A snapshot from our 3-Day Art Therapy Diploma Intensive in Kuala Lumpur, Malaysia.
It’s always a pleasure to host one of my students’ articles on the website. Thank you, Cassie Wong Mun Yew, for sharing this essay as part of her coursework for the Art Therapy Diploma Course.
Enjoy,
Rob
Director and Lecturer at CECAT
Art Therapist, Psychologist and Theologian
MA A. Th., AThR; B. Soc. Sc. (Psych.) (Hons.), MAPS, AAPi.; BA. Theol. (Hons), MA Theol.
Art Therapy
within the Malaysian mental health landscape
My pursuit of art therapy studies with Rob Gray’s College for Educational and Clinical Art Therapy (CECAT) became a lot more meaningful and empowering given the context of my personal experiences in the family, amongst them are members who have suffered from depression and Alzheimer’s disease. As a caregiver to an individual who has depression, and observing the other senior members in the family who are trying their best to cope with their lives, I realised the value and importance of creative therapies like art therapy made available besides their medical and clinical needs, to better improve their mental, emotional wellbeing and psychosocial connection.
There is a growing trend and interest in non-pharmacological intervention around the world, seeking a more holistic approach in the treatment for mental illnesses, and improving the quality of life for individuals who have symptoms. Like certain countries in Asia, non-verbal therapeutic modalities are not very common in Malaysia, and many people here didn’t even know that they have an option for that, whether it is supplementary to their primary pharmacological treatment, or solely as a support or maintenance to their mental wellbeing.
While advances in medicine have kept pharmacological agents at the forefront of psychiatric disorder treatment, many psychotropic agents, and especially antipsychotics, contribute to poor quality of life and debilitating adverse effects even when the medications are able to alleviate the major symptoms of a disorder (Hanevik et al., 2013, as cited in Chiang, Reid-Varley, Fan, 2019). In this essay, I will discuss the importance of creative expression for mental health in the Malaysian context.
Art therapy in the Malaysian landscape
While the field is established in the West, its integration into the Malaysian healthcare and social system is still evolving. Despite the slow growth, limited resources, and lack of awareness and misconceptions about mental illness are the primary challenges in early intervention or treatment (CK Phang, M. Marhani, and Salina AA, 2011). As we have seen evidence about the benefits and effectiveness of art therapy, its efficacy in Malaysia is limited by a shortage of localised available services, clinical trials, and the prevailing preference for pharmacological interventions in hospitals.
Based on the National Health and Morbidity Survey (NHMS) 2023 released by the Ministry of Health Malaysia, the data shows a significant rise in mental health issues, yet a persistent lag of professional help-seeking. About 70% of Malaysians with general health issues seek advice from practitioners, mental health specifically shows a different trend. For those with depression, about 50% have considered self-harm, yet a significant portion of the population relies on informal support (family/ friends) or "self-medication" rather than clinical intervention (NHMS 2023).
With heavy social stigma, it is estimated that only 20% of Malaysians with a mental disorder will access professional care. The lack of education about and understanding of mental illness, a cohort of traditionally conservative people in Malaysia tends to avoid medical treatment and seek religious practitioners or shamans (Raaj, Navanathan, Tharmaselan and Lally, 2020).
Following this, I would like to discuss how art therapy can play a role as an intervention and/or a supporting treatment to the primary psychiatric treatment with people suffering from mental health issues in a society like Malaysia.
