Exploring intimate partner violence survivors’ experiences with group art therapy

ABSTRACT

Background

Intimate partner violence (IPV) is one of the major health and human rights issues of our time, affecting one in three women worldwide. Despite IPV’s prevalence, limited research investigates the healing process for survivors or the efficacy of group art therapy (GAT). This study is grounded by a person-centred approach to art therapy and an interpretive method, highlighting the contextualised nature of reality and experience of social phenomena.

Aims

The aims of this community-based, qualitative study were to explore women IPV survivors’ experiences of GAT and better understand what aspects of GAT contribute to healing.

Methods

During 2018–2019, six women were interviewed about their experiences of participating in a 12-week GAT program within a Canadian domestic violence prevention agency. The transcribed interviews were analyzed with the method of thematic analysis.

Results

Four themes emerged from the analysis, and an overarching theme/pattern was identified through interpretation of these themes. The overarching theme was transformative healing, which women appeared to experience by creating connections in a safe space, using visual metaphors in their art-pieces, reclaiming an empowered self, and building resilience.

Conclusion

This study found that GAT was experienced as providing a relational component to healing and as fostering self-expression, inner and interpersonal growth, and confidence.

Implications

Art therapists and other mental health practitioners who support survivors may want to consider the unique contributions of art making when designing interventions. Future research should examine which arts-based interventions delivered in a group therapy context can promote IPV survivors’ mental health and wellness.

Plain-language summary

This article shares information from a qualitative study about group art therapy (GAT) for women survivors of intimate partner violence (IPV). IPV affects one in three women worldwide, including 6–8% of married/cohabiting women in Canada. Despite IPV’s prevalence, limited research investigates the healing process for survivors or the benefits of GAT services and approaches. This study was conducted in partnership with a non-profit organisation serving women survivors in a small Southwestern Ontario municipality.

The aims of this study were to explore women IPV survivors’ experiences of GAT within a domestic violence prevention agency, and better understand what aspects of the GAT process, if any, contribute to healing. The study involved interviews and an arts-based research component with six participants who completed the organisation’s 12-week GAT program. Researchers utilised thematic analysis, a method of uncovering key themes across the interviews, to learn how participants experienced the GAT program. Through the process of thematic analysis, the study found that participants appeared to experience transformative healing by creating connections with the therapists, peers, and art media in a safe space; using visual metaphors in their art-pieces to symbolise their emotions and future possibilities; reclaiming an empowered self, which was creative, playful, and hopeful; and building strength and resilience through the group process.

This study found that art therapy in a group context was experienced as providing a relational component to healing and as fostering self-expression, inner and interpersonal growth, and increased confidence. Art therapists and other mental health practitioners who support survivors may, therefore, want to consider the unique contributions of art and art making when designing interventions. Future research should examine which specific arts-based interventions delivered in a formal group therapy context can promote mental health and wellness in individuals who have experienced IPV.

KEYWORDS:

• Group art therapy
• group work
• intimate partner violence
• women
• community
• qualitative research
• thematic analysis
• arts-based research

Introduction

This article shares information from a community-based study about group art therapy (GAT) for women survivors of intimate partner violence (IPV). IPV is a form of violence against women, men, non-binary, and transgender persons. IPV includes physical, sexual, emotional, and psychological abuses and controlling behaviours by a current or former intimate partner (Tjaden & Thoennes, 2000). It is one of the major health and human rights issues of our time (Crann & Barata, 2016; Tutty et al., 2016), affecting one in three women worldwide (World Health Organization & Human Reproduction Programme, 2019). Over the past 20 years, physical, sexual, emotional, and financial abuses have impacted between 6 and 8% of Canadian women in married/common-law relationships (Statistics Canada, 2011). The most severe form of violence results in an average of one woman killed by her male partner every week (Canadian Femicide Observatory for Justice & Accountability, 2019). While the national prevalence rate of 6-8% is low compared to global rates of IPV, ranging from 20 to 70% of women reporting some form of harm from their current intimate partner (Krug et al., 2002), the short-term and long-term outcomes of violence are similar for women everywhere. Physical health consequences include chronic pain, pelvic pain, gastrointestinal problems, fibroids, migraines, and severe injuries related to strangulation, blunt force trauma, weapon use, and sexual assault (Coker et al., 2000; Sheridan & Nash, 2007). Psychological and emotional health consequences include anxiety, depression, fear, post-traumatic stress disorder, and decreased self-esteem and life satisfaction (Stith et al., 2004; Zlotnick et al., 2006).

