Art therapy research within emergency shelters, military museums, secure care, schools, and communities

It is with great honour that I am writing this editorial in my new role as Editor-in-Chief (EiC) Designate. Following a successful interview with the British Association of Art Therapists, and under the support of our current EiC, Alex McDonald I am committed to taking on the EiC role starting from April 2024. This would not have been possible without Alex’s generosity with her time to support each one of us in the editorial board in order to maintain the success of our journal, and her genuine determination to bring our journal to its highest quality standards it has ever been. I am grateful to Alex for her extraordinary contribution to our journal and for raising the profile of the art therapy profession.

My first action as an EiC Designate is the announcement of a special issue call on Nature-based Art Therapy. Alongside guest co-editors Dr Pamela Whitaker and Dr Caroline Hickman, we are inviting original and evidence-informed research, practice, and opinion contributions on nature- and outdoor-based art therapy. This special issue is a timely opportunity to explore how nature-based art therapy can contribute to both human and planetary health, (re-)connect us with nature, and facilitate equity of access to the arts, therapy, and nature. Aspects of nature-based art therapy we are particularly keen to develop stronger evidence for include:

• Establishing and holding a therapeutic frame in natural environments

• Exploring existentialism and meaning of life

• Addressing health inequities

• Cultivating cultural humility and anti-oppressive practice

• Connecting people with nature

Submissions beyond these themes are strongly encouraged. The deadline for submissions (including artwork submission) is on the 31st of March 2024. We also welcome applications for mentoring by sending us a draft version of your article until the 10th of September 2023. We are excited to read your submissions and bring this special issue to life.

In this current issue, we are bringing together six research papers presenting the evidence of art therapy taking place in a wide range of settings including secure care centres, community settings, emergency shelters, military museums and schools.

The efficacy of art therapy on hope and resilience in youth within a secure care centre

Collins et al. (2023) conducted a study to evaluate the efficacy of art therapy on hope and resilience in young people residing in a secure care centre in Canada. Using a pre-and-post experimental design, 13 young people aged 12–19 participated in 12 weekly individual sessions of art therapy. Most participants had experiences of multigenerational trauma, and chronic and complex mental health challenges. Changes in participants’ hope was measured using the Children’s Hope Scale (CHS; Snyder et al., 1997), resilience using the Resilience Scale (Wagnild & Young, 1993), and individual goals using the Bridge Drawing with Path (BDP; Darewych, 2013) art-based assessment tool. The authors found that young people’s self-reported hope improved by 29%, showing a moderate effect size. The ‘agency’ component of hope increased more substantially, suggesting that art therapy may prepare youth for their transition back into the society. Changes were smaller for resilience, where a 16% improvement was reported, and no significant changes were observed through the BDP tool. However, BDP showed potential in detecting early signs of suicidal thoughts, suggesting that secure care setting and forensic mental health services could benefit from incorporating this tool in their practice. Overall, art therapy provided a space for young people to communicate their life goals, and reflect on people, places, and things that offer them life meaning and a sense of hope. Despite the small sample size and the lack of a control group, these are important findings suggesting that secure care settings can benefit from art therapy as a rehabilitation treatment which can improve young people's hope, resilience, self-determination, and future pathways.

Measurement and development of art therapeutic actions in the treatment of children and adolescents with psychosocial problems

Bosgraaf et al. (2022) from the Netherlands have developed a new instrument that can be used to measure whether important therapeutic actions are being achieved during art therapy. This instrument was applied in their art therapy programme called ‘Affect regulating Arts Therapies’ (ArAT), which was aiming to address emotion regulation problems in children and adolescents with psychosocial problems. The reliability of the measure was tested through video-recorded art therapy sessions and scoring by multiple raters. In their article, the authors describe the challenges around the process of their tool construction, including defining, observing, and capturing non-verbal, implicit, and multifaceted therapeutic actions, or avoiding long checklists that cause response fatigue and lower the tools’ reliability. They also questioned whether converting complex theoretical concepts into observable therapeutic actions can adequately capture the essence of these concepts. Despite these limitations, this tool could be a great starting point for defining key therapeutic actions and observing core changes happening during art therapy practice. Further research into the tool’s reliability and content validity could increase our confidence in its value and use in future research and practice.

