I am often consulted for advice from art therapists regarding professional questions and concerns. Here is one, from an art therapist in a major metropolitan city in the US. She has given me permission to share this because she and I both felt it an important topic to contemplate and discuss.
Question:“I was asked what I would charge to do an art therapy group for a newly opening clinic. When I told them my fee, (the going rate in this area is $125 for a private practice hour and insurance reimburses $50 – $125) they were shocked because they wanted to pay $30/group hour. Are art therapists accepting that pay rate in other clinics?”
Response: Under all circumstances $30 an hour for a Master’s level mental health worker is not equitable pay. But let’s run through a few other factors that may make sense in terms of the gap between what you were requesting and what they are offering and then I will do a final price break down at the end and show why you would most likely find yourself in the red at the end of the year, if this is what most of your work opportunities were like.
There is a big difference when you provide fee-for-service work, also known as contract work, and employee wages. When the company reports your earnings on a 1099, you are self-employed. Employees paid on a W-2 status usually have benefits (i.e., health and life insurance, flexible spending account, paid days off, employer contributions to a retirement plan, and sometimes tuition reimbursement). When you are self-employed you do not have paid time off and you must pay for your own benefits as well as pay the employer part of the taxes, which, can be a big deal and add up to thousands of dollars per year depending on your income (between 12% – 15% of your earnings).
Second, knowing the number of groups per week they would like you to run at this rate as well as how are you compensated for documentation and/or treatment team meetings will be important. Obviously, the more groups and compensated time there, the better. You can make the most of your time if you are running three groups a day in one place, rather than three groups on three separate days. To leave the house for an hour appointment, there is a usually a commitment of approximately three hours:
The hour to get ready, drive to the location, and prepare for the session,
The hour for the session itself, and
Then the time to clean up, leave some communication with other team members, and most likely documentation (which can extend this time considerably) and then the ride home.
And although you are technically not getting paid for travel you must consider this time in your worth, as we all have 24 hours in a day, no more, so you cannot fill this time with another job, time with your kids, or time making your own art.
Third, the market may be very saturated with mental health clinicians willing to work for anything. Sometimes there are many hungry new professionals, paraprofessionals, and students willing and able to take whatever work they can, thus undercutting clinicians with years of experience, appropriate credentials, and expertise. For many new graduates, $30 per group may sound really good (mostly because they may not fully appreciate their professionalism yet, nor do they fully comprehend the investment of their time, or because they are desperate with the thought of looming student loans and other living expenses).
Regardless of the stated terms, consider the added expense of liability insurance. The rate will be different if you are a contract, self-employed person versus working for an agency. It is more expensive for self-employed persons.
The penultimate consideration: Assess if the hiring agency is a big-name place that has a lot of prestige. If so, you may be surprised what doors this experience may open for you in the future and likewise, they may know this and use it to their advantage as the “honor” to work for them may be bigger than you realize at the moment (this is hard to gauge but I believe it is worth mentioning as it too can lower the going rate due to perceived prestige and because there are so many applicants).
Lastly, location can make a big difference. For example, the going rate in San Francisco versus some small town where the cost of living is very low may not be accounted for. To give them the benefit of the doubt, it may be that this new clinic is coming from a lower cost of living area and opening in your city, presumably a place with a higher cost of living or paying wage. Take this last bit cum grano salis (with a grain of salt) because most successful companies who are expanding to new cities do a detailed cost analysis including competitive pay scales before making the decision to open their doors.
If it turns out that this is a contract only job, and you are responsible for all of your taxes and have no benefits, let’s break this down:
If your group is 1 hour but you devote three hours of your day to it, right there it is $10 per hour. Most people will pay approximately 1/3 of your income to taxes, bringing their take home pay to $20 for three hours (approx. $6.70/ hour).
In addition to this, in order to hold yourself out as a professional, you pay dues to your professional membership and credentialing agencies, and your liability insurance. Let’s just ballpark these three figures to be approx. $500 per year which is roughly $10 per week. At this point your earnings are $10 for your three hours (approx. $3.30/hour) assuming this is the only work you have at the moment.
