Virtual Art Therapy

Research and Practice

Michelle Winkel, Michelle Winkel

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000556254
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

This book provides a practical and research-based exploration of virtual art psychotherapy, and how its innovations are breaking new ground in the mental health field.

With seventeen chapters authored by leaders documenting their research on creative arts therapies online, along with findings from the Virtual Art Therapy Clinic, this volume presents examples, strategies, and experiences delivering arts-based therapeutic services and online education. Clinical practice examples support and provide evidence for the transition from in-person to virtual sessions.

By combining the collected expertise of all the contributing authors, this book encourages art therapists to support further growth in the field of virtual art therapy.

1 Our Changing Role

Expanding the Reach of Art Therapy

Michelle Winkel

DOI: 10.4324/9781003149538-1

Recent pressures around the world due to physical distance, along with increasing access to low-cost internet services and equipment, make conducting art therapy over online platforms a viable and important option. One of the most pressing issues with in-person therapy is often the lack of access for populations who need therapeutic services the most. Single parents may not be able to leave their homes to attend weekly appointments. Youth might struggle finding safe transportation to go to a therapist’s office. Ageing seniors may not be aware of therapy options within their community. Despite the world becoming more connected over the last decades, we are, in many ways, failing to connect with the most vulnerable populations. As a growing number of art therapists become confident and competent in providing online, or virtual, art therapy, it is our sincere hope that more clients will benefit from this development worldwide. Throughout this book, we propose that the best of in-person art therapy can be safely transferred to virtual platforms in order to expand its reach to a much wider population.

In general, clinical and counselling psychology services are inequitably distributed, with shortages in remote and rural areas of most countries (Simpson & Reid, 2014). The outreach possibility of virtual art therapy helps extend the access of services to isolated and marginalized people, including:

• Rural and remote populations
• Populations reluctant to leave their homes, including the growing number of people struggling with anxiety, agoraphobia, and social phobias
• Persons not comfortable going outside the home for traditional psychotherapy in cultures that stigmatize mental health practices
• Persons required to stay physically distant due to health considerations
• Confined populations
• Persons who do not have the time to commute or are most comfortable online
• Disabled or differently abled populations who are unable to physically access outside therapy services
• Military personnel

Virtual art therapy can provide a critical alternative for these populations, including people like Wayne Smith¹.

Wayne is a military veteran who has served several tours of duty. After retiring, he moved with his family to a farming community without a registered art therapist. He deals well with balancing his physical pain from injuries sustained in service, and emotional challenges related to PTSD. While he doesn’t identify as an artist, he finds joy in making marks, painting, and drawing shapes on big sheets of cardboard, and is able to access art therapy services through our online clinic. His therapist acts as a witness to his newly discovered creative process and joins him in co-creating a more pleasurable day-to-day life.

A note about terminology: ‘Virtual’ is the term used in this book for synchronous online videoconferencing, in which the therapist and client can see each other simultaneously through a webcam, and hear each other through the computer microphones or telephone. It is a generic term that does not distinguish between web conferencing platforms such as Zoom, Microsoft Teams, Jane, Doxy, SharePoint, and others. In this context, teletherapy pioneer Kate Collie chronicles the early days of telehealth and art therapy in Chapter 2, discussing videoconferencing predecessors, which includes other forms of electronic communication, such as telephone, email, text, fax, chat, forums, that have been—and in some cases continue—to be used.

Fundamentals Are Still Fundamental: Ethics, Security, Confidentiality

The fundamentals of art therapy have not changed; the art therapist working virtually is responsible for gaining informed consent, sharing the limits of confidentiality, and conveying in clear language the potential risks of working online. As in face-to-face therapy, the art therapist conducts a thorough intake and initial assessment to determine if there is a therapeutic fit, including the client’s suitability and capacity for working remotely. For example, most clients in immediate crisis or clients who struggle with orientation to reality or have significant trauma usually need to be referred to a local service provider in their area. Helping support the client to make those linkages falls within this practice. Next, the art therapist collaboratively guides the process of establishing treatment goals based on the client’s presenting challenges and experiences. Helping the client to create a virtual studio for art making and dialoguing with the client about the creative process and their artwork continue to be focal points in virtual art therapy. Therapists must also adhere to relevant privacy legislation and counselling regulatory bodies, which vary depending on where the art therapist resides and works. Issues of security must be addressed with the client, such as encryption of the video platform, firewalls, and anti-virus and anti-malware software, and how this might impact the client’s personal information (Le Bihan, 2020). Therapists should also implement and inform clients about their policies and procedures concerning the safe storage, transfer, and disposal of data. Insurance coverage across provincial and national boundaries, which is continually shifting, remains the responsibility of the therapist. While many issues are similar to the brick-and-mortar art therapy studio, working virtually does require extra training, knowledge, and equipment—the art therapist’s task. In a recent UK-wide survey about online art therapy practice and client safety, therapists’ confidence was found to be generally lower with respect to providing online art therapy sessions in relation to in-person therapy (Zubala & Hackett, 2020). We aim to change that for our readers.

The Therapeutic Alliance: Same Glue, Different Container

When you think of effective art therapy, what comes to mind? Perhaps it’s a client’s subjective view of their progress, or a certain level of trust between that client and their therapist—in other words, the therapeutic alliance. The therapeutic alliance, or working alliance, is often considered the cornerstone for successful outcomes in many therapies (Doran, 2016), including art therapy. It can be summarized as the affective bond or attachment between therapist and client, the collaborative quality of the relationship, and the ability of the therapist and client to agree on mutually acceptable therapeutic tasks and goals (Simpson & Reid, 2014). A solid therapeutic alliance is a connection unlike any other.

