Introduction
Psychosis is a mental health condition characterized by a disconnection from reality, often manifesting through hallucinations, delusions, and disorganized thinking. These symptoms can cause significant disruption to an individual’s ability to function in everyday life, affecting their relationships, sense of self, and overall well-being. For many, the experience of psychosis is deeply distressing—marked by confusion, fear, and a profound sense of isolation. These feelings are often compounded for individuals who identify as trans*, queer, nonbinary, or otherwise marginalized, as societal stigma, discrimination, and inadequate access to inclusive care can exacerbate the challenges they face in seeking support.
Understanding psychosis from an anti-oppressive lens is crucial to providing effective, compassionate care. An anti-oppressive framework acknowledges that systems of power and privilege shape individual experiences and access to mental health care, particularly for those who exist at the intersections of multiple marginalized identities. In the context of psychosis, this means recognizing how factors like racism, homophobia, transphobia, and ableism can contribute to the stressors that trigger or worsen symptoms. It also involves offering therapeutic interventions that are inclusive, affirming, and responsive to the unique challenges faced by these communities.
Art therapy, as an expressive and non-verbal modality, provides an avenue for individuals to explore their experiences in a way that feels accessible and supportive. For Two Spirit, trans, nonbinary, and queer clients, the creative process of art therapy can serve as a powerful tool for navigating the complexities of psychosis, identity, and trauma. In addition to its therapeutic benefits, art therapy can complement other treatment modalities, such as pharmacological interventions and psychotherapy, creating a more holistic and personalized approach to care.
In this blog post, we will define psychosis and delve into its clinical features, considering how art therapy can be integrated with more traditional forms of treatment. We will also reflect on the specific benefits that art therapy offers to Two Spirit, trans, nonbinary, and queer individuals, who may experience additional stressors related to their gender identity or sexual orientation. Through the lens of trauma-informed and anti-oppressive care, we aim to explore how art therapy can foster healing, self-expression, and resilience for those navigating both psychosis and marginalization.
What Is Psychosis?
Psychosis is a mental health condition that involves a profound disruption in a person’s thoughts, perceptions, emotions, and sense of reality. When someone experiences psychosis, they may lose the ability to distinguish between what is real and what is not, leading to a range of symptoms such as hallucinations, delusions, and disorganized thinking. These symptoms can be disorienting and frightening, leaving individuals feeling disconnected from themselves and the world around them. Psychosis is not a disorder in itself but a symptom that can occur as part of several mental health conditions, including schizophrenia, schizoaffective disorder, bipolar disorder, and major depressive disorder with psychotic features (Kleiger & Khadivi, 2024).
One of the hallmark features of psychosis is hallucinations, where an individual perceives sensory experiences that are not based in reality. These can occur in any sensory modality—sight, sound, touch, smell, or taste—but auditory hallucinations (hearing voices or sounds that others cannot hear) are the most common (Aitchison et al., 1999). Visual hallucinations, such as seeing people or objects that are not there, are also frequent in psychotic episodes. These experiences often feel very real to the individual, making it difficult for them to trust that others do not share their perceptions. This can lead to confusion and distress as they attempt to reconcile their experiences with what others are telling them.
Delusions, another key feature of psychosis, are strongly held false beliefs that persist even when evidence contradicts them. These beliefs often take on a personal significance for the individual and can be highly distressing. For example, a person might believe they are being watched, followed, or persecuted—a common delusion in psychosis known as paranoid delusion (Kleiger & Khadivi, 2024). Others might experience delusions of grandeur, where they believe they possess special powers, knowledge, or identity, such as thinking they are a famous person or a deity. Delusions can vary widely in content but are unified by their resistance to logical reasoning and external reality.
Disorganized thinking and speech are additional indicators of psychosis. Individuals may have trouble organizing their thoughts, leading to incoherent or fragmented speech. This might manifest as jumping between unrelated topics, providing answers that are only loosely connected to the question, or using words and phrases in an illogical manner. For those experiencing psychosis, these cognitive disruptions make it challenging to communicate or follow conversations, further isolating them from others (Schaverien & Killick, 1997).
