Michelle Dean

As we wrap up 2010, I write my last blog installment for ARTSblog, which features an interview with American Art Therapy Association President, Joan Phillips, Ph.D., ATR-BC. Dr. Phillips enthusiastically addressed the three primary elements covered in this blog about art therapy: vision for the future of art therapy; obstacles to achieving that vision; and strategies to overcome those obstacles and make that vision a reality from the perspective of the American Art Therapy Association (AATA). Dr. Phillips discussed the consolidation of the National office to the Washington DC area in order to achieve greater collaboration with policy makers and other officials, which may be a positive influence and advocate for the field of art therapy. She also noted the expansion of the dedicated staff of the organization, which includes a now Full-time Executive Director, Susan Corrigan, and an additional six support staff to better meet the needs of the membership, provide advocacy for the profession, and increase in public awareness about the value of art therapy.

Dr. Phillips also described efforts for greater inclusion of educators and mental health professionals into the field of art therapy. She described “warm receptions to those we reach out to in other professions” such as in a recent meeting with representatives of K-12 Educational Association of Superintendents and representatives from the Veteran’s Association. Representatives from both associations mutually expressed much excitement about art therapy and the possibility for partnership and collaboration with the National organization and its members. She acknowledged a fear, that may have acted as an obstacle to the profession and may have prohibited such partnerships in the past, need not threaten to dilute the profession of art therapy, only enrich through collaboration. She cites the example that the credential for an art therapist is unified through the Art Therapy Credentials Board (see previous posts) and that many art therapists also choose to apply for licensure through their states as, “one size does not fit all.”

Just as each State or Local Chapter of AATA operates independently, through the work of countless volunteer hours of its board and committees, the National office has developed educational and support packets to assist in realizing the Chapters’ capacity to execute their mission, which often promotes the development and public awareness of the field of art therapy through the advancement of research, professional standards, education, legislation and public forums. This resource and leadership minimizes the need to “recreate the wheel” and continue to expand the vision of the profession through continued elected leadership.

Additionally, Dr. Phillips has been very impressed by the hope and inspiration of graduate students and young professionals she has had the opportunity to meet and work with in her elected positions and as an educator at the University of Oklahoma.  She highlighted The American Art Therapy Association’s new Mentoring Program as a means of cultivating the important role of providing collegial relationships to assist with navigating the sometimes-challenging territory of the field of as a new professional.

In closing, I have been honored to write this blog and have been greatly appreciative of the opportunity to convey some ideas about the future of art therapy. Sadly, due to time and life obligations (some anticipated and some unforeseen at the time of my original agreement to this commitment) I have much more material, wonderful interviews, and resources, than I was able to write about in the time allotted.  I am grateful to all of those who were so generous with their time and energy.  I am especially thankful for the work of Christine Ruberti, Research Assistant for this project, Julia Connell, former Policy Advocate at the American Art Therapy Association, Susan Corrigan, Executive Director of The American Art Therapy Association, and my esteemed colleagues and friends of the Delaware Valley Art Therapy Association Board, of special note: Carol Pletnick, President; Johanna Kane, Public Relations Co-Chair; Sarah Abramovitz, Corresponding Secretary; and Adele Minton, Recording Secretary, as well as all of you who have taken the precious time to read, post comments or reply privately. Many thanks and a most prosperous New Year to all!

American Art Therapy Association’s Mentoring program: http://www.americanarttherapyassociation.org/aata

Michelle Dean

In Part Two, a discussion regarding the vision for the future of art therapy from the Art Therapy Credentials Board’s (ATCB) perspective, Deborah A. Good, ATCB President and Rita Maloy, Executive Director, discussed additional endeavors to support a secure future for the ATCB and its credential holders. In the last blog, opportunities to become credentialed through ATCB were discussed and thus the discussion turns to the vision of mentoring new professionals, while helping those credentials grow credence outside of our profession. It has been noted that effective counselors, [and it could be implied art therapists] do not necessarily make effective supervisors (Dye & Borders, 1990) and so credentialing certifications have been developed to address this need.

