Celebrating 20 years. This article appeared in the ten year anniversary issue – ANZJAT, volume 10, number 1, 2015.
Open Access
Published: September 2015
Issue: Vol.10, No.1
Word count: 3,476
About the author
What’s our impact? Transforming art therapy through connectivity, action, and research
Lynn Kapitan
Abstract
What are the implications for the field when art therapists put connection, action, and impact at the front and centre of all their efforts? Collaboration and rapid dissemination across interconnected groups offer tremendous opportunities to transform art therapy knowledge directly into action. This article argues for strategic use of the ‘ripple effect’ to multiply art therapy impacts across time, distance, and cultural differences. The author proposes an art therapy research paradigm that is rooted in practices and communities instead of philosophies or orthodoxies of methodology. In such a paradigm various sub-communities of art therapy would be understood to exist within different subject areas, orientations, and research traditions. Intentional interaction with diverse standpoints, identities, and sociopolitical experiences will dissolve long-standing barriers and transform knowledge.
Keywords
Collaboration, research, research paradigm, multiplier effect, strategic action, cultural diversity, art therapy
Cite this articleKapitan, L. (2015). What’s our impact? Transforming art therapy through connectivity, action, and research. ANZJAT, 15(1), 21–27. https://www.jocat-online.org/a-15-kapitan
Introduction
‘Embracing Ripples of Growth’ was the theme of the LASALLE College of the Arts/The Australian and New Zealand Arts Therapy Association’s 2014 symposium in Singapore that engaged international critical reflection on the discourses of contemporary arts therapy research and practice. Ideas presented in my keynote address (published herein) were drawn from experiences shaped by my 30 years as an art therapy educator, researcher, consultant, activist, and editor of a leading scholarly journal in art therapy. I asked, what are the implications for the field when art therapists put connection, action, and impact front and centre in all their efforts? My hope is that the ideas that follow will continue to inspire reflection and knowledge-sharing in the field.
Confounding art therapy research
I begin with an anecdote that occurred just weeks before the symposium. One day, an art therapist I will call Lisa was reading an issue of Art Therapy: Journal of the American Art Therapy Association. She happened across something I wrote in an editorial, which posited that if “more art therapists [were] documenting outcomes with a standard measure before and after treatment and publishing the results, we would have a much stronger case on which to base claims” (Kapitan, 2012, p.48). Lisa thought, “Well, hey! I have some evidence. My hospital is collecting data from patients as part of a standard protocol they use to evaluate the art therapy program in order to keep funding it.” The hospital’s measure, called the Distress Thermometer (Baken & Woolley, 2011), had cancer patients rate the level of their distress before and after an art therapy session. Data had been collected for six months of art therapy programming in four distinct delivery methods: (a) individual art therapy, (b) group art therapy, (c) informal encounters with art therapists in the waiting room, and (d) the weekly open studio. But it seemed that no-one had analysed the data! The evaluations were just taking up space in the hospital files. So, Lisa decided to gather them up and crunch the numbers with the help of a statistician. Remarkably, she found statistically significant evidence that art therapy was effective across all four formats. It didn’t matter how art therapy was delivered; art therapy had produced effective outcomes in lowering self-reported patient distress. Lisa decided to write up her results and submit them to Art Therapy in order to share them with others in her profession.
And the response of the peer reviewers who evaluated the paper for possible publication? To paraphrase their professionally worded, detailed feedback: “Yikes!! What kind of outcome study is this? No control group! Convenience sample! Too many variables and confounds! Self-report is a weak measure – use something more robust! You can’t possibly generalise this!”
