Art Therapy: Journal of the American Art Therapy Association, 21(3) pp. 125-135 © AATA, Inc.

2004

A rticles
Art Therapy and the Brain: An Attempt to Understand the
Underlying Processes of Art Expression in Therapy

Vija B. Lusebrink, Palo Alto, CA

Abstract activation of the corresponding neurophysiological pro-

cesses and brain structures. The process of art expression is
The application of new techniques in brain imaging has considered an important part of art therapy and art thera-
expanded the understanding of the different functions and py research (Kaplan 1998; Malchiodi, 1998; McNiff,
structures of the brain involved in information processing. This 1998). Several art therapists (Kaplan, 2000; Malchiodi,
paper presents the main areas and functions activated in emo- 2003; Menzen, 2001) have pointed out the need for art
tional states, the formation of memories, and the processing of therapists to become familiar with the basic brain struc-
motor, visual, and somatosensory information. The relationship tures and functions that support art therapy expressions
between the processes of art expressions and brain functions is and interventions. According to Malchiodi (2003), art
approached from the viewpoint of the different levels of the therapy is a mind-body interaction; her brief overview of
Expressive Therapies Continuum (Lusebrink, 1990, 1991) research involving brain functions in areas related to art
with examples from art therapy interventions. The basic level therapy covered formation of imagery, physiology of emo-
of interventions with art media is through sensory stimulation. tion, attachment theory, and placebo effect.
Visual feature recognition and spatial placement are processed The advent of neuroimaging methods, such as func-
by the ventral and dorsal branches of the visual information tional Positron Emission Tomography (fPET) and func-
processing system. Mood-state drawings echo the differences in tional Magnetic Resonance Imaging (fMRI), has expanded
the activation of different brain areas in emotional states. The understanding of the different structures and functions of
cognitive and symbolic aspects of memories can be explored the brain involved in information processing (Carlson,
through the activation of their sensory components. 2001; Fuster, 2003; Gazzaniga, Ivry, & Mangun, 2002;
Hughdahl & Davidson, 2003). These studies can provide a
Artists are in some sense neurologists, studying the brain
with techniques that are unique to them, but studying
starting point for making general assumptions about the
unknowingly the brain and its organization nevertheless. connections between the visual expressions in art and art
(Zeki, 1999, p. 10) therapy and the brain structures and functions involved in
these processes. Neurobiologist Zeki (1999), in his explo-
rations of art and the brain, stated, “The brain…is…an
Introduction active participant in generating the visual image, according
to its own rules and programs” (p. 68).
The process of expression through art media and the Art therapy involves visual expression on different lev-
products created in an art therapy session engage and are els of complexity. A human being functions as a whole
perceived predominantly through the tactile-haptic and organism, and at any given time, many brain processes and
visual sensory and perceptual channels, and then are areas are active and involved. The interaction with art media
processed for their affect, associations, and meaning in art therapy can proceed from the peripheral stimulation
through cognitive and verbal channels. These activities of the different sensory modalities or from spontaneous
involve different motor, somatosensory, visual, emotional, expression of emotions, or both. An expression through art
and cognitive aspects of information processing with the media can also originate from complex cognitive activity
involving decisions and internal imagery, thus activating the
Editor’s note: Vija B. Lusebrink, PhD, ATR-BC, HLM, sensory channels and motor activity (Lusebrink, 1990).
Professor Emerita, was for many years an art therapy educator
The first part of this paper presents predominant areas
and is the author of the text Imagery and Visual Expression in
Therapy. Correspondence concerning this article may be sent to and functions of the brain involved in visual and somato-
Dr. Lusebrink via e-mail at vblusebrink@earthlink.net. The auth- sensory information processing, emotional states, and the
or wishes to thank Ingrid Lusebrink for creating computer images formation of memories. The motor component is consid-
for Figures 2 and 3. ered in regard to working with tactile media, use of art
125
126 ART THERAPY AND THE BRAIN

implements, and kinesthetic imagery. This part of the paper

also covers a brief review of the structure and functions of
the neocortex, the limbic system, and the basal ganglia
involved in the different aspects of information processing
of interest to art therapists. Examples of fMRI research
reflect the internal processes of dealing with imagery. The
second part of the paper elaborates on the processes of
expression on the different levels of information processing
in art therapy, followed by two illustrative case examples.

