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Embodied Narratives

Hannah Zipes
Pennsylvania Western University
Department of Psychology, Counseling and Art Therapy
COUN 7550: Introduction to Research in Art Therapy
Dr. Sheila Lorenzo de la Peña & Dr. Carolyn Treadon
Summer, 2024

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Table of Contents
Abstract...........................................................................................................................................5
Section I: Introduction....................................................................................................................6
Problem to be Investigated..................................................................................................6
Purpose Statement...............................................................................................................7
Justification.........................................................................................................................7
Terms Related to this Study................................................................................................8
Section II: Literature Review........................................................................................................13
Adversity...........................................................................................................................13
Family Rejection...................................................................................................14
Political Erasure...................................................................................................15
Mental Health Needs.............................................................................................16
Frameworks.......................................................................................................................17
Queer Theory........................................................................................................17
Narrative Therapy.................................................................................................18
Role of Others.......................................................................................................20
Expressive Therapeutic Modalities...................................................................................21
Body Psychotherapy..............................................................................................21
Translating to Art Therapy................................................................................................23
Social-Justice Oriented.........................................................................................23
Social Acceptance.............................................................................................................24
Historical Acceptance of Tattoos..........................................................................25
Historical Acceptance of the Queer Community..................................................26

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Therapeutic Potentials of Tattooing..................................................................................28
The Human Body as Art........................................................................................29
Tattooing Motivations...........................................................................................29
Tattoos as an Art Therapy Tool............................................................................30
Psychological and Biological Aspects of Pain.....................................................31
Space.................................................................................................................................33
Placement..............................................................................................................33
Holding Space.......................................................................................................35
Limitations........................................................................................................................35
Section III: Methodology..............................................................................................................38
Beneficiaries/Participants.................................................................................................38
Project Design...................................................................................................................39
Procedure..........................................................................................................................40
Week One..............................................................................................................40
Week Two..............................................................................................................41
Week Three............................................................................................................42
Week Four.............................................................................................................42
Six-Month Debrief.................................................................................................43
Section IV: Data Analysis.............................................................................................................45
Rosenberg Self-Esteem Scale...........................................................................................45
Kinetic-House-Tree-Person..............................................................................................46
Purposed Method for Data Analysis.................................................................................46
Section V: Discussion...................................................................................................................48

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Summary...........................................................................................................................48
Discussion.........................................................................................................................48
Limitations........................................................................................................................50
Suggestions.......................................................................................................................51
References.....................................................................................................................................53
Appendix........................................................................................................................................58

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Abstract
The mental health challenges and needs within the queer community are multifaceted and often
influenced by social, cultural, and systemic factors. Addressing these obstacles requires a
comprehensive approach that addresses systemic barriers, promotes societal acceptance and
inclusion, and provides tailored mental health support and resources for queer individuals. This
paper examines the potential of tattoos as an inclusive form of care that bridges the gap between
minority health disparities. Tattooing as an art therapy intervention holds promise for addressing
mental health issues among queer and trans populations by reclaiming personhood amid
oppression.

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Section I: Introduction
The queer community faces unique mental health challenges stemming from societal
stigma, discrimination, and lack of affirmation. On average, individuals who identify as lesbian,
gay, and bisexual are twice as likely to face discrimination in their lives compared to those who
are cisgender and heterosexual (Pachankis & Goldfried, 2010). Considering these challenges,
there is a pressing need for culturally competent and inclusive therapeutic interventions that
address the specific needs and experiences of queer individuals. Art therapy, particularly through
tattoos, offers a promising avenue to promote mental health and identity affirmation among
queer individuals. Through an art therapy lens, tattoos can be viewed as a powerful artistic
expression with significant meaning. Tattoos, latent with symbolism and personal significance,
hold promise as a therapeutic tool for fostering resilience, empowerment, and regulation among
queer individuals. The subsequent sections will review existing research on art therapy, tattoos as
a therapeutic device, and mental health within the queer community, describe the methodology
employed in this study, present the findings, and discuss implications for clinical practice and
future research.
Problem to be Investigated
Individuals in the queer community often face significant challenges related to identity
due to systemic marginalization, leading to an increased prevalence of mental health issues
(Williams, 2021; Zeeman et al., 2018). This disparity in mental health outcomes underscores the
urgent need for effective and innovative treatment modalities tailored to the unique experiences
of queer individuals. Historically, tattooing has served as a powerful means of identity
expression across various cultures (Atkinson, 2003). However, there is a notable lack of research
on the integration of therapeutic tattooing within the context of art therapy. This research

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proposal aims to address the mental health disparities faced by the queer community by
exploring the potential of tattooing as an art therapy intervention.
Purpose Statement
The purpose of this research is to explore the potential of tattooing as a therapeutic tool
within the queer community, focusing on its role in reclaiming personhood and fostering selfexpression amidst oppression. By examining existing literature, this study aims to investigate
how tattoos can facilitate agency, identity affirmation, emotional healing, and empowerment
among queer individuals. The research seeks to develop a curriculum for utilizing tattoos as an
art therapy modality, contributing to a deeper understanding of alternative therapeutic
approaches and their effectiveness in helping queer people cope with mental health challenges.
Justification
The Minority Stress Theory posits that individuals from minority groups are more likely
to experience stressors stemming from experiences of prejudice, discrimination, and stigma. The
accumulation of stressors in minority groups can have profound effects on an individual’s mental
and physical health. This suggests that queer people aren’t having mental health problems
because they’re queer but because of the societal stigmas around being queer (Meyer, 2003).
Gay-related stress is a manifestation of the external stressors and expectations of rejection as
outlined in the Minority Stress Theory (Lewis et al., 2003). The outcomes of these external
stressors can be seen in comparison statistics such as; 13% of queer people had a suicidal attempt
contrasted with 2% of cis-het individuals (Williams, 2021). Over 50% of queer individuals
engaged in suicidal ideation, contrasted with 13.6% in the cis-het population (Williams, 2021).
On average, 61% of queer people are diagnosed with anxiety, while only 39.3% of cis-het
individuals are diagnosed (Williams, 2021). The alarming difference in these numbers puts queer

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individuals at a higher risk for developing various mental health disorders as well as a higher risk
for houselessness (Williams, 2021; Zeeman et al., 2018). Unfortunately, major psychological and
physical health issues are exacerbated by the avoidance of healthcare due to homophobia,
heteronormativity, and discrimination (Williams, 2021). Given these profound disparities, it is
imperative to develop innovative and effective therapeutic modalities that address the unique
challenges faced by queer individuals. This research is motivated by the urgent need to bridge
the gap in mental health outcomes and contribute to therapeutic approaches that can empower
queer individuals, enhance their mental health, and improve their overall well-being.
Research question
How does the tattooing process symbolize the development and maintenance of a selfcare routine aimed at reclaiming queer personhood?
Terms
For this research, the following terms are used.
Asexual (Ace)
Describes a person who does not experience sexual attraction. An umbrella term that can
also include people who are demisexual, graysexual, asexual, and aromantic.
Binary construct
Traditional understanding of gender as consisting of only two categories: male and
female. It assumes that individuals can only identify as either male or female, based on their
biological sex.
Bisexual
A person who can form enduring physical, romantic, and/or emotional attractions to those
of the same gender or more than one gender. Bisexual people need not have specific sexual

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experiences to be bisexual; they need not have had any sexual experience at all to identify as
bisexual.
Cisgender (Cis)
Denoting or relating to a person whose gender identity corresponds with the sex
registered for them at birth.
Gay
Encompassing term for people whose enduring physical, romantic, and/or emotional
attractions are to people of the same sex. Alternatively, used to describe a non-woman attracted
to another non-women.
Gay-related Stress
An individual’s minority status conflicts with other roles in which the individual is acting
(Lewis et al., 2003).
Gender Identity
One’s innermost concept of self as male, female, a blend of both, or neither – how
individuals perceive themselves and what they call themselves. One’s gender identity can be the
same or different from their sex assigned at birth.
Grand Narrative
A broad, overarching story or metanarrative that attempts to explain the nature of human
existence, history, and culture. It is a story that tries to provide a comprehensive and unified view
of reality and explain the meaning and purpose of human life.
Heteronormative
World view that promotes heterosexuality as the normal or preferred sexual orientation.
Heterosexual (Het)

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Sexually or romantically attracted exclusively to people of the other sex.
Homophobia
Dislike of or prejudice against gay people.
Internalized Homophobia
The queer person’s direction of negative social attitudes toward the self. Intrapsychic
conflict between queer experiences and feeling a need to be heterosexual.
Intersectionality
The interconnected nature of social categorizations such as race, class, gender, and
sexuality as they apply to a given individual/group, regarded as creating overlapping and
interdependent systems of discrimination or disadvantage.
Intersex
Used to describe a person with one or more innate sex characteristics (genitals, internal
reproductive organs, and chromosomes) that fall outside traditional conceptions of male or
female bodies. Not all intersex folks identify as being part of the queer community.
Lesbian
A non-man whose enduring physical, romantic, and/or emotional attraction is to other
non-men.
Minority stress:
“...culturally sanctioned, categorically ascribed inferior status, social prejudice, and
discrimination, the impact of these environmental forces on psychological well-being and
consequent readjustment or adaptation” (Brooks, 1981, p. 107).
Non-Binary

