Navigating Ethical Dilemmas in Creative Arts Therapies

A Case-Based Approach

Thomson J. Ling, Jessica M. Hauck, Thomson J. Ling, Jessica M. Hauck

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000523522
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Navigating Ethical Dilemmas in Creative Arts Therapies uses a case-based approach to provide practical guidance for practitioners on the skillful application of ethical decision-making in art therapy.

The book introduces the DO ART model, an ethical decision-making model specific to the practice of art therapy. Walking readers through common areas of ethical dilemmas, chapters detail how art-making can be used to navigate the model, supporting the well-documented practice of art therapists engaging in art-making processes themselves. Topics covered include boundaries and confidentiality, assessment, storage and exhibition, materials, multicultural issues, technology in art therapy, working with vulnerable populations, supervision and training, and ethical research.

Art therapists at all levels will find this book to be a necessary resource for their practice.

1 Introduction to Ethical Issues in Creative Art Therapies

Jessica M. Hauck and Thomson J. Ling

DOI: 10.4324/9781003175124-1

Art therapy is a unique branch of the helping professions. The American Art Therapy Association (2017) defines art therapy as “an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship.” This places art therapy as a unique intersection between verbal, visual, and kinesthetic therapeutic interventions. While art therapy provides a unique and comprehensive treatment approach, it also creates challenges in ethical practice. As with all therapeutic interventions, ethical practice in art therapy is of profound importance and literature has elucidated the harm unethical art therapy can cause clients (e.g., Furman, 2013; Moon & Nolan, 2020; Sprigham, 2008).

In recent years, the importance of ethical art therapy practice has been demonstrated through an increase in research and literature (e.g., Hinz, 2013, 2017; Kaiser, 2016, 2017; Kapitan, 2011; Karcher, 2017; Molloy, 2017; Talwar, 2017; Zappa, 2017). Twice, Art Therapy: Journal of the American Art Therapy Association has dedicated an issue to the topic of ethics: in 2011 an issue was focused on ethical challenges (Kapitan, 2011), and in 2017 an issue was dedicated to ethics and cultural competence (Talwar, 2017). In addition, the American Art Therapy Association’s Annual Conference has included ethics as a topic of perennial interest (e.g., Agell & Goodman, 1995; McAlevey et al., 2016; Robb et al., 2015). Multiple books have been written on ethical issues in art therapy (e.g., Moon & Nolan, 2020; Furman, 2013; Farrant et al., 2014; DiMaria, 2019). Further, the art therapy literature has also extensively discussed ethics, covering topics such as positive approaches to ethics (Hinz, 2011, 2017), ethics and cultural competence (Kaiser, 2016), foster care (Molloy, 2017), ethical treatment of art therapy images (Hinz, 2013), social justice (e.g., Kaiser, 2017; Karcher, 2017; Zappa, 2017), social media in art therapy (Alders et al., 2015; Belkofer & McNutt, 2011), the exhibition of artwork (Vick, 2011), art therapy with specific populations and settings (e.g., Furman, 2011; Moriya, 2011), the conduct of research in art therapy (Deaver, 2011), and the practice of pro bono art therapy (Moon, 2011).

1.1 Common Issues in the Ethical Practice of Art Therapy

Some ethical issues that art therapists face overlap with other helping professions. For example, the practice of art therapy involves working with diverse populations. Indeed, art therapists’ ethical principles include multicultural and diversity competence (American Art Therapy Association, 2013) and the American Art Therapy Association has promoted multicultural competence through formal initiatives (Potash et al., 2015). Yet, literature has indicated that increased diversity is needed in this field (Awais & Yali, 2015). While multicultural competence is an important part of all clinical work, the specific ethical issues surrounding multicultural competence are unique for art therapists. For example, art therapists must be cognizant of ensuring access to culturally diverse materials (e.g., paints and other art materials often do not represent all skin tones). In addition to materials, art therapists also need to take care to ensure that the techniques they use honor the cultural origins from which they are borrowed (e.g., using mandalas in therapy).

