What Happens in an Art Therapy Session: Materials, Silence and the Image

An art therapy session is an hour in a consistent room with a consistent set of materials, in which nobody teaches you technique and nobody tells you what your picture means, and the therapist’s attention is on what happened while you were making it rather than on the thing you made. Most of what people imagine about it is drawn from film and from the phrase itself, and both mislead in the same direction: they suggest a session organised around producing and then decoding an image, when it is organised around a relationship in which making is one of the things available.

I have to be clear about something before going further, because it changes how this page should be read. I have never sat in an art therapy session, as a client or as an observer, and I am not going to write as though I have. I am a community arts practitioner. I run singing and songwriting in two care homes and on a stroke rehabilitation unit, I have never trained as a therapist, and I have never been a patient of one. What stands in place of first hand experience here is the profession’s own published standards, the practice guidance of its UK professional body¹, and Dr Rhian Vaughan, the registered arts therapist who reviews this page and who has the authority over every description of practice on it that I do not. That is worth more than a convincing paragraph I made up, and if a page like this ever reads as though I were in the room, something has gone wrong with it.

There is one adjacent thing I can speak to honestly, and it turns out to be the most useful way I know of describing what the clinical version adds. In one of the homes where I sing, there is an art table on a Wednesday. It is a good table. There is a coordinator who knows who likes company and who wants the far end to herself, there are decent acrylics rather than the dried out ones, and there is a man who paints the same view of a bridge most weeks and has done for two years. What I notice about that table is not what is on it but what is absent from it. Nobody was assessed before they sat down. Nothing is written about any individual afterwards, so nothing carries from one Wednesday to the next except the coordinator’s memory and mine. Nobody in the building has clinical supervision for what happens there. There is no ending; it runs while the activities budget runs. And there is nobody whose job it is to attend to what the making did to the man painting the bridge, as opposed to what the painting looks like. Every one of those absences is a thing the clinical version supplies, and listing them is a better description of art therapy than any adjective I could reach for.

No effect size appears on this page, because it is a description of a practice rather than a claim about outcomes. Where this site does make claims about effect it grades them: Tier 1 supported, Tier 2 promising but limited, Tier 3 either not properly studied or studied and null, with the article saying which. The reasoning is on reading arts in health research, and the evidence for specific conditions sits on the condition pages, including art therapy for psychosis.

Before the first session: referral, assessment and the working agreement

Nothing that happens in the first hour is the beginning. The work starts with a referral, an assessment over one or two meetings, and an agreement about how the two of you are going to proceed.

Referrals into art therapy in the UK come from a community mental health team, a child and adolescent service, a learning disability team, a hospice, a school’s special educational needs coordinator, a prison healthcare team, or occasionally a GP where a local service accepts that route. Some services take self referrals and most do not. What the referral does is get you an assessment, not a course of therapy, and the assessment is a genuine decision point in both directions: the therapist is working out whether this is the right intervention now, and you are working out whether you want it.

The assessment is usually one or two sessions. Materials are normally present, and you may or may not use them. Expect questions about what has brought you, what has been tried, what you want to be different, and what happens to you when things get difficult. Expect also to be asked practical things that matter more than they sound: whether you can reliably get to the same place at the same time every week, who else is involved in your care, and whether anybody else knows you are coming.

The working agreement that follows is the part I would pay most attention to, because it is where the ordinary conditions of the work are made explicit. It covers the day and time, the length of the session, how many sessions are envisaged and when that will be reviewed, what happens if you miss one, whether the therapist can be contacted between sessions, and confidentiality. Confidentiality in a health service is never absolute and a good therapist will say so plainly at this point rather than later. What is said and made in the room is held privately, and the exceptions are the usual ones: a risk of serious harm to you or somebody else, and the fact that the therapist works within a team and keeps records that the team’s governance can reach. Ask what goes into those records, and ask specifically about the images, because the answer is not obvious and it is easier to ask now.

The room and the materials, and why the range matters

The room is deliberately the same one every week, and the materials are laid out across a deliberate range, from something very controllable to something you cannot control at all.

A typical spread runs something like this: pencils and fineliners, charcoal, pastels, poster and acrylic paint, big brushes and small ones, paper in several sizes, glue and magazines and scissors for collage, and clay. That range is not a matter of generosity or budget. A sharp pencil on small paper is a material for somebody who needs the outcome to stay under control, and it will do what it is told. Wet clay is the opposite: it collapses, it is cold and unpleasant before it becomes pleasant, it responds to force, and it cannot be made tidy quickly. Charcoal smudges the moment you touch it. Paint runs and mixes into brown if you keep going. What a person reaches for, what they refuse, and what happens when a material stops cooperating are all part of what the therapist is working with.