But really you are paying to go to this job because, you must upkeep your credentials during the year via continuing education credits which is roughly another $30 per week, maybe more (I came to this number by taking the average cost to attend an annual conference and associated travel expenses [$2,000] and dividing it by 52, the number of weeks per year. Obviously, this number could be more or less depending on the proximity of the conference and what type of CEC’s are obtained. I personally think it is important to attend the AATA conference and do so whenever I can in order to keep abreast of the newest innovations in our field and for the collegial comradely).
In addition to maintaining your professional standards, you need gas and insurance for the car and money for its maintenance, and your own healthcare, and if you have to pay for childcare – well, forget it!
Because art psychotherapists working as contract workers, or in private practice, must bear all the expenses for their business, they must charge well over $100 an hour in most parts of the country, which is comparable to other mental health professionals.
Now $30 an hour may be doable if you are working a 40-hour a week job with benefits. But as a consultant with this pay, you will have a similar plight as many adjunct professors. It seems you may be better off working for or consulting with a company that respects your time and expertise. Or honor your unique qualities and hard earned skills by marketing your art psychotherapy services as a private practice clinician and educate others about your worth.
I know there is a lot in this post and even more that could be said. Share your thoughts and comments below and be sure to sign up for our blog.
Group therapy works! In studies comparing group psychotherapy to individual therapy, group therapy has been shown to be as effective and sometimes even more effective. In cases of medical illness, there is substantial evidence that this form of therapy helps people cope better with their illness, enhances the quality of their lives and, in some cases, such as breast cancer, has even been shown to help people live longer (AGPA).
Group psychotherapy is a special form of therapy in which a small number of people meet under the guidance of a professionally trained therapist to help themselves and one another. Group therapy has been widely used and has been a standard treatment option for over 50 years (AGPA). There are many benefits of group therapy, which cannot be obtained, in individual therapy alone. Using art, a creative process, in the group therapy context, facilitated by a nationally certified professional enhances the group therapy experience (Bloomgarden & Kaplan, 1993; Drapeau & Kronish, 2007).
LIFE IS A CREATIVE PROCESS!
By utilizing materials, that promote a flow of creative energies allows for expression of ideas, emotions, and provides a reflective process ripe for insight and transformation. Previous artistic ability or experience is not needed, only a willingness and an open mind. In group art therapy, facilitated by Michelle L. Dean, MA, ATR-BC, LPC, CGP most groups are either 60 or 90 minutes depending on the group and begin with a brief check-in to ascertain important themes and concerns of the group. From group generated themes, a focus for creative therapeutic work is derived. Group members spend 30 – 50 minutes engaged in creative work (i.e., drawing, painting, mask making, collage, writing) sometimes working quietly or in lively conversation. All materials are provided by Ms. Dean, but on occasion and with advance notice, personal materials are brought to sessions for a particular focus such as work on childhood issues, loss, or identity and body-image concerns. These items may include found objects, copies of personal photographs or magazine pictures for collage. The last third of the group time is left for sharing stories, narratives, and associations to the work as well as group feedback.
There is no right or wrong in group art therapy. Unlike art classes, artistic skill is not our ultimate goal as not everything in life that needs to be expressed is beautiful, but is no less important. One goal is to help group members create grace and beauty from life’s messes.
EVIDENCE ON THE EFFECTIVENESS OF GROUP THERAPY
According to American Group Psychotherapy Association, during the last 30 years, studies have shown the growing benefits of group psychotherapy in a number of areas of life challenges. Through groups, individuals find a forum of peer support, gaining strength as they share their feelings and experiences with others who are facing the same obstacles as themselves. Some gain strength in seeing the resourcefulness of those in the same situation, while others renew their feelings of self-worth through assisting others.
During the group process, people develop a support network through each other — no longer feeling isolated by their condition and gaining a greater sense of normalcy. With certain medical conditions, group psychotherapy can contribute to general improvement in one’s psychosocial functioning. Research also has shown that survival rates have, in some cases, actually increased, with proper therapy. Research has demonstrated that various forms of group psychotherapy, including group art psychotherapy (Bruch, 1973), are equally beneficial with positive results found across the board for a variety of disorders. Group therapy is considered cost-effective when compared to individual treatment. When a therapist’s time is spent with an entire group instead of one person, the expense for individuals is significantly reduced while the benefits remain and, in some instances, even greater. Although there may be individuals for whom group therapy may not be a viable option and as such individual therapy remains the treatment of choice, there are numerous therapeutic factors for participating in a group.
