Lesley University

DigitalCommons@Lesley

Graduate School of Arts and Social Sciences

Expressive Therapies Capstone Theses (GSASS)

Spring 4-13-2023

Tattoos and Healing: Considerations from an Art Therapy Lens

MARIELLE CARPENTIER
mcarpen4@lesley.edu

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Recommended Citation
CARPENTIER, MARIELLE, "Tattoos and Healing: Considerations from an Art Therapy Lens" (2023).
Expressive Therapies Capstone Theses. 697.
https://digitalcommons.lesley.edu/expressive_theses/697

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 Tattoos and Healing: Considerations from an Art Therapy Lens- A Literature Review

Capstone Thesis

Lesley University

4/8/2023

Marielle Carpentier

Art Therapy

Raquel Stephenson, Ph.D., ATR-BC, LCAT

Tattoos and Healing

Abstract

Tattooing in North America is becoming more common as negative stigmas change and

the types of tattoos available are as diverse as the people getting them. One interesting new

motivation guiding individuals to get tattooed is a potential healing or therapeutic benefit. The

field of art therapy explores how art can facilitate healing and the therapeutic process. Because of

the emerging literature exploring these new tattoo motivations and the need for art therapists to

continually expand their understanding of art and its many applications it would be beneficial for

art therapists to understand this emerging practice. The literature in this study reveals that there is

a significant amount of overlap between tattooing and art therapy in the themes the two explore.

Additionally, tattooing offers new ideas and benefits that should be explored by art therapists

more to identify how these could be applied in the therapeutic field.

Keywords: Art Therapy, Tattoos, Tattoo Motivations, The Body, Stigma, Self-Expression
Tattoos and Healing

Tattoos and Healing: Considerations from an Art Therapy Lens

Introduction

Within the field of art therapy, it is understood that using art as therapy came well before

the creation of the field. Many engage in artmaking as a therapeutic practice without the

intervention or suggestion of a therapist. In the world of tattoo art, there is a similar phenomenon

occurring as this form of permanent body art rises in popularity and the diversity of applications

increases as well. From early historical uses to its adoption in the western world, tattooing has

been pursued for many different reasons. However, in recent years, some of these reasons have

become more therapeutic in nature. I can see this in my own life when, before I even had an

understanding of art therapy, I used tattooing as a therapeutic source myself. When I was a senior

in high school, I got my first tattoo. I experienced a loss that significantly impacted me, and

almost immediately I began drawing ideas of tattoos to get as a memorial of this person. I created

a symbol of that relationship and brought it to a tattoo artist to have it tattooed on my body. The

tattoo became a permanent change to my physical self, just as my loss had caused a permanent

change to my mental self. I found the process to help me move through my grief. In my research,

I have learned that, in addition to my own motivation, there are even more ways the tattoo

process has been therapeutic for others.

The population of tattooed people in the US and Canada is between 21 and 22 percent

according to a 2022 study done by Zidenberg et al. (2022). This number increases to 36 percent

of Canadians and 32 percent of Americans when limiting the age range to 18-34. A fifth of the

population is a significant number of people creating a unique population with their own unique
Tattoos and Healing

experiences. However, it is still a population that has certain stigmas surrounding them, as well

as a lack of understanding of tattoo culture and practices. The population of tattooed people is as

diverse as the reasons they choose to get tattooed, and tattooing is an art form with a history as

long as more traditional art forms. Alter-Muri (2020) explains that since the mid-twentieth

century, there has been a tattoo boom in the Western world and with this rise in popularity

among diverse groups, their connections to groups like criminals, gangs, the military, and certain

subcultures lessen. Broussard and Harton (2018) Identify in their study that stigma around this

population still exists, but that much of the research around tattooed individuals is over a decade

old and many studies don’t apply to the overall population. Because of this stigma and the lack

of research, more prosocial elements of tattoo culture have not had a chance to shine.

Because of this growth in popularity and the diversity of people getting tattooed, I will

explore several emerging themes that exist in modern tattoo motivations, including emerging

motivations around healing and other therapeutic benefits. In addition to understanding

individuals’ motivations more clearly, I will also explore what current literature exists for

tattooing in the fields of psychology and art therapy. From this exploration, I will have core

themes to guide my exploration of current foundational art therapy literature. Catherine Moon

(2010) wrote a book on the importance of the use of materials in art therapy and in this book, she

urges art therapists to explore media outside the traditional forms of drawing, painting, and

sculpting. Within the world of contemporary art, and cultural shifts, there is much for the field of

art therapy to learn from and incorporate for a more culturally aware and integrated

practice. Tattooing is one of these areas that can provide a wealth of knowledge for therapists.
Tattoos and Healing

Method

When conducting my research, I approached it in three steps. I first wanted to collect an

understanding of the historical background of tattooing as this can lend insight into the origins of

tattoo culture but also stigma. This area I broke into two categories: ancient and modern history.

I utilized Lesley Universities Library as well as Google Scholar to identify research and literature

in this area as well as the entirety of my literature exploration. For the second step I explored the

literature on modern tattoo motivations. Gaining a grasp of these motivations required a less

straightforward approach. For this section of research, I broadly searched the literature, not

limiting myself to psychology research but branching into areas like sociology as well. I began

by searching for the term tattoo alongside terms like healing, therapy/therapeutic, motivations,

psychology, and others. Due to the limited amount of research in this area, it became necessary

at times to only use the search term “tattoo”. Any research that held relevance to this exploration

was saved. Once this was completed, this list of literature was edited down to remove literature

that was too short or limited in scope to be relevant to this exploration. The final step after

analyzing this research was to utilize the themes that emerged to search the art therapy literature.

For this step, I included 4 books written by prominent art therapists on foundational art therapy

concepts, Bruce Moon, Catherine Moon, Cathy Malchiodi, and Judith Rubin.

