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Mental health and creative therapy field

Art Therapy

A structured creative process and therapeutic dialogue that help explore the inner world and emotions, even when words fall short.

Combining visual art and psychological support

An art therapist is a mental health and rehabilitation specialist who combines visual creative work with psychological counselling and therapeutic dialogue. Sessions use various art media, including drawing, painting, clay sculpting, and collage, to explore thoughts, emotions, and life events. At the centre of the work is the triangular relationship between the client, the therapist, and the art medium, where the focus is not on artistic skill or the aesthetic final product, but on the creative process and its meaning.

Art therapy differs from conventional talk therapy in that complex experiences do not have to be formulated verbally right away. An image created on paper or in three-dimensional form provides a safe distance, allowing the person to observe their issues from the outside before making sense of them. This makes the method accessible to people who find it difficult to put their feelings into words, including children, adolescents, people with trauma experiences, or those whose intellectual defence mechanisms hinder direct conversation.

Art has been used across cultures for millennia in rituals, self-expression, and healing-related practices, but the modern professional discipline emerged in the mid-20th century in the United Kingdom and the United States. The term was introduced in 1942 by Adrian Hill, who observed the supportive effect of art-making during recovery from illness. The theoretical foundation of the field was further developed by Margaret Naumburg with a psychodynamic approach and by Edith Kramer through emphasising the creative process as an independent therapeutic mechanism.

In Estonia, the profession of art therapist is not state-regulated, and there is no unified regulation across the European Union; in other member states, status depends on national law. In Estonia, an art therapist does not hold a healthcare professional licence from Terviseamet (the Health Board), and the field is linked to the Creative Therapist, level 7 occupational standard operating under Kutseseadus (the Professions Act), with art therapist as one of its specialisations. Because the occupation is not state-licensed, the responsibility for verifying a specialist's education, master's degree, supervised practice, and code of ethics rests with the client.

Art therapy is not a separate state qualification but one specialisation within the creative arts therapist qualification (Loovterapeut, level 7). The same qualification also covers music therapy and dance and movement therapy.

Professional identity and responsibility of an art therapist

A certified art therapist, or one trained according to the occupational standard, is a master's-level specialist who supports the client in achieving mental health, emotional coping, or rehabilitation goals through the creative process and dialogue. Due to the unregulated title, the education of a specific service provider must be verified. In Estonia, professional competence is confirmed by the level 7 occupational certificate for creative therapists in the art therapy specialisation. An art therapist is not a psychiatrist who establishes medical diagnoses, nor do they make universal psychological assessments of artworks; rather, they create a non-judgemental environment where clients discover meaning through their own creation.

In art therapy, artworks are not created for an exhibition: the visual medium gives shape and space to experiences for which the right words are initially lacking.

Mechanisms and framework of visual art therapy

The triangular relationship as the foundation of the process

Therapy does not rely solely on conversation, but on the interaction between the client, therapist, and art materials. The material and the image serve as a third party that helps safely reflect emotions.

Non-judgement of skills and outcome

No drawing skills are required in a session, and the aesthetics of the work are not judged. Attention is focused on experiencing the creative process, not on artistic perfection or technical skill.

Personal and shared meaning-making

The therapist does not make cryptic diagnoses based on an image or assign predetermined meanings to symbols. The content and emotional charge of the image are interpreted by the client themselves with the therapist's support.

Diverse media and materials

Paints, pastels, clay, collage, or digital tools are used. Fluid paints support the expression of feelings, while clay or drawing tools help establish boundaries and grounding.

Confidentiality and preservation of artworks

Works are kept securely and confidentially in the therapy room by agreement. The created images are part of the therapeutic process, and exhibiting or destroying them is agreed upon separately.

Responsible boundaries of competence

An art therapist recognizes the limits of their competence and does not replace emergency psychiatric care during an acute crisis. When necessary, they collaborate with physicians, clinical psychologists, and support networks.

Main approaches and modalities of art therapy

Psychodynamic approach

Focuses on exploring unconscious conflicts, symbols, and relationships. Spontaneous creation is used to become aware of inner patterns and analyse them within the therapeutic relationship.

Process-oriented creative work

Draws on Edith Kramer's approach, where art-making and working with materials are themselves considered therapeutic. The focus is on releasing tension and fostering self-regulation without mandatory intellectual analysis.

Directive and goal-oriented method

The therapist offers specific themed tasks, such as depicting a safe place, mapping emotions, or problem-solving. This is well-suited for training coping skills.

