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Empowerment in Art Therapy: Whose Point of View and Determination?

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Abstract

Empowerment is both a process and a product, the outcome of which is self-efficacy. Art therapy is discussed in this editorial on a continuum of client empowerment, with choice and control in art making on one end and social, cultural, and collective efficacy on the other. Given their different perspectives, the goals and outcomes determined by art therapists may not be aligned with what clients see as most important. Art therapy's effectiveness is determined in part by the strength, direction, and sustainability of client-centered empowerment.
Art Therapy: Journal of the American Art Therapy Association, 31(1) pp. 2–3 CAATA, Inc. 2014
editorial
Empowerment in Art Therapy: Whose Point
of View and Determination?
Lynn Kapitan,Editor
Art therapists firmly believe that their work is
powerful—and empowering. This widely accepted idea is
reinforced daily with clients who use art to tap into power-
ful emotions and self-expression. Less understood, however,
are the processes by which the power of art therapy intersects
with identity, culture, and the structures of oppression. Iden-
tity not only is integral to how we negotiate who we are in
the world and with others, but also incorporates our power
and privilege. If you asked your clients what they think is es-
sential to their empowerment, what would they say? Would
it surprise you to learn that the people who participate in art
therapy have a very different idea about what is empowering
than you do?
Recently I read an interesting study by Boehm and Sta-
ples (2004), two social workers who uncovered important
differences in how clients and practitioners viewed em-
powerment. Like their therapists, clients said that mastery
over personal challenges was important, but the clients did
not see how to connect with resources and opportunities
to gain empowerment in their lives. Empowerment meant
participation: in society, social networks, and supportive
group processes. The practitioners, by contrast, conceived
of empowerment primarily as a personal process that was
detached from the collective level. They concentrated
on individual therapeutic change to the exclusion of their
clients’ struggles with social and societal oppression. In these
findings Boehm and Staples saw disturbing implications for
their profession. The practitioners understood and easily
embraced the idea of empowerment but then altered it to fit
preconceived approaches. This particular outcome is what
caught my attention. Professional training and socialization
are profoundly embedded in traditional approaches to art
therapy as well. It can be difficult to shift our practice
to what clients see as empowering due to how our own
professional identities and culture shape our points of
view—and the privilege to act accordingly.
A Continuum of Empowerment
In some respects art therapy has an advantage when it
comes to empowerment because of the relationship between
clients and their art. Art making opens a conduit of power
that flows between the artist and the work produced, along
with the possibility of continuous feedback. Many art ther-
apists see their function primarily as facilitative of this pro-
cess; that is, focused on removing barriers to empowerment
between clients and their art making. If we view empow-
erment along a continuum, on this end is the notion that
art therapy is empowering because it gives clients the power
to choose and have control over materials, art processes, and
content. In addition clients overcome feelings of helplessness
via self-expression and the power to disclose what is happen-
ing to them. Art therapists allow clients to make these deci-
sions based on a determination of their capacity and treat-
ment goals.
Empowerment, however, doesnt really have much to do
with giving or taking power (Anderson & Funnell, 2010).
The language of “giving” or allowing” power exposes an il-
lusion that the art therapist is in charge of these decisions
and metes out power like a benevolent parent. Practitioners
who are used to a framework in which they provide (mate-
rials, directives, empathy, a safe space to work in, etc.) and
clients receive tend not to incorporate reciprocity, mutual-
ity, and partnership into their approach. Thus we can believe
intellectually in empowerment while behaving in ways that
actually limit or contradict it, without being aware of the
contradiction (Anderson & Funnell, 2010).