The Main Areas of the Brain Involved in

Art Therapy
The main functions of the left and right hemispheres
are commonly known by art therapists: The left hemisphere
is involved in analytical and sequential processes whereas
Figure 1
the right hemisphere deals predominantly with intuitive Areas of left hemisphere: a. striate cortex;
and syncretistic processes in a parallel manner. Verbal infor- b. extrastriate cortex; c. inferior temporal cortex;
mation is processed predominantly in the left hemisphere, d. second level visual association cortex
which is also in control of serial movements. Previous work in parietal lobe; e. primary somatosensory cortex;
(Lusebrink, 1990) summarized the results of psychophysio- f. premotor cortex; g. supplementary motor area;
logical studies by different authors in regard to the func- h. primary motor cortex; i. orbitofrontal cortex;
j. primary auditory cortex; l. Wernicke’s area
tions of the right hemisphere. It processes visual-spatial
(word recognition); m. posterior language area;
information, visual imagery, and visual memory. It also dis- n. Broca’s area (speech production).
criminates between color and hue. The right hemisphere
integrates information across modalities more readily than
the left hemisphere. In normally functioning individuals,
both hemispheres are fully active and integrated with each to Fuster (2003), sensory information is processed on three
other in their functioning even if their contributions vary hierarchical levels of perceptual knowledge. These are (a)
(Gazzaniga, Ivry, & Mangun, 2002). Recent literature refers the primary sensory cortex, which analyzes and maps the
to a fair number of studies exploring different aspects of the elementary sensory features of perception; (b) the uni-
asymmetrical nature of the brain (Hughdahl & Davidson, modal association cortex, which analyzes associated fea-
2003). The present paper refers to a few of these studies per- tures of complex stimuli in the given sense modality; and
tinent to visual information processing. (c) the transmodal or multimodal association cortex, which
Structurally, the cerebral or neocortex and its four integrates the percepts across several sensory and nonsen-
lobes—frontal, parietal, temporal, and occipital—envelop sory modalities. Most of the perceptual stimuli are
the limbic system, which includes the anterior thalamic processed in parallel and unconsciously. The conscious part
nuclei, hippocampus, amygdala, and parts of the hypothal- of perceptual processing “is guided by selective attention, a
amus and basal ganglia. The limbic system is, from a phy- top-down cognitive function that, like memory, deter-
logenetic perspective, the old cortex. The thalamus is a relay mines the course of categorization” (Fuster, 2003, p. 85).
Sensory and other types of information are transferred
station with specific areas that receive information from dif-
between the two hemispheres via the corpus callosum
ferent sensory systems, which it relays to the corresponding
through differentiated channels. The specific structures and
projection areas in the cerebral cortex. The hippocampus is
pathways of the brain involved in processing visual, soma-
instrumental in converting information into long-term
tosensory, motor, emotional, and memory-related infor-
memories. The amygdala is essential for the integration of
mation are discussed below.
emotional components. The basal ganglia receive informa-
tion from the frontal, parietal, and temporal cortices and are Visual Information Processing
an important part of planning and executing movements
(Carlson, 2001). The current trend in cognitive neuro- The primary visual or striated cortex (Figure 2) is locat-
science, though, is to investigate neural systems instead of ed in the occipital lobe. This area contains modules of cells
neural structures (Gazzaniga et al., 2002). that respond to direction, movement, texture, and color of
Functionally, the cerebral cortex is divided into two visual stimuli. The striated cortex is surrounded by the
parts: frontal cortex or executive networks, and posterior extrastriated or visual association cortex, which gathers and
cortex or perceptual networks (Figure 1). The frontal cor- analyzes the information received from the different mod-
tex incorporates the prefrontal and motor cortices, where- ules. Subsequently, the visual information is divided into
as the posterior cortex consists of several areas that process two streams of analyses. The lower or ventral stream goes to
sensory and perceptual information— namely, the occipi- the secondary visual association cortex in the inferior tem-
tal, temporal, parietal, and somatosensory cortices—which poral lobe that responds to the features of shapes and inte-
are all subdivided into smaller functional areas. According grates form and color. Information regarding shapes is bet-
 LUSEBRINK 127