Therapists who work with women survivors of IPV and other forms of domestic violence establish supportive spaces and administer creative strategies that enable individuals to heal from their abusive experiences, focus on their present and future lives, and learn new skills (Binkley, 2013). Women IPV survivors have reported a preference for interacting with therapists who are caring, active listeners, knowledgeable, non-judgemental, and open to sharing feelings (Battaglia et al., 2003). Often, therapists put into practice these supportive characteristics through various talk-based therapeutic approaches. Studies have reported positive impacts of talk-based group therapy processes for survivors, including re-establishing safety and personal space (Allen & Wozniak, 2010), building trust and support networks (Larance & Porter, 2004), restoring hope (Santos et al., 2017), increasing self-esteem (Tutty et al., 2016), and gaining control over their participation in group sessions (Preston, 2002). In Allen and Wozniak’s (2010) study, women survivors of domestic violence constructed the following themes that were representative of healing: creative safe places, establishing autonomy, taking pride in appearance, reclamation of self, developing inner peace, and rejoining the community.

Research, however, suggests that talk-based therapy may not always be suitable for women IPV survivors who have difficulty verbalising their feelings because of past abusive and traumatic experiences (Binkley, 2013). Specifically, trauma affects the way experiences are cognitively and emotionally processed and organised (Buschel & Madsen, 2006), and has been described as ‘speechless terror’ (van der Kolk, 1996, p. 23), whereby feelings are stored in ways that language cannot access them.

Art therapy is one therapeutic approach that appears to enable IPV survivors to undergo growth, self-discovery, and symbolic healing both verbally and through creative processes (Binkley, 2013; Malchiodi, 2012). Through these processes, women survivors of domestic violence externalise current positive and negative feelings, regulate emotions and behaviours, enhance self-esteem, reduce anxiety, and gain awareness of other healthy self-aspects beyond their survivor self-aspects (Buschel & Madsen, 2006; Cardinal, 2014; Ikonomopoulos et al., 2017; Rankin & Taucher, 2003; Thomson, 2012). Art therapy can also assist with the recognition of feelings among women art therapy participants living in domestic violence shelters (Malchiodi & Miller, 2003).

Art therapists working with women survivors of IPV and other domestic violence in non-profit community support agencies and shelters tend to facilitate therapeutic groups rather than individual sessions. For example, Bird’s (2018) arts-based participatory study concluded that through visual image creation within group settings, women survivors of domestic violence can be empowered to represent their thoughts, feelings, and responses about their experiences of abuse. Although this and other studies have found group art therapy (GAT) to be a beneficial treatment approach for IPV survivors, there is a knowledge gap regarding suitable GAT frameworks for supporting the physical, psychological, social, and spiritual well-being of survivors, and the therapeutic process of healing for this population.

Aims of present study

The aims of this community-based, qualitative study were to explore women IPV survivors’ experiences of GAT and better understand what aspects of the group process, if any, contribute to healing. This study is one of the first in Canada to have invited women IPV survivors during an interview to verbally share their experiences of GAT. The research question for this study was: How do women IPV survivors experience art therapy within a group context?

Methods

Participants

Using convenience sampling, six (N = 6) women IPV survivors, who completed at least one 12-week GAT program at a domestic violence prevention centre between 2015 and 2019, volunteered to participate in the study. The research team recruited participants from three GAT programs (fall 2018, winter 2019, and spring 2019). Three women completed the fall 2018 group, five completed the winter 2018 group, and four completed the spring 2019 group. Out of these 12 women, five (42%) volunteered to participate in the study. Women, who had completed GAT prior to 2018, were also recruited via informational posters displayed in the agency’s waiting room and on their website and social media feeds. This strategy resulted in recruitment of a sixth study participant who had completed a GAT program in 2015. Participants’ self-identified as women between the ages of 34 and 65, reported having between one and four children, and defined their current relationship status as single, divorced, separated, or married.

Placement of study

This study was conducted with Nova Vita Domestic Violence Prevention Services (Nova Vita), a non-profit organisation founded in 1983 and located in Brantford, Ontario, Canada. Nova Vita provides residential services, crisis intervention, safety planning, transitional support, court support, system navigation, and counselling services for women and children who experience homelessness and abuse. Since 2012, Nova Vita has offered a structured GAT program for women healing from IPV. The program is offered one to three times per year and is co-facilitated by the same art therapist and a community counsellor. The groups are theme-based and are grounded in a client centred approach (Rogers, 1993) and in philosophical concepts from anthroposophy (Bar-Sela et al., 2007; Hamre et al., 2007). Each group runs for 12 weeks and involves three art media: watercolour, charcoal, and clay (see supplementary materials 1 – TIDieR checklist for GAT interventions). The primary objectives of the program are to help group members develop self-awareness, identify their strengths, support fellow group members, as well as focus on their present emotions, capacities, and needs, rather than on past experiences of abuse.

Research design

The qualitative study utilised a community-based research (CBR) design, which values collaboration with non-academic stakeholders, power sharing, interdisciplinary knowledge, and community change processes (Goodman et al., 2017; Leavy, 2017). The CBR design enabled the academic researchers to work closely with Nova Vita to design the study, recruit participants, discuss project updates, and plan knowledge mobilisation strategies. The research team was comprised of Registered Social Workers (first, third, and fourth authors) and a Registered Art Therapist (second author). These researchers were not involved in the GAT interventions.

