Art Therapy

Journal of the American Art Therapy Association

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The Therapeutic Presence of the Art Therapist

Naftali Schwarz, Sharon Snir & Dafna Regev

To cite this article: Naftali Schwarz, Sharon Snir & Dafna Regev (2018) The Therapeutic Presence
of the Art Therapist, Art Therapy, 35:1, 11-18, DOI: 10.1080/07421656.2018.1459115

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Published online: 08 May 2018.

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 Art Therapy: Journal of the American Art Therapy Association, 35(1) pp. 11–18, © AATA, Inc. 2018
The Therapeutic Presence of the Art Therapist
Naftali Schwarz, Sharon Snir, and Dafna Regev
Abstract
This study examined how a sample of art therapists (N D
14) describe their experience of therapeutic presence in the art
therapy triangular relationship formed among the therapist,
the client, and the artwork. Qualitative data were collected in
semistructured interviews and analyzed using a grounded
theory method. Component themes of therapeutic presence were
identified as attentive focus, joining, movement, uncertainty,
and sense of completeness. Preparation was found to be
important to the art therapists’ therapeutic presence, as were
the influences of clients, time, art materials, accessibility, and
external factors. Results highlight the role of art in all main
areas of the art therapist’s therapeutic presence.
The therapeutic relationship, especially with respect to
the therapist’s inner stance, has undergone substantial con-
ceptual modification over the course of the history of psy-
chotherapy as a result of the flux in theoretical trends and
clinical realities. Therapeutic presence, defined by Geller and
Greenberg (2012) as the therapist’s internal and interper-
sonal stance, involves the therapists’ sensory, emotional,
and cognitive attention to themselves and to the client in
the moment (Robbins, 1998). This particular conception,
as referenced herein, is anchored in postmodern theories
(Geller & Greenberg, 2012; Geller, Greenberg, & Watson,
2010) and in clinical practices (Hayes, 2014; Robbins,
1998).
Review of the Literature
In the early decades of the 20th century, psychoanalysts
viewed the therapist’s personality as a hindrance to the psy-
chotherapeutic process (Freud, 1912/1958b). Attention to
the patient’s transference of feelings onto the therapist led to
considerable insights into the nature of the therapeutic rela-
tionship and process (Freud, 1912/1958a). It was thought
that as long as the therapist was “being technically neutral
and anonymous, then the transference would
Naftali Schwarz is an Art Therapist and Supervisor in the
Education System and a Graduate of the School of Creative Arts
Therapies at the University of Haifa, Haifa, Israel. Sharon Snir is
an Art Therapist and a Senior Lecturer at Tel Hai College, Tel
Hai, Israel, and in the Art Therapy Division in the Graduate
School of Creative Art Therapies at the University of Haifa, Haifa,
Israel. Dafna Regev is the Head of the Art Therapy Department at
the University of Haifa, Haifa, Israel. Correspondence concerning
this article should be addressed to the first author at
snaftali@hotmail.com
11
spontaneously unfold and would not be distorted by the
personality of the analyst” (Aron, 1990, p. 478). The thera-
pist’s own emotions and reactions were defined as counter-
transference and viewed as a disturbance that had to be
overcome
(Heimann, 1950). Although Klein (1946) and Bion (1967)
also adhered to this classic neutral stance, they acknowl-
edged that countertransference provided cues to the client’s
psyche and was an important part of therapy. Other later
psychoanalytic theorists underscored the importance of the
therapist’s presence in therapeutic relatedness (Bugental,
1987; McWilliams, 1996). Presence is considered to be
central to humanistic (Geller & Greenberg, 2012) perspec-
tives and is viewed as a way to help clients become more