First, let me discuss the implementation of the new certification for art therapy clinical supervisors. This credential, the Art Therapy Certified Supervisor (ATCS) is offered to qualified Board Certified Art Therapists, art therapists who in addition to obtaining registration have also successfully completed the board certification examination to earn the ATR-BC designation, and who are interested in demonstrating substantial supervision qualifications. Like the art therapy registration (ATR), the ATCS sets criteria including education, experience, and peer recommendations for potential supervisors with the goal to better prepare supervisors, while providing better tutorage of young professionals. In turn, this action may create a greater retention of professionals and ultimately increase career satisfaction. The ATCB is supporting the art therapy profession’s progress by establishing parity with other mental health professions, which have already established a credential for their supervisors, and that promotes recognition for the unique services art therapists provide while fulfilling the mission of the Art Therapy Credentials Board, to “protect the public through the competent and ethical practice of art therapy.”

Secondly, the ATCB is in the process of securing its status through the National Commission for Certifying Agencies (NCCA). According to its website, the NCCA helps to ensure the health, welfare, and safety of the public through the accreditation of a variety of certification programs/organizations that assess professional competency. The NCCA uses a peer review process to:

• Establish accreditation standards;
• Evaluate compliance with the standards;
• Recognize organizations/programs which demonstrate compliance; and
• Serve as a resource on quality certification.

Bill More, Chair of the ATCB Ad Hoc Committee on NCCA accreditation reports that “Once the board certification process is accredited, the public and stakeholders, including employers, clients, and state licensing boards, will be assured that an art therapist’s professional competence has been assessed through an examination and certification process that meets national standards.” As Bill points out in his article in the fall edition of the ATCB newsletter, this action may be imperative as Congress has begun efforts to enact law that would require all federal contracts that include the hiring of employees from professions covered by a certification process to only be filled by those from fields with a certification process accredited by the NCCA.

I welcome your comments.  Do you believe the ATCB efforts will be enough to entice more new graduates and those from other related fields to apply for the art therapy credential(s)? Is there a rising incident of art therapy students who graduate from accredited art therapy programs who either do not obtain the ATR or ATR-BC and/or do not maintain the credential? And since many more art therapists are now eligible for different licenses and credentials, what impact does this have on individual art therapists, the profession, and related fields?

Michelle Dean

What are all those letters after your name? is a frequent question I am asked, to which I often jest I have more letters after my name than in it. In a long-overdue, two-part installment of the blog, I will not only explain what all those letters mean, but also convey some significant changes that the granter of the credentials, The Art Therapy Credentials Board (ATCB), is making. Deborah A. Good, ATCB President and Rita Maloy, Exective Director, were very generous to grant an interview to discuss the vision for the future of art therapy from the ATCB’s perspective. The ATCB is an organization that credentials art therapists.  Credentialed art therapists must prove competency and are accountable to ATCB in terms of maintaining ethical standards of practice. The organization has recently unveiled an update of opportunities for becoming a registered art therapist (ATR), as along with a new certification for supervisors, the Art Therapy Certified Supervisor (ATCS). Additionally, the ATCB plans to apply for accreditation of the ATR-BC through the National Commission for Certifying Agencies (NCCA) later this year.

Historically, it has been difficult, and at times impossible to obtain the highest level of credential as an art therapist if one did not attend a graduate art therapy program, even if education and experience were comparable. This may have repelled professionals who hold licenses and credentials in related fields who were unwilling to return for another master’s degree for which some, or much, of the coursework would be redundant. In my opinion, it also implied an arbitrary exclusivity without consideration to competency based on education, supervisory, and experience criteria. As of January 1st, new and welcoming opportunities to become a credentialed art therapist will be made possible through the single application process, which includes several routes of demonstrating art therapy educational standards; all of which focus on coursework, supervision, and experience and thus, promote greater inclusively and diversity for credentialed art therapists.