Cultural barriers and stigma
In Malaysia, cultural norms often emphasise emotional restraint to avoid being seen as “weak”, being a family shame (“guarding face” or “jaga muka” in Malay, is a cultural concept focused on maintaining personal, relational, and social dignity by avoiding public embarrassment, conflict, or shame), and being stigmatised. Based on what is stated earlier in this essay about art therapy, it provides a non-confrontational "safe space" by bypassing the cognitive-verbal requirements of traditional therapy, when verbal expression may be too distressing and threatening for some individuals when exploring mental health difficulties. Non-verbal techniques such as art therapy maintain the client within their window of tolerance, and it gives the clients additional and prolonged processing time before being verbally exposed to their mental health struggles (Perryman, as cited in Lian, et al., 2025). The art therapy process formed a triangular relationship between the client, the artwork, and the therapist, reduces the intensity of the encounter, allowing the client to discuss the art instead of themselves, thus “guarding face" while still achieving therapeutic breakthrough. In the case of traumatic clients, research published in the Idealogy Journal (2025), specifically addresses the "psychological pressure" of direct verbal sharing in Malaysian culture. Art therapy, specifically drawing, allows clients to tap into repressed memories within a safe setting, alleviating the stress of having to "talk" about trauma. It helps externalise complex feelings that are hard to put into words, fostering self-awareness and emotional regulation.
Findings show that many Malaysian still attribute mental illness to supernatural causes, such as witchcraft or spiritual possession. This contributes to a stigma of “the crazy” and makes traditional talk therapy intimidating (Shoesmith W, et al, 2020). Art therapy may be the perfect middle-ground between seeking pharmacological treatment, which taking pills can be daunting to many, and the “expression problem” that most people feel embarrassed or difficult to put into words.
Hierarchical culture in the healthcare setting
Most patients here are in the position of ‘following orders’ from their psychiatrists or doctors, the ward staff, their carers, and no questions for those who are seeking help from religious and spiritual healers. In their journey of recovery, most of them stays passive over what is laid ahead for them as the treatment plan, without expressing his/her opinion (behaviour), because he/she is afraid that the doctor will be angry (feeling). This feeling is likely related to a stereotype (in fact the doctor has never been angry), underlying this feeling may be assumed rules: ‘the doctor makes the decisions’, ‘I am expected to follow orders without questioning or complaining’ (beliefs). In a study conducted in Sabah, Malaysia (Shoesmith W, et al, 2020), lack of autonomy, power differences and hierarchy were identified as a major barrier to collaboration by the majority of staff (doctors, nurses, carers and family members) and patients. Almost all participants involved in this study identified the same power structure, with the doctor at the top, the patient at the bottom and the nursing staff and family somewhere in the middle. Patient’s perspectives are very unlikely incorporated in the process.
The principle of art therapy approach will eliminate this hierarchical and power structure, as the art therapy way is never about the therapist’s opinion or telling the client what to do, it is about the client’s expression, and being able to express freely and authentically. To enable a successful art therapy outcome, forming a respectful alliance with the client is essential, so that the work is truly cooperative (Rubin, 2009). Many different approaches within the art therapy realm also emphasise the importance of this, for example the Person-Centered approach developed by Carl Rogers, was originally called the client-centred approach. It is based on the therapist’s unconditional positive regard for the patient, and the powerful effect of empathy as a way of fully responding to the person in pain (Rubin, 2009).
From my personal experience seeing the importance of enabling autonomy to the client was simply an art as therapy session with my grandmother.
My grandmother is 89, she hasn’t been talking much. After falling numerous times recently, she has been “grounded”; she became inactive and almost immobile without assistance, and the days became duller. In one of our conversations I asked if she likes to paint and if she would like to try, she shied away and said she’s not good at painting. I planned my visit one day, and attempted to do a simple art-making session with her. I picked up some fallen leaves and flowers from the garden, and we simply trace the shapes and colour them on a piece of paper with colour pencils, all with minimum directives. Her hand tremors, her eyes were not sharp, and she was hesitant at first, but with a little encouragement, she eased into the process really well. I see the level of focus she had, it was what in front of her that matters, she was present all the time, choosing her preferred colours, tracing it slowly and carefully. The picture was far from perfect, but she received compliments for her artwork, and she was absolutely pleased, as we discussed how she felt during the process, despite being not very confident, she expressed interest in future sessions and look forward to what she could create next. I witnessed a simple art-making process with an older adult brought back confidence in her, and she was empowered to do it on her own. When the elderly feel they are seen, and that they are autonomous in the setting, they carry the sense of empowerment into other areas of their lives (Partridge, 2019). Through this, I understand that my grandmother is still curious, and she is absolutely eager for new experiences.