attuned to their own experiences (Rogers, 1980). In the
shift from a one-person psychology to a two-person psy-
chology, intersubjective and relational theorists (Aron,
1990; Benjamin, 1998) placed presence as central to the
therapeutic relationship.
Emphasis on the relationship between two subjective
individuals forms the basis of relational psychologies (Aron,
1990; Jordan, 1995; Mitchell, 2000). Relational theory is
essentially anchored in the idea that it is relationships—
internal and external, real and imagined—that are central
to the therapeutic endeavor (Aron, 1996). By seeking to
diminish the distance and hierarchy between the therapist
and client, the therapist’s subjectivity is used as part of the
therapeutic encounter to help clients unfold or discover
their own subjectivity (Benjamin, 1998). However, this
emphasis on mutuality does not deny the hierarchical asym-
metry of the therapeutic relationship. Mitchell (2000)
emphasized the professional responsibility of the therapist
to maintain the therapeutic alliance within its ethical
parameters.
Robbins (1998) described therapeutic presence in art
therapy based on years of clinical experience with clients in
individual psychotherapy. He defined a therapist who is
therapeutically present as able to attend to the movement
between his or her own inner self and the self of the client;
that is, the to-and-fro oscillations of cognition, feeling, and
embodiment, as well as between one’s own experience and
experiences shared with another. In their qualitative study
Geller et al. (2010) identified four components of therapeu-
tic presence: (a) being fully in contact with one’s self in the
moment; (b) simultaneously being open, receptive, and
immersed in what is poignant in that moment; (c) receiving
a larger sense of spaciousness and expansion of awareness
and perception as a result; and (d) accompanying this larger
sense with the intention of being with and for the clients in
service of their healing process. Therapeutic presence
12 THE THERAPEUTIC PRESENCE OF THE ART THERAPIST
involves bringing one’s whole self on multiple levels to the
therapeutic encounter: physically, emotionally, cognitively,
and spiritually (Geller & Greenberg, 2002, 2012). This
study sought to explore therapeutic presence in art therapy
where art plays a central role in the therapeutic relationship.
In art therapy the relationship among the art therapist,
the client, and art has been conceptualized as a triangular
relationship (Schaverien, 2000; Wood, 1984). For the pur-
poses of this study it is important to comprehend the com-
plexity of introducing art into the therapeutic relationship
and its effects on art therapists’ therapeutic presence. There
are times when the artistic activity mediates the therapeutic
relationship by reducing the threat of direct, face-to-face
intimacy and allowing a mutual space to develop during the
artistic process (Regev & Snir, 2013; Robbins, 1998). In
such instances client engagement with art materials allows
the therapist to take on a more observing role in the thera-
peutic relationship. However, art materials are not just
objective items for the client, but are infused with subjectiv-
ity—whether that of the client, the therapist, or both. The
art piece can be likened to an internal object (Klein, 1946)
that might depict the therapeutic process and relationship
and convey internal conflicts, unspoken emotions and con-
cerns, and unconscious processes (Case & Dalley, 2014;
Snir & Hazut, 2012). Given the presence of art as such a
powerful object in the therapeutic endeavor, it is worth
inquiring into the impact that art has on art therapists’ ther-
apeutic presence.
Art therapists’ therapeutic presence has been described
in the literature but not formally researched. We believe an
investigation of this important aspect of the therapeutic
relationship will enhance understanding of how art thera-
pists assist their clients relationally. This study thus aimed
