Art on Trial

Confessions of a serial art therapist

Art Therapy with a Recalcitrant Sociopath—What’s the Point?

"Why bother?" was a question addressed in an earlier post when considering whether those in prison should receive therapy - this post goes even further by asking 'why bother' with a more specific type of inmate: the truly sociopathic. Read More

Fantastic article! Similar

Fantastic article! Similar to the same principles used in MRT work to reframe socio-pathological ideologies commonly seen in prisoners! Thanks! Deana White MA LPC-Michigan

Art with prisoners

Very good article Dr. David! Always so well put together, informative, clear, and pithy.
sahnta

Thank you Sahnta.

Thank you Sahnta.

Thank you Deana

Thanks for the comment; and I agree--I think many of the underlying principles are similar.
Dave

so

Let's see, denigrating the client, using offensive, stigma inducing language, and and overall attitude that the client is beyond help. I can't imagine why these unprofessional, uneducated morons pushing art therapy are not more widely accepted in the mental health fields. Unbelievable.

social function of art therapy

It resonnates with me that art therapy should serve a social function as you have pointed out. we must think as art therapists, do we want to help individuals get well one at a time in an office which is cut off from the rest of society or do we want to use the full function of art as therapy to improve society? Perhaps we can do both?

Is this approach even

Is this approach even evidence based?? Seems overly subjective and I can't find any peer reviewed studies validating the approach.

response to anonymous

To Anonymous: your comments are inflammatory, deliberately abusive and worst of all, posted anonymously. Anonymous, you have broken every conceivable convention for having an enlightening disscusion yet your understanding of ethical considerations tells me you have some degree in social sciences or a helping profession. Try again, use your name and say specifically what you are thinking by referring to examples.

Wow. Abusiveness is exactly

Wow. Abusiveness is exactly why I was calling the author out. An ethical practitioner does not use stigma inducing language and imply their clients are beyond help. It's not 1955 anymore. It's odd that asking simple questions about the validity of an approach (as professionals are required to do). Is it evidence based? Are there studies validating "art therapy"'s effectiveness? I can't find any. If you find this "abusive" you may need to look up the meaning of the word.

I'm not sure what is so mystifying to you or what examples you need. I asked very simple, common questions related to the cornerstone of ethical practice, which is whether or not the approach used is validated by peer reviewed research. If not, is has no place in professional therapeutic treatment and should be considered on par with psychics, palm readers and of tarot card readers.

Forgot to add this in my

Forgot to add this in my previous post. Simple question: can you point to peer reviewed validation of art therapy??

In Response--and support of Tom Shortliffe

Dear all;
I have appreciated the viewpoints that have developed on this post. It is gratifying when people become impassioned enough about what the posts contains to feel compelled to write a comment. However, like Tom, I don't appreciate when people hide behind the Anonymous designation. Quite frankly, if someone writes a comment as Anonymous, I tend not to respond at all--however, I felt I needed to for no other reason than I did not want to leave Tom hanging out there by himself--thank you Tom for responding.
If I may also say so, when Tom was mentioning abusive and inflammatory language, I believe he was referring to your designation of those that use art therapy as uneducated, unprofessional morons. To be clear, I am a professional, educated moron. Your comments were indeed slurs, and I would ask that, in the future, if you wish to take part in such dialogue, you refrain from such insulting language.
If you have read my other recent posts, you will see that my whole focus in the prisons was to remove such stigmatization and labeling; by using such terms in this post, I was calling to attention the perspectives of those who don't work in the prison, and while others may see them as beyond help, my point is that this work is necessary--having said that, after working in the prisons for so long, I worked with those who were recalcitrant and were deemed to be sociopathic-their behavior was dangerous, and many other professionals deemed them unreachable. Otherwise, I do not see how the post reflects abusiveness. However, this is your opinion, you are entitled to it, and nothing I can say can or should change your mind.
Having said all this, what is fact is that there are a number of peer reviewed, empirically supportive articles in respectable journals from across forensic disciplines that validate and support the effectiveness of art therapy in a variety of settings; more specifically, there are a number of articles that focus specifically on research conducted to demonstrate the effectiveness of art therapy in correctional institutions. I suggest you dig a bit deeper before making such claims otherwise.
Again. thank you for the time you took in writing your comments, and I appreciate those that wish to engage in conversation and healthy, professional debate--however, after this, I will not be responding to Anonymous.
Dave

I understand I was out of

I understand I was out of line in those comments. I apologize. I would add that my decision to remain anonymous is my own, and you are not in a place to ask me to do otherwise. I am simply trying to discern how this therapy is validated. As a PhD you have to know that the fact you see improvement in some people is not evidence that it should be used as a therapeutic approach. Where is the hard research? Thanks for your thoughtful reply and I do not mean to offend anyone.

