Existential Exchanges 5: Art

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/11/19

Sapira Cahana is a New York-based mental health counsellor and is an interfaith chaplain-in-training specializing in existential and relational therapy. 

In dialogue with Scott Douglas Jacobsen, she traces art therapy’s modern roots—from Adrian Hill’s 1940s coinage through Naumburg’s psychodynamic approach and Kramer’s making-as-healing—to today’s practice. Cahana integrates vocal training, close reading, and shared media to externalize inner life, using artworks as a “neutral third” that widens perspective while guarding against shame. She describes chapel-side encounters with dying patients, and the clarifying limits of “dark” art. Cahana cites Janet Cardiff’s Forty-Part Motet and texts like Sappho as portals to awe, meaning, and connection.

Scott Douglas Jacobsen: All right, the first opener will be “Good morning,” and the second will be the traditional question: When did art start leaning into becoming therapy? I do not mean it has not always served that purpose for people—evoking emotion or offering solace—but rather in terms of a formal therapy process. 

For instance, humans have long used art, but what we now call therapeutic or psychological purposes are much more contemporary. Freud and Jung analyzed art in terms of psychological symbolism, notably Jung, who also used drawing and “active imagination.” In the early 1940s, art therapy became a profession in Britain with Adrian Hill, an artist recovering from tuberculosis, who coined the term “art therapy” and wrote Art Versus Illness about his experience. 

In the United States, Margaret Naumburg and Edith Kramer were pivotal. Naumburg developed what she called dynamically oriented art therapy (rooted in psychoanalysis), and Kramer emphasized art as a healing process through making. The field was further institutionalized with the founding of the American Art Therapy Association in 1969.

That is the first time I have heard of these people and this field in any significant sense outside Freud and Jung. So, following Freud and Jung, there is clearly a trajectory of seeing the utility of art for therapeutic purposes. Have you ever incorporated this into your existentialist practice?

Sapira Cahana: Yes.

Jacobsen: How so?

Cahana: In my therapeutic work, I have used vocal training and colored pencils. While I am not an art therapist, I definitely incorporate artistic means. I lean into the poetic—finding it in writing, in close readings of people’s texts, in listening to their voices, and in using the voice as an emotional indicator. Instead of saying, “I feel sad,” I hear the intonation, the vocalization, and the cadence. We use these together.

I use art extensively in my therapy, and I am completely inspired by it. My whole way of being is informed by the artistic and the creative. My therapeutic style is rooted in creativity, and I often work with artists. I am a poet and a painter. Those are my primary forms of art. I used to sculpt more, but I don’t do as much sculpting anymore. I really see the therapeutic process as a kind of sculpting—we’re co-designing together, creating a shape together.

There’s a great deal of art imbued in my therapeutic practice. Can I tell you about a recent experience? I was at the Museo del Prado in Madrid, walking through the halls and meandering, when I saw these enormous, incredible paintings. I was overcome by emotion—completely touched and crying at the grandeur of these late medieval and early Renaissance works. I kept walking through this labyrinthine museum, looking for Hieronymus Bosch’s The Garden of Earthly Delights.

I was crying and walking when I eventually found The Garden of Earthly Delights. Again, I was in tears, walking through the entire museum, overwhelmed by the sheer power of art. Were all the paintings the best I’d ever seen? I don’t know. But the incredible nature of art itself completely overwhelmed me.

When I encountered this painting, which I’d seen thousands of times in so many different versions—never in person—mybody was overcome by its transcendence. It’s a triptych. I learned new things about it. Bosch’s triptychs are hinged panels that open and close, and artists often painted the exterior panels; in this case, the exterior of The Garden of Earthly Delights, when closed, shows a grisaille scene of the created world. I hadn’t fully registered that before, and I studied art history a little bit. For whatever reason, I had never realized they were painted on the outside surfaces as well. Again, I was overwhelmed.

Throughout my life, I’ve had many experiences in which others’ artistic voices have deeply moved me. Art brings me very close to the feeling of transcendence and awe.

Jacobsen: Are there people for whom art, within a therapeutic practice, does not evoke that same feeling? It’s not a medium for them that works.

