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Published in: Morning Watch: Educational and Social Analysis Special Issue, 46(1-2). This article discusses the role of arts-based research in generating a supportive cross-cultural way for newcomer refugees to express themselves within an emerging aesthetic intersubjective paradigm of arts-based research and art therapy (Chilton, Geber, & Scotti, 2015). It begins by reviewing literature on the global and contemporary experiences of refugees and displaced persons and the need to support newcomer refugees, particularly women. Furthermore, this article briefly discusses the connection between art-making and health with recent relevant systematic reviews, experiential designs, and biomarker evidence. It concludes that arts-based research can be a way to support diverse forms of knowledge and communication, with a particular focus on cultural humility (
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The Morning Watch: Educational and Social Analysis Vol 46. No 1-2, Fall
The Role of Arts-Based Research in Creating Safe Spaces for Newcomer Refugees
Haley Rebecca Mary Toll
Memorial University
This article discusses the role of arts-based research in generating a supportive cross-cultural
way for newcomer refugees to express themselves within an emerging aesthetic intersubjective
paradigm of arts-based research and art therapy (Chilton, Geber, & Scotti, 2015). It begins by
reviewing literature on the global and contemporary experiences of refugees and displaced
persons and the need to support newcomer refugees, particularly women. Furthermore, this
article briefly discusses the connection between art-making and health with recent relevant
systematic reviews, experiential designs, and biomarker evidence. It concludes that arts-based
research can be a way to support diverse forms of knowledge and communication, with a
particular focus on cultural humility (Bal & Kaur, 2017; McNiff, 1984; Tervalon & Murray-
Garcia, 1998).
Keywords: newcomers; refugees; arts-based research; art therapy; cross-cultural.
“Counselors who use the creative arts have, within their grasp, a tool that can
help transcend the differences in clients whose cultures differ from their own”.
(Henderson & Gladding, 1998, p. 187)
In this article, I briefly summarize how the creative arts within research, often called arts-based
research (McNiff, 2017), can create a participatory, empowering, and multilayered way for
newcomers to express their experiences. I begin the discussion by providing a broad synthesis of
current and global literature regarding newcomer refugees moving to St. John’s, Newfoundland
in a brief literature review. I particularly focus on newcomer Syrian refugees, because of the
Government of Canada’s focus on resettling these newcomer individuals (Government of
Canada, 2018). Furthermore, I concentrate the literature on supporting newcomer women in
particular, as their matriarchal roles in supporting families and communities are important
(Guruge, Khanlou & Gastaldo, 2010).
I delineate the need to support newcomers when relocating to a new country on the long term, to
create a sense of belonging and wellbeing. This can begin with understanding their experiences
in a supportive, accessible, and nuanced manner (El-Bialy & Mulay, 2016; Li & Grineva, 2015;
Reitmanova & Gustafson, 2008). Then, I discuss how new methods of arts-based research, from
the perspective of an art therapist, can provide an opportunity for newcomers and particularly
women to express their experiences and discuss ways that local communities can support them in
participatory and empowering ways (Chilton, Gerber, & Scotti, 2015; Lewis et al., 2018). The
arts-based research stems from current contemporary research on how the arts and artmaking
benefits health and wellbeing of diverse individuals in both hospitals and community settings,
which is also outlined in the text (Jensen & Lo, 2018, Bungay, Munn-Giddings, Boyce, &
Wilson, 2014; Boehm, Cramer, Staroszynski & Osterman, 2014; Boyce, Bungay, Munn-
Giddings, & Wilson, 2018; Shella, 2018; Staricoff & Clift, 2011; Stuckey & Nobel, 2010). This
growing body of knowledge can connect arts-based research with this new knowledge regarding
the benefits of art making.
Global Context
In 2015, United Nations High Commissioner for Refugees (UNHCR, 2018) announced that the
growing number of forcibly displaced people is at its highest in fifty years and is a current global
crisis, amounting to over sixty-eight million refugees and internally displaced people (Miller &
Rasmussen, 2017). This unprecedented number is due to many factors, including the civil war in
Syria that began in 2011, lasting much longer than expected. The war resulted in the
displacement of over 12.6 million Syrian people, with 6.3 million of those being refugees,
146,700 asylum-seekers, and 6.2 million internally displaced people in 2017 (United Nations
Refugee Agency, 2018). This country’s emergency refugee crisis has eclipsed other crises in
Myanmar, West Papua, and the Western Sahara (Silove, Ventevogel, & Rees, 2017; United
Nations Refugee Agency, 2018). Refugees, and particularly intersectional1 vulnerable
populations within this group, experience an unprecedented high prevalence of anxiety, post-
traumatic stress, and depression symptoms due to natural reactions to trauma and loss (Alpak,
Unal, Bulbul, Sagaltici, Bez, Altindag, et al., 2015; Ghumman et al., 2016; Naja, Aoun, El
Khoury, Bou Abdallah & Haddad, 2016). Authors Ghumman et al. (2016) recommend unique
ways to support these individuals in evidence-based and culturally competent manners.