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Describes a person whose gender is not male or female and uses many different terms to
describe themselves. Other terms include genderqueer, agender, bigender, genderfluid, and more.
None of these terms mean exactly the same thing, but all speak to an experience of gender that is
not simply male or female.
Queer Personhood
The sense of identity, dignity, and agency experienced by individuals who identify as
queer. It encompasses the rights, recognition, and validation of one’s identity within society,
including aspects such as relationships, family, community, and self-expression.
Queer
Adjective used by some people whose sexual orientation is not exclusively heterosexual
or straight. In this paper, ‘queer’ will be used as an umbrella term for the LGBTQIA+
community.
Questioning
The ‘Q’ at the end of LGBTQIA+ can also mean questioning as in someone who is
questioning their sexual orientation or gender identity.
Sexual Orientation
An inherent or immutable enduring emotional, romantic, or sexual attraction to other
people (this is independent of their gender identity).
Transgender (Trans)
An umbrella term for people whose gender identity and/or gender expression differs from
what is typically associated with the sex they were assigned at birth. People under this umbrella
may describe themselves using one or more of a wide variety of terms. A transgender identity is
not dependent upon physical appearance or medical procedures.

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Transphobia
Dislike of or strong prejudice against transgender people.
Conclusion
The queer community faces significant mental health challenges due to societal stigma,
discrimination, and lack of affirmation, leading to higher rates of depression, anxiety, substance
use, and other adverse outcomes when compared to their cis-het counterparts (Williams, 2021).
To effectively address these disparities requires a culturally competent therapeutic modality and
intervention, such as art therapy. Art therapy, particularly utilizing tattoos as a form of
expression, holds promise for fostering self-affirmation and empowerment among the queer
community. There is a gap in understanding the efficacy of tattoo art therapy in this context and
this research aims to explore how tattoos, as an art therapy tool, impact self-expression, identity
affirmation, and emotional healing within the queer community. The study seeks to contribute to
a deeper understanding of alternative therapeutic modalities and their role in promoting wellbeing and resilience among marginalized communities.

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Section II: Review of Literature
A comprehensive review of existing literature is outside the scope of the research
parameters. Historical erasure and discrimination have created gaps within literature; often
excluding the experiences of further marginalized groups within the queer community, such as
people of color, transgender individuals, and those with disabilities. To complicate things further,
relevant literature can be dispersed across various fields or not readily accessible. Lastly,
identities within the queer community exhibit a spectrum of shades and hues – no single color
can encapsulate the complexities of the queer experience, making it difficult to capture all the
nuances of the queer experience. Within these limitations, this document introduces tattooing as
an art therapy tool to reclaim personhood amid oppression. Engaging in the tattooing creative
process allows a queer individual to externalize internal conflicts, develop coping strategies, and
gain insight into their experiences, fostering autonomy and cultivating self-acceptance in the face
of oppression and adversity.
Adversity
To adequately address the needs of the queer community’s mental health and
comprehend the reasons behind the ineffectiveness of existing interventions, it’s crucial to reflect
on the pervasive impact of stigma and discrimination. Stigma and discrimination not only
undermine queer individual’s fundamental rights by impeding their ability to live authentically,
pursue happiness and participate in society but also exact profound psychological, emotional,
and social tolls such as identity concealment, social isolation, minority stress, and vulnerability
to victimization. From subtle microaggressions to overt acts of violence, the impact reverberates
across every aspect of queer lives, shaping experiences of self-esteem, mental health, access to
care, employment opportunities, and overall well-being.

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Family Rejection
The formation of queer identity starts with a complex interplay between internal selfperception and external influences such as societal interactions and cultural norms (Schmitz &
Tyler, 2017). A particularly crucial element in this developmental journey is the support and
connectedness provided by one’s family, which significantly impacts the maintenance of positive
mental health among young queer individuals (Schmitz & Tyler, 2017). Family acceptance
emerges as a vital contributor, fostering positive self-esteem and serving as a protective shield
against the harmful effects of stigma (Ryan et al., 2009). Contrastingly, instances of family
rejection are alarmingly linked with adverse health outcomes (Ryan et al., 2009). Adolescents
facing familial rejection due to their queer identity are confronted with staggering negative
outcomes when compared to their cis-het counterparts: queer people are 8.4 times as likely to
attempt suicide, 5.9 times more likely to report high levels of depression, and 3.4 times more
likely to use illegal drugs (Ryan et al., 2009). Moreover, the repercussions extend beyond mental
health, contributing to the formation of negative self-perceptions and increasing the risk of
houselessness among queer youth (Schmitz & Tyler, 2017).
Political Erasure
As if the struggle for family acceptance wasn’t difficult enough, queer individuals
confront a myriad of additional hurdles across various facets of life, including relationship
formation, parenting issues, access to care, immigration status (systemic barriers, legal
inequalities, and social biases), eligibility for government benefits (legal recognition,
discriminatory practices, gender-affirming care, and marriage), employment, education, and
safety. 2023 served as a grim testament to the uphill battle faced by the queer community,
witnessing an overwhelming influx of over 520 proposed anti-queer legislature bills, of which 70

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were ultimately enacted into law (HRC, 2023). These erasure bills are aimed at systematically
stripping away legal protections and rights for the queer community (HRC, 2023). A finding by
Horne, McGinley, Yel, and Maroney underscored the detrimental impact of such legislative
onslaughts, revealing a marked increase in anxiety and depression levels among queer
individuals (2021). This outlines an ongoing threat to the mental health and overall welfare of the
queer community, underscoring the imperative for continued advocacy and support.
To add to these barriers, sexual orientation and gender identity have been historically
pathologized by the psychoanalytic school of thought. Prevailing notions include viewing samesex orientation as a developmental deficiency during the Oedipal stage, a deliberate choice to
evade psychosis, or as aligning with the 'opposite' sexual archetype. These entrenched beliefs led
to the institutionalization, emotional and physical abuse, and dehumanization of many queer
individuals in efforts to 'cure' their perceived 'illness.' It wasn’t until 1987 that homosexuality
was removed from the Diagnostic and Statistical Manual and, five years later, was mirrored by
the World Health Organization in their decision to declassify homosexuality as a disease
(Drescher, 2015). It is important to note that the DSM-5 still includes diagnoses related to gender
dysphoria. While this aids in accessing gender-affirming treatments, it also perpetuates the
medicalization of transgender identities.
Dissemination of these beliefs by trained professionals has contributed to the narrative of
pathologizing gender and sexual identity, thereby reinforcing and perpetuating stereotypes. The
multifaceted effects of oppression within the queer community highlights the complexities of
these challenges and amplifies the need of exploration for avenues that foster inclusivity,
understanding, and acceptance. This further emphasizes the overwhelming need for a critical

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framework that understands gender, sexuality, and identity that transcends the fixed categories to
embrace diversity, fluidity, and intersectionality (Henderson, 2019).
Mental Health Needs
Supportive networks play a crucial role in mitigating mental health challenges and
fostering resilience among the queer community. The mental health needs of the queer
community are complex and often overlooked, with unique obstacles such as stigma, lack of
support, and social exclusion (Rees, 2020). Many queer individuals report experiencing stigma
and discrimination within mental health care settings, ultimately deterring them from seeking
help or disclosing their identities (Rees, 2020). As previously stated, research indicates that queer
individuals are at a higher risk for mental health issues such as depression, anxiety, substance
use, and suicidal ideation when compared to their cis-het counterparts (Meyer, 2003; Pachankis
& Goldfried, 2010; Williams, 2021; Zeeman et al., 2018). Challenges are further exacerbated
with intersectional identities, such as race, ethnicity, gender identity, and socioeconomic status,
often compounding discrimination and barriers to care (Rees, 2020). These multifaceted
challenges illuminate a need for promoting acceptance and inclusion, reducing stigma and
discrimination, improving access to affirming care, and fostering supportive communities where
queer individuals can thrive.
Frameworks
Using frameworks that embrace queerness from a mental health perspective is essential
for promoting acceptance, inclusivity, and well-being within the queer community. By affirming
identities, reducing stigma, providing culturally competent care, empowering self-expression and
agency, promoting resilience and well-being, and advancing social justice and equity, these
frameworks contribute to creating supportive and affirming therapeutic environments.

