Open Access
Published: November 2024
Licence: CC BY-NC-SA-4.0
Issue: Vol.19, No.2
Word count: 4,140
About the author
Looking back: How I navigated the online art therapeutic space for the first time
Athena Lucas
Abstract
This reflective essay aims to revisit the creative responses from a trainee art therapist’s research conducted in 2021, at the height of Covid-19, about navigating the online art therapeutic space for the first time. The digital environment presents a reimagined therapy space – a convergence of multiple reconstructions of the physical, virtual, metaphorical, psychological and social experiences embodied by the client–therapist relationship. This essay borrows Judith Rubin’s art therapeutic model, called ‘the interface’, which suggests a step-by-step approach in conducting a session as applied to online art therapy. My personal reflections highlight the similarity of face-to-face and remote art therapy following the stages of the interface: (1) setting the online therapeutic stage by preparing for safety considerations and risk management; (2) evoking expression in a connected environment despite being in separate locations; (3) enabling creation through digital means as a tool and medium; and (4) facilitating reflection within the virtual art therapy space.
Keywords
Art therapy, art-based inquiry, autoethnography, online art therapy, reflexive practice, reflective writing, Covid-19
Cite this reflectionLucas, A. (2024). Looking back: How I navigated the online art therapeutic space for the first time. JoCAT, 19(2). https://www.jocat-online.org/re-24-lucas
Introduction
This essay includes the creative exploration of journal entries, artworks and poetic reflections, as excerpts from a trainee art therapist’s research conducted in 2021 during Covid-19. During the pandemic, the health industry proactively adopted telehealth and virtual therapy on various platforms. Art therapists and art therapy students were part of this response. With limited literature to draw on at the time, I adapted Judith Rubin’s practice framework (Rubin, 2012) to the new online context in my clinical placement.
Taking an autoethnographic perspective, I used art-making as a form of inquiry to respond to the sudden shift to the delivery of health services online. The written reflections were part of my autoethnographic layered accounts, which also consisted of existing literature, art and poetry as multiple sources and representations of my experience (Ellis & Adams, 2014; Saldana, 2011; Van Lith, 2019). Art in arts-based research may be used as a representation of the process and findings, a mode of communication and expression, a product of creative inquiry, and a means of gaining meaning (Potash, 2019; Saldana, 2011). For context, the community I was working with included young adults with complex mental health diagnoses, from different cultural backgrounds living in Australia. The participants had their privacy and safety protected by the exclusion of identifiable characteristics such as names, places and circumstances. I facilitated group and individual art therapy sessions online for six consecutive weeks. Each week, I created an art response with a corresponding poem that extended the interpretation and creative processing of the artwork as raw data (Potash, 2019). I also wrote a journal entry per week to document observations, learnings and self-dialogue (Saldana, 2011; Van Lith, 2019).
Research into the inclusion of digital media in art therapy has actually existed since the 1990s, prior to Covid-19 (Malchiodi, 2018; McNiff, 1999; Miller & McDonald, 2020; Zubala et al., 2021). Malchiodi (2018) addresses the development of digital art therapy, including how it has aided the participation of people disadvantaged by their physical, mental and cognitive conditions in creative intervention (Malchiodi, 2018; McNiff, 1999; Miller & McDonald, 2020; Zubala et al., 2021). ‘Art therapy in the digital world: An integrative review of current practice and future directions’ by Zubala et al. (2021) is a comprehensive literature review of the risks, benefits, ethics, barriers and effects of conducting art therapy sessions online from 1999 to 2020.
I have drawn on established concepts regarding the art therapy space to support my reflections on merging the physical and virtual environments in a therapeutic setting. I returned to the fundamental elements of the art therapy space as conceptualised in Fenner’s and Moon’s studies. Fenner (2019) considers the psychological, emotional and material aspects of the art therapy room, an experience rather than a place, where therapeutic relationships happen as we relate to the environment itself. In the same vein, Moon (2001) describes the poetic quality of the art therapy studio as what people and things inhabiting it make of it. I aim to reconceptualise the digital art therapy space – its physical, material nature, and the metaphorical, psychological quality of a contained yet transforming environment influencing and being influenced by the interaction of everything within it.
The interface: A reimagined space
An interface – a place where things, or people, or people and things (like you and your computer) meet. Any common boundary or area of convergence can be an interface. (Vocabulary.com, n.d.)
The physical and metaphorical space
Judith Rubin refers to the space where art and therapy meet as “the interface, the synergistic core of the work of the art therapist” (2011, p.77). What happens when this interface exists simultaneously in a virtual space in separate locations inhabited by the client/s and therapist converging onscreen?