Trauma-informed and sensory therapy

Uses the tactile and sensory properties of art materials to soothe the nervous system and process traumatic experiences when verbal description of events causes excessive anxiety.

Group therapy and studio format

Participants create in a shared space, sharing experiences and works if they wish. Group work supports a sense of social belonging, developing interpersonal skills, and reducing isolation.

Professional training and creative therapist qualification level

Because art therapy is not a legally regulated healthcare profession, the primary indicators of reliability when choosing a practitioner are an academic master's degree, supervised clinical practice, and an occupational certificate verifiable in Kutseregister (the Estonian Register of Occupational Qualifications).

  1. 1

    Academic master's degree (120 EAP)

    In Estonia, Tallinna Ülikool (Tallinn University) offers a 3-year session-based programme in the Art Therapies master's curriculum, specialising in visual art therapy, which meets the requirements of the creative therapist occupational standard.

  2. 2

    Occupational Certificate: Creative Therapist, Level 7

    A specialisation under the Estonian national occupational standard: 'Art Therapist, level 7'. Applying for the qualification requires a master's level degree, a specialised thesis, and practical training.

  3. 3

    Internship and supervised client work

    Applying for the occupational qualification requires at least 250 hours of documented internship client work, at least 200 hours of post-training supervised client work during the two years preceding the application, and a separate 90 academic hours of group supervision.

  4. 4

    Regular supervision and personal therapy

    A therapist adhering to professional ethics undergoes personal experiential therapy and regularly participates in professional supervision to support work quality, self-reflection, and the maintenance of competence boundaries.

  5. 5

    European and international associations

    At the European level, organisations such as EFAT and ECArTE bring together universities and specialists. In the United Kingdom, the profession is regulated by HCPC, and in the United States, certificates are issued by ATCB.

In Estonia, the art therapist profession is not state-regulated with a healthcare professional activity licence and is not entered into the register of Terviseamet. The standard 'Creative Therapist, level 7' from Kutsekoda (the Estonian Qualifications Authority) is a voluntary occupational qualification; its absence does not prohibit offering the service, but its presence in Kutseregister is an important and verifiable way for clients to assess professional training. Short-term art courses or training certificates are not equivalent to a university master's degree.

Eesti Loovteraapiate Ühing and the occupational qualifications system

Eesti Loovteraapiate Ühing

Eesti Loovteraapiate Ühing (ELTÜ, the Estonian Creative Therapies Association) is a professional union and awarding body. The association acts as the awarding body for the occupational standard 'Creative Therapist, level 7' in cooperation with Kutsekoda.

ELTÜ is a voluntary professional organisation, not a state supervisory agency or healthcare authority. Completion of the required master's studies, internship, and supervision is confirmed by the practitioner's valid occupational certificate, not mere membership in the association.

Status
Professional association and qualification awarding body in cooperation with Kutsekoda
Occupational standard
Creative Therapist, level 7 (specialisation in art therapy)
State licence
None (not a healthcare professional activity licence)
Ethel Espenberg
Psühhoterapeut, jungiaanlik psühhoanalüütik ja kunstiterapeut. Terviseteaduste magister MSc
0,0(0)
Ethel Espenberg
Eesti Psühhoteraapia AssotsiatsioonEesti Psühhoteraapia Assotsiatsioon

I am a psychotherapist, art therapist, and Jungian psychoanalyst. For me, psychotherapy is above all a relationship and a shared process of exploration — an opportunity to pause, look more deeply, and begin to understand what in our lives may have remained unclear or difficult to make sense of. In psychotherapy, we do not seek only a quick solution to a symptom. Together, we explore what is happening in a person’s inner world, which patterns are shaping their life, and what possibilities for change may lie behind them. The work is deeply individual and is particularly suited to people who are willing to take the time to get to know themselves more fully. In longer-term therapy, something more than problem-solving can gradually emerge — greater inner clarity, more conscious choices, and a deeper connection with oneself. Psychological change does not always come solely through what we can explain in words. Sometimes an image, an imagination, a dream, or a symbol can provide access to something that the conscious mind alone cannot reach. People who come to me * are going through a major life transition, crisis, or questions around identity * want to engage with personal growth and self-actualisation at a deeper level * are ready to invest in themselves and to allow the time needed for meaningful change. If you feel that you have reached a point in your life where simply “getting by” is no longer enough, it may be the right time to begin a deeper process of working with yourself.