to explore how art therapists describe their experience their
therapeutic presence in the therapist–client–art relation-
ship. The study design was adapted from Geller and Green-
berg’s (2012) qualitative analysis of therapists’ reflections
on their experience of therapeutic presence.
Method
Participants
Interviews were conducted with 14 experienced art
therapists who, in addition to their clinical work, also super-
vise other therapists. The rationale for this inclusion crite-
rion was that supervisors have a wealth of experience and
generally are accustomed to articulating it. We applied the-
oretical sampling (Hood, 2007; Patton, 2015) by purposely
selecting and adding participants to the sample until the
complete descriptive range of concepts that make up the
theory had emerged. A snowball process (Hood, 2007) in
which participants recommended other art therapists to
interview provided additional participants who met our
criteria.
The interviewees were initially approached by the first
author, who presented the goals of the study, the research
principles, the research stages, and the procedures to the
therapists in a preliminary telephone conversation. During
this conversation, all participants were guaranteed anonym-
ity and privacy. All participants gave their written informed
consent to participate. Participation was voluntary and par-
ticipants were free to drop out of the study at any time.
The study was approved by the Faculty of Social Welfare
and Health Sciences Ethics Committee of Haifa University.
The participants in the sample were between 36 and
63 years old (M D 47.42), had art therapy experience rang-
ing from 7 to 30 years (M D 14.93), and had provided
supervision for 2 to 15 years (M D 5.5). All participants
had master’s degrees and three were doctoral students at the
time of the study. They were Jewish with varied ethnic
backgrounds and practiced in the central and western
regions of Israel. All participants were female. Thirteen of
14 participants identified their therapeutic orientation as
psychodynamic; 8 combined a psychodynamic orientation
with other theories, including cognitive-behavioral, human-
istic, systemic, dyadic, narrative, and play therapy. One par-
ticipant practiced from a relational framework.
Procedure
Of the 14 participants, only one had prior knowledge
of the concept of therapeutic presence. Therefore, before
the interview a short synopsis of the concept (Figure 1)
extracted from the literature was provided. The interviews
were conducted in person in Hebrew and lasted between
1 hr and 2 hr and 20 min (M D 1:41). All interviews were
recorded and later transcribed. Recruitment of participants
was discontinued at the point of data saturation (O’Reilly
& Parker, 2012) when no new information emerged.
Data Collection
The interviews were conducted using a phenomeno-
logical approach to qualitative research, which is appropri-
ate for descriptive studies of human experience that place
the individual and his or her perspective at the center
(Creswell, 2013; Moustakas, 1994). The semistructured
interviews were aided by an interview guide (Figure 2)
composed of four main categories to explore (a) the theo-
retical orientation of the interviewee’s clinical practice; (b)
the interviewee’s experience of herself during the thera-
peutic process; (c) the relational dimension of the inter-
viewee’s presence, both in relation to the client and to the
art objects in the therapeutic process; and (d) feedback
from the client. All interviews were conducted by the first
author, a clinical art therapist who has practiced art ther-
apy for the last 12 years in elementary and secondary
school settings.
Data Analysis
The interviews were analyzed using a grounded theory
method (Strauss & Corbin, 1990). In the first stage of the
analysis known as open coding, three of the interview tran-
scripts were read and examined by the lead author and by a
fellow art therapist. The transcripts were coded for concepts
 SCHWARZ / SNIR / REGEV 13