Psychosis can arise from several causes, including genetic, neurobiological, and environmental factors. In some cases, it may be triggered by substance use, particularly the misuse of drugs such as cannabis, methamphetamines, or hallucinogens (Aitchison et al., 1999). Psychosis can also occur as a result of medical conditions, such as traumatic brain injury or neurological diseases, or in response to severe stress or trauma, particularly in individuals who are predisposed to psychotic disorders. For trans*, nonbinary, and queer individuals, the additional stressors related to societal marginalization, discrimination, and internalized oppression can exacerbate the risk of developing psychosis, highlighting the importance of addressing these intersecting factors in treatment (Killick, 2017).
For many, the onset of psychosis is sudden, often marked by a distinct psychotic episode. This initial break from reality can be terrifying, leaving the individual confused, fearful, and vulnerable. It is not uncommon for them to feel as though they are losing control of their mind or body, which can provoke significant anxiety. During the first episode of psychosis, it is crucial for individuals to receive prompt care and support, as early intervention has been shown to improve long-term outcomes (Aitchison et al., 1999). Treatment typically involves a combination of antipsychotic medications, psychotherapy, and supportive care, with art therapy often serving as a complementary modality to help individuals process their experiences and regain a sense of agency.
It is important to recognize that psychosis is not a one-size-fits-all experience. The way in which someone experiences psychosis is deeply personal and can be influenced by a variety of factors, including their socio-cultural background, gender identity, and life experiences. For individuals from marginalized communities, such as Two Spirit, trans*, and queer individuals, psychosis may intersect with experiences of oppression, trauma, and identity-related stress, which can intensify the emotional impact of the condition. An anti-oppressive, trauma-informed approach to treatment is essential in helping these individuals navigate both their mental health challenges and the broader societal pressures they face (Schaverien & Killick, 1997). Providing gender-affirming care that is sensitive to these intersecting identities can greatly enhance treatment outcomes and support the individual’s overall well-being.
In summary, psychosis is a complex and multifaceted mental health condition that can have a profound impact on an individual’s sense of self and reality. Hallucinations, delusions, and disorganized thinking are the most recognizable symptoms, but the experience of psychosis is highly personal and influenced by a range of biological, psychological, and social factors. Understanding psychosis through an inclusive, anti-oppressive lens allows us to provide more effective and compassionate care, especially for those whose experiences of marginalization may heighten their vulnerability to this condition.
Pharmacological and Psychotherapeutic Interventions
When treating psychosis, pharmacological interventions are often the first course of action. Antipsychotic medications, which target neurotransmitter systems such as dopamine and serotonin, are essential in managing the primary symptoms of psychosis, including hallucinations, delusions, and disorganized thinking (Aitchison et al., 1999). These medications work by reducing the overactivity of certain brain chemicals that contribute to the disruption in perception and cognition characteristic of psychosis. For many individuals, antipsychotic drugs provide significant relief, enabling them to regain a sense of clarity and stability in their thoughts and perceptions.
However, while antipsychotic medications can be highly effective, they are not without limitations. Some individuals may experience side effects, such as weight gain, drowsiness, or tremors, which can affect their quality of life (Kleiger & Khadivi, 2024). Additionally, not all individuals respond in the same way to these medications, and some may require adjustments in dosage or a combination of drugs to achieve the desired therapeutic effect. For marginalized populations, including trans* and queer individuals, the potential side effects of antipsychotics may intersect with existing body dysphoria or physical health concerns, necessitating a nuanced and individualized approach to treatment.
Beyond pharmacological interventions, psychotherapy plays a crucial role in supporting individuals through the emotional and cognitive challenges associated with psychosis. Cognitive-Behavioural Therapy (CBT), in particular, has been shown to be effective in helping individuals manage the cognitive distortions and thought patterns that often accompany psychosis (Killick, 2017). CBT encourages clients to examine their beliefs and perceptions, challenge the distortions that may contribute to their symptoms, and develop healthier ways of thinking and coping. For example, a person experiencing paranoid delusions might work with their therapist to question the evidence for their beliefs and develop strategies to reduce their distress when these thoughts arise.
However, for many individuals, psychosis is not just a cognitive issue but an emotional and relational one as well. The sense of disconnection from reality can lead to profound feelings of fear, shame, and isolation, which are not always adequately addressed by medication or CBT alone. This is particularly true for marginalized individuals who may already face systemic barriers to care and whose experiences of psychosis may be intertwined with trauma, discrimination, or identity-based stress (Schaverien & Killick, 1997). For these individuals, traditional talk therapy may not fully encompass the depth of their emotional experience, nor does it always provide the relational support necessary to foster trust and healing.