Figure 2
A schematic diagram of visual information processing (shaded areas seen through a transparent brain)
(based on Carlson, 2001)

ter encoded in the right hemisphere than the left hemi- Somatosensory Information Processing
sphere. The upper or dorsal stream goes to the secondary
visual association cortex in the parietal lobe and responds to The somatosensory information from the body travels
spatial locations (Kosslyn, 1987; Kosslyn & Jacobs, 1994). through the dorsal column of the spine via the medulla and
Studies using fPET scans of the processing of visual stimuli midbrain to a specific nucleus in the thalamus and to the
have shown increased blood flow in the ventral and dorsal primary somatosensory cortex that contains groups of neu-
rons representing the different parts of the body. Each area
visual streams, respectively, corresponding to the presenta-
of the primary somatosensory cortex responds differential-
tion of stimuli as objects or as a spatial location. Laeng,
ly to the different submodalities of somatosensory stimula-
Chabris, and Kosslyn (2003) have proposed a further divi-
tion. From here the information is transmitted to the sec-
sion of the dorsal visual stream into coordinate and cate-
ondary somatosensory association cortex. The multiassoci-
gorical subnetworks that process qualitatively different ation area of the parietal lobe integrates the somatosensory
types of spatial information. According to these authors, the information with the spatial information from the visual
coordinate network encodes percepts related to distance, cortex (Carlson, 2001).
size, and orientation, and is processed in the right hemi- For art therapists, the sensory modalities of touch and
sphere. The categorical network deals with spatial relation- haptic sense are of special interest. Touch activates the cuta-
ships and is processed in the left hemisphere. neous senses that respond to pressure, vibration, cooling,
Color is processed in the ventral stream (Carlson, and heating. The haptic sense helps to perceive the shape,
2001), and its processing depends on the abstract or iconic weight, and hardness of an object through the kinesthetic
nature of the stimuli. The responses to abstract color stim- sensations from joints and muscles experienced in the
uli activate the color areas in the striated and extrastriated manipulation of the object (Gibson, 1966). Textures are
cortices, but responses to iconic or representational color experienced through the movement of skin over a surface
stimuli involve an additional activation of the hippocampus that creates a vibration of the skin. The manipulation of an
and right inferior temporal lobe. The activity in the frontal object creates kinesthetic sensations from joints and mus-
cortex in response to representational color stimuli also dif- cles. Touch and haptic perceptions involve movement and
fers from that created by abstract color stimuli (Zeki, 1999). also activate emotions because the amygdala receives infor-
As the complexity of the information increases, the cerebral mation from the somatosensory primary cortex (Carlson,
activation which was constricted to one hemisphere appears 2001). James et al. (2002) in a fMRI study found that hap-
to spread over both hemispheres (Saron, Foxe, Schroeder, & tic exploration of three-dimensional objects activated not
Vaughan, 2003). only the somatosensory cortex but also the occipital cortex,
128 ART THERAPY AND THE BRAIN

thus indicating the involvement of the ventral visual path-

way in the haptic perception of objects.

