Adult coloring books, paint-and-sip evenings and weekend workshops that hand out certificates all borrow the same two words. In a January 2016 statement on coloring books, the American Art Therapy Association drew a public line, and its website still makes the point. The association says it does not discourage coloring for recreation and self-care, but that coloring has to be distinguished from services delivered by a credentialed art therapist.
The profession behind that line asks more of its members than its nearest neighbor does. Music therapists can qualify with a bachelor’s degree. Art therapists, according to the association, are clinicians with master’s-level or higher degrees. Yet the largest trial of art therapy for schizophrenia, a UK study of 417 adults offered a year of weekly 90-minute groups, found no benefit. And the two Cochrane reviews of art therapy contain two studies each.
Both facts are true at once. This article explains what the credentials certify, where the law protects the title and where it does not, what trials found condition by condition, and the ways the research says it can go wrong.
What makes it art therapy rather than an art class
The association defines art therapy as a mental health profession that works through active art-making, the creative process and applied psychological theory, inside a psychotherapeutic relationship. The relationship is the part that separates it from a class. The association also warns that some workshops issuing certificates give attendees “the erroneous impression that art therapy is a modality rather than a profession,” and says genuine art therapy is beyond the scope of practice of people who are not art therapists.
Cochrane’s reviewers borrow their definition from the British Association of Art Therapists, and it corrects a common assumption. Under that definition clients need no skill or experience in art, and the therapist is not primarily concerned with judging the image, either for its aesthetic quality or as a diagnostic test. In that framing the drawing is mainly a way of communicating, rather than a test to be scored.
The wider field of arts in health is far bigger and much looser. A 2019 scoping review for the World Health Organization’s European office, published as Health Evidence Network synthesis report 67, drew on results from over 3,000 studies and identified a major role for the arts in preventing ill health, promoting health and supporting treatment. Its evidence ranged from small pilot studies and case reports to large cohort studies and randomized trials. The report’s summary speaks of the arts and arts engagement in general terms and does not separate arts therapies from arts activities, so a headline citing thousands of studies is not a claim about art therapy as a profession.
That labeling problem cuts across the creative therapies. This library’s music therapy article explains how much research filed under one therapy’s name tested something else, and the same caution applies below.
The credentials, from provisional to board certified
Art therapy credentials come from the Art Therapy Credentials Board, which the association describes as an organization independent of itself. The ladder has four rungs.
- ATR-P, provisional. An active ATR-P is required before someone can become registered, which makes it the provisional stage between graduate education and full registration.
- ATR, registered art therapist. This recognizes graduate-level education. For graduates of programs accredited by the Commission on Accreditation of Allied Health Education Programs, the board requires 1,000 hours of direct client contact with 100 hours of supervision, at least 50 of them from a board-certified art therapist. People with other master’s-level mental health degrees follow an individual bridging plan.
- ATR-BC, board certified. This is open to registered art therapists who pass the board’s national exam. Holders recertify every five years by completing 100 continuing education credits or by passing the exam again.
- ATCS, art therapy credentialed supervisor. This marks board-certified therapists with substantial supervision qualifications. The board’s page does not spell out the hours.
Two details are easy to miss. First, ATR is a registration, not board certification, and the two are easy to conflate. Someone can truthfully call themselves a registered art therapist while holding no state license at all, because the registration is private. Second, only ATR-BC carries outside accreditation: the board says the National Commission for Certifying Agencies has fully accredited that program since 2012. The music therapy credential has held the same accreditation since 1986, 26 years longer. No published count of credential holders could be found.
The credentials board is also clear about its own limits. It says it does not issue, regulate or enforce state licenses, which are granted by state boards, although some states require a passing score on its exam as a condition of licensure. People who pass the exam for a state license are granted the registration and the board certification through reciprocity, so in those states the license and the private credentials travel together.
Here is how the two credentialed creative therapies compare on the points that can be checked:
| Music therapy | Art therapy | |
|---|---|---|
| Entry degree | Bachelor’s or higher | Master’s or higher |
| National credential | MT-BC | ATR, then ATR-BC |
| Outside accreditation of the credential | Since 1986 | ATR-BC only, since 2012 |
| States with a distinct license | 13 (AMTA, February 2026) | 12 plus DC (ATCB list) |
| Named in the 2023 SIO-ASCO cancer guideline | Yes, for anxiety and depression during treatment | No |
| UK protected title | Yes | Yes, as art therapist and art psychotherapist |
Where the law protects the title, and where it does not
Counting the states is harder than it should be, because the two national organizations do not agree.