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Queer Theory
When researching frameworks that embrace queerness, Queer Theory by de Lauretis
emerges as a structure for understanding and critiquing the norms, assumptions, and power
dynamics related to identity (de Lauretis, 1991). This theory draws upon ideologies from
Foucault, Rubin, Sedgwick, and Butler. Beginning with the norms surrounding sexuality as a
construction of power dynamics established to serve, categorize, and regulate individuals' bodies
and behaviors (Kurzweil, 1979). Rubin's concept of a sexual behavior hierarchy delves into the
hierarchical organization of sexuality within societies, where adherence to normative
frameworks determines one's social standing (Rubin, 1975). Sedgwick further explores the
gendering of sexuality, emphasizing the mutual constitution of gender and sexuality (Durgin,
2019). To add another layer, Butler views sex and gender as performative acts rather than static
concepts, i.e., a set of behaviors performed to conform to societal norms of masculinity and
femininity (Butler, 1988).
Incorporating queer theory into mental health practices enhances clinicians’
understanding of the unique experiences and needs of queer individuals, promotes affirming and
inclusive care, and supports clients in navigating societal challenges to their mental well-being.
This underscores a need for a sensitive and anti-oppressive approach to working with the queer
community to recenter care and avoid harm (Kapitan & Kapitan, 2022). Using language that
acknowledges diversity, affirms identities, and avoids reinforcing stereotypes can make a client
feel valued, respected, and understood.
Narrative Therapy
The importance and power of language is amplified through the core beliefs of narrative
therapy. Interestingly, it also incorporates elements of feminist theory and critical social theory.

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Narrative therapy delves into the understanding of gender and power dynamics to decenter
dominant narratives and promote an egalitarian therapeutic relationship – an essential aspect for
promoting inclusivity, respect, and empowerment, ultimately facilitating meaningful and
effective therapeutic outcomes. Language, once was used for pathologizing and dehumanizing
purposes, shifts to elevate narratives that present alternatives and vitality. There are 4 central
concepts: giving new meaning to life, meaning shaped through language, frame the story is told
in, and externalization.
Externalization is the core process that separates the problem from the person. By
creating distance, there is a reduction in emotional intensity associated with the problem,
enabling clearer thinking and problem-solving. When therapists encourage their clients to
explore alternative narratives that reflect their experiences, they create space for them to see
themselves as active agents capable of responding to and overcoming the problem. In return, this
promotes a collaborative element between therapist and client, allowing them to work together to
explore the narrative’s origins, effects, and possible solutions.
A therapist’s first instinct wouldn’t be to externalize a queer person from their queer
identity. However, when combining narrative therapy and queer theory, one would question the
Grand Narrative of heterosexism and the roots it has in defining non-cis-genderedheteronormative narratives (Steelman, 2016). Instead, a therapist should empower clients to
transcend imposed labels and boundaries to foster a relationship where one precedes their
identity (Steelman, 2016). Coherent life narratives integrate past experiences, present
circumstances, and future goals, contributing to a sense of continuity and meaning in life.
Internalizing dominant stories can cause individuals to believe the problem is within. Narrative
therapy deconstructs this idea, allowing individuals to recreate their life stories.

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When narrative therapy is applied within the context of art therapy, realities transform
into metaphorical narratives, enabling individuals to articulate their challenges through diverse
forms or symbols. Additionally, art introduces a literal dimension of re-editing and
reinterpretation. The opportunity to visually manifest internal struggles facilitates the process of
externalization and offers new perspectives. These narratives are tangible manifestations of a
person’s lived experiences and identity (Baştemur, & Baş, 2021). The resulting artworks serve as
artifacts, capable of anchoring and reinforcing therapeutic insights and objectives.
Role of Others
To better reinforce insight, social identity theory can increase comprehension of how
individuals cultivate their self-concept through affiliation with various social groups, thereby
enriching the understanding of how the resulting artworks function as powerful tools for
therapeutic exploration and growth. Social identity theory examines how individuals develop a
sense of self-based on their membership in social groups. People categorize themselves and
others into groups to establish their social identity, contributing to their self-concept and selfesteem. This provides insights into how social contexts influence behavior and attitudes,
emphasizing the importance of understanding group dynamics in various social settings. When
applied to the queer community, it provides understanding as to how individuals form and
negotiate their identities which can provide insight to their experiences of discrimination, social
support, and mental health outcomes. Additionally, it elucidates the complexities of
intersectionality, acknowledging that individuals may hold multiple social identities that intersect
and influence their sense of self. Lastly, for mental health professionals, it assists in tailoring
interventions that affirm identities and address the aberrant challenges, ultimately fostering a
more inclusive and affirming environment.

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On the other hand, sociogenesis investigates how social phenomena emerge and evolve
over time within a social context (Atkinson, 2003). While social identity theory focuses on
processes involved in individual identity construction, sociogenesis examines the broader social,
cultural, and historical factors that shape collective identities. This provides a more
comprehensive understanding of the interplay between individual and collective identities in
shaping social behavior and group dynamics. More specifically, how societal attitudes, historical
events, and cultural shifts have influenced the formation of queer identity throughout time.
Together, they offer complementary perspectives for comprehensively analyzing the
complexities of identity processes in society.
Expressive Therapeutic Modalities
By examining how tattoos and queer individuals intersect within societal contexts, and
unraveling the motivations behind body modifications, one can seamlessly transition into
exploring therapeutic approaches that delve into the mind-body connection. These approaches
are centered on exploring and processing emotions, memories, and traumas stored within the
body, offering profound insights into the intricate relationship between the physical self and
psychological well-being.
Body Psychotherapy (BPT)
These approaches focus on the mind-body connection and may incorporate techniques to
explore and process emotions, memories, and traumas stored within the body. In BPT, mental
health professionals work with clients to investigate and address emotional, psychological, and
relational issues through the body’s sensations, movements, and expressions. By attending to
bodily sensations, therapists can help clients explore underlying emotions, traumas, and
psychosomatic symptoms (Leijssen, 2006). Body validation emphasizes the interconnectedness

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of mind and body, recognizing the body as a source of wisdom, insight, and healing. This not
only honors the lived experience of clients but also facilitates the integration of somatic and
emotional processes and promotes empowerment and agency by encouraging clients to reclaim
ownership of their bodies (Leijssen, 2006). It assists clients in gaining deeper insight into their
psychological patterns, develop greater self-awareness, and cultivate more adaptive ways of
coping with stress, trauma, and relational challenges.
Tattooing can intersect with body psychotherapy in several ways, particularly in how it
engages with the body as a site of expression, healing, and transformation. This deliberate,
physical alteration of the body often expresses one’s identity, beliefs, or experiences (Pew
Research Center, 2023). Like the BPT belief that the body reflects one’s inner experiences,
tattooing can reflect embodied expression through externalizing experience. The emphasis on
integrating bodily experiences with cognitive and emotional processes mirrors the experience of
getting a tattoo. For some, tattoos process and integrate past traumas or emotional experiences
symbolically into the body (Alter-Muri, 2020). Integration of experiences creates a pathway to
empowerment and agency, a way to assert control over bodies and narratives. In BPT, reclaiming
agency over one’s body and experiences is often a central theme. Similarly, getting a tattoo may
represent a form of reclaiming ownership and autonomy, especially for marginalized individuals.
Lastly, BPT encourages somatic awareness, or the ability to tune into bodily sensations and cues,
paralleling itself with tattooing as it requires individuals to be attuned to their body’s responses,
such as pain tolerance and comfort levels.
Through this heightened somatic awareness, individuals may develop a deeper
connection with their bodies and emotions, fostering a sense of embodied mindfulness for both
tattooer and client. Moreover, the stop-and-go nature of tattooing simulates pendulation or going

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from a relaxed to a heightened state back to relaxation. This is based on the concept that the
nervous system has an innate capacity to self-regulate and find equilibrium when faced with
stress or trauma, ultimately assisting the client in learning to tolerate difficult emotions and
sensations without becoming overwhelmed. Tattoo artists may guide clients through these
oscillations by employing techniques that help clients manage discomfort and promote
relaxation. Ultimately, pendulation when applied to tattooing can help cultivate mindfulness,
body awareness, and acceptance, which parallels the starting point of healing (Alter-Muri, 2020).
Titration is the gradual introduction or exploration of difficult or distressing material at a
pace that the client can manage without becoming overwhelmed. The goal of titration is to
prevent re-traumatization or overwhelming emotional responses while still allowing the
individual to process and integrate challenging experiences. Titration can also mirror the
tattooing process as tattoo artists typically work in layers to gradually build the ink to achieve the
desired darkness and saturation as it is crucial to add ink to the skin in controlled amounts to
avoid overloading the skin or causing excessive trauma. Also, while not directly related to the
process, titration can be applied to managing the pain experienced by the client during the
session. Tattoo artists may work in shorter sessions or focus on less sensitive areas first before
moving on to more painful areas, allowing the client to gradually acclimate to the sensation of
being tattooed.
Translating to Art Therapy
Social-Justice Oriented
The previously mentioned historical foundations of psychological theories have often
reinforced a power dynamic where mental health professionals hold authority over their clients.
Art therapy, however, offers a distinctively egalitarian approach, centering the client as the