Great Article

I respect and applaud professionals like you Dave that can reach patients that are deemed "unreachable" by many others. As a forensic mental health professional I have seen art therapy provide a constructive and healing outlet for many patients even the most intractable. Thanks.
Katie Grogan
Registered Nurse-California

Thank you Katie

I greatly appreciate your support and I applaud the work that you do in the forensic system. Thank you.

re: evidence based practice

In fairness, the hard scientific evidence in support of art therapy is it's Achille`s tendon. There are no randomized double blind trials in the field that i know of, but then again, there is no radomized double blind support for any function of art in society. In fact, the existence of art has never been proven if you want to get scientific about it. There are some things which the scientific method finds difficult to penetrate and one of those things happens to be the world of art and psychotherapy. However, neuroscience is promising to quantify the impact of art in the brain. I would suggest you read Dr. Ramachandran of California, Dr. Levitin of Montreal, Robert Solso, Clifford Rose`s ``Neurobiology of Painting`` and Hass-Cohen and Carr's``Art Therapy and Clinical Neuroscience`` for an introduction to the relationship between hard science and art therapy. These authors all bring something to the table towards demonstrating that art therapy is a scientifically ascertainable treatment approach. Psychoannalysis helped people for nearly 70 years before people anyone started to take an evidence based approach to testing its effectiveness. Then again, if you want an evidence based approach to treatment, there are always pharmaceuticals like adderal, ritalin and electroshock therapy and institutions like psychiatry to help you with any depression or anxiety one might be feeling. Art Therapy emerges in large part because those evidence based approaches fail in so many important ways.

Psychoanalysis did a lot of

Psychoanalysis did a lot of damage as well. It is of course a sexist, misogynist one sided approach based on shoddy research and it is a good thing that it's on the ash heap of psychology's history. That you would scoff at evidence based (things proven to work) practice is disturbing to say the least. The jibe about electroshock therapy is nonsense, though it was effective it's no longer in use. And are you claiming that adderall and anti psychotic medications do not help people? I'm really questioning your competence at this point. I hope you work with an interdisciplinary team because some of what I'm hearing is scary.

Art therapy has had no double blind studies which validate the approach, as someone else has posted. In other words, you're just taking stabs in the dark and hoping something works. Not the stuff of ethical practice as far as I can tell.

my last try

After this, i think i am going to have to adopt the original article authors' better judgement and leave the discussion with you. Questioning my competence is an ad hominem attack which you used in your original posting as "anonymous". I am sure you understand that it is unethical to insult people or question their competence from behind a veil without revealing anything about yourself. The author put himself out there. I put myself out there too. Are you going to come out or just sit there throwing mud? I met you half way and acknowledged your point that art therapy as a discipline has produced relatively little hard scientific data as compared with say cognitive behavioural therapy which i am going to assume you might be a proponent of. Now meet me half way and confess that evidence based practice and the hard scientific method have not yet solved everything and that CBT does not address the systemic, societal and cultural aspects inherent to depression and anxiety while art therapy does recognize those dimensions and makes some attempt to do so. Cognitive behavioural therapy addresses cognitions and behaviours. Art therapy takes the position that human being consists of more than simply thoughts and behaviours. Though it should be said that many art therapists are trained in and do incorporate CBT techniques into their practice because they recognize the benefits and limitations of such evidence based practices. What i am saying is that science and technology do not address problems of morality nor the enigma of consciousness. Be patient, the science is coming. Have you done any reading in the field? You seem to have made up your mind already but have you studied the questions from another angle? Surely, you understand that you can not just criticize from an uninformed perspective, from behind the shadows of anonymity. If you are confident about your position, tell us something about your background, your studies so that we can understand how it is that you came to have such a pejorative view of all things lacking the complete scientific stamp of approval? Is science the new religion? are we all to be burned at the stake for not falling within the intellectual parameters set out by the scientific method? Is there no knowledge of value which exists outside of scientific knowledge? Must i now prove to my wife that i love her scientifically? Slippery slope me thinks.