According to Freire (1993), power is not a quantity that
can be distributed in this way but rather is both a process
and an outcome. Nor does empowerment occur to the indi-
vidual alone; it is a multidimensional process having to do
with shared experience and connectedness with others. As
a process, people move from relative powerlessness to self-
determination; as an outcome, empowerment results in in-
creased self-efficacy (Freire, 1993). Toward the middle of the
continuum of empowerment, art therapists do more than di-
rect or facilitate art making; they work in partnership with
their clients to connect to strengths, resources, and proactive
social behaviors and relationships that result in reclaimed
identities and life spaces. Clients gain self-efficacy by exer-
cising creative and critical thinking, by taking risks, and by
making the exhilarating discovery of how to participate in
the influences that shape their lives and the lives of others.
Where art therapists are starting to stretch is toward the
cultural and social transformative end of empowerment. By
this I mean taking into account the contexts that surround
2
KAPITAN 3
their clients’ lives and incorporating inclusion and partici-
pation on all levels of decision making in ways that reduce
silence, isolation, and stigma. When invisible people are in-
vited to become visible in their societies, power flows from
that visibility with an insistence on mutual respect, equal-
ity, and support for self-determination. Here empowerment
embraces what Freire (1993) called the practice of freedom”
through clients’ collective efficacy. Its achievement involves
joining with others to bring about social change from which
self-efficacy is derived.
Given their different points of view, there is always the
possibility that the goals and outcomes determined by art
therapists are not the ones their clients find useful or impor-
tant. There must be cultural empowerment as well, which
means the transfer of power from therapists to clients to de-
fine their care according to their own empowering ethnic,
cultural, and individual norms and expressions. This chal-
lenge requires not only the art therapist’s cultural compe-
tence but also, as Megan Robb points out in her article in this
issue, recognition of unequal power relations and oppres-
sion. Effective art therapy requires collaboration between
the therapeutic expertise of the art therapist and that of the
clients who are experts about their priorities, concerns, and
cultural traditions and values. Diversity, thus collaboratively
empowered, unleashes genuine creativity.
The Powerful Effects of Illness
In this issue readers will encounter power in people
whose identities are constructed in part from a close en-
counter with or chronic experience of illness or distress. In
Frances Johanna Morris and Mallori Willis-Rauchs social
empowerment model of art therapy with long-term psychi-
atric patients, Sonia Stace’s narrative of a woman in recovery
from complex trauma, and Jo Wallace and colleagues’ study
of healthy (yet suffering) children whose siblings are being
treated for serious disease, we are reminded that one’s relative
health or illness profoundly affects perceptions of one’s self
and place in the world. Despite the fact that their concerns
are quite different in symptomology and treatment, they ex-
perience very similar social and psychological impacts. Dis-
empowerment of people with mental health problems occurs
at every level, from societal barriers to full participation to
internalized effects on identity and self-worth. People who
use our services often feel that their affliction drives them
away from full participation in society and into a marginal
space where self-efficacy disappears. Clients exercise power
and agency in art therapy by drawing upon identities, values,
and beliefs in ways that disrupt the oppressive structures of
hegemony and reconnect them to a social world.
Annick Maujean, Christopher Pepping, and Elizabeth
Kendall contribute to the literature in this issue by reviewing
five years of art therapy efficacy studies. They found grow-
ing evidence of the psychosocial benefits of art therapy for
a range of populations and emotional states, but mixed re-
sults on general well-being, especially long term. We cannot
know how long the positive effects of art therapy last unless
follow-up assessments are conducted. Is it possible that we’ve
limited the power of art therapy by focusing more on what
happens in the session than on what clients carry with them
when they leave? Or by not learning what they see and deter-
mine would be most helpful to them in gaining long-term
self-efficacy and empowerment in their lives?
Empowerment is not a state or location that one
reaches; rather, it is more like a direction in which to move.
As an analogy, Anderson and Funnell (2010) wrote that if
compliance with preconceived or assumed goals and prac-
tices means to go east, then empowerment means to go west.
The question becomes, how far west must an art therapist go
to be considered western? I would assert: However far you
are willing and able to go. The strength, direction, and sus-
tainability of client-centered empowerment are indications
of art therapy’s effectiveness.