The same coursework in specific content areas is expected of all applicants (as cited in the fall 2010 ATCB newsletter) and as David Gussak, PhD, ATR-BC, highlighted at this years Coalition of Art Therapy Educators (CATE) meeting at the American Art Therapy Association (AATA) Conference in Sacramento.  The traditional route, is one in which the individual graduates from an AATA approved graduate program.  These new graduates may pursue 1,000 hours of supervised clinical experience and are eligible to apply for the Art Therapy Registration (ATR) upon completion. The second and third credentialing avenues for graduates of non-approved AATA programs allow application for the ATR after 1,500 hours and 2,000, respectively, of supervised clinical hours with the ratio of supervision hours to clinical hours remaining the same (10:1) for all three types of applicant.  The greatest difference includes consideration for volunteer work (instead of paid work) at a 2:1 ratio and that clinical hours may be accrued through the applicant’s private practice, ONLY if the applicant holds a license in another mental health discipline.

Additional information about the Art Therapy Certified Supervisor Credential (ATCS) and the application with the NCCA will follow. You may watch the ATCB website for updated information regarding the material presented in this article.

In the meantime, what are your thoughts regarding the new ATCB application routes? Does greater inclusively appeal to you?

Michelle Dean

As cited in the Green Pages: Does the intense federal focus on “evidence-based” practices results in a premature dismissal or disregard for therapeutic practices that are beneficial to many populations?

Let’s face it, value placed on evidence-based practices is not just because of federal funding but a cultural bias that values scientific method, in an attempt “to prove” or “validate” what is real. The economic origins of this long-standing bias are beyond the scope of this blog but none-the-less the question remains: How does art therapy fit in this model?  Well, not so well due to its very symbolic nature.  And why should it?

Although there have been great efforts to promote and conduct evidence based treatment (EBT) and research in art therapy, it may be said that art therapy (or any therapeutic relationship for that matter) is a symbolic process, which is embedded in a relation-based therapeutic practice. So when symbols or people in a relationship are taken out of context they lose their meaning. For example, it would be like taking two people in love and removing one person in the couple and plopping them down with someone else and expecting the same amorous feelings – this is clearly absurd.  Sociologist, Durkheim discusses the advantages of being in a relationship as a reduced risk factor to suicide. However, when an art therapist is actually working with a patient, the statistical risk factor is far less important than the qualities and meaning of the relationship. And it is those relationship qualities that are so elusive to measure.  Elkins debunks the validity of empirically supported treatments, by uncovering the insidious economic gains for the insurance and pharmaceutical companies. And Seife points out, in his soon to be released text, Proofiness: The Dark Arts of Mathematical Deception, “Our society is now awash in proofiness. Using a few powerful techniques, thousands of people are crafting mathematical falsehoods to get you to swallow untruths”. Who is to say that what is being conveyed by the statistics of EBT are even measuring what they are claiming?

Although objective observation may be desirable in evidenced-based therapies, it is not truly possible in this relational, creative, and symbolic context. One cannot remove the therapist, or be replace by another, as no two therapists are the same person.  And the artwork that emerges in the session does so because of the surrounding conditions: time, place, therapist, and other numerous clusters of factors, some easily definable other not so. The observer or researcher cannot ever truly remove himself or his biases from the equation.  Gilfoy, states EBT’s are a modernist concept, which “[…] seeks universal absolutes that derive from a single narrative trajectory that assumes its truths are superior to others”. Scientific Methodologies do have their place in hard-science but to reduce or generalize results to patient care or other symbolic manifestations in a therapeutic context or in turn to deny services or payment for services because they do not fit neatly in this economically driven method, may actually do more harm than good; one could even argue, they are unethical in practice due to their deception.  So although art therapy may not fit neatly into the current psychological trend of EBT, it does not mean that its significance is lesser or that its benefits are not profound.

“Promising practices” is a concept, which has only begun as a means to document and highlight the effectiveness of the relationship, the interaction achieved in multidisciplinary treatment, and a host of creative, symbolic, and environmental factors, which may be a more reasonable way to inform support for a soft-science practice such as art therapy. In the meantime, without question, the real underlying drive and pervasive use of a data measurement is used to attract funding and monies.  How else might one draw  economic viability for the work of art therapists, without losing sight of the importance of the symbolic nature of the work?