As a theoretical framework, the study was grounded by a person-centred approach to art therapy (Rogers, 1993) and by an interpretive method, which highlights the contextualised nature of reality and the experience of social phenomena (Leavy, 2017). As Green and Thorogood (2018) explained, ‘The aim of interpretive research is an understanding of the world from the point of view of participants in it, rather than an explanation of the world’ (p. 13). This theoretical framework was well suited for exploring how women IPV survivors understood and interpreted their GAT experiences, since it privileged their subjective experiences over the academic expertise of the researchers and the professional knowledge of Nova Vita staff.

Instrument

A semi-structured interview guide (see supplementary materials 2 for interview questions) was designed by the research team for this study. The interview questions provided an opportunity for participants to verbally identify their GAT experiences at Nova Vita and future service needs. The interview guide also included an arts-based component: participants were invited to create a drawing depicting their GAT experiences towards the end of the interview.

Procedures

Following project approval by Wilfrid Laurier University’s research ethics board, study recruitment flyers were posted on the agency’s information boards and social media accounts. In-person recruitment was also conducted during the fall 2018, winter 2019, and spring 2019 groups. The research assistant (fourth author) contacted interested participants by phone to discuss the study and schedule interview dates and times that worked best for participants’ schedules. Participants selected whether they preferred to be interviewed in a private room at Nova Vita or at the university. Each participant attended a single, 90-minute, face-to-face, individual interview facilitated by the research assistant who was trained in conducting interviews. As an incentive, participants received a $20 gift card and childcare for interview attendance.

The interviews were audio-recorded with participants’ informed consent. Each participant completed a form asking their age, gender, relationship status, number of children, and year they participated in the GAT program. Participants were then asked a series of questions from the interview guide about their GAT experiences. Responses were often probed through follow-up prompting questions to gain greater detail. Near the end of the interviews, participants were invited to draw a picture depicting their GAT experience. The instruction was: ‘Using shapes, figures, and/or colours, draw a picture symbolically depicting your experience of the group art therapy’. Once the drawings were completed, participants were asked to verbally share the stories captured by the drawing. After each interview, the research assistant wrote memos capturing key themes reflections, and impressions.

The demographic information forms, signed consent forms, audio interview recordings, post-interview memos, and drawings comprised the research data. The de-identified audio interview recordings were professionally transcribed and then reviewed by the first and fourth authors to ensure accuracy and remove all identifying information. Participants had the option of keeping their original drawings, giving their drawings to the research team, or having them returned later. With participant consent, all drawings were photographed for the purpose of data analysis and knowledge translation. All data collection occurred between September 2018 and December 2019.

Data analysis

The in-depth interview data was used to explore and understand how participants experienced GAT. A thematic analysis (Braun & Clarke, 2006) was used to analyze the interview data and the narratives associated with each drawing. Thematic analysis permits researchers to identify patterns and themes related to the research question and provide thick description, which is a richly detailed account of the social phenomena being investigated (Braun & Clarke, 2006). Thematic analysis aligns with a variety of theoretical frameworks (Braun & Clarke, 2006); for the purpose of this study, thematic analysis was applied within an interpretive and person-centred paradigm. An inductive and semantic form of thematic analysis (Braun & Clarke, 2006) was applied to identify and describe themes within and across participants’ narratives. There was also a latent (interpretive) and theoretical component of data analysis; during the final stage of coding, an overarching theme was created through an interpretive process of analysis.

To begin the analysis, the first and fourth authors became familiar with the data through multiple readings of the transcripts and listening to the digital recordings of the interviews. The transcripts were then uploaded into NVivo (version 11), a computer software program for qualitative data analysis developed by the company QSR International. This software was selected because the researchers’ university has a program licence and was used to facilitate initial coding of the interview data and to create the first theme-based codebook (a system for organising, representing, and defining the relationships across themes and subthemes). To establish interrater reliability, both the first and fourth authors open-coded the first few transcripts independently, and then met to discuss impressions of these codes, review the data extracts supporting each code, and develop the initial codebook. The fourth author continued the coding of all transcripts, generating further codes and expanding the codebook. After the transcripts were coded, the first and fourth authors identified and analyzed the themes and patterns across the initial codes and defined these themes.

The next step involved the second and third authors reviewing and refining the initial themes by independently analyzing the interview data. The second author analyzed the data through an art therapy lens (e.g. by exploring themes related to participants’ experiences of specific art media) and a group psychotherapy lens (e.g. by exploring themes about group dynamics) while the third author analyzed the data from an IPV lens (e.g. by exploring themes related to IPV within the group context). Subsequently, all research team members met together three times to discuss the developing distinct themes (i.e. non-overlapping and presented across all six participants) and saturated themes (i.e. themes that were repeated across participants). During the final meeting, the established themes were given a name and an overarching theme was interpreted based on the process of data analysis combined with relevant literature on art therapy and IPV. The involvement of all researchers in the process helped enhance the reliability of the identified themes. The researchers shared the themes with Nova Vita to ensure ongoing communication with the community partner.

