Essay: The Promise and Problem of Art Therapy in Schools

Essay: The Promise and Problem of Art Therapy in Schools

by Day Parker

Introduction

Schools have a greater responsibility than simply banking knowledge, for the sake of the future they must also enable students to thrive socially, emotionally, and culturally. In their 2019 work, All Students Must Thrive, Howard et al. advocate for schools to promote critical wellness in their students. Critical wellness is a framework for educators that is underpinned by wellness, critical pedagogy, and critical race theory (p. xx). How we teach, intervene, and discipline students must be trauma-informed and culturally responsive. Young kids must engage with topics of justice, diversity, and identity for them to be well. They must also be humanized through their school experience, a key component of which is developing knowledge of self. Children who do not have the opportunity to learn about themselves, whether through teaching or experience, will “fear what they do not understand, and they hate what they fear- themselves” (p.127). School professionals and researchers are seeking effective ways to bring about this humanization and critical wellness. This paper will argue that the process of artmaking could be one piece of that puzzle. However, if it is not done through a critical lens, it may fail at maximizing its potential to meet the child's holistic needs.
One method that has been gaining popularity to promote wellness in schools is the use of arts-based therapies (ABT). ABT sets itself apart by relying on creative expression to help facilitate the therapeutic practice. It has been used in a wide range of cases but is most often used to benefit the mental health of students and address the emotional impacts of trauma. Compared to other forms of therapy, ABT feels less intimidating and may even be considered fun by the students (Deboys et al., 2017). Depending less on verbal communication, ABT can be especially useful when working with youth who may not have the vocabulary or ability to express how they feel.
While ABT has done tremendous work within schools, there are several caveats that should be considered when one wants to use this power of art to help students. It may be the case that art therapy is not the best approach. As detailed below, there are tensions within the body of research as well as problematic underpinnings to its psychological and psychiatric foundations. At a time when educators need to be more culturally responsive, our interventions within schools must also reflect that. ABT is not concerned with the socio-historical context of its patients, rather it focuses on pathologizing the individual. This form of therapy may promote wellness, but it falls short of promoting critical wellness.
This does not mean that the use of art for growth and healing should be tossed out, in fact, one could argue that youth need it now more than ever. Future work can be informed by ABT but must be accountable to the whole student and its own history. Currently, there are emerging paradigms that intertwine the transformative nature of art with critical youth studies, called critical arts pedagogy (Wright, 2020). Integrating this into youth-led participatory action research could address the shortcomings of ABT while further empowering youth. There is great potential for this to be used to foster critical wellness and social transformation within schools, communities, and beyond.

