A kaleidoscope of ways of using art therapy within child-based contexts

Forward to International Journal of Art Therapy special issue; Art therapy with Children

This special edition of the International Journal of Art Therapy is timely and important. In the current context, where mental health, social/relational, and emotional difficulties are prevalent, wide spread, and pervasive; it feels integral to highlight useful and effective ways of working with children, and their surrounding adults. This collection of papers places a spotlight on the usefulness and effectiveness of art therapy by qualified art therapists with children in a range of contexts, including within schools, those impacted by their refugee experience, those in medical settings, and those within ‘at risk’ parent–child dyads. It also opens an arena for considering what the existing evidence base currently is around the effectiveness of art therapy within different child-based populations (group and individual); whilst creating a platform for future research and discoveries in this area. This edition also presents an array of varied papers, each with a focus on contributing using mixed methods and specifically quantitative approaches to further add evidence to the usefulness, effectiveness, and applicability of art therapy with children. This is even more crucial, given that in the current literature base, often adults are foregrounded and more represented than children; therefore, this edition is widening the lens, and moving children to the centre.

The first featured article titled, ‘The effectiveness and contribution of art therapy work with children in 2018 -what progress has been made so far? A systematic review’ by Cohen-Yatziv and Regev (2019) is a systematic literature review of the effectiveness of art therapy with children in a range of different contexts.

After a wider scope review of the existing literature, the authors found 13 studies which met their inclusion criteria and, in the article, they summarise their findings from these studies; which are from a range of child-based contexts (e.g. Children who have been impacted by traumatic events, children who have a diagnosis of a specific medical condition, in this case asthma; children who have been described as ‘juvenile offenders’, children in the general population, and children with special educational needs and learning disabilities). This review aimed to detail the existing quantitative studies which have researched the effectiveness of art therapy with child populations which the authors deemed had used adequately robust methodologies.

The authors discuss some of the complexities and limitations of existing studies including: small sample sizes, lack of a control group, lack of randomisation, measures being used which were not standardised, normed, or validated; a lack of existing quantitative studies, some studies having limited information detailed such as the length of the intervention, the gender of the participants, the diagnosis/presenting difficulties, and the qualifications of the person/people undergoing the intervention. The authors advocate that there are some positive findings and indications of the effectiveness of art therapy with children in a range of contexts which is promising; and which echo lots of the existing positive findings within the qualitative literature base around the use of art therapy with children. However, also advocate that more planned, robust, and systematic research on a larger scale, ideally with control groups and randomisation, are needed in this area.

In the second featured article, ‘A dyadic art psychotherapy group for parents and infants – piloting quantitative methodologies for evaluation’ written by Victoria Gray Armstrong, Egle Dalinkeviciute, and Josephine Ross (2019), the authors describe a pilot of an art psychotherapy 12-week group (1.5-hour duration each week) using a dyadic approach for 10 mothers and their infants described as ‘at risk’ using a broad inclusion criteria ranging from parenting capacity difficulties through to postnatal depression through to bereavement, with the aim of improving the parent–child relationship.

This intervention was a collaboration between a qualified art psychotherapist and a Developmental Psychologist; and drew on principles from both disciplines, as well as having a focus on theories, such as, mentalisation and attachment. This pilot was measured using a range of standardised measures which focused on parental wellbeing and object relations theory; as well as an observational tool which the authors developed themselves. This observational tool was used when analysing video footage of the group intervention (at the beginning and end of the sessions). The video clips were analysed using computer software both by the author, and to reduce researcher bias, also by an independent coder.

Although the sample was small, and therefore the findings need to be interpreted with caution. This pilot promisingly found an overall improvement in maternal mental health and well-being. Findings and observations also including reports that mothers seemed to increase in their confidence, make friendships with others in the group, and seemed more comfortable in their parenting role. Findings also reflected comments from the mothers about how they were finding it more fun to be a mum, and how they had more people to talk to than they used to. They also described new activities and games that they were engaging in and that they had been playing with their babies at home. Moreover, the results from the standardised measures showed some positive improvement in how the mothers felt about their relationship to their infant; however, these findings were not statistically significant. The authors offer a range of explanations as to why this may have been the case; as well as some detailed observations about individual parent–child dyads. The self-designed observational tool also showed a positive result with an overall increase in the time spent engaging in positive attachment behaviours from the beginning to the end of the intervention which promisingly reached statistical significance. Building on this, around half of the sample also showed decreases in negative and flat/absent attachment behaviours. The authors then go on to offer recommendations for future research.

