At the National University Hospital (NUH), art therapy is an important part of psychosocial care.

A typical session starts quietly. “Sessions typically begin by establishing a sense of safety, building rapport and supporting orientation,” Ms Loo explained. “I tailor each session to each patient’s specific challenges, aiming to help them express themselves and discuss their emotions.”

Patients choose materials that feel right for them – drawing, paint, collage, clay or mixed media – and take the process at their own pace. “Some begin creating immediately, while others may first reflect, observe or take time to emotionally settle,” she added. “In art therapy, there’s no right or wrong way to create. The goal is to provide (patients) with the freedom to express themselves.”

This emphasis on choice and readiness is central to trauma-informed care. Patients who have experienced trauma often need predictable rhythms and a sense of control before they feel able to engage.

Sessions end with structure and grounding so that patients leave feeling contained and regulated. That closing step matters, especially for people facing long-term treatment or destabilising life events.

When pictures say what words can’t

Much of art therapy’s value comes from how imagery changes over time, mirroring a person’s growing sense of safety and emotional capacity. Ms Loo sees this across many clinical contexts, from early childhood trauma to medical trauma and complex grief.

One young child who had experienced sexual trauma drew a door with multiple locks, adding more locks on the back of the paper in subsequent sessions. The repeated image, Ms Loo said, expressed “a need for safety and protection long before the child felt ready to speak”. Only later, with a drawing of a “spotted ice cream”, did the child begin to express feelings of shame that had previously been impossible to verbalise.

Another child coping with medical trauma drew a small figure standing alone in a precarious setting. Over weeks, the image changed: stabilising structures appeared, then supportive figures and eventually a safe environment. As the illustrations shifted, the child’s ability to talk about fear and uncertainty also grew. The artwork served as “a visual record of internal change, and a bridge between overwhelming experiences and growing resilience”, said Ms Loo.

She recalled another piece by a teenage patient: a painting of two split faces. “What could this represent? Maybe it’s about wearing different faces depending on the situation,” she said. “These kinds of pieces really open up conversations, allowing us to explore the patient’s emotions in new ways.”

This pattern of healing is not limited to children. Adults and families use art therapy to navigate grief, loss and identity changes after illness. A family who had recently lost their son created a memory book together, selecting photographs and arranging them page by page. The process allowed for moments of silence, shared laughter and tears – a gentle, structured way to remember and reconnect.

Progress can be subtle. A child who once avoided eye contact might enter the room more confidently; a teenager who answered “I don’t know” may begin to state a preference, choosing clay over drawing.

In artwork, shifts may show as larger, more assured strokes, fuller use of the page, clearer organisation of imagery or a gentler, more deliberate way of working, Ms Loo said. “These nuanced changes often reflect deeper internal movement before patients themselves are fully aware of it,” she added.

Helping patients cope and recover

Observations at NUH align with existing research. “Findings indicate that art therapy can support meaningful psychological and behavioural shifts,” Ms Loo said. These shifts include reduced distress, greater tolerance for difficult feelings and improved communication with healthcare teams.

“Patients often become more engaged in their own care, better able to articulate needs and preferences, and more confident participating in treatment planning,” she added.

Ms Koh Xin Yu, Head of Psychology, Department of Psychological Medicine, NUH, said art therapy can be especially helpful for people who struggle with emotion regulation. “We find that art psychotherapy can support them in expressing their emotions and gaining experience in regulating emotions in the process,” she added.

The department offers art therapy across age groups and is exploring age-specific themes, including potential groups for elderly patients with mental health conditions.

Art therapy is also being considered for patients facing sudden changes in functioning, for example, those in rehabilitation wards adjusting after stroke, brain injury or spinal cord injury. For people adapting to loss of independence, creative work can be an accessible way to express and process complex emotions.

A growing role in patient-centred care

Demand for art therapy at NUH has risen. At KTP-NUCMI, outpatient art therapy sessions increased by 79 per cent from 2018 to 2024. The team has expanded to meet clinical needs and, since 2022, therapists have run lunchtime workshops for staff as part of wellbeing initiatives.

NUH plans to deepen integration of art therapy across multidisciplinary teams. Efforts include collaboration with trauma-informed groups, caregiver programmes and cultural partners, and further research into how creative processes shape regulation, resilience and recovery.

Art therapy offers patients a way to deal with trauma and uncertainty with care, agency and dignity. It helps them reconnect with strengths, make meaning from difficult experiences and move towards healing.

KTP-NUCMI is part of the National University Centre for Women and Children (NUWoC), a national university specialist centre that aims to empower women, children and their families to lead healthier lives.

In consultation with Ms Loo Hwee Hwee, Principal Art Therapist, Division of Paediatric Psychological Services, Department of Paediatrics, KTP-NUCMI, and Ms Koh Xin Yu, Head of Psychology, Department of Psychological Medicine, NUH.