What had happened? Lisa had submitted an evidence-producing outcome study, which many art therapists assert the profession desperately needs. Certainly, Lisa’s was not a perfect or even a great research design. But here was a practitioner scooping up real, live, on-the-ground art therapy data from real patients (not undergraduate students in a psychology course or research lab somewhere). As Lisa later explained to me, “I’m not a research lab; I don’t have any funding or help to do this. I’m just an ordinary art therapist with information that other art therapists might build on and use to create a ripple effect”. Even a small or imperfect research study, when precisely focused on demonstrable benefits, can jumpstart a whole movement of interacting demands for art therapy services in different quarters (Kapitan, 2010). But the peer reviewers seemed disappointed with the fact that Lisa’s study wasn’t the beautifully elegant, randomised controlled clinical trial – that ‘gold standard’ of science – we’ve been conditioned to desire above all else.
Decentring the research discourse
Lisa had bumped into an old narrative in the profession. Historically, the art therapy world has been configured around the binaries of art and therapy, artistic versus scientific knowledge claims. Over the years this narrative has been refined, but, I believe, not much changed. As discussed in a recent article (Kapitan, 2014), art therapists have long engaged questions of ‘where is the art, where is the evidence, and how does one acquire that evidence?’ – whether through science or clinic or studio. While writing the textbook Introduction to Art Therapy Research (2010) one of my first challenges was to sort through all the contested claims and counterclaims regarding how art therapy knowledge is created. I created a simple diagram (Figure 1) to show the focal interests of art and therapy on one axis and approaches to knowing (scientific or artistic) on the other. For example, much of the research in the USA has been in the upper left quadrant of Figure 1, which is perhaps best characterised by art-based assessment. Art is used to collect data for the purposes of prediction and control. In contrast the upper right quadrant is also focused on art but via the path of artistic knowing. Here, I would argue, is where much art-based research is located. Research that examines the therapeutic aspects of art might be located in the lower right quadrant, whereas evidence-based outcomes research, which is guided primarily by scientific knowing, would be identified with the lower left quadrant (Kapitan, 2014).
Recently, Kaiser and Deaver (2013) conducted a study to find out what a panel of experts, comprised of 20 prominent art therapy researchers in the USA, thought were the most important questions and areas of art therapy to investigate with research. Figure 2 suggests how the researchers’ responses might be plotted on the diagram. There still is an emphasis on research directed at developing art-based assessments and also a growing interest in evidence-based outcomes studies (lower left quadrant). However, the artistic ends of the spectrum are not represented in the research questions and areas these researchers believed were most important to the field. Art does not appear as contributing something of value or importance to the research agenda. Is this perception a reality for the field at large? Or is it bias? If we art therapists hold such bias, what are we not seeing? What important research questions are we not asking?
I believe that we can overcome long-standing biases and limitations in research discourse by standing in different places in this terrain and reflexively entertaining diverse perspectives that might bring more of what art therapists are not seeing into view. In actual practice, of course, research is not as simple as delineated in this diagram; the divisions are much fuzzier than suggested by the literature. Research lives in a dynamic, ever-changing landscape. Research is like a river flowing with potential benefits, where a little study like Lisa’s hooks a little fish that, in turn, attracts a larger fish to nourish many people (Kapitan, 2010). Our investigations are like one or many stones thrown into the constantly moving flow of human knowledge. Each art therapy contribution creates a ripple effect that may influence the thinking and creative ideas of other art therapists – some who might use a study as a stepping stone toward describing a larger pattern of evidence or to create shifts and new standpoints from which to practice.
Figure 1: Art therapy research and knowledge claims.
Figure 2: Research agenda aligned with knowledge claims.
Figure 3: Dynamic intersections of research and practice.
Figure 4: Re-positioning of research to construct new knowledge claims (DeLucia, 2015; Haag, 2015; and Klorer, 2014).