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expert thus restoring power and agency to them (Baştemur, & Baş, 2021). By incorporating a
social-justice-oriented perspective, art therapy holds the potential to confront systemic injustices
that contribute to both individual and collective trauma (Karcher, 2017). Creating a therapeutic
environment grounded in empowerment, advocacy, and cultural humility can nurture resilience,
agency, and community solidarity among clients (Karcher, 2017). This shift can be validating for
queer individuals who may have experienced rejection or invalidation in previous experiences.
In addition to this restorative element, a unique therapeutic relationship exists between
the therapist, client, and artwork. The artwork acts as a bridge between the client’s inner
experiences and the external world, expressing complex emotions and experiences that may be
difficult to articulate (Hilbuch, et al., 2016). The connection between emotional and physical
well-being and self-expression can generate positive results (Pelton-Sweet & Sherry, 2008).
Individuals can reclaim agency over their narratives and identities, challenge internalized stigma
and shame, and cultivate a sense of pride and empowerment.
These collaborative art-making experiences can deepen the interpersonal bond between
client and therapist, fostering mutual trust and empathy (Hilbuch, et al., 2016). Through the joint
exploration of materials, clients, and therapists collaboratively generate meaning and redefine
relational patterns. Simultaneously, by attuning to the client’s material choices and artistic
process, therapists access implicit communication channels, enabling them to interpret and
navigate the transferential landscape (Hilbuch, et al., 2016). Art is not only a communication
medium between art therapists but also between the client and others.
When applied to queer clients, art therapy emerges as a tool for navigating the intricate
psychosocial challenges they may encounter (Addison, 2003). Its efficacy lies in its capacity to
address identity exploration, trauma, and oppression (Addison, 2003; Alter-Muri, 2020). By

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engaging in the creative process, clients can externalize internal conflicts, develop coping
strategies, and gain insight into their lived experiences, thereby fostering agency and cultivating
self-acceptance.
Social Acceptance
Social standards often protect the interests of established groups by reinforcing existing
power structures through the promotion of specific behaviors and characteristics which
consequently marginalizes and/or stigmatizes deviations from these conventional archetypes
(Atkinson, 2003). Thus, granting the established groups power to dictate body norms and
designate outsider groups as inferior (Atkinson, 2003; Gröning, 2002). Examining normative
dynamics throughout history provides valuable insights into understanding the current social
acceptance of queer and trans individuals as well as tattoos. The overlap is created through
instances of stigmatization, self-expression, resistance and subversion, shifting attitudes and
solidarity.
Historical Acceptance of Tattoos
As exhibited throughout the marks of history, tattoos have historically been associated
with the designation of the ‘lesser’. Afterall, stigma means to prick. Ancient Greece used tattoos
to mark slaves and prisoners of war, a form of punitive tattooing (Luzier, 2023). Dynastic China
also exploited punitive tattooing, using it as a brand for slaves or punishment (Luzier, 2023). The
most memorable form of punitive tattooing was during the Holocaust; tattooing identification
numbers as a dehumanization tool (Luzier, 2023). This designation of the lesser is further driven
by livestock tattooing, a connection between the objectification of living beings marked to serve
others' interests. After World War II, awareness of human rights grew, and punitive tattooing
was recognized as a clear violation of fundamental human rights.

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A new era of tattooing entered the world when the American circus, heavily drenched in
racist, ableist, and imperialist ideologies, utilized tattoos as a means of spectacle and
entertainment. Tattooed individuals were often showcased as “freaks” or attractions, drawing
audiences intrigued by adorned bodies. Fascination became a way to commodify difference and
exploit shock. In between the lines of entertainment and monetary value, the American circus
played a pivotal role in familiarizing, normalizing, and fostering acceptance of tattoos in the
United States (Luzier, 2023).
Various cultures worldwide have forms of tattooing that carry deep cultural or spiritual
significance, countering negative perceptions of tattooing. For instance, Samoan tatu, or “tatau”,
is a traditional practice in Samoa or Polynesian cultures, involving an elaborate and sacred
process lasting days or weeks. These tattoos hold deep cultural significance and are considered a
rite of passage, marking significant milestones in an individual life. Similarly, the Maori “ta
moko” tattoos convey their genealogy, social status, and personal journey. In Japan, traditional
irezumi tattoos were historically associated with the criminal underworld but have evolved into a
rite of passage that symbolizes devotion, resilience, and a commitment to one’s chosen path.
These examples illustrate how tattoos transcend mere decoration, symbolizing identity,
belonging, and personal growth across diverse cultures.
To align with the narrative of reclamation, both within the world of tattoos and the world
of queerness, there will be a focus on ritual/ceremonial tattoos. Ritual tattoos can vary widely in
purpose, symbolism, and cultural context, but are typically regarded as more than just decorative
body art. They are seen as sacred expressions of identity, tradition, and belief within the context
of the community. When compared to the therapeutic setting, rituals create structure, meaning,
containment, transition, connection, and trust. Rituals in this mixed therapeutic-tattooing space

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lean on elements of preparing the body, setting intentions, cleaning skin and space, and the
aftercare regimen. This is accompanied by the melody of the needle, wiping the ink away,
stretching the skin, marking the skin, layering of ink, and cleaning the tattooed area. While
divided opinions of body modification persist, the shift in use and perception may provide
opportunities to use tattoos in therapy as part of the client's journey toward emotional healing
(Alter-Muri, 2020).
Historical Acceptance of the Queer Community
The historical acceptance of tattoos has parallels with the acceptance of the queer
community. Ancient civilizations such as Greece and Egypt exemplify relatively fluid attitudes
towards sexuality and gender, as evidenced by their art and cultural practices (Gröning, 2002).
Similarly, in pre-colonial societies, many Indigenous cultures embraced expansive identities,
with Two-Spirit individuals playing revered roles that bridge gender divides and promote
community harmony (Gröning, 2002).
However, the imposition of Eurocentric norms through colonialism and globalization has
led to the suppression of expansive identities and the establishment of rigid gender and sexual
norms. These values marked a decline in cultural acceptance of queer individuals, often resulting
in the criminalization and stigmatization of non-cis-heteronormative individuals and behaviors.
Although significant progress has been made, there is still a long journey ahead. Increased
visibility and activism have contributed to the decriminalization of queerness and greater
recognition of queer rights.
The historical acceptance of the queer community has varied significantly across
different cultures and periods. In some societies, such as Native American tribes or ancient
Greece, there are stories of acceptance and/or reverence for individuals who did not conform to

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traditional gender or sexuality. However, in many other societies, queer individuals have faced
discrimination, persecution, and even violence due to prevailing social, religious, and legal
attitudes.
The spread of European colonialism and Christian missionaries used subterfuge to
impose rigid gender and sexual norms that often criminalized/stigmatized non-cis-het identities
and behaviors. Initially, western values characterized a decline in cultural acceptance of queer
individuals. Today, attitudes towards the queer community vary widely depending on cultural,
religious, and political beliefs. While there have been influential strides in terms of legal rights
and social acceptance, discrimination and violence against the queer community persists in many
parts of the world.
Therapeutic Potentials of Tattooing
The Human Body as Art
Over the ages, body decoration has persisted as one of humanity’s earliest artistic
expressions. The human body has served as a focal point in comprehending identity dimensions
like gender, sexuality, race, and ethnicity. Through its diverse forms and practices, body art
challenges the hegemony of Eurocentric norms, embracing the richness of cultural pluralism.
Additionally, body art reflects the interconnectedness of global cultures by showcasing the ways
in which ideas and techniques have been shared, transformed, and reinterpreted across time and
space.
Mummification in Ancient Egypt symbolized reverence for the deceased by preserving
the body as a vessel and was initially practiced by the elite to signify status and social standing.
Ancient Greek sculpture evolved from idealizing the human form to expressing extreme
emotions; a synthesis of Platonic and Aristotelian views where art serves as both a tool for

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education and emotional catharsis. The Baroque period utilized dramatic tableaux, employing the
body as a symbolic or allegorical device to evoke emotional responses. In the 20th century, artists
explored performance art as a declaration of autonomy and a challenge dominant narratives of
the human body.
Performance art overlaps with body modification to assert individuality and catalyze
connections with like-minded individuals. During the 1960s, this physical manifestation of art
gained prominence as it emerged as a fundamental aspect of how society understands the
gendered body and sexuality. One of the earliest instances of tattoos being utilized as fine art was
VALIE EXPORT’s artwork, “Body Sign Action.” EXPORT tattooed a garter strap on her thigh,
symbolizing the fetishization and repressed sexuality of women, a declaration of autonomy, and
a challenge to societal expectations. The commitment to exploring and challenging how
women’s bodies are objectified, commodified, and controlled within a patriarchal society is
echoed in Hannah Wilke’s, “S.OS. Starification Object Series.” Using her body as the canvas,
Wilke challenges viewers to confront their perceptions of beauty, femininity, and objectification.
Tattooing Motivations
Humans exist in a web of interdependence, a vacillation between constraint and
facilitation of our actions. In this flux and flow, tattoos become constructed social figurations – a
way to understand individual behaviors because of collective social activities over extended
periods (Atkinson, 2003). This highlights the charged dialogue between agency and structure as
tattoos become an accepted form of communication. Having a tattoo is inherently a declaration
to non-normative ideologies that represent cultural dislocation and social resistance (Atkinson,
2003).

