A Bird’s Eye View: Toward a Comprehensive and Collaborative Review of Art Therapy Research (Une vue du ciel : vers une revue globale et collaborative de la recherche en art-thérapie)

Navigating art therapy: A whole-eyed approach

Disciplines such as art therapy progress by gathering, critiquing, and building upon bodies of knowledge to amend and construct theories, generate new methodologies, and establish best practices (Gopalakrishnan & Ganeshkumar, 2013; Liberati et al., 2009). If researchers and practitioners lack methods to analyze the accumulated knowledge on art therapy experiences, their understanding of its broader implications may be limited (Liberati et al., 2009).

The intention of this special issue of the Canadian Journal of Art Therapy/Revue canadienne d’art-thérapie was to explore the metaphor of a bird’s eye view. This perspective aims to provide a preliminary composition that can help art therapy practitioners, researchers, and allies generate insights about the field by gathering and reviewing relevant literature. The journal’s aims and scope, which prioritize diverse ways of knowing, are informed by the Two-Eyed Seeing approach, known as Etuaptmumk (Bartlett et al., 2012; Whyte & Toll, 2023). This “whole eye[d]” and inclusive way embraces breadth through literature reviews that examine the effects of experiences over time that is prioritized in Western medical models (Ermine et al., 2004, para. 20).

Although this special issue called for various types of literature reviews, it also includes arts-based and practice papers. While exploring the initial metaphor of a bird’s eye view using a Two-Eyed Seeing approach, I was delighted to discover the diverse ways birds perceive and visually sense their environment compared to humans (Hodos, 2012). Birds, the vertebrates most highly adapted for life in the visual world, rely heavily on sight (Hodos, 2012, p. 5). Many species of birds can see luminance and contrast through ultraviolet rays, in addition to perceiving color, detail, contrast, size, and motion, which differs from human vision (Hodos, 2012). The embodied and sensory experiences of art making and viewing can help us understand the world differently and attune us to ambiguous or tacit knowledge through imaginative and dialectical experiences with others (Gerber, 2022). As Gerber and Myers-Coffman (2017) describe:

Ambiguity highlights the necessary concepts of not knowing and being known—knowledge that is incompletely formed, outside of full consciousness, concealing the full truth—and how we acquire knowledge of the unknown and ambiguous through the arts-based processes and products. (p. 594)

Therefore, some knowledge is inherently incomplete or not fully understood. Art-based methods can facilitate the exploration of such knowledge.

The whole eye also unequivocally values depth through community arts-based research that highlights soul in medicine, Indigenous wisdom, ethical spaces, interrelatedness, imagination, holistic embodiment, symbolism, ambiguity, connection, collaboration, and honoring the unknown. Therefore, this special issue on a bird’s eye view embraces all ontological and epistemological assumptions in the spirit of growth and understanding. The painting below of an eagle flying over a mountain in Canmore in Figure 1 illustrates the theme of the bird’s eye view by representing this special issue’s focus on movement, illumination, transformation, and understanding.

Figure 1. Toll, H. (2023). A bird’s eye view. Oil on canvas. Ottawa, ON.

In the initial call, authors were invited to contribute to this special issue by submitting systematic reviews, meta-analyses, scoping reviews, and other creative approaches to look at the effects and experiences of art therapy across diverse peoples. The goal of collecting amalgamated literature is to highlight potential benefits and impacts of art therapy to ultimately influence on public policy, art therapy education, future research, ethical frameworks, and best-practice recommendations to enrich therapeutic experiences. Synthesized research that analyzes, critiques, and sheds light on a topic can help communicate the effects and advantages of art therapy to decision-makers and policymakers, while also highlighting important areas that need further investigation.