Conclusion
Writing this has made me realise just how vital creative modalities are to the future of our healthcare system. Ultimately, looking at art therapy through a Malaysian lens has shown me that healing cannot be a one-size-fits-all Western import for us. In a society where “jaga muka” (“guarding face”) keeps people silent and a rigid medical hierarchy keeps patients passive, art therapy offers a quiet, revolutionary alternative. It gives people like my grandmother a voice when words fail, and it restores autonomy where a sterile system strips it away. As I continue my studies, I realise that having a heart for this field is just the beginning. Malaysia's mental health landscape has a long way to go in terms of awareness and formal integration, but seeing the profound shift a simple box of coloured pencils can bring makes me incredibly hopeful. We aren't just teaching people how to paint, we are giving Malaysians a safe, culturally honouring space to finally step out of the shadows of stigma, be truly seen and understood.
Ready to transform your passion into a career? Explore our Art Therapy courses to get started today.
References:
Mathew Chiang, William Bernard Reid-Varley, Xiaoduo Fan (2019) Creative art therapy for mental illness (https://doi.org/10.1016/j.psychres.2019.03.025).
Czamanski-Cohen, K.L. Weihs, (2016) The bodymind model: A platform for studying the mechanisms of change induced by art therapy (https://doi.org/10.1016/j.aip.2016.08.006).
Cathy A. Malchiodi (2011) Handbook of Art Therapy second edition, “Introduction”.
Edith Kramer (2001) Art As Therapy: Collected Papers, Chapter 6: Art Therapy and Sublimation
Judith A. Rubin (2016) Approaches To Art Therapy: theory and technique, Part 1: Art is the Therapy.
Judith A. Rubin (2016) Approaches To Art Therapy: theory and technique, Part 1: Art is the Therapy, Symbolising by Laurie Wilson.
Judith A. Rubin (2016) Approaches To Art Therapy: theory and technique, 9) Jungian Art Therapy by Nora Swan-Foster.
CK Phang, M. Marhani, and Salina AA. "Help-seeking pathways for in-patients with first-episode psychosis in hospital Kuala Lumpur." Malaysian Journal of Medicine and Health Sciences (2011). (https://medic.upm.edu.my/upload/dokumen/FKUSK1_MJMHS_2011V07N2_OP04.pdf)
Malaysia National Health and Morbidity Survey (2023), Non-communicable Diseases: Depression (https://iku.nih.gov.my/images/nhms2023/report-nhms-2023.pdf)
Raaj, Navanathan, Tharmaselan and Lally (2020) “Mental disorders in Malaysia: an increase in lifetime prevalence” (https://pmc.ncbi.nlm.nih.gov/articles/PMC8554924/#ref5)
Lian, A.E.Z, Low SR,Yong LWS, et al. (2025) Cultural Sensitive Art Therapy: The development of an ETC-Based intervention for depression amidst Malaysian stigma: 1.2 Expressive Art Therapy
Idealogy Journal Vol. 10 No. 2, (2025) "Psychology And Art: Exploring Drawing As Of Interaction Counter-Reaction & Self Healing To Traumatic Experience.” (https://ir.uitm.edu.my/id/eprint/125289/1/125289.pdf)
Shoesmith W, Awang Borhanuddin AFB, Pereira EJ, et al. (2020) “Barriers and enablers to collaboration in the mental health system in Sabah, Malaysia: towards a theory of collaboration.” (https://doi.org/10.1192/bjo.2019.92)
Judith A. Rubin (2009) Introduction to Art Therapy, Chapter 4: The Basics
Judith A. Rubin (2009) Introduction to Art Therapy, Chapter 5: Approaches
Erin Partridge (2019) Art Therapy with Older Adults: Connected and Empowered, Chapter 2: Philosophical Framework.
