Sibel Ozer’s smile is warm and genuine, conveying a calm, collected kindness that belies some of the darker experiences she’s had over the course of her 15-year-long journey with art therapy.

At a hefty 7.4 on the Richter scale, Turkey’s 1999 Izmit earthquake claimed thousands of lives and left even more injured, along with destroying several hundred thousand properties and buildings. Ozer, who had worked as a clinical psychologist in Izmit prior to the quake, had her first experience with art therapy when a group of Israeli volunteers, one of whom was an art therapist, came to help train local therapists in trauma intervention methods.

“We don’t have master’s programs (for art therapy) in Turkey, so the work she did with us was definitely very intriguing,” Ozer, a board-certified art therapist and a licensed, certified professional counselor, said. “She worked to support us as we went into the field, so that we weren’t traumatized ourselves, but also showing some of the work the children would do, how to look at the art, how not to interpret.”

In 2000, Ozer and her family moved from Istanbul to the United States, but it wasn’t until several years afterward that she decided to go back to school to pursue art therapy instead of repeating clinical psychology schooling. Art therapy is much more prevalent in the United States than it is in most countries. It calls the American Art Therapy Association and several major art therapy journals home, but it’s also a licensed and regulated profession in the United States, with master’s programs available and specific steps that must be undertaken in order to become credentialed and board certified.

The process is not one to be taken lightly. Apart from receiving a master's degree and partaking in supervised internships, students are required to complete at least “1,000 hours of direct client contact” to even apply for certification. The AATA site has a page specifically dedicated to helping people determine whether someone is a qualified art therapist.

Ozer though has experienced art therapy beyond her role as a therapist. In October, she was diagnosed with Stage 1 breast cancer, which set about a rapid progression of appointments, and, eventually, surgery. Throughout the process, she relied on art therapy as both a source of insight and self-care. Today, she is cancer-free.

“One of the things when you become a patient is that suddenly you’re diagnosed and you have no choice in what has to unfold — I think the definition of a patient is that things are done to you — and so being able to exercise choice and agency and bringing myself into a position of doing was really helpful in undoing some of the effects of that choicelessness,” Ozer said.

Ozer doesn’t necessarily consider herself an artist, even though art is so central to what she does. In the field, art therapists tend to come from one of two paths: an art background or a psychology background. The difference may be hard to distinguish at first, but makes sense once it’s more closely observed. Art, in itself, has its own structured techniques, rich history and movements, and the approach of an artist is likely to be drastically different compared to that of a psychologist.

“I’m always more looking from the lens of a psychotherapist; it was after I’d gotten my degree that I really started to develop my artist self" Ozer said. "And to this day I really don’t consider myself an artist but more an art therapist."

Linda Adamcz, a Kalamazoo-based counselor and mental-health therapist who uses music and art therapy in in her practice, also emphasizes the distinction between structured art and art therapy, though she is not a licensed art therapist. For many, it can be difficult to fully embrace free flow painting and let go of the idea that art has to be perfect or have a specific technique.

“Sometimes people have a hard time not letting themselves have an agenda or plan and be open to receiving intuition and trusting themselves,” Adamcz said.

During her 14 years of experience working in a traditional mental-health setting, Adamcz saw patients experiencing blocks while talking about issues. She was first introduced to working with art through integrative breathwork training, which involved utilizing breathing techniques and music, then creating art afterward. Adamcz has a master’s of social work, is a certified practitioner of Integrative Breathwork and Psychospiritual Integration, and has been working in the mental-health field for more than 28 years.

Unlike other forms of cognition-based therapy, art therapy utilizes the emotional, creative right hemisphere of the brain instead of the analytical left.

“Sometimes, when emotions are stuck deep inside the body, both music and art are helpful,” Adamcz said. “With children, for example, who can’t necessarily verbalize trauma, nonverbal types of therapy are a good way to express that.”

Adamcz looks to art for deeper personal spiritual fulfillment and guidance, but emphasizes that while art therapy can indeed be very powerful, it should be considered an alternative to more mainstream forms of therapy, not necessarily a replacement, especially if someone is completely closed to the merits of art therapy.