Results

All six participants completed their interview within the 90-minute timeframe; five participants chose to complete a drawing at the end of their interview. Four descriptive themes emerged from the thematic analysis relative to how participants made meaning of their GAT experiences: creating connections, using visual metaphors, reclaiming the empowered self, and building resilience (see supplementary materials 3 for an overview of themes with key quotes). For readability, non-content words and hesitations (e.g. ‘um’, ‘like’) were removed, and lengthy quotations shortened. To ensure anonymity, the researchers replaced participant names with numbers (e.g. P1) and removed identifying information from quotations.

Theme 1: creating connections in a safe space

This theme includes sub-themes to highlight how study participants created connections to the art therapy space, therapists, fellow group members, and art media; participants also requested opportunities to participate in further GAT programming to foster ongoing connections within the self and with each other.

Connection to the space

All six participants shared their experiences of creating connections to the space. GAT at Nova Vita occurred in a small and quiet room, which participants found to be safe, comfortable, and peaceful. P5 explained,

that was such a plus to be in an atmosphere that’s totally different from your atmosphere at home … being in a sort of an emotionally turmoil atmosphere at home and then to be in a place where you feel this sense of peace.

By contrasting the ‘atmosphere’ of her home to the art room, P5 illuminates the qualities needed in a therapeutic environment for emotions to be expressed and one to feel sheltered.

Connection to the therapists

The experience of connecting to a peaceful and safe space not only pertained to the physical environment, but also to the containing structure of the GAT sessions and the therapists’ facilitation. All six participants shared their experiences of connecting with the authentic, non-judgemental, and participatory therapists who guided them on their healing journeys. P3 stated:

There’s a gentleness about how they approach it [GAT facilitation] … no right or wrong, it was just what it was and however you wanted to express … I think them doing it with us was different than having somebody walking around and saying, ‘Oh, you know, oh', so they were a part of us, they weren’t above or below us … maybe a good word is ‘guidance’.

P3’s statements highlight how the therapists’ group facilitation strategies, including taking on the role of guides and creating art alongside group members, fostered connection through a collaborative approach. By means of these strategies, the therapists were modelling the sharing of power, control, and vulnerability within the group.

Connection to fellow group members

In addition to connection with the therapists, all participants described how connecting with their fellow group members enabled them to gain a sense of commonality. As P6 explained:

We’re all different, but we’re the same, and seeing that likeness and that sameness, we probably went in there thinking that I’m going to be with these people, they don’t know me, they don’t know what I’ve gone through … - yes, they do. Just different words, different stories, but the connection is there … when they share their story and I’m like ‘Me, too!’

All participants described the experience of social support within the groups. As P4 explained, ‘we provided a lot of support to each other within group, too. So, there was a lot of breaking down and crying, and upset and frustration, but it was very helpful’. P4’s quotation highlights the power of sharing feelings when group members experience trust, belonging, and safety.

Connection to the art media

Participants not only connected with each other, but also connected with a variety of sensory-stimulating art media to express their positive and negative emotions through creative means. P5 addressed the power of art making to facilitate self-expression:

With art therapy, it was hands-on where you can physically get some release from the emotions that you’re feeling inside. I mean, in the other [talk-based] groups, emotions come out with the listening and the talking, and then the crying or the laughing comes out, right? … But with art therapy, you have an actual physical something, like the clay, to actually hang onto and to squish and tear apart and to roll, and you’re physically feeling those negative emotions to come out to the clay. Like, you’re kind of releasing them into the clay. I really love the clay part of it, that was my highlight.

This quote highlighted how the use of clay was an action-oriented, kinesthetic, and embodied experience, which differed from the processing of emotions in talk-based groups.

Three participants also expressed how art served as an entry point for accessing memories about their childhoods, families, and experiences of abuse, allowing for new understandings of past experiences. P1, for instance, described:

 … the very first sculpture we did on our own, which would have been the second week, ended up being that … little person inside the heart thing … I've seen this little girl running around inside of me for a while, but I haven’t fully understood who she is. It’s been more recent that I know that she is me … And I realized that it was about maybe not so much giving me voice as she needs to be heard. And so that’s kind of where I’m at right now. But the art therapy part was in, in exploring her and what had happened, and bringing truth to it.

Opportunities for further connection

By developing connections to the art therapy space, therapists, group members, and art media, participants experienced meaningful connections and insights within themselves. These experiences were so profound that five participants shared their desire to have more than 12 sessions within the existing GAT program, as well as opportunities to participate in future GAT programs. For example, P6 stated: ‘  …  I didn’t want it to be over, because I felt there was so much more greatness to come out of us, that we, as women there, didn’t realise we had’. P6 is speaking to the importance of having further sessions for group members to fully uncover and realise their strengths and capacity for ‘greatness’ together. In comparison, P2 wanted to maintain connections with her peers, joking about continuing the group on an informal basis: ‘I wanted it to go longer and I want to know whose house we’re going to [chuckle]’.

