In the Eye of the Storm: Working with ArTA in a hospital setting: when images speak faster than words

Ingrid Pénzes in conversation with art therapists Marion Winters and Linda Heerschop from Frisius MC

Linda & Marion

ArTA is typically conducted across three – and sometimes more – observation sessions, using different materials, techniques and instructions. But what does this look like in a setting where time is limited, hospital stays are short, and diagnostic questions often arise quickly? What does it require of an art therapist when there is no time for a process to unfold over three sessions, and you need to get to the heart of the matter in just one or two encounters?

With ArTA Stories, I want to collect and share experiences from clinical practice. Not only to inspire one another, but also to learn from each other. What choices do colleagues make? What works well? What challenges do they encounter? And what do they learn along the way?

For this ArTA Story, I spoke with Marion Winters and Linda Heerschop, art therapists at Frisius MC. Both have completed the ArTA Basic Certification and now work with a shortened format of ArTA. They talk about how they have adapted their approach to the hospital setting, and how working with ArTA has influenced both the way they observe and the visibility of art therapy within the multidisciplinary team.

About Frisius MC

Frisius MC is a large teaching hospital providing highly specialized and complex care. As a member of the Dutch Association of Top Clinical Teaching Hospitals (STZ), it combines general hospital care with highly specialized services that require specific expertise, complex facilities, and a high level of quality and continuity. Teaching and research are also central to its mission, with an ongoing focus on educating healthcare professionals and improving and innovating patient care.

Art therapy at Frisius

Art therapy has been part of the hospital’s range of services for many years, but its role has developed significantly in recent years. Organizational changes within the hospital, together with the implementation of ArTA, created new opportunities to broaden the role of art therapy in clinical practice.

Marion explains that evidence-based practice is highly valued within the hospital. She wanted to strengthen the position of art therapy and therefore began looking for an art-based assessment method that would fit within this culture. Through Linda’s graduation research, they discovered ArTA and were subsequently given the opportunity to complete the training.

Today, Marion and Linda are consulted by a range of medical specialties for questions relating to behaviour, stress regulation, coping and adaptive functioning. Referrals come primarily from psychiatry and geriatrics, but also from internal medicine, neurology and oncology.

Psychiatric care at Frisius MC is organized somewhat differently from that of many general hospitals. There is no psychiatric ward providing long-term treatment. Instead, art therapy is mainly offered within the Medical Psychiatric Unit (MPU), a small inpatient unit for patients experiencing an interplay between physical and psychological difficulties. In addition, Marion and Linda work hospital-wide on a consultation basis and are also involved at other Frisius MC locations, including Heerenveen. Their work focuses primarily on assessment and observation, as well as supporting the treating physician or psychiatrist in addressing complex clinical questions.

Why ArTA fits so well here

This is precisely the kind of setting in which ArTA can be particularly valuable. Diagnostic questions are often complex, hospital stays are short, and there is a need for information that can be directly incorporated into clinical decision-making.

ArTA provides a structured, evidence-based framework that enables art therapists to gain insight into a patient’s adaptive functioning and balance within a relatively short period of time. At the same time, the method helps translate observations into a language that can be understood across professional disciplines. This allows the information to become part of the wider clinical picture and to inform decisions about further treatment and care.

As Marion puts it:

“They really respond to the fact that there is research behind it. It’s not so vague anymore; it’s medical language, and they can do something with that.”

In this way, ArTA becomes more than a methodological tool. It also acts as a bridge between art therapy and the wider medical context.

Working with ArTA in a shortened format

ArTA was originally developed as an assessment conducted across three sessions. In practice, however, this format did not always fit the clinical context in which Marion and Linda work. Patients in the Medical Psychiatric Unit typically stay for only a few days, while consultations on other wards often need to be scheduled at short notice. There is therefore a need for focused observation and assessment within a limited timeframe.

Marion and Linda began experimenting with a shortened format of ArTA, in which the full assessment is carried out in one or two sessions.

“It actually started out of practical necessity,” Linda explains. “We simply didn’t have time for three observation sessions. And nowhere did it say that we couldn’t do it differently.”

What began as a pragmatic solution gradually developed into a workable clinical approach. Not less thorough, but differently structured in terms of time and focus.

Clinical reasoning in the moment

Working with ArTA in a shortened format requires continuous clinical decision-making. Because the assessment takes place within one or two consecutive sessions, there is less opportunity for reflection afterwards – including for the patient. As a result, the image remains more closely connected to the person’s immediate responses and behaviour.

Linda explains:

“You capture much more of the essence of that particular moment. The image shows how someone is dealing with stress, making choices and responding to challenges at that moment. And the patient doesn’t have time to start thinking things through between the observation sessions.”