Canada has responded to this global crisis by resettling approximately 57,000 Syrian refugees
since November 2015 (Government of Canada, Immigration, Refugees and Citizenship Canada,
Communication Branch, 2018). With these changes, the demographic landscape within culturally
homogenous provinces, such as Newfoundland and Labrador, is also diversifying (Statistics
Canada, 2016). Yet, local systems and attitudes may not be adapting to this diversity as quickly.
In Newfoundland and Labrador, where currently 560 Syrian refugees have resettled since 2015
(Government of Canada, 2018), newcomers experience particular challenges due to social and
environmental remoteness, language barriers, access to social and economic resources, and
discrimination and racism (Baker, 2013; Burnaby, Whelan & Rivera, 2009; Gien & Law, 2009;
El-Bialy & Mulay, 2016; Reitmanova & Gustafson, 2008; Sullivan, Ring, & Harris 2009; Uttley
et al., 2015).
Post-Migratory Experience of Refugees
1Intersectionality refers to how the complex experiences and identities of race, class, gender, ethnicity, age, abilities, sexuality
(among others)- and the informal and formal power dynamics related to these identities- influence how an individual experiences
the world (Berger & Guidroz, 2009).
Post-migration experiences can significantly impact the mental and physical health of
immigrants and refugees, leading to new holistic ecological models that try to broadly
understand complex refugee and migratory experiences (Miller & Rasmussen, 2016). Although
migration may be linked to various stresses and adaptations, immigrants moving to Canada tend
to have a lower mental health incidence than the general Canadian population when arriving,
with the exception of Post-traumatic stress disorder (PTSD) (Canadian Mental Health
Association, n.d.). The healthy immigrant effect may be due to the fact that migrants need to pass
health tests to enter Canada and healthier people are given the opportunity to move. However,
after ten years of living in Canada, immigrant and refugee mental health prevalence becomes
worse than the general population (Ng, 2015). Post migration rates of depression, PTSD, chronic
pain, and somatic symptoms become ten percent higher than the overall Canadian population for
adults and adolescents. According to Canadian researchers Kirmayer et al. (2011), the process of
migration includes three major transitions: 1. Changes in socioeconomic systems; 2. Changes in
personal ties to rebuild social networks; and 3. Changes in cultural systems. These adaptations
may incite feelings of anxiety and a lost sense of identity when the changes are substantial,
leading to distress and “post-migration traumatization” (Beiser & Hyman, 1997; Murray,
Davidson, & Schweitzer, 2010; Schweitzer, Brough, Vromans, Asic-Kobe, 2011; Vissandjée et
al., 2005).
In addition, refugees are unique because they did not make the decision to immigrate. The
United Nations High Commissioner for Refugees defines a refugee as:
someone who has been forced to flee his or her country because of persecution, war, or
violence. A refugee has a well-founded fear of persecution for reasons of race, religion,
nationality, political opinion or membership in a particular social group. Most likely, they
cannot return home or are afraid to do so. War and ethnic, tribal and religious violence
are leading causes of refugees fleeing their countries. (para. 1)
Individuals may have left their country quickly under extreme conditions and without their
whole family or possessions. Furthermore, they may have experienced various traumas while
living in the previous location, such as in a warzone or within a refugee camp. Gender-based
violence is common in refugee camps and during war conditions, which particularly affects
women and children (Sexuality Education Resource Centre, 2012). Despite these real and
important challenges, it is important not to focus on the experience of victimization related to an
individual’s unique experiences when it is disempowering and creates negative and unhelpful
narratives, nor should refugee experiences be equated with mental health symptoms (Hanania,
2017). It is important to note the resiliency in each individual’s story- within their day-to-day
lives and social practices (Lenette, Brough, & Cox, 2012). Furthermore, it is important to
acknowledge their strengths as communities and individuals. Therefore, supports that focus on
strengths, empowerment, and resiliency that already exist within individuals’ everyday life and
community is helpful (Lenette et al., 2012). Resiliency, within strength-based psychology, refers
to “a dynamic process that allows for positive adaptation despite the experience of adversity”
(Li, Chi, Sherr, Cluver, & Stanton, 2017, p. 257; Zimmerman, 2017). Fostering and focusing on
these helpful and unique adaptation skills that communities and individuals hold counters deficit
or pathology-focused support interventions (Li et al., 2017; Zimmerman, 2017).
Supporting strengths and resiliency may also include focusing on an individual's’ subjective
experience of empowerment, which refers to the layered and multifaceted processes whereby
people (individuals, organizations, or communities) influence matters that are important to them
and the outcomes (Damen et al., 2017, p. 424). This often occurs when individual and
communities “shape and give meaning to interactions with their environment” in ways that they
deem important (Damen et al., 2017, p. 424). Therefore, empowerment focuses on active
engagement in important issues to individuals and communities, which could be economic,
social, political, emotional, etc.
Intersectional Experiences of Refugee Women
Female refugees have unique needs, strengths, and challenges when they move to a new country.
