Coloring Books in Therapy
A few years back the field of art therapy was getting some mainstream attention because of how coloring books were being marketed to consumers. The way it was and still is (see here) being marketed is problematic. This type of product and its marketing created a wave of ethical and philosophical responses from the mental health community, especially art therapists (see some good reads about it: here, here, here and here). As someone who identifies as an art therapist, I used to find it offensive when people would acknowledge my field (art therapy) by referencing coloring books. As if the whole history of art therapy, the variety of applications, the years I spent studying in my specific art therapy graduate program could be summed up in a leisure activity.
This marketing and subsequent attention on art therapy as a product like coloring books also probably touched a nerve because the field of expressive therapies is often looked down upon in scientific communities and lacks longitudinal and empirical studies to be called “evidence based practice”. (Side note about this: as a result of the absence of scientific studies of art therapy outcomes/efficacies, insurance companies are often no longer covering this kind of treatment, so many intensive treatment programs are reducing or eliminating art therapy offerings to patients. More on that another time!)
Fast forward years later, I feel differently about the use of coloring books in therapy. As you can see in my website shop, I’m actually spending time designing and selling coloring book pages for people (therapists, providers and clients) to use as part of Exposure & Response Prevention treatment for OCD. Below are some thoughts about what’s problematic, what’s helpful to know, and how coloring books could be used ethically within and outside of therapeutic settings.
First, let’s be clear about two things: calling yourself an ‘art therapist’ and practicing ‘art therapy’. To call yourself an ART THERAPIST requires specific education requirements, there is a licensing process for this credential (which is lengthy, expensive and deserves much respect), there is an Association for this field, and clear ethical principles followed. To use ART THERAPY as a mental health provider simply implies using art as a therapeutic tool or intervention (similar to any other framework or therapy intervention: ACT, CBT, DBT, EFT, etc.). This means any therapist interested in using art with clients can say they are doing “art therapy”. Art isn’t owned by anyone and it’s OK for creative people to use art in session without being an art therapist, but therapists should be as thoughtful about this as they would be with any other intervention. To me, what’s special about being an art therapist is the ability to think more creatively about therapy applications, the deep insight into materials/use, awareness of what may be evoked through media, and the knowledge on how to intentionally facilitate the use art for therapeutic gain.
What’s Problematic About Calling Coloring Books “Art Therapy”:
It is not accurate or ethical to generalize or label a whole therapeutic field based on a single art-making practice, especially if that practice does not require a therapist presence. Without a therapist presence, it is not ‘therapy’ and could do harm to imply it is.
What happens if someone is using a coloring book titled “Art Therapy” and while using the product they have a traumatic memory resurface or become dysregulated using the coloring material? This could harm someone, to be unsupported in that moment. A coloring book does not replace a therapist.
If someone is easily dysregulated and using a difficult to control medium, this would likely add to their distress. An art therapist would know this information. Art therapists are often artists themselves and are aware of what materials could be used as agents of grounding. There is often much more occurring in therapy than people realize. There’s movement, frustration tolerance, building mastery, and much more happening that an art therapist is skilled in tracking, observing and supporting.
What’s Helpful About Coloring Books Being Used In Therapy Or For Therapeutic Use:
In the first few therapy sessions, the therapist and client co-create a therapy plan, which consists of a goal for therapy and objectives on how to meet that goal. There could be ethical use of coloring books to meet client objectives and goals, but this requires therapeutic intention and facilitation.
Many art therapists have had the experience of clients being nervous to engage with art because of being inexperienced or not skilled naturally. Some art therapists view art therapy as process based, where the product is less important than what is occurring during the making or through the making. Some art therapists view the product as just as important and will support the making with a desired outcome in mind.
Coloring books can be an accessible way to enter into art making with little room for self-criticism. While painting on a canvas is intimidating, picking up a colored pencil to fill in a shape feels more gentle. While making art about your life challenges may seem really abstract and fear-inducing, filling a page with color is not so abstract. Coloring books in session could be used as a supplementary tool to keeping clients emotionally present during difficult moments in session.
I often use coloring book pages as a form of alternate rebellion (DBT skill) and as a behavioral activation for depressed clients (CBT). Coloring books can be a coping skill, too. There is some wonderful evidence (also see: here and here) that coloring can be a mindfulness practice and tool for building emotion regulation skills.
As a therapist who specializes now in anxiety and OCD, I am finding that coloring books can be an effective tool within exposure work. ERP is a form of CBT used to treat GAD, OCD and Specific Phobias. In this treatment there are 3 kinds of exposures (imaginal, in-vivo and interoceptive) and clients work with a skilled clinician to co-create a hierarchy of fear-inducing activities meant to increase the person’s tolerance of distress, while reducing compulsions (response prevention). Coloring books with specific content can be used as a form of imaginal exposure for someone to interact with content that provokes some mild anxiety with the intention of habituation. Many people come to ERP really fearful of having to do stuff outside their comfort zone and have very little distress tolerance. The way I’m designing coloring book pages for folks living with and treating OCD are about leaning into fears, tolerating uncertainty and interacting with imagery with the intention of increasing tolerance. For someone with Harm OCD, seeing an actual knife in front of them may be too intense, but seeing a drawing of one might be tolerable. A therapist using coloring book pages in the treatment of GAD, OCD and Specific Phobias could be an accessible way for someone to start treatment. (If interested in this therapy please do: check out the International OCD Foundation page for more information on effective therapies and use their directory to find therapists in your area!)
In my perspective, what makes coloring books a legitimate form of art-based therapy depends on: therapy goals and objectives, intention of use and facilitation. While coloring books do not accurately represent the entire field of art therapy, I do think there is much value in coloring books used in therapy or with therapeutic intention.