Arts-Based Therapies (ABT) within Schools

Art can be the bandage that helps invisible wounds heal. Arts-based therapies, sometimes referred to as creative arts therapy, tap into the creative, expressive side of an individual for the purpose of recovery and growth. This form of therapy can take on many different forms depending on the medium that is used. Visual arts, such as painting, maybe the first to come to mind, but under the larger umbrella of ABT music, drama, and writing can also be implemented for the patient’s expression. These forms of therapy have been growing in popularity, seeing use in a multitude of contexts for a diverse range of populations, psychological conditions, and social-emotional improvements (Davis, 2020; Deboys et al., 2017; Esterline, 2021; Frydman et al., 2022; Moula, 2020; Moula et al. 2022). There is much promise in its power to help individuals, particularly youth who may lack the verbal means to fully express their inner worlds. This has led to it becoming increasingly popular in school-based settings within the past couple of decades. This section will cover some of the most recent literature reviews on the application of ABT within schools and detail some of the benefits of its use.
Frydman, Hyman, and Caputo (2022) evaluated the quality of school-based interventions that used creative arts therapy. Their findings agree with the work of others that while it can be said there are psychosocial and behavioral improvements for the students, there does exist a need to reduce biases, expand the evidence base, and diversify methodological approaches. These obstacles make it difficult to generate broad-based claims on creative arts therapy’s efficacy. One way to accomplish this would be through narrative-style publications that focus on the child’s experience. Despite all of the studies involving art, no study was found that evaluated arts-based data. The authors also suggested enhancing the rigor of the quantitative aspects and creating a systematic approach to design, data collection, and analysis so that the adoption of creative arts therapy may be data-driven.
In another systematic review, Moula (2020) concludes that art therapy is effective in improving children’s quality of life, but there exists a number of concerns around bias, risk, reporting, the administration of therapy, and long-term effects. Future efforts need to take into consideration the therapist’s positionality and any other parameters that might affect the intervention’s effectiveness. The author advocates for a more pluralistic understanding that accounts for first, second, and third-person outcomes. This study focuses solely on experimental design studies which are less common compared to the body of qualitative and case study research that exists.
The nonverbal elements of ABT lend themselves to be evaluated with arts-based techniques. Moula et al. (2022) conducted a randomized controlled study that focused on the child-centered qualitative and arts-based outcomes that resulted from a number of creative arts therapies (art, drama, dance, and music) treated as one domain. Art therapy provided significant improvements in children’s mental health. This study was noteworthy in that it was validated through quantitative, qualitative, and arts-based data- all of which were grounded in the children’s perspectives. The children verbally and artistically expressed that their mental health and sense of well-being improved. The authors linked their findings to several theories including self-determination, self-actualization, and empowerment theory.
ABT has also been implemented in special education settings. Malhotra (2019) conducted a case study with a 16-year-old African American female who was diagnosed with Autism Spectrum Disorder (ASD). The researcher conducted a puppetry intervention that consisted of just twelve 30-minute sessions. The student would make a puppet with the guidance of the art therapist and would then take part in unstructured, client-directed playtime with the puppets. The results indicated an increase in emotional empathy. Though more research is needed, puppetry-based art therapy may be a way to help promote emotional empathy in adolescents with ASD. If effective, this could become a strategy for helping students in special education grow emotionally and socially. This may also be effective in developing empathy for all students.

ABT for Queer Youth

Queer and transgender communities experience higher rates of mental illness than their cisgender peers. According to The Trevor Project, in 2019 54% of transgender youth reported having seriously considered suicide in the past year (Gender-Affirming Care for Youth, 2020). Presently, there is a lack of research surrounding how art therapy may specifically benefit queer and transgender youth. Through a heuristic study, Esterline (2021), who identifies as transgender, evaluated how art therapy may assist youth in articulating their internal world. Sometimes language lacks the ability to convey the feelings that one experiences and challenge systemic norms that increase that difficulty. Art therapy resists assimilation by operating outside the confines of verbal language. It also allows for exploration outside of binary thinking. The researcher calls for not only more research into this area but also more representation of the LGBTQ+ community within the mental health professional field.
Art has tremendous use in describing the undefinable. Here, Davis (2020) details some of the best practices as a therapist when working with members of the transgender community. The focus of this study is on mental health and is informed by psychology. However, Davis encourages therapists to be culturally responsive and to depathologize their work. This can be accomplished by asking young artists to demonstrate personal agency and self-definition. An example is offered through a case vignette, where art therapy was employed to help transgender youth overcome their feelings of isolation. A noteworthy concern that has not been mentioned in other articles is the potential for danger when this work is done publicly. One benefit of ABT is its confidentiality. While increasingly celebrated, transgender youth are currently under attack and face countless forms of oppression.