Figure 1. Athena Lucas, The interface, 2021, digitally enhanced pen drawing, 960 × 540 pixels.
My art response in Figure 1 expresses the sanctity of our living and working spaces as extensions of ourselves, visible onscreen, which would otherwise be kept private in the art therapy room. Moon cites Bachelard’s concept of home as an inhabited place extending beyond the physical space (2001). The interface’s homepage welcomes the clients. It reassures the exclusivity (through passwords) and inclusivity as invited guests arrive, forming a sense of belonging. The metaphor is reinforced as the clients open up parts of their homes while they also reveal aspects of themselves in parallel within the shared virtual space.
Throughout the duration of the online art therapy program, our clients became more comfortable in showing their faces (and the intimate spaces of their homes) with the group. As we got acquainted with technology and mode of delivery, comfort levels increased both for the clients and myself as a therapist. For example, one client started out with her camera shut off but then in the following sessions placed her camera where I could observe her facial expressions, her body movements, her process and reiterations of her artwork. I finally felt invited as a witness, a guest in her personal, inner domain. Arguably, I was conducting a ‘face-to-face’ art therapy session in its essence. The client’s avoidant tendency, social anxiety and body dysmorphia were still at the forefront even in the digital space. In this example, moving to the unfamiliar online space meant working through the anxiety of starting anew and settling in. Appropriateness of technology for specific mental health presentations, as to when it is helpful or harmful, could be an area of exploration for art therapists in expanding virtual therapeutic spaces.
Coincidentally, for this particular client’s artwork, she drew a dioramic view of a room filled with things she did not currently have, such as a dog on a sleeping mat, her artworks on the wall and new console games on the computer table. With all the conflict going on outside, she referred to this room as her world. Moon expounds on Becker’s “imagined space” (2001, p.85) to describe the therapy studio as a nurturing environment fostering creative, imaginative expression. I would like to call the online art therapeutic space a reimagined space, an expansion of our physical, virtual, metaphorical homes into a site of convergence, reconstructed within technical boundaries and the simultaneous interaction of all the psychological elements, as highlighted by Fenner and Moon earlier, taking place within the socio-cultural context of where it is located. The online art therapeutic space becomes the intersection of inhabited virtual worlds as a lived experience, rather than just a place we go to, where people are engaging, evolving and transforming the space as it transforms them.
The interface as a reimagined space does not simply exist within a computer monitor. The online art therapy I conducted was accessed through multiple devices – mobile, tablet, laptop, tv monitor – in separate locations. The spaces within spaces converge into a common place, into one screen of convergence. This is reminiscent of Deleuze and Guattari’s assemblage of a place where social, material, contextual and sensual experiences become interwoven as we actively construct and become part of the reconstruction of space (Fenner, 2019) – alive, organic, and in real time. Technological advancement in expressive therapies conducted within and beyond the screen could call upon critical perspectives from emerging art therapists today on its implications in our practice.
Setting the practical space
Setting the stage is the first step of the interface (Rubin, 2011), wherein I highlight the practical considerations to prepare for the delivery of art therapy online.
Figure 2. Athena Lucas, Layers of masks, 2021, digitally enhanced mixed-media collage, 960 × 540 pixels.
Figure 2 is an art response created on my first day back at my clinical work placement, after being offsite due to lockdown restrictions. Pre-sessions gave me the opportunity to check in with the clients about their current mental state, about technological guidelines in logging into the web platform, and about their comfort levels with devices. I did a risk assessment in conducting telehealth sessions, as outlined in the literature, which included privacy, security, access and restrictions. With less exposure to the danger of contracting the virus, I was reassured that I could also run sessions without a mask if done remotely. I could see my clients ‘face-to-face’, but in two-dimensional form, with our screens acting as a window and a barrier at the same time. For the artwork, I used a mask, a magazine cut-out of a mountain desert to symbolise the desolation of being locked up in our homes, and a transparent sheet on top (not visible) as an additional layer of protection and/or hindrance.
Ethical guidelines and risk management in providing digital art therapy have been a priority among practitioners (Malchiodi, 2018; Miller & McDonald, 2020; Zubala et al., 2021). I had my reservations, because of my lack of experience in holding a safe virtual environment with limited support, yet with growing expectations from clients and organisations, in common with art therapists globally (Zubala & Hackett, 2020; Zubala et al., 2021). There was also the hesitation to come out from lockdown, similar to an art therapist’s reluctance to leave their home after a period of isolation (Lay, 2020). Despite the barriers, I adjusted my program to be delivered remotely, choosing appropriate materials and sending them to clients’ homes beforehand, to aid the extension of setting the stage for them with safe, contained resources. Initial considerations were negotiated with clients during pre-sessions to ease them in. Slowly. Slowly. Gently. Gently.