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Aligning tattooing with social resistance, individuals can reclaim agency over their
bodies through this assertion of ownership and autonomy (Alter-Muri, 2020; Atkinson, 2003).
This claim is supported by a study of college students where major reasons for getting tattoos
were self-expression, self-identity, and to feel unique and independent (Drews, et al., 2000).
Further applying this thought to marginalized communities, tattoos can serve as acts of resistance
and empowerment, challenging dominant narratives and reclaiming cultural heritage (AlterMuri, 2020).
By choosing to permanently mark their bodies with tattoos that symbolize defiance or
resistance, individuals create a lasting testament to their beliefs. Entrenched in symbolism,
tattoos can represent resistance, express dissent, nonconformity, or the desire to challenge
prevailing attitudes or injustices – a testament to the search for identity against dominant
narratives (Atkinson, 2003). Moreover, getting tattoos with shared symbolism can create a sense
of belonging and collective strength in the face of adversity.
Tattoos as an act of nonconformity can be likened to an act of radical self-love. Radical
self-love challenges conventional notions of self-worth and encourages individuals to reclaim
their inherent value, dignity, and worthiness. It is a journey of self-discovery, growth, and
liberation that can lead to greater fulfillment, resilience, and authenticity in life. Overall, radical
self-love is an act of rebellion against systems of oppression that seek to diminish or erase the
inherent value of marginalized communities. Through the lens of radical self-love, tattoos
become a symbol of strength, signifying the endurance it takes to get tattooed, dedication to the
process, reminders of resilience, reflection of identity, and/or a connection to a legacy of
strength.
Tattoos as an Art Therapy Tool

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The decision to get tattooed is profoundly personal and multidimensional, influenced by
many individual, cultural, and socio-political factors. There are various motivations behind the
adornment of bodies with permanent ink, ranging from expressions of identity, belonging, and
autonomy to acts of commemoration, rebellion, and transformation (Alter-Muri, 2020). Tattoos
serve as embodied symbols that encapsulate personal narratives and emotional truths. When this
permanent imagery is used with the Queer population, the permanent imagery can speak to an
autobiography of self-reclamation.
The transformation starts with a dialogue surrounding imagery. An art therapist can
engage the client in conversations surrounding personal narratives which can provide valuable
insights into their thoughts, emotions, and experiences (Alter-Muri, 2020). This reflective
process can help clients gain insights to the connections between their artwork and lived
experience. As a form of nonverbal communication, it assists clients in expressing complex
thoughts and feelings that may be difficult to articulate. Exploring and validating the client’s
perspective helps foster a sense of agency and autonomy.
By providing a canvas for self-expression and transformation, tattoos emerge as a tool for
promoting psychological well-being and resilience (Alter-Muri, 2020). The process can
inherently be therapeutic as it offers individuals a sense of catharsis, empowerment, and selfdiscovery. In a study by Frederick and Bradley, tattooed participants had significantly lower
depression scores than non-tattooed individuals (2000). Additionally, themes of empowerment
and self-esteem enhancement suggest that this practice can serve as a mechanism for bolstering
confidence and self-image (Frederick & Bradley, 2000).
The intricacies of tattoos extend beyond the individual as tattoos can forge connections
and foster community among like-minded individuals (Alter-Muri, 2020; Atkinson, 2003).

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Tattoos are permanent imagery that are literal signs of an individual's connection to themselves
and others. The drive for belonging is mirrored within the tattoo studio as well. The
collaborative process of creating a tattoo helps build rapport and understanding. Storytelling is a
fundamental aspect of human communication that strengthens social bonds, preserves cultural
identity, fosters empathy and understanding, inspires action, and creates a sense of belonging
within communities. By sharing and listening to stories, individuals form a cohesive and resilient
community grounded in shared experiences, values, and aspirations.
Psychological and Biological Aspects of Pain
In the face of adversity, the queer community remains resilient. The perpetual struggle
for visibility can be heard from echoes in the past, insistent sounds of the present, and the distant
rumbling of the future. Friedrich Nietzsche said it best, “Suffering is the father of all things.”
This belief is attributed to the value of suffering as it exemplifies the strength to endure,
awareness of limitations, and a heightened appreciation for life’s joys.
Pain’s subjective, personal, and involuntary nature contributes to the perception that
something is happening to an individual intimately connected to their sense of self and bodily
experience. An alternate definition embraced through the eyes of narrative therapy, would be
pain serves as a compelling reason to act. Pain is a fundamental imperative, a call to action to
bring the body back into balance (Klein, 2015).
The question then becomes...what happens when pain is sought out? What kind of call to
action is that? Enter: the realm of masochistic pleasures or enduring pain for something desired
(Klein, 2015). This can be exhibited through enjoying the burn of spicy foods, a painful massage,
extreme sports, and body modification. This novelty experience of finding the edge of
tolerability explores control, boundaries, and emotional regulation skills (Klein, 2015). “So what

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is pleasant there is the feeling of growing beyond patterns that you’re trapped in: you’re finding
out that a slight or a loss that seemed unendurable is perhaps bearable after all. (Klein, p. 180,
2015)”
Tattooing can provide a sense of control in situations when the individual feels powerless
or overwhelmed. By willingly subjecting themselves to pain, they may feel a sense of agency
and mastery over their experiences. Additionally, physical pain can distract from emotional pain
or psychological distress as tattooing elicits the endorphin release. Interestingly, the body is
unable to tell the difference between emotional or physical pain, thus providing relief to both
(Klein, 2015). Lastly, pushing oneself outside of comfort zones allows individuals to gain insight
into their limits and capabilities, inevitably leading to personal growth and discovery.
Through the lens of pain, tattooing elevates the mind and body connection. The process
of getting tattooed requires the client to have a level of mindful awareness; to be present and
attentive to the sensations and emotions they experience. The somatic experience of these
physical sensations can deepen the mind and body connection by fostering a greater awareness of
the interconnectedness between physical sensations, emotions, and cognitive processes.
Space
To enter a tattooing space is to enter a place of mental and physical vulnerability. To
achieve desired results, it’s important to assess the space one enters for comfortability. Next, the
individual should consider the amount of exposure that is given to the tattoo artist. Some who
have had previous experiences, may feel more comfortable being tattooed in areas that are often
covered by clothing. Those getting their first tattoo may opt for something less intimate.
Placement

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Before entering a space, the individual should consider their tattoo placement. Like the
design itself, placement can hold various meanings, both culturally and personally. For example,
a forearm tattoo is often visible, making a bold statement of self-expression and can allude to
strength, confidence, and assertiveness. On the other hand, back tattoos offer a large canvas for
intricate designs and storytelling. Some choose to use this as a form of protection as they cover a
vulnerable part of the body that is often covered up by clothing.
Tattoo pain can vary depending on the placement largely due to differences in skin
sensitivity, proximity to bone and nerve endings, and muscle and fat composition. Some of the
more painful spots are bony, thin skinned, or highly innervated areas. It’s important to keep in
mind that pain tolerance varies from person to person, so what may be painful for one individual
may not be as uncomfortable for another.
Factors like hydration, fatigue, and emotional state can influence pain perception during
the tattooing process. Taking care of these factors can be likened to Maslow’s Hierarchy of
needs. At the base of the hierarchy, one must meet physiological and physical requirements, in
preparation of a tattoo session. This helps maintain energy levels and prevent fatigue, allowing
both parties to endure the session comfortably. Additionally, this helps promote healing as
proper nutrition and hydration are essential for the body’s ability to heal and recover.
Once physiological needs are met, individuals can focus on seeking safety and security.
The tattooing space plays a crucial role in the experience for several reasons. First, the
environment should be comfortable and conducive to relaxation for both the client and the tattoo
artist. This includes factors such as appropriate lighting, comfortable seating, and music to help
create a calming atmosphere. A comfortable environment can help alleviate anxiety and promote
a positive tattooing experience. Furthermore, the space should reflect professionalism and