In addition to attending more sessions within the same group, P1 wanted the opportunity to attend further programs:

I would love to take it again because … it's a living thing that’s happening inside of you and so that process is ongoing even after the 12 weeks … it would be nice to have that group setting again to continue that process from where I’m at now.

This quote highlights the value of providing further GAT programming so that participants can return to the process at different moments in time and stages of their life journeys.

Theme 2: using visual metaphors in their art-pieces

Participants emphasised how they used visual metaphors in their art-pieces and how each metaphor indirectly embodied and projected outward a personal viewpoint. Participants used metaphors to signify the: healing process (P1), power of future dreams and desires (P2 and P3), expression of negative emotions (P4), belief in faith (P5), and experience of abuse (P6). P1, for example, explained how the hearts in her drawing represented the healing process: ‘To me, it was like what healing and wholeness looks like, and it was like all those little hearts joined together to make one big heart’.

Whereas P1 used hearts to reflect on her ongoing healing process, P2 used an art creation to project a future aspiration. Specifically, a horse sculpture she made from clay indirectly represented her dream of one day living in the countryside:

I did a horse with the clay, which I thought after I started, what have I got myself into, because they were talking about what you want, like … so when retiring, my husband and I dream if we could just find a little place in the country … and have a couple of horses … that was kind of my dream. So, I did a horse with the clay.

While P2’s work symbolised a future dream, P4 used art creation to externalise negative emotions in a healthy and restorative way:

When we painted red that day, I was just so frustrated with everything that was happening that I ended up painting a volcano, like, erupting, because I just felt like I just needed to get it all out, and once I had done that painting, I felt better … It helps with the emotions, just getting them out, even [if] it’s like on a paper … sometimes you don’t have the words to say, but that picture can say it all.

P5 drew a cross to represent her faith and realised her need to lean on faith to move forward with her life:

My last picture was a cross, and I realized for myself  …  that’s who I needed to lean on, that no matter how bad things were going to get  …  that I had to lean on the Lord in order to get through it, and that’s exactly what I did …  Cause I realized where my Christianity was and how far I was falling from it, and they helped me to bring it back to the cross. So that’s pretty amazing for me.

Lastly, P6 created a brain to represent being in a controlling relationship and the process of internalising negatives beliefs about herself:

I looked and I’m like, ‘It looks like a brain’  …  the reason I think I picked a brain subconsciously, totally out of my conscious thinking, was because my mind was so controlled through all my abuse, and what was taken away from me was the love for self, and, like …  “You’re stupid, you just—” BAM! ‘You’re stupid. You’re ugly. You’re this’. So, I was able to see, without saying it and without anybody questioning me, what happened to myself in that relationship.

Though the symbols and images created were diverse, what unites each of the above responses is that, in each case, the GAT participant used an artistic metaphor to communicate an emotion, engage in meaning-making, and either gain new understandings of lived experiences or explore future life possibilities.

Theme 3: reclaiming the empowered self

Through GAT, participants reclaimed aspects of themselves which had been silenced and supressed through the experience of abuse. These self-aspects included autonomy, creativity, confidence, peace, happiness, hope, playfulness, and survivorship. This process of reclamation involved integrating past with present, a resumption of past interests, and accepting one’s self as a work-in-progress. The autonomous, creative, and confident self-aspect was expressed by P4:

It [GAT] built my self-esteem a little bit … realizing that I can do something, that I don’t need somebody else to help me with anything. I was once able to do things by myself. I still can. I was told that I wasn’t going anywhere, that I wasn’t going to have anything or anybody, but it turns out, I’ve met so many people through all these groups that I’ve got a good support system to help me, and I realize that I can do things, I can go into groups and create something, I can make art that is … is beautiful in the end, even after everything that I’ve been through, that there’s still a lot left …  It made me a lot more confident … 

Three participants also identified how GAT led to a peaceful and happier sense of self. After the program, P5 expressed feeling, ‘so much more joyous. So much happier. I’ve learned not to fuel the fire’. P3 also described the journey of finding peace within herself.

 … what makes it meaningful is kind of seeing where it takes you, what it reminds you of, what you might feel like if you got there, how would that change your life, what can I do  … where I live, what can I do here to kind of evoke some of that peace inside of myself … So that’s a bit of a work in progress … I’m trying to find more peace inside of myself that’s realistic and here and present.