References:

Web

• Lies, Damned Lies, and ‘Proofiness’ (Sept 19, 2010). NPR STAFF

Documents

• Durkheim, E. (1979). Suicide: A study in sociology. New York: The Free Press.
• Gilfroy, A. (2006). Art therapy, research and evidenced-based practice. London: Sage Publications.
• Seife, C. (2010). Proofiness: The Dark Arts of Mathematical Deception. New York: Viking Adult.

Michelle Dean

With the emphasis nationwide on access to health care for everyone, art therapists, creative arts therapists and other arts professionals need work to be included in the group of defined providers in national and local health care solutions. In the US, there are five major mental health professions that have occupational regulations, including: psychiatrists, psychologists, psychiatric nurses, counselors, and social workers. Lack of occupational regulations for art therapists in most states creates a challenge for inclusion in healthcare reform and insurance reimbursement.

Laura Greenstone, long-time, legislative advocate for art therapy, has worked tirelessly in her role as The Chair (and now Past Chair) of The National Coalition of Creative Arts Therapies Associations (NCCATA). As NCCATA Chair, Laura joined the National Arts in Healthcare Advisory Council, which was initiated by the Americans for The Arts, The Society for the Arts in Healthcare, The American Music Therapy Association, and other national arts organizations. The main task of the Advisory Council has been to create issue briefs for Arts Advocacy Day – an advocacy event held each year in DC where over 80 arts organizations and arts advocates gather to lobby in Congress. One can find the latest issue brief on Arts in Healthcare listed here: http://artsusa.org/get_involved/advocacy/aad/issue_briefs/2010/advocacy_issuebrief_011.asp

ARTS IN HEALTHCARE, is a multidisciplinary field dedicated to improving the healthcare experience for patients, families, and caregivers. This rapidly growing field integrates the arts, including literary, performing, visual arts and design, into a wide variety of healthcare settings for therapeutic, educational, and expressive purposes. 

Laura points out, and the American Art Therapy Association confirms that art therapists comprise a relatively small number of professionals, approximately 5,000 by recent national accounts, and if strong strategic planning is not accounted for and adhered to into the future that art therapists may be overlooked or even forced out of inclusion of important legislative matters facing the profession. An alternative in many states, but not all, is an option for art therapists to be included under the umbrella of counseling, which of course has generated much debate, about issues ranging from professional identity, the content of material taught in graduate art therapy programs and scope of practice for those seeking post-master’s training in art therapy.

It’s both an invigorating time and a time in which a central voice for the professional art therapist is more critical than ever.  Advocacy, communications, training and expansion of membership are just a few of the major areas of work ahead. It starts with defining the priorities.  The American Art Therapy Association has begun a comprehensive strategic planning process: a review of the fundamental challenges and opportunities before the profession and the Association.  It has been announced, the initial phase will uncover specific issues identified by practitioners, students, researchers, educators and others around the world.  Working from that broad view, the Association will create a plan that will support the art therapy profession over the next decade. Members of the American Art Therapy Association are encouraged to voice their views through the Strategic Plan Members Survey, while simpatico supporters and others are encouraged to provide comments about such matters both in response to this blog as well as with the National office.  

Work with like-minded arts in healthcare professionals may lead to other avenues of funding and inclusion in the Healthcare Reform.  This may be an opportunity for art therapists who wish to work exclusively in the Mental Health field, which primarily requires licensure in most situations. So as numbers climb to almost 15,000 professionals working in Arts in Healthcare, art therapists may wish to join with their colleagues in the Creative Arts Therapies and arts professions, for what may ultimately create a stronger voice for all.

As always, additional resources are given in the reference section of this blog.

One of the issues discussed in the book is the importance of education and the ability to “DEVELOP a new level of sophisticated dialogue that comprises many different levels of abstraction and conceptualization,” stated panelist and research psychologist, Martha Davis, (p. 83). Art therapist, Myra Levick responded, “The whole reason for […] communication is to increase our sharing and to avoid isolation.  If we can’t do that, we are going to be in trouble.  If we […] have something special, but we don’t tell anyone, then we do everyone an injustice” (p. 83).