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respect; this includes maintaining a clean and organized workspace, adhering to ethical
guidelines, and treating clients with dignity and respect. Lastly, there should be an overarching
prioritization of safety and security to address any unforeseen emergencies or accidents that may
arise.
After safety needs are satisfied, individuals can facilitate social connections thus
cultivating a sense of belonging. As previously mentioned, tattoos can serve as symbols of
belonging to certain communities or as a way of making connections with others who share
similar interests or values. Connection and belongingness are fundamental to human well-being
and play a paramount role in a queer person’s life. A sense of community can negate experiences
of historical marginalization and cultivate ones of shared experience, a celebration of
intersectionality, and empowerment. In some cases, tattoos can fulfill needs related to cultural or
spiritual significance as a means of connecting to one’s cultural heritage, traditions, or spiritual
beliefs, providing individuals with a sense of connection to something greater than themselves.
Next, individuals strive for self-esteem and recognition from others after individual needs
are met. Getting a tattoo can be a way of enhancing self-esteem and confidence. While meanings
range from personal achievements, milestones, or overcoming challenges, they can all contribute
to boosting one’s sense of self-worth and self-respect. Additionally, receiving positive feedback
or admiration from others about their tattoos can further enhance self-esteem.
At the top of the hierarchy is self-actualization, which represents the realization of one’s
full potential and the pursuit of personal growth, creativity, and fulfillment. Tattoos can fulfill
needs related to self-expression and identity as they can be a vehicle for expressing one’s unique
identity and striving for personal growth and fulfillment. For some, tattoos represent a form of

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self-discovery and exploration, allowing them to define and express themselves in meaningful
ways.
Holding Space
Holding space involves being fully present, listening with empathy, and offering
unconditional acceptance to others as they navigate their inner experiences and emotions (Nolan,
2021). Creating this environment can provide individuals with the opportunity to confront and
process their deepest fears, traumas, and insecurities in a nurturing and compassionate space
(Nolan, 2021). By holding space for others, individuals can feel seen, heard, and validated,
which can lead to profound emotional healing and transformation. Individuals can cultivate a
deeper sense of self-awareness, self-compassion, and self-love. Embracing their vulnerabilities
and honoring their authentic selves, individuals can reclaim their personal power and embark on
a journey of self-discovery and personal growth. This has significant implications for therapeutic
practice as mental health professionals should strive to incorporate the principles of holding
space by cultivating presence, empath, and unconditional positive regard. This helps create a
conducive environment for healing, growth, and transformation.
Limitations
One of the primary constraints in the realm of tattooing revolves around age restrictions.
Across all 50 states, the minimum age for consenting to the tattooing process is set at 18,
symbolizing the transition into adulthood. Nevertheless, there are countries such as Austria and
Scotland, where adulthood is recognized at 16. Factors such as personal growth, the lasting
nature of tattoos, and the importance of proper after-care contribute significantly to determining
the appropriate age of consent.

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It’s paramount to address client’s concerns regarding stigma, discrimination, and regret
associated with tattoos (Alter-Muri, 2020). While the permanence of a tattoo is not inherently
negative, it can be a potential drawback due to the lifelong commitment they represent. For
instance, what someone finds aesthetically pleasing or meaningful at one point in life may
change, leading to potential regret. Moreover, tattoos can impact professional opportunities or
personal relationships for some individuals, depending on societal norms and expectations.
When considering permanence, the art therapist and client should reflect on imagery and
potential symbolism (Alter-Muri, 2020). Remaining culturally sensitive to both the client and
other communities. Additionally, the art therapist should be aware of symbols in the queer
community that hold significant meanings (Addison, 2003). While some queer iconography,
such as the traditional pride flag, maybe overtly recognizable, others may be more subtle, like the
green carnation. Lastly, each state may have different regulations for tattooing. License
requirements vary from state to state, some requiring specific training while others only need to
comply with certain health and safety standards.
As working with any population, but especially in the queer community, retraumatizing is
a potential risk when using art therapy (Addison, 2003). There is an overwhelming requirement
for vulnerability in both the therapeutic and tattooing spaces. Additionally, many queer
individuals have experienced various forms of trauma related to their sexual orientation, gender
identity, or experiences of discrimination and rejection. Introducing physical touch into the
therapeutic setting will be a delicate balance of multiple complexities.
Conclusion
Tattooing holds potential as an art therapy tool for the queer community for numerous
reasons, including identity affirmation, empowerment, reclaiming agency, healing, belonging,

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visibility, and beyond. By examining the historical marginalization, discrimination, and violence
faced by the queer community, art therapists gain a deeper understanding of the systemic
obstacles and ongoing challenges they confront. This recognition forms a solid foundation for
crafting effective treatments, catalyzes social progress, and validates the queer narrative.
Embracing this perspective influences the choice of therapeutic modalities, prompting art
therapists to adopt theories that authentically reflect and empower the queer experience, thus
fostering self-resilience and efficacy.

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Section III: Methodology
As discussed, mental health disparities persist within the queer community, ultimately
leading to barriers to healthcare, diminished employment opportunities, increased prevalence of
mental health disorders, and susceptibility to houselessness and substance use. This underscores
the overwhelming need for mental health interventions that decenter dominant cisgender
heterosexual narratives and empower queer personhood. The tattooing process evolves as an
allegory to developing and maintaining a self-care routine that is targeted at reclaiming
personhood amid oppression. From beginning to end, getting a tattoo can symbolize agency,
reclamation, and self-love. This proposal is designed to propel further research on the therapeutic
potential of tattoos for the queer community.
Beneficiaries/Participants
This is specifically geared towards individuals 18+ in the queer community who are
contemplating a ritual-based tattoo. Individuals with medical conditions (any conditions needing
immunosuppressants, diabetes, medication/condition related to blood thinning, etc.), skin
conditions (eczema, acne in desired tattoo area, psoriasis, etc.), and/or pregnancy will be
excluded for health and safety reasons. Individuals who engage in ideations or acts of self-harm
will not be included in this study. There are several confounding factors informing this decision,
such as health, safety, ethical considerations, indications of other underlying mental health
conditions, and respect for autonomy. However, it’s important to note that there could be
potential benefits from supportive interventions such as tattooing rather than exclusion.
Ideally, the participants would be of varying gender, sexuality, ethnicity, and
socioeconomic status. Purposeful sampling can be utilized as an attempt to capture the varying
shades and hues of the queer community. To meet expansive goals, the study would be executed

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virtually and in person cohorts. Groups will first be run in person to gather participant feedback
to improve flow. As the project grows, it can be expanded to virtual groups. Ideally, cohorts
would have 6-8 participants who would begin and end the process together. Once the project
leader has an additional 6-8 individuals interested, a new group can begin. When it comes to
recruiting potential participants, referrals should be gathered through queer community
centers/affiliated groups and inclusive care health professionals. Lastly, this is designed to be led
by a licensed art therapist who is queer and/or has comprehensive knowledge surrounding the
queer community.
Project Design
Using the research compiled through the literature review, several studies and theoretical
conceptualizations assess identity construction with or through tattoos. Most of the data was
collected through qualitative interviews, surveys, and questionnaires. This represents the
prevalence of tattoos, demographics of tattooed individuals, and self-reported attitudes towards
tattoos and identity. Additionally, standardized scales have been used to measure self-esteem,
body image, and identity formation.
This model can be adapted to measure the self-care allegory by compiling a comparative
study of non-tattooed and tattooed individuals. Based on this knowledge, the design begins with
participants who live in the United States, completing a survey assessing their demographic
information, history of tattooing, and experiences with self-expression, identity affirmation, and
emotional healing. The survey will extend to a Mental Health Status Questionnaire, similar to the
Hospital Anxiety and Depression Scale to assess for depression, self-harm, and suicidal ideation.
This will inform the purposeful sampling process to achieve an expansive group of 6-8 queer
individuals contemplating a tattoo and an equal size of queer individuals with no desire to be

40

tattooed. Measures of self-expression, identity affirmation, and emotional healing will be
analyzed and compared between the two groups using statistical analyses, such as independent ttests or one-way Analysis of Variance, controlling for potential confounding variables such as
age, gender, and mental health status. A structured interview will be administered before the
group begins and as a 6-month follow-up.
Procedure
In this four-week program, each week will cover a different topic leading up to getting a
tattoo. The group will meet weekly for two hours; the first hour is reserved for artmaking, and
the second hour can revolve around reflection and discussion. To accommodate the time variable
in waiting for a tattoo appointment, a debrief will be offered every six months to all participants.
Week One
The first week will involve preparing the mind and body for a tattoo – an important first
step to a ritual. Art can be a powerful tool for exploring and defining what self-care means to an
individual, offering a starting point for establishing a routine. Creating art based on this topic can
facilitate self-reflection, visualize self-care practices, identify emotions and needs, explore
limitations, and overall promote a mindful experience. Utilizing visual imagery can assist in
generating discussion around what the body needs for a tattoo and ultimately how basic needs
catalyze the healing process. Topics can include:
● Sleep and restoration: How does sleep heal? What do individuals notice when they lack
sleep? How do individuals feel when they get adequate sleep? Does being rested impact
mindfulness?