Therapeutic presence describes the therapist's inner stance when entering into the therapeutic
encounter. This inner, intersubjective stance includes the therapist's physical, emotional,
cognitive, and spiritual qualities and that of the client at that moment. Therapeutic presence is
about bringing one's whole self into the therapeutic encounter by being in the moment. Being
present in the therapeutic encounter means there is a to-and-fro movement between cognition,
feeling, and embodiment of the therapist and the client. Therapeutic presence refers to the
constant movement between the therapist's attention to both his or her own inner self and that
of the client.

Figure 1. Therapeutic Presence (Synopsis Read to Participants)

and then compared and categorized. Each of the next eight
interviews were then similarly examined, coded, compared,
and categorized. In the subsequent stage of analysis known
as theoretical or axial coding, conceptual connections
between and among the categories were found and the
main themes were concentrated. Then through a process of
focused coding (Ayalon & Sabar Ben-Yehoshua 2010), these
themes were clarified by reexamining all of the data they
covered and identifying variations within each category.
Next, the remaining three interviews were coded based on
these emergent themes and were found to capture all the data
in the interviews. The second author served as an auditor by

Figure 2. Interview Guide

14 THE THERAPEUTIC PRESENCE OF THE ART THERAPIST

helping to conceptualize and concentrate the main themes, and
to verify that all raw data had been faithfully represented in the
core ideas (Hill et al., 2005). Finally, the frequency of each
theme was tabulated (Creswell, 2013). Themes that were
found in 4 to 6 of the total interviews were labeled with “a few
interviewees.” Mentions by 7 to 10 of the interviews were
referred to as “some interviewees.” Themes labeled with “most
interviewees” were mentioned in 11 to 14 of the interviews.
Themes with a frequency of 3 or less were examined by the
authors and, when found to contain no information relevant to
the study, were not included in the results.
Results
The data were found to conform to three core catego-
ries: (a) components of therapeutic presence, (b) prepara-
tion for therapeutic presence, and (c) influences on
therapeutic presence, within which several themes were
identified (Table 1), detailed next. All names have been
changed to pseudonyms.
Components of Art Therapists’ Therapeutic
Presence
Attentive Focus. Most interviewees stated that being
present in the therapeutic relationship meant that they were
attentive to themselves and their clients in a state of dual
focus. For example, one participant said, “I am there, truly
open, and trying to understand what the client brings to
the room.” The data suggest that this attentive focus mani-
fested itself in three ways: First, as attentive embodiment,
in that most interviewees paid attention to their own
embodied presence, as in the statement, “I am focused,
observing and sensing. How does the client’s presence feel
in the room? How do I feel? And I actually feel it in my
body.” Second, attention manifested as attentive emotions,
meaning that the therapists paid attention to their own
emotions in the encounter with the client. Attention to
emotions helped express the client’s story; for example, “I,
too, was activated by [the client] in a negative way. And
then I did an inner mental check. What did it mean for me
to suddenly feel aggression towards her?” Third was the
notion of attentive art, meaning that most interviewees
gleaned further information about their client through the
artwork, process, and art objects present in the therapeutic
setting. Mira told a story about a client whose mother had
died in a terrorist attack: “He was busy building houses,
every time with a different shape and color. And I remem-
ber that each house felt like I had been punched in the
stomach from the deeper meanings of those houses.”
Joining With the Client. The interviewee’s presence
in the therapeutic setting was defined not only as that of an
observer, but also as a participant. Therapists reported try-
ing to join with clients by actively entering into their experi-
ence. For example, “I let the client lead me, but I’m not just
following, I’m aware of what’s going on and shine a light on
the path we are walking down.” The construct of joining
considers the client’s wants and needs through enhanced
understanding of the client. In joining, the therapist makes
an active choice between different ways of being. This is an
inner dilemma the therapist experiences, which is not
always expressed behaviorally:
I feel that the role I play in the encounter changes according
to how I interpret the needs of the client. If she’s a teenager
and she needs a comforting grandma, I will be that grandma.
If she needs a friend, I will find the teenager that is still in
me and be on her level.
Data analysis showed that the theme of joining recurred
in most interviews. Although wanting to join with their cli-
ents, most of the interviewees also set limits on this stance.
They acknowledged that they drew the line when it came
to aggressive behavior, saying, for example, “I won’t allow
the client to hit me. That’s a boundary I won’t cross.”
Sometimes the boundaries were not so clear-cut, though.