Issues Surrounding ABT

Though ABT has been shown to promote significant improvements in self-esteem, confidence, and mental health, some skepticism can arise when the studies almost exclusively report positive outcomes (Moula et al., 2020; Moula, 2020). Despite its praise and adoption within school settings, ABT as a scientific field is far from perfect. For instance, there are numerous tensions regarding bias and validity surrounding ABT (Frydman et al., 2022; Moula, 2020; Rolling, 2010). Though its principles show promise, there are also some considerations that may inadvertently harm students. As the body of research grows it is vital that the interests of dominant groups do not spoil the transformative power of artmaking.
Talwar (2019) critiques art therapy for its foundations in the fields of psychology and psychiatry, both of which have an entangled past with the eugenics movement. Work is still being done to uproot the deficit-based foundations within them and art therapy. This extends beyond physical characteristics, in the 19th century the artistic expression of the mentally ill was used to diagnose, criminalize, and pathologize the individuals. The aspect of art in art therapy was discarded early on to adopt psychoanalysis. Researchers and therapists need to acknowledge the colonial discourse and dangerous precursors that informs their practice. Though it may seem like part of the past, its oppressive influences still linger, threatening how it disseminates information about race, gender, and sexuality. Beyond that, practitioners must resist domestication and refocus their efforts on emancipatory practices.
Another layer that needs to be considered while implementing interventions with youth are the discourses that surround the youth themselves. Though much research in this field focuses its research ‘on’ or ‘for’ students, rarely does it do so ‘with’ them (Coll et al., 2018; Goopy & Kassan, 2019). While engaging in research and interventions with youth, it is essential to consider how deficit-driven discourses affect our work (Wright, 2021). One way to counter the dominant discourses that surround youth is to intentionally and explicitly include the viewpoints of the young participants.
Despite being arts-based, there is a lack of research that centers the child’s voice and their art as an expression of it (Deboys et al., 2017; Moula et al., 2022). In their review of child-focused outcomes in school-based ABT interventions, Moula et al. (2020) synthesized the outcomes from 1 qualitative and 6 quantitative experimental studies. The children appeared to benefit the most from a child-centered and interactive approach. Along those lines, the authors speak on an emergent theme of the use of “prevention-related outcome measures,” rather than focusing on the child’s strengths (p.12). Though the authors sought arts-based data, no articles met their criteria. Since arts therapies rely so much on non-verbal communication, more arts-based research approaches need to be developed and would contribute to centering youth voices.
There is a fine line, however, when utilizing art. Its use must be threaded throughout the research process- there is a distinction between arts-based and arts-
informed
research (Domínguez & Cammarota, 2022; Rolling, 2010). The latter is still rooted in quantitative methods that might be reductionistic of the whole child. Though therapists should avoid such an approach, “this might be the only way for art therapy to gain public recognition. Using the strengths of qualitative and arts-based research methods, and embedding them into rigorous experimental designs, may … allow this field to continue flourishing” (Moula, 2020, p.97). There exists several obstacles that make it difficult to generate broad-based claims on the efficacy of ABT in schools. It is difficult to compare and weigh the results of studies when there is a lack of standardization in implementing treatment, measuring results, and reporting outcomes (Moula, 2020; Moula et al., 2020). At the same time, some call for an expanded evidence base and to diversify methodological approaches (Frydman et al., 2022). Adopting both of these approaches could aid in the future synthesis of ABT research.

Arts-Based Paradigms

Theories of Change in Arts-Based Therapy

What is it about ABT that makes it versatile, impactful, and transformative for young people? In response to a lack of research into the matter, Deboys, Holttum, and Wright (2017) introduce a grounded theory of change in school-based art therapy. The perspectives of parents, teachers, and researchers were also taken into consideration. The model has three components: school context, core model, and change/no change. The school context fed into the gentleness and approachability of art therapy. Whereas some clinics and mental health professionals may be intimidating and stigmatizing to youth, the school environment afforded a more accessible experience. The core model of art therapy relies on the therapy being child-centered and individualized. In this particular study, all of the interventions were one-on-one. Other aspects that enabled expression was the making of art itself, privacy, and the perception of the therapy sessions as fun and happy. While interviewing the children, several expressed that they did not experience significant changes as a result from the therapeutic intervention. While that is the case, often other parties, such as the parents and teachers, did report a significant change. Standardizing the measures of change would benefit the efficacy of these reports and aid in their synthesis with the findings of others.
The use of art itself may be key to better understanding the transformative processes of artmaking. Gerber et al. (2018) used an arts-based research (ABR) approach to study the mechanisms of change in creative arts therapies. The purpose of their study was to identify, document, and describe the transformative phenomena that were present in arts therapies and arts-based expression. The systems of change that take place in creative arts therapy (CAT) are dynamic and cannot be fully understood simply through a linear, reductive type of measurement. The aesthetic knowledge exercised in CAT is “idiosyncratic, circuitous, dialectic, dynamic and emergent” (p. 15). The findings in this study necessitate a paradigm shift that takes into account these qualities. One theme that was identified within the authors’ dialectical aesthetic intersubjective theory was the ruptures, resolutions, and resulting transformation that are part of the art-making process. It is the rupture and resolution of dialectical tensions that create transformation within the individual. Rolling (2010) describes ABR in education as pre- and post-structural, performative, pluralistic, proliferative, and post-paradigmatic. In other words, it is a “de/re/construction of research methodology” that transcends quantitative and qualitative methods (p. 108). This can lead researchers to novel directions in how they conduct research, make curriculum, and generate social agency. However, all of this creates a need to reconceptualize what it means to establish validity.