Anticipated Outcome

Through doing the research and writing this paper, I hoped to not only see my own

experiences reflected in research but also to learn about the deeper connections between tattoos

and art therapy. I intend to add a more expansive perspective on the connections that exist within

tattooing in a body of literature that can often skew toward the negative. In this paper, I will

show the clear therapeutic benefits that people connect with their tattoos, as well as how those
Tattoos and Healing

benefits and themes connect to the practice of art therapy and psychology as a whole. In my

future practice, I plan to be able to more deeply connect with clients around their tattoos and

practices of externally representing symbols. In addition to my work with tattooed and non-

tattooed clients, I hope to also share my passion and knowledge with others in my field. I hope to

raise awareness around the changing culture of tattoos, specifically in the US, and the potential

therapeutic ways people engage in them.

Literature Review

Historical Context

Ancient History and Origins

The practice of tattooing has been around since ancient humankind. Krutak (2015) shared

that throughout history tattooing was used for adornment, representing identity, representing

status and position, therapeutics, and apotropaism and mimicry (spiritual practices). According to

Krutak, many of the discussions around the historical use of tattooing identifies the elements of

beauty, community identity, and spirituality. However, he also discusses how underreported the

therapeutic uses of tattoos are. These were mostly medicinally therapeutic and used to treat

things like joint pain and even heart disease. Krutak describes the discovery of one of the oldest

examples of curative tattooing as well as tattooing in general. This individual is known as “the

Iceman” and is around 2,500 years old. He has over 50 tattoo marks, mostly clustered around

joints. It is hypothesized due to their locations and the arthrosis found in his body, that these

marks were for a therapeutic purpose, similar to acupuncture. In their article on the oldest tattoos,

Deter-Wolf et al. (2016) Explain that tattooing has been found in indigenous cultures on every

continent except Antarctica and that in each one, tattooing was an essential part of their culture.
Tattoos and Healing

They identify that because of certain cultural contacts and especially the spread of colonial

empires, much knowledge of ancient tattoo practices has been lost. More recently, efforts have

been made to preserve and rediscover this knowledge. Even from this brief overview, it is clear

that tattooing has always been a practice used by humans for creative expression, identification,

and healing.

Transitions to the West

Kluger (2015) discusses the more recent history of tattooing in the West. They explain

how in its early rise to popularity in the 50s and 60s it was most associated with sailors, the

military, criminals, prostitutes, and other marginal groups. Since this time, there has been a

significant rise in the popularity of tattooing. Kluger cites that while tattooing is still popular in

prisons and the military, other groups are seeing a rise in tattoos such as athletes. Women are

also getting tattooed much more. Overall, they found the more recent reasons for getting tattooed

often overlap for each individual and shift over time. To better understand how we got here, it is

important to gain a deeper context of how tattooing shifted from its original cultural contexts in

ancient indigenous cultures to its western form. In their book, DeMello and Rubin (2000) explain

how European explorers encountered tattooing practices in Polynesia and many Europeans

received tattoos as souvenirs of their journeys. The Tahitian word for tattoos, ta-tu or tatau was

taken on by these explorers and has remained the name we call them in modern times. In

addition to Tahiti and Hawaii, explorers also took interest in the tattooing practices of New

Zealand. Bringing people back from these countries as examples of “savages” and putting them

in side shows is an early example of stigmas associated with tattooing. As sailors returned with

tattoos, interest in getting tattooed grew and those in the West (Europe and America) began their

own tattoo practices, focusing on patriotism over the exoticism of the souvenir tattoos. Later in
Tattoos and Healing

the same chapter DeMello and Rubin discuss that after the invention of tattoo machines, the

American traditional style of tattooing was created. With this invention, it became more

accessible to the lower class and this shift began new negative associations. Just as tattooed

native peoples had been displayed in shows, heavily tattooed western people also became

attractions. During the world wars, many who got tattooed were in the military and the tattoos

they received often reflected this. After the wars ended and regulations around tattooing

increased it lost some popularity. Tattooing moved from a patriotic working-class practice to a

form of defiance against middle-class values. Interest in tattooing rose with biker groups, gang

members, and criminals. Other marginalized groups such as hippies were also drawn to tattooing.

This shift gives perspective on where many of the modern stigmatized beliefs around getting

tattooed come from that many still hold today.

Stigma

After completing my overall research, I was excited by my findings but still aware of

how little research has been done on some of the more modern motivations behind tattooing.

Through my research one explanation stood out, stigma. As seen in the history of tattooing

explored earlier in this paper, stigmas around tattooing existed since its arrival in the West and

shifted over time as it was adopted by different groups. According to Maxwell et al (2020), much

of the literature studying tattooed individuals explores and documents correlations between

tattoos and specific deviant behaviors such as drug and alcohol use, violence, risky sexual

behaviors, and more. However, they continue on to explain that this research has also almost

solely focused on stigmatized populations such as juvenile delinquents, incarcerated populations,

medical facility patients, and those of low socioeconomic status. They express that at one time

these populations were representative of those with tattoos, but as tattooing has grown in
Tattoos and Healing

popularity, they can no longer be used to draw conclusions about tattooed people as a whole.

Occupations of tattooed individuals have become increasingly diverse and Maxwell et al. (2020),

mention that it is estimated about 20 percent of the US population and 40 percent of those under

40 have a tattoo. In addition to this shift in tattoo popularity, the authors share potentially

conflicting research showing that those with body modifications (tattoos and piercings) are more

likely to engage in positive social and health behaviors like voting, volunteering, donating to

charities, and engaging in a healthy diet and exercise habits. This research represents how older

research with this population is less and less relevant to today’s population.