Lifeline Syria (2016), an aid organization for Syrian refugees based in Toronto, estimated that
four out of five Syrian refugees arriving in Canada are women and children, which amounts to
32,065 people. To further complicate the intersectional experiences of pre- and post-migration
challenges and trauma, women from traditional societies that undergo cultural transition to an
industrialized country may have unique difficulties balancing diverse or contrasting values of the
two cultures (Meleis & Pollara, 1995). Gender roles may become complicated when seeking
employment in Canada, potentially clashing with traditional roles, responsibilities, and the
balance of power in spousal relationships. Attempting to reach equilibrium between two
conflicting cultural norms and values may result in a personal struggle. Tangible effects of this
struggle can include role overload, marital problems, and child rearing difficulties (Guruge,
Khanlou & Gastaldo, 2010).
The matriarch role has a profound effect on the family culture and health of the community
(Guruge et al., 2010). Although newcomer minority women are undergoing changes and possible
stress in their adaptation to a different cultural context, they may also take on the role of shaping
the mental health of their families, while participating in community organizations to improve
the wellbeing of their society (Guruge et al., 2010; Lenette et al., 2012). Thus, working with and
supporting recent female refugees to Canada is important for the health of family structures and
growing communities. Despite the various challenges in the new environment, migrant women
are less likely to seek mental and physical support in the medical system than Canadian women,
due to various barriers and preferences (Kirmayer et al., 2011; Reitmanova & Gustafson, 2008).
Potential reasons include feelings of being misunderstood due to the lack of linguistically
accessible services, feeling stigmatized, belief that their symptoms are inappropriate for medical
interventions, and other cultural barriers (Kirmayer et al., 2011). Thus, it is important to more
fully understand the needs of this unique community to better support them, without imposing
Canadian and/or western standards of mental and emotional wellbeing.
Mediated Safe Spaces with Creative Arts
Creating safe spaces2 to support these individuals to help build support networks and experience
empowerment both during and after relocating to a new country is vital. Nonetheless, few
culturally competent support groups are emerging in Canada that are particular to refugee and
immigrant women (Anderson, 2012; Valle Painter, 2013). Psychological and emotional factors
greatly influence health outcomes. For example, a sense of belonging to a community has larger
positive health impacts (Valle Painter, 2013). While research indicates that isolation and lack of
social support is a particular challenge for newcomer refugees, Canadian researchers know little
about their unique intersectional experiences (El-Bialy & Mulay, 2016, Hanania, 2017).
Compounding this challenge, feminist researchers De-Vault (1999) and Greenwood, (2012)
believe that Western and male-dominant forms of research that emphasize language-heavy
questionnaires and interviews may not be appropriate or meaningful for women from traditional
backgrounds. This is because individuals who experience less power may attempt to say the
“right” and appropriate answer to questions (Huss & Cwikel, 2005). Feminist authors
recommend more collaborative, empowering, inclusive, and creative ways to gather information
to build nuanced and culturally appropriate support (Griffin, 2016). Li & Grineva (2016) call for
a mediated space, where locals and newcomers can facilitate cultural differences in a safe
manner and without losing their connections to their home culture.
Educational researcher Greenwood (2012) suggests that arts-based approaches to research have
developed from researchers’ desire to create and communicate understandings that may not be
readily available through more traditional scientific qualitative and quantitative approaches.
Sullivan (2010) believes that arts-based approaches have developed from constructivist and
subjectivist philosophies and a desire to pragmatically integrate participatory, multidimensional,
and reflexive experiences into research.
Art has been used as a form of expression throughout diverse cultures and history and can hold
multiple coexisting meanings and truths (Belfiore, 2016; McNiff, 2017; Weber, 2013). The
creative arts include all forms of creative expression and are not limited to visual arts, theatre,
poetry, literature, music, dance, and multimedia art. Art therapist Wadeson (2000) evaluated how
sensitively focusing on traditional art forms from the client’s unique culture may comfort,
empower, and validate traditions while in a new country. Art expression can represent and
communicate individual experiences that hold layered implications towards wider social,
cultural, and historical experiences (Abu-Lughod, 1991; Weber, 2013). Lastly, images can carry
embodied knowledge that can provide rich, emotional, and multilayered meanings, which
surpass purely intellectual understandings (Weber, 2013). They can engage empathy by seeing
the world through the artists’ eyes, without the necessity of detailed explanation (Weber, 2013).