This is where art therapy becomes a powerful complement to both pharmacological and psychotherapeutic interventions. Art therapy addresses the emotional, relational, and sensory experiences of psychosis in ways that traditional therapy may not. Through the use of creative expression, clients are able to access and explore parts of their inner world that are difficult to articulate through words alone. The process of creating art allows individuals to externalize their emotions, giving them a tangible form that can be reflected upon, processed, and understood within the context of a supportive therapeutic relationship (Killick, 2017).
For Two Spirit, trans, nonbinary, and queer clients, art therapy offers a unique and inclusive space where their identities and experiences are not only recognized but celebrated. In many cases, these individuals have faced significant challenges in accessing gender-affirming care or may have encountered therapists who lack the cultural competence to understand their specific needs. By integrating art therapy into a treatment plan that includes both pharmacological and psychotherapeutic interventions, therapists can offer a more holistic and individualized approach to healing—one that honours the full complexity of the client’s experiences, both with psychosis and with their identity.
Art therapy can also provide relief from the sensory overload that often accompanies psychosis. For many individuals, psychosis brings with it heightened sensory perceptions, making the world feel chaotic, overwhelming, or even frightening. The physical act of creating art—whether through drawing, painting, sculpting, or other mediums—can serve as a grounding tool, helping clients reconnect with their bodies and regain a sense of control over their environment (Schaverien & Killick, 1997). This tactile engagement not only offers a soothing outlet for expression but also facilitates emotional regulation, allowing clients to process their feelings in a safe and controlled manner.
In conclusion, while pharmacological and psychotherapeutic interventions are foundational in the treatment of psychosis, they do not always address the full scope of the individual’s experience. For many, particularly those from marginalized communities, psychosis is a multi-dimensional experience that affects not only their thoughts but also their emotions, relationships, and sense of self. Art therapy provides a powerful complement to these traditional treatments, offering clients a space to explore their inner worlds, process their emotions, and express their identities in ways that feel safe, affirming, and empowering.
How Art Therapy Supports Psychosis Treatment
Art therapy, a form of psychotherapy that uses the creative process of making art, provides a safe, non-verbal means for individuals experiencing psychosis to express thoughts and emotions that may be difficult to articulate verbally. This therapeutic modality is especially valuable for clients who feel overwhelmed by the sensory or cognitive distortions caused by psychosis. Art therapy helps individuals externalize their internal experiences, fostering insight and emotional regulation in a supportive, non-judgmental environment (Killick, 2017).
1. Externalizing Internal Experiences
One of the most profound benefits of art therapy for individuals experiencing psychosis is the ability to externalize their internal turmoil. When words fail, the creative process allows clients to project their complex emotions and thoughts onto a canvas or other medium, providing a new perspective on their inner world (Schaverien & Killick, 1997). This is particularly beneficial for clients who struggle to verbalize their experiences due to cognitive disorganization, a common symptom of psychosis (Kleiger & Khadivi, 2024). By creating tangible representations of their inner state, clients can distance themselves from the intensity of their emotions, gaining insight into patterns, fears, and desires that may be contributing to their distress.
2. Containment and Grounding
For individuals whose psychosis manifests in a sense of fragmentation or disconnection from reality, the process of making art can provide a much-needed sense of containment and grounding. The structured activity of art-making offers a way to impose order on the chaos of psychosis, helping clients feel more in control of their thoughts and emotions (Killick, 2017). The physical engagement with art materials—whether through painting, sculpting, or drawing—can reconnect individuals to their bodies and the present moment, fostering a sense of stability. This grounding effect is particularly important for clients who experience sensory overload or disorganized thinking, as it helps them re-establish a sense of connection to the world around them (Schaverien & Killick, 1997).
3. Non-Threatening Exploration of Trauma
For many individuals experiencing psychosis, there is a significant overlap with trauma. Research shows that trauma can be both a contributing factor to psychosis and an outcome of psychotic episodes (Kleiger & Khadivi, 2024). Art therapy provides a gentle way to explore traumatic experiences without the need for direct confrontation, which can be overwhelming for trauma survivors. The non-verbal nature of art therapy allows clients to approach their trauma at their own pace, gradually uncovering and processing difficult memories in a way that feels safe. By externalizing these experiences through creative expression, clients can begin to reframe their relationship with their trauma, reducing its power over their current emotional state (Killick, 2017).
