Shifting sensitivities in art therapy research and practice

The image on the front cover of this issue of the International Journal of Art Therapy, ‘A Reflection on Identity’ by Trina Hobson, frames and resonates with the major themes to emerge from the papers within. Reference to reflections, mirrors, and a sensitivity to the relationship between self and others appear throughout this issue, with particular attention to how those qualities shift in a changing world. As the effects of two years of pandemic responses move on, to be replaced by other pressing global events, this issue of the IJAT is a reminder of how art therapy can adapt and adjust itself to meet how the contexts it operates within shift and change. The papers in this issue reflect something of the range of locations and contexts within which art therapists work. They reveal the willingness of art therapists to adapt and embrace new ways of working. They reflect the international aspects of art therapy. Through the research and reflection presented, we observe a willingness to be creative about how art therapy can be thought about and practiced. There are important insights here for practitioners, researchers, and educators.

‘Therapist and client experiences of art therapy in relation to psychosis: a thematic analysis,' by Helen Barrett, Sue Holttum and Tim Wright, present an approach to doing research and writing about art therapy that centres the voice of clients. This will be an approach familiar to readers of the 2021 special issue of IJAT (Vol 26, Issue 1–2) that focused on the lived experience of clients and the co-production of knowledge within art therapy. Barrett, Holttum and Wright continue the themes introduced in that special issue by framing co-production as a form of triangulation, whereby the perspectives of clients and therapists on the process of art therapy are used to identify overlapping themes. As the authors note, triangulation is an important validating process within qualitative research. It is on a par with the p-value of probability within quantitative research. The researchshows a strong correlation between clients and therapists in how they view the process of art therapy and what they value about that process. What emerges as a key finding is that art making is an important method of communicating embodied and non-verbal thoughts and feelings, which in turn initiates changed perceptions of self and other. As such, this paper offers a useful counterpoint to the doubts about art therapy’s use in relation to psychosis that were raised by the MATISSE trial (Holttum & Huet, 2014).

The four-sided reflecting mirror: art therapists’ self-portraits as testimony to coping with challenges of online art therapy, by Liat Sharmi-Zeevi and Aya Katz, also extends the topic of a previous IJAT special issue (Vol 25, issue 4) that was focused upon on-line art therapy. This is a theme that has become relevant to most art therapists since March 2020. Love it, loath it, or ambivalent about it, on-line art therapy is here to stay in one form or another. Any new insight that assists art therapists to think about and navigate this new paradigm is to be welcomed. Using a qualitative methodology, Sharmi-Zeevi and Katz explore, through self-portraits produced by art therapists as they respond to their appearance on-screen, and then through interviews, what the experience of conducting art therapy on-line feels like. From the images and responses, the authors propose that on-line art therapy disrupts the triangular relationship between client, therapist, and image; making the witnessing of the client by the art therapist (especially when art making) partial and hidden, at the same time as creating a mirror within which the client and art therapist can see their own reflection. This altered quality of the therapeutic relationship adds to other findings which show that the lack of physical proximity is problematic for therapists (Weinberg, 2020). The authors do though identify that providing a process for reflecting on how the art therapist appears and is located within the on-line therapeutic space, such as that developed here, can help to alleviate some of the challenges and anxieties online working provokes.

The altered structure of the therapeutic relationship that online art therapy brings about, is also explored in the opinion piece ‘Reimagining art therapy for the digitally-mediated world: a hexagonal relationship’ by Sarah Haywood and Bridget Grant. In addition to conscious and unconscious material appearing in – and being contained by – the image, transference, and countertransference within art therapy, the move to an online offering adds what the authors identify as ‘the virtual’ into the triangular relationship. This addition creates a hexagonal relationship, within which the image is located somewhere between the client, the therapist, and their respective virtual spaces. The common-to-art-therapy metaphor of alchemy is used to think about both the virtual and the digital as a containing vessel, and in this way demonstrates how the well-understood features of art therapy can be renewed and adapted to meet the demands of new and unique circumstances. Thinking around the implications for art therapy theory and practice of on-line working is in its early stages; the two papers that address that topic in this issue add substantially to that thinking.

Moving on from how art therapy addresses changes to ways of working opened up by COVID-19 are two papers that illustrate the international reach of art therapy. The first, a research article by Soo-Yoon Kim et al., ‘Art therapy for immigrant Korean youth: indications of outcomes, acceptability and satisfaction’, uses a quasi-experimental methodology to examine the effects of a short-term art therapy intervention. Their results show a positive correlation between participation in art therapy and lowered levels of depression and levels of anxiety reported by participants. Three-month follow-up measures appear to indicate that while the therapeutic nature of art therapy has a positive impact on depression and anxiety, this decreases over time. The authors draw upon the reports of art therapy conducted with migrants published in Canadian (Lemzoudi, 2007) and US (Linesch et al., 2012) art therapy journals. In all three cases attention is drawn to the process of acculturation that migrants must navigate as they balance forming new relationships and connections at the same time as maintaining a link with their countries of origin. Soo-Yoon et al. note that all the participants of their study were legal residents, and so were not at risk of deportation in the same way that those migrants and refugees awaiting right to remain decision might be. There were language differences to manage, and this seems to be something that art therapy can be especially helpful with, in terms of helping to express thoughts and feelings that might otherwise remain unspoken. The authors note that the study is limited in scale but quite rightly identify the need for similar research to be conducted in the future, and for different cultural characteristics to be carefully considered when thinking about the therapeutic features of art therapy when addressing issues of migration and acculturation. With the increase in the number of displaced persons globally this, and other research published recently in this journal (Akthar & Lovell, 2019), will raise the ability of art therapists to work confidently within such contexts.

Continuing the international perspective, is a research paper that addresses the psychological distress felt by women living in Hong Kong who have experienced cancer. ‘Brief, structured, group art therapy for women with breast and/or gynaecological cancer by Nga Chee Tristan Chan and Debbie Michaels.’ In this qualitative pilot study a thematic approach to art therapy was developed in collaboration with the participants’ wishes. Initial findings point to the positive value of art therapy in this setting, with the authors usefully identifying the need for the use of specific outcome measures sensitive to art therapy, rather than more generic measures used in this pilot study. Like the previous paper, the authors pay attention to specific cultural sensitivities that arise in their practice. The authors observe that Honk Kong’s status as a former British colony entails navigating, within the context of cancer care, the blend of Eastern and Western perspectives related to mental health, family pride and sexuality. Of special relevance, given the ongoing task of decolonising the teaching and practice of art therapy in the UK, is the observation that the lead author trained in the UK and is now practicing in a country in which all art therapists have been trained overseas. This is not an uncommon experience, and if art therapists trained in the UK are to work sensitively and productively in other countries, training needs to become more mindful of the plurality of perspectives that pertain to issues of identity, psychology and society across the globe. A future special issue of IJAT on intersectionality, due to be published in 2023, will address such concerns in greater detail.