Special Issue on Medical Art Therapy

When I tell people that I am an art therapist, I am frequently asked, “Oh, so, you work with kids with cancer?” Despite this association to our profession, my colleagues and I found relatively low numbers of art therapists who are documenting their work in medical settings (Potash et al., 2016). This is surprising given that the U.S–European model of art therapy might very well have originated in a medical facility. In the United Kingdom in the 1940s, artist Adrian Hill turned to art making when recuperating from tuberculosis. After his discharge, he worked in a sanatorium. At this same time, both he and artist Maria Petrie sought to change the status of an “artist” as one of exclusivity into “a new, social role” that promoted art making for people in need of recovery (Waller, 1991, p. 47). In the sanatorium Hill (1948) aimed to complement occupational therapy by distinguishing art therapy as follows:

[Art therapy] seeks to look a little deeper in order to ascertain the essential causes of introspection and despondency and the evidence so far collected goes to prove that drawing and painting while completely engrossing the mind (as well as the fingers) of the patient, and being continual and progressive, offer a fuller life in hospital and create an added zest for living. (p. 101)

By becoming “a real member of the medical team” (p. 103), Hill envisioned an opportunity whereby “Art in illness, as well as in health, will together forge a new national characteristic” (p. 97).

In tribute to Hill’s vision, the current state of health care strives for a better integration of physical and mental health services. This behavioral health model emphasizes “a coordinated service system based on a continuum of care … with a longitudinal focus on disease management and health promotion at both the individual and the community level” (Kiser, 2013, p. 13). In such a unified system mental health providers are increasingly offering services in primary care and other medical settings to address psychosocial aspects of disease and to tend to the mind–body connection for illness recovery.

Unlike in the United Kingdom, where medical art therapy is central to the founding of the field, the U.S. origins are attributed to Naumburg’s psychoanalysis, Kramer’s work in special education, and Huntoon’s attention to psychiatric treatment (Rubin, 1999). Even though published accounts of art therapy began with the first volume of the Bulletin of Art Therapy in 1961 (later renamed the American Journal of Art Therapy), it took that journal 14 years to publish an account of art therapy in a medical setting (Dodd, 1975). Cotton (1985) wrote what seems to be the first account of art therapy and cancer. It was not until the 1990s that Malchiodi (1993) defined medical art therapy as “the use of art expression and imagery with individuals who are physically ill, experiencing trauma to the body, or who are undergoing aggressive medical treatment such as surgery or chemotherapy” (p. 66). Despite the late entry of medical art therapy in the United States, art therapists have contributed case studies, research, and best practices for working with clients living with chronic illness, short-term conditions, and longer, more intensive physical treatment (e.g., Ainlay Anand, 2015; Councill, 2013; Malchiodi, 1999a, 1999b, 2012; Rosner Davis, 2015).

It is fitting that this journal devotes a special issue to medical art therapy 25 years since its first one that focused thus (Malchiodi, 1993). Given the impact of medical conditions on individuals, families, communities, and societies—as well as the constant debates on health-care access, delivery, and legislation—it is important to situate art therapy within the larger U.S. health-care agenda. The U.S. Department of Health and Human Services (2017) issued the U.S. National Quality Strategy to outline three aims to achieve quality health care: (a) safe and accessible patient-centered, (b) prevention services to target health disparities, and (c) affordability. There are six priorities to meet these objectives, discussed here, most of which are addressed by contributors in this special issue.

Making care safer by reducing harm caused in the delivery of care. Generally, reducing harm relates to better screening, accurate diagnosis, and tailored treatment. One of the unrecognized causes of threats to client safety pertains to professional burnout (Hall, Johnson, Watt, Tsipa, & O’Connor, 2016). In this issue, Diana Gibson shares how art journaling combined with supervision allowed her to recognize burnout, gain new perspectives, and improve the art therapy she provided to patients.

Ensuring that each person and family is engaged as partners in their care. Patient-centered care includes active engagement with patients and caregivers. Abbien Crowley Ciucci and Hope Heffner-Solimeo describe how altered book-making workshops support parents of pediatric patients. All interpersonal interactions and relationships between medical professionals and those seeking treatment necessitate cultural understanding, which is a factor in reducing health disparities associated with socioeconomic, racial, and social identities (Schneider & Squires, 2017). Mariya Keselman and Yasmine Awais’s study on cultural humility demonstrates areas in which medical art therapists succeed and others in which to improve.

Promoting effective communication and coordination of care. Positive outcomes are more assured when the various members of the treatment team have a shared understanding of how their roles each contribute to the patient’s well-being. Theresa Van Lith and Heather Spooner’s study demonstrates the ways in which art therapists and arts-in-health professionals can collaborate while also specializing in respective areas. Kaley Wajcman describes how educating others on her role as an art therapist in a children’s hospital is key to maintaining a sustainable program.

Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. Treating any condition, but especially chronic diseases, mandates constant evaluation and research. Deborah Elkis-Abuhoff and Morgan Gaydos review their past decade of research and direct service with patients living with Parkinson’s disease. In so doing, they offer a tiered strategy for research and an example of how art therapists can move from investigating the psychosocial aspects of disease to targeting physical and neurological change.

Working with communities to promote wide use of best practices to enable healthy living. Prevention services and promoting health are fundamental to addressing medical conditions. Community-based services are a key partner. Kaitlyn Streeter and Sarah Deaver’s study investigates individual art therapy for women struggling with infertility. Not only does their study provide insight into art therapy treatment-as-usual, but it demonstrates the value of addressing medical concerns in community care facilities.

Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health-care delivery models. Although none of the articles in this issue evaluates cost, based on findings that art therapy might be more cost-effective than other mental health treatment options (Uttley et al., 2015), it is reasonable to wonder whether the same might be true in medical settings. Future researchers might consider conducting a cost–benefit analysis of art therapy’s effect on medication usage and doctor’s visits.

I hope that readers are inspired by the accounts in this issue and to include medical applications of art therapy in their practice.