2014: Our 31st Year of Publication
With this first issue of 2014 we take the opportunity
to introduce readers to Dr. Donna Kaiser, who has been
appointed Editor-Designate by the American Art Therapy
Association. Donna is a long-standing member of the Edi-
torial Review Board, past chair of the American Art Ther-
apy Association’s research committee, and an experienced
academic and researcher. She will be working closely with
Associate Editor Holly Feen-Calligan and me, Editor Lynn
Kapitan, throughout the year in order to effect a seamless
transition to Editor in 2015. In the meantime we have a
great year planned, with a special issue on the growing im-
pact of neuroscience in art therapy and another special issue
on art-based research. Please consider submitting a response
to our call for papers that critically examine the challenges of
diversity in art therapy practice, research, professional edu-
cation, and relevant concerns for an upcoming special issue.
And, as always, we hope you will enjoy each issue of the
Journal and participate in its discourse.
References
Anderson, R. M., & Funnell, M. M. (2010). Patient empower-
ment: Myths and misconceptions. Patient Education and Coun-
seling,79(3), 277–282. doi:10.1016/j.pec.2009.07.025
Boehm, A., & Staples, L. H. (2004). Empowerment: The point of
view of consumers. Families in Society: Journal of Contemporary
Social Science,85(2), 270–280. doi:10.1606/1044-3894.314
Freire, P. (1993). Pedagogy of the oppressed. New York, NY: Con-
tinuum.
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... An underlying theme which emerged from the interviews was that of the impact of the setting on the power dynamics between art psychotherapists and service users, and between service users and the wider social context. Drawing on definitions of 'power' as the 'ability to act or produce an effect' (Merriam-Webster, 2020), and 'autonomy' as 'self-directing freedom' (Merriam-Webster, 2020), a service user can use power and autonomy within a therapeutic relationship to enable a collaborative therapeutic process which respects their needs, wishes and preferences (Jury, 2020b;Kapitan, 2014). More broadly, a sense of personal power and autonomy can enable active and beneficial engagement with the wider community (Kapitan, 2014). ...
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... However, being responsible for choosing and bringing in the art materials and looking after the art products, positioned me as the all-knowing powerful "provider," the one in control. Thus, Leah was positioned as a passive receiver instead of an active mutual partner [28]. Nevertheless, it did not feel like a beneficial Regression to Dependence in the context of therapeutic holding [48], but rather a malignant regression aimed at maintaining gratification [61]. ...
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... However, being responsible for choosing and bringing in the art materials and looking after the art products, positioned me as the all-knowing powerful "provider," the one in control. Thus, Leah was positioned as a passive receiver instead of an active mutual partner [28]. Nevertheless, it did not feel like a beneficial Regression to Dependence in the context of therapeutic holding [48], but rather a malignant regression aimed at maintaining gratification [61]. ...
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Quality of life (QoL) is influenced by physical and psychological health, but includes subjective qualities that are inherent in social and cognitive processes necessary for healthy aging and overall well-being. A quantitative study analyzed the effects of art therapy for 14 aging adults utilizing the Brunnsviken Brief Quality of Life Scale (BBQ) at pre, mid, and post 32-week study. Regression analysis showed significant positive changes in two areas: Importance of Learning and Leisure. Participating in art therapy increased the importance of learning and leisure, that are influential factors in QoL for aging adults. This demonstrates that art therapy has the potential to support healthy aging.