The credentials board’s state list, which carries no date but refers to 2025 exam materials, shows 12 states plus Washington, DC, with a distinct art therapy license: Connecticut, Delaware, Kentucky, Maryland, Mississippi, Nebraska, New Jersey, New Mexico, Ohio, Oregon, Tennessee and Virginia. In three more states art therapists practice under a different license. Texas offers a professional counselor license with a specialty designation in art therapy through its State Board of Examiners of Professional Counselors. New York licenses creative arts therapists through its Education Department’s Office of the Professions. Wisconsin pairs the registered art therapist credential with a license to practice psychotherapy.
The association’s advocacy page, last updated in May 2025, opens by saying art therapy is regulated in 15 states and DC. Its own lists do not quite match that number. Nebraska, where a licensing bill was signed in March 2024, and Ohio, where a licensing bill was signed in July 2023, appear in the page’s success stories but not in its opening list. The page also counts Pennsylvania and Utah as related-license states, names Arizona, Louisiana and New Hampshire for title protection or state hiring recognition, and notes that Virginia’s proposed regulations were still under executive branch review.
Under the four-bucket test, the title art therapist is defined in regulation in roughly a dozen states plus DC, and folded into counseling, creative-arts or psychotherapy licenses in a few more. In most of the country it is undefined, which means anyone can use it. In those states the practical safeguard is the private credential, and the credentials board describes its own authority as limited to reviewing, issuing and, when needed, disciplining the credentials it grants. The registration and board certification are private third-party credentials, and only the second is independently accredited. How counselors, psychologists and other therapists are licensed more generally is the subject of this library’s overview of the mental-health professions.
The United Kingdom takes the opposite approach. Art therapist and art psychotherapist are both protected titles there. Only people on the national register kept by the Health and Care Professions Council may use either one, as the council’s list of regulated professions states in its May 2025 update.
Schizophrenia: the largest trial, and what blinding did to the rest
The trial called MATISSE, published in the BMJ in 2012, is the profession’s largest test in schizophrenia. It recruited 417 adults with long-standing schizophrenia, average age 41 and average illness duration 17 years, through mental health services in England and Northern Ireland. People were randomly assigned to weekly 90-minute group art therapy for about a year, to weekly activity groups of the same size, or to standard care alone. The activity groups played board games, watched films and visited cafes, and art materials were banned. The researchers who measured outcomes did not know who was in which arm.
At two years there was no difference in overall functioning or in symptoms. On one secondary measure, the activity groups did better than art therapy: people in them had fewer positive symptoms, such as hallucinations and delusions, at 12 and 24 months. Attendance was a real problem. Almost 40 percent of people offered art therapy never went to a session, and the median wait from randomization to a first group was about two months. Among those who did go, the typical person attended 11 art therapy sessions over the year, and many groups had only one or two regular members, so the group interaction the therapy relies on was often thin. But an analysis designed to estimate the effect for people who did attend found that going more often was not linked to better outcomes.
The authors wrote that their results challenged UK guidance at the time, which advised clinicians to consider referring everyone with schizophrenia to arts therapies, a group label that covers several creative therapies. They also noted that trials of music therapy and body movement therapy in schizophrenia looked more promising than their own result.
The older evidence does not rescue the picture. The 2005 Cochrane review on art therapy for schizophrenia noted that the practice grew up largely in adult psychiatric inpatient units, for people with whom talking therapy was not possible. It found two studies with 137 people, one small difference in negative symptoms, and concluded that benefits and harms remained unclear. The review dates from 2005.
A 2019 meta-analysis from the University of Hertfordshire pooled nine randomized trials and 948 people under the umbrella of art therapies. Only three of the nine tested visual art therapy. Three tested music therapy, two body psychotherapy and one dance. Across all nine, negative symptoms such as withdrawal and flat emotion improved by a small amount. But in the six trials where assessors were blinded, the effect shrank to a small figure that could not be distinguished from zero. The three unblinded trials produced a large one. Adjusting for studies that were probably missing from the published record reduced the overall effect to almost nothing. The authors also found larger effects in trials with more women and with younger patients, patterns that later trials could test directly.
Graded by claim, group art therapy offered broadly to people with established schizophrenia is tested and not supported, on the strength of its largest blinded trial. The claim that arts therapies as a category reduce negative symptoms rests on unblinded trials, and disappears under blinding.
Dementia, trauma, cancer and everyday mental health
Dementia. The 2018 Cochrane review found two eligible studies, with 60 people analyzed out of 88 randomized. One compared group art therapy with simple arithmetic activities over 12 weeks, the other with recreational activities over 40 weeks. Neither showed clear differences, and the evidence was rated very low in quality. That is insufficient evidence to assess, in the sense that it has barely been tested.
Trauma. A 2015 systematic review by Dutch researchers found only six controlled studies of art therapy for traumatized adults. Trauma symptoms fell significantly in half of them. A 2025 meta-analysis of creative arts therapies for post-traumatic stress disorder pooled seven studies and found a large average benefit, but the results varied so much between studies that the average means little. Its subgroup analysis credited drama therapy most, with art therapy showing less pronounced effects. For refugee children and young people, a 2022 review from the American University of Beirut found eight eligible studies from 2010 to 2020 and, judged against formal standards for evidence-based practice, classed art therapy as having insufficient evidence despite its promise.