Another article by Broussard and Harton (2018) attempts to further explore these

discrepancies. They explain that, because tattoos are a choice, rather than an inherited attribute,

the public's negative perceptions could be legitimate. They explore the idea of a “kernel of

truth”, considering that stigmas around tattooed people may stem from some truth. Broussard

and Harton echo the mixed findings of previous research. Overall differences between tattooed

and non-tattooed individuals in previous research have been minimal and potentially not

applicable to the wider population. In their article Broussard and Harton then attempt to explore

for themselves if the kernels of truth do exist, but they also explore how much negative stigmas

are still held against those with tattoos. In their first study on stigma, they surveyed 142 college

students with character ratings for images of tattooed and non-tattooed individuals on perceived

character traits. Additionally, participants took a survey on personality, drinking behavior, and

cognitive ability and answered demographic questions including if they had a tattoo. They found

that, though one might expect younger people to have fewer stigmas against tattooed individuals,

the participants did view tattooed people negatively. One exception was that participants found

tattooed women to be stronger and more independent. They found that those with tattoos scored
Tattoos and Healing

higher in defiance and alcohol use, but they note that this may be due to age differences as those

with tattoos skewed older. The second study surveyed 104 participants of a more age and

racially-diverse group of adults with the same process. The results mirrored the first study, but

participants rated tattooed individuals more negatively overall. In terms of the other ratings, in

the second study, there were no differences between tattooed and non-tattooed participants

indicating that stereotypes may be based more on stigma than truth. Overall, they note that while

the stigma may not be based in truth it still can impact people with tattoos through things like job

discrimination.

Finally, in my exploration of stigma, I encountered an article by Zidenberg et al

(2022) on public perceptions of tattooed mental health professionals. It is important not only to

consider the effects of stigma on those seeking care but also on those giving care because stigma

may impact the relationship on either end. From their research Zidenberg et al. (2022) found

previous literature indicated that the perceived competence of healthcare professionals may be

negatively impacted by visible tattoos. However, other sources found no differences between

tattooed and non-tattooed healthcare providers aside from rating tattooed women as slightly less

professional. They identify a lack of research into stigmas around mental health professionals

and attempted to fill this gap with their present study. They surveyed 534 participants who were

Canadian citizens and were recruited on social media and through a university. They recruited

those who would likely have mental health concerns. Participants were asked to rate a therapist’s

profile with a randomly assigned image of a non-tattooed person, a person with tattoos, or a

person with a provocative tattoo on the perceived level of competency and their feelings towards

them. Participants also filled out a demographic questionnaire. The study found that having a

neutral tattoo and no tattoo was statistically equivalent while having a provocative tattoo had a
Tattoos and Healing

mildly positive effect. The therapist with no tattoos was seen as more professional but this had

no impact on feelings towards the tattooed therapist or desires to seek care from them. The

authors hypothesize that having a visible tattoo, particularly a provocative one may make them

appear more genuine. Overall, their results show that concern about tattooed clinicians' perceived

competence is not warranted and that a clinician having a tattoo may benefit the therapeutic

relationship. After looking into the literature on stigma I can identify how understanding stigma

can help clinicians better understand and connect with clients, and also explains why a lot of

research has not been conducted on identifying positive and pro-social connections to tattoos.

Current Understandings of Tattoo Motivations and Meanings

While there has been a lack of detailed research in the past, with the quickly growing

popularity and diversity of tattooing, research has begun to be conducted on the new populations

of people getting tattooed. The exploration of the history of tattooing revealed many of the early

motivators and uses of tattooing, but this has since expanded. Several articles in my research

highlight and explore new and diverse reasons people in modern society get tattooed as well as

the themes that emerge from these motivations. These articles come from mostly psychological,

but also sociological and anthropological approaches. When the literature is explored, the

common themes that exist shed light on why this topic is relevant to psychologists and especially

art therapists.

The Body

When talking about motivations and meanings behind tattoos in the literature, the body

and the skin as the canvas cannot be ignored. Throughout the literature, the body takes on

different roles when it comes to tattoos. One way in which the literature explores the body is
Tattoos and Healing

through the body as the canvas. Why select the body as the surface for the artwork? In an article

by Maloney and Koch (2020) exploring the motivations and meanings behind religious tattoos of

college students, they found that the placement of the tattoo was significant to its meaning and

the motivations behind it. For those with the tattoo in a more visible area, they were often used as

an outward expression of faith to others, an “advertisement of identity” or an expression of group

affiliation. While others were more obscure or in hidden areas representing a private dedication

to their faith. Either way, their location was essential to their meaning and how the individual

wanted the meaning communicated. In addition to this exploration of placement, Maloney and

Koch found that many tattoos were “themed” to the body part they were on. Several tattoos with

themes around “walking with God” were placed on the foot for example. This shows that not

only does visibility play a role in the purpose of the tattoo, but it can also deepen its meaning.

The body can often be a signifier of group identities such as race and ethnicity, gender, and age.

Another aspect Maloney and Koch’s research shows is that with tattoos, less visual identities can

be represented like religious affiliation.

In addition to placement, another significant quality of using the body as a canvas is the

concept of permanence. Canvasses like paper, wood, fabric, etc. are all impermanent and at risk

of change or loss over time. The body is something that is with us always. In the article on

religious tattoos by Maloney and Koch (2020) themes emerged of reverence, respect, and

remembrance. According to the participants in their study, the permanence of the tattoos

heightens the significance and impact of these themes for themselves and how they are conveyed

to others. In an exploration of memorial tattoos and grief done by Buckle and Dwyer (2021),

they discuss how tattooing can be a way that grief is embodied on the skin and its permanence

reflects for its wearer and those who view it how grief is lifelong. When society seeks to hide
Tattoos and Healing

grief, tattoos give it a spotlight. The authors describe the phenomena perfectly when they say that

”...memorial tattoos are the internal grieving process drawn on the external body”

(Buckle&Dwyer, 2021, p. 2). Additionally, after surveying the participants in their study they

found that the permanence of the tattoo was also a response to the impermanence the experience

coming from their loss. It was a way to reclaim and fight back against the heartbreak of that

impermanence. One participant additionally mentioned that most memorials are impermanent

and don’t stay with us while the tattoo goes everywhere with you. This discussion introduces yet

another perspective on tattoo placement and its visibility to others. Maloney and Koch (2020)

describe how memorial tattoos that are in visible locations can open a dialogue about loss. They

found that there is a dual stigma for tattoos and also around those grieving, the visibility of the

tattoos then allows for this dialogue that combats the stigma around loss and grief as well as the

stigma around tattoo associations.