For a safe, shared virtual art therapy space, a stable, secure online video conferencing platform was organised by my clinical work placement. As a host, I was the gatekeeper of this space, which was password protected. Sending out visual step-by-step instructions made it easier to manage technical issues when clients got disconnected. Following clinical work placement policies, I only conducted online sessions using devices onsite. A private office set up with a desk large enough for art-making, away from distractions and open for creative expressions, provided a containing practical space from which to conduct online art therapy sessions and also for making my own art responses (Fish, 2012) to the online sessions. This separate space and time for reflective artistic practice was an important way of containing and understanding my emotional responses to the work. In the second session, I set up my camera so the group could also see the art materials laid out on my desk space to mimic the creative, inviting ambience of an art therapy studio, despite being within the confines of a borrowed office space. Seemingly trivial details, such as staring at the screen unsure of whose turn it was to speak, breathing loudly through the microphone, spilling water on the keyboard, could have been therapeutically disruptive. But with technology being well integrated in our daily lives, speaking for my clients and myself, these familiar instances became awkward teaching moments instead of disasters.
To ensure a safe online therapeutic space, I have come to apply the following guidelines since I first compiled them during my placement as a trainee. It would be beneficial for any art therapist looking to facilitate sessions online to consider: (a) prior to the session, checking in with the client regarding current mental health state and availability of immediate support; (b) accommodating various levels of engagement and skills with technology; (c) setting up a conducive online art therapy session, with noise and mess management in place and proper access to devices, internet, cameras, materials, desk space, lighting, ventilation; and (d) ensuring privacy, i.e., establishing boundaries of who could be in the vicinity on both ends (ANZACATA, 2020; Biro-Hannah, 2021; Zubala & Hackett, 2020; Zubala et al., 2021).
Setting up the stage also meant holding the space for psychological experiences. At the beginning of each session, similar to face-to-face therapy, I acknowledged everyone’s presence and the different locations they were coming from, mentioning their names, making them aware of the confines of their surroundings and then inviting them to look at each other’s faces on separate windows held within the wider all-encompassing space of the online art therapy session.
Evoking expression in the social space
The next phase of the interface is evoking expression, but how do we do this remotely? During the first online art therapy session, members of the group were invited to express their personal experience with Covid-19 before even attempting to start the structured program. While we were isolated due to the lockdown, restricted within our homes, trapped within the four corners of our screens, I observed that we were still present with each other, socially connected within the online art therapeutic space. Week after week, we bonded through common narratives in mental health and the effects of Covid-19. This serves as a testimony to what the research in community art therapy prior to Covid reiterates – that therapeutic goals could be achieved online by connecting authentically, building resilience through each other’s support, and witnessing expressions of a shared experience despite being separated by accessibility, mobility or disability (Biro-Hannah, 2021; Malchiodi, 2018; Miller & McDonald, 2020; Zubala & Hackett, 2020; Zubala et al., 2021).
Figure 3. Athena Lucas, Separate yet connected, 2021, digitally enhanced mixed-media collage, 960 × 540 pixels.
Figure 3 is a digitally manipulated artwork I created in the presence of clients during one of our online art therapy group sessions. With the impact of Covid-19 as a global pandemic, we were navigating a new normal of rising death tolls, statewide lockdown, strict social-distancing laws, limited access to day-to-day services, and socio-cultural shifts in all aspects of society. Engaging in visual and verbal expressions unintentionally became my outlet for personal musings and ruminations. For the artwork, I used a fibre string to create a spider web and pompom balls to resemble the Covid-19 coronavirus. During the process of art-making, I was intending to trap the virus and to eventually get rid of it, but I realised that the web, with its obvious association with the terms ‘world wide web/internet’, became a safety net for the individuals in the group, weaving through the direct and indirect effects of the pandemic. The relational exchange of common experiences, struggles and coping strategies brings a sense of hope, autonomy and resilience (Biro-Hannah, 2021; Miller & McDonald, 2020; Zubala & Hackett, 2020; Zubala et al., 2021). Within a social space, the spider web in my artwork resonated with the clients’ images, including octagonal-shaped rooms and crochet pieces. We were physically distanced yet socially connected. Unlike doing group therapy in person, a shared screen actually allowed participants to witness each other’s process with strategic placement of the camera to view the art, the art-maker and the art-making. Group resonance became more apparent with the similarities in themes, use of materials, creative techniques and styles, or the outcomes themselves (Biro-Hannah, 2021; Miller & McDonald, 2020). The group was not just passively watching each other do their art, but witnessing each other’s presence through artistic explorations.