4. Community and Connection
Psychosis often leads to feelings of isolation and alienation, as individuals struggle to connect with others who may not understand their experiences. Group art therapy can be a powerful tool for fostering a sense of community and shared experience, helping individuals with psychosis realize that they are not alone in their journey (Schaverien & Killick, 1997). The act of creating alongside others who are facing similar challenges can help break down feelings of isolation, providing a space for mutual support and understanding. For queer and trans* individuals, group art therapy can also serve as a space where their identities are affirmed and celebrated, offering a sense of belonging that may be lacking in other areas of their lives (Killick, 2017).
Art Therapy for Trans* and Queer Individuals with Psychosis
For trans* and/or queer clients, the intersection of gender dysphoria, sexism, societal stigma, and mental health challenges can exacerbate the distress of psychosis. Many individuals in these communities face heightened stressors, such as discrimination or a lack of access to gender-affirming care, which can trigger or worsen psychotic episodes (Killick, 2017). The challenges of navigating a world that invalidates or marginalizes their identities can make the experience of psychosis even more isolating.
Art therapy offers a validating and affirming space for exploring identity in a way that transcends verbal language. Through art, clients can visualize their internal experiences of gender, sexuality, and self-expression, offering a form of self-affirmation and healing that feels less intrusive than traditional talk therapy (Schaverien & Killick, 1997). For example, a trans woman experiencing gender dysphoria may use art to externalize her feelings of discomfort, working through them in a way that allows for emotional processing without the pressure of having to explain her experiences verbally. This creative outlet can foster a sense of empowerment, as clients take control of their narrative and explore their identity in a safe, supportive environment (Killick, 2017).
In summary, art therapy provides a unique and effective complement to traditional psychotherapeutic and pharmacological interventions for individuals experiencing psychosis. Its ability to address emotional, sensory, and relational aspects of the condition, while offering a space for identity exploration and healing, makes it particularly valuable for trans* and queer individuals. By providing a non-verbal, creative approach to therapy, art therapy fosters resilience, insight, and connection, helping clients navigate the complexities of psychosis with greater confidence and self-understanding.
Practical Applications: How to Get Started with Art Therapy for Psychosis
For individuals seeking to incorporate art therapy into their treatment for psychosis, it’s essential to understand how the process works and how to find the right support. Art therapy is a powerful complement to pharmacological and psychotherapeutic treatments, but starting something new can often feel intimidating. Below are some practical steps and insights to help you get started with art therapy and understand how it fits into your broader mental health care.
What to Expect in an Art Therapy Session
Art therapy sessions vary depending on the therapist’s approach and the client’s needs, but most sessions involve a combination of art-making and reflective discussion. In an art therapy session, you will likely be encouraged to use a variety of materials—such as paints, clay, or pastels—to express yourself creatively. You do not need any prior art experience; the focus is not on creating a perfect piece of artwork but on using the creative process to explore and communicate feelings that may be difficult to verbalize (Killick, 2017). Art therapists work to provide a non-judgmental space where you can externalize your emotions and make sense of the internal chaos that often accompanies psychosis (Schaverien & Killick, 1997).
Sessions typically begin with an open-ended prompt or an invitation to create spontaneously. After the art-making portion, your therapist will guide you through a discussion of what you have created. This reflective process allows you to gain insights into your emotional world, helping you to connect your artistic expression with your lived experiences (Killick, 2017). It’s important to remember that art therapy is flexible and tailored to each client’s unique needs, so your sessions will evolve as you and your therapist build a relationship and establish therapeutic goals.
How to Find a Highly Qualified Art Therapist
Finding the right art therapist is crucial for ensuring that you receive high-quality, compassionate care. It’s important to seek out a therapist who is certified through recognized bodies, such as the Canadian Art Therapy Association (CATA), which provides the designation of Registered Canadian Art Therapist (RCAT), or the Art Therapy Credentials Board (ATCB) for Art Therapist, Board Certified (ATR-BC). These credentials ensure that the therapist has undergone rigorous training and adheres to ethical standards of practice (Schaverien & Killick, 1997).
