David Gussak Ph.D., ATR-BC

Art on Trial


Silver Linings Sketchbook

Art therapy in a forensic psychiatric hospital revisited

Posted Oct 16, 2014

While giving a keynote address last month for the Delaware Valley Art Therapy Association, I had the great fortune of meeting many art therapists working with forensic populations. One such person was Nicole Barash MA.

Ms. Barash, this post’s guest blogger, completed her master’s degree in art therapy at Drexel University, and immediately began work as an art therapist in the Forensic Mental Health unit for a  state psychiatric hospital in the Northeast. The vignette at the end of this post clearly demonstrates the value of what Ms. Barash offers. It was wonderful speaking with her at the conference, and I think the field can look forward to many more contributions from her over the years.

Art Therapy in a Forensic Mental Health Hospital [FMHH] Revisited…

By Nicole Barash

I am currently an Art Therapist at a state psychiatric hospital in the Northeast. The 600-bed inpatient hospital is comprised of several specialized units that service acute, chronic, gero-psychiatric, dual diagnosis (mental health and developmental disability), and Forensic Mental Health client populations. In my state, there are two facilities that provide treatment to forensic mental health clients. My facility is the less restrictive of the two.

As an art therapist, I function as a part of the Rehabilitation Department, which also includes music, dance-movement, physical, and occupational therapists, speech-language pathologists, vocational counselors, interpreter services, educational/teacher services, and therapy aids. Art therapists run individual art therapy sessions, administer creative arts therapy and rehabilitation service assessments, and contribute to treatment planning as part of a treatment team comprised of a psychiatrist, psychologist, program coordinator, and social worker.

The Forensic Mental Health Unit

  • Not Guilty due to Reasons of Insanity (NGRI)
  • Incompetent to Stand Trial (IST)
  • In need of evaluation to determine fitness to proceed to trial.

Length of stay varies drastically from a few weeks to many years.

My groups have many interesting characters, depending on who shows up. They are in all life stages; some may be stable on medication, actively psychotic, have borderline intellectual functioning, have cognitive issues due to aging or traumatic brain injury, and, clients so high-functioning and creative that they could MacGyver a lighter out of a pipe cleaner, pom-pom, and rubber band.

We must be cognizant of the prison culture and the effects of institutionalization that is ever present in this setting. There is a definite pecking order amongst clients, fostering high levels of defensiveness and testing behaviors. Staff must be hyper-vigilant, aware of manipulative behavior, and be able to set limits and boundaries.

Time to Make Some Art

Some have indicated that art therapy may assist clients in correctional and inpatient psychiatric hospital settings by improving social skills, frustration tolerance, impulse control, anger management, and problem solving, and reduce negative moods (Breiner, Tuomisto, Bouyea, Gussak, & Aufderheide, 2011; Gussak, 2006; Kimport & Robbins, 2012).

Fortunately, in my particular facility, there is a large space specifically designated for art therapy, and an abundance of materials --yes, sharps included—are available for use, which is a tremendous therapeutic asset for numerous reasons. Clients are naturally drawn to the space; its colorful, safe, non-judgmental atmosphere allows clients to feel “normal” and productive, even if it is just for a brief period of time. With cabinets full of materials, I am able to offer many activities to suit their interests and abilities through structured therapeutic directives, mural painting, and open art studio. These provide them a safer outlet for expression as verbal therapy can render clients vulnerable and targeted by peers.

In art psychotherapy sessions, tasks and directives are often selected based on the needs and comfort level of the clients. In my opinion, some of the most successful groups are multipart tasks that involve individual and group elements such as individual animals in a group created environment, individual bird nests in a group created tree, and puzzle tasks. Volcano related tasks are also a big hit.

The Man-A Case Vignette

One day, a toothless man, sans dentures, sat down at the table in the art therapy studio and began to draw. He drew, and drew, and drew, and did not stop until he had depleted all of the materials in his radius –seriously, I could fill an entire filing cabinet drawer with his artwork.

However, after a few weeks in the art therapy studio, the man began to feel safe enough to talk in a group about his artwork. He talked about memories of past jobs, life experiences, and people, about his own interests such as sports and superheroes. Now, after working with the man for several months, he has advanced to discharge-ready groups. He is still in art therapy-- and can be found on the ward playing board games with peers and staff.

What I Learned from The Man: Never Doubt the Process

I may never know what the man was expressing in many of his artworks. He may not even know, or remember, the meaning of these pieces; but he knew he needed the art.


Breiner, M. J., Tuomisto, L., Bouyea, E., Gussak, D. & Aufderheide, D. (2011). Creating an art therapy anger management protocol for male inmates through a collaborative relationship. International Journal of Offender Therapy and Comparative Criminology, 56(7), 1124-1143.

Gussak, D. (2006). The effects of art therapy with prison inmates: A follow-up study. Arts in Psychotherapy, 33, 188-198.

Kimport, E. R., & Robbins, S. J. (2012). Efficacy of creative clay work for reducing negative mood: A randomized controlled trial. Art Therapy: Journal of the American Art Therapy Association, 29(2), 74-79.