The third paper of this special edition is titled ‘Primary-school-based art therapy: Exploratory study of changes in children’s social, emotional and mental health’ by Alex McDonald, Sue Holttum, and Dr Nicholas St Drey (2019). This paper begins with a helpful summary of considering areas including mental health and art therapy in schools, before going on to introduce the current study. This current real-world study explored the benefits and impact of an art therapy intervention within a London-based primary school; from the teachers (10 teachers), children themselves (45 children), and therapist’s perspective. This intervention was funded by the Pupil Premium Fund; where the majority of the interventions were carried out by the lead Art Therapist. The intervention length, like in the real world, varied in length from a range of 8–158 weeks. The main described presenting difficulty for the reason for referral was listed under the broad category of ‘disruptive behaviour’. There was also a large age range of the children who took part in the study ranging from age 4–11; positively this included a mix of boys and girls. This study also aimed to further understand qualitatively what specific elements or ingredients the teachers and children found useful about art therapy and what changes might have been observed in their social, emotional, and mental health. This study used an exploratory mixed methods design (E.g. Including focus groups with teachers, interviews and visual research approaches with the children; including the children visually representing their experiences and take-home messages; photographed art work and art journals, and teachers completing standardised questionnaires).

Promisingly, the findings showed significant and medium effect sizes for positive teacher-rated changes in children’s overall stress, conduct, hyperactivity, and prosocial behaviour; as well as a large effect on an indicator of the impact of children’s difficulties on their lives. Although emotional distress and peer problems showed small changes, they did not reach statistical significance. These positive changes were also reflected through both the teachers’ and the children’s qualitative reports and through powerful art work ‘answers’. These responses were analysed using thematic analysis and some useful recommendation and key messages and themes are captured within this paper, as well as photographed examples of some of the children’s art work. Recommendations and limitations are then described.

The fourth and final paper featured in this special edition is titled ‘Art therapy with refugee children: a qualitative study explored through the lens of art therapists and their experiences’ by Zahra Akthar and Andrew Lovell (2018). This paper focuses on the use of art therapy with children whom are also refugees; from the perspective of the art therapists. First the paper sets the scene, and describes the context of work, including some background information and key definitions. This study used semi-structured interviews with three art therapists working specifically with refugee and asylum-seeking children to explore some of their experiences and stories which emerged from working with this population of children.

The authors acknowledge that this is a preliminary study, and that their intention is to carry out a follow-on study which draws on the experiences and stories of art therapy with the children themselves. Thematic analysis was used to identify emerging themes, and the authors discuss five key themes with accompanying quotes and explanation. These include (1) giving voice; (2) rebuilding trust, opening wounds; (3) sharing stories, healing pain; (4) exploring identity, discovering new-self; and (5) understanding art therapy.

Further recommendations, lessons learned, and practice recommendations are then discussed; this included highlighting some key areas such as the centrality of safety; and also, around the area of supporting children to have agency and to have a voice to express and share their stories and feelings. The authors concluded that they feel art therapy can be a useful and important intervention and opportunity for young people within a refugee context.

Concluding thoughts

It has been a joy and privilege to be part of this important edition of the International Journal of Art Therapy. As a Clinical Psychologist who uses the arts and creative and expressive approaches professionally and personally, but is not a qualified art therapist, I have always been a supporter and advocate of Art Therapy and Art Therapists. I have thoroughly enjoyed reading about the variety of contexts art therapy is being used currently with children; and about some of the creative and innovative ways in which these interventions have been measured and researched; whilst they have also been respectful and acknowledging of real-world applications.

All of the authors discussed the dearth of current studies, and therefore the need for increasing the amount of robust, quantitative, mixed method, high-quality, and larger sample studies around the use of art therapy with children; and so I hope that this edition will act as an inspirer and springboard for future research, write-ups, and sharing of ideas. Including those from specific contexts to identify and share the key ingredients, the effectiveness, and the recommendations to optimise the intervention- there are endless options however some of the ones which this journal identified were around the parent–child dyadic work (I hope to see this including fathers and their children, and other caregiving situations such as foster carers and adopters and their children in future); art therapy with specific population such as in medical settings with specific medical conditions, schools, war torn environments, those with special educational needs, those with emotional and behavioural needs, those who have experienced trauma, and so forth.

Additionally, I also was struck by some of the creative approaches used throughout these papers, such as the children’s perspective being gained through them visually recording their hopes and thoughts through artistic quotes in McDonald et al. (2019) paper; and by the mixed method design used in Armstrong et al. (2019) paper. This really captures the importance of thinking creatively about different ways of optimising the way data is collected and shared, and around the power of gaining multiple perspectives and voices; such as from the children themselves, parents, teachers, therapists, and so forth.

I also was struck by the collaboration between art therapy and developmental psychology in the Armstrong et al. (2019) paper, and I think this reflects some of the benefits and usefulness of multi-disciplinary working, sharing, and learning; and so I hope this encourages and inspires further such collaborations and sharing of best and innovative practice.

Positive vibes and inspiring reading

Karen Treisman

Clinical Psychologist, Trainer, Author, and Director of Safe Hands and Thinking Minds

Correction Statement

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