While psychoanalysis may be on the shelf, the psychodynamic models which are born from that theory are alive and well within the psychiatric institutions i know of. Lastly, if art therapy was so irrelevant to the realm of healing of the psyche, do you think so many psychiatrists, psychologists, social workers and other helping professionals would be willing to work along side us in hospitals, psychiatric institutions, schools, community contexts? What is it you think we do exactly? Do you have any idea what an art therapy session looks like, how it is constructed? There is more to the understanding of the human condition than science alone. is there not? Or do you adopt the position that if something is not scientific, it can not be? We don't use science to live day to day. We use instinct, intuition, emotion at every turn, to help us make sense of what we are living. Art Therapy belongs to those things which help us make sense of what we are living. Science only needs to catch up and study the questions which art therapy brings to the table such as: "how to people use creativity to overcome adversity?" and "how does creative process in art tell us something about creative process in daily life?" These are important questions and no one is waiting for CBT or pharmacology to ask them. How about the question: "how can we use art to bridge social, cultural and economic gaps in society?" art therapy and artists are the only ones asking that question. How about : "how can creativity help us improve our lives? or as the original article asks: how can art therapy help improve the lives of others? How about: "how can art therapy help protect us from the constant bombardment of mainstream media in an society which is increasingly apathetic and individualistic?" "how can we avoid mental health problems rather than having to rely on evidence based cures later on?" Most evidence based approaches to mental health are not actually concerned with mental health, they are concerned with mental illness, they are concerned with curing problems like depression and anxiety after they have set in. Art therapy goes a step further and asks: "what are the optimal conditions for living and how might we prevent mental illness?" By the way it is extremely difficult to scientifically demonstrate a decrease in incidence of a mental disorder. I am sure that as a proponent of the scientific method, you understand that absence of evidence does not mean evidence of absence. So we are going to have to concede that the jury is out or at least your jury is out.

The genetic componnent of problems like depression and anxiety is evaluated somewhere around 50% or less in the DSM and that means at least 50% not accounted for by innate biological factors. PTSD is an environmentally caused problem which then produces a biological shift. Art therapy asks, how can we address the non biological components of those problems? It is also starting to ask how are we subsequently addressing the biological factors involved in those problems. We are hoping that neuroscience will help us in this task. So my recommendation, before i sign off is that you do some introductory reading in art history, art theory, practice art, study neurology, psychology and psychotherapy and finally read up on the hybrid discipline of art therapy to get a better ground upon which to form an opinion about what art therapy is or is not. After all, that is what art therapists have done prior to forming their opinions.
I wish you well on your journey anonymous. My hope is that one day, you and i could have an exchange face to face about our different views and that we could continue to learn from each other.

Last try indeed.

You are woefully uninformed about CBT and you do not seem to be well informed about modes of psychotherapy. It is a framework not an exact science. It is very humanistic and in tune with the human condition. I hope you understand this because it is pretty basic. CBT (and more specifically REBT) posits that thoughts (specifically irrational thoughts ARE the underlying cause of disturbances and self defeating behavior. If you don't understand that I really don't understand why you are commenting.

You're stuck in this presupposition that the psychoanalytic/psychodynamic approach of insight and rooting around in the past will somehow fix disturbances which occur in the present. It's nonsense and not supported by evidence. The idea that an event causes a disturbance is unfounded, as it is the beliefs about the event which are the cause (example: 10 people may have the exact same experience but only 1 might end up with PTSD. Why would that be if the event was the cause?).

Your apparent rejection of evidence based practice is scary. Would you go to a Dr. who dabbles and experiments with his own concoctions and disregarded modern science if you had cancer? I would hope not. You would probably seek treatment that is evidence based, which means that peer reviewed evidence has shown it is effective.

I agree wholeheartedly that the questions you suggest: " "how can creativity help us improve our lives? or as the original article asks: how can art therapy help improve the lives of others? How about: "how can art therapy help protect us from the constant bombardment of mainstream media in an society which is increasingly apathetic and individualistic?"

Are excellent indeed. Why not formulate a study and take an academic approach to see what you can discover? Asking questions is fine but it's also important how you determine the answers, which is why we have Phds laboring to apply their knowledge to find valid answers. Anecdotes aren't good enough, unfortunately. I don't understand why you think you deserve points for asking good questions and having good intentions.

Yes it is difficult to demonstrate improvement in mental illness. That is why we conceptualize treatment plans with the client to decide how to measure improvement and how we will know when there is improvement. I'd add we do use science to live every day as we (hopefully) base decisions on rational thought, observation and hypotheses, though of course not in a laboratory setting.

Your bizarre suggestion for me to read up on art history and psychotherapy is confusing, as you seem to be unable to provide a strong evidentiary basis for the efficacy of art therapy and do not seem to understand the basics/philosophy of CBT/REBT.

Random points to address: Whether or not you need to prove to your wife you love her scientifically is a non sequitur and does not apply to what we're talking about. Yes art therapy asks many questions...how about coming up with some answers? How can you feel ethical just treating a client based on how you feel? Do you think the house-tree-person is a valid assessment tool? Would you want that from a medical doctor? Last but not least...no science is not a religion, as it is not faith based.