THE THERAPEUTIC FACTORS OF GROUP THERAPY AND APPLICATION TO GROUP ART THERAPY
Yalom described these therapeutic factors (originally coined “curative factors” but renamed therapeutic factors in the 5th edition of his seminal text,The Theory and Practice of Group Psychotherapy). The following list names Yalom’s therapeutic factors followed by a brief explanation of how art therapy may complement and be seen in these therapeutic factors.
Universality – To know that others have similar experiences decrease group member’s sense of isolation, validate their experiences, and raise self-esteem. In group art therapy, feeling awkward about creating art in therapy is almost universal, until you realize everyone shares that feeling and the need to make beautiful pictures fades, and acceptance of who you are and what you create is authentic.
Altruism – When members help each other, they begin to feel a sense of value and purpose. This leads to more adaptive coping styles and improved interpersonal skills. In group art therapy, altruism may be seen in assisting others in their creative process and thus promoting value and a sense of belonging or purpose.
Instillation of hope – Group members can learn from others who have gone through life’s challenges and know that there is hope in recovery and support. In art therapy, hope may given when one group member says, “Don’t worry, when I started I felt I could only draw a stick figure too.” Hope may also be seen in the graphic images created over time. Progress and hope may be demonstrated by viewing artwork created at the beginning of treatment and again later on. Changes that occur in therapy can be slow, like any growth process, psychological growth may not always be visible without a means to mark progress, much like tick marks drawn on a wall marking the inches of a child grown over a lifetime. Over time, development in artwork may be detected in more intense or brighter color usage, just as affect may have brightened. Energy may have increased thus resulting in a more active line quality and larger space usage on the page as well the inclusion objects or supports. These changes and much more may be visible in the art productions as the psychological transformation occurs.
Imparting information – Understanding the stages and struggles of recovery from can reduce anxiety. For example, understanding the discomfort associated with the re-feeding process common in some eating disorders is temporary, helps with the commitment to stick to a meal plan. As well as knowing that body image distortion is one of the last things to change in recovery from an eating disorder helps to understand the patience and self-compassion needed for this healing process. Imparting information in an art therapy group can be as simple as explaining how oil pastels blend. Or using artwork to outline the stages of grieving or to examine a decision by graphically drawing the pros and cons of an issue can yield visual cues such as weight and importance not always conveyed in words alone.
Corrective recapitulation of the primary family experience – Understanding how our past relationships influence our current ones can be liberating. In group therapy, members can learn how to identify these patterns and avoid repeating unhelpful, or even toxic, past interactive patterns in present-day relationships. It is sometimes much easier to observe family patterns and relationships in imagery than through words alone. Proximity, weight, tension and line quality all can convey past and present unhelpful patterns while exploration of fantasy through art can reveal pined for relationships.
Development of socializing techniques – The group provides a safe and supportive environment for members to take risks by expanding their repertoire of interpersonal behavior and improving their social skills. Often, in group art therapy, group members are called upon to create one work of art in which problem-solving and strength building skills are required thus building new patterns and skills.
Imitative behavior – One way in which group members can develop social skills is through modeling in which, group members observe and imitate the therapist and other group members. This happens more often than most would admit. For example, sharing personal feelings, showing concern, and supporting others can all be modeled. Adolescents are notorious for trying on different fads and personae’s as they seek to express parts of themselves that feel like a good fit. In an art psychotherapy group, working with various media can also help expand and amplify one’s ability to effectively understand and express oneself. Imitative behavior is a common aspect of creativity and play.