Arts-Based Action Research

Art therapy is not necessary to tap into the therapeutic benefits of artmaking. Goopy and Kassan (2019) propose a new methodological approach to research called Arts-Based Engagement Ethnography (ABEE) that utilizes cultural probes, or creative expressions, made by its participants. These artifacts can be created through photography (photovoice), film, sketchbooks, and journals. The cultural probes are starting points for more traditional qualitative research via interviews and focus groups. Other forms of research can be privileged and attempt to contain diversity, but the research that uses visual media on the other hand intentionally and actively subverts this bias by encouraging imagination, empathy, and playfulness. The data that is collected is multi-layered, rich, and even surprising. The authors argue that this type of approach is especially useful when working with what are often called “harder-to-reach communities.” Arts-based youth programming also shows promise. Ballard et al. (2021) detailed ‘Authoring Action,’ a summer program that strived to go beyond typical positive youth development and instills in its participants' agency to promote positive community change. It is quite similar to a youth-led participatory action research (YPAR) project in its intent and impact, but the research here was done retrospectively rather than as part of the process. The researchers interviewed participants and alumni of the program to identify the themes of the self-described impact of their participation. The themes were developing a voice, cathartic and transformative experiences, connection, and critical consciousness. The arts were embedded into the entire program, operating as a vehicle for positive youth development and community engagement.
Dominguez and Cammarota (2022) outline the theoretical foundations of creative arts YPAR in their model called the arc of transformation. The researcher assists with a number of the principles of YPAR, one of which is creative praxis. Inviting youth to create radical possibilities for the future is a catalyst for social transformation. The potential for positive change is maximized when the researchers adapt to the universe of the youth. Art was identified as a useful tool to let them depict, imagine, and make sense of their world. The authors stress the importance of threading art throughout the process, not just as an afterthought or add-on. Integrating art into social justice-oriented research will promote both cultural synthesis and humanization.
Goessling (2020) introduces a YPAR framework that creates research spaces that taps into the imaginative, visionary, and healing power of art to elevate youth voices. Youthspace praxis is informed by art, politicized trauma, and YPAR. Art is inseparable from the human experience and has played a role in generating social change. Within this framework, art has two uses: enhancing self-understanding and as a form of healing. Social justice arts develop a better understanding of the sociocultural context one finds themselves in and engages creativity to imagine how the world could be. As for healing, the author describes contemplative art practices, which is used within art therapy. One could argue then that artmaking can be a form of political action when done with the correct intentions.
In a later study, Goessling and Wager (2021) build on the concept of youthspaces through a collaborative self-study. One of the three predominant themes discussed is creative practices as pedagogy and echoes Goessling’s previous assertion that art allows youth to (re)imagine who they are, the world they live in, and the actions that they can take to spark change. Supporting their own cultural production is a transformative act for both the individual and the local environment. Places of Possibility are the literal and metaphorical locations where this work can occur. Unfortunately, they have become increasingly rare despite their growing need. The frameworks of youthspaces and Places of Possibility by Goessling offer an ethical approach to co-creating an equitable future with youth.

Critical and Social Justice Arts

Wright (2020) proposes a framework for critical arts pedagogy that combines critical youth studies, youth participatory action research, and social justice arts pedagogy. The principles of this framework suggest that creative practices can not only be used as an analytical tool, but also as a strategy to disrupt youth discourses that commonly operate from a deficit framework. The proposed framework is applied to a vignette of a YPAR study which allowed young people to create skits that envisioned a more just future. The young people were excited to have the opportunity to share their individual experiences and apply them in a creative, transformative way. Art-making opened up a space to make sense of what is happening to them, analyze it, and channel their energy into collective action.
Wright (2021) continues to build on this, introducing a critical arts framework that can help discern the extent of these biases. Critical artmaking empowers young people to reframe themselves and how they operate, all the while revealing and challenging the deterministic discourses that attempt to define them. When art is made, there is a sense of ownership throughout the process. When integrated with research, this defies the asymmetrical power traditionally found between the subject and researcher. Art is a unique tool that offers engagement, analysis, and expression that is liberating. Social justice work needs the input, experiences, and creativity of young people. This chapter details a research vignette in which learners in a critical arts education project translated their analysis of injustice into art and action which eventually led to community change. Integrating art into the work of research can have transformative impacts on individuals and the communities that they find themselves in.