In response to the blog post

Thank you for reminding those of us that work in such harsh environments with the chronically uncooperative and seemingly resistive to treatment, that change can still take place - tho minute. It is still an improvement to their quality of life, not that they'll readily admit it. Yet, it can be seen from time to time.

response to anonymous

Anonymous, Call me recalcitrant but i am back for more punishment. We agree on the following things:
1) evidence based psychotherapy is defined as a practice which has been proven effective by the scientific method.
1b) Those approaches which have achieved evidence based status, are proven effective.
2)All effective psychotherapies must be evidence based.
3)there are very few if any hard scientific studies to demonstrate the effectiveness of art therapy though there are countless case studies and many small sample studies covered by the American Art Therapy Association journal or elsewhere.
4) Your point that psychotherapy is not an "exact science" is quite just. Art therapy is even less of an exact science. It is part art just as any psychotherapy is. This means that there is subjectivity involved and not just objective phenomenon. For example, thousands of art therapists know inter-subjectively that art can be useful in the alleviation of mental discomfort. Granted, intersubjectivity is not hard science so let's consider that scientifically speaking, art therapy is in a phenomenological stage in which thousands of master's level and phD. educated professionals have come together to confirm that they have observed unique phenomena and that they wish to see it scientifically investigated. Until then, they will continue to employ it within the ethical Socratic guidelines that it must do no harm.

I think your enquiry into the effectiveness of art therapy is a testament to your passion for helping people. that is why i would like to ask you to bring your concerns to the International Art Therapy Organization facebook group. There are over 8,000 members of that group, many of whom are art therapists. I would be curious to know how some of the elders in our field address the critique that art therapy effectiveness is scientifically unproven. There are many people far more advanced than i in the field who might be able to mount a better defense.

I will get down on my knees and pray to evidence based practice if you promise not to make any more assumptions about what is going on in my head or what my competence and abilities are because doing this is called mindreading and it is a thought distortion which is recognized as maladaptive by people who practice CBT.

We wish there were more research in art therapy. Art therapists are losing their jobs everyday to people working with evidence based approaches such as CBT. But then we are finding jobs in places where people seem to think CBT is not getting the whole picture. I have personally seen a couple of clients who have been in CBT and tell me that something was missing. Could it be that CBT and art therapy are a good match in the treatment of PTSD or depression? Let's do research together, you can be the brains, and i'll be your artsy side-kick. Problem is research costs money and you have to have a group of scientifically competent people working together, who also have knowledge and experience with art therapy.

Art therapy is not the brainchild of science, it is the child of grass roots. It was brought to the attention of science by ordinary fields like education and art and by ordinary people such as children who feel compelled to draw out their bobos. Art Therapy is having a really hard time convincing people in positions of power that it has merit and that it is truly a "therapy for the people". That you have taken such issue with it's existence as an alternative approach to healing of the psyche suggests that we have more work to do in winning you over as a practitioner.
Let's remember that the Greek roots of the term psychotherapy mean healing of the soul, not healing of the thoughts and behaviours. I love CBT for what it teaches us about cognitive distortions, obsession and anxiety. My only bone to pick with it is that it never asks "why?" It only wants the how, what, where and when but it never asks "why?" things happen the way they do. It pays no attention to the unconscious which is also kind of problematic for me. I realize the unconscious has not been scientifically verifiable but neuroscience will fix all that too in short time. In fact, all of these questions psychotherapeutic philosophy or approach will be answered through neuroscience at some point. For now, i have to hand it to you that art therapy is not considered evidence based practice for lack or research. Only i would submit that this in no way implies that art therapy is not effective.

You wrote: "Your apparent rejection of evidence based practice is scary. Would you go to a Dr. who dabbles and experiments with his own concoctions and disregarded modern science if you had cancer? I would hope not. You would probably seek treatment that is evidence based, which means that peer reviewed evidence has
shown it is effective."

I agree with you, i would seek out the help of a medical professional to help me deal with cancer but i would want to see an art therapist to help me make sense of the experience.

Now stop assessing my intelligence, only an Iq test can do that effectively because an Iq test is scientifically proven to assess the phenomenon known as human intelligence right? I digress.

Research posts

Dear all;
I have been enjoying the back and forth between Thomas Shortliffe and he/she who shall not be named, as despite some of the vituperative statements made (and I appreciate Thomas' attempts to rise above this and and carry forth a reasonable and well-thought out discussion) many good and valid points have been made. Therefore, the shift of the blog will change somewhat and the next several posts, beginning next week will focus on some of the research that has been conducted with the arts and art therapy in prison. I no way have the illusion that this will convince some of the naysayers and reverse some of the hard earned opinions, but it seems that this discussion stream certainly signals a need to begin this series. As expected, I may be using some of the comments made in this discussion for these posts. Please check the blog next week for the first in the series. Thank you all.
Dave

As promised...

The new post that begins a series on research conducted in the prisons has been uploaded. Thank you for the inspiration.

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David Gussak, PhD, ATR-BC, is professor and chairperson for the Florida State University Department of Art Education, and Clinical Coordinator of its Graduate Art Therapy Program.

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