TRANSCRIPT: Is art therapy an evidence-based practice?
This is a transcript of a youtube video posted 2/8/2026.
Here’s a question that every art therapist has been asked. Is art therapy an evidence-based practice? What we don’t talk about is what even is evidence and who decides and how much evidence is enough evidence to be evidence-based? And is art therapy ever going to be permitted to cross that evidence-based finish line?
Hi, I’m Malissa Morrell, and I’ve been an art therapist since 2003. I’ve been a graduate instructor since 2015, and now I’m getting a PhD, and I’m researching how therapists do their best work. And I have to tell you, I do not think this evidence-based problem actually belongs to art therapy. As far as I can see, the whole system for every mental health practice is inherently flawed, and I don’t think enough people are talking about it.
I went back to school after a very long career and it was not because I thought art therapy was broken or art therapists needed to change. It was because I just kept seeing the same patterns over and over again and I didn’t know what to do about it. Art therapy is always being devalued and diminished and dismissed and we get all these demands for more evidence but nobody will tell us what kind of evidence they want. And we have a field full of art therapist colleagues who are doing incredible work.
But they still feel like they have to prove themselves. So the more I study, the more I see signs that this frenzy around standardized treatments and manualized treatments and evidence-based whatever is starting to fade. Finally.
And get that some people are going to want to consider me some kind of expert because I have nearly 25 years of working and supervising and teaching and now researching, but I’m trying to be in community with regular therapists who are willing to believe something radical. That the art therapists who are doing the work
are actually the experts. And I think part of my job is to figure out how to amplify and validate all of that wisdom.
And I have spent years reading research, not just art therapy research, research about research, research about therapists, research about how these clinical trials actually work, who’s getting included in our samples and who’s getting excluded from our samples.
So let’s look at what some of the research says about evidence-based treatments because it might not be what you’ve heard. The whole premise of manualized treatment is this. If therapists just follow the treatment manual, the client gets better. And in this framework, your job as a therapist is literally just to carry out the protocol.
Don’t deviate, don’t ask questions, definitely don’t adapt anything. The manual tells you what to do and you do it.
And I guess that sounds reasonable if you think about science in certain ways. But here’s the problem. It’s now commonly accepted that between 30 and 65 % of real world clients don’t respond to the evidence-based treatments that we’re being required to
In fact, recently, treatment resistant PTSD has become a whole research category and it’s not because the clients don’t respond. It’s because the treatments themselves don’t work for a huge chunk of people.
I know that’s not what you’ve been told, but on top of the clients who don’t respond to our treatments, a 2019 study found that on average, 86 % of real world clients would have been excluded from the exact same studies that validated the treatments that we have to use with real world clients. Some of the studies excluded up to 99.8 % of people who would have been found in real world clinics.
The problem is actually getting worse, not better.
So the therapies that you’re required to use have largely been tested on ideal clients in controlled settings and your actual clients, they probably haven’t been studied at all. Another 2019 study found that manualized therapy is not actually more effective than non-manualized therapy. Even though your boss and your jobs policies and the insurance companies that pay us
even though they all expect us to use them. Manualized therapy is not more effective than non-manualized therapy. So a therapist who’s really, really good at following the manual doesn’t actually improve the client’s outcomes.
Standardizing therapy makes it more researchable, but it doesn’t necessarily make it better.
When clients don’t improve, the system doesn’t question the manual. It assumes that you, the therapist, just didn’t do it right. So then what? Then they do more check-ins and observations and audits to make sure that you get better at following the manual.
The researchers blame the therapists. The therapists are taught to blame themselves and the clients go home just thinking they’re broken because TikTok told them that the treatment was gonna work.
But like I tell my students all the time, research is based on averages, not individuals. But your work is based on individuals, the person right in front of you.
So how does this relate back to art therapy?
In my experience, art therapists have often resisted manualization of art therapy and it isn’t because of ignorance or stubbornness or some sort of anti-science woo-woo. It’s professional instinct because research shows that art therapists are willing to use evidence-based practices and most of the settings that art therapists work in require evidence-based practices. The problem is, and we all know it,
The minute you introduce art, you’re off script. You can’t standardize what the client creates and how you should respond to it. You can’t script how these things are gonna go. Art therapy requires a level of personalization that most evidence-based practices just can’t accommodate. It’s art therapy’s flexibility that has been dismissed as resistance to research,
I think art therapists feel like art therapy is behind the research game, but science is finally starting to catch up to us.
For example, a 2024 study of treatment resistant PTSD found that our best interventions at the moment are the ones that are moving away from traditional talk therapy.
Ask any art therapist, that just makes sense. Another recent study found that both verbal memory and processing delays can predict treatment non-response.
Any art therapist could have told you that. So all of a sudden, art therapy doesn’t look so anti-science.
In 2022, and I love this so much, there were two big name, long time therapy researchers who came forward and issued a public apology for their role in the manualization of therapy. Here’s what they said. “It is crucial to flexibly follow the patient, not slavishly worship the manual. People are complicated and their problems are far too individual and specifically personal to
ever be comprehended within any set of rules.”
Another prominent researcher recently said, “Fueled by growing criticism that disorder-specific manuals fail to address an individual’s complexity, research paradigms are currently shifting toward personalization.”
You guys, the era of one size fits all treatment manuals might actually be coming to an end. And art therapists are uniquely positioned to show the world what it looks like to practice without them.
There is a ticking clock. The profession of art therapy is facing real threats and I am going to talk about them in an upcoming video, which I will link in the description after it’s posted.
I know we just met, but I like to live by a philosophy called “learning in public.” And what that means is that I want to put my ideas out there because I expect that other people know more than I do. And I actually want people to call me out when I’m wrong or when I’m missing something. So I hope you will. I’m going to read every comment and I’ll actually spotlight the most helpful comments in future videos because everyone is a teacher when you’re open to learning.
So if any of this resonates with you, if you’ve ever felt the pressures of evidence-based requirements, or if you’ve ever had to justify your work to a bunch of skeptics, or if you’re the kind of therapist that struggles to use the right research language to articulate why art therapy matters, stick around.
So now you know more about how the evidence-based system is fundamentally flawed.
In the next video, I’m gonna light up the two ways that art therapists tend to drift from their training and why most therapists don’t even notice that it’s happening.
You might feel called out in that one, but no judgment. I’ve been there too, and it’s totally fixable.
I’ll link that video in the description below when it’s posted, so go check it out. I’ll see you in the next one.