In addition to peace and happiness, two participants expressed the budding of a hopeful self. As P2 explained, the program:

 … changed me that I have a little bit more hope now … I did have hope before, but … When you see it on paper or when you see it in clay, it’s an object that you can see … It gave me more hope that I can get out of this. I mean, I’ll always have this, but I can get better, feel better, feel, be more … me, and live a happy life … 

The GAT process also supported participants in reclaiming their playful self-aspects in their relationships and daily lives. As P2 noted in reflecting on her renewed sense of playfulness:

[P]roof was even playing with my granddaughter. Now we’re right into the Play-Doh and the painting … I definitely took all that away with me … Now I’m colouring again, too, so it kind of sparks that again at home. So usually at night I colour and meditate … 

Finally, through the therapeutic group process, several participants redefined themselves and reclaimed their identities as survivors specifically. P6, for example, stated:

it was in conjunction with other forms of therapy, the art therapy and … those groups that were around during my consultations with the social workers [that was when] my label for myself changed from a victim to survivor. I stopped seeing myself as a victim because if I was there to talk about it [abuse] and deal with it and belong to these groups and everything … I definitely was a survivor. But … the programs that I was able to go through changed that way of thinking.

Theme 4: building resilience

The final theme identified in the study centres on participants’ building of resilience through the GAT process. Most saliently, four participants expressed resilience through their determination to work through their past relationships and experiences of abuse. As P4 explained:

There’s a lot of things that I didn’t realize that came up, and it’s helped me to deal with that, to be able to move forward and find my new life, and different things about the relationship that I was in that I didn’t even realize.

As P4’s experience highlights, GAT fostered an inner process of growth and change of which participants may not have been fully aware at the time.

Participants also demonstrated resilience through their drive to connect with others along their transformative journeys. P5, for instance, described the importance of social support in helping to sustain hope and forward movement:

I learned that nothing is impossible, that no matter what you’re going through in life, just to hang in there, keep going, don’t hold everything in, find someone, find some sort of support that will help you walk through it all. Don’t do it alone.

Finally, participants’ resilience was highlighted through their realisation of their own capacities and strengths. As P6 stated:

We came out more empowered. I think that we came out knowing where we wanted to go next in our next step of recovery and our journeys, because we went down a path we would have never known. That was part of it. It could have been something we’d been resisting or just unaware, or sometimes I think I look at it and think it was maybe a lot of avoidance because we didn’t know how to deal with it, express it.

P6’s quotation underscores both the growth that occurred through the ‘path’ of GAT and that the outcome of this process was self-empowerment.

Overarching theme: transformative healing

During the thematic analysis, the overarching theme and pattern of transformative healing developed from the analysis and interpretation of the four themes. Transformative healing refers to how participants appeared to experience the culmination of the GAT process as a personal journey of growth and change by creating meaningful connections in a safe space, using visual metaphors within their artwork, reclaiming an empowered self, and building resilience. P2 shared her experience of transformative healing through art therapy: ‘I think it’s very healing, because you dig up things, and you have emotions that just come out with doing that art activity that you, you’re like, Wow!’ Later in the interview, P2 described that:

 … I’m on a journey right now. Who really am I? I’ve been the people pleaser, the person everybody else wanted me to be. Who am I? Well, I like, I like doing art … I’ve learned that art can be therapeutic.

In comparison, P3 reconceptualised her vision of what she wanted in life:

 … through talk therapy, through the art … I know what I don’t want in my life … Despite the fears of being alone, I don’t want to be verbally abused like that again. I want to be kinder to myself … I’m trying hard to take myself to a better place with where I am … 

This theme of transformative healing was most clearly illuminated in P5’s drawing of her change process and release of negative emotions, which she created at the end of the research interview (Figure 1).

short-legendFigure 1.

P5 shared with the interviewer the meaning of her drawing:

I put the sunshine in my painting because it brings a ray of sunshine to all the hurt and darkness that I was feeling, that’s what the art therapy brought me, sunshine, and I did a train, sort of the process of what I went through in art therapy, and I put clay, because it was the first [material used], and to me it was the engine of the train, and this engine gave me the release that I need while working with the clay, and I put this chimney, so I put the smoke going up the chimney, so that’s all my negative feelings going out from me in this little train and the engine. So that’s what those are.

The four emergent themes and overarching theme, in combination, provide a conceptual framework for art therapists working with this clinical population. Figure 2 displays the novel conceptual framework for transformative healing.

short-legendFigure 2.

Discussion

The study’s research question explored how women IPV survivors experience art therapy within a group context. Through creating connections (Theme 1) participants were able to voice their feelings of trust, safety, and belonging in the group setting; realise that their experiences were shared by fellow group members; and explore past and present feelings within the group. The GAT facilitators fostered this connection and community by creating art together with participants, and thereby modelling the sharing of power and voicing of experiencing. This finding supports the suggestions that art therapy within a group context provides a safe and secure space for women survivors of violence to creatively and verbally externalise positive and negative feelings, and gain awareness of other healthy self-aspects (Ikonomopoulos et al., 2017; Thomson, 2012).