A final theme that emerged from the literature around the body and tattoos is the theme of

reclaiming control over one’s body. In their article about the motivations of sexual assault

survivors seeking tattooing as an alternative therapeutic process, Maxwell et al. (2020) discuss

themes of control and reclamation. This control includes bodily as well as environmental control.

In the tattoo process, a client has control over the image, and control over when they will

experience pain. Even when tattoos were not related to the trauma in terms of their content,

participants cited that the control they had over the tattoo process and what happened to their

bodies was indirectly connected to their processing of the trauma. The theme of control over

one’s body is echoed in the study done by Crompton et al. (2020) when they explored themes

from public postings on those with trauma discussing their tattoos. One example they found was

that for some, reclaiming the body from trauma meant tattooing directly over scars. Additionally,
Tattoos and Healing

in their article they express the overall idea of individuals reclaiming the body by saying “their

accounts appear to indicate the need to turn their invisible injury into a visible mark, thus

reclaiming their bodies, regaining control over their lives, encouraging their transparency and

avoiding social isolation” (Crompton et al., 2020, p.9) Additional themes from the article by

Maxwell et al (2020) fall under the category of general cultural reclamation. This is seen in the

reclamation of what defines beauty from patriarchal standards and the reclamation of the body,

that was ‘owned’ by someone else. Not only do the tattoos on the body help survivors have

control over and reclaim it from their trauma, but they also offer control over and reclamation

from the hold that patriarchal norms have on the female or femme body. Finally, an article about

decorative, non-medical tattooing over scars by Kieran Moulton (2022) echoes this idea of

reclaiming the body as people use decorative tattooing to cover their scars.

Documenting Narratives and Events

A concept that could be found multiple times throughout the literature on tattoos was the

idea of expressing narratives and documenting life events through the process and product of

tattoos. Maxwell et al. (2020) share how much of the previous research done on those with

tattoos focused on behavioral correlations without allowing individuals to provide a personal

narrative. As discussed above they found participants used tattoos to rewrite society’s patriarchal

narrative from their lives. This concept can be seen more broadly when, in their article on

religious tattoos, Maloney and Koch (2020) are surveying college students mentioning how early

adulthood is often a time of exploration of religion and pursuit of body modifications. The

tattoos owned by these participants are reflective of that time in their life. For more specific

examples, Hill (2021) found that many of the participants in the study used symbols of animals

to represent their life stories. For certain participants, the tattoos reflected specific times in their
Tattoos and Healing

lives like places they went or things they did. They even said that while some tattoos may not be

a design they would choose in the present, it represents an identity that was important to their

past self. Hill also mentions the use of tattoos to mark moments of pain and loss. In their article

on memorial tattoos Buckle and Dwyer (2021) discuss how, in their research, a key motivation

behind tattooing is expressing the story of one’s life, and for memorial tattoos, they mark the

grief experience and reflect that part of their life story.

Part of telling one’s story includes meaning-making. Buckle and Dwyer (2021) discuss

shows how meaning-making plays an important role in grief, and, importantly, its absence can

lead to complicated grief. Within one’s narrative, meaning-making can take many forms, and for

some, this is the form of the tattoo process. With the tattoos, participants could represent the

process of making meaning from grief and have control over how this meaning is presented to

others. Crompton et al. (2020) also recognized that for those with trauma, meaning-making

through the tattoo was part of understanding the trauma in a personal, interpersonal, and social

way. The animal tattoos in Hill’s (2021) article were often used by individuals as a way to

articulate ideas that one cannot through language alone, expressing and making meaning out of

experiences and relationships they had with animals or others they associate with animals. Many

of the tattoos surveyed in all of the articles held meaning for the wearer, and it is clear that in

addition to inherently holding a meaning, many tattoos were used to create meaning, often from

the specific life events also being documented.

Self-Expression and Identity

Tattoos can not only be tools for expressing what one is experiencing but also a way to

express who one is. Identity exploration and self-expression came up in several articles in the

literature. One concept explored was group identity. Affiliation with a group was a concept
Tattoos and Healing

brought up by Hill (2021) regarding cultural and political connections important to the person's

identity, Maloney and Koch (2020) regarding religious affiliation, Crompton et al. (2020)

regarding experiencing a shared traumatic event, as well as more generally discussed in the

literature reviews of Maxwell et al (2020) and Alter-Muri (2020).

In addition to a connection with a group identity, many tattoos can be used as a reflection

of one’s unique individual identity. Self-identity and self-expression were mentioned either

briefly or extensively in several of the articles exploring tattoo motivations. Additionally, the

concept of identity formation was brought up several times. Some participants in the studies used

tattoos to express identities such as religious affiliation like in Maloney and Koch (2020),

survival of traumatic events like in Crompton et al. (2020) and Buckle and Dwyer (2021), and

general uniqueness or individuality like in Maxwell et all (2020) and Hill (2021). Maxwell et al.

(2020) also emphasize how tattoos are used as a tool to reclaim one’s identity, especially for

survivors of sexual assault. Identity formation implies a more process-based approach that goes

further than some tattoos' more straightforward reflection of internal identity. For example, in

Hill’s article (2021), participants used the tattoo to embed animal traits into their identity, in an

active process of forming and then representing their identity. Similarly, college students getting

tattoos to represent their religious affiliation followed this same process of embedding and then

representing in Maloney and Koch’s (2020) article.

Finally, not all tattoos reflect a deep personal meaning, but they can still act as a way of

self-expression in the pursuit of aesthetics. Most of the articles in this literature surveyed specific

populations on their tattoos that hold meaning and have specific purposes. However, a broad

survey done by Alter-Muri (2020), found in a group of 122 college students with tattoos, the
Tattoos and Healing

motivation of aesthetics was cited by 17 percent of participants, though 97 percent of all

participants did report that their tattoos had a symbolic meaning.