An Aesthetic Intersubjective Paradigm of Arts-based Research and Art Therapy
As an art therapist who has worked in several countries and across Canada in hospitals,
ministries, non-governmental organizations, and homeless shelters, I have witnessed the ability
2A safe space in this text is a term used in psychotherapy that broadly refers to an interpersonal space where individuals can feel
free to express themselves and explore ideas openly without fear of judgement (Yalom, 2009). Other terms that refer to the same
sense of safety to explore ideas include: transitional space, mediated space, creative space of play, holding space, third space, and
potential space (Winnicott, 1953; 1965; 1989). In open art community studios, Janice Timm-Bottos (2017) describes a third space
as “welcoming spaces to connect with each other in ways that inspire our imaginations, awaken our hearts and provide places to
mobilize collective actions” (p. 95).
of art-making to express experiences that are too painful or emotional for words alone. For
example, I have created handbooks, training manuals, and trainings to support professionals in
Mochudi and Gaborone, Botswana, and in Ulaanbaatar, Mongolia to ethically support
individuals who express their emotions and experiences through artmaking (Figure 1). I believe
that arts-based research can be useful when working with individuals who have challenges
communicating in the dominant language, and particularly when the individual is learning a new
language. From my personal and professional experience, I propose that we, as educators and
counselling professionals, begin thinking about creative and artistic ways to support these
individuals by creating safe spaces to express non-dominant perspectives in creative,
empowering, and expressive ways. The following text provides examples and research to
substantiate this idea.
Figure 1. Cover page and handbook that I had designed for a non-governmental organization in
Mochudi, Botswana. (Toll, H., 2012).
Recently in St. John’s, Lewis, McLeod, and Li (2108) created an open and supportive art studio
for a group of newcomer adolescents at a local high school to create a safe and creative space
that encourages belonging and empowerment. The authors found that the open studio created a
social space, which felt like home for the participants, and helped them learn English in a non-
evaluative manner in their pre-and post- semi-structured interviews and focus groups. The three
themes that emerged from the qualitative analysis were that the students saw the open studio as a
social space within their school; viewed the open studio as what felt like a home; and felt
comfortable engaging in English-learning in “a non-evaluative setting” (Lewis, McLeod, & Li,
2018, p. 13). One young student participant stated, “I feel just like I’m back in Ethiopia…
connected with people, you know…even if you’re from a different country….like you both have
similarities? Yeah, that’s the biggest part” (p. 13). Regarding the non-evaluative and comforting
nature, another newcomer student stated:
I feel at know with math you worry am I going to get this right, am I going to
get this wrong, whatever…but art is just like…you put your ideas on paper…it gives me
peace….yeah, I like doing it for myself…I just like, relax. (p. 14)
In addition to creating non-evaluative spaces that felt like home, the authors found that the open
studio group formed supportive peer connections between newcomer participants within the
school setting. Finally, the students stated that they wanted to build connections with their local
peers in school and created a student-led exhibition of their artwork in the open studio, in
addition to hosting a printmaking workshop (Lewis, McLeod, & Li, 2018). This desire to bridge
connections with their local peers through teaching artmaking skills and showing their artwork
seemed to be meaningful for the newcomer student participants. Furthermore, they
recommended that upcoming open studios include both newcomers and their local student peers.
Based on the results from interviews and recommendations of participants with this action
research study, the authors concluded that, “culturally-informed art-making should also be
encouraged as a means of exchange of ideas and expertise, and a means of empowerment for the
participants” (p. 17).
Stress-reducing Effects of Artmaking Research
The relaxing experiences generated from art-making at any skill-level have been corroborated
with several recent experimental and quasi-experimental studies. These studies measured both
non-invasive biological markers (such as cortisol levels in saliva) and validated psychological
assessments to measure increased positive affect, and anxiety and stress reduction with diverse
adults and youth (Kaimal, Ray, & Muniz, 2016; Walsh et al. 2007). An example of such a study
is when researchers and art therapists, Kaimal et al. (2016), found a statistically significant
reduction in cortisol levels (indicating a reduction in the body’s response to stress) after a 45-
minute art making session with 39 adults. The participants in this study wrote reflections after
artmaking and found the session “ relaxing, enjoyable, helpful for learning about new aspects of
self, freeing from constraints, an evolving process of initial struggle to later resolution, and about
flow/losing themselves in the work” (Kaimal et al., 2016, p. 74). Another pre-post-test design
conducted by Walsh et al. (2007) measured salivary-cortisol levels to determine stress levels and
also measured anxiety levels with the Beck Anxiety Inventory (Beck & Steer, 1993) to assess the
effects of an art making class with family caregivers of patients diagnosed with cancer (ages 18-
81 years). They found similar results to Kaimal et al.’s (2016) study, where anxiety symptoms
and stress levels decreased after the art-making session.
Moreover, an open studio approach may have unique effects on individuals, compared to solely
artmaking. Various studies have tested various art making setting conditions in order to
understand which may be the most beneficial for adult and young participants. A recent study by
Kaimal, Mensinger, Drass, & Dieterich-Hartwell (2017) found that participants (ages 19-67
years) indicated that a single session of art-making lowered the participants’ reported stress and
negative emotions. Nonetheless, the same study shows that in the open studio session which was
facilitated by an art therapist, compared to the open colouring condition “resulted in superior
improvements in positive affect, creative agency, and self-efficacy compared to the coloring
condition” (p. 56). Types of measurements for the pre-post-test quasi-experimental design
included the Positive and Negative Affect Schedule (PANAS) (Watson, Clark, &
Tellegen,1988), the General Self-Efficacy Scale (GSE) (Schwarzer & Jerusalem,1995), the
perceived stress scale (PSS) (Cohen, Kamarck, & Mermelstein,1983), and questions about self-
efficacy that were created by the authors.