Enabling creation in the virtual space
While the discussion of digital art therapy as a medium exceeds the scope of this essay, I went through the next phase of the interface, which was enabling the clients’ and my own creative expression within the virtual space. This allowed for experimentation with digital media and using online tools to display the process and product of art-making in a therapeutic context.
Figure 4. Athena Lucas, Expansion, 2021, digitally enhanced oil-pastel drawing, 960 × 540 pixels.
Figure 4 is my art response to when I was encouraging the online art therapy group to make use of materials they had not tried before, from the art kit sent out prior to the program. The kit included basic resources such as drawing and painting materials, tactile craft supplies, glue sticks and rubber erasers. Some participants chose to create digital art using their tablet devices. I had to sit with my feelings of insecurity for my lack of confidence in illustrating or painting digitally. Having worked as a designer in my previous career, one would think that I was already an expert, yet new technologies come out each year and I found myself always playing catch-up. Seeing clients explore more options using digital media, which would otherwise be limited with traditional media, inspired me. Clients expressed that by using a digital application, they could make mistakes and were able to ‘undo’ as many times as they wanted. The literature discusses the advantages of the therapeutic quality of digital media to modify, save multiple copies, share and go back to the history of both process and product, thus allowing for mistakes in a transportable, mess-free environment (Malchiodi, 2018; McNiff, 1999; Zubala et al., 2021). A client reflected that with a drawing application, he had more choices and a sense of control. Unlike the others, one participant took feathers out of the art kit to make a collage artwork. My immediate art response was to draw patterns of feathers using my go-to material, oil pastel, as I myself also wanted to be ‘free as a bird’. I worked on my art response more after the session and experimented on my oil-pastel drawing using a computer software program. I ended up with a series of highly saturated images, as if pushing the limits of technology’s capabilities both as a tool (with the devices used to scan the original and upload to a program, which was another tool in and of itself) and a medium (with the filtering options to digitally paint the original).
Resistance to using and delivering through technology-based mediums is a recurring response of the art therapy community, with issues such as lack of training, confidence and evidence in practice (Malchiodi, 2018; McNiff, 1999; Zubala & Hackett, 2020; Zubala et al., 2021). Personally, having worked in the digital industry, I have my own internal conflict, with a strong desire to go back to traditional mediums after producing digitally manipulated designs as a job. I did not expect that I would revert to computer graphics, as inspired by clients using free digital applications on their tablets during our online art therapy sessions.
Reacquainting myself with Photoshop, a graphic editing program, I realised that there was more expansion than restriction in using it. As McNiff describes, Photoshop has “expressive transferability and similarity to conventional painting processes” (1999, p.198). Seeing the stages of transformations before my eyes immediately reflected my own processing as I reclaimed control within the limitation of conducting remote therapy. The digitally enhanced drawing of wings (Figure 4) captured this spreading out as I expanded my options. Aesthetically, the artworks in the research, which this essay is based on, became more cohesive through the use of similar styles of digital manipulation.
Facilitating reflection in a psychological space
For the next part of the interface, I looked into how the psychological space occupied within the online art therapy session could facilitate reflection between the client/s and the therapist.
Figure 5. Athena Lucas, The virus, 2021, digitally enhanced alcohol ink painting, 960 × 540 pixels.
Figure 5 is an art response made during the last session of the online art therapy program. It was my way of illustrating the interruptions that occurred throughout all the sessions. I actually reused an artwork that I had created when I decided to postpone returning to my clinical work placement. Even though there was a possibility of conducting remote art therapy, there was (a) fear of being infected by the virus and (b) fear of the difficulties and the possible failure to engage online. Manipulating this image digitally by inverting the colour brought the photo negative of the same image into light. The frequency of technical issues and cancellations, and the symptoms of mental illness being exacerbated by the effects of Covid-19 and the lockdown were almost unavoidable. But at each succeeding session, I found it easier to navigate through these disruptions and was able to adjust in real time, while continuing to hold a therapeutic space.