Notable art therapy and arts in health literature reviews include a large-scale, highly publicized scoping review on the effects of arts on mental and physical health conducted for the World Health Organization (WHO), which analyzed over 900 research studies by Finn and Fancourt in 2019. This scoping review influenced the development of WHO’s Arts in Health initiatives. For example, the WHO stated:

Including the arts in health care delivery has been shown to support positive clinical outcomes for patients while also benefiting health care providers, the patient’s loved ones, and the wider community. Benefits are seen across several markers, including health promotion, health condition management, and disease prevention. (WHO, 2024, para. 1)

Critical, systematic, integrative, and scoping reviews on the effects, value, and impact of arts engagement on health and well-being with diverse international populations have increasingly influenced national public health decisions in jurisdictions such as Denmark, Norway, Sweden, Finland, United Kingdom, United States of America, and Australia, among others (Boyce et al., 2018; Bungay et al., 2014; Jensen & Bonde, 2018; McQuade & O’Sullivan, 2023; O’Donnell et al., 2022; Staricoff, 2006; Staricoff & Clift, 2011; Stuckey & Nobel, 2010; Tomlinson et al., 2020; Van Lith et al., 2013; Wilson et al., 2016). These national and international reviews highlight the global recognition of the connection between arts engagement and good physical and mental health.

Over the past decade, large-scale reviews specifically analyzing the effects and experiences of art therapy on mental health in adults and children have emerged (Boehm et al., 2014; de Witte et al., 2021; Harris et al., 2024; Hu et al., 2021; Regev & Cohen-Yatziv, 2018; Shukla et al., 2022; Uttley et al., 2015). These reviews are important contributions that provide a wider lens on the field and potentially influence clinical practice guidelines and highlight gaps in literature and evidence. For instance, a critical narrative literature review by Shukla and co-authors (2022) in India found that “art therapy as an adjunct treatment showed improved mental health in patients” (p. 1). De Witte and colleagues (2021) conducted a scoping review identifying 19 domains of change by reviewing 67 empirical studies on creative art therapy.

Nonetheless, funding constraints for art therapy research and practice can limit the scope, reach, and scale of art therapy programs and studies. Numerous studies indicate that the small sample sizes and lack of comparative analyses with other therapies affect the generalizability and reliability of the effects of art therapy across diverse populations. Consequently, the challenges in robustly assessing the evidence base of art therapy practice hinder its capacity to secure research funding and support. Moreover, cultural barriers and accessibility are significant issues that require continued, ongoing, and critical work with a lens of cultural humility and anticolonial practice.

Simultaneity of multiple concurrent views and truths

In addition to a wider perspective on the effects and experiences of art therapy, Volume 37(1) also includes arts-based and practice papers to provide an in-depth, embodied, emotional, and sensitive understanding of the ambiguous nature of art making and art therapy, focusing on connection and experience. Utilizing an arts-based research approach, this issue features articles that embrace “pluralism and ambiguity, employing the dialectic between inductive and deductive, discursive and nondiscursive, past and present, concealed and revealed, and immersion and reflection to create new ways of being and knowing” (Gerber & Myers-Coffman, 2017, p. 594).

The expanded metaphor of a bird’s vision informs this special issue, recognizing the limits of our understanding while embracing unknown areas. This perspective simultaneously delves deeply and broadly into the impacts and experiences of art therapy for both populations and professionals. It embraces a multifaceted approach that values diverse ways of understanding simultaneously (Chilton et al., 2015; Gerber & Myers-Coffman, 2017). Therefore, similar to artwork, this issue presents a simultaneity of all-at-onceness (Chilton et al., 2015; Gerber & Myers-Coffman, 2017) that values multilayered ways of understanding. Gerber and Myers-Coffman describe simultaneity as granting:

[r]epresentation of past and present realities at the same time, which unearths, pre-serves, and narrates our collective and individual histories. Simultaneity also implies the coexistence of multiple realities and truths, some apparent and others concealed, which are revealed and reexperienced within the emergent iterative arts process (p. 591).

By incorporating community-focused and arts-based research, this special issue facilitates the necessary “weaving back and forth” between different forms of knowledge and perspectives (Ermine et al., 2004, para. 21). Thus, this issue creates space for arts-informed, narrative, grounded, creative, and community-based epistemological lenses. Offering a bird’s eye view of synthesized research in art therapy, this issue provides both extensive and in-depth understandings of art therapy practice. It includes broader studies discussing amalgamated research on the effects of art therapy with various population groups (Al-Rawi & Morcos, 2024; Sahai & Tiwari, 2024) and the experiences of art therapists in Canada (Bookbinder, 2024; Puharich-Clarke, 2024b), while also offering insights into practice through community-focused, arts-based research (Bbira, 2024; Heller, 2024). This issue contains the following sections: Cover Artwork, Articles, Soundings, Art Therapy Approaches, and Art Therapy in Practice.