This recent study extends other research that has found similar results regarding a reduction in
anxiety for an open-studio art making condition versus relaxing in chairs at a college campus
(Sandmire et al., 2012); making art versus solely viewing art at a drug treatment centre
(Laurer & van der Vennet, 2015); and an open studio versus other art therapy conditions for
adults who had cancer (Glinzak, 2016). The four conditions in Glizank’s recent study
included an oncology unit, infusion clinic, individual sessions, and an open studio. The
results from the pre-post- tests with 73 patients indicated a decrease in anxiety within all four
art therapy conditions, but the open studio condition showed the greatest mean decrease in
terms of stress. Other authors suggest that short artmaking sessions can repair negative mood
after induced sadness (Dalebroux, Goldstein, & Winner, 2008; Drake, Coleman, & Winner,
2011; Drake & Hodge, 2015; Drake & Winner, 2012). Furthermore, the types of art projects
may also affect how and whether an individual experiences reduced anxiety. Curry and Casser
(2005) found that colouring mandalas and geometric shapes reduced anxiety levels using
Speilberger’s State Anxiety Inventory (adapted by Goolkasian, n.d.) more than unstructured
artmaking with 84 university students.
Kaimal et al.’s (2016) study uses larger scoping, critical reviews, and meta-analyses to
understand the effects of artmaking on health and wellbeing in hospitals and wider communities
with various participants. Uttley, Scope, Stevenson, Rawdin, Buck, Sutton,…Wood (2015)’s
systematic review evaluated clinical outcomes and cost-effectiveness of art therapy interventions
with participants who had non-psychotic disorders. Clinical outcomes for patient participants
included improved: ability to cope, experience of quality of life and subjective wellbeing,
comprehension of one’s body and emotional experiences, perceptions of positive distractions,
self-confidence, sense of self-worth, sense of hope, social interactions, and ability to connect
with oneself in meaningful way (Uttley et al., 2015). Recent larger studies, systematic and
critical reviews, and meta-analyses supported the growing evidence that participation in specially
designed arts interventions and creative arts therapies “can reduce physical symptoms and mental
health issues” (Jensen & Lo, 2018, p. 209; Bungay, Munn-Giddings, Boyce, & Wilson, 2014;
Boehm, Cramer, Staroszynski & Osterman, 2014; ; Boyce, Bungay, Munn-Giddings, & Wilson,
2018; Shella, 2018; Staricoff & Clift, 2011; Stuckey & Nobel, 2010). This accumulation of
contemporary evidence from various authors has led to the current 19th Surgeon General in the
United States of America, Vivek H. Murthy, to stating in a recent National Organization for Arts
in Health White Paper (2017):
Within the arts lies a powerful but largely untapped force for healing. The arts and
science are two sides of the same coin, which is our shared humanity. Our ability to live
fulfilling, healthy lives depends on bringing these two forces together. (p.ii)
Furthermore, Canadian leaders in medical care are also beginning to discuss the growing
evidence for the effects of arts on health and wellbeing. Dr. Hélène Boyer, vice-president of
Médecins francophones du Canada and the head of the family medicine group at the CLSC St-
Louis-du-Parc, recently stated in an interview for the Montreal Gazette (Kelly, 2018) that there is
“more and more scientific proof that art therapy is good for your physical health” (para. 2).
These findings and recommendations have recently been published in policy frameworks and
inquiry reports to influence public health and wellbeing policy in the United Kingdom, United
States, and Australia (All-Party Parliamentary Group on Arts, Health, & Wellbeing, 2017;
Davies, Pescud, Anway-McHenry, & Wright, 2016; NOAH, 2017).
Theoretical Paradigm
Therefore, creating art in supportive environments can influence an individual’s experience of
health and wellbeing, and has also recently been integrated into a new form of research. Various
scholars note the difficulty in capturing emotional, intuitive, and holistic research with
conventional quantitative and qualitative research practices (Clift & Camic, 2017; Knowles &
Cole, 2008; Sullivan, 2010; Hodgins & Boydel, 2014). In order to achieve a more holistic and
multidimensional understanding of complex experiences, health researchers searched for
“visceral, emotional and visual elements in research creation and dissemination, which rely on
alternative expressive possibilities, [that] can allow us to access and represent different levels or
types of experience” (Hodgins & Boydell, 2014, p. 4). Hodgins & Boydell (2014), among other
scholars, believe that creative arts can have a critical role to describing and expressing illness,
health, and somatic experiences. The intersections of arts-based and arts in health research may
converge to generate fascinating and immersive results.
Due to research on the effects of art therapy and artmaking briefly outlined in the previous
section and my personal practice, my research theoretical paradigm3 is often informed by the
new and emerging aesthetic intersubjective paradigm of arts-based research and art therapy4
(Chilton, Geber, & Scotti, 2015). Defined by Chilton et al. (2015) the paradigm considers that
investigating aesthetic, sensory, and imaginal knowledge can “allow for access to multiple
dimensions of human experience and understandings typically unavailable by usual research
approaches” (p. 1). It integrates an intersubjective pluralist ontology and a dialectics pluralist
view, where multiple realities can co-exist, and concepts of truth are created between individuals
(Johnson, 2012).