Cohesiveness – Group cohesiveness is an instinctive need to belong, and personal development can only take place in an interpersonal context. A principle goal of all of the groups offered at The Center for Psyche & the Arts, LLC is to offer cohesive groups in which all members feel a sense of belonging, acceptance, and validation. Connecting to others through similar forms and patterns drawn on a piece of paper can be easier and less stressful than sharing personal aspects of oneself. Through the images, a bridge is created allowing for connection. An example of such is to temporarily subgroup based on line quality such as fuzzy lines, muted colors, or by pictorial elements. When in small groups to discuss the images (before returning to the larger group), personal patterns can be observed and discussed by using the graphic qualities of the images created as they often yield information about personality types, likes and dislikes, and ways of relating to others. Group members are often amazed about how much is revealed in such a safe and enjoyable way.
Existential factors – Typically apply to learning that one has to take responsibility for one’s life and the consequences of one’s decisions. In group art therapy each person makes a difference in our group and this world by sharing a part of themselves. Focus on how our actions and relationships, can positively influence and help others, now and into the future is created in art therapy groups. One never knows how a piece of art may move another group member, creating resonance and meaning that permeates positively beyond the immediate group experience.
Catharsis – Catharsis the experience of relief from emotional distress through the free and uninhibited expression of emotion. Have you every scribbled on a piece of paper hard? It can be both exhausting and enlivening at the same time – this is a cathartic experience. In addition to increasing creating physical energy from making art, when members tell their story to a supportive audience, they can obtain relief from chronic feelings of shame and guilt.
Interpersonal learning – Group members achieve a greater level of self-awareness through the process of interacting with others in the group, who give feedback on the member’s behavior and impact on others. The goal of interpersonal learning is to take these skills and experiences in group therapy back into their lives to enrich their relationships with others in many different contexts such as work, school, and family.
Self-understanding – This factor overlaps with interpersonal learning but refers to the achievement of greater levels of insight into the genesis of one’s problems and the unconscious motivations that underlie one’s behavior. The images created in art therapy mirror internal conflicts and experiences, much in the same way a signature is unique to each person, one’s artwork is unique as well. Each image holds facets of a personal story, ready to be mined through a relative, therapeutic experience. Images created over time, create the complete portrait and evolve as the individual and group evolve.
by Michelle L. Dean, MA, ATR-BC, LPC, CGP HLM (DVATA)
Co-Founder, The Center for Psyche & the Arts, LLC, Board Certified Art Therapist, Licensed Professional Counselor & Certified Group Psychotherapist Honorary Life Member – Delaware Valley Art Therapy Association
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In terms of relationships and the ability to bridge at least two terrains, I personally like Hermes as a possible mascot for art therapy. All humor aside, Hermes was most commonly described as a Greek Olympian god of boundaries and travelers who cross them. He was a translator and messenger from the gods (the spiritual realm) to the humans (an earthly realm). He was a psychopomp, meaning he was a conductor of the soul, on of his responsibilities included bringing newly dead souls (akin to those struck by symbolic illnesses in response to personal conflict or cultural affliction) from the Underworld or Hades (metaphorically – a dark underworld, a shadow world) and was attributed to bringing dreams to the living. Hermes gives us our word hermeneutics, the art of interpreting hidden meaning.
Art therapy is very much about creating meaning, although too often meaning making is confused with interpretation. Art therapy involves both the creative emergence of meaning and the revealing of existing but veiled meanings. At its best, art therapy is a co-created experience, one in which mutual admiration and respect is given to the art making process and to the symbolic material of the individual, family or group. It is a therapeutic experience in which art materials are used to facilitate insight, process and integrate experiences. It need not be a set of coveted techniques although they are spoken of frequently as interventions but instead covers an orientation and attitude towards everything that is creative in life. For it is the nature of imagery and creativity, like Hermes, to transcend boundaries, to dissolve them, recreate, and redefine them. Hence art therapy shares this distinctive quality of defying easy definition.
Many graduate art therapy programs teach from a psychodynamic or depth psychology theoretical orientation. Perhaps this is due to the close affinity to symbols and images, which are found in archetypes, active imagination, dreams, free associations, and artwork. Certainly the function of art transcends current psychological theories, which typically explore one aspect of development or function. It is often the liminal, the changing, the “just forming” terrain of psychic life and this is its virtue. So defining succinctly the profession and modality of art therapy is challenging.