In addition to the importance of creating connections (Theme 1), this study reveals how participants during GAT sessions, used visual metaphors within their artwork to express feelings, make meaning of their experiences, and explore future possibilities (Theme 2). According to art therapist Moon (2009), visual metaphors are vessels that carry the creator’s personal internal and external information hidden in symbolic form. This theme of use of visual metaphors illuminates the rich interplay among cognitive conceptualisation, art making, and words in expressing the nuances of lived experiences. This finding supports Cardinal’s (2014) viewpoint that visual metaphors within artwork can facilitate enhanced self-awareness and self-expression in women IPV survivors. in their arts-based research study, McGarry and Bowden (2017) also found that older adult women IPV survivors’ use of metaphors in their creative expression helped them engage with, contextualise, and express their complex feelings and experiences.

Few studies explore the use of metaphor within the group context. For example, Buday (2019) found that women living with cancer, who participated in a single art therapy workshop, used metaphor and common symbols to express their illness journeys. One of the novel contributions of this IPV study is that it sheds light on the diversity of ways that participants use metaphor to express emotions and future possibilities over the course of multiple GAT sessions. Future studies could examine how the context of the group (e.g. facilitation, group dynamics, etc.) supports the use and expression of metaphor during the process of artmaking.

The third finding of this study (Theme 3) was that GAT helped participants reclaim their empowered selves, which were hopeful, creative, and playful. One participant discussed how her ability to belong to a group and deal with her experiences of abuse helped her to redefine herself as a survivor rather than a victim. This sense of belonging highlights the efficacy of the GAT process given that an overall program objective is for women to support one another. Reclaiming the self also points to the process of having one’s identity and strengths recognised and validated by the group; the empowered self has the space and freedom to come alive through play and creativity when it is affirmed by supportive others. This finding is also reflected in existing literature on positive impacts of group therapy for women IPV survivors around restoring hope (Santos et al., 2017) and reclamation of self (Allen & Wozniak, 2010).

The fourth finding of this study (Theme 4) was that participants reported GAT as fostering strengths and resilience in women IPV survivors. Resilience is a concept describing the moderation of the negative effects of stress (Wagnild & Young, 1993), and a process that involves an individual’s ability to consciously ‘move forward in an insightful integrated positive manner as a result of lessons learned from an adverse experience’ (Southwick et al., 2014, p. 4). This conceptualisation of resilience is represented in the data, specifically in a participant’s discussion of how GAT helped her to process experiences of IPV and ‘move forward and find my new life’. This finding of resilience sheds light on how participants experienced the GAT process as one of forward movement propelled by the safety and social support of the group.

As previously discussed, participants’ resilience was highlighted through their realisation of their own capacities and strengths. For example, participant 6 discussed developing new insights about feelings and situations ‘… we’d been resisting or just unaware …’ These new realisations are fostered through the group process; members contribute fresh perspectives and analyses about their peers’ artwork, thereby challenging them to view experiences from different angles. This finding contributes to the qualitative scholarship, as there was limited focus on resilience in either the IPV or art therapy literature reviewed for this study. This points to the need for further empirical research on how GAT can help women build or rediscover resilience following IPV.

The overarching theme of transformative healing developed from the four emergent themes. For study participants, the GAT experience appeared to be a transformative one. Healing, growth, and change appeared to transpire when women IPV survivors: (1) created meaningful connections in a safe space with participatory therapists, individuals with shared lived experiences, and a variety of expressive art media; (2) used visual metaphors within their artwork to project outward personal viewpoints, dreams, desires, memories, positive and negative emotions, beliefs, and values; (3) reclaimed the empowered self that is autonomous, creative, confident, happy, peaceful, hopeful, and playful; and (4) built resilience by working through past traumatic relationships and memories, cognitively envisioning a better future self, and gaining the strength to move toward that self. This conceptualisation of transformative healing fits with Wendler’s (1996) definition of healing as ‘an experiential, energy-requiring process in which space is created through a caring relationship in a process of expanding consciousness and results in a sense of wholeness, integration, balance and transformation and which can never be fully known’ (p. 841). The four emergent themes and overarching theme, in combination, provide a conceptual framework for art therapists to work with when constructing a clinical group treatment plan that supports the healing of women survivors (see Figure 2).

Limitations of study and future implications

Limitations of this study should be noted. First, the small sample size reflected challenges in recruiting individuals from vulnerable populations to participate in the research (Dutton et al., 2003). To extend the sample size, it is recommended that future studies of IPV survivors’ experiences with GAT recruit from multiple community-based agencies. Second, the interviews were limited to face-to-face interviews, which may have limited GAT participants’ ability to participate in the study. The authors therefore recommend adding phone and online interviews to the research design so potential participants have a range of options. During the recruitment phase, researchers should discuss and assess potential safety issues with participants before collaboratively deciding which mode of interview to conduct. Third, recollections varied based on the amount of time between program completion and study participation. For example, one study participant, who completed the GAT program five years prior to being interviewed, provided more of an overview of the impact of GAT as compared to five participants, who completed the program the month before the research interviews, and recalled detailed examples. However, the former participant did recall in vivid detail how one of the art activities had a profound impact on her life, thereby highlighting the longer-term benefits of GAT. Fourth, given the single interview design, participant perspectives of how art therapy has led to personal growth are limited to a fixed moment in time. The authors suggest that future studies include a longitudinal design to explore whether participants’ experiences of personal growth shift over time.