The Tattoo Artist

Another important point to explore can be identified in Kivanc et al’s (2021) article when

they say, “... the process of tattooing involves three main constituents, the skin of the client, an

image or design, and a tattooist” (p.269). The client and their design have now been discussed at

length in this paper, however, the third aspect not yet identified is that of the tattooist. This is a

unique third party, (or perhaps, third hand). In the article exploring tattoos as non-medical scar

decoration, Moulton (2022) interviewed tattoo artists on their understanding of the process. One

theme identified was having a positive impact, and a subtheme of this was titled “therapist”. The

tattoo artists identified the importance of listening to and understanding clients and their

motivations behind covering their scars. In the interviews, the tattoo artists understood the

position of power they held in the situation. Tamara Santibañez (2020), a tattoo artist and writer,

wrote a workbook highlighting the deeper work tattoo artists are doing in response to the shifting

motivations behind getting tattooed. In their book, they identified that due to the strong

emotional content that clients can bring concerning their tattoos, tattoo artists must be mindful of

understanding trauma-informed approaches, boundary setting, creating a safe and supportive

environment, power dynamics, consent, and many other factors while also emphasizing to clients

that they are not therapists. Santibañez (2020) recognizes the power tattoo artists hold to create a

transformative and healing space while also recognizing the slippery slope of taking on more

than tattoo artists are trained to do. In their book, they encourage tattoo artists to explain these

limitations to clients and encourage the pursuit of professional help. Their book reflects the shift
Tattoos and Healing

in attitudes towards tattooing and how tattoo artists are changing to accommodate this shift and

ensure that both they and their clients are safe.

Supportive Research from Psychology

In my research, many articles looked into specific experiences of people with tattoos.

However, some research looks more broadly into psychological themes and concepts that can be

connected to the process of tattooing. Some discuss psychological concepts while others discuss

specific connections to the practice of therapy itself. In their article on tattoos in

psychodermatology, Kivanc et al. (2021) explore the psychoanalytical aspect of tattoos. In their

article, they identify multiple motivations behind tattooing that echo the research explored before

such as aesthetics, group affiliation, the marking of an event, meaning-making, loss of loved

ones, identity formation, and individuality. They also introduce motivations such as medical

applications and self-esteem. They share how tattoos can be an alternative to cutting or can be

markers to identify an underlying medical condition in case of a crisis. They identify that there is

a relationship between tattoos and emotions, identity, sociocultural environment, and

psychological states. Another article from my research that explored the psychological basis of

tattooing comes from Grumet (1983) in his article, The Psychodynamic Implications of Tattoos,

a very early exploration of tattooing done before many of the modern explorations of tattoo

motivations.

Several themes explored in the literature thus far are examined in Kivanc et al’s (2021)

article. They explore symbols and how they can come from intrapsychic conflicts and “...reflect

the developmental state of the ego and how it deals with objects” (p.270). For the development

of personal individualization, the symbol on the skin as well as the literal penetration of the skin

by the needle can act as a transitional object. Grumet (1983) identifies that clear body boundaries
Tattoos and Healing

are essential in the development of a clear ego identity. He identifies that many younger

individuals, still seeking to cement their identity, may find tattooing a useful tool. Kivanc et al.

(2021) recognize how these images also represent the importance of group psychology in

facilitating group identification and bonding. Grumet (1983) includes identity in a historical

context to this aspect. Additionally, Kivanc et al (2021). explore the concept of the body.

Coming from the teachings of Freud around the bodily ego of infancy, skin is a tool for

communication between the mother and infant and thus reflects how tattooing can be a form of

nonverbal communication that allows the wearer to express emotions or thoughts. The skin is the

outermost part of the self and represents the transition from the self to others (connecting to the

transitional object referenced previously). Grumet (1983) also discusses the ideas of nonverbal

communication that tattoos can provide. He hoped that there could be examinations of tattoos

that would lead to objective analysis, but there were too many factors in the tattoo acquisition

process that impacted accurate analysis. However, he found that “a tattoo worn on the skin for

many years often assumes symbolic importance, becoming a reservoir of emotionally charged

memories and talismanic meanings for its bearer” (Grumet, 1983, p.489) So while there may not

be directly translatable meaning from tattoos through analysis, it is clear that a tattoo is a form of

communication.

Kivanc et al. (2021) argue that tattoos are a reflection of one’s inner world. They argue

that instead of being an indication of psychopathology, tattoos are a representation of the

wearers' desire to express identity. This leads to their discussion of personality associations,

which were also studied by Broussard and Harton (2018) in their article on tattoo stigma. Their

findings echo that of Broussard and Harton in that many studies have been done on specific

populations that cannot be applied the general population. However, they did identify that
Tattoos and Healing

individuals with tattoos are more likely to engage in risky behaviors such as smoking, drug use,

and sexual activity. They also found that the presence of a tattoo may indicate an underlying

mental health condition. However, the question of correlation versus causation emerges. One

hypothesis is that the benefits tattoos can provide, as mentioned in the literature explored in this

paper, may be ones sought out by those with mental health conditions leading to these

associations. Kivanc et al. (2021) found for example, that those who use heroin struggle to

symbolize and express their feelings, and tattooing may be a tool used to cope with depression

and other psychiatric problems. Whether it is a reflection of one’s identities or a way to cope

with psychiatric illnesses, it is clear that tattoos offer a wealth of useful information for

psychologists looking to explore and understand the psychology of those with tattoos.

Identifying psychodynamic concepts and internal motivations is one aspect of exploring

tattoos from a psychological perspective, but an additional and practical element of this

exploration involves identifying the role of tattooing in therapy. After the identification of the

wealth of information tattoos hold, Grumet (1983) states that tattoos can be a springboard for

discussing private feelings. A person’s reaction to their tattoo can reflect their self-esteem as,

according to Grumet, tattoos represent the efforts of the wearer to solidify identity and symbolize

the self. Grumet argues that exploring a “tattoo history” can provide essential information just as

a family, vocational, or medical history would. Grumet is not alone in his identification of tattoos

as a useful therapeutic tool. Returning to their exploration of the stigma tattooed mental health

professionals may face, Zidenberg (2022) also found clinicians noticed that having a tattoo

visible encouraged clients to be their true selves. The opinion of clinicians is that a therapist

having visible tattoos may strengthen the bond between therapist and client, as they can be

interpreted as a gesture of self-disclosure. Therapists that discussed tattoos with clients felt closer
Tattoos and Healing

to them. They also discuss how the client having a tattoo can provide meaningful information

about them, and that discussing tattoos in therapy may be beneficial for the treatment.