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● Hydration and nourishing the body: How does food impact energy? How are bodies
affected by nourishment? Why is it important to find balance? What is the connection
between nutrition and sleep?
● Alcohol/drugs and complications: What kind of choices are made when under the
influence? How do drugs affect the body? Where does the mind go?
Week Two
The second week will be centered around imagery exploration and creation. Participants
will explore visual references such as tattoo designs, artwork, photographs, and/or symbols to
define aesthetic preferences and style. The leader will assist clients in identifying elements or
themes that resonate with them and discuss how these visuals can be incorporated into their
tattoo design.
Additionally, there are unique levels of disclosure to discuss with the participants. The
first level of tattoo design is decoration and representational designs. This could be common
symbolism representing generalized personality traits (lion for strength, semicolon for hope,
etc.). If a tattoo relies on more limited decorative elements, then it can limit communication
potential and interaction with other people as viewers may engage with them on a more
superficial level, relying on the visual appeal rather than reflecting on significance. The next
level evolves into a more relational and representative design. Often, it incorporates more
personal symbolism, storytelling elements, and/or cultural awareness which makes room for
potential recreation of meaning in conversation. This level of tattoo designs has an openness for
collaborative meaning which translates beyond identity creation into the individual’s connection
with queerness.
Topics to discuss this week can include:

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●

Representational or relational design: What meanings should the tattoo hold? How does
the individual want others to engage with their tattoo? How do representational and
relational designs impact levels of safety? How does aesthetic influence meaning?

● Body placement and implications: How would it feel for another person to touch the
body? How visible will it be when wearing clothes? What will the intensity of pain be
like? Does this spot hold any other memories? What does it mean to bear a tattoo?
● Size and implications: What is the intricacy level of the design? What would it mean for
the tattoo to be subtle and simplistic versus expansive and detailed? How does the size tie
into reclamation? How does size influence how the wearer engages with it on a physical
and emotional level? What is your pain threshold?
Week Three
This week will center around finding and consulting with a tattoo artist. Picking an artist
can mimic how an individual chooses their community. The artist should appeal to them
aesthetically but also empathetically. Additionally, building rapport with the artists involves trust
and open communication. This bond of trust enables a deeply personal process where clients feel
safe expressing their stories and emotions, knowing they will be artistically captured with respect
and understanding. This exchange marries vulnerability with creativity, with artists often
adopting the mantle of confidants and facilitators of catharsis. When likened to building
community, the group can explore characteristics of a safe person, red flags, and building social
skills. Furthermore, this encapsulates the question: what does the individual need to feel safe?
While searching around for artists, the participants must consider the space that they’re
entering. Similar to a therapeutic setting, a ‘safe’ tattoo parlor prioritizes the health, safety, and
well-being of both clients and staff. Generally, a parlor should have sterilization practices,

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properly trained artists, aftercare guidance, and an informed consent process. In a group setting,
this can spark conversations around what constitutes a safe space.
Week Four
Week four will culminate all the previous weeks, leading to a commitment in the form of
a deposit for the appointment. Due to a tattoo artist’s availability and booking times, it is unlikely
that all the participants can get tattooed during the same week, let alone so soon. The group topic
will focus on setting goals and their effect on overall well-being (stress reduction, positive
reinforcement, coping skills, etc.). Participants will create art surrounding goals, resolutions, and
commitment.
Anticipation can stir conversations surrounding:
● Physical sensations and the potential discomfort – what will it be like to have the tattoo
artist bear witness? How can pain be managed?
● Seeing their chosen design come to life – what can that mean? How does that impact the
body? What will it mean for others to witness this?
● Mindfulness of the connection between mental and physical pain – how does the body
signal mental discomfort? What role does pain play? What responses are driven by
mental/physical pain? How does one heal?
●

The permanent transitional object – what does it mean? How does permanence impact
the meaning? What reactions do the participants desire?

Six-Month Debrief
The debrief will be offered to all cohort members who have either received their tattoo or
have decided against getting a tattoo. Art-making will explore the symbolism and meaning of
chosen tattoo. Discussion will be centered around themes and emotions that emerged during the

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project, allowing participants to share their thoughts, feelings, and takeaways from one another.
Topics can include:
● What was this process like from beginning to end? How do the participants feel about the
art they made in the group?
● What was it like to get tattooed? How did the body and mind affect the tattooing process?
How did the individual manage pain? What was it like to have someone witness this
process?
● How does the individual feel about their tattoo? Does the tattoo meet their expectations?
How has this impacted the participant’s relationship with their body? Are there things
they wished they knew or would change about the experience?
● Have individuals been able to apply what they learned in group to their lives? What is
their takeaway from this experience?
Conclusion
The findings of this study will provide valuable insights into the potential therapeutic
benefits of utilizing tattoos as an art therapy tool among members of the queer community. By
exploring the impact of tattooing on self-expression, identity affirmation, and emotional healing,
this research may inform the development of culturally competent interventions and support
services tailored to the unique needs of queer individuals.

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Section IV
The purpose of this curriculum is for queer folks to externalize internal conflicts, develop
coping strategies, and gain insight into experiences, ultimately fostering autonomy and
cultivating self-acceptance in the face of oppression and adversity. To determine whether this
curriculum accomplishes the goal, there will be 2 assessments utilized. The first assessment to be
administered is the Rosenberg Self-Esteem Scale (RSES) to obtain a baseline measure of the
participant’s self-esteem. This is to be followed up by the Kinetic-House-Tree-Person drawing
task to help explore the qualitative aspects of the individual’s self-concept and emotional state;
ultimately offering a deeper understanding of the factors influencing their self-esteem.
Rosenberg Self-Esteem Scale
The RSES is a widely used self-report tool in social science research for measuring selfesteem. This assessment assesses positive and negative feelings about the self while
demonstrating test-retest reliability and concurrent, predictive, and construct validity. Adding
supplementary questions or scales may be beneficial to address further self, expression, identity
affirmation, and emotional healing. The additional scales will be kept separate from the RSES to
maintain reliability and validity. It’s optimal to use this in a longitudinal study to track changes
in self-esteem before the curriculum begins and after getting therapeutic tattoos at the six-month
debrief.
Addendums to Rosenberg’s Self-Esteem Scale
Scores will be calculated as strongly agree = 3, agree = 2, disagree = 1, and strongly disagree =
0.
1. I feel that my identity is valued and affirmed by others.
2. I can heal emotionally from difficult experiences.

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3. I feel comfortable expressing all parts of my identity.
4. I feel I can emotionally heal from adverse experiences.
5. I am comfortable expressing my identity in all situations.
Kinetic-House-Tree-Person
After the RSES, the participants will take the Kinetic-House-Tree-Person (KHTP) before
the curriculum begins and at the six-month debrief. The KHTP provides a more unified approach
to evaluating a client’s psychological state, self-concept, and relationship to their environment.
While the reliability and validity of this assessment have not been conclusively proven, it can be
a useful tool to gain insights into the participant’s psychological state and their perception of
their environment. Combined with the RSES, it can provide a comprehensive evaluation of an
individual’s self-esteem.
Purposed Method for Data Analysis
Data analysis will involve comparing levels of self-expression, identity affirmation, and
emotional healing. The results will be analyzed using appropriate statistical tests to determine if
there are significant differences in the assessments gathered before the curriculum begins and
when the individual receives their therapeutic tattoo. Furthermore, conducting a multiple
aggression analysis to explore the relationship between changes in RSES scores and specific
features or changes in the KHTP drawings will aid in deciphering the impact of the curriculum.
This can help identify which aspects of the drawings are most predictive of changes in selfesteem.
For the RSES, the evaluator will calculate means, standard deviations, and other
descriptive statistics for the self-esteem scores at both points. Using a paired t-test to compare the
RSES scores before the group begins and at the six-month debrief to determine if there is a
statistically significant change in self-esteem over time. Since the KHTP is qualitative, the data

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must be summarized to identify common themes or patterns. Additionally, comparing the KHTP
drawings from before the curriculum begins and at the six-month debrief will help identify any
changes in themes or patterns that might indicate psychological progress or changes.
Analyzing the relationship between changes in the RSES and KHTP drawings, it can
pinpoint which aspects of the curriculum are most effective in enhancing self-esteem. This
allows for the refinement and enhancement of these components to maximize their impact.
Understanding these specific elements of self-expression and identity affirmation that correlate
with positive changes in self-esteem can help tailor the curriculum to better meet the diverse
needs of participants. This personalization can lead to more meaningful and effective outcomes.
Regular analysis of data allows for ongoing assessment and improvement of the
curriculum. This iterative process ensures that the curriculum remains relevant and effective over
time. By grounding curriculum changes in empirical data, art therapists can adopt evidencebased practices that are more likely to produce desired therapeutic outcomes. This approach
enhances the credibility and reliability of the curriculum. Insights gained from data analysis can
inform the scalability of the curriculum to different populations or settings. Understanding which
components are universally effective versus those that require adaptation can facilitate broader
implementation.
Conclusion
With both assessments, one can compare the RSES score with the themes and indicators
found in the KHTP drawing. For instance, low self-esteem on the RSES might correlate with
negative or insecure elements in the KHTP drawing, such as small or isolated figures. A high
self-esteem score might be reflected in confident and well-integrated figures in the drawing,
while discrepancies between the two assessments can highlight areas needing further exploration.
The qualitative data from the KHTP can explain the reasons behind the RSES score, offering