Obesity prevention: a pilot study on community workshops delivered by art therapists

Bokoch et al. (2022) from the USA piloted community workshops facilitated by an art therapist to prevent obesity. The primary aim of their study was to investigate the effectiveness of these workshops in increasing the participants’ motivation to change health and eating behaviours, and confidence in their ability to manage emotional eating. The workshops were facilitated by an art therapist who integrated psychoeducation, experiential art activities, culturally sensitive and community-oriented communal eating, as well as interactive sharing and discussion. Using a pre-post-test one-group design, alongside an empirically informed drawing protocol, the impact of the workshops was evaluated by 40 participants with (or with risk of) obesity. The authors found significant improvements in the participants’ motivation to change their health and eating habits, but not in their confidence to manage emotional eating. All workshops received positive feedback. Although the sample was relatively small and self-selective without a control/comparison group, this study provides us with valuable insights into the importance of art therapy in bridging the gap between physical with mental health.

Home representations of at-risk children in an emergency shelter

Shtern-Eden and Bat Or (2022) explored home representations in drawings of at-risk children in an emergency shelter in Israel. Eight children aged 5–7 with experiences of domestic violence, abuse, and neglect participated in this study. The projective house drawing test was used, which was part of the House-Tree-Person (HTP) test (Buck, 1969), aiming to illustrate children’s perceptions of their home and family relationships. Children’s drawings and play narratives were analysed using phenomenological and thematic approaches. The authors found that that most children viewed their house as a threatening space which exposed them to memories of threat and loss. However, drawing and dramatic play provided children with an avenue to express and communicate their home experiences and offered them opportunities for emotional regulation. The information shared during drawing and play also enabled the art therapists to understand the children’s needs and support their mentalization process. The authors have discussed thoroughly the tension between the invitation to create and the encounter with threatening and overwhelming content and have situated their findings within a wealth of existing literature.

Outcomes of professional training in online arts therapies in the education system

Korman-Hacohen et al. (2022) evaluated the Israel Ministry of Education strategy to offer all arts therapists working in educational settings a 30-hour course in delivering sessions online during the COVID-19 pandemic. Fifteen female art therapists who participated in this study gave the research team access to their coursework to understand what they learned from the course and how they benefitted from it. The authors found that the programme made arts therapists feel more confident in their skills and abilities to deliver their sessions online. It also prevented solitude and potential burnout through the mutual support that arts therapists were offering to each other. However, a need that remained unaddressed was the arts therapists’ difficulty in defining their boundaries in educational settings, especially considering the increasingly high demand for children’s mental health support. The authors recommend that this should become a priority in future art therapy trainings.

Museum-based art therapy and wellbeing programme: experiences of veterans with PTSD

Finally, Baumann et al. (2023) conducted an art therapy study in a military museum in the UK. Seven veterans who participated in the Creative Wellbeing Programme (CWP) consented to be interviewed to share their experiences and the impact the programme had on them. All participants in this study had reported experiences of military trauma and met the diagnostic criteria for PTSD. Authors adopted a qualitative design informed by the principles of realist evaluation. Interviews suggested that the museum was a more accessible and less stigmatised environment for therapy and offered veterans a sense of control. Although the military museum inevitably triggered distressing memories, reflections and discussions around the museum items stimulated creativity and resulted in group cohesion and a sense of belonging.

Concluding remarks

It has been a great pleasure learning and sharing the growing evidence-base of art therapy across different contexts and populations in the UK, US, Canada, Israel, and the Netherlands. I hope this research-focused issue generates new ideas for future research and practice, as well as hope for the vast potential of the future of the art therapy profession.