Cover artwork artist statement

The cover artwork was created by Jessica Puharich-Clarke (2022, 2024a) who is an author in this special issue. Tree Metaphor (Puharich-Clarke, 2022) represents the author’s artistic personal inquiry into her experience as an art therapist and mother of a child with a chronic disability. In this image, she investigates her experience of chronic sorrow, a term developed by Olshansky (1962) to describe the emotional experiences of parents of children who have severe chronic disabilities. The watercolor painting blends an image of a lung and a tree to portray the connection between breath and growth.

Articles: A broad lens with literature reviews

The articles section contains research that evaluate existing literature by focusing on the effects and outcomes of art therapy with a post-positivist lens (Kapitan, 2017). Technological advancements over the past 20 years have helped researchers assess the effects of therapeutic experiences on the body using biomarkers. By analyzing physiological changes, art therapy researchers and practitioners can gather evidence that extends data gained from subjective assessments or observations (Kaimal et al., 2016; Warson & Lorance, 2013). Therefore, cumulative evidence on the effects of art therapy on biomarkers that indicate changes in psychological experiences of anxiety, depression, and stress, as shown through the body’s heart rate, blood pressure, and cortisol levels, among other biomarkers, has been increasing.

In this issue, art therapist researchers Al-Rawi and Morcos (2024) conducted a systematic review to consolidate recent literature that tested the impact of creative art therapy on the heart rate and blood pressure of adults. The authors emphasized the essential connection between mind and body in art therapy, stating that “depression is now considered an independent risk factor in the manifestation of serious cardiovascular events” (Al-Rawi & Morcos, 2024, p. 11; Amadio et al., 2020; Trivedi, 2004). Their scoping review ascertained that visual art therapy benefits adults by increasing relaxation and lowering the body’s stress response (Al-Rawi & Morcos, 2024). Moreover, Al-Rawi and Morcos (2024) recommend that art therapy researchers examine the effects of using different art materials on cardiovascular biomarkers. They also suggest including larger sample sizes in experiential studies and seeking to understand the nuanced intersectional experiences related to the effects of art therapy on cardiovascular health.

Sahai and Tiwari (2024) assessed the experience of art therapy among a unique population group, conducting a scoping review to explore its effects on identity exploration, self-discovery, empowerment, and acceptance among LGBTQIA + individuals. This review, originating from the Manav Rachna International Institute of Research and Studies in Faridabad, India, focused on international research published between 2018 and 2023. Their findings suggest that “art therapy may serve as a valuable tool in facilitating clients’ exploration and discussion of topics related to sexuality during therapy sessions” (p. 23). Viewing art making as a way to authentically express and “realign one’s spiritual journey with that of the Universe,” this unique therapeutic modality provides an extended space for the safe expression of complex intersectional identities through reflective symbolic artistic processes, while also critiquing systemic inequities. Sahai and Tiwari (2024) recommend ongoing research and critical examination with a “nuanced lens that acknowledges and respects intersectional diversity with cultural humility” (p. 28).

Soundings: An in-depth lens with emergent and imaginative art making

When describing the role of imagination, generated by emergence and insight with arts-based and arts-informed qualitative research, Gerber shares that:

Imagination can penetrate fixed, embedded systems and structures that have dominated thinking in our culture, often obstructing, obfuscating, and marginalizing knowledge perspectives that might offer additional insight, understanding, and empathy to the human condition and human behavior. (n.p.)

This unique imaginal way of gathering and viewing knowledge is honored in the Soundings section. With a more detailed and tacit arts-based approach to research, Vera Heller (2024) partnered with the Montreal Museum of Fine Arts to create a transformative art therapy program supporting the well-being of newcomer immigrants to Canada from diverse geographic locations, including Eastern Europe, Latin America, Middle East, and Asia. Using the arts-based research and visual story approach, Heller invited participants to engage as coresearchers, encapsulating their significant life experiences in artworks created over 12 sessions within the community space of an art museum.