Integrating Tattooing and Art Therapy

Literature With Overlap

While there have been connections made between psychological concepts and tattooing as

mentioned in the section above, what does art therapy have to say about tattooing? Through my

research, there was limited literature that specifically reference both tattooing and art therapy.

The one article that I found is by Alter-Muri (2020) who took a look at the motivations of

tattooing in college students and how understanding these motivations connects to art therapy. In

their article, they referenced the lack of written information on tattooing and art therapy.

However, they do discuss that through personal communication they found some therapists who

include tattoos in their practice. One works with existing tattoos with negative histories to

transform them. Another uses non-permanent tattoos with adolescents resistant to art therapy and

watercolor pencils to draw on the body as a technique for trauma survivors. In their conclusions,

similar to the findings of Zidenberg et al. (2022), Alter-Muri argued that because tattoos can be

tools of self-reclamation and autobiography, they can open up discussions about personal

narratives earlier than with a client with no tattoos. Additionally, there are implications of tattoo

exploration for art therapists. She says that art therapists can use the symbolic meaning of the

tattoo in further artwork with the client. Narratives can be explored and expanded upon through

other art forms in session. For those who do not have tattoos or do not wish to use their body as a

canvas, they can still make symbols for display.

Tattoos and Healing

In addition to the article by Alter-Muri, Catherine Moon’s (2010) book on materials and

media in art therapy specifically discusses the art form of tattooing in the context of art therapy.

In her book, she argues that Art Therapists must explore and understand the vast array of artistic

approaches and techniques used today and go beyond the limited scope of art materials

commonly used in art therapy. She identifies tattooing as an art form growing in popularity in

our modern culture. She argues that recognizing the historical and cultural contexts of tattooing

can help art therapists better identify the therapeutic potentials and limitations of tattoos. She

mentions that, because of issues of safety and practicality, the application of tattooing in the

therapeutic setting could be more limited to non-permanent body art such as temporary tattoos,

henna, or painting on the body. However, some art therapists like Dean Spruth, as noted by

Moon (2010) have engaged in direct therapeutic work with tattoos. Spruth works with members

of groups such as gangs or white supremacist groups to transform their tattoos and change their

meaning. In the practice, “The tattoos function not only as metaphors of personal expression but

also as mediators of interpersonal relationships and activators of social and cultural change”

(Moon, 2010, p.xxi). Additionally, Moon urges therapists exploring this art form to be mindful

of the multiple cultural implications of tattoos across identities. While the discussion in her book

validates that tattooing is an art form deserving of understanding in the field of art therapy, it

does not explore deeply into the therapeutic elements of art therapy that tattooing reflect.

Therefore, further exploration into the literature is needed.

Exploring Foundational Literature

While it is clear that the literature on art therapy and tattooing is limited, themes from the

tattoo literature discussed previously guide exploration into the existing literature on core

principles and practices of art therapy. Pulling from Bruce Moon’s (2016) book on the
Tattoos and Healing

introduction to art therapy he outlines several principles and curative factors of art therapy that

are of note in this context. When considering communication/ personal expression, two of Bruce

Moon's principles discuss how the art allows for meta-verbal communication, but also that there

is safety in verbalizing around an artwork. The image can communicate ideas on its own, but

when the image represents painful things, discussing the image and its process allows for safety

and distance from the intensity. In the literature explored earlier, those with tattoos in visible

places used them to discuss painful things like grief or communicate aspects of identity like

religion. Directly related to this Bruce Moon also discusses another principle, that art therapy

encourages clients to render emotional portraits of people and events. Moving with the concept

of “communication”, another curative aspect of art therapy Bruce Moon describes is the aspect

of relationships. He states that artmaking is relating and that people desire connection with others

and art facilitates this connection. He says that artmaking as an action acknowledges that there is

something beyond the self. This connects directly to the psychological concepts in the section

above that covers how the skin represents the transition from self to others. In addition to this

Moon states that in relating to the community, the artist establishes their own identity. From this

idea of identity Bruce Moon (2016) describes the curative element of soul, which expresses how

artmaking is creating a portrait of selfhood, and that the soul transforms random events into

meaningful experiences. The self/ identity was a key theme discussed in the tattoo literature.

Another element at the core of tattooing is the art as a symbol/ metaphor, which Bruce

Moon discusses as having both conscious and unconscious symbolic meaning. This is also a

theme in his eighth principle of art therapy, which says art therapy lets clients make tangible

objects that represent feelings and thoughts. Malchiodi (2011) discusses how art therapy allows

for the processing of painful feelings safely through the metaphor and symbolism of their
Tattoos and Healing

artmaking. She also mentions multiple times when discussing diverse populations, the benefits of

symbols as a tool to nonverbally communicate ideas, especially difficult ones. In her book

exploring Approaches to art therapy, Rubin (2012) discusses the image and symbolism and

shares how the symbol can become infused with personal meaning which impacts one’s

conscious attitudes. In the tattoo literature, the tattoo images were symbols representing a

multitude of ideas and needs and facilitated transformation within the tattooed individual.

What about documenting life events? Rubin (2012) discusses how art allows people to

share their stories, promote positive experiences, and reflect one’s internal experiences. Placing

the narrative into the visual format can provide a way to reframe it. She says in one part of her

book, “Through artistic symbols, metaphors, and stories, we can illustrate the narratives of our

lives. The richness of visual imagery provides opportunities to examine and to reframe that

narrative, to help us see things differently” (Rubin, 2012, p.259). Additionally, Malchiodi

(2011) found that art can allow for meaning-making and gives examples of cancer survivors

utilizing art for this purpose. She shares how the narratives of art can include triumphs and

traumas. One of Bruce Moon’s (2016) principles of art therapy identifies connections clients can

make to their past through the image. He says that art provides an emotional window to the past,

and this allows for the processing of these emotions. These forms of documentation were key for

many interviews in the tattoo literature, with tattoos marking moments in people's lives and

acting as reminders and connections to the past.