“If you’ve got the mindset that there’s no value in it — you need to have at least a little bit of openness to it,” Adamcz said. “I’d suggest they give it a try and see what it’s like.”

Ozer agreed, citing the complexities that make up the human consciousness.

“We’re highly mental beings, but we’re simultaneously deeply emotional, completely illogical and spiritual beings as well,” Ozer said. “And sometimes those deeper parts of ourselves really know what we need more than we are able to figure it out with our minds — art sort of bypasses all the noise and goes right to where some of the wisdom is.”

There’s no limit to who can use art therapy; basically, anyone who wants to engage with it can. It can be used for a variety of demographics and settings, from a traditional client and therapist setting to more trauma-based therapy, like with those affected by the Izmit earthquake.

“Any population that you can think of that needs help, it can bring things that the verbal modality just doesn’t have,” Ozer said. “So, I would think of it as a wonderful, necessary adjunct, additional, not something to replace … it’s a wonderful, additional, enriching addition to the general field of psychotherapy.”

When Ozer talks about art therapy, she breaks it down into three main parts: the materials, the process itself and the product. Materials can include pencils and finger paints, one offering a lot of control and the other offering much less control; the abundance of different material qualities available allow an entire, multifaceted spectrum of expression. Ozer believes that the specific materials a person chooses in art therapy are an important window into their deeper thoughts, pointing to the concept of isomorphism.

“So what isomorphism means is that what ends up happening with your hands here in the art, very often, but not always — sometimes the cigar is just a cigar, not a symbol," Ozer said. "It’s connected to what’s going on inside of us both internally and psychically; when you have an abundance of materials and you let the person choose, there’s information there with regards to what might be going on."

Sometimes, isomorphic patterns are easier to recognize after the artistic moment has passed. Back when Ozer was completing her internship at a hospice center in Denver, she took up wood burning. Before, her primary medium was painting, and it wasn’t until looking back that she realized the connection between the material and her surroundings at the time.

“It occurred to me that it captured the experience of death so much better than painting because in painting there’s this possibility to do, undo, change and shift, bringing things back, whereas once you burn into the wood, that dent — you will not be able to get that wood back," Ozer said. "That wood is gone for good and the mark is permanent."

Art therapy highlights sublimation, which is the conversion of unacceptable emotions or ideas into constructive, more socially acceptable forms. Instead of acting upon angry or even destructive thoughts, art therapy provides an outlet for a person to undergo a full, transformative response to a problem; after creating, the pent-up feelings usually disappear.

Art therapists might differ on how they approach a finished product, depending on what school of thought they come from. A classically Freudian therapist might tend toward a more intellectual interpretation according to their knowledge of symbology, while a more Gestalt-oriented therapist might work more collaboratively with a client to uncover information.

“The way I was educated, I’d never interpret based on what I think I know, because that’s bound to include more of my projections," Ozer said. "So I would go about interpreting through a lot of asking of questions, getting ultimately to where we’re going through what you see, what you feel, what your association are,” Ozer said.

Differences arise because of culture, too. The United States’ heavily individualistic society tends to result in a much more client centered approach, but in a more authoritarian culture, an art therapist might be more directive in how they offer knowledge.

“What I’m saying is just a general statement,” Ozer said. “Given a situation with the right person, I might choose to be directive because that might be what that situation demands. It’s very flexible.”

Today, the biggest obstacle to art therapy’s proliferation is not the negative stigma around the profession, but rather its lack of widespread exposure. For the most part, people don’t know what it is or what it does.

“If there’s only one position for somebody in the helping field, it’s going to start with a social worker,” Ozer said. “To be hired purely with an art therapy degree continues to be a challenge around the U.S.

And the difficulties also apply to other non-traditional forms of therapy, like drama therapy, which aims to accomplish the same goals as art therapy, but utilizing a different medium. According to the North American Drama Therapy Association, drama therapy “is the intentional use of drama and/or theater processes to achieve therapeutic goals.”