Motor Information Processing

Paralleling the levels of visual and somatosensory repre-
sentation, the hierarchical levels of motor representation
involve the primary motor cortex, premotor cortex, and
prefrontal cortex (Figure 3). The basal ganglia, a group of
subcortical nuclei in the forebrain, are an important part of
the motor system. The primary output of the basal ganglia
goes to the premotor cortex and supplementary motor area
via specific nuclei in the thalamus. The basal ganglia also
monitor information from the somatosensory areas. The
basal ganglia and thalamus form one of the two pathways
between the motor association cortex and the somatosenso-
ry association cortex. The other pathway between these two
areas is a direct transcortical connection. This arrangement
is similar to the visual system that also has a direct connec-
tion to the prefrontal cortex and another through the thal-
amus (Carlson, 2001). Knowledge of the two pathways
involving the basal ganglia is important to art therapists
involved in the reconstitution of lost mental facilities for
stroke and Alzheimer’s patients (Menzen, 2001).
Figure 3
Brain Areas and Processes Involved in Emotions A schematic diagram of the basal ganglia
(shaded areas seen through a transparent brain)
Emotions are addressed in studies of affective neuro- (based on Carlson, 2001)
science. Emotions involve patterns of autonomic activity
and hormonal and cortical responses. The integration of
Similar to the hemispheric differences in the frontal cortical
these different inputs takes place in the amygdala. The con-
areas in expressing approach and aversive reactions, the left
nections of the amygdala to the neocortex are direct as well
amygdala is involved in reward processing whereas the right
as indirect through the thalamus (Fuster, 2003). The infor-
amygdala is associated with aversive processing (Pizzagelli
mation integrated by the amygdala goes via the thalamus to
et al., 2003). In a fPET study, subjects with Post-Traumatic
the orbitofrontal cortex (OFC) and to the prefrontal cortex
Stress Disorder (PTSD) as compared to control subjects
(PFC). The OFC is likely involved in emotional regula-
showed increased activity in the anterior cingulated gyrus
tion, whereas the different areas of the PFC have been con-
and right amygdala while imagining combat-related pictures
ceptualized as dealing with affective working memory
(Carlson, 2001).
anticipating the consequences of positive and negative
emotions (Davidson, 2000; Davidson, Putnam, & Larson, Brain Areas and Processes Involved in Memory
2000). The left amygdala is preferentially involved in pro-
cessing conscious emotional information whereas the right Memory is an associative function and involves the
amygdala processes nonconscious information (Pizzagalli, formation and activation of different areas of cortical net-
Shackman, & Davidson, 2003). Different emotions con- works. Perceptual memory is based on the three hierarchi-
stitute different activation patterns in the brain (Jennings, cal levels of perceptual knowledge gained through the sens-
2001). The central nucleus of the amygdala is important es and stored in the posterior cortex. Most of the percep-
for expressing fear, whereas the anterior cingulate cortex of tual memory is implicit or nondeclarative (Fuster, 2003).
the limbic system is activated during irritation and anger The recall of perceptual memories involves ventral and
(Carlson, 2001). dorsal streams for the two types of visual information. Both
The right hemisphere is better than the left in the streams have direct reciprocal connections to the prefrontal
expression of emotions and in the recognition of emotions cortex; the latter is involved in short-term memory for all
in facial expressions. Emotions are predominantly processed sense modalities (Carlson, 2001).
in the right hemisphere, especially negative emotions such Executive memory is stored in the frontal cortex. The
as sadness and fear. The arousal of the right frontal region is prefrontal cortex performs the integrative functions of
associated with emotions involving reflective awareness, working memory, attention, and inhibition. Motor memo-
depression, and withdrawal. Arousal of the left frontal ries of concrete and stereotypical sequences of actions are
region is associated with alert expectations and approach stored in the basal ganglia. Long-term or declarative mem-
(Heller, Koven, & Miller, 2003; Tucker, 1981). Depression ories involve two brain areas: the right hippocampus and
involves decreased activity in the left frontal and in the right the right prefrontal cortex. The integration of sensory infor-
parietotemporal cortex (Bruder, 2003; Heller et al., 2003). mation and formation of declarative memories take place in
 LUSEBRINK 129