Art therapy as communities of practice
To get out of the old binaries, it might be useful to think of art therapy not as a unified profession but perhaps more pragmatically as a complex social landscape that contains many, many communities of practice (Kapitan, 2014). A community of practice – yours and mine – is a group of people who share a common sense of purpose and who connect their practices, resources, and perspectives into a diverse knowledge base that informs their work (Wenger, 2008). Art therapy, I have recognised,
has wonderful richness in its practices, boundaries, peripheries, overlaps, connections, and encounters. We might imagine many encampments all along the river of knowledge, like art therapy villages having their own histories and local characters. The river itself [has] its currents and shallows, deeper pools and landings [...] Clearly, what you take as knowledge and how you think and practice is the product of many interactions in the terrain. (Kapitan, 2014, p.12)
A single art therapy practice within a community of practice is necessarily influenced by its surrounding contexts of culture, language, institutions, ethics, supervisory relationships, regulators and other public policy concerns, client outcomes, other professionals, and so on. We can complicate the practice reality even further by locating the art therapy landscape in the twenty-first century, in which art therapy also intersects with the fluid realities of the internet and social media, online networking and learning communities, online client communities, and myriad other complexities (Kapitan, 2014). As it continues to migrate around the globe and become intertwined with distinctly local cultures, moreover, we may come to understand that art therapy can no longer be conceived as a single profession. Rather than a professional role or identity, what may define art therapy in the future is a common sense of purpose, brought by people coming together in the dissolving boundaries of an increasingly globalised world.
Wenger (1998) identified three ways to identify with a community of practice: (a) through one’s own engagement, (b) by imagining the places and positions of others, and (c) by re-aligning or positioning oneself with particular discourses. Each mode calls attention to one’s standpoint or position in the landscape, one’s trajectory through it, and the ways in which one may hold multiple memberships or identities. For example, we can nurture professional identity by engaging more deeply in our daily work of art therapy or by committing to making a difference for clients in the local milieu. Via the second mode – imagining others – we can traverse geographic, theoretical, methodological, and other boundaries and push beyond current limitations by entertaining new or different perspectives. With the third mode, of realignment, art therapists can build a career trajectory through the art therapy landscape by relocating or reinventing themselves as the situation requires. In this way,
professional knowledge is not a thing but a dynamic that arises from how people live in their landscape of practice. How we inhabit art therapy is material to the sort of professional we become and the identities we have. Whenever we get together to discuss theory, practice, or research, what we are doing is negotiating and presenting different parts of the landscape to each other and persuading one another of its importance. (Kapitan, 2014, p.16)
A dynamic art therapy research paradigm
Thinking of research, then, how might we as art therapists open our minds to this incredible twenty-first century world of flux and change? What if we conceived a new paradigm for art therapy research? Such an invention would have to be sufficiently flexible, permeable, and multi-layered for these times, as well as being able to accommodate the inevitable variations and inconsistencies in art therapy ideas and practices throughout the world. Back in 1965 when Kuhn coined the term ‘research paradigm’, his definition did not emphasise methodology as is common today. Instead, a research paradigm was defined as centred on three characteristics: (a) mutual engagement in specific problems or issues to advance knowledge, (b) shared practice and understandings about appropriate research techniques to address those issues, and (c) a shared researcher identity that is reinforced through exchange and networks (Kuhn, 1970). Additionally, all these activities operated in a research paradigm by connecting to multilevel, overlapping, and potentially fluid communities on various levels.
Interestingly, these same four criteria that define a research paradigm precisely map onto the notion of art therapy as ‘communities of practice’ rather than as a single profession. I argue that if we rooted our research agenda in practices and communities instead of philosophies or orthodoxies of methodology, an array of possibilities would present themselves with respect to where art therapists put their focus and choose to construct knowledge and create greater impact. In such a paradigm various sub-communities of art therapy would be understood to exist within different subject areas, different orientations, and different research traditions (e.g., post-positivist, constructivist, historical, etc.).
In a community of practice, research and practice can be one and the same. Research can inform one’s practice; practice can inform one’s research. Figure 3 illustrates this idea of cross-fertilisation. Moving in the direction of research for practice, we can investigate art therapy to develop evidence-based practice; with research into practice we are able to create practice-based evidence. Both these positions turn practice into an object of study. Movement in the opposite direction, however, positions practice not as an object but as a research method; that is, research through and as practice. The kinds of studies produced in this way include participant research, participatory research, action research, and participatory action research among others. When leading with art practice (i.e., practice-led research) we produce art-based research.