Like art therapy, drama therapy isn’t necessarily about creating a flawless product to be consumed by an audience. These “drama and theater processes” take the form of “storytelling, projective play, purposeful improvisation, and performance,” which help participants “rehearse desired behaviors, practice being in relationship, expand and find flexibility between life roles, and perform the change they wish to be and see in the world.”

For Kristi Davis, a registered drama therapist, one of the hardest parts of practicing drama therapy is convincing people that they don’t actually have to be partaking in a stage performance in order to participate.

“You’re not trying to be an actor, you’re just being real,” Davis said. “You’re not trying to act like you’re auditioning. It sounds scary, I think, to a lot of people. Art sounds easier, music sounds easier, but drama therapy sounds scarier.”

Drama therapy differs from art therapy in that it is an embodiment technique; clients will use their entire bodies as a part of the process. With talk therapy alone, defense mechanisms might unconsciously prevent someone from reaching repressed emotions, but through drama therapy, new information can rise to the surface, bypassing blocks that may have been in place for years or even a lifetime.

“That’s like when people see things in their art that come out that were unconscious — same with the drama, the unconscious things that were suppressed come out and it’s just really amazing to see,” Davis said.

Drama therapy relies heavily on imagination and the connection between thoughts and physical symptoms. For example, someone in a profoundly stressful situation might have trouble sleeping or could suffer from headaches.

“With anxiety and worry, you’re thinking about something bad that could happen, but your body is experiencing it as if it were real,” Davis said.

The distinction from traditional forms of therapy is that drama therapy can use this connection to help people change for the better. Sometimes, physically acting out a positive outcome can be more permanent and powerful than simply imagining it.

“You could imagine good things happening, how you want things to be and start acting that way,” Davis said. “(Drama therapy) gives you a viscerally real experience; it’s super healing and helpful, almost like you’re developing new neural networks in the act of pretending and imagining.”

This technique is especially useful for interactions that might no longer be possible. For example, if a client recently had a loved one pass away, but they still had unresolved issues with the deceased, a drama therapist might roleplay the situation by reversing positions back and forth until the patient feels at peace. In addition, role reversal can help with conflict resolution, or to help someone practice their verbal skills during a difficult situation.

“Role reversal is a favorite technique, because it’s really like you’re stepping into someone else’s shoes,” Davis said. “When you become them and say what you think they would say, and you start to feel their perspective, it’s easier to understand and accept.”

Such understanding is more important than ever in the midst of the current polarizing political climate.

“It’s a great way to facilitate understanding and know how to have a positive, helpful discussion with them,” Davis said. “It helps a lot with forgiveness too, especially now, with political forgiveness.

Drama therapy can also be used artistically, in the form of transformational theater. If a client chooses to, they can work with a drama therapist, take an issue they’ve struggled with and create an actual theater piece out of the issue. During the creation of the piece, the client would have some sort of transformation take place and theatrically show how the change develops. The finished production might have the creator as the only performer, or it might star a complete cast, and depending on the producer’s wishes, it might only be performed for a private audience or a larger group of public viewers.

“That becomes a real artistic endeavor,” Davis said. “You’re doing it for yourself first, to heal whatever your issue is, but then you’re taking it to the next step, and then you’re giving it away so that it also benefits other people, because a lot of people are helped by seeing someone else transform something they’re struggling with.”

An important aspect of drama therapy is that it’s usually done in groups, which can create a fun and exciting atmosphere (something that usually isn’t associated with therapy) and facilitate group bonding.

“There’s tremendous power in the group working together to help each other — a lot of people would recognize that if the had been in a musical, you end up developing a bond with your fellow actors,” Davis said.

In the end, it’s the unconventional nature of drama therapy that makes it stand out.

“Being able to use your body and sound that isn’t language, per se, gives you another way to express what you’re feeling, just like art and artwork,” Davis said. “Therapy can be scary, and if you can approach it in a different way using the arts, it gives you more tools.”

Non-traditional forms of therapy are still a largely untapped source of healing. It is only with increased public awareness, education and time that artistic therapies can reach broader populations, and perhaps even help people all over the world.

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