Cancer. A 2024 review of creative arts therapy for adults with cancer, in which most studies used painting, drawing or sculpture, found 25 studies but only eight randomized trials, with moderate to high risk of bias. Quality of life improved; depressive symptoms did not differ from controls. Labels matter here too. A 2026 meta-analysis of creative arts therapies in cancer pooled 67 randomized trials, but 80.6 percent of the interventions were music-based, so its encouraging findings, rated low to very low in certainty, are mostly about music. The 2023 integrative oncology guideline that ASCO issued jointly with the Society for Integrative Oncology names music therapy for anxiety and depression during treatment, while art therapy is absent from ASCO’s summary of its recommendations.
Depression, anxiety and related conditions. A 2015 assessment for the UK’s national health research program reviewed 15 randomized trials with 777 people who had mental health problems other than psychosis. Pooling the data was impossible. Ten of the 15 trials favored art therapy, but trial quality was generally low. The authors’ economic model found group art therapy cost-effective against a waiting list with high certainty, while noting it was unclear how well that applied to the wider population. Against group talking therapy, the talking therapy looked more cost-effective, though with considerable uncertainty and a real chance that art therapy was the more effective of the two.
Documented risks, and when to involve your clinician
The same UK assessment included a review of qualitative studies, research built on interviews about people’s experience. It identified three areas of potential harm. The first is emotions stirred up in sessions and then left unresolved. The second is a lack of skill in the art therapist. The third is therapy that ends suddenly. Each is a reason the credential matters.
The two Cochrane reviews could not assess harms at all. In MATISSE, serious adverse events, including deaths, occurred during the two years of follow-up, and the investigators judged that none was related to the interventions. The trial’s finding that the activity groups had fewer positive symptoms than the art therapy groups does not show that art therapy caused harm, and should not be read that way.
Tell the clinician who manages your care if sessions leave you with distress that does not settle between appointments, if a therapist ends the work abruptly, or if the symptoms you sought help for get worse. Every trial described here added art therapy on top of standard care. Changing anything else in your treatment is a matter for the clinician who manages it.
Payment follows the same narrow federal route as music therapy. Medicare’s rule for partial hospitalization programs covers individualized activity therapies only when they are not primarily recreational or diversionary, which is the art-class distinction written into federal regulation. The regulation itself never names art, but the billing code used for these sessions lists art alongside music, dance and play. Private insurance coverage could not be documented for this article.
Checking an art therapist before the first session
- Ask which credential they hold. ATR-BC is board certification. ATR is registration. A workshop certificate is neither.
- Ask whether your state issues a distinct art therapy license, or whether they practice under a counseling, creative arts or psychotherapy license, and get the license number so you can look it up with the state board.
- Ask what the goals of the work are and how progress will be judged, because a defined goal inside a therapeutic relationship is what separates therapy from an activity.
- Ask how they will coordinate with your doctor or other therapist.
- If the person offers art sessions for relaxation or self-expression without a clinical credential, that can be worthwhile, but it is an arts activity, and it should be described as one.
The bottom line on art therapy
The useful summary is a mismatch. Art therapy demands more training at entry than music therapy, yet it has fewer trials, smaller Cochrane reviews, no recognition in the main integrative cancer guideline, and a large blinded trial that found no benefit in the condition where UK guidance had backed it. Evidence elsewhere is too thin to judge, not proven to fail. When you read that art therapy works, the two questions that sort the claim fastest are whether the trials tested visual art therapy rather than a creative-arts bundle led by music, and whether the people scoring the outcomes knew who had received it.
Sources
- American Art Therapy Association. “About Art Therapy (definition; master's-level entry; statements on workshops and coloring books; page modified February 2024).” arttherapy.org
- American Art Therapy Association. “Credentials and Licensure (ATCB described as independent of AATA; page modified July 2024).” arttherapy.org
- American Art Therapy Association. “State Advocacy (headline count of 15 states and DC; section last updated 9 May 2025).” arttherapy.org
- Art Therapy Credentials Board. “About ATCB (ATR-BC accredited by the National Commission for Certifying Agencies since 2012).” atcb.org
- Art Therapy Credentials Board. “2026 ATR Credential Requirements (1,000 direct client contact hours and 100 supervision hours for CAAHEP-accredited program graduates).” atcb.org
- Art Therapy Credentials Board. “Board Certification (ATR-BC eligibility and five-year recertification).” atcb.org
- Art Therapy Credentials Board. “Art Therapy Credentialed Supervisor (ATCS).”