the hippocampus, which is active in the formation of long- the possible brain structures and functions involved. The
term memories but does not store them. The hippocampus discussion is presented along the levels of the developmen-
receives and processes information from the sensory associ- tally based model of the Expressive Therapies Continuum
ation areas in the parietal lobe as well as from the amygdala, (ETC) (Lusebrink, 1990, 1991). This model presents in-
basal ganglia, and other subcortical areas. In this process the teractions with media and expressions created in art thera-
hippocampus forms associations between the representa- py on three different levels of complexity: Kinesthetic/
tions and relays them back to the association cortex, where Sensory (K/S), Perceptual/Affective (P/A), and Cognitive/
the memories are consolidated and modified (Carlson, Symbolic (C/Sy). A fourth level, the Creative Level, is con-
2001; Fuster, 2003). As shown in two fMRI studies of war ceptualized as crossing the other levels. In a well function-
veterans with PTSD (Carlson, 2001), traumatic combat ing individual, all these levels are readily accessible, but
experiences can result in hippocampal damage. individual expressive styles or an art therapist’s approaches
Speech production involves Broca’s area in the inferior may emphasize a particular level. The conceptual model of
left frontal lobe whereas speech comprehension and recog- the ETC and its three levels echo Fuster’s (2003) proposed
nition of words are located in the Wernicke’s area. The pos- three hierarchical levels of sensory information processing.
terior language area surrounding the Wernicke’s area inter-
faces with the perceptions and memories stored in the sen- Basic Kinesthetic and Sensory Stimulation
sory association cortex, thus contributing to the meaning
of words (Carlson, 2001). An fPET study of responses to The K/S Level refers to basic kinesthetic-motor and
naming animals and tools showed activity in Broca’s area sensory-tactile and interaction with the art media. All art
and inferior temporal cortex, the latter indicating activa- experiences involve motor action and movement, but the
tion of the visual ventral stream. In addition, there were motor action itself can be used as a stimulus and as a recon-
two selective activations: one in the premotor cortex for stitutive agent. It can be used therapeutically to express
the images of tools and one in the visual association cortex energy through the art media (Lusebrink, 1990). Further,
for the images of animals (Martin, Wiggs, Ungerleider, & the kinesthetic interaction with media modified through
Huxby, 1996). visual feedback can form lines and, therefore, can involve
Mental images share the same pathways and brain areas the activity of the directional columns of cells in the pri-
for their formation and processing as do perceptions in the mary visual cortex. The perception of straight lines is based
different sense modalities (Horowitz, 1970; Lusebrink, on alignment of the cellular columns in particular areas of
1990; Lusebrink & McGuigan, 1989). As recorded with the primary visual cortex (Zeki, 1999).
fMRI, mental images of the construction of three dimen- In the rehabilitation of stroke patients, Alzheimer’s
sional objects activated the dorsal visual stream and the patients, and chronic schizophrenics, kinesthetic action can
frontal lobes; the concomitant activity recorded in the ven- serve as a reconstitutive agent in that it can stimulate motor
tral stream of the inferior temporal cortex presumably indi- memories including those sequences of motor actions rele-
cated the subject’s recognition of the shape created gated to the basal ganglia. Haptic sensory stimulation can
(Carlson, 2001). At times, internally formed images may bypass impaired brain areas and help to reconstitute mem-
interfere with the processing of external stimuli (Kosslyn & ories (Menzen, 2001). The formation of episodic memories
Konig, 1995; Marks, 1983; Segal, 1972). involves the basal ganglia in connection with the hippo-
campus. As one of the two pathways between the motor
Levels of Expression in Art Therapy and association cortex and the somatosensory cortex, the basal
the Implied Brain Processes ganglia and the associated motor movements can provide a
bridge between the two association cortices in cases where
The human body processes external and internal stim- the transcortical pathways may be impaired (Carlson,
ulation as a complex organism with multitudes of finely 2001). The actions and memories activated through motor
tuned and interactive systems. Art therapy focuses pre- action presumably become accessible to conscious inspec-
dominantly on visual and somatosensory information; that tion and visual processing.
is, how images and their expression reflect emotional expe- The sensory modality of touch involves motor move-
riences and how the emotional experiences affect thoughts ment. Sensory stimulation, exploration, and play with art
and behavior. Formation of internal images activates senso- media facilitate imagery formation. For developmentally
ry pathways (Lusebrink & McGuigan, 1989). Literature impaired children and adults, tactile interaction with art
suggests that art therapy interventions benefit predomi- media stimulates new development. Menzen (2001) de-
nantly the following general areas: (a) reconstitution and fined this level of interaction as the “basic (‘basal’) aesthet-
rehabilitation of physical impairments (Kaplan, 2000; ic stimulation” (p. 149). He pointed out that the use of dif-
Menzen, 2001); (b) promotion of mental, emotional, and ferent tactile materials, such as sand, water, seeds, and
physical healing (Kaplan, 2000; Malchiodi, 1999a, rocks, stimulates the sensory and motor systems of indi-
1999b); and (c) enhancement of cognitive and emotional viduals who suffer from organic or traumatic brain dam-
growth (Kaplan, 2000; Menzen, 2001; Rosal, 1992). age. Tactile interaction with fluid media, such as finger-
The following discussion gives examples of art therapy paints or paste, adds additional aspects to the stimulation
expressions and interventions on different levels of com- that include color (Kahn-Dennis, 1997). Tactile media are
plexity in the preceding three areas with some references to also likely to stimulate emotional responses. In addition to
130 ART THERAPY AND THE BRAIN

