The state-of-the-art: building a positive future for art therapy through systematic research

In our previous editorial we considered the history of the journal and the importance of understanding and building on past work and development in order to shape the future of this journal and art therapy research, in a positive, coherent and unified way. To do this we need to make ourselves aware of the current issues facing our clients in terms of funded accessibility, and also the art therapy profession in terms of jobs and livelihoods.

The recent Workforce Survey (2018) by the British Association of Art Therapists (BAAT), has shown that at the time of the survey only 25% of responding art therapists were in full time employment, with a growing number developing their own practices and becoming self-employed; 10.17% solely self-employed; 17.10% part-time self-employed; 17.53% mixing part-time employment and self-employment (Workforce Survey BAAT, 2018). This demonstrates a level of resilience as a profession to the austerity driven funding cuts of art therapy services. Developing resilience as individuals and as a profession will enable us to create new knowledge and coping strategies that can be brought to bear on the problems we and our clients face. The survey also highlights that there were slightly more responding art therapists working with adults than children: 61.56% working with adults; and 68.00% working with children (Workforce Survey BAAT, 2018). This is in contrast to the lack of parity for child and adolescent mental health services (CAMHS) compared to spending on adult mental health services in the UK (Office of the Children’s Commissioner [OCC], 2018).

In preparation for our forthcoming special issue focusing on art therapy with children – an area for which there is a need for further research on clinical effectiveness (McDonald & Drey, 2018; Regev & Cohen-Yatziv, 2019) and further understanding of the mechanisms of change (Deboys, Holttum, & Wright, 2017) – we discuss the impact of real-term funding cuts on mental health provision for this client group and art therapy in general. It is a challenging time to be an art therapist and the impact on children and young people is particularly concerning. In the UK around three children in every class (one in eight) experience difficulties with their mental health (Government Statistical Service [GSS], 2018). The government has stated that children and young people’s mental health is a priority area and acknowledged that mental health issues often persist into adulthood, leading to individual harm and wider societal costs (DoH & DfE, 2017). However, the rate of progress is slow in some areas and there is a gap between what is provided and what children need with the Office of the Children’s Commissioner (OCC) reporting more than 338,000 children referred to CAMHS last year, yet less than a third (31%) receiving treatment within the year (OCC, 2018).

In her 2018 briefing, the Children’s Commissioner Anne Longfield stated that the current system was:

[…] failing to meet children’s needs at every level; a system failing to give children’s mental health the resources, leadership or priority desperately required […] (Longfield, 2018, p. 2)

Clearly inadequate funding for children & adolescent mental health is having a negative impact, with much publicised increases in self-harm, suicide (NCISH, 2017) and also knife crime (Allen & Audickas, 2018, p. 4) in this age group. Suicide in the UK is the leading cause of death in young people, accounting for 14% of deaths in the 10–19 years age group, with over half of these also having a history of self-harm (NCISH, 2017). Understanding the mechanisms involved through systematic research is vital, and includes developing strategies for prevention and psychological support and effective treatments for young people who self-harm (Hawton, Saunders, & O’Connor, 2012).

An 8% (real-term) reduction in school funding per pupil over the past 8 years (Roberts, 2019, p. 5) has also had an impact. In November 2018, following Budget 2018, the National Association of Head Teachers, the National Education Union, and the Association of School and College Leaders said that they were ‘dismayed by the lack of understanding shown by the chancellor … ’ and that ‘funding pressures have resulted in cuts to curriculum options, enrichment activities, individual student support, classroom resources and maintenance budgets […]’ (ibid.).

Ultimately the tragic loss of the young and most vulnerable in society, through suicide and knife crime, reminds us of the fragility of human life and strengthens our commitment as art therapists to challenge the lack of provision by the government for children and young people who self-harm, and whose self-destructive activities, we know, often originate in ‘painful encounters with hostile caretakers during the first years of life’ (Van der Kolk, 1996, p. 189).

Recognising the shortcomings of our political system, culture and our health service, is an important function of culturally and socially aware art therapists, and if we do not question or critique cultural constructs, then ultimately, we risk colluding with that culture. As therapists we should not be afraid of social action, when we see injustice or prejudice, or when funding for art therapy is cut from vital services.