- Art Therapy Credentials Board. “State Licensure (ATCB does not issue, regulate or enforce state licenses; exam reciprocity).” atcb.org
- Art Therapy Credentials Board. “Licensure Requirement by State (12 states plus DC with distinct licenses; Texas, New York and Wisconsin under related licenses).” atcb.org
- Health and Care Professions Council (United Kingdom). “The professions we regulate: protected titles for arts therapists (page updated 12 May 2025).” hcpc-uk.org
- World Health Organization Regional Office for Europe. “What is the evidence on the role of the arts in improving health and well-being? A scoping review. Health Evidence Network synthesis report 67 (5 November 2019).” who.int
- Cochrane Database of Systematic Reviews. “Deshmukh SR, Holmes J, Cardno A. "Art therapy for people with dementia." Cochrane Database Syst Rev, 2018. PubMed. DOI: 10.1002/14651858.CD011073.pub2.” pubmed.ncbi.nlm.nih.gov
- Cochrane Database of Systematic Reviews. “Ruddy R, Milnes D. "Art therapy for schizophrenia or schizophrenia-like illnesses." Cochrane Database Syst Rev, 2005. PubMed. DOI: 10.1002/14651858.CD003728.pub2.” pubmed.ncbi.nlm.nih.gov
- BMJ. “Crawford MJ, Killaspy H, Barnes TRE, et al. "Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial." BMJ, 2012. PubMed. DOI: 10.1136/bmj.e846.” pubmed.ncbi.nlm.nih.gov
- World Journal of Psychiatry. “Laws KR, Conway W. "Do adjunctive art therapies reduce symptomatology in schizophrenia? A meta-analysis." World J Psychiatry, 2019. PubMed. DOI: 10.5498/wjp.v9.i8.107.” pubmed.ncbi.nlm.nih.gov
- Trauma, Violence & Abuse. “Schouten KA, de Niet GJ, Knipscheer JW, Kleber RJ, Hutschemaekers GJM. "The effectiveness of art therapy in the treatment of traumatized adults: a systematic review on art therapy and trauma." Trauma Violence Abuse, 2015. PubMed. DOI: 10.1177/1524838014555032.” pubmed.ncbi.nlm.nih.gov
- BMC Psychology. “Wang J, Zhang B, Yahaya R, Abdullah AB. "Colors of the mind: a meta-analysis of creative arts therapy as an approach for post-traumatic stress disorder intervention." BMC Psychol, 2025. PubMed. DOI: 10.1186/s40359-025-02361-4.” pubmed.ncbi.nlm.nih.gov
- Frontiers in Psychology. “Annous N, Al-Hroub A, El Zein F. "A Systematic Review of Empirical Evidence on Art Therapy With Traumatized Refugee Children and Youth." Front Psychol, 2022. PubMed. DOI: 10.3389/fpsyg.2022.811515.” pubmed.ncbi.nlm.nih.gov
- Supportive Care in Cancer. “Abu-Odah H, Sheffield D, Hogan S, Yorke J, Molassiotis A. "Effectiveness of creative arts therapy for adult patients with cancer: a systematic review and meta-analysis." Support Care Cancer, 2024. PubMed. DOI: 10.1007/s00520-024-08582-4.” pubmed.ncbi.nlm.nih.gov
- Psycho-Oncology. “Chou ASL, McKechnie T, Arora V, et al. "Creative Arts Therapy for Anxiety, Depression, and Quality of Life in Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." Psychooncology, 2026. PubMed. DOI: 10.1002/pon.70425.” pubmed.ncbi.nlm.nih.gov
- Health Technology Assessment (National Institute for Health Research, UK). “Uttley L, Scope A, Stevenson M, et al. "Systematic review and economic modelling of the clinical effectiveness and cost-effectiveness of art therapy among people with non-psychotic mental health disorders." Health Technol Assess, 2015. PubMed. DOI: 10.3310/hta19180.” pubmed.ncbi.nlm.nih.gov
- American Society of Clinical Oncology and Society for Integrative Oncology. “Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: 2023 recommendation summary table (recommendations 1.5 and 3.3, evidence quality low, strength moderate).”
- American Music Therapy Association. “Requirements to be a music therapist (bachelor's or higher from one of over 80 approved programs; 1,200 clinical hours; page undated).” musictherapy.org
- American Music Therapy Association. “Music Therapy National Overview, February 2026 (13 licensure states, 4 registry or state certification, 2 title protection).”
- Certification Board for Music Therapists. “About CBMT (established 1983; NCCA accreditation since 1986; over 10,000 MT-BC holders).” cbmt.org
- Legal Information Institute, Cornell Law School (text of the Code of Federal Regulations). “42 CFR 410.43, Partial hospitalization services: Conditions and exclusions.” law.cornell.edu
- AAPC (HCPCS code reference). “HCPCS code G0176: Activity therapy, such as music, dance, art or play therapies not for recreation.” aapc.com