Nothing is set up to produce a good result, and this is the deliberate part that most confuses people arriving from a class. There is no still life arranged on a table, no demonstration, no reference photograph, no suggested subject unless a therapist offers one for a reason. The absence of a task is not a lack of structure; it is the structure. It makes the choice of what to do the person’s own, which is the thing that then has something to say.

Setting shapes the range. On an inpatient ward, some materials are unavailable for safety reasons and scissors are not on the table. In a prison the constraints are tighter again. In a hospice the practical limits are energy and time rather than security. Arts in mental health inpatient units covers how the ward context changes the offer.

The first ten minutes, and permission to make nothing at all

The first ten minutes are usually the hardest part of the whole hour, and the most common thing to happen in them is that nothing happens.

You come in, you sit down, the therapist says very little, and there is no instruction. Most people find this uncomfortable. The urge to be a good participant is strong, and a great many people reach for a material immediately in order to have something to be doing. That is fine, and so is not doing it. Making nothing at all for an entire session is a legitimate use of it. Talking for the whole hour and never touching the materials is a legitimate use of it. So is doing something small, dull and repetitive with a lump of clay while talking about something else entirely.

Nobody is going to fill the gap to rescue you, and it helps to know that in advance rather than reading the pause as disapproval. The room being unhurried is doing work. A therapist who chatted through the opening minutes to make everybody comfortable would be removing the thing that makes the following fifty minutes possible.

What the therapist is doing, what they are not, and why silence is part of it

The therapist is not teaching and not decoding. The attention is on what happened during the making, and on what the two of you do with it in the room now.

Take the negatives first, because they are the misconceptions. They are not teaching technique: there is no advice about perspective, no correcting of proportion, no suggestion that the composition might work better shifted left. They are not judging the work, displaying it or valuing it as art. And they are not interpreting the image back at you like a dream dictionary. The idea that a therapist reads a picture the way a fortune teller reads a palm, with fixed meanings for colours and sizes and positions, is the most persistent thing people believe about the profession and it is not the method. A therapist may notice something aloud, may say what an image evoked in them, may wonder about something, and all of that is offered tentatively and can be rejected. The meaning of the image belongs to the person who made it.

What they are doing is harder to describe because it is less dramatic. They are watching the process: what got chosen, how quickly, what got abandoned, what got covered over, whether the making became frantic or stalled, whether you looked at them while you worked, what you did when a material misbehaved. They are holding the frame: the time, the boundaries, the consistency of the room. They are tracking the relationship between the two of you across weeks, which is the actual medium of psychotherapy and the reason continuity matters. And afterwards they are writing notes, taking the work to clinical supervision, and often discussing it in a team meeting, which is the unglamorous half of the job and the half that distinguishes it from an activity.

Silence is a bigger component than almost anybody expects, and people find it harder than the making. In ordinary life a silence between two people is a problem to be solved within a few seconds. Here it is not, and nobody is going to solve it for you. It is worth going in knowing that a long quiet stretch is normal, is not a sign that the session is failing, and is not the therapist waiting for you to produce something. The parallel with the other modalities is close: what happens in a music therapy session describes the same discipline with sound instead of paper, and dramatherapy does it with role and story.

Individual work and group work

Individual sessions and group sessions are different interventions, not different sizes of the same one, and which you are offered has more to do with what a service commissions than with what suits you best.

Individual work is one person and one therapist in a consistent room, weekly, usually for about an hour, over months. It is the format most of the description above assumes. The relationship is the working material, the pace is set by the person, and the confidentiality is comparatively simple.

Group art therapy is a smaller, quieter thing than the phrase suggests, and it is delivered by the same registered practitioners described on art therapy. To give a concrete published example rather than an impression: the group art therapy delivered in the MATISSE trial ran weekly for 12 months, in groups of up to eight people, 90 minutes at a time, delivered by registered art therapists to nationally agreed standards². That is a useful anchor for what a properly resourced group looks like, and the trial’s results are a separate matter set out on art therapy for psychosis. In a group, people make alongside each other, may or may not talk about what they have made, and much of the work is in what happens between members. Confidentiality now involves everybody in the room and is agreed collectively, which is a meaningfully weaker guarantee than in individual work and should be described as such at the start.

For children, the format shifts again: sessions are often shorter, play and mess have a larger part, and the people with parental responsibility are involved in a way that changes what confidentiality can mean. Art therapy for children deals with that properly.

What happens to the image

The images are normally part of the clinical record rather than possessions, and they stay with the service. This is the single question most worth asking at the first session and the one people ask last.