Within this aesthetic intersubjective paradigm, people may gain knowledge about the world
through subjective aesthetic experiences. The etymology of the word aesthetic is a Greek term
that describes awareness that emerges through various senses simultaneously (Chilton et al.,
2015). This epistemology values pre-verbal sensory, kinaesthetic, emotional (proprioceptive),
imaginal, intuitive, embodied, and spiritual ways of knowing as equally important as cognitive
thoughts. This also includes interoceptive knowledge, which describes when larger-picture
(metacognitive) is obtained through sensations that are felt within the body and is connected to
gut-feelings (Brosch & Sander, 2013; Smith & Lane, 2015). This form of knowing can emerge
3A paradigm is “a worldview ot framework through which knowledge is filtered” and involves an individual’s
particular ontology and epistemology that is often formed through life experiences (p. 11; Kuhn, 1962). Paradigms
are also regarded as “lenses through which research is conceived and executed, and thus they are often difficult to
see” (Leavy, 2017).
4For more information on the aesthetic intersubjective paradigm of arts-based research and art therapy, please see
Chilton et al.,’s (2015) publication.
through creative art praxis and in the process of flow5 during the full-immersion in an activity
(Csikszentmihalyi, 1996). Furthermore, valuing knowledge development through active aesthetic
experiences is also influenced by neurobiological findings on how artmaking changes the brain
(Bolwerk, Mack-Andrick, Lang, Dörfler, & Maihöfner, 2014; Warson & Lorance, 2013). Larger
insights and meaning can be generated through discussing the art creations with others in a
dialectic process and when creating a larger body of art that expands upon a topic or experience
(Chilton et al., 2015).
Consequently, this paradigm has materialized from interconnecting transdisciplinary and
interdisciplinary fields of: the arts in medicine, indigenous holistic knowledge, psychoanalysis,
humanities, psychotherapy, fine arts, psychology, semiotics, and anthropology. It allows for
space for multiple identities of a researcher, artist, therapist, educator, etc. to exist. Therefore, the
identity of an art therapist within the Faculty of Education can co-exist and bridge knowledge
from across education, creative arts therapies, and health fields.
The field of arts-based research within social sciences and health is growing, with an upward
trend, according to the literature review by Fraser & al Sayah (2011) and a scoping review by
Boydell, Gladstone, Volpe, Allemang, and Stasiulis in 2012. These authors conclude that, “In
spite of some challenges there are significant benefits: namely, that the arts are useful for
uncovering or producing knowledge and also for translating knowledge” (Fraser & el Sayah,
2011, p. 138). Nonetheless, much work regarding creating systematic methods and critical
literature on the process remains (Hodgins & Boydel, 2014).
Ethical Considerations of Arts-Based Research
Arts-based research must be practiced with ethical care and rigor, as powerful emotions can
surface from introspective art making. Furthermore, research within cross-cultural contexts with
individuals who may experience marginalization and vulnerability must be done in a safe, caring,
supportive, empowering, and ethical manner with an emphasis on cultural humility (Bal & Kaur,
2017; Tervalon & Murray-Garcia, 1998). Various art therapists (Acton, 2001; Hocoy, 2002;
Kapitan, 2015; McNiff, 1984) who have published in the past thirty years have cautioned against
practitioners and researchers imposing their own cultural paradigms (mainly Western) and biased
interpretations onto artworks of participants from other cultures, which can be almost impossible.
Thus, the researcher must be aware that symbolism and the artistic process is unique to each
individual’s familial, ethnocultural, sociohistorical, and personal experiences. Ethically, art
therapists and researchers must be aware of the participants’ cultural symbols and underlying
practices without creating or imposing assumptions from an ethnocentric lens. This process can
include engaging in reflexive practices to continuously challenge one’s underlying beliefs and
assumptions (Acton, 2001; Kapitan, 2015; McNiff, 1984). In addition, the researcher must be
acutely aware of power hierarchies within their roles to mediate these power differentials,
acknowledge experiences of oppression, and strive for providing safe and equitable spaces
(Hocoy, 2002; Karcher, 2017). Finally, not all people are comfortable expressing themselves
5Flow is a term used in psychology to refer to when an individual experiences full absorption in an enjoyable
activity and loses their sense of self, space, and time while engaging in the activity (Csikszentmihalyi, 1996).
through the creative arts so it is important not to impose the researcher’s paradigms and beliefs
about art upon participants who may prefer other ways to express themselves.
Professor of Art Education and curriculum theorist, Elliott Eisner (2008) believes that art plays
an important role in the development of human understanding and diverse forms of knowledge.