The choice of materials, techniques and instructions emerges directly from the interaction with the patient. This requires a sharp clinical eye and the ability to quickly recognize and interpret what is happening.

Marion describes it this way:

“We are used to making contact very quickly, attuning ourselves: who is this person in front of me, what do they need, and how do I get there? ArTA actually fits seamlessly with that.”

Patients themselves also tend to experience this as valuable. The many thank-you cards and poems displayed on the noticeboard in the art therapy office are a telling indication of this.

Marion describes her role in the hospital through a striking metaphor:

“As an art therapist, you can be such a beacon in the storm here in the hospital. They are in a tornado, and for a moment you sit there with them in the eye of the storm, where it is quiet. They are in contact with you, and while you can be confronting, they experience it as such a source of support and calm in what can be a very unpredictable journey. That is very valuable and deeply rewarding.”

For Marion, the greatest challenge is not necessarily shortening the method, but trusting your own professional expertise.

“You have to dare to lean on your knowledge and experience,” she says. “The more you practise with ArTA, the more it is like peeling an onion. Eventually, you start seeing the core more and more quickly.”

ArTA as a complement to psychiatric assessment

Marion and Linda are clear that ArTA is not a substitute for psychiatric assessment. The medical history and clinical observations remain essential, but working with images adds another layer of information.

“It gives you insight into nuances,” Linda explains. “You don’t always see those in a conversation. It really is complementary.”

This additional perspective can be particularly valuable in complex or recurrent admissions, or when behaviour is difficult to interpret. ArTA can also help clarify adaptive functioning when physical health problems may have a psychological component.

Not explaining, but letting people experience it

Frisius MC is a teaching hospital where doctors, psychiatrists, medical students and trainees are constantly learning and observing. That curiosity has proved to be an important opportunity for Marion and Linda to introduce colleagues to ArTA.

They deliberately choose not only to explain their work through lectures and presentations, but also to let colleagues experience it for themselves.

“They saw our reports and thought: how can this be so accurate? So we said: just experience it for yourself.”

That became a turning point. ArTA was no longer something that was simply explained; it became something that was experienced.

Marion and Linda approached this deliberately, keeping the experience light-hearted while remaining professional. They invited psychiatrists and medical students to briefly take part in an ArTA assessment themselves, without turning it into a heavy or overly theoretical exercise. The emphasis was on experience rather than explanation, in a setting that felt safe and accessible.

It was important to maintain trust and equality: not to give a ‘lecture on art therapy’, but to explore together what happens when working with materials. This relaxed yet carefully facilitated approach allowed colleagues to participate freely and to reflect openly afterwards.

Linda explains:

“They kept talking about it afterwards. They started making connections themselves with their work and their home life. That really made an impression.”

Marion adds:

“It also makes it clearer to them when requesting an ArTA assessment is useful.”

Positioning: from evidence to visibility

ArTA has influenced not only the way they work, but also the position of art therapy within the hospital. Because the method aligns with the language and working practices of the medical field, confidence in the contribution of art-based assessment is growing. This strengthens both the visibility of the profession and the position of the art therapist within the multidisciplinary team.

At the same time, Marion and Linda emphasize that a method alone is not enough. Establishing a stronger professional position requires active visibility. In a teaching hospital, where new colleagues are constantly starting, you need to keep showing what you do and why it matters.

They provide training sessions, present to teams, have integrated the ArTA system into the electronic patient record (EPIC), and actively bring ArTA into multidisciplinary meetings. Whenever possible, they include the artwork itself.

“An image often says much more than a page of text,” Linda explains.

They are also deliberate about how they present themselves: wearing a white coat, having a current photograph on the hospital intranet, and inviting colleagues to come and observe.

“Don’t assume that people automatically know what art therapy is,” Marion says. “You have to take that step yourself.”

Linda and Marion presenting at Frisius

Professional expertise in the moment

What comes through again and again in Marion and Linda’s experience is that working with ArTA in a shortened format is much more than a practical adaptation to the hospital context. It requires clinical expertise: the ability to observe quickly, make sense of what emerges in the artwork, and translate this into information that can be used directly by the treating physician or psychiatrist.

At the same time, ArTA also plays an important role in strengthening the position of art therapy. Because the method connects with the language of medical practice and is actively shared with colleagues, it increases not only the visibility of the profession, but also confidence in the contribution of art therapists to assessment and treatment.

Do you also work with ArTA and have an experience, best practice or lesson learned that could be interesting for a future edition of ArTA Stories? I’d love to hear from you: mail@ingridpenzes.com. Together, we can continue building a strong, visible and learning ArTA community!

The images accompanying this ArTA Story were kindly provided by Marion and Linda.