Another major curative element Bruce Moon (2016) discusses that was a key concept in

the tattoo literature is the art as empowerment. In this section, Bruce Moon talks about the artist's

power over the image to transform it how they like. This reflects the ability to make choices and

have free will within their own lives. Malchiodi (2011) found that art therapy with pediatric
Tattoos and Healing

patients helped them feel more empowered in their medical treatment, and children who

experienced trauma used the art to feel empowerment over the trauma, along with several other

examples. Rubin (2012) discusses the power of empathetic listening and witnessing to empower

clients. It follows that those who pursue tattooing can become empowered from the empathetic

listening to their stories. She also notes for clients, that witnessing their art can be empowering as

they recognize it as a metaphor for resilience. Witnessing of tattoos was a key element of them

for many in the tattoo literature.

Finally, the idea of the third hand can be interpreted from the tattoo literature when

considering the tattoo artist as a third party facilitating the client’s creative expression. Bruce

Moon (2016) describes this concept, coming from Edith Kramer, where the therapist can lend aid

to make another’s creative expression possible. In their article exploring self-identity through

portraiture and the concept of the third hand, Carr (2014) discusses Kramer's third hand. They

share how an important element of the third hand is that it doesn’t distort meaning or impose

ideas not relating to the client. Kramer used this concept to create portraits of her clients, which

had an impact on their identity formation. Carr (2014) further explains that “Third hand

techniques allow the patients' lived experience to be temporarily held and contained by the

therapist and then transformed within the portraits in a process that involves the ‘empathic

passage through the other...” (p.57). In the process of getting a tattoo, the creative expression of

the client is facilitated by the tattoo artist. While unable to practice this concept therapeutically,

the process looks very similar as the client’s concept is held by the tattoo artist and returned to

them through the tattoo.

The final consideration to explore when discussing the art therapy literature is to identify

the key ideas identified in the tattoo literature that are not reflected in the art therapy literature.
Tattoos and Healing

One concept was that, for some receiving tattoos, the goal is purely aesthetic. Another term not

quite reflected in art therapy literature is the body. While much of art therapy explores the body

in terms of movement and concepts like the mind-body connection discussed at length in

Malchiodi’s (2011) book, it does not quite explore it in the way tattoos do. In this case, the body

is used as the canvas, where placement and visibility are essential parts of the art itself. Tied into

this concept is another term not explored as much in the foundational art therapy literature which

is permanence. For many participants in the tattoo literature, permanence was essential to the

artistic and personal meaning of their tattoos. The permanence transformed the artwork into

something it could never have been in another medium.

Discussion

In this review of the literature, I have attempted to collect and organize what is known

about the reasons individuals are seeking tattooing in recent years. I began by grounding my

understanding of this population by exploring the history of tattooing in antiquity as well as its

more recent history in North America. I also recognized the significant impact of stigma on this

population and explored it through the literature. This gave insight into potential reasons more

pro-social motivations behind tattooing have been explored in a more limited capacity. After

building this foundation I explored current research on tattoo motivations and applications. I then

explored research on tattoos in the field of psychology followed by research in art therapy.

Finally, recognizing the limited information I found from the art therapy research, I explored

foundational art therapy literature to identify core themes and principles of the practice. Through

the literature, it is clear that some kind of healing or therapeutic benefit is a rising reason people

get tattooed. The main theme of healing is not where this motivation ends, as it is clear that there

is a diverse and complex list of reasons certain tattoos can be healing. The literature reveals that
Tattoos and Healing

the broader field of psychology is not unaware of the connections between tattooing and one’s

psychology. While the field of art therapy has limited information combining the two disciplines,

it is clear that the possible connection has been noticed by some and implications are being

explored. After reviewing the literature on tattoo motivations and moving into the foundational

art therapy literature, key approaches and principles stand out as they parallel the findings from

the tattoo literature.

Themes

Through my exploration of the tattoo literature, psychological literature, and art therapy

literature, it became clear that many of the reasons individuals sought tattoos reflect reasons

clients find benefits in art therapy. Overlapping themes included the art as a symbol/metaphor,

the art as a tool that facilitates communication, the art as self-expression and a representation of

identity, art as empowerment, art as meaning-making, and art as a tool for documenting life

events. It is clear that whatever artistic medium an individual uses, the benefits of art therapy can

be pulled from them. Additionally, two key considerations overlap between the two. The first is

the exploration of the importance of art materials. In Catherine Moon’s (2010) book she explores

the impact art materials have on the therapeutic abilities of artmaking and encourages art

therapists to identify the benefits of art materials and modalities outside of the traditional art

therapy world. Tattooing is one of these unique modalities. The second, is how the role of the

tattoo artist offers an interesting potential parallel to Edith Kramer’s concept of the therapist's

third hand. The role of the therapist and the tattoo artist when it comes to their client’s art is

surprisingly similar. Even in the writings of Santibañez (2020) we see steps tattoo artists take to

ensure clients know that the space is not a clinically therapeutic one, though it may still be

healing. This shows me how a tattoo client may feel drawn to using the tattoo artist like the third
Tattoos and Healing

hand and also how naturally clients are making the connection to a therapeutic space when in a

tattoo space. Surprising to me was the discussions of tattooing that already exists in

psychological literature, like the connections Kivanc et al. (2021) made between tattooing and

the concepts of Freud and other foundational psychologists. Tattoos can help bring up ideas that

connect the psyche to the physical body. Art therapy has its own foundational concepts, but is

also at its foundation, the overlap between art and psychology. After I explored the current tattoo

literature, it was impossible to read the foundational art therapy literature without connections

and revelations emerging after every page.

Not everything from the tattoo literature could be found in the foundational art therapy

literature explored. Central to and unique to tattooing is its relationship to the body and skin, and

its permanence. Art therapy explores mind-body connections, but limited work has been done

utilizing the body itself as the canvas. Alter-Muri (2020) describes some therapists working with

the body, and some literature exists describing using painting or temporary tattoos on the body.