This idea of knowledge includes, but also extends beyond Aristotle’s categorization of
theoretical, practical, and productive knowledge (Eisner, 2008). Thus, creative arts and embodied
knowledge may expand positivist and postpositivist6 logical and rational reasoning, and touch
not only emotional connection and empathy, but open up possibilities of acknowledging and
integrating intuitive, symbolic, and multilayered understandings of the world (McNiff, 2017;
Sullivan, 2010). Furthermore, the experience of creative arts can positively impact an
individual’s mental health and reduce anxiety (Jensen & Lo, 2018, Kaimal et al., 2016; Kaimal et
al., 2017; Bungay, Munn-Giddings, Boyce, & Wilson, 2014; Boehm, Cramer, Staroszynski &
Osterman, 2014; ; Boyce, Bungay, Munn-Giddings, & Wilson, 2018; Shella, 2018; Staricoff &
Clift, 2011; Stuckey & Nobel, 2010; Uttley et al., 2015). Chilton et al.,’s (2015) aesthetic
intersubjective paradigm of art therapy and arts-based research describes a different way to
understand knowledge development and frame research in a way that values subjective ways of
knowing through active and participatory aesthetic experiences. Nonetheless, more research must
be done.
The experiences of displaced people are of international importance (UNHCR, 2018). As
newcomers arrive in Canada, researchers must find supportive, empowering, helpful, and
participatory ways to involve their profound experiences within research to influence wider
public policy decisions (Guruge & Butt, 2015). This research must be done with cultural
humility and a deep respect for the artistic process of each participant (Acton 2001; Bal & Kaur,
2017; McNiff, 1984; Tervalon & Murray-Garcia, 1998).
The Author
Haley Rebecca Mary Toll, MA, CCC, RCAT is the President and Board Chair of the Canadian
Art Therapy Association and PhD student in the Faculty of Education at Memorial University of
Newfoundland, Canada. As a Registered Canadian Art Therapist and Certified Canadian
Counselor, she has worked with children and adults internationally and across Canada in
primarily trauma-care related to cancer diagnosis, sexual abuse, and other psychological and
emotional challenges. Haley has also trained mental health practitioners in Botswana, Thailand,
and Mongolia in arts-informed and crisis intervention practices. Her primary research focus
intermixes multicultural and international art therapy and arts-based research.
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... Through art, people can connect with 'preverbal, affective, and novel cognitive views of the world in ways that capture nuance' (Corbett and Moxley, 2018, p. 149). These activities facilitate distancing from trauma and create safety (Green and Denov, 2019), opening up opportunities to capture human experience despite linguistic and communication barriers, and transcending the confines of speech (Guruge, 2015;Toll, 2018;Chatzipanagiotidou and Murphy, 2020). Using art materials creatively enables the processing of emotions, increases self-awareness, selfesteem and fosters coping mechanisms (Ugurlu et al., 2016). ...
... Photographs often triggered participants' memories of what was left behind, allowing them to integrate their experiences before and after immigration and to express feelings that were difficult to put in words. (Brigham et al., 2018, p. 109) Communicating through art Art has been a form of expression across diverse cultures, geographies and histories, and images can hold multiple layers of meaning that engage with empathy while expressing experiences too painful to speak of (Toll, 2018). ...
... Hanania (2017) suggests that engaging with refugee Syrian women through embroidery would benefit them and help to build strong communities. Toll (2018), like Hanania (2017), considers there to be few culturally appropriate support networks for Syrian women refugees who have settled in Canada. She remarks that educators and professionals should: … begin thinking about… artistic ways to support these individuals by creating safe spaces to express non-dominant perspectives in creative, empowering, and expressive ways (Toll, 2018, p. 6). ...
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The United Nations High Commissioner for Refugees (UNHRC) has identified that refugee children's participation in mainstream schooling in many refugee host countries (RHCs) is substantially lower than their settled peers and that for girls the gap is even more significant. Furthermore, the gap between refugee girls, their settled peers and refugee boys widens, as girls get older. This is often attributed to social and cultural traditions that under-value girls' education and limit their participation in activities outside the home or immediate community setting. This project has explored the literature around arts-based interventions aimed at girls and young women and the particular affordances and ethical complexities of these.
... Art-based interventions and creative initiatives can provide alternative potentialities while offering space and time for inspiring hope and resilience. Additionally, art practices offered to refugees in non-art institutions have been acknowledged as an effective alternative therapeutic approach in comparison with more traditional medical cures (Alexander, Arnett, and Jena 2017;Toll 2018). Arts-based practices are also used broadly by scholars in refugee research in order to stimulate critical thinking, evoke reflection, question stereotypes and social discrimination, and open up possibilities for social action and change. ...
... The benefits of a safe place for newcomer refugees and migrants prove vital during and after their resettlement in the new country. A protected space enables the development of relational bonds through regular meetings, which, together with practices related to creative processes, can shape and open up possibilities of belonging (Toll 2018;Nunn 2020). On the other hand, the concept of belonging incorporates its opposite, nonbelonging, as "inclusion entails exclusion, if only by default" (Jenkins 2004, 102). ...