Despite these limitations, this study has found that art therapy in a group context appears to provide an important relational component to transformative healing, and that creative and verbal processes together can foster self-expression, inner and interpersonal growth, increased confidence, and skill building in women IPV survivors. The new conceptual framework, which evolved from the study findings, may assist art therapists employed in domestic violence agencies with the development and implementation of GAT treatment plans and interventions to support survivors’ healing journey (see Figure 2). It is recommended that future studies implement and evaluate this novel conceptual framework for transformative healing in women IPV survivors within GAT. While the rationale for using qualitative methods in this study was to investigate women’s experiences of GAT in an open-ended and in-depth manner, future studies could use mixed methods or quantitative experimental designs. For example, the authors suggest a future quantitative study, involving a pre–post control group, to predict whether GAT itself supports IPV survivors’ transformative healing or whether there are other variables which impact this process. A pre–post design could also be used to investigate whether women’s perceptions of their strengths and resilience changed due to GAT participation. Researchers could adopt a participatory action framework by involving former service users in the planning and carrying out of future studies about GAT interventions with women IPV survivors.

Although this study was completed prior to the onset of COVID-19, the need for formal services to support survivors is more important than ever. Journalists (e.g. CBC, 2021; The Guardian, 2020) and researchers (Bradbury-Jones & Isham, 2020; Campbell, 2020) have reported that the public health measures meant to protect the public from the global pandemic have simultaneously led to increased rates of IPV. Future studies could explore the impact of the pandemic on arts-based therapeutic programming and supports for survivors, and potential adaptations of arts-based interventions for virtual service delivery.

Conclusion

This community-partnered, qualitative study explored women IPV survivors’ experiences of GAT within the context of a domestic violence prevention agency in Canada. The GAT experience appeared to be a transformative healing process when participants: (1) created meaningful connections in a safe space with participatory therapists, individuals with shared lived experiences, and a variety of expressive art media; (2) used visual metaphors within their artwork to project outward personal viewpoints, dreams, memories, emotions, and beliefs; (3) reclaimed the empowered self that is autonomous, creative, confident, happy, peaceful, hopeful, and playful; and (4) built resilience by working through past traumatic relationships and memories, cognitively envisioning a better future self, and gaining the strength to move toward that self. The new conceptual framework, which evolved from the study findings, may assist art therapists employed in domestic violence agencies with the development of GAT treatment plans to support survivors’ healing journey.

Overall, this study contributes new knowledge about how GAT may be therapeutically beneficial for women IPV survivors and provides a conceptual framework for group treatment planning. It also demonstrates the importance of university-community partnerships to ensure that research is informed by the needs of agency programs, practitioners, and service users.

Acknowledgements

The authors thank the participants who volunteered to share their experiences, as well as art therapist Irena Zenewych and registered psychotherapist Ashley Davenport who co-facilitated the GAT sessions at Nova Vita. The authors are grateful for the support of study collaborator, Raghida Mazzawi, who initiated this community-partnered project and all stakeholders at Nova Vita. This article draws on research supported by the Social Sciences and Humanities Research Council.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This article draws on research supported by the Social Sciences and Humanities Research Council, Partnership Engagement Grant [grant number 892-2018-0091].

Notes on contributors

Michelle Skop

Michelle Skop, PhD, RSW, is an Associate Professor in the Faculty of Social Work at Wilfrid Laurier University. She researches: (a) the use of arts-based methodologies to explore the intersections of identity, health, and wellness; and (b) the development, implementation, and evaluation of innovative pedagogies and experiential learning processes.

Olena Helen Darewych

Olena Darewych, PhD, RP, RCAT, is a Registered Psychotherapist in Ontario, a Registered Canadian Art Therapist, and Adjunct Faculty at Wilfrid Laurier University and Adler University. She is also a Past President of the Canadian Art Therapy Association. Her current research and clinical work centres on digital art therapy for adults with autism spectrum disorder.

Jennifer Root

Jennifer Root, PhD, RSW, is an Associate Professor in the Faculty of Social Work, Wilfrid Laurier University. She examines the impacts of and resistance to gender-based violence experienced by women, children, and families, as well as sexual and sexualised violence experienced by students in post-secondary settings.

Julie Mason

Julie Mason, RSW, who was the Research Assistant for this project, is a Mental Health Counsellor with the Guelph Family Health Team, an arts-based researcher, and a community mental health educator and therapist.