The following are four examples of how research can be dynamically positioned within a community of practice paradigm (Figure 4). The first is the doctoral research of Jonathan Haag (2015). Over the course of many years, Haag utilised Silver’s (1993) Draw-A-Story (DAS) assessment in his clinical practice. The DAS is one of the oldest and most independently validated art-based assessment for various clinical conditions (see e.g., Earwood, Fedroko, Holzman, Montanari, & Silver, 2005; Kopytin & Lebedev, 2013; Silver & Ellison, 1995). But Haag was not interested in Silver’s assessment as a means of clinical appraisal or research measure; as a practitioner he valued the DAS for its tremendous value as a creative tool in art therapy. His research re-conceptualised the DAS to document its therapeutic effects in actual, real-life practice. For his study, Haag invited client participants to recreate their DAS drawings in a stop-motion video, along with an added voice-over in which clients told the narrative of their stories in their own words. The participants worked with the DAS creatively in therapy, then re-created their DAS drawings in the medium of a video. Finally, they viewed their video in a subsequent therapy session. The entire process produced a ‘ripple effect’ that transformed the participants’ therapy.
Haag’s (2015) study is a dynamic re-positioning of a traditional art assessment that can promote scientific knowledge, to that of a creative tool producing verifiable therapeutic outcomes. New knowledge was created, first by drawing from the researcher’s understandings, beliefs, and attitudes to pose new possibilities for an old idea, and then by organising and re-shuffling these ideas into coherent patterns. Having re-contextualised old patterns and ideas into new ones, assimilation and/or accommodation become possible. Haag produced new knowledge about the therapeutic use of the DAS through re-purposing the assessment’s established function and testing out the validity of the new ideas produced. Dissonance between established and newly created ideas, insights, and outcomes was resolved through realignment and repositioning of art therapy values and practices.
The research of DeLucia (2015) is a dynamic example of what happens when an evidence-based study crosses into participatory practice. DeLucia found that most knowledge about art therapy with veterans comes from evidence-based treatments of post-traumatic stress. However, her art therapy work with combat veterans is aimed at veterans’ struggles with re-adjustment to civilian life. DeLucia decided to acquire evidence of art therapy’s effectiveness by directly involving USA combat veterans who were clients to participate as co-researchers in her study. The client-veterans documented their own outcomes from art therapy as evidence of what approaches worked best in their treatment.
Another dynamic example is an art-based research study conducted by Klorer (2014) after discovery of an old newspaper clipping in an abandoned building that inspired artwork about her family’s and local history. Collaborating with a local natural history museum, Klorer playfully hid her art works (many of them altered books and sculptures) throughout the library where patrons would come upon them unexpectedly. The library, in turn, sponsored community workshops for people who were researching their family histories. Exposure to Klorer’s artworks inspired the workshop participants to incorporate art-based research into their own family projects. Klorer’s study was grounded in artistic knowing but crossed over from her own art-based inquiry to a form of community art therapy, which created a ripple effect that impacted more than 500 people.
As a final example, for over a decade I have been involved in collectively organised action research to address the effects of trauma in Nicaraguan communities (Kapitan, Litell, & Torres, 2011). My collaborators are explicitly organised as a community of practice to address common needs. Initially they invited me to incorporate art therapy into collective research projects that were being conducted by 30 to 50 local community leaders. They, in turn, multiplied their research knowledge by sharing it with people in their local communities and using art therapy to assess what they needed and how to go about it. Where once there had been no art therapy, and art-making itself was relatively unknown or under-utilised, today over 1000 people are using art therapy in over 20 research projects all over Nicaragua.