Cahana: Of course, not everyone resonates with all forms of art. Often, week to week, we’ll share a piece of art or a creation with clients. We might listen to a podcast or watch a film or television show they love. I’ll follow up, and we’ll both watch it together. We’ll listen to it together, read together, and I have yet to find a client who says this practice of choosing a piece week to week doesn’t resonate.

Even people who don’t consider themselves creative sincerely appreciate television, or reading, or whatever it is—and I really do see art everywhere. So, at a minimum, I would say our therapeutic work is artistic. At the most, I’m working with artists who are really delving into the artistic process—listening for the afflatus, which is the divine spirit that enters the body during a creative momentum.

Jacobsen: Are there limits to how effective it can be?

Cahana: I have only found that it deepens the work. I’ve never found it to be limiting. I’m not an art therapist, and I wouldn’t purport to be one—that’s not my licensing, and that’s not the only thing I do. In general, what type of art do people most often respond to?

Lots of people love music, but different people resonate with different things. Some people really respond to television and love its art. Some people love visual media; some are more auditory. Others love performance art and the experiential. We reference a lot of art and artistic pieces, though we’re not constantly experiencing art. I try to create a kind of artistic sphere as part of my relational practice.

Jacobsen: Are there points at which clients have surprised you—where they’ve called something “art,” like the television example—after some reflection and deepening in the relationship?

Cahana: Yes, absolutely. There’s often art in what they’re describing that I hadn’t necessarily considered before. I’ve watched television shows for clients, and I’m frank with them. I’ll say, “I’m really trying to watch this show but can you tell me what you like about it?” Because I want to see it through their eyes.

As a therapist, it really doesn’t matter what my opinion of a piece is. The goal is to understand the person better, and art is an incredible mediator for the relationship. Without art, when we keep the therapeutic space contained only to what’s happening between client and therapist, it can become a narrow view. Art gives me more freedom to move through different lenses, to widen the aperture, to turn the kaleidoscope just a bit further each time.

Jacobsen: Is there the risk of countertransference in making a kind of artistic sphere, as you called it earlier?

Cahana: Yes, that risk is always there and always about me. The risk of countertransference is  necessary to evaluate always because it is very high. It’s up to me to modulate myself in the space and use myself as a refined instrument. I’m doing that inner work all the time, moving through, reflecting, returning to the relationship. I’ll think, “Oh, I’m not sure I attuned exactly to what you were seeking, I want to clarify this point you mentioned a few sessions ago.” I work very intentionally on recognizing where I am, where the other person is, and how that’s expressed in our relationship through what I’m missing and offering, what they’re responding to, what they’re offering, what I’m responding to.

Art is actually an invaluable tool because it externalizes so much of the internal process. It becomes easier to look at psychological symptoms, family history, emotions, and worries. It’s beneficial to externalize, so art becomes a kind of neutral third, it is something outside of both of us. It’s not about the human directly but about an objectified experience that the person relates to subjectively. That actually clarifies the therapeutic process much more clearly.

It also helps to relieve internalized fear and shame. For instance, if we’re reading a play by Samuel Beckett and discussing its existential themes, the client can project their inner experience of existential dread onto the work rather than feeling it as a personal flaw. This creates a sense of normalization—it shows that these struggles are shared across time. It also connects them to a kind of temporal transcendence, the idea that what they’re feeling has been lived and expressed before.

I love using ancient texts for this reason. If someone is questioning their sexuality, reading Sappho’s poetry can be profoundly helpful. It gives language and legitimacy to feelings that might otherwise be difficult to articulate. Eventually, we always bring it back to the person—it’s not literary analysis; we’re doing psychotherapy. But using another’s words helps inform the self and builds bridges between personal experience and the wider human condition.

There’s another benefit too—it positions me not as the “keeper of secrets” or the sole healer, but as someone who helps reveal the abundance of wisdom already in the world. It lessens my ego and decentralizes authority. Wisdom is out there, available for the client’s discovery. I just help them find it.

Jacobsen: It really keeps you from becoming the Wizard of Oz.

Cahana: That’s exactly my therapeutic style—it’s relational, existential, and experiential. It’s all about the shared human condition. Everyone experiences the human struggle. I’m part of it. You’re part of it. We’re all part of it. There’s no anonymous, impenetrable therapist immune to life. The work is about being human together.