This study cross-referenced artwork and verbal data from interviews and transcripts to ascertain participants’ unique experiences of therapeutic factors and artistic processes within the visual story approach. Ultimately, the study evaluated the therapeutic applicability of this approach for newcomer immigrants in Canada within an arts community space. When describing their positive experience of the visual life story program, one coresearcher shared: “A kind of door had opened for me … I felt super included, super at my place, and with people who share the same mindset” (Heller, 2024, p. 47).

While it is essential to understand the effects and implications of art therapy on populations, examining art therapists’ professional and personal experiences using an arts-based reflexive approach is equally significant. Art therapists like Kapitan (2017), Hewitt-Parsons (2021), and Beaumont (2018) advocate for art therapist researchers to explore their own vulnerability and perspectives through reflexive practices, thereby renegotiating power dynamics when analyzing their inner worlds. Through the author’s unique lens as both an art therapist and a mother, Puharich-Clarke (2024b) conducted arts-based autoethnographic research to delve into her encounters with chronic sorrow as a parent of a child with a lifelong disability, using metaphorical representations. This research, which centered on symbolic response artwork (Fish, 2012), aimed to narrate their story through artistic expression and offered insights to enhance art therapy practitioners’ understanding of the challenges and emotional experiences encountered by parents of children with lifelong disabilities. Additionally, Puharich-Clarke (2024b) provided practical art invitations and symbolic metaphors that art therapists could utilize in practice to explore chronic sorrow with clients.

Art therapy can enable art therapists, among other professionals, to understand their identities and develop confidence in their professional roles more deeply. Art therapist researchers and counseling psychologists, Ming Hsuan Wu and Hui Chuang Chu (2024) integrated Glaister’s (1996) serial self-portrait method to examine self-conceptual changes as new female college graduates develop their professional identity in Taiwan. The authors employed a phenomenological approach to understand how self-portraiture over six art therapy sessions can impact this population’s self-esteem and self-perception. Thus, in the Soundings section, the diverse applications of arts-based and phenomenological research to better understand art therapy experiences collectively demonstrate the role of creative exploration in enhancing personal and community insight and development.

Art Therapy Approaches: Insights with a conceptual review

The Art Therapy Approaches section includes theoretical contemplations and introduces new ideas based on historical and contemporary research. Bookbinder (2019, 2024) extended her body of work that previously examined the sustainability of art therapy in Canada and the business practices of art therapists. In her conceptual literature review, the author examined the external factors and systems that impact the sustainability of art therapy practice in Canada. By using conceptual mapping, she organized and visualized this information, highlighting the key elements and their relationships. Bookbinder generated seven different categories to contextualize the sustainability of art therapy work in Canada, which include gender, social activism and advocacy, socialized healthcare systems, feminism, psychology of identity and brand, and economic implications. Based on this review, the author recommended that Canadian art therapists generate a unified brand. Bookbinder concluded that establishing art therapy within the developing provincial regulatory colleges will help increase future healthcare funding for art therapists.

Art Therapy in Practice: Amplifying perspectives with community-based art therapy

The Art Therapy in Practice section features publications that provide detailed descriptions of art therapy practices on-the-ground. Bbira (2024) incorporated an anti-oppressive and politically informed approach (Potts & Brown, 2015) in this this international art therapy project that integrated photography with art therapy. The arts-based research project, conducted collaboratively with participants acting as coresearchers, sought to enhance the emotional well-being of 10 formerly unhoused Ugandan children with an art therapy-based photography project and a community exhibition.

The author utilized an interpretative phenomenological analysis (IPA) research method to explore the experiences and culturally informed therapeutic impact of the community-based art therapy photography project with the coresearchers. Additionally, the article emphasizes the significance of empowering marginalized groups, such as children in care, by celebrating their valuable perspectives through the sharing of their photographs. Therefore, integrating artwork can centralize and highlight the viewpoints of participants, who are involved as creative coresearchers and artists.