tactile stimulation, work with wood or styrofoam blocks Emergence and Function of Emotions
lends itself to three-dimensional exploration of space. Work
with three dimensional media, such as clay, gives the indi- The affective component of the ETC deals with the
vidual haptic feedback about the form and its spatial rela- expression and channeling of emotions through art media
tionships. This observation is corroborated by the knowl- and the effect of emotions on information processing
edge that Alzheimer’s disease is associated with damage to (Lusebrink, 1990). Emotions influence many cognitive
the visuo-constructive skills (Wald, 1986). aspects — such as attention, memory, perception, and in-
formation processing (Heller et al., 2003). The presence of
Formation of Visual Gestalts emotion modifies the visual expression including imagery
and its formal elements. Visual responses to the names of
The term “perception” in cognitive neurosciences mood states — such as sad, mad, glad, and scared — dis-
refers to all the sensory modalities on their different levels play differences in the type and placement of lines, colors,
of complexity. In art therapy, the perceptual end of the P/A and forms for the different states. Each mood state,
Level of the ETC (Lusebrink, 1990) refers to the formal though, has commonalities in the expression across many
elements in visual expression— such as forms, colors, and subjects (Rhyne, 1979, 1983). The elaboration of a single
lines. This level of the ETC focuses predominantly on the word defining a mood state in art therapy gives visual
activity of the visual association cortex and the subsequent expression of this state, thus making it accessible for con-
two streams of visual information processing. The division scious observation. The differences in the expressions of
of the visual information encoding in the visual association the mood states echo the fact that there are differences in
cortex is of interest in that the ventral stream recognizes brain areas activated when experiencing these emotions
what an object is by recognizing the patterns of its features. (Jennings, 2001).
The dorsal stream determines where the object is located The inhibition of emotion manifested in visual expres-
spatially in relation to other objects (Kosslyn & Jacobs, sion through the decrease in color usage, size of forms, and
1994). Interactions with art media facilitate a differential spatial arrangements seen in depression (Wadeson, 1980)
emphasis on either the formal features or spatial aspects of may be related to the decrease of activity in the left pre-
the expressions. frontal and right parietotemporal region as discussed before
The ventral or “what” stream in the inferior temporal (Heller et al., 2003). The influence of emotions, or lack
cortex elaborates on perceptual forms through external and thereof, on cognitive functions can be seen in memory for-
internal input including color and emotional aspects. A mation and recall. Emotions are important in forming
good gestalt or configuration reflects the search for con- memories, and emotional memories are easier to recall than
stancies through distilling all essential features of an object. nonemotional ones (Fuster, 2003). A fPET study of
The receptive fields of visual cells in the early stages of visu- women with posttraumatic stress disorder (PTSD) showed
al processing are usually square or rectangular in shape, that emotional memories of sexual abuse in childhood acti-
thus supporting artists’ quest for essential basic forms vated the orbitofrontal cortex and anterior temporal lobes
(Zeki, 1999). Visual expression involves the organization (Carlson, 2001). The activity in the orbitofrontal cortex
of forms and can help to achieve good gestalts through points to the influence of the emotional content of the
visual feedback. In art therapy, the exploration of external memories. A possible resolution of traumatic memories
objects visually or through the modality of touch may help could be directed through a paced approach with art media
to define and elaborate forms. without emotionally overwhelming the individual. The
Different lesions, depending on their location in the inability to express emotions is manifested in alexithymia,
cortex, produce impairments in the processing and expres- under the influence of which an individual’s drawings show
sion of visual information. Menzen (2001) discusses the ef- an inability to thematically integrate forms indicating dis-
fect of left- and right-hemisphere brain injuries on an indi- turbances in spatial integration and the symbolic function
vidual’s ability to construct shapes. The drawings of indi- (Demers-Desrosiers, 1982).
viduals with left-hemisphere injury are schematic and rep-
Cognitive and Symbolic Processes
etitive, whereas those of individuals with right-hemisphere
injuries reflect their inability to perceive and draw com- The C/Sy Level of the ETC involves activities of the
plete gestalts. Wais’s approach (cited in Menzen, 2001) to frontal cortex and encompasses memories, problem solv-
art therapy with the brain injured focused on the forma- ing, and anticipatory operations with images, concepts,
tion of new neural pathways and functional reorganization and the corresponding verbalizations. The cognitive com-
through creating arrangements and three-dimensional ponent focuses on analytical and sequential operations,
structures of foam and wood blocks. His work with indi- logical thought, and abstraction. Symbols refer to intuitive,
viduals suffering from left-hemisphere injuries incorporat- multidimensional concept formation, part of which may
ed attention to details and sequences. On the other hand, be unknown or not available for conscious processing
his work with those suffering from right-hemisphere in- (Lusebrink, 1990). Both cognitive and symbolic aspects are
juries emphasized spatial perception and reconstruction necessary for memory work, and both aspects rely on the
through emphasis on the aesthetic and pleasurable aspects information stored in the multimodal area in the parietal
of the experiences. cortex (Fuster, 2003).
 LUSEBRINK 131