In my chaplaincy work, I once worked with an artist. She was terrified of dying. She was clutching the bedrails, terrified to let go. She didn’t like the “rocket ship” she was on, as she described it. Sometimes I would tell her about visiting MoMA or The Met, and about pieces that inspired me. We would talk about art. Those conversations created a glimmer of hope and the love of the world-out-there that helped reconnect her to herself.

She was in this sterile, institutional space that stripped her of her humanity. The white walls, the smell of disinfectant, the sounds—it was all disjointed from her life as an artist. She tried to make art in her hospital bed, but couldn’t fully access her creative side. So, I tried to offer her the world through conversation—through art. It was a beautiful relationship until she died.

Another patient during my chaplaincy was a poet. I would read poetry with him; he would write, and we’d workshop his lines together. I’d ask, “Tell me about that line. Where did this come from?” It connected him deeply to his own sense of spiritual transcendence and self-transcendence. It made dying easier.

Jacobsen: One old boss once said, “When people are depressed, don’t read them Camus.” Are there certain things you have to be careful about when choosing art to discuss—certain sensitive areas that require mindfulness?

Cahana: Yes, absolutely. For example, Dostoevsky’s Notes from Underground is an extraordinary book about isolation and bitterness, being a kind of hermit or misanthrope. It can be beneficial for someone in that state to feel seen or corroborated, but I have to be careful. It’s not my first line of defence. There’s dark art, and there’s art about depression, grief, and suffering. Art can move people powerfully, but not always in a healing direction. There are countless examples of people attaching to an artist or a song in ways that deepen their pain or lead to harm. There are unequivocally limits, boundaries, and necessary cautions that I painstakingly weigh.

Anything that touches or inspires us can move us in many directions. Some pieces call forth suffering and pain—they can be valuable but must be handled with therapeutic guardrails. It’s not a book club. We’re not reading or enjoying art for its own sake, even though that has value too. Everything comes back to the self—the art is a means for transformation, not distraction. It’s for the therapeutic, the spiritual, or the transcendent.

Jacobsen: Are there times when you’ve made recommendations, something like, “Read this,” or “Go home and reflect”?

Cahana: Yes, and here’s the fascinating part. Sometimes I’ll recommend a poem, but the person will take from it something completely different than what I expected. That divergence itself becomes insight into the therapeutic process. I’ve recommended poems many times. You can often see the reaction instantly—the look on their face says everything. Before I even hand over the text, I’ll say, “I can tell you’re not sure. Do you want to go down this path, or do you want to explore a different one?”

It actually happened quite recently. I recommended a poem by a famous Sufi poet and immediately saw the expression: “not that guy.” So, we went with something else. But that in itself was revealing; it showed what resonated and what didn’t, and why.

As for recommending that clients engage in creative practice themselves, rather than only interpreting or analyzing art, I don’t push. I’ll make suggestions based on what they’re already expressing, but I always emphasize that there’s no obligation. If they choose not to, it’s completely fine. Many therapists assign homework; I avoid that framing. I make sure they know there’s no guilt or shame attached if nothing happens between sessions.

I usually like to end on a quote, since you’ve asked.

Jacobsen: Sure—what are you choosing this morning?

Cahana: I love surrealism. It’s an artistic movement that embraces irony, paradox, and play—all things that help open the unconscious. I’m especially drawn to surrealist painting and sculpture, as well as to audio art. One of my favourite artists is Janet Cardiff, a Canadian sound artist. She created one of the most moving installations I’ve ever experienced in Röda Sten Konsthall —The Forty-Part Motet. It’s a reworking of Thomas Tallis’s 1573 choral composition Spem in Alium,played through forty-two individual speakers, each one capturing a single singer’s voice. You walk among them, hearing the music as if moving inside a living choir. Each speaker coughs or giggles as it prepares to come as a collective and enliven the soul. It’s mystical and otherworldly, an experiential encounter with the sacred in sound. My heart weeps when I remember her gift to the world. This is why I bring art into the therapeutic process, it enunciates the feeling of being porous and permeable.  

Jacobsen: Thank you for the opportunity and your time, Sapira.

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