However, none can reach the degree and involvement that tattooing provides. Core to this

process is the desire for and utilization of permanence. In tattooing it seems to be a

transformative tool as many participants in the tattoo literature, like those in Maloney and Koch

(2020), discuss how the permanence strengthens the tattoos meaning and its personal

significance. In addition to this permanence, is the fact that a tattoo is always with the wearer.

While things like physical memorials may help with processing, they must be left behind. In

their article on memorial tattoos Buckle and Dwyer (2021) share how essential the tattoo is in

representing the continuation of the bond they share with the person who passed. The benefits

that can be seen overlapping between tattooing and art therapy can seemingly be amplified by

this permanence and intensity of process. Communication with others can be more impactful as
Tattoos and Healing

others recognize the work and dedication of the wearer. The reflection of the self is intensified in

its commitment as permanent ink in skin. Physical pain is not a part of most art processes, and in

tattooing, the client takes control of the experience, more deeply connecting to feelings of control

over one’s life, and control over one’s pain.

Implications and Recommendations

These two core themes, one being the significant overlap between Art Therapy and

tattooing and the second being the unique benefits that individuals find in tattoos, help guide the

interpretation of the implications this research has for art therapists. Catherine Moon (2010)

challenges current therapists by expressing the importance for the field to not stay stuck in

tradition and recognize growing artistic trends within the culture. These trends show implications

for how the field must change to continue its growth. To understand our clients, we must

understand artmaking within the current social and cultural contexts. Moon emphasizes however,

that it isn’t just about following trends, but that it must be a mindful practice. Art therapists must

not, “...use materials and media simply because they are novel, but rather to use them because

they are just what the client needs, the specific artistic vocabulary that corresponds with what the

client needs to articulate” (Moon, 2010, p. 37). Not only are there core art therapy principles at

work in a client’s tattoo process, but it is also clear that tattooing provides a unique artistic

vocabulary that corresponds to the client’s needs. For art therapists to ensure that they recognize

the artistic trends in our culture, understanding tattooing is essential.

art therapists cannot tattoo their clients for many ethical reasons and so, the application of

this data is not as straightforward as the application of other new media practices. One of the

most direct ways art therapists can apply this knowledge is by recognizing the benefits tattoos

have to the therapeutic alliance. For therapists with clients who have tattoos, discussions of the
Tattoos and Healing

client’s tattoo history can provide a rich personal history as well as identify artistic

considerations the client is already making. Alter-Muri (2020) emphasized the ways that tattoos

could springboard creative processes. This could be based on existing narratives, symbols, and

imagery the client created. The tattoos can help guide the therapist in knowing what visuals the

client may want to work with. Interest in and listening to clients’ tattoo stories can also help

build the therapeutic alliance, as it is clear from the literature that for most people, their tattoos

mean a lot to them. For therapists with tattoos themselves, some of the research showed that

clients may view the visibility of these tattoos positively. Art therapists should recognize the

creative and therapeutic power their clients’ tattoos hold while on their skin and in further

creative processes.

Therapists can also learn a lot about applying core therapeutic principles, like meaning-

making, empowerment, and symbolism, with clients by learning about the unique ways these

principles are used in tattooing. Additionally, therapists would benefit from understanding and

seeking ways to apply the benefits of tattooing not yet present in art therapy such as its unique

relationship to the body and its use of permanence. To better understand these applications

further research is needed. While there were a significant number of studies to explore for this

study, a trend is apparent in that many of them are from the past few years. It is clear that this

research is still emerging, and concepts are still being explored. This research should seek to

explore the benefits of using the body as a canvas, and/or how art therapists can help clients who

may not want tattoos, to find the benefits of permanence found in tattooing.

The literature on therapeutic or healing benefits that people seek in tattooing is still

limited. While I explored several, these studies were still limited in scope and would benefit

from repeat studies in different locations with different population sizes. These studies also did
Tattoos and Healing

not cover all of the current reasons people get tattoos or trends in tattooing. Further research

could explore the semicolon tattoo, a tattoo that is pursued by people who experience suicidal

ideation, depression, and addiction representing a sentence that could have ended but didn’t, or

medusa tattoos often referencing experience with sexual assault. Another area to explore could

be the “still not asking for it” movement which has its own website for information

(https://www.stillnotaskingforit.gives/) that focuses on raising awareness and funds to help those

who experience sexual violence and helping prevent sexual violence. There are many other

movements in tattooing like this one to explore. The therapeutic benefits of scar tattooing are

another area where a therapist could pursue further research. I name these specific examples to

reflect the limitations of this current paper in representing the expansive tattoo culture that

currently exists, and all the potential therapeutic implications being pursued therein.

Conclusion

The objective of this literature review was to more deeply understand a population upon

which has had limited qualitative research and has been impacted negatively by stigma and

previous associations. It seeks to explore a growing motivation behind tattooing that emerges

from a more healing and therapeutic space and see, how prevalent this motivation exists and if

this way of therapeutic art is relevant and applicable to the field of art therapy. The research

shows that there is a clear pursuit of therapy and healing within the tattoo world and that many of

the themes that emerge in the literature reflect the values and principles of art therapy. Not only

this but tattooing also has its own unique benefits that clients seek out that art therapy has yet to

explore. Finally, an understanding of clients and their relationships to tattoos can greatly benefit

the therapeutic alliance and provide fuel for the creative art process in the therapeutic space.
Tattoos and Healing

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Tattoos and Healing

THESIS APPROVAL FORM

Lesley University
Graduate School of Arts & Social Sciences
Expressive Therapies Division
Master of Arts in Clinical Mental Health Counseling: Art Therapy, MA

Student’s Name: Marielle Carpentier

Type of Project: Thesis

Title: Tattoos and Healing: Considerations from an Art Therapy Lens- A Literature Review

Date of Graduation: May, 2023

In the judgment of the following signatory this thesis meets the academic standards that have
been established for the above degree.

Thesis Advisor: Raquel Chapin Stephenson