Table 1. Art Therapists’ Reported Experience of Presence: Themes

Components of Art Therapists’ Art Therapist Preparation for Influences on Art Therapists’
Therapeutic Presence Therapeutic Presence Therapeutic Presence
Attentive focus Preparing for a specific client Factors emanating from the client’s
presence
 On the body  Preparing the setting
Development over time
 On emotion  Preparing mentally
 On art  Preparing through supervision Presence and qualities of art materials
and subsequent preparation
Accessibility (i.e., accessing what is
Joining with the client Strengthening through personal on one’s mind)
enrichment
External factors to the therapeutic
Sense of flow in oneself
 Accumulation of theoretical relationship
Unknown allowed to be present knowledge
 Belief in the therapeutic
Sense of being entirely present process
 Belief in the power of art
 SCHWARZ / SNIR / REGEV
There were incidents described as creating a dilemma for
the therapist between joining the client or working accord-
ing to the client’s therapeutic needs and setting boundaries,
as in the statement, “Somehow I go with his every whim.
The room is very small and he wants to fill containers with
water, so I put a bucket in the room.” Thus, the joining
behavior spurs therapists to examine their therapeutic
presence.
Perceiving a Sense of Flow in Oneself. Most inter-
viewees felt more present when they experienced a psycho-
logical sense of flow in the therapeutic process. Amalya
described this state as being without gravitational force: “A
client enters the room and I let my mind wander. Heart,
mind, and soul just wanders.” Movement, freedom, and
vitality were the terms the interviewees used to describe
their therapeutic presence. For Limor, some of the aspects
that have developed over the years were her “flexibility,”
“elasticity,” and “ability to have a range as a person and as a
therapist.”
The Unknown Is Allowed to Be Present. When
entering the therapeutic setting, most interviewees reported
that they allowed the unexpected and unknown to ensue by
opening themselves up to whatever might occur. For exam-
ple, one participant reflected, “I don’t come to each
encounter with a preconceived notion. I remember the
therapeutic history of the patient. I remember the issues
that came up during the therapeutic process, but I am also
open to whatever may come.”
A Sense of Being Entirely Present. Most interviewees
described their therapeutic presence as a complete presence
that was not partitioned into being a therapist and being a
person. They perceived their presence as a whole body–
mind experience, with such personal characteristics as dic-
tion, sense of style, and personality traits. This meant for
Shira that a client might meet her “inner child” as well as
her “internalized objects, [her] parents.” In a similar fash-
ion, art was reported to be a central part of their whole pres-
ence. Some interviewees emphasized that for them to be
wholly present meant engaging in art, because art consti-
tutes such a significant part of their lives; as in the state-
ment, “I know that for me, that kind of expression
[through art] was there way before I became a therapist. It’s
like it was always there.”
Preparation for the Therapeutic Presence of the
Art Therapist
Therapeutic presence is not a guaranteed experience in
the therapeutic encounter; thus, preparation for it helps it
to emerge (Geller & Greenberg, 2012). Accordingly, most
interviewees actively prepared to be present in the therapeu-
tic encounter.
Preparing for a Specific Client. In preparation for a
specific therapeutic encounter, most interviewees paid
attention to the therapeutic setting by adjusting it to the cli-
ent’s therapeutic needs as well as to their own. Galit specifi-
cally assigned different materials to the top and bottom
shelves of her open cupboard for one young overwhelmed
15
client. “On the top shelves I put the acrylic paints and other
material which are more regressive,” making it harder for
him to reach those materials by himself and thereby giving
her more control during the encounter. Some interviewees
prepared mentally by reading the client’s case history or by
performing a ritual of preparation, such as one interviewee
who explained, “I have a transition process which is like a
prayer. It feels like when you’re tuning an instrument. I
tune myself, the instrument.”
Another important way that most interviewees identi-
fied as helpful to presence was supervision and processing
the session afterward. When information gathered in the
session is processed and assimilated, it might be easier to
join the client more attentively in the next session. For
example, “You keep on working on the countertransference
and process it. It’s constant work emotionally and
cognitively.”
Strengthening Through Personal Enrichment. The
interviewees described the ways they attempted to facilitate
and deepen their therapeutic presence in their day-to-day
lives. Most interviewees discussed the theoretical knowledge
that they had accumulated over the years. Their growing
expertise enabled them to be confidently present in the
therapeutic setting, as suggested by the statement, “I know
how emotionally important knowledge is for me. How it
makes me feel secure and confident.”
Most interviewees approached the therapeutic encoun-
ter with a sense of belief in its power to heal. Mira said, “I
came with a very strong will to be empathic, and enable the
client to get to a better place than he is in now.” They also
believed in the inherent power of art to heal. Art has the
ability to bypass defense mechanisms and help clients
express their feelings directly; for example: “This child kept