On the cognitive end of the C/Sy Level, art therapy

experiences and interaction with art media facilitate the
elaboration of conceptual and abstract thought and of prob-
lem solving. The spatial and temporal relationships between
objects, people, or specific occurrences can be concretely
represented through the realistic or abstract images created
in the art media. Rhyne’s (1979) problem-solving collage
used colored abstract cut-out shapes to represent the differ-
ent aspects of a problem. The spatial arrangement of the
shapes portrays the relationships among the different parts
of the problem, which then can be observed, changed, and
reintegrated on a cognitive level. The media can be helpful
to elaborate the emotional or value judgments of the topics
being explored. This is an example in art therapy of the use
of top down differentiation followed by integration on a
higher level of brain functioning as discussed by Fuster Figure 4
R.’s sequence of tactile/haptic/visual expression in
(2003). An important part of the actions on the cognitive
colored modeling clay (courtesy of Janet K. Long)
end of the C/Sy Level is verbalization and naming of the
images created.
In art therapy, the symbolic component of the ETC areas and functions. The first example deals with the sub-
deals with the different aspects of formation and affective ject’s sensory, perceptual, and cognitive involvement on
resolution of symbols (Lusebrink, 1990). Fuster (2003) these consecutive levels of information processing through
defined symbols as “derivative gestalts” in that they are his interaction with three-dimensional art media.
formed in the perceptual cortex “by repeated experience R., a 50-year-old who was clinically depressed and suf-
with variants of the gestalt they represent or with other fered from chronic schizophrenia, was asked in his third art
symbols (e. g., words)” (p. 94). It is interesting to note that therapy session to explore the medium of modeling clay
C. G. Jung conceptualized archetypal symbols as based on (Figure 4). He made several flat oblong pieces. In response
the structural determinants of the psyche (Jacobi, 1959), to the art therapist asking what it was, he said it was “a
presumably meaning the underlying structure of the brain. sock” and rolled up the flat pieces. Following the therapist’s
The process of symbolic exploration may activate the example, he then made a number of yellow, red, and blue
lower levels in the hierarchy of perceptual processing clay balls. When the therapist asked whether he would like
(Lusebrink, 1990), including the primary sensory cortices to arrange them in a row or on top of each other, he made
in different modalities because “symbols are solidly based four “snowmen.” Then he added, “Now they belong there”
in perception by virtue of their perceptual origin and their and put the rest of the balls on black pieces of clay.
nature of perceptual retrieval” (Barcalou cited in Fuster, (Interestingly, his family consists of four people: self, moth-
2003. p. 95). The activation of the unimodal primary sen- er, stepfather, and estranged father, who abandoned him as
sory cortices seems to be especially important in the explo- a teenager after he had been first diagnosed). R. said that
ration of symbolic aspects of memories as well as emotion- he was very satisfied with his creation of clay forms. (J. K.
al elements that may have been repressed or dissociated. Long, personal communication, April 20, 2003).
Expressions through art media may help to recover the In the absence of concurrent brain activity measures,
components of symbols and related emotions on the lower one only can venture to make the following assumptions
levels of the perceptual hierarchy and to contribute to the about the sequence of the corresponding activation of dif-
exploration of the meaning of symbolic images (Lusebrink, ferent brain functions: (a) initial stimulation of sensory-
1990). The exploration of symbols and their sensory motor activity; (b) visual inspection with activation of the
aspects in all modalities can contribute to an individual’s ventral stream of visual processing, followed by creation of
growth and further the development and understanding of defined forms; (c) spatial orientation of forms with corre-
self and others. sponding activation of the categorical branch of the dorsal
Creative exploration can occur on any level of the ETC visual stream; (d) spontaneous arrangement of balls in a
and involves the interaction of both hemispheres. An row with concurrent activation of the coordinate branch of
important part of creative activity is the excitement and the dorsal visual stream; and (e) definition of forms as
pleasure of involvement, which in itself can be healing “snowmen,” pointing to the activation of the cognitive
(Lusebrink, 1990). The brain functions involved in creativ- processes involved in symbol making. This sequence sug-
ity, though, have not been addressed in the present paper. gests progression from a simple tactile-sensory experience
to the more complex processes of definition and symbol-
Case Examples ization of visual forms. It also parallels Fuster’s (2003) pro-
posed ascending hierarchical levels of perceptual knowl-
The following examples from two case studies in art edge processing from unimodal to multimodal association.
therapy illustrate the processes involved in art expression Excerpts from the second case (Lusebrink, 1974) illus-
and reflect, by implication, the activation of different brain trate the stylistic changes in visual expression from a com-
132 ART THERAPY AND THE BRAIN