The lack of interest in, and even vocal opposition to, educating professionals in other fields may be due to economic factors and proprietary rights rather than what is in the best interest of art therapists and the patients they work with.  I see this reflected in many ways in our profession and there seems to be a genuine fear of educating others about the field and the importance of the arts for development and as a therapeutic modality.  Here are a few examples of the comments I’ve received from some respected and well-known art therapy colleagues in response to workshops I presented:*   

“Why would you teach such dynamic art therapy material to MH [mental health] clinicians when you spent so much time and money learning and acquiring art therapy credentials?”

“I still think you sell the art therapy field very cheaply…. and someday it will come back and bite you in the ass… maybe you won’t be able to find a job because they will all be filled by other mental health/nursing professionals you taught the business too…”

Despite their objections, neither art therapist has ever attended one of my workshops, so they only know the tiny bit about the workshops that neatly fits in a small brochure meeting the requirements of the National Board for Certified Counselors. (Those of you who are familiar with these requirements will know this is a feat unto itself!)  They seem to believe that if I educate other professionals about the significance of art, image, and symbolization and the dimensions of which may be applicable for mental health clinicians (not to mention to the greater cultural society) I will be undermining or “selling out” the field.

So I ask, in what other disciplines do professionals fail to educate others about what they do and its importance?  Do they not offer seminars and workshops, and publish scholarly works for peers and the public? Perhaps this is a relic of art schools, ateliers, guilds, and creative apprentices and their need for exclusiveness in methodologies and techniques? Cults and secret societies may also operate in this way, but accredited professions? Reading a book or attending a workshop certainly does not result in a license to practice art therapy. The educational opportunities are just that: education.

I am definitely not the only recipient of such disdain and criticism from other art therapy practitioners – and it’s these kinds of comments that lead to divisiveness within the field. With so few credentialed art therapists, how can we afford so much rancor? How will we be able to unite to work toward greater inclusion in licensure issues?  How will we collaborate with others both in and outside of our field if we cannot work within it?

Personally, I agree with the message my esteemed colleague Marcia Sue Cohen Lieberman espouses: “Promote, Publish, and Present!”.  What do you think?

* NB: These emails were sent to my personal email regarding a series of workshops that I co-teach about the use of art, image, and symbolization and its significance in mental health practices. I hold a national accreditation as a Continuing Education Provider by the National Board of Certified Counselors (NBCC). The workshops are open to art therapists and non-art therapists who have earned mental health degree and credentials.  Thus they are post-graduate continuing education workshops and seminars.

Art therapy is very much about creating meaning, although too often meaning making is confused with interpretation. Art therapy involves both the creative emergence of meaning and the revealing of existing but veiled meanings. At its best, art therapy is a co-created experience, one in which mutual admiration and respect is given to the art making process and to the symbolic material of the individual, family or group.  It is a therapeutic experience in which art materials are used to facilitate insight, process and integrate experiences. It need not be a set of coveted techniques although they are spoken of frequently as interventions but instead covers an orientation and attitude towards everything that is creative in life. For it is the nature of imagery and creativity, like Hermes, to transcend boundaries, to dissolve them, recreate, and redefine them. Hence art therapy shares this distinctive quality of defying easy definition.

Many graduate art therapy programs teach from a psychodynamic or depth psychology theoretical orientation.  Perhaps this is due to the close affinity to symbols and images, which are found in archetypes, active imagination, dreams, free associations, and artwork. Certainly the function of art transcends current psychological theories, which typically explore one aspect of development or function. It is often the liminal, the changing, the “just forming” terrain of psychic life and this is its virtue. So defining succinctly the profession and modality of art therapy is challenging.

The American Art Therapy Association provides the following definition for the profession:

Art therapy is a mental health profession that uses the creative process of art making to improve and enhance the physical, mental and emotional well being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and self-awareness, and achieve insight.

So with this broad definition where do you think we need to go from here?