creating art and something in him opened up. The process
was whole, and the healing power of art came through.”
Influences on the Therapeutic Presence of the Art
Therapist
The third category of themes that emerged from the
data analysis had to do with influences on therapeutic pres-
ence. These themes comprised factors emanating from the
client, the development of therapeutic presence over time,
the presence or qualities of the art materials, access to what
might be on the therapist’s mind on a particular day, and
factors external to the therapeutic relationship.
The Clients’ Presence. Most interviewees described
situations in which the client influenced their therapeutic
presence. The interviewees investigated their presence
alongside their clients, thinking that perhaps countertrans-
ference was also in play. Shira recalled an encounter with a
client when she was very tired: “Suddenly he started sharing
his problems with me. I was fascinated but couldn’t remem-
ber what I said because I was so tired.” She only later real-
ized that she had acted like the client’s tired mother, which
seemed to be what he needed in that moment.
Development Over Time. The element of time was
another influence and included both the therapeutic process
16 THE THERAPEUTIC PRESENCE OF THE ART THERAPIST
over time with a specific client and time as a process in the
personal development of the therapist. A few interviewees
observed changes in presence with the same client over the
course of therapy. Amalya felt that softer parts of herself
were more present as the therapeutic relationship devel-
oped, saying, “In the beginning I perceive my presence to
be more controlled. When the therapeutic relationship
deepens and my understanding of the client grows, my
presence softens and becomes more flexible, more me.”
Most interviewees viewed their therapeutic presence change
as their professional self developed; for example, “The first
years were really difficult, I didn’t trust my intuition.
Today, I’m genuinely present.”
Presence and Qualities of the Art Materials. Some of
the interviewees perceived their therapeutic presence as
being aided or hindered by the art materials in the thera-
peutic setting. For some, the materials ensured they would
be more present in the therapeutic setting. For example,
one interviewee said, a client “was sucking all the energy
out of me, so I tried to steer her to start working with the
art materials.” For other therapists, some art materials and
the way the clients used them hindered presence by causing
the therapist to feel less secure. Billy said, “Plaster is white,
powdery and cold; it doesn’t give me a good feeling.”
Accessibility (“What Is on My Mind”). Some inter-
viewees discussed how ideas, emotions, and experiences
that were accessible to them prior to the therapeutic
encounter were noticeably more prominent in their minds
during therapy. Galit noted, “I’m very much influenced by
the theory I’m studying in the ‘here and now.’ Now I’m
studying Frances Tustin, so her theory comes readily to
mind during the therapeutic session.”
External Factors to the Therapeutic Relationship.
Most interviewees addressed a number of external factors
that influenced their therapeutic presence, such as the
parents of the client, the person who referred the client to
therapy, where the therapy took place, and others. For
Lucy, working in a school meant the therapy had a limited
time frame that made her scared that she would not have
enough time with the client, “so there’s a dilemma whether
to pay attention to that, or to what’s going on in the
therapy.”
Discussion
The study findings shed light on the factors that come
into play with therapeutic presence from the perspectives of
a sample of female Israeli art therapists. These include being
actively attentive, open-minded, and flexible in the thera-
peutic setting. A number of contextual elements were
shown to be so intertwined with therapeutic presence that
one cannot be discussed without the others, such as preses-
sion preparation, the art materials used in session, and the
therapeutic setting.
Art therapists engage in becoming present and attentive
in the therapeutic encounter to glean deeper information
about clients. This position is consistent with the psychody-
namic approach, which most participants stated was a cen-
tral component in their theoretical orientation. Basically,
the therapists asked themselves two main questions: (a)
How much information about my client will I obtain from
this source? and (b) How significant is this source to me?
Their emotions and embodied presence were considered to
be highly important means of information. This was also
true of art, given that the artistic process and the use of art
materials provide art therapists with a great deal of informa-
tion about their clients’ subjective emotions and percep-
tions (Snir & Hazut, 2012). Thus, therapeutic presence
might be somewhat paradoxical in that the art therapists
reported being simultaneously focused on themselves but
doing so expressly in the service of their clients.
Although the theme of attentive focus was experienced
as primarily a passive process, interviewees described the
process of joining as highly active. Therapists used their
nascent understanding of clients’ experiences to tailor their
presence to best suit specific needs. This finding corre-
sponds to Kossak’s (2009) definition of therapeutic attune-
ment in the expressive therapies as that of promoting
growth and change in therapy. Nonetheless, art therapists
must frequently assess whether joining the client could hin-
der the client’s therapeutic goals. For example, joining