Small scale systematic research studies with diverse client groups, as published in this journal, are vitally important to the development of the profession, however their impact will be greater if they are part of a much wider research strategy, one that will influence contemporary health care policy and its political agenda. An international strategy for research in the art therapy profession is long overdue, offering the kind of evidence that will demonstrate the effectiveness of its clinical practice in a format that funders will accept. This is a challenging thought when there is, of necessity, such diversity and innovation within our profession. This diversity will be highlighted at the Inaugural International Art Therapy Practice/Research Conference in London (11–13th July 2019), which will be an opportunity for art therapists from 35 countries – to present to a multi-national audience, the latest in practice innovation and research, bringing together worldviews, perspectives and ideas.

As co-editors of the International Journal of Art Therapy (IJAT) we are committed to publishing high quality systematic research and the best examples of practice, as a way to inform, inspire and find the best way to help our clients, as well as ensuring that art therapy is on the agenda of policy makers and funders. However, it is clear that further research is urgently required, focusing on the clinical and cost effectiveness of art therapy, if it is to be taken seriously by stakeholders (Uttley et al., 2015).

Producing high quality research in art therapy is a collective responsibility, and it is this, more than anything else that will determine how the field is shaped and its capacity to influence policy and practice within the wider health care community. There is a need for us all to constantly question, through systematic research, the dominant beliefs in the field of art therapy, as well as our social positions, roles, motivations, and relationships to power and privilege (Johnstone & Boyle, 2018; Potash, 2018; Talwar, 2010), so that we can remain relevant, contemporary and ethically grounded, with an integral and vital part to play in the health care community. It is by critically examining and considering our practice, as well as the historical, social and current political context, that we can re-vision art therapy theory and practice and build a stronger platform from which to help others and ensure that the voices of those people who are marginalised in our society, are listened to, enabling life-saving support to be given.

As part of our editorial strategy we have revised and updated the aims and scope of the journal to reflect its development as an ethical journal and our ongoing commitment to publishing ethical, systematic and innovative scholarly research on art therapy practice, theory and the development of the profession, from a variety of perspectives and approaches, that advance the understanding of how art therapy contributes to effective treatments. This focus on systematic research is to enable best practice development and to support art therapists and service users to respond to commissioners and funders when asked for evidence, which is essential if we are to create and maintain art therapy posts.

As the house journal of the BAAT, this is our public facing publication, and we need to continue to make it visible in the research community, by increasing our accessibility, through online search engines and databases. We are also aware that many service users, art therapists and commissioners find reading articles that use academic and technical language challenging, so we have now included plain language summaries for all articles. A plain language summary describes a paper’s findings in simple everyday language that is understandable to a non-research audience, and is published alongside the abstract. This will make IJAT more accessible and the plain language summary is also easier to translate into other languages.

We are also committed to developing our readership, ensuring that IJAT remains relevant, both to art therapists and to other professionals. We aim to do this through maximising the technological advances now available, including the social media platforms. In this time of accelerated technological advances it is important to keep up with what is new and exciting, and how this can be used to improve, not only our art therapy practice, but also access to this journal. However, we must never lose sight of the things that cannot be automated by machines, things that make us uniquely human – things like empathy, creativity, imagination and presence. These are the qualities that all good art therapists have in abundance. And these are also the qualities that make art therapists great researchers.

As our profession develops it is also important to challenge ourselves to keep art as a central focus of theory building, using art media as the primary mode of expression and communication is after-all what makes the art therapy profession unique (BAAT, 2016), and, where possible, to challenge ourselves to include the voices and perspectives of those we seek to help, our clients/patients/collaborators, in research and theory building. With this in mind, we have recently sent out a call for a future special issue on Co-Production in Art Therapy Practice, Research and Publication, guest co-edited by Neil Springham (Consultant Art Therapist) and Ioanna Xenophontes (Lived Experience Practitioner). Please see the call here: https://think.taylorandfrancis.com/art-therapy-si-co-production-in-practice/ – we look forward to reading submissions for this important and pertinent special issue!

Notes on contributors

Susan M. D. Carr, BA (Hons.), MA ATH, PhD, is currently Co-Editor in Chief for The International Journal of Art Therapy and an art therapist in private practice, with 12 years experience working in palliative care. Susan is also a writer and practicing artist, with her first book entitled Portrait Therapy published in September 2017 by Jessica Kingsley. Susan is also a member of the council for the British Association of Art Therapists.

Alex McDonald, SRA’sT (Art), MRes (Clinical Research), has worked as an art therapist with children, young people and families since 2005. She is currently an Officer at the British Association of Art Therapists, coordinates the Art Therapy Practice Research Network, and is Co-Editor in Chief of the International Journal of Art Therapy: Inscape.