From Black Box to Shared Language: How ArTA Strengthened Clinical Documentation at Ciro

How can we make what happens in art therapy visible, understandable, and meaningful for colleagues within the multidisciplinary team? And how do we translate rich observations from the art-making process into an Electronic Health Record (EHR) without losing the essence of our profession?

These are questions that regularly come up in conversations with art therapists participating in ArTA training. In fact, they are among the issues many colleagues begin to wrestle with once they become familiar with the language of ArTA. As soon as you discover how much information material interaction, material experience, and the art product can reveal about a person's balance and adaptability, it becomes almost impossible not to want to share those insights with others.

With ArTA Stories, I hope to collect and share experiences from clinical practice. Not only to inspire one another, but also to learn from each other. How are colleagues applying ArTA in their own settings? What works well? What challenges do they encounter? And what lessons have they learned along the way?

For this first ArTA Story, I spoke with Lara Maessen-Schaefer, an art therapist at Ciro in Horn, the Netherlands. Lara completed both the ArTA Basic Course and the Advanced ArTA Course. Together with her colleague Lisanne Collewijn, who completed the Basic Course and will continue with the Advanced Course next year, she used the implementation of a new Electronic Health Record (EHR) system as an opportunity to structurally integrate ArTA into their clinical documentation.

Their experience illustrates how a shared professional language can not only improve the quality of documentation, but also strengthen the position of art therapy within a multidisciplinary treatment team.

About Ciro

Lara works at Ciro, a specialised treatment and expertise centre for people with complex chronic respiratory disease, heart failure, and sleep-related breathing disorders. Professionals from a wide range of disciplines work closely together to support patients with often complex and long-term health conditions. Research is an integral part of the organisation. Ciro has collaborated closely with Maastricht University Medical Center+ (MUMC+) for many years and, since 2010, has been part of a formal partnership in which clinical care, research, and innovation reinforce one another.

Introduction: From Implicit Knowledge to Explicit Language

For many years - and perhaps some of you will recognise this from your own practice - art therapy has often had a rather elusive image among other healthcare professionals. Almost like a black box: everyone knows that something valuable happens during a session, but what exactly? And how does it contribute to assessment or treatment?

For art therapists, the connection between artistic expression and mental health often feels self-evident. Every day, we observe how clients engage with materials, the choices they make, how they respond to challenges, and what their artwork reveals about the way they function.

Yet translating these observations into language that resonates with colleagues can be surprisingly difficult. How do you explain them during a multidisciplinary team meeting? How do you document them in an Electronic Health Record? How do you put into words the richness of observations that feel so familiar to us? This is precisely where many colleagues have found ArTA to be invaluable.

What I often hear from participants in ArTA training is that the method provides a language that feels familiar to art therapists while also being understandable to other professionals. There are several reasons for this.

First, the research underpinning ArTA shows that a limited number of aspects of the art-making process are meaningfully related to mental health: material interaction, material experience, and the art product. Not everything that happens during a session has diagnostic significance. This makes the observations more focused and concrete.

In addition, these aspects are linked to balance and adaptability. These concepts are not tied to a specific diagnosis, but are relevant across almost any treatment context. This makes them a good fit with the language used by other disciplines.

And perhaps equally important: ArTA is research-based. It provides an evidence-based framework that makes what happens in art therapy more visible and easier for others to understand and follow.

Art therapy educators also regularly identify this as an important benefit. A shared professional language contributes to a clear and recognisable professional identity. The more consistently we communicate about our profession, the stronger the position of art therapy within organisations, educational programmes, and collaborative networks.

A Practical Example: An Opportunity to Do Things Differently

When Lara and her colleague Lisanne completed their ArTA training, something else was happening at Ciro at the same time: the organisation was introducing a new Electronic Health Record (EHR) system. While many therapists might see a system change primarily as a challenge, they saw an opportunity.

“ArTA provides a clear language that makes it easy to bring our colleagues on board. It makes what we observe very concrete and shows how these observations contribute to our understanding of the patient. It helps our colleagues understand what we do in art therapy, why we do it, and how it works. It makes our work more visible, and communication has become smoother as a result.”

According to Lara, before using ArTA, finding the right words was often difficult.

“We tried to translate what was happening in art therapy into the language used by psychologists. But that remained difficult. What exactly do we mean by ‘the medium’, for example? And how does drawing or painting actually contribute to assessment and treatment?”

Once she and Lisanne both started working with ArTA, this changed.

“Because we were speaking the same language and using it consistently in our communication, it really started to take hold. Balance and adaptability are concepts that every discipline is concerned with. This makes it clearer what art therapy contributes and why it is relevant to the patient. The fact that ArTA is evidence-based also helped.”

Less Writing, More Meaning

An interesting benefit Lara highlights is that ArTA has actually made their clinical documentation more straightforward.

“Systematically observing material interaction, material experience, and the art product saves us a lot of time compared with the way we used to document.”

Where their documentation previously consisted of lengthy descriptions, ArTA provides a clear structure. This makes it easier to identify what is relevant and, importantly, why it is relevant.

What Does ArTA Look Like in the EHR?

When Ciro transitioned to EPIC, the different disciplines were asked what information they wanted to document and how they wanted to document it.

For Lara and Lisanne, the answer was clear: ArTA needed to have a place within the new system. Their documentation consists of two components.