Art therapy is a mental health profession that uses the creative process of art making to improve and enhance the physical, mental and emotional well being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and self-awareness, and achieve insight.
I am often asked how I became an art therapist and my best answer is that it was a marriage of passions: Art and working with others. I came to this realization at a young age. I had always been interested in art, drawing, painting, calligraphy, you name it, I was into it, if it was art. I became a certified Red Cross aquatics instructor in high school as a means to summer income and it eventually helped pay my way though college. I progressed to swim team coach and taught, and trained others to become lifeguards, and certified others in CPR and First Aid, eventually teaching and coaching at city pools year round. In addition to the hundreds of children I taught how to swim, I found myself most drawn to the challenge of helping those who had an intense fear of water (also known as, Aquaphobia). In my experience, I found many adults and children were fearful of the water because they had had a near drowning experience (a trauma) or their parents were especially anxious or frightened around water, sometimes they had had a bad experience or they just never learned to swim. Oftentimes there was intense panic around water. Don’t get me wrong, a healthy respect for water is very important, as it only takes 2 tablespoons of water to drown and statistically, more swimmers than non-swimmers drown each year. These facts aside, the fear and anxiety in these especially anxious parents was oftentimes paralyzing, for them and their children. This intergenerational anxiety was not lost on me and I still appreciate how parents’ fears, anxieties, and oftentimes, their traumas may be passed on to their children. I found this especially true when working at a rape crisis agency, where many of my clients were under the age of 12 and many more of them had had parents with significant trauma in their histories.
Michelle L. Dean, MA, ATR-BC, LPC, CGP
After four years, I earned a BFA in Illustration with an undergraduate certification in Art Therapy from The University of the Arts. After my senior year of college, I was hired as an activities therapist on the acute psychiatric unit, where I had completed my undergraduate practicum requirements. I continued to work for a year before returning to graduate school to study art therapy at Hahnemann University (now a part of Drexel University). For me, working through graduate school was both necessary and an honor, although it is not always possible or desired by some. I have been working in the field since 1992 and earned my master’s degree in 1996. During this time, I have met many wonderful people, both as clients and other fellow clinicians.
In general, art therapists are a passionate, inspired, and creative group of professionals. Many have come to this rewarding field from more traditional paths of art or psychology. Art therapy: a marriage of passions, as it were for many, myself included . Just as there are numerous avenues to enter into this work, there are many diverse schools of thought and theoretical orientations from which to practice as well as a myriad of settings in which to work. When asked for advice as to how to pursue a career in art therapy, I would suggest starting with an accredited school that fits you: your vision and passions.
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The quote “Hardening of the categories leads to art disease” is attributed to Kenneth Snelson, and his defiance to define his work as science or art. He described his work, a cross between aesthetic vision and the scientific inspiration behind the engineering of his sculptures, which defy the neat categorization of art or science. Art therapists too grapple with the continuum of the artistic and scientific but it is evident that hardening of any category related to a creative function can lead to a malady and stagnation.
Art, psychology and religion share a fluid symbolic nature. Thus it is the symbol, which is the lens that we may see the world. It both consolidates and expands. And all symbols are relational, meaning when taken out of context they often lose their significance. Although some have their misconceptions about art and psychology, or should I say stigmas about either as a profession, they are often equally dumbfounded at the mention of combining the two into the profession of art therapy. Most of this is due to unfamiliarity with the concepts. So for clarity sake, let’s start with some of the basics. The etymology of the word art comes from the Latin ars, which is defined as a “skill as a result of learning or practice” or “to fit together or join” And psychology is a derivative from the Greek word: psych, “soul”; and, logos, “word” or “speech” or the manifestation of the soul. Thus the word psychology implies “the speech or manifestation of the soul”. The speech here is not defined to only words but to other manifestations of expression as found in images and symbols. Historically, psychology has had more to do with spirit than the mind, as a more operational definition may apply. So the discipline of art psychotherapy may be loosely defined as the learning or practice of the ability to fit together or join expressively, coupled with the ability to give speech or expression of the soul in a symbolic artistic means. So if the work of art therapists are more akin to spiritual guides, it would make sense that we too must possess some flexibility and creativity to see things anew as well as in relation.