Figure 5 D.’s wall collage

plex, spatially oriented arrangement of forms to an emo- nite spatial arrangement, the two paintings have minimal
tionally charged representation of large, primitive forms. spatial differentiation. The hallucinatory image represent-
D., a 22-year-old diagnosed with acute schizophrenia, cre- ed in Figure 6 is portrayed as a big face in a style which
ated a free collage on the walls of his room in a locked inpa- Simon (1991, 1997) defines as “archaic.” Figure 7 displays
tient setting. (The collage was subsequently transferred to a a figure-ground reversal. The spatial structure of the col-
large sheet of paper by the therapist; see Figure 5). The lage reflects Simon’s “traditional style” and the possible
structure of the collage is mandala-like, with a definite cen- involvement of ventral and dorsal visual streams of brain
ter and four corner areas. The center refers to communica-
tions (phone) and wisdom (Einstein); it also displays the
face of an Indian girl and a circle with number 1 on it. The
upper left stands for “does America have to die?” and the
lower left represents lies (Nixon) and an egg heading
towards explosion. The lower right pictured a flight (birds)
and the upper right a boy pointing towards “a skier going
out of control and jumping tracks.” About a week later, D.
produced a free painting representing his persecutory hallu-
cinations (Figure 6). When asked about the most important
part of the painting, D. pointed to the visually undifferen-
tiated lower right portion. In a following exploration of that
area, D. painted densely condensed images of a “bunny/
bowling pin,” an angel, and a half moon (Figure 7).
The two last paintings are remarkably different from
the collage in their style, size of images, and affective
involvement. Whereas the collage has its focus on a defi- Figure 6 D.’s painting of his hallucination
 LUSEBRINK 133

Figure 7 D.’s elaboration of the lower right corner of the hallucination painting

activity. The collage seems to involve memories and sym- of the perceptual stimuli are processed in parallel
bolic associations, as contrasted to the immediacy and pre- and unconsciously; part of the processing is guided
sumed predominance of ventral stream processing reflect- by cognition through selective attention in a top
ed in the last two paintings. down manner (Fuster, 2003).
The understanding of the brain functions underlying 2. Brain structures provide alternate paths for accessing
the different processes of art expressions in art therapy can and processing visual and motor information and
help the therapist to become aware of different aspects of memories. Art therapy is uniquely equipped to take
these processes and their implications. Both case examples advantage of these alternate paths and activate them
deal with severe psychopathology, but an increase in com- through the use of various art media in therapy.
plexity of expression or changes in expressive styles can be
3. Art therapy offers the possibility to emphasize
incorporated into the therapeutic design in dealing with
selectively different aspects of visual information
cases involving less or minimal psychopathology.
processing.
Conclusions and Recommendations 4. Art therapy offers the possibility to deal with basic
sensory building blocks in the processing of infor-
This paper has presented some of the basic structures mation and emotions. The most elementary
and functions of the brain that could be of interest to art expressive forms may reflect the underlying brain
therapists. The examples of art experiences and levels of structures.
expression illustrate possible applications of this informa- Further explorations of the relationship between the
tion to the processes in art therapy. Four main areas stand processes of art expression and the functions of the brain
out when considering art therapy in regard to basic brain could benefit from the area of art assessments based on the
functions and structures: formal elements of visual expression, such as the
1. Brain functions and areas are specialized for dis- Diagnostic Drawing Series (DDS) (Cohen, Mills, & Kijak,
tinctive tasks at different levels of complexity. Most 1994; Mills, 2003) and the Formal Elements of Art
134 ART THERAPY AND THE BRAIN

Therapy Scale (FEATS) (Gantt, 2001, Gantt & Tabone, Heller, W., Koven, N. S., & Miller, G. A. (2003). Regional brain
2003). These assessments are backed by extensive research activity in anxiety and depression, cognition/emotion interac-
involving different populations, thus providing a solid base tion, and emotion regulation. In K. Hughdahl & R. J. Davidson
for the exploration of the relationship between brain (Eds.), The asymmetrical brain (pp. 533-564). Cambridge, MA:
processes and the processes involved in art expression. MIT Press.
Another area for exploration concerns the relationship be- Horowitz, M. J. (1970). Image formation and cognition. New
tween brain functions involved in emotions and their visu- York: Appleton-Century-Crofts.
al expression based on Rhyne’s (1983) research.
The artistic background and understanding of visual Hughdahl, K., & Davidson, R. J. (Eds.). (2003). The asymmetri-
language in health and psychopathology provide art thera- cal brain. Cambridge, MA: MIT Press.
pists with an intuitive appreciation for the structural, func-
tional, and emotional qualities of art expression. The under- Jacobi, J. (1959). Complex/archetype/symbol in psychology of C. G.
standing of these qualities in relation to brain structures and Jung. Bollinger Series LVII. Princeton, NJ: Princeton University
functions could provide a starting point for elaborating on Press.
the unique role and importance of art therapy in the arenas
James, T. W., Humphrey, G. K., Gati, J. S., Servos, P., Menon, R.
of therapy, healing, and growth.
S., & Goodale, M. A. (2002). Haptic studies of three-dimen-
sional objects activate extrastriate visual areas. Neuropsych-
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