I learned that the art therapist in the online art therapeutic space has to maintain an active facilitation with multiple communication channels going on simultaneously, while accommodating for limited facial expressions and body language, having a back-up plan during technical difficulties, and constantly checking the safety of people in the environment when it becomes less stable (ANZACATA, 2020; Zubala & Hackett, 2020; Zubala et al., 2021). Examples of these are outlined in the earlier sections. Expanding on what Rubin (2011) describes as an art therapist having a third eye or a third ear, active facilitation also means being attuned to the felt sense that is being transferred beyond the audio and the visual onscreen. During one of the sessions, a client quickly scribbled words associated with loneliness and feelings of isolation using coloured markers. With nothing else to do but to stare at the monitor, she was invited to continue with her art-making. At a much slower pace, she made a window; inside it she drew a sunny field at the top and, at the bottom, a wolf looking out to the moon. She shared that, during the lockdown, she could not tell day and night apart anymore. What was reflected in her artwork was a collective sense of disorientation expressed in the group discussion. She described the wolf as howling ‘help me’ to the moon. She was reassured that it was ok to ask for help sometimes. And that she was being heard. Being seen. Being felt.
Active facilitation before and after sessions was just as crucial in preventing further cancellations and escalation of distress. Throughout the duration of the program, I wondered whether it was easier to cancel a therapist’s appointment online than in person. Walking out was easier with just the touch of a button, after all. In one of the sessions, a client found it difficult to follow the verbal instructions due to surrounding noises, which was made worse without the hands-on guidance in a face-to-face art therapy. She disconnected and turned off completely. And while I was able to check in over the phone in the end, she momentarily shut down both virtually and psychologically. To repair the rupture, simplified instructions and demonstrations were shared onscreen in the succeeding sessions. Emergency contacts from the therapist side and client side were made available prior to the session. Heightened attunement to compensate for the lack of in-person interaction, quick responsiveness to potentially anxiety-inducing technical glitches and creative flexibility allow art therapists to adapt to clients’ immediate needs, the disruptions and interruptions in therapeutic relationships, the here-and-now demands of the space and the challenges of the current socio-cultural context (Miller & McDonald, 2020; Zubala & Hackett, 2020).
The fundamental aspects of the art therapy session – the materials, the environment, the therapeutic alliance of the therapist, the client and the artwork, and the practice itself, being a psychological phenomenon (Fenner, 2019; Lay, 2020; Moon, 2001; Rubin, 2011), are still maintained whether it exists within the physical or virtual realm.
Conclusion
Looking back on how I navigated the online art therapeutic space for the first time, I realised that responding to the circumstances of wherever the therapy is situated, online or offline, means ‘being with’, present and engaged in the internal and external experiences of art therapy. As we have adapted to delivering remote art therapy since our collective Covid-19 lockdown experience, we have learned that, though clients and therapists are physically distanced, we are socially connected in the online environment; far from escaping reality, we are in a real, authentic interaction.
Reimagining the online art therapeutic space using Rubin’s interface could provide a basic framework for emerging art therapists to set safe converging virtual spaces, to evoke expression in a supported online social setting, to enable creativity with digital technology as a tool and medium, and to facilitate reflection in repairing the recurring ruptures in remote art therapy. By considering not just the practical but also the psychological phenomena situated within specific socio-cultural locations, online art therapy is a mode of delivery in its own right extending beyond the Covid-19 pandemic.
While my work was mainly focused on community mental health, a number of sources in the literature include accounts of the efficacy of delivering online art therapy in various settings. Therefore, more evidence-based research with people of different physical, mental, cognitive and psychological conditions, in different stages in life, and in different contexts such as natural disasters and war zones is warranted (Malchiodi, 2018; McNiff, 1999; Miller & McDonald, 2020; Zubala & Hackett, 2020; Zubala et al., 2021).
Moving forward, 21st-century art therapy has stretched its arms to embrace technology-based mediums, electronic communication and social media as legitimate platforms for conducting, assessing, sharing and viewing art, to go along with the rise in use of the internet and telehealth in therapy, counselling and education (Malchiodi, 2018). May the art therapy community continue to contribute to the growing insights on integrating current and future advancements in technology (i.e., online gaming, virtual reality, artificial intelligence) into our therapeutic practice.
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Author
Athena Lucas
MATh, MMAP, BDes, AThR
Athena is an art therapist from Sydney, Australia. Her educational background includes arts, design and media prior to pursuing a career in art therapy. She worked as a creative designer in the advertising world for many years while facilitating art groups in the community. Athena is currently working as an art therapist in both private and public mental health hospital settings in Sydney. She remains connected with her heritage by being a part of The Arts and Health Institute in the Philippines offering therapy and training services, both online and in person.