Art, psychology and religion share a fluid symbolic nature. Thus it is the symbol, which is the lens that we may see the world.  It both consolidates and expands. And all symbols are relational, meaning when taken out of context they often lose their significance. Although some have their misconceptions about art and psychology, or should I say stigmas about either as a profession, they are often equally dumb-founded at the mention of combining the two into the profession of art therapy. Most of this is due to unfamiliarity with the concepts. So for clarity sake, let’s start with some of the basics. The etymology of the word art comes from the Latin ars, which is defined as a “skill as a result of learning or practice” or “to fit together or join” And psychology is a derivative fromthe Greek word: psych, “soul”; and, logos, “word” or “speech” or the manifestation of the soul. Thus the word psychology implies “the speech or manifestation of the soul”.  The speech here is not defined to only words but to other manifestations of expression as found in images and symbols.  Historically, psychology has had more to do with spirit than the mind, as a more operational definition may apply. So the discipline of art therapy may be loosely defined as the learning or practice of the ability to fit together or join expressively, coupled with the ability to give speech or expression of the soul in a symbolic artistic means. So if the work of art therapists are more akin to spiritual guides, it would make sense that we too must possess some flexibility and creativity to see things anew as well as in relation?

Reducing the practice of art therapy (and for that matter many things) to sound-bite size pieces of information robs the work of its integrity and diminishes the complexities of process and of people’s lives. Oversimplifications of a subject can dumb it down to the point of being meaningless. What I want to do is convey the depth, significance, and creative life-enhancing power of the work, and the advantages and limitations of this very diverse profession.

It is not surprising to me that art therapy has emerged as a profession that at its core is about both art and psychology, each having to do with the spirit or psyche. It is now believed that the earliest of rock and cave paintings had to do with a spiritual practice more than a depiction of the mundane or literal record of animals. The marriage of art and psychology embodies a living, spiritual connection, as in life itself. Life is a creative process, full of slippery slopes and transcendent moments.  It is akin to a shape-shifting beast and has always and will always defy constancy.  It is restorative, transformative, and healing and above all must remain fluid and moving in order to stay alive.

To make art can be rewarding, cathartic, and energizing, and it can be anxiety producing and heart-wrenching. It is simultaneously fluid and dynamic (the process of creating) and corporeal and relatively static (the product: the completed artwork). Hence, artwork and the imagery it consists of act as a doorway or threshold of the emergent spirit or self.  It ties one’s inner and outer world together: it offers a window into one’s inner world and a reflection of one’s outer world, simultaneously. Much like the spatial matrix, art therapist, Harriet Wadeson speaks of, we can see many aspects all at once in artwork because it is not linear. Imagery and artwork are not bound by the conventions of time, logic, and order in the same way speech is confined.

It is my belief that art therapists have the potential to be the metaphorical midwives (gender specificity not intended, although roughly 95% of art therapists in the U.S. are women) of personal, spiritual, and cultural transformation if they are able to focus, unite, and organize themselves in a way that is fluid and creative.  More on this in following entries…

Your comments, questions, feedback, and suggestions are encouraged and welcomed. Please be sure to subscribe to the blog, through the RSS feed for the most recent postings. And as always, resources have been posted in the Resources Section, so please be sure to visit this ever growing list.

Documents:
Dashwood, R. (2005). How Art Made the World (DVD). http://www.pbs.org/howartmadetheworld/series/buy/

Elkins, D. N. (October 2007).  Empirically supported treatments: The deconstruction of a myth. Journal of Humanistic Psychology, 47, 4,  pp. 474 – 500.

Paul, L., B. (2010). Knep Links Science and Art: Artist fosters dialogue between artists and HMS scientists

Wadeson, H. (1980). Art psychotherapy.  New York: John Wiley & Sons.

In general, art therapists are a passionate, inspired, and creative group of professionals. Many have come to this rewarding field from more traditional paths of art or psychology. Art therapy: a marriage of passions, as it were for many, myself included. Just as there are numerous avenues to stumble upon this work, there are many diverse schools of thought and theoretical orientations from which to practice as well as a myriad of settings in which to work. We do not work in isolation and we can not continue to build an enriching profession alone. Your comments, questions, feedback, and suggestions are encouraged and welcomed. Please be sure to subscribe to the blog, through the RSS feed for the most recent postings. And of note, resources have been posted in the Resources Section, so please be sure to visit this ever growing list.