Ethical practice with populations is especially important when it comes to working with vulnerable populations. Typically, vulnerable populations refer to children, prisoners, pregnant women, mentally disabled persons, or economically or educationally disadvantaged persons. While the literature is somewhat limited in this area, art therapists should be sure to follow all relevant laws and regulations. One issue that has been identified in the literature, which relates to working with vulnerable populations, is the use of the third-hand technique, first developed by Edith Kramer (Kramer, 1986). This technique can be thought of as a way of intervening therapeutically and should be used to support or enhance a client’s creative development, without being intrusive. It may be done verbally (e.g., cautioning a client that their hand may smudge the paper if they continue) or physically (e.g., holding a client’s clay figure together while they reinforce it). The issue of when to intervene or when not to intervene is directly related to several aspirational principles for art therapists, including client autonomy. However, the issues surrounding the ethical practice of art therapy with vulnerable populations transcend issues of client autonomy.

Aside from issues that overlap with other helping professions, there are also ethical issues specific to art therapy. As a growing profession, the ethical supervision and training of new professionals are of utmost importance in the field. Art therapist supervisors are responsible for ensuring that all those who supervise and train are practicing ethically and within their bounds of competence. Important general ethical issues to consider include navigating dual relationships and disclosing personal information. More specific to art therapy, the use of response art in supervision (Fish 2006, 2012), a commonly used technique, should also be approached carefully (Deaver & Shiflett, 2011). Likewise, while all helping professions include maintaining healthy boundaries and ensuring confidentiality as central tenets of ethical practice, these issues are often magnified in the field of art therapy. For example, the American Art Therapy Association’s (2013) Ethical Principles discuss the ethical exhibition of client artwork and requires art therapists to take extra steps to maintain confidentiality. Similarly, art therapists are often involved with the art community and this creates possibilities for multiple relationships.

Another aspect of art therapy educational training is the ethical research practices, which include both conducting research (Anderson, 2001) but also interpreting and applying research to practice (Kaiser et al., 2006). However, what constitutes good research has been discussed by the literature (Deaver, 2002). For example, art therapy research tends to focus on qualitative methodologies and case studies. Consequently, research has suggested that the need for studies that demonstrate art therapy effectiveness is needed (Slayton et al., 2010). Without a strong research foundation, art therapists may unethically engage in practices that have little to no support. Further, without proper training, art therapists may misinterpret research findings.

In today’s world, technology and technology-assisted services are being utilized more and more to provide therapeutic services for individuals who are unable or unwilling to attend in-person treatment. These telehealth services can be incredibly beneficial for clients, and increase access to those who may otherwise have gone without, but they also come with a variety of ethical concerns. This includes determining/verifying the identity of the client, maintaining confidentiality, and following licensure and legal requirements for the state(s) where both the client and art therapist reside (American Art Therapy Association, 2013). Clients should also be provided with informed consent regarding how the session is being documented and if it’s being recorded. Telehealth can be difficult to navigate for all helping professions, but with art therapy, ethical issues may be magnified. These include, but are not limited to, access to art materials and a safe and confidential workspace.

More recently, art therapists have begun to embrace digital mediums in the practice of art therapy. The use of digital art in the therapeutic process has both benefits and drawbacks, which should be carefully addressed with clients before incorporating its use in treatment. For some clients, especially those with sensory issues, it can open up a world of opportunity for treatment. But for others, it may be inundating them with an unnecessary amount of screen time and distancing them from the overall process and hands-on therapeutic benefit. These concerns raise important questions on how and when to use various art-making methods in art therapy treatment.

Art therapists are well aware of the importance of access to art materials in art therapy. Art materials range on a continuum from fluid to rigid, with different types of materials eliciting different reactions from clients. Fluid art materials provide less control, but more flexibility. However, they may be over-stimulating, and cause clients to regress. Rigid art materials provide more control, but less flexibility. Clients may view rigid art materials as safer than fluid art materials, but they may also be too restricting or under-stimulating. Careful consideration should be used to determine which types of materials are most appropriate for which client, in which situations (American Art Therapy Association, 2013). It is important to consider sensory sensitivities, fine motor skills, and culturally appropriate/inclusive materials. Other ethical concerns may relate to the use of the materials themselves, including how to effectively work with clients that are resistant toward certain materials, or insist on taking more than is needed of others (e.g., using too much paint, breaking charcoals). The gathering of materials also brings its own ethical challenges, as many agencies are un...