When clients are physically separated from their therapists through communication tools such as videoconferencing, the therapist may be concerned about the development of the therapeutic alliance. The loss of ability to see the client, their artwork, and the process of creating that artwork in one physical space may be uncomfortable. In the tele-mental health field, however, various research studies conclude that the therapeutic alliance is not negatively impacted by telecommunication tools (Wehmann et al., 2020). Themes from this prior research suggest that clients often show lessened inhibitions to disclose intimate details about their lives when conducting therapy through technological aids (Beyens et al., 2018). Authors AlDaleel, Proulx, and Sughondhabirom will share their observations of reduced inhibition in students and clients during online art therapy and education when compared with in-person art therapy in Chapters 4, 10, and 11.

Jerome and Zaylor (2000) first identified several differences between in-person and online therapies, including a slower rate of communication, differences in depth perception, and interpersonal distance. Despite these differences, they found that videoconferencing’s unique factors may actually enhance some psychotherapeutic endeavours. For example, videoconferencing requires turn-taking—a skill that some clients need to practice in therapy—as both participants cannot be heard at the same time. Clients in videoconferencing sessions must also engage in additional awareness of what the other participant can see, particularly if they are switching between views of themselves and views of their art making. Skills acquired during these online sessions can be immediately practiced in daily lives. Many of our authors explore these differences and include vignettes to convey their findings.

It is understandable, however, that some art therapists have been hesitant to take their professional practice online. Studies undertaken in Australia with psychologists indicate that they were concerned that the therapist would be compromised in being able to communicate warmth, understanding, sensitivity, and empathy as a result of the video medium (Rees & Stone, 2005). Despite numerous studies rebutting this, the negative bias persists. One of the goals of this book is to ease the sense of discomfort or belief that virtual art therapy is less valuable than in-person therapy. Indeed, there are logistical, ethical, and technical challenges that must be carefully considered. This book addresses and explores these challenges, shares new discoveries, current research, as well as new practice concepts and techniques to inspire our readers.

Shifting the Power Balance

As with in-person therapy, virtual art therapy starts with building trust between the client and the therapist. A successful beginning entails helping the client value their creative process and involves the supportive and clear boundaries of the therapist to guide the initial process. For art therapy to be productive for the client with the challenges that brought them to therapy, it is essential to create something meaningful and authentic in the therapeutic alliance. Conducting sessions through videoconferencing requires a different level of effort to create an atmosphere of trust (Le Bihan, 2020). Technological issues may also cause interference. Low bandwidth can cause audio lags or visual distortions. It is important for the therapist to feel competent in guiding the client to technical solutions and have alternatives and backup plans in place. Throughout this book, authors share their innovative solutions to technological and ethical challenges.

In a traditional setting, the therapist’s studio or office is the familiar, safe, and containing space that the client regularly visits. In virtual art therapy, the therapist has considerably less control over the physical space of the client. They are essentially visiting the client in their home or wherever they choose to be sitting for their sessions. The client is now the designer and holder of their own physical therapeutic space and will need guidance from the art therapist on how to turn that space into a suitable environment that they can associate with positive, creative, and healing work. In the virtual relationship, both client and therapist are responsible for safety and privacy (Weinberg & Rolnick, 2020).

Hanaa is in her mid-30s and deals with symptoms of anxiety. She has been doing online art therapy through the Virtual Art Therapy Clinic at the Canadian International Institute of Art Therapy for a few months. She says, “There is the benefit of using my own tools and supplies. There is a comfort that comes from using what I own that I don’t think I recognized before. There is a relationship built between myself and those objects … a healthy, healing relationship that extends far beyond the one-hour session. And lastly, the inner strength that I build within a session transcends into my everyday life much faster, as opposed to leaving my strong self in the therapy office to return to that person only at my next appointment.”

“I have had years of experience with psychotherapy, from talk therapy to somatic experiencing. I have processed a lot of painful traumatic experiences through these therapies, and I am very grateful for them. However, art therapy has been a completely new and powerful experience for me. A completely liberating experience.”

In art therapy, one of the goals for the client is to discover new and unexpected outcomes through the art making process. This vital process can only happen based on a strong relationship with the therapist. The image, picture, video, collage, or sculpture that the client makes in art therapy becomes a third element, and creates the therapeutic relationship triangle (Schaverien, 1999). In the triangular relationship, two sets of eyes look together at the art piece in joint attention. This process of joint attention prioritizes the art as a piece of value in its own right, causing it to almost function as a third entity in the therapeutic dynamic (Isserow, 2008). In virtual art therapy, we propose that there is a fourth element: the computer screen. We call it “Squaring the Schaverien Triangle” and will explore this in Chapter 10.

Setting up the Studio and Other Practical Considerations

As the physical space is no longer determined solely by the art therapist, they should offer to help the client set up their studio. They will need to brainstorm together where to store the artwork the client creates so that it is kep...

Table of contents

• Cover
• Endorsements
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures
• List of tables
• List of Contributors
• Acknowledgements
• Foreword
• 1. Our Changing Role: Expanding the Reach of Art Therapy
• SECTION I: How Did We Get Here?
• SECTION 2: Clinical Perspectives
• SECTION 3: Innovations in Training and Supervision
• SECTION 4: Virtual Vis
• Index