might not be appropriate when it encourages clients to
behave destructively, thereby potentially inhibiting the art
therapist’s therapeutic presence. Furthermore, the art thera-
pists experienced movement, uncertainty, and a sense of
completeness in their presence. These experiences corre-
spond to ideas found in Buddhism such as the illusion of
stability, uncertainty, and wholeness (Pelled, 2007) that the
participants found deepened their presence of being.
Consistent with Geller and Greenberg’s (2012) study,
our results suggest that an art therapist’s therapeutic pres-
ence could be enhanced by preparation. Presession prepa-
ration in art therapy includes preparation and display of
art materials. When the interviewees described this pro-
cess, they suggested a parallel internal process of prepara-
tion going on for them as well. Thus, preparation could
mean external and internal processes of adapting the art
materials to a specific client’s needs, goals, and issues
(Pesso-Aviv, Regev, & Guttmann, 2014). Additionally,
mental preparation and preparation through supervision
were perceived as instrumental in gaining a better compre-
hension of clients. Supervision was seen as an opportunity
for therapists to connect theory and practice and to attune
their therapeutic presence, which might explain why the
participants reported not being preoccupied with theory
during the therapeutic encounter. However, the interview-
ees also stressed the importance of theoretical knowledge
for enhancing therapeutic presence, and being able to
access this knowledge during therapeutic encounters in
particular. Theoretical thoughts might assist therapeutic
presence when integrated into preparation for therapy, but
can disconnect therapists from their clients when these
thoughts take place during the therapeutic encounter. As
noted by Sucharov (2013), “Knowledge, especially if it is
held tightly, pulls us away from complexity. At the experi-
ential level we run the risk of violating our clients’ precari-
ous sense of wholeness, thereby falling out of connection”
(p. 391).
 SCHWARZ / SNIR / REGEV
Among the themes identified that influence the art
therapists’ therapeutic presence were the client, which was
indicative of the asymmetry of the therapeutic relationship
(Aron, 1996); time, and particularly its quality as the thera-
pist becomes more deeply involved with the client; and art
materials, either in strengthening an art therapist’s sense of
security and confidence in the therapeutic setting, thus
enhancing their therapeutic presence, or in contributing to
feelings of insecurity and potentially restricting presence
(Geller & Porges, 2014; Nissimov-Nahum, 2013). The
accessibility theme refers to the therapist’s thoughts, feelings,
and issues prior to the therapeutic encounter, which
increases the likelihood of being attuned to related issues
that might be present in therapy. This theme emphasizes the
importance of continuing to engage in ongoing learning, as
mentioned briefly in the context of theoretical knowledge.
The final theme, external factors, surprisingly did not include
mention of the therapists’ personal lives as an influence on
their therapeutic presence in sessions. When their personal
life did come up in the interviews it was in connection to
their entire presence; that is, of being a complete person with
both personal and professional life components. This finding
might exemplify the asymmetrical nature of the therapeutic
relationship in that the interviewees focused on their clients’
issues and therapeutic needs rather than their own when
addressing external factors.
Art is found in all three of the core categories of the
study findings. Art helps to enhance and influence thera-
peutic presence in a complex relationship. On the one
hand, art can be experienced as part of the art therapists’
presence and aids client understanding. On the other hand,
art can function as an object that is influential yet external
to the art therapists’ presence (Schaverien, 2000). Over the
course of this study it became clear that these aspects of art
do not represent a contradictory relationship with therapeu-
tic presence, but rather a dialectical one, with each factor
contributing to the overall picture (Nissimov-Nahum,
2013) of the art therapist’s presence.
Limitations and Contribution
This study has a number of limitations. The cultural
and gender homogeneity of the sample limit generalizability
of the findings. Additionally, although the interviewees’
therapeutic orientations appeared to vary considerably, the
framework for their practice was clearly psychodynamic.
This uniformity might have biased the findings. Future
researchers might examine the therapeutic presence of art
therapists practicing with different theoretical orientations
to better understand the influence of therapeutic orientation.
Despite these limitations, this study contributes evi-
dence of an important phenomenon in art therapy that is
relatively unexamined in the field’s research literature.
Results demonstrate the salience of being actively attentive,
open-minded, and flexible in the art therapy setting. Inte-
grating a better understanding of therapeutic presence into
art therapy practice can assist art therapists to become more
attuned to their clients, as well as strengthen the therapeutic
relationship. This study also contributes to a better
17
understanding of the complex, dialectical nature of art in
the therapeutic encounter that can assist in attuning to dif-
ferent facets of art in the therapeutic setting. In light of
these findings, future research on this topic is strongly
recommended.
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