In our study, community participants generated local, grassroots knowledge and societal impacts that expressly addressed social justice concerns. As ‘ordinary people’, community members are continuing to transform knowledge through research in just the ways I am describing here. Acting on “a universal right to participate in the production of knowledge” (Freire, 1997, p.xi), such research collectives are being organised throughout the world by disenfranchised or marginalised people. Those of us who are interested in research to inform art therapy would benefit from connecting with these communities of practice, given the latter’s emergence as leaders in transformative research. Thus, we might recognise the fundamentally collective bases of learning and research, which is to say that the knowledge we acquire is always shared knowledge; the process of acquiring it is through participation and shared practice. Research does not exist in isolation nor hew to a singular place or hold up the perfectly generalisable research design as a community’s only valid model. Rather, research is conducted in collaboration with and through relationships with the people who are closest to the problems and critical questions, yielding new, innovative thinking and solutions.
If art therapists were to conceive of art therapy research within communities of practice, the differences and inconsistencies in the art therapy discourse would quite possibly no longer be a problem. This is because communities of practice can provide a research paradigm to accommodate all the ways art therapy is used and the variety of motives that art therapy researchers have. Rather than treat research design decisions as purely individual, or even entirely rational, we would accommodate the ‘social’ real-world art therapy factors that influence research frames and methodological choices.
What’s our impact?
In the world today, people are continually exposed to the principle of connectivity: the rapid exchange of knowledge and ideas that is increasingly internationalised, diverse, and interdependent. Why not make better use of it, especially for a relatively small field like art therapy where our efforts are dispersed across different geographic and cultural locations? The ripple effect of these exchanges produces growth and change as it carries knowledge across time, distance, and cultural/disciplinary differences. Collaboration and rapid dissemination across interconnected groups offer tremendous opportunities to transform knowledge directly into action.
Imagine what art therapy would be like if every art therapist asked the question: ‘What’s my impact – not just for one’s own clients but for every art therapist’s clients and toward a better, more just world?’ The problem, I’ve observed, is the temptation to say no. We might say, ‘oh, I’m an art therapist, not a researcher’ or ‘oh, I don’t have time. I don’t know how I’d go about it’. But take another look at your clients and consider: what if they are the world’s researchers and change agents? Research that multiplies impact and creates change is highly valued among the very ordinary people I have collaborated with, despite living in one of the poorest countries in the world and suffering from traumas, poverty, and economic despair. They are committed, socially engaged researchers. They, more than anyone, could be forgiven for not having the time, resources, money, skill and knowledge, influence or power to make change and increase impact. But that is not the case. They are doing the work of knowledge construction and transformation. They are claiming their voices and making research a priority despite having little expectation of success.
It is time for us to dissolve the barriers and learn to maximise art therapy impacts in the world. When research moves beyond individuals and into the wider world, its effects are multiplied and transformed by interactions with diverse standpoints, identities, and sociopolitical experiences. Thus, we come to know much more about the world than we could possibly access solely through our own art therapy practices.
Author’s note
This article was presented as the keynote address at the LASALLE College of the Arts/The Australian and New Zealand Arts Therapy Association’s International Symposium – ‘Embracing ripples of growth: An international critical reflection on the discourses of contemporary art(s) therapy research and practice’ – held in Singapore, 31 October to 1 November 2014.
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Author
Dr Lynn Kapitan
PhD, ATR-BC
Lynn is Professor and Director of the Professional Doctorate in Art Therapy at Mount Mary University in the USA. She is the former editor of Art Therapy: Journal of the American Art Therapy Association, Past President of AATA, and author of Introduction to Art Therapy Research. She has taught graduate art therapy for 25 years, having co-founded master’s and doctoral degree programs at Mount Mary and a vibrant professional community. Lynn has worked with a wide variety of groups and people over the years. She currently practices cross-cultural community art therapy, primarily as a pro bono research consultant for arts and non-governmental agencies in the USA and Latin America. An art therapist activist, her research interests have been in the evolution of art therapy as an emancipatory artform for social transformation. She has presented nationally and internationally on the global reach of art therapy as intersecting communities of practice, and has published numerous editorials and peer-reviewed papers. Lynn’s latest article, entitled ‘Social action in practice: Shifting the ethnocentric lens in cross-cultural art therapy encounters’, has just been published in Art Therapy.