Applications of Arts-Based YPAR

ABT may be adapted to fit into a critical arts framework by translating its processes into arts-based YPAR. Fenner (2022) introduces a framework to accomplish this. The a/r/tography framework, “references the multiple roles of Artist, Researcher, and Teacher, as the frame of reference through which art practice is explored as a site of inquiry” (Conceptual Framework section). Arts-based YPAR offers temporary relief in the face of individual oppression while also empowering voices for change at a larger scale. When the marginalized youth are centered as artists, researchers, and teachers their confidence and agency grow. School counselors could play a role in this too, as Cook et al. (2020) suggest. Since they have similar aims, the YPAR paradigm lends itself to be incorporated with counseling practices within schools. Their study reported the perceptions of counselor trainees while using hip-hop therapy as a form of YPAR within urban schools. The trainees reported that YPAR was helpful in the process of connecting with their students and that the process was effective as a training tool for social justice counseling. ABT disrupts the use of language, but arts-based YPAR goes further in that it disrupts traditional power dynamics that are especially present in a student-therapist relationship; it appears that this is mutually beneficial.
Other YPAR projects could benefit from the integration of arts-based components. One such example is the project that centered on student voice in the development of a sexuality education curriculum in Australia, by Coll et al. (2018). Negotiating curriculum challenges the privileged interests of teachers and researchers. This could inform art education, art therapy, and critical arts pedagogy so that the work done through them is more meaningful for the students. One way in which this study could be improved would be through the integration of an arts-based component. The freedom of expression offered through this medium would enhance the student's ability to explore new meanings and inspire the illustration of a future that is difficult to verbally communicate.

Conclusion

Artmaking can be empowering and transformative. ABT only partially realizes the potential of art-making in school-based settings. Despite the “increased recognition that art and creative practices are important to learning and development, neoliberal austerity [has] cut arts curriculum and programming in and outside of schools” (Goessling, 2020, p.18). This has to change. Creative expression has played a role in people’s own meaning-making, healing journeys, and larger social justice movements, Tying social justice work and the act of artmaking together “[holds] the potential to change our understanding of educational theory and practice while connecting education to living moments, identities, histories, families and communities” (Goessling & Wager, 2021, p. 760). Creating space for youth to exercise their creativity, agency, and authentic expression will lead to both personal and social transformation. In a time when students face unprecedented levels of toxic stress, art could be a healing salve.
The process of creative expression does not need to be gatekept by medical and psychological professionals. Art is timeless and universal to the human experience. Arts-based YPAR offers the same benefits often seen in arts-based therapy, but is better informed, more accessible, and promotes social justice. In fact, their theories and mechanisms parallel each other in a way that one could argue they are different perspectives on the same construct of transformative artmaking. Youth development programs can take inspiration from this research and begin applying it within their own communities. Within the school setting, counselors and psychologists can also enact similar interventions without the need for years of professional training and expensive certification. As seen in both ABT and arts-based YPAR, this work can be done with youth on an individual or group basis. This could be invaluable in combating the levels of toxic stress and improving the mental health of students on a wider scale.
Just as there is a lack of research surrounding ABT for helping queer-identifying students, there is even less research on the use of critical arts-informed YPAR. Exploring this approach in addressing the mental health epidemic that is present in the community should be a priority for researchers. Art empowers the artist in communicating the indescribable. This will be a critical tool in helping LGBTQ+ youth explore their identity, express the qualia of queer experiences, and promote positive visibility.
This does require care in its implementation, however. It is crucial that the process and outcomes are centered around the voices of the youth who participate. Artmaking is worldmaking and practitioners must respect what is born out of it. Fortunately, art inherently resists assimilation by operating outside the confines of verbal language (Esterline, 2021). If art is going to be used to promote critical wellness, it must also be done so in a way that is culturally responsive.
 

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