The logic is straightforward once stated. If the making is part of the therapy, the things made are part of the record of the therapy, in the same way that what you said is. So in most UK services the work is stored by the service, securely, in a locked space or a designated folder, and it is not routinely taken home at the end of each week. It is not displayed. It is not shared with family. It is not put in a newsletter, and it should never appear in a funding report or on a website.

What gets written about it in the notes is usually a description rather than a reading: what was made, with what, how the session went, what was said, and how the work relates to the goals agreed at the start. Who can see it is whoever can see the clinical record, which in practice means the therapist, their supervisor in the course of supervision, and members of the treating team with a legitimate reason, plus anybody exercising a lawful right of access, which includes you.

At the end of the work, practice varies and there is no single answer, which is exactly why it needs asking. Some services return the work at the final session, often as part of a review of the whole course, and looking back through months of images together is itself a piece of the ending. Some retain it for the period their records policy specifies. Some photograph the work for the record and hand over the originals. Some will not release it, for reasons that may include the wellbeing of the person or the presence of other people’s material in a group.

So, the questions worth asking at session one, in plain words: where will my work be kept, who is allowed to look at it, what will be written about it, will any of it be seen by anybody outside this room, what happens to it when we finish, and can I have it. None of those is a difficult or an impertinent question and a good practitioner will have ready answers to all six. Where the person making the images is a child, or an adult who cannot give informed consent, the questions become considerably harder and a relative usually cannot answer them on somebody else’s behalf, which is set out on consent and safeguarding in arts in health.

Endings, and why they are planned

The ending is part of the therapy rather than the point at which it stops, and it is worked towards rather than announced.

In practice that means the ending is visible from some way off: named at the outset if the number of sessions is fixed, brought into the room at a review point, and then talked about in the final weeks. There is often a looking back over the work made, which is a use of the images that only exists because they were kept. There may be a conversation about what happens next, what to do if things deteriorate, and how a further referral would work.

This matters more than it sounds. For many people the therapeutic relationship is one of the few reliable ones they have, and a course that simply evaporated when funding ran out would repeat something they already know too well. It is also a real difference from a community group, which is open ended and which people join and leave as they like, and where the ending, when it comes, is usually a budget rather than a plan. Art therapy against an art class works through that distinction and the five others that go with it.

How the session changes by setting

The method travels. The conditions do not, and the differences are practical rather than philosophical.

On an inpatient mental health ward, sessions may be shorter and are more likely to be interrupted. The person may not have chosen to be there at all, which changes the meaning of agreeing to attend. Observation levels, ward rounds and leave arrangements shape the hour, and some materials are unavailable. In a school, the room is frequently borrowed, the young person has to go back to a lesson immediately afterwards, and information sharing with teachers and parents has to be negotiated in advance rather than improvised. In a prison, security governs the materials, the movement of people and what may leave the room, and confidentiality operates within an institution designed around the opposite principle. In a hospice, the course may be brief, sessions may happen at a bedside rather than in a studio, energy is the limiting factor, and the ending may not be a planned discharge.

In every one of those settings, consent is a live constraint rather than a form. Somebody who lacks capacity cannot consent to being described, photographed or recorded, and a relative usually cannot consent on their behalf for anything that leaves the building.

What it costs and how people get it

Most people who receive art therapy in the UK do not pay for it directly, because it arrives through a service. Where it does not, the honest position is that this site cannot tell you the price.

No fee figure is attributed to the British Association of Art Therapists anywhere on this site, and the reason is specific: BAAT publishes its fee guidance to members only¹. There is therefore no public number from the profession’s own UK body, and any BAAT attributed fee you meet has been picked up somewhere else and given that attribution along the way. Practitioners in private practice set their own rates and will quote them if you ask, and that is the only source worth using.

Where the work comes through the NHS, a school, a hospice, a prison, a local authority or a charity, it is free to the person receiving it. The constraint is whether a post exists. In July 2026 the Health and Care Professions Council register listed 6,103 arts therapists across all four protected titles, art therapist, art psychotherapist, dramatherapist and music therapist³, for populations in the tens of millions, so waiting times and simple absence of provision are far more often the obstacle than money is. If you are considering the profession from the other side, training as an art therapist sets out what the route requires and what it does not.

If you are offered art therapy and want to prepare for it, there is almost nothing useful to do beforehand, which is itself worth saying. You do not need to practise, buy materials, think of a subject, or work out what you want to make. The one preparation worth making is a list of the questions above about the images, and a decision to ask them in the first session rather than the last. Nothing described on this page substitutes for treatment, and art therapy sits alongside the rest of somebody’s care rather than instead of any part of it.