Art Therapy: The Role of the Relationship

Does art therapy effectively support relational treatment goals?

Posted May 30, 2018

© 2018 Digitally-generated image courtesy of C. Malchiodi, PhD
Source: © 2018 Digitally-generated image courtesy of C. Malchiodi, PhD

Art therapy as an approach to health and well-being is often described as form of non-verbal communication with the potential to help individuals of all ages in the process of reparation and healing. Art therapists also propose that “art therapy, facilitated by a professional art therapist, effectively supports personal and relational treatment goals” (AATA, 2017). Personal goals (art therapy for non-verbal communication, stress reduction, moderation of mood and quality of life) continue to be well-documented in an increasing body of research literature. But relational components of art therapy and the unique role of art therapists in “relational treatment goals”—not so much.

A recent study conducted at the Mayo Clinic brings up questions about just what reparative factors are inherent to art making and how the art psychotherapeutic relationship differs from other relationships involving art making for therapeutic outcome. In the Mayo study, researchers did not specifically set out to evaluate relational components of what they refer to as a “bedside visual art intervention” or BVAI with the participants. Their intervention simply allowed individuals to engage in creating art without targeted psychotherapeutic goals. The BVAI’s goal was to provide a relatively brief art making experience for each participant and sought to measure results in three important areas: pain, anxiety and mood. The artist educators who carried out the BVAIs were trained to provide an art-based activity and in healthcare-relevant issues such as confidentiality and professionalism in interactions with patients (for a more detailed description of this study, see reference below). In brief, this study demonstrated that perhaps paraprofessionals providing simple artmaking experiences could indeed influence significant positive changes in patient populations.

Art therapists propose that the art psychotherapeutic relationship is unique and grounded in an advanced understanding of the integration of art making with principles of psychotherapy. Often they infer that art therapy is inherently relational because of art-based strategies that support positive attachment, integration, resilience and self-regulation, all important objectives in treatment. However, most art therapy research to date focuses on measurement of various art-based activities rather than the human-to-human art psychotherapeutic relationship that conceivably is a key part of the reparative process. In other words, the experience of attunement, a meta-skill that includes presence, active response, mindful interactions, and empathy and comes in the form of prosody, facial expressions and body gestures, mirroring and entrainment. If an art psychotherapeutic relationship has different benefits and outcomes than the BVAIs provided by the paraprofessionals in the Mayo Clinic study and thus a specific form of sensory, emotional and cognitive attunement, then it is important that the field of art therapy begin to really determine just what those differences are.

My point is no amount of encouraging clients to “draw a safe place” or autopilot applications of “bottom-up,” brain-based art interventions will magically transform traumas and losses into positivity, nor do any art-based activities constitute a reparative relationship in service of the individual. Even self-regulatory experiences are formed within relationship—they are initiated and strengthened by repeated relational experiences with a trusted adult; that adult [the therapist, in this case] supports regulation through reflection, presence, gestures and ultimately, attunement.

Art therapists, as well as my colleagues who use art-based methods to support reparation and recovery, let’s begin to more deeply consider the art psychotherapeutic relationship within our own interactions with clients as well as “relational treatment goals” within in the context of research. The skill of attunement is where the real transformative moments emerge and flourish and where the art psychotherapeutic relationship has the potential to make a measurable difference in our clients’ lives.

References

Saw JJ, Curry EA, Ehlers SL, et al. (2018). Brief bedside visual art intervention decreases anxiety and improves pain and mood in patients with haematologic malignancies. European Journal of Cancer Care. e12852. https://doi.org/10.1111/ecc.12852. 

American Art Therapy Association. (2017). Definition of art therapy. See www.arttherapy.org.