To find a qualified art therapist in your area, you can begin by searching professional directories like CATA’s member listings or the ATCB’s online directory. Additionally, many mental health organizations and clinics offer art therapy as part of their services. If you are already working with a psychiatrist or psychotherapist, they may be able to refer you to a trusted art therapist who specializes in psychosis or related conditions.
How Art Therapy Fits with Other Treatments
Art therapy works best when integrated with other treatment modalities. For individuals experiencing psychosis, it is often part of a broader therapeutic plan that includes pharmacological treatments and talk therapy (Killick, 2017). While medications such as antipsychotics help to manage symptoms like hallucinations and delusions, art therapy allows individuals to explore the emotional and sensory aspects of their experience. Cognitive-Behavioural Therapy (CBT), for example, may help clients challenge cognitive distortions, while art therapy provides a non-verbal outlet for expressing emotions that are difficult to put into words (Schaverien & Killick, 1997).
Art therapy does not replace other treatments but rather enhances them by addressing emotional and sensory experiences that medication and talk therapy may not fully encompass (Kleiger & Khadivi, 2024). For example, some clients may find it easier to process trauma or work through difficult emotions using art, rather than in a verbal setting, especially if their psychotic symptoms include disorganized thinking or speech difficulties.
Preparing for Your First Session
The idea of starting art therapy might feel overwhelming, especially if you’re unsure of what to expect. One of the best ways to prepare for your first session is to go in with an open mind. Remember that you do not need to have any artistic skills or experience—your therapist is there to support you, and the focus is on the therapeutic process, not the final product (Killick, 2017).
It can also be helpful to take some time before your session to reflect on what you hope to gain from therapy. Are there particular emotions or experiences you want to explore? Are you looking for a way to manage your symptoms in a more embodied way? These reflections can give you a starting point for your work with your art therapist and can help guide your therapeutic journey.
In conclusion, art therapy offers a powerful, accessible way to explore the complex emotional landscape of psychosis. By integrating art therapy into your treatment plan, you can access a unique form of self-expression and emotional healing that complements traditional interventions. Whether you are just beginning your journey with psychosis or looking for new ways to manage ongoing symptoms, art therapy provides a safe, supportive space for growth and discovery.
Conclusion
Art therapy is a powerful and flexible tool in the treatment of psychosis, offering a unique complement to both pharmacological and psychotherapeutic interventions. For individuals navigating the complexities of psychosis, especially those who are trans*, queer, or otherwise marginalized, art therapy provides a safe and affirming space for self-expression, emotional exploration, and identity validation. By utilizing the creative process, individuals can externalize overwhelming thoughts and emotions, process trauma in a non-threatening way, and reconnect with their sense of self and reality.
Creative interventions not only address the cognitive and emotional dimensions of psychosis but also the sensory and relational challenges that often accompany it. For trans* and queer clients, in particular, the opportunity to explore their gender and identity through a creative, non-verbal medium can be profoundly healing. When integrated with traditional treatment approaches, art therapy helps to foster a more holistic, individualized path to recovery—one that honours each person’s unique experiences and intersections, providing a foundation for resilience, connection, and personal growth.
Continue the Convo
If the ideas in this blog resonate with you, I warmly invite you to connect with me. Whether you’re a therapist seeking guidance on incorporating art therapy into your work or someone navigating psychosis and looking for support, I’m here to help. You may book individual therapy sessions or peer consultations online. Be sure to bookmark this blog for future insights, reflections, and updates.
References
Aitchison, K. J., Meehan, K., & Murray, R. M. (1999). First episode psychosis. CRC Press.
Killick, K. (2017). Art therapy for psychosis: Theory and practice. Routledge.
Schaverien, J., & Killick, K. (1997). Art psychotherapy and psychosis. Routledge.
Kleiger, J. H., & Khadivi, A. (2025). Assessing psychosis: A clinician’s guide (2nd ed.). Routledge.
Disclaimer: This blog offers general educational information and does not constitute professional advice or establish a therapist-client relationship. Please consult a healthcare provider for personalized guidance. Any decisions based on the content are the reader’s responsibility, and Clayre Sessoms Psychotherapy assumes no liability. All case studies are hypothetical with fictional names and do not reflect actual people. We prioritize your privacy and the confidentiality of all of our clients. We are committed to maintaining a safe, supportive space for 2SLGBTQIA+ community care.