1. A Brief Form for the Multidisciplinary Team

This section is visible to all professionals involved in the patient's treatment and includes:

• the goals of art therapy;

• a brief explanation;

• the main findings from art therapy, particularly material interaction, material experience, and the art product;

• what these findings mean in terms of balance and adaptability;

• the implications for treatment.

This gives colleagues a quick overview of what art therapy contributes to the overall treatment process.

2. The Clinical Reasoning Process in Art Therapy

The second form is more comprehensive and primarily intended for the art therapist. Lara and Lisanne refer to this section as “Clinical Reasoning Process in Art Therapy.”

Although other colleagues can access it, it is mainly intended to support the art therapist's own documentation, monitoring, and clinical reasoning.

The structure largely follows the ArTA Observation Form.

Step 1: Recording the Materials and Instructions

The documentation starts by recording:

• the materials used;

• the techniques applied;

• whether the materials were chosen by the patient or provided by the therapist;

• the instructions given.

There is also space to note any relevant details, for example when a patient primarily copies or imitates, or conversely experiments in order to engage in the art-making process.

Step 2: Observing Material Interaction

For each category of material interaction, a set of response options has been developed.

For example:

Category	Options
Movement	large – small – not prominent
Tempo	fast – slow – not prominent
Force	much – little – not prominent

A similar set of options is available for each observation category.

Lara explains that they deliberately chose to keep the options simple.

“For us, it is mainly the extremes that are relevant when determining whether the material interaction is more rational or more affective in nature.”

After completing the individual categories, there is an open text field in which the overall pattern of material interaction can be described and interpreted.

Step 3: Recording Material Experience

Within material experience, they record:

• whether the patient is able to connect with feelings;

• whether bodily sensations are experienced;

• how the patient responds to and manages these experiences.

They specifically look for signs of under- or over-regulation. Any relevant observations can be elaborated on in an open text field.

Step 4: Describing the Art Product

The six formal elements of the art product are also recorded using response options:

• much;

• little;

• not prominent.

The therapist then describes what these observations indicate about the degree of structure and variation within the art product.

Step 5: Meaning for the Patient

Alongside the observations themselves, Lara and her colleague consider the patient's own reflection to be essential.

They record, among other things:

• which insights the patient identifies themselves;

• whether connections can be made between experiences in art therapy and everyday life;

• the relationship to the patient's own physical functioning.

There is also space for other observations, for example regarding the therapeutic relationship.

Translating the Findings for the Multidisciplinary Team

Ultimately, all the information is brought together in a brief, cross-disciplinary conclusion. What stands out? What does this tell us about the patient's balance and adaptability? And what does this mean for treatment?

The same terminology is used consistently in both written and verbal communication.

“Then I am in a multidisciplinary team meeting with all the professionals involved in the patient's treatment, and I briefly explain the findings. Because the information has already been clearly documented, I can be very focused. It creates understanding.”

Lessons Learned

Of course, I was curious to hear what Lara might have done differently with the benefit of hindsight.

“We had to implement this at a very fast pace. This was our opportunity, and we really wanted to make sure that the art therapy component was properly represented. That was quite a challenge, especially because I had only just completed the training.”

With what she knows now, she would formulate some of the sections more explicitly. She also sees opportunities for further development.

“I would really like to be able to add photographs of art products to the documentation. We haven't managed to do that yet. It may have something to do with privacy or with the way EPIC is set up. But it would be very valuable for handovers and referrals. After all, a picture is often worth a thousand words."

I would also like to be able to document progress across the three ArTA sessions more effectively. At the moment, I use the open text field to record the key findings from each session, but that means some duplication of work.”

*See the footnote at the end of this ArTA Story.

Lara's Golden Advice

Finally, I asked Lara what advice she would give to colleagues who want to integrate ArTA into their own EHR.

Her answer was:

“Make sure you are clear beforehand about exactly what you want to document. And practise using it. Once the system is in place, it is not always easy to make changes.”

Final Thoughts

What strikes me most about Lara and Lisanne's experience is that implementing ArTA in an EHR is not simply about systems and forms. Ultimately, it is about visibility: finding words for what we as art therapists observe every day, strengthening our professional identity, and creating a shared language that helps colleagues understand what art therapy contributes to assessment and treatment.

In this way, the implementation of ArTA in the EHR demonstrates how we can move from a black box towards a shared language that makes our professional contribution visible and understandable.

Perhaps you recognise yourself in their search for the right language. Perhaps you are currently thinking about how you could integrate ArTA into your own documentation or communication within the multidisciplinary team. If so, I hope this story inspires you and offers some useful lessons.

Maybe you have your own tips for using ArTA in communication with colleagues. Please feel free to leave a comment!

Do you work with ArTA and have an experience, best practice, or lesson learned that could be interesting for a future edition of ArTA Stories? I would love to hear from you. Together, we can continue to build a strong, visible, and learning ArTA community!

*During the preparation of this ArTA Story, I also spoke with Marion Winters and Linda Heerschop, art therapists at Frisius Hospital. Coincidentally, they also spoke about the importance of language, including within the EHR. They work with EPIC as well and have found a way to include photographs of art products by uploading them as a Word document within EPIC. What else did we discuss? You'll find out soon in a future edition of ArTA Stories!

The image accompanying this ArTA Story was AI-generated.