Serves in: Eesti · EnglishEEEesti,GBEnglish
🇬🇧🇪🇪
€100

Key questions before starting art therapy

Do you need to know how to draw to participate in art therapy?
No, no artistic background or drawing skills are required. Sessions do not judge the beauty, technical level, or realism of the works. What matters is the creative process itself and what feelings and thoughts working with materials brings up in you.
What happens during a typical art therapy session?
The session begins with a brief conversation about how you are feeling and the focus theme, followed by creative work with paint, clay, collage, or other media. In the final part of the session, the finished work is viewed together with the therapist to discuss what it means for the creator. Throughout the process, the client may speak or, if preferred, create in complete silence.
Does an art therapist make a diagnosis based on my drawing?
No, a professional art therapist does not use the image as a cryptic test or interpret symbols according to predetermined schemes. The creator themselves gives meaning to the artwork, and the therapist helps explore it with reflective questions. No single colour or shape is assigned a universal psychiatric diagnosis.
Who is art therapy not suitable for, and when should one seek help elsewhere?
Art therapy is not intended as emergency crisis support in cases of acute psychosis, severe suicide risk, or uncontrollable self-harm, where one must turn to emergency medicine or a psychiatrist. An art therapist does not prescribe medication, and art therapy does not replace necessary pharmacological or psychiatric treatment. For severe psychiatric disorders, the method can function only as part of a broader treatment team.
How much does an art therapy session cost in Estonia, and does the Estonian Health Insurance Fund reimburse it?
In private practices, sample prices for an individual 45- to 60-minute session in 2026 were predominantly between 60 and 90 euros, though these are sample prices from a small sample rather than an official national average, and the specific price must be verified with the service provider. In its 2024 proceedings, the Estonian Health Insurance Fund (Tervisekassa) did not add a separate creative therapy service to the list, which is why clients generally pay for private appointments themselves. The service may be free of charge for an individual if referred through social rehabilitation by Sotsiaalkindlustusamet (the Social Insurance Board) or occupational rehabilitation by Töötukassa (the Estonian Unemployment Insurance Fund).
Is a doctor's referral needed to go to art therapy?
No referral is needed to visit an art therapist operating in private practice, and appointments can be booked directly. If you wish to receive the service under national social or occupational rehabilitation, a need assessment, rehabilitation or case plan, and an institutional referral may be required depending on the programme. For services offered within educational institutions or hospitals, procedures follow internal institutional regulations.
How long is a session and how many sessions are needed?
An individual session typically lasts 45 to 60 minutes; some service providers offer 60 to 90-minute sessions. A short-term goal-oriented intervention often lasts 8 to 20 sessions, but for deeper trauma or rehabilitation, the process may last several months. Sessions generally take place once a week, and progress is evaluated regularly.
What does scientific research show about the efficacy of art therapy?
The scientific evidence base is limited and heterogeneous, showing supportive effects in relieving stress, anxiety, and adapting to chronic illness. A 2024 systematic review of 69 studies found small positive pooled effects, but the methodological quality of the studies was predominantly low and 81 percent of outcomes showed no significant difference compared with the control group. Similarly, the TTH69 report from Tartu Ülikool (University of Tartu) found the evidence insufficient in treating mental disorders in children, which is why art therapy cannot be considered a panacea or an independent evidence-based treatment for severe disorders.
What is the difference between an art therapist and an art teacher or psychologist?
An art teacher focuses on technical skills, aesthetics, and the resulting artwork, whereas art therapy focuses on the individual's inner world and the therapeutic relationship. A psychologist holds a higher education degree in psychology, an art therapist's primary medium is visual art, and one qualification does not automatically include the other. An art therapist qualification does not automatically grant the occupational title of psychologist or art teacher, and vice versa.

Scientific articles, clinical reviews, and official registers

*) In Estonia, art therapist is not a state-regulated healthcare professional title. There is no unified regulation in the EU, and status varies across member states. It is not listed in the healthcare professionals register of Terviseamet (the Health Board). Art therapy does not replace psychiatric treatment, clinical psychologist diagnosis, or emergency medical care in an acute crisis. Evoluna does not recommend or vouch for any practitioner: Evoluna provides a platform where you can compare a specialist's background, training, and working method, and make an informed choice yourself. Before booking an appointment, review the specialist's educational background and occupational certificate in Kutseregister (the Estonian Register of Occupational Qualifications), and discuss with your treating doctor if necessary.

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