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richer insights for the impact of the curriculum. Using both tools addresses the limitations of
each method, with the RSES providing reliable, validated numerical data and the KHTP offering
nuanced, context-specific information. Ultimately, this information will highlight the effective
curriculum areas that need refinement.
Section V: Discussion
This section provides an overview of the literature review, influences and potential biases in the
program's development, the limitations inherent to this project, and potential avenues for future
research.
Summary
The existing literature underscores a critical need for therapeutic modalities tailored to
minority experiences. Art therapy utilizes a distinctive approach to explore self-discovery,
healing, and personal growth. By combining the permanence and cultural significance of tattoos
with the therapeutic benefits of artmaking, participants can explore their identities, process
emotions, and develop a stronger sense of self in a supportive and affirming environment.
Engaging in the creative process of tattooing allows queer individuals to externalize internal
conflicts, develop adaptive coping strategies, and gain insight into their lives. This process
ultimately fosters autonomy and cultivates self-acceptance in the face of societal adversity. The
synthesis of tattoo artistry and therapeutic practice presents a promising avenue for addressing
the unique challenges faced by marginalized populations, particularly within the queer
community.
Discussion
As adrienne maree brown (2020) eloquently said, “It always feels important to me to
reveal who I am as the author of these ideas, and the lineage I draw upon.” In the spirit of

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transparency and self-awareness, I acknowledge my identity as a white, non-binary, queer,
tattooed, student art therapist and artist. My lived experience is shaped through a diptych of
privileges afforded by my race and socioeconomic background, while also encountering
adversity due to my queer presentation. It is crucial to recognize that my ability to engage in this
work is underpinned by the privileges I hold. As this research evolves, my aim is to broaden the
discourse to include the various shades and hues of the queer community.
My upbringing in a Jewish household was marked by the pervasive myth that “Tattooed
Jewish people cannot be buried in a Jewish cemetery.” While the Torah does admonish against
desecrating the body, it does explicitly mandate exclusion from burial grounds. This cultural
narrative significantly impacted my perception of tattoos. As a child immersed in imagination
and creativity, I eagerly awaited the day I could my first tattoo, which, in a twist of irony, was a
Hebrew word. My tattoos, whether whimsical or profound, are integral to my identity, making
my body feel authentically mine. This journey towards autonomy and self-expression often led to
feelings of ostracization, particularly within the context of my artistic and personal endeavors.
These experiences underscore my inherent bias: I am a fervent believer in the therapeutic
potential and healing power of tattoos. I view tattoos not merely as adornments but as extensions
of my identity and memory. This conviction has driven my research interests, and the
development of a curriculum tailored for the queer community.
My identity as queer and non-binary heightens my sensitivity to issues surrounding
identity, sexuality, and self-expression. This personal connection enriches my research and
allows for a more nuanced interpretation of participants’ experiences. As an artist and student art
therapist, I am uniquely positioned to explore the intersection of creativity and therapy,
leveraging my personal insights to inform my work.

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It is essential to acknowledge that my personal experiences and identity may introduce
biases into my research. My interpretation of the data is inevitably influenced by my journey.
However, I believe that sharing these aspects of myself enhances the authenticity and depth of
my research, providing a richer context for understanding the therapeutic potential of tattoos in
fostering self-expression and identity affirmation with the queer community.
Limitations
As previously mentioned, there is a gap in understanding the efficacy of tattoo art
therapy. A crucial concern is to delineate the roles of the tattoo artist and the art therapist to
avoid dual relationships and potential conflicts of interest. While tattooing can be therapeutic, it
is not a substitute for mental health therapy.
The ethical application of tattoo art therapy requires a nuanced understanding of cultural
symbolism. Art therapists must exercise caution to avoid the exploitation or misappropriation of
cultural symbols in therapeutic contexts. Additionally, tattoos are intertwined with various forms
of privilege. People of color often face additional challenges when getting tattoos. The tattoo
industry has been criticized for its lack of skill and experience in working with darker skin tones,
leading to issues such as less precise lines and blurred images (Assam, 2023). This can make it
more difficult for people of color to find artists who can provide high-quality tattoos, thereby
limiting their access to this form of self-expression.
Furthermore, stigmas surrounding tattoo culture can impact different facets of life. The
ability of white individuals to obtain employment while having visible tattoos can be seen as an
expression of white privilege. Additionally, the high cost of getting a tattoo can be a barrier for
individuals from lower socio-economic backgrounds, allowing those with more financial
resources to access better-quality tattoos and more reputable artists.

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Currently, self-harm and suicidality present significant challenges in my research. On
one hand, I recognize the necessity and importance of interventions that are inclusive and
understanding of self-injurious behaviors. On the other hand, as a researcher, I am concerned
about the potential impact on the validity and outcomes of the study when including individuals
with histories of self-harm, as it might shift the narrative towards body hatred and punishment.
Within the queer community, self-injurious behaviors are more prevalent due to the oppression
and obstacles faced. While it seems unjust to exclude these individuals, my goal is to expand this
research to be more inclusive once more data has been collected.
Suggestions
As this field continues to evolve, interdisciplinary collaboration between mental health
professionals, tattoo artists, and researchers will be crucial in refining and validating tattoo art
therapy as a legitimate therapeutic modality. Future research should focus on conducting
controlled trials, developing standardized protocols, and assessing the psychological and
physiological effects of tattoo art therapy across diverse populations. Moreover, folks who are
further marginalized in the queer community are crucial to this ongoing conversation to steer the
curriculum to one of inclusivity. Additionally, the scales used for measuring the outcome may
need to be adjusted as more trials are conducted.
It could be beneficial to gather a working list of tattoo artists to collaborate with; both in
research and for the participants. A strong relationship with tattoo artist fosters trust and open
communication which allows for better collaboration to ensure the final tattoo aligns with their
vision. It can also contribute to a more relaxed and friendly atmosphere during the tattooing
session, making the experience more enjoyable for the participant.

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While this research paper explores the role of permanence, further investigation into the
differential impacts of permanent versus temporary body modifications could significantly
enhance the understanding and effectiveness of the proposed curriculum. Examining the
psychological and emotional effects associated with both permanent and temporary
modifications, future studies could elucidate the unique benefits and potential drawbacks of each
approach. This comparative analysis would not only provide a more comprehensive framework
for therapeutic interventions but also underscore the specific advantages of incorporating
permanent body modifications, such as tattoos, into therapeutic practices. Such insights could
propel the directive of this curriculum, highlighting its efficacy in fostering self-expression,
identity affirmation, and emotional healing within expansive populations.
Conclusion
This research highlights the potential of tattoo art therapy as a transformative modality for
addressing the unique challenges faced by the queer community. While promising, the field of
tattoo art therapy is still in its nascent stages, necessitating further exploration and validation.
Acknowledging the inherent biases and privileges influencing the researcher’s perspective
emphasizes the importance of transparency and self-awareness in scholarly work. Future efforts
should focus on interdisciplinary collaboration to refine and standardize tattoo art therapy
practices. Through the conduction of controlled trials and developing robust protocols, art
therapists can better assess the psychological and physiological impacts of this approach.
Additionally, expanding the research to include diverse populations and addressing issues of
accessibility and privilege will be crucial in ensuring that tattoo art therapy becomes an inclusive
and effective therapeutic modality.

53

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Kinetic House Tree Person Assessment

Instructions:

I would like you to please draw a house, a tree and a whole
person on this piece of paper with some kind of action. Try
to draw a whole person, not a cartoon or stick person.

During administration, pay attention to the subject. Note any
unusual body movement, verbalizations, apparent frustration
erasures and other items that are unusual.

Once the subject has completed the image, subject is asked
to tell a story about what is happening in the picture.
Specific questions should be asked by the assessor based
upon the story told.

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House Tree Person Assessment

Instructions:

Take one of these pencils, please. I want you to draw me as
good a picture of a house as you can. You may draw any kind
of house you wish, it is entirely up to you. You may erase as
much as you like, it will not be counted against you. In
addition, you may take as long as you wish, just draw me as
good a house as you can.

For the tree and person drawings, the word house is
replaced with tree, person or person of the opposite gender

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During administration, pay attention to the subject. Note any
unusual body movement, verbalizations, apparent frustration
erasures and other items that are unusual.

● House: age, location, inhabitants, best thing, thing
dislike most
● Tree: age, type, location, best thing, thing dislike most
● Person (both): age, name, what need most, best thing,
thing dislike most

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