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Art Therapy: It’s Not an Art Class

The profession still struggles with public perception—and ethical boundaries.

©2018 C. Malchiodi, PhD
"Grounding Objects," courtesy of the collection of C. Malchiodi, PhD
Source: ©2018 C. Malchiodi, PhD

It’s pretty obvious that art therapy, in contrast to other mental health and health care professions, has a uniquely visual component. That is, it involves not only the psychotherapeutic process between therapist and individual, but also the creation of actual art expressions as key elements. It is a dynamic, integrative approach to treatment that capitalizes on the expressive component of art making as a central factor in supporting health and well-being.

There is no doubt, by most definitions put forth by professional guilds and regulating bodies (including a growing number of state licensure boards across the US), that art therapy is a mental health profession and one that involves a psychotherapeutic relationship. So why, after five or more decades, are art therapists are still perceived as “art teachers,” “activity therapists,” or purveyors of “art lessons” despite so many regulatory definitions and career descriptions?

In some ways, the answer is fairly simple; in many cases and in contrast to most mental health counseling or psychotherapy sessions, art therapy sessions are often accessible to individuals other than clients in treatment. While I work with clients in the privacy of a clinic office or a contained, confidential group session, often art therapists work with clients in environments where other individuals may enter the space at any time. For example, medical art therapy is presented at bedside, in a waiting room or multi-purpose room is populated by family members, friends of the patient, technicians and others. Art therapy “open studios” that are meant to allow participants to come and go at their own pace as part of a normalizing and empowering therapeutic environment, also often have fluid boundaries of who can be present.

To lay people, these examples and others do understandably look like art classes, especially when compared to counseling or psychotherapeutic services where boundaries and treatment objectives are clear. Even research on what constitutes positive therapeutic outcome blurs the lines between art therapy and art activities; a recent Mayo Clinic study underscores the efficacy of artists in the provision of expressive activities that improve patient outcomes in several key areas. In brief, the field of art therapy has yet to effectively demonstrate the actual differences between specific art therapy approaches to health and wellness versus the services of other art-based practitioners or for that matter, mental health professionals who integrate art-based methods within psychotherapy.

Additionally, the fact that art therapy may be perceived as an “art lesson” presents numerous ethical quandaries that the profession often fails to address, especially in this age of social media. To my best understanding, as a licensed and board-certified art therapist, I am governed by HIPPA (Health Information Portability and Accessibility Act) in not only how I protect individuals’ identities, but also under what circumstances I provide art therapy sessions, including who has access to those sessions and to clients’ art expressions. Because of HIPPA and other individual protection acts, many art therapists are now asking their regulating bodies and membership organizations, “just what constitutes ethical boundaries when publicly posting photos of clients engaged in art therapy and art expressions created by clients?”

In contrast, the closely related profession of mental health counseling promotes its value via social media and print publications, but in my experience only stock photos are used rather than photographs of actual counseling clients. In other words, even if clients may have given permission to appear in media, in most cases counselors and other mental health professionals choose to protect identities and disguise communications and clinical records. Similarly, play therapy, an approach similar to art therapy that involves props, toys, and art making, communicates its value through stock photos of therapists and children in its publications and discourages play therapists from public display of child clients and discussion of cases on social media platforms. In contrast, it is relatively easy to find photos of client art expressions and even art therapy clients or patients (with names) in publicly posted photos throughout the Internet.

The issue of ethical boundaries in art therapy is a complex question and the subject of recent communications within the art therapy community, it’s worthy of more discussion. Of equal importance, exploration of art therapy ethics in a digital age is central to addressing or at least clarifying the question—is this art therapy or is it an art class?

*Special thanks to colleague art therapist Kathryn Mierke for stimulating my thinking about this issue that continues to challenge the art therapy community.

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