What Do Structural Racism and Oppression Have to Do With Scholarship, Research, and Practice in Art Therapy?

The publication of the third issue of the Journal this year, a special issue on Ethics, Law, and Cultural Competence in Art Therapy, has kindled a lot of interest, both positive and negative. The call for papers for that issue was disseminated in August 2016, in response to questions raised by the passage of Tennessee HB 1840 allowing counselors to decline services to clients whose desired goals of therapy or their behaviors, are in conflict with counselors' beliefs. Since that call for papers, the landscape of daily life has changed for many art therapists, mental health clients, and art therapy students. The unexpected election of Donald Trump, the policies of the Trump/Pence administration, and the decision of the American Art Therapy Association (AATA) to align with Karen Pence and her initiative Healing with the HeART have negatively impacted many providers of art therapy and probably hurt clients they work with, and changed how people outside the field view art therapy. Changes to U.S. immigration policies, the hateful rhetoric of the administration's alt-right allies, and hostility to LGBTQIA rights have direct negative effects on the mental health of traditionally marginalized individuals. These events have also brought to the forefront the reality of whiteness and white privilege in the individual, social, political, and professional arenas in which art therapists operate.

Compared to the rest of society, the profession of art therapy has been and still is primarily constituted of an unusually high percentage of white people (Elkins & Deaver, 2015). This is problematic because as Carr (2016) has noted,

Since Whiteness is extensive, often elusive, well protected, nebulous, and extremely difficult to unravel and identify, it is essential that discussions, deliberations, and action plans be conceptualized and implemented to address, at myriad levels, White power, and privilege in and through education. (p. 74)

Racism and oppression reside not just in individuals, but also within larger institutions and societal structures (Metzl, Petty, & Olowojoba, 2017). Just as in the country at large—in which there are continuing noteworthy racial inequities (Clair & Denis, 2015)—whiteness in art therapy has led to deeply embedded systems of structural racism and oppression that perpetuate the silencing of marginalized voices. Structural racism refers to the ways that society perpetuates discrimination and oppressive actions through multiple systems acting together to reinforce inequities, biased values, and access to resources that benefit white individuals and groups (Bailey et al., 2017). Despite months of objections expressed by art therapists from diverse groups and their allies, structural racism persists in the decision by the AATA to associate with Karen Pence's project on art therapy in that it aligns the profession with a powerful administration that stands for and attempts to maintain denial of health care for many groups, denial of reproductive rights for women, denial of rights for LGBTQIA individuals, and is anti-immigration. What must art therapy clients who suffer the daily injustice of multiple covert and subtle, as well as overt oppression from numerous sources, think of this relationship between the profession of art therapy and the current administration in Washington, D.C.? What thought was given to the perspectives of those who are committed to social justice in the profession of art therapy in addition to the larger systems within which art therapy clients engage daily, when the decision was made to align with Karen Pence?

When institutions, laws, public policies, and the systems in which art therapists work, enact trauma on those who receive services meant to ensure safety, mental health, and well-being, what is the profession to do? At the very least, it is not to affiliate with it. As Talwar (2017) asserted, the question has now become, “What should art therapists do in the face of white supremacist policies that reinforce discrimination?” (p. 103). The articles in the September 2017 special issue Talwar edited address the broader cultural and systemic issues requiring the attention of the field including white supremacy, white fragility, toxic whiteness, trauma perpetuated at social and cultural levels, contemporary neoliberal influences that appropriate resources from people of color and poor communities, and the need for critiquing multicultural approaches that ignore the long-standing systems of oppression in which art therapists operate. Being in a position of privilege, these structures of power are largely invisible to white people and they go unexamined for the most part. At the 2017 AATA conference these power structures manifested in the division between those who support Karen Pence's art therapy project and those who oppose it as was evident in the members' meetings, the meeting of the Coalition of Art Therapy Educators, and the resolutions that were put forward challenging the initiative. Problems related to structural power and privilege also manifested in sharp criticisms directed toward the editors of this journal and accusations were made that some of the articles were not genuine scholarship because they were not research reports or descriptions of specific aspects of art therapy practice. These criticisms can be seen as silencing efforts arising from the structural effects of racism.

Contesting Structural Racism in Medicine

Given this contemporary moment in the profession of art therapy, it is useful to turn to another profession, one that has been viewed as exceptionally prone to structural racism: medicine (Hardeman, Medina, & Kozmimannl, 2016). An expanding literature on structural racism and oppression in medicine provides lessons that art therapists might find useful for rethinking their preconceived notions of scholarship, research, and practice.

Student activists in medicine and public health have begun to engage their educational institutions in examining both the problem of racial essentialism in teaching and the pervasive health inequities that continue to plague U.S. healthcare (Braun & Saunders, 2017). Many current medical students, with their undergraduate exposure to national events involving racial discrimination and structural oppression, want to engage in questioning the social and systemic causes of racism and work to overcome health disparities, moving beyond just documenting them without questioning their origins as the profession of medicine has done in the past. This activist approach of pursuing solutions to racism has generated coalitions of faculty, administrators, and students who are reconsidering the ways in which race and racism are addressed in medical education. Recent critiques of bioscientific knowledge embrace ethical issues connected to bias and social justice that have not been previously acknowledged. Braun and Saunders (2017) emphasized that,

… educators now face an ethical imperative to improve academic capacities for robust interdisciplinary teaching about the conceptual apparatus of race and the recalibration of its use in teaching both genetics and the more pervasive and urgent social causes of health inequalities. (p. 518)

Metzl et al. (2017) asserted that a structural competency framework is needed to push beyond recognizing the importance of cultural competency in medical education. Structural competency entails studying how structural aspects of the world lead to poor services and health inequities. Structural competency also involves engaging with current controversies about racism and the influence of the long history of racism in medicine. Metzl et al. acknowledged the need to work with communities and those who have been disadvantaged by structural racism to advance knowledge that interrogates the long legacy of racism in medicine and health care.

