted:

• SWAIP: tag "map", Menzen 2008 city map of childhood places (pp. 63–65) and Connert 2019
• SWAIP: tag "sensory perception", Menzen 2008
• Ellermann, L.: BA thesis on art therapy in dementia, TH OWL (cites Ganß 2009)
• Table of contents of Methoden und Konzepte in der Heilpädagogik (Kohlhammer, hugendubel)
• Masuch et al. (2023): Effekte von Kunsttherapie bei geriatrischen Patient:innen, Die Psychotherapie 68(4) (checked; does not describe Menzen's methods)
• Deutsche Alzheimer Gesellschaft (2016): Informationsblatt 6, Die nicht-medikamentöse Behandlung von Demenzerkrankungen

Books cited:

• Menzen, K.-H. (1994). Heilpädagogische Kunsttherapie. Freiburg i.Br.: Lambertus.
• Menzen, K.-H. (2008). Kunsttherapie mit altersverwirrten Menschen (2nd ed.). München: Ernst Reinhardt. [known via SWAIP summary only]
• Menzen, K.-H. (2017). Kunsttherapie in der Förder- und Heilpädagogik: Neurobiologische Grundlagen. Heidelberg: Winter.
• Menzen, K.-H. (2021). Grundlagen der Kunsttherapie (5th ed.). München: Ernst Reinhardt (UTB). [reading sample and ToC only]
• Franzen, G. & Menzen, K.-H. (Eds.) (2022). Rezeptive Kunsttherapie. Baden-Baden: Alber. [reading sample only]
• Hampe, R. & Wigger, M. (2020). Heilpädagogische Kunsttherapie: Grundlagen, Methoden, Anwendungsfelder. Stuttgart: Kohlhammer. [ToC only; not the version followed]

• Connert, S. (2019). Ein Leben mit Demenz im hohen Lebensalter. Beispiele aus der Kunsttherapie. Forum für Kunsttherapien, 47(1), 8–11. [known via SWAIP only]
• Ganß (2009). Demenz-Kunst und Kunsttherapie. [known via Ellermann's thesis only]
• Methoden und Konzepte in der Heilpädagogik. Stuttgart: Kohlhammer (ISBN 978-3-17-042371-8). [table of contents only]