Facing our shadows: understanding harm in the arts therapies

ABSTRACT

This paper examines what harm reveals about psychoactive power in the arts therapies. A 20-year sample of fitness-to-practise cases brought to the UK statutory regulator (the Health and Care and Professions Council) was examined to establish the prevalence of practitioners who cause harm which was low (0.165%). Transcripts of sanctioned cases were used to construct a grounded theory of how harm is mediated in arts therapies practice. This revealed service users enter arts therapies with damaged self-trust in the expectation that they can trust the professional. In non-harmful therapy, trust in the professional is then used to boost self-trust in the service user. In arts therapies practice, the arts create powerfully emotionally salient elements to aid therapy which can affect both service user and arts therapists’ attachment systems to fulfil this task. Harm was enacted when the arts therapist used the power of that trust to isolate the relationship and introduce their own needs through arts therapies practices. This increased service user dependency on the arts therapist and further decreased their self-trust resulting in harm. Harm was only possible where the arts therapist’s self-reflection failed and they distorted theory to self-justify their actions and refute all feedback to the contrary.

Plain language summary

This paper examines harm in the arts therapies (art, drama and music therapies as regulated by the Health and Care Professions Council (HCPC)). Harm is understudied but important because it tells us how things can go wrong and also indicates where areas of strong psychoactive power may operate in therapy which can also help people. Arts therapies have been regulated by the HCPC for 20 years and we found there were 77 cases brought against arts therapies practitioners with a total of 16 cases that led to HCPC sanction. We used a grounded theory method of analysis to try to understand how harm was mediated in those harmful arts therapy practices because it is an established form of qualitative research used to construct a theory of social action using examples drawn from real-world examples. We found that service users enter arts therapies with damaged self-trust in the expectation that they can trust the professional. In non-harmful therapy, trust in the professional is then used to boost self-trust in the service user. Within arts therapies, the arts support access to powerful emotions which underpins the building of trust, an element essential to good therapy. However, harm happened when the arts therapist used the power of that trust to isolate the relationship, introduced personal issues and used the service user for their own needs. This increased service user dependency on the arts therapist, detrimentally affecting their sense of self-trust and resulting in harm. Harm was only possible where the arts therapists’ self-reflection failed and they distorted theory to self-justify their actions and refute all feedback to the contrary.

KEYWORDS:

• Harm
• arts therapies
• psychoactive power
• grounded theory research
• health care professions council

Acknowledgements

We wish to record our gratitude to those service users whose courage in sharing deeply painful experiences through the HCPC increased public protection. We would also like to acknowledge the role of professionals who raised concerns and in particular Karen Huckvale in contributing her experience as an art therapist supervisor in a case of harm. It is our hope this research goes a small way to recognise the considerable power of the arts therapies to help and harm.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Dr Neil Springham had a background in fine art painting before training in Art Therapy in 1988. He has worked in adult mental health specialising in addictions and more recently in services for people diagnosed with a personality disorder at Oxleas NHS Foundation Trust, London. He was a course leader at Goldsmiths College, University of London, twice elected chair of the British Association of art therapists and Co-founded the UK Art Therapy Practice Research Network with Dr Val Huet. He has a PhD in psychology which focused on mentalising in art therapy and currently coordinates ResearchNet (a co-production-based research network). Dr Springham has published and lectured internationally on a range of practice-research issues.

Dr Val Huet trained in sculpture at Camberwell School of Art and qualified as an Art Therapist in 1986. She is a qualified Group Psychotherapist and Organisational Consultant. Throughout her career, Val worked in mental health services for adults and within Child and Adolescents Mental Health Services. She also spent twelve years as a tutor training art therapists. Her practice is now with professionals and teams, having completed a PhD on art therapy groups for work-related stress in 2015. Since 1987, Val has been active within the British Association of Art Therapists and in 2003, Val took up the post of Chief Executive Officer of the British Association of Art Therapists. Having organised the first art therapy international practice/research conference in July 2019, she is about to change her role within the BAAT to focus on art therapy research. She has lectured internationally and remains an enthusiastic life drawing student.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.