Hardeman et al. (2016) emphasized that structural racism leads to suffering on a broad scale for all groups in this country, not just those who have been disadvantaged, and that health professionals should work to improve the well-being of all by undoing structural racism. They pose three recommendations. First, they insist it is critical to learn about the racist history of this country that arose from white supremacy and privilege at the expense of the oppression of African Americans. Second, the authors emphasize the importance of recognizing that narratives about current health disparities often attribute poor outcomes to those who have been oppressed rather than the systems that enact oppression based on implicit bias about racial differences. And third, Hardeman et al. affirmed that racism must be named and defined as a force that promulgates systems of privilege and domination for some and oppression for others based on race and other differences. It is vital to understand how this occurs in daily interactions, in work, in research, and to use scholarship to critique the systems that perpetuate injustice and oppression.

Borrowing Lessons on Structural Competency From Medicine

Multicultural competency is not enough (Gipson, 2015)—advancing and improving services for marginalized and disadvantaged groups who seek art therapy requires a framework that integrates scholarship and research with practice and pushes the boundaries of what many art therapists consider scholarship, the critique of institutions and systems that sustain inequitable treatment. Moreover, scholars and educators must embrace scholarship that brings to the forefront the lived experiences of those on the margins, those who are different and who encounter daily affronts to their value as human beings. At the 2017 conference it was apparent there are many students and young professionals who expressed values upholding those who have been marginalized and that run counter to those that are represented by a relationship with Karen Pence as the ambassador of art therapy. The voices of these inspiring young art therapists should be honored and highlighted. Their expression of value for social justice and activism must extend to scholarship, and to organizational policy such as reconsidering what it means for the AATA to engage with Pence's initiative. The intentions, actions, and work of art therapists, both individually and organizationally, should be dedicated to the safety, health, and well-being of clients and communities with particular attention to those who have been marginalized. And this now means to challenge and dismantle systemic racism and oppression through education, daily art therapy practice, research, social justice efforts, and all forms of scholarship. The incorporation of a structural competency framework is a starting point for challenging the often-insidious effects of racism and oppression that have been barely acknowledged by the profession. A relationship with the current administration in the White House does not make sense if the field truly values equality, inclusivity, and social justice.

In This Issue

I am pleased that this issue contains both excellent art therapy practice and research articles. Lenore Steinhardt contributes an intriguing practice piece based on eliciting unconscious imagery using dots, lines, and planes. This protocol arose from her study of the ideas of Kandinsky and evolved through her work with clients and students. In a study by Irish researchers Katharina Keogh and Ann-Marie Creaven, participants engaged in one of three artistic conditions following a stress induction to determine whether any of them promoted cardiovascular recovery. The researchers also investigated participants' responses to task enjoyment and perceived creative control.

Next, two articles on autism research present interesting results: Miranda D'Amico and Corinne Lalonde from Canada examined the use of art therapy for teaching social skills to children with Autism Spectrum Disorder (ASD), and Celine Schweizer, Marinus Spreen, and Erik J. Knorth of the Netherlands contribute a qualitative study about the tacit knowledge of art therapists who work with children with ASD. Both are vital to the continued study of art therapy for individuals with autism.

Megan Robb and Abbe Miller provide results from their very interesting qualitative research on a particular form of art-based supervision, El Duende Process Painting. They were interested in how supervisee disclosure might emerge and in what ways it could be connected to art making. In an article on an art therapy task, Michael Hanes, who developed the Road Drawing, describes how this technique has been useful in gender specific substance use treatment. The final article, by Jessie Spraggins Rochford, discusses a visitor-focused collaboration between art therapy and art museum education that has been successful at Florida State University.

This issue ends with two short pieces about art therapists who have been historically prominent in the profession. Natalie Carlton contributes an interview with Myra Levick in which Dr. Levick provides her opinions on current issues she sees as important to the field. Finally, Sarah Deaver provides a personal account of meeting and working with Ron Hays, a well-known and beloved art therapy educator who died this past summer.

Final Issue

This issue concludes my three-year term as executive editor of Art Therapy. I have worked to establish the link between art therapy practice and research that is needed to advance the field by encouraging articles on the daily practice of art therapy that should be linked to art therapy research efforts. With the special issue recently published, Savneet Talwar has pointed to the need to critically engage in scholarship that contests racism in the profession. I thank Associate Editor Talwar for her tireless work in this important domain of scholarship, and the inspiration she has provided to countless others who devote efforts to making art therapy equitable to all. This scholarship should inform both practice and research endeavors going forward.

I wish to also honor the work of our distinguished book review editor, Gaelan Harmon-Walker, who has also contributed excellent reviews when there was a dire need for his input and other reviewers were busy. Thank you, Gaelan! The collegiality and support of Savneet and Gaelan have been indispensable in the operation of the Journal these past three years. Of course, hearty thanks also go to those on the Journal Review Board who volunteered tireless hours to critiquing submissions and rendering difficult recommendations so this journal can be the best possible to represent scholarship in the profession. I value all that the reviewers and editors have contributed to this collaborative effort.