... Limited migration research has explored a gendered perspective despite gender being "an essential element to consider in the context of international migration, as it is a key feature in the complex and intersecting asymmetrical social power relations embedded in society"; hence, the focus of this paper (Brigham et al., 2018, p. 107). Images can hold complex multiple layers of meaning, enabling powerful communication, and art can elicit empathy in viewers while also enabling the expression of experiences too painful to speak about (Toll, 2018). Indeed, inchoate feeling can be eloquently captured in art works (Hogan, 2016). ...
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This article explores the particular benefits of arts-based interventions with refugee women and girls and the potentialities for enhancing social justice. This truncated review of literature makes reference to arts-based communication, notions of female empowerment, symbolism and metaphor, and expressions of identity and agency and then moves on to explore a number of primarily participatory arts-based interventions with women and girl refugees, looking at the particular affordances yielded.
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The Open Studio is a publicly accessible art-making space grounded in ideals of collaborative community development, Adlerian theory, social justice, and feminist thoughts. Our project involved visual art-making and exploring high school immigrant students’ experiences of inclusion and belonging. The purpose was to help immigrant and refugee youth to adapt to a city in Newfoundland, where newcomers often face an insider/outsider dynamic of disconnection. The Open Studio was structured along seven parameters: focus on intentional art-making; no judgmental commentary (positive or negative); non-evaluative in nature; no forced participation, including witnessing and sharing; and as importantly, participatory involvement of facilitators. The participant-planned and hosted final school exhibit contributed to learning, sharing, and group cohesiveness. A plain language needs assessment, semi-structured interviews, and focus group, were also used to generate data on how an Open Studio informs cultural experiences and feelings of integration and belonging. Keywords: Immigrant and refugee youth, art-making, belonging, integration
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Aims: This literature review aims to illustrate the variety and multitude of studies showing that participation in arts activities and clinical arts interventions can be beneficial for citizens with mental and physical health problems. The article is focused on mental health benefits because this is an emerging field in the Nordic countries where evidence is demanded from national health agencies that face an increasing number of citizens with poor mental health and a need for non-medical interventions and programmes. Methods: A total of 20 articles of interest were drawn from a wider literature review. Studies were identified through the search engines: Cochrane Library, Primo, Ebscohost, ProQuest, Web of Science, CINAHL, PsycINFO, PubMed and Design and Applied Arts Index. Search words included the following: arts engagement + health/hospital/recovery, arts + hospital/evidence/wellbeing, evidence-based health practice, participatory arts for wellbeing, health + poetry/literature/dance/singing/music/community arts, arts health cost-effectiveness and creative art or creative activity + health/hospital/recovery/mental health. The inclusion criteria for studies were (1) peer review and (2) empirical data. Results: The studies document that participation in activities in a spectrum from clinical arts interventions to non-clinical participatory arts programmes is beneficial and an effective way of using engagement in the arts to promote holistic approaches with health benefits. Engagement in specially designed arts activities or arts therapies can reduce physical symptoms and improve mental health issues. Conclusion: Based on the growing evidence of the arts as a tool for enhancing mental health wellbeing, and in line with the global challenges in health, we suggest that participatory arts activities and clinical arts interventions are made more widely available in health and social settings. It is well-documented that such activities can be used as non-medical interventions to promote public health and wellbeing.
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Background: Coloring books for adults have become a ubiquitous presence in retail outlets worldwide and in the visual cultural landscape. The goal of this study was to determine differences in outcomes between art therapist-facilitated open studio and individual coloring. Methods: The study used a within-subjects experimental design. Healthy adult participants (aged 19–67 years) were invited to engage in one session each of individual coloring, and open studio facilitated by an art therapist. A total of 36 participants enrolled in the study; 29 completed pre- and post-surveys for both conditions. Outcomes measured included positive and negative affect, perceived stress, self-efficacy, and creative agency. Results: The art therapist-facilitated open studio condition resulted in superior improvements in positive affect, creative agency, and self-efficacy compared to the coloring condition. Both conditions resulted in lowered stress and reduced negative affect. Discussion and implications: The results indicated that coloring might have therapeutic benefits on distress; however, only the art therapist-facilitated open studio session showed significant improvements in self-efficacy, self-perceptions of creativity, and positive mood. Art therapists might consider using the phenomenon of coloring as a doorway to art therapy and more spontaneous creative and self-expression for transformative change. Future studies should seek to identify the unique mechanism of change through which art therapist-facilitated art making explains the shifts in positive affect, creative agency, and self-efficacy.
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Art therapists hold a unique position to facilitate healing during a time of intense sociopolitical trauma. The current U.S. political climate is causing harm to marginalized groups, which necessitates an intentional exploration of how art therapists hold and wield power and privilege and how this can affect client outcomes. In this article, I offer an expanded definition of trauma as it relates to social and political oppression, and examine the privileges and assumptions I hold as a therapist. I provide case examples from my clinical practice of client responses to political and societal trauma, ending with suggestions for critical self-reflection for art therapists invested in a social justice framework.
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There has been an unprecedented upsurge in the number of refugees worldwide, the majority being located in low-