Conclusion: Toward more inclusive and expanded views with two eyes

The compilation of diverse publications in this special issue offers a multifaceted perspective akin to a bird’s eye view, encompassing articles, practice papers, and arts-based research. Through unique lenses and an international focus, all the contributions underscore the potential of art therapy in promoting health and well-being across diverse peoples. From exploring identity and empowerment among LGBTQIA + individuals (Sahai & Tiwari, 2024) to examining the physiological impacts on cardiovascular health (Al-Rawi & Morcos, 2024), the literature reviews within this issue highlight the benefits of creative expression and engagement in therapy. Together with this broader view of overall impact, arts-based, narrative, phenomenological, and imaginative research details how art therapy can “promote[s] reflexivity and facilitate[s] the exploration of deep existential themes of universal concern” (Heller, 2024, p. 47).

The symbolic eagle painting in Figure 1 soaring over a mountain embodies change, flow, movement, and transformation through gaining knowledge with a bird’s eye. However, the ability for one being, represented by the eagle, is diminutive compared to the expansive terrain symbolizing the widespread utilization of art therapy across the field. The limited scope of articles within a single issue underscores the necessity for broader representation, indicating the need for additional voices and perspectives to enrich our understanding in subsequent issues. Thus, while offering a glimpse and perspective, a single special issue can only become a catalyst to drive further exploration and expansion. Thus, there is a need for more inclusive Black, Indigenous, and People of Color (BIPOC) representation.

Our symbolic gaze and view must widen further. While this eclectic collection of manuscripts provides insights into the applications and effects of art therapy through both a broad and detailed (imaginative) lens, there is a call to expand “our Circle.” This expansion should prioritize Indigenous, reconciliatory, and anticolonial approaches that value a commitment to inclusiveness, community, and belonging. As Whyte & Toll (2023) state,

Circle, through an Indigenous Way of Knowing, can be both a place of gathering and a metaphorical frame for connecting on the same level. It is a space where we can share our unique gifts as people to build a stronger community… By stepping into the Circle, we validate our own vulnerability as Indigenous people, people of color, and allies so that we can build a space where everyone feels heard, seen, and safe. (p. 6)

The journal’s dedicated section on Anticolonial, Indigenous, and/or Two-Eyed Seeing Approaches to Art Therapy, edited by Megan Kanerahtenha:wi Whyte, aims to bridge and frame this relational inclusive Circle by emphasizing art therapy research rooted in Elder Teachings, Indigenous Wisdom, Dreams, and Land-Based Wisdom. It is important to note that the development and organization of this significant section is still ongoing.

Recognizing the challenges and limitations facing art therapy research and practice is crucial. These obstacles encompass funding constraints, biases, research gaps, methodological limitations, and cultural barriers, all of which impede resource allocation and equitable access to art therapy. Meanwhile, systemic societal inequities, political binaries, mass violence, and collective trauma, including the impacts of climate change, stress the critical need for art therapy to be integrated into various levels of care (Carpendale, 2010; Carpendale & Toll, 2021).

To address these challenges, collaborative and inclusive engagement from researchers, art therapists, allied practitioners, participants, and policymakers is essential. By fostering dialogue, partnership, and innovation within our unique art therapy community, we can navigate these obstacles together while gaining a broader view of art therapy’s landscape as a field of practice. We must approach intentional partnership with openness and inclusiveness, akin to the impactful Circle described by Whyte (Whyte & Toll, 2023). Through our shared work and comprehensive vision, we can intentionally gather research to guide the discourse and practice of art therapy toward greater inclusivity, efficacy, and accessibility, ensuring its healing potential reaches all who can benefit from its transformative capacity. Therefore, let us widen our bird’s eye view and embrace a more inclusive Circle. I invite you all to contribute to this vision by sharing your unique forms of viewing, understanding, gathering, and expressing your art therapy knowledge.

Haley Toll, PhD (Candidate), MA, RCAT, CCC, RP
Canadian Journal of Art Therapy: Research, Practice, and Issues Editor-in-Chief,
Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
[email protected]

Disclosure statement

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