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Background This article presents a client’s (art therapee’s) conceptualisation of his experience of art psychotherapy for symptoms of complex post-traumatic stress disorder (C-PTSD). Context He was receiving treatment through a community adult mental health team within the UK National Health Service. Approach The art therapee wrote about his art psychotherapy experience, and then he and his art psychotherapist identified key themes. They related his account to art psychotherapy theory and evidence and drew out implications of his experience for art psychotherapy research. Outcomes/Conclusions The art therapee found that an art psychotherapy approach was helpful in these ways: having control; expressing without words; distancing from trauma; being creative and playful. He identified some aspects of the art psychotherapy which seem to be under-represented in art psychotherapy literature: the importance of the therapist’s acceptance of the client’s artwork for building trust; the way in which artmaking bypasses the fear of ‘telling’ about past abuse; and the therapeutic value of creativity and play for accessing positive aspects of the child self. Implications for research It would be valuable to gain information from other clients with C-PTSD about their experiences of art psychotherapy. Research into the identified under-explored aspects of art psychotherapy practice, the use of artmaking for C-PTSD symptom management and how artmaking can be integrated within other approaches to C-PTSD treatment would be useful. Plain-language summary This article describes how a client (art therapee) with symptoms of complex post-traumatic stress disorder (C-PTSD) experienced art psychotherapy. The art therapee received therapy through a UK National Health Service community adult mental health team. The therapy sessions were on a weekly basis over an 18-month period. The art therapee wrote about his art psychotherapy experience, and then he and his art psychotherapist identified some themes. They related his account to art psychotherapy theory and evidence and drew out implications of his experience for art psychotherapy research. The art therapee found that an art psychotherapy approach was helpful in four main ways. It helped him to feel in control of the therapeutic process, and enabled him to express experiences of past abuse without having to use words. It gave him a sense of distance from his traumatic experiences. Finally, it helped him to connect with his creativity. He identified some particular aspects of his experience which seem to be under-represented in art psychotherapy literature: the importance of the therapist’s acceptance of the client’s artwork for building trust; the way in which artmaking bypasses the fear of ‘telling’ about past abuse; and how creativity and playfulness in art psychotherapy sessions can enable a more positive view of oneself as a child. The authors consider that it would be valuable to gain information from other clients with C-PTSD about their experiences of art psychotherapy and to undertake research into those aspects of the client’s experience which appear not to have been explored significantly so far. Research into how artmaking can help relieve C-PTSD symptoms and how artmaking might be used within other approaches to C-PTSD treatment would also be useful.
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The theory about "empowerment" has been formulated primarily in the academy. Consumers and social work practitioners generally have not taken an active role in the theoretical development of this concept. This study examines empowerment from consumers' and social workers' point of view. Twenty focus groups composed of four different Israeli consumer populations and social workers serving them were examined. The findings reveal the significance of empowerment from the perspectives of the different groups and identify differences among the consumer populations, as well as between consumers and social workers. The perceptions of consumers and social workers about empowerment provide deeper insights into and sharper formulation of this concept. The theoretical and practical implications of these findings are discussed.
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The purpose of this article is to clarify the concept of empowerment and to correct common misconceptions about its use in diabetes care and education. The patient empowerment approach is well suited to helping patients make self-selected changes related to weight, nutrition, and physical activity. Although the concept of patient empowerment has become an integral part of diabetes education, an accurate understanding and authentic application of empowerment has not occurred as readily. The empowerment approach is clarified and common misconceptions have been corrected. Embracing empowerment means making a paradigm shift that is often difficult because the traditional approach to care is embedded in the training and socialization of most health care professionals (HCPs). Unlike the traditional approach, empowerment is not something one does to patients. Rather, empowerment begins when HCPs acknowledge that patient are in control of their daily diabetes care. Empowerment occurs when the HCPs goal is to increase the capacity of patients to think critically and make autonomous, informed decisions. Empowerment also occurs when patients are actually making autonomous, informed decisions about their diabetes self-management. Clarity about all aspects of the empowerment approach is essential if it is to be used effectively.
Patient empower-ment: Myths and misconceptions. Patient Education and Coun-seling Empowerment: The point of view of consumers
  • R M Anderson
  • M M Funnell
Anderson, R. M., & Funnell, M. M. (2010). Patient empower-ment: Myths and misconceptions. Patient Education and Coun-seling, 79(3), 277–282. doi:10.1016/j.pec.2009.07.025 Boehm, A., & Staples, L. H. (2004). Empowerment: The point of view of consumers. Families in Society: Journal of Contemporary Social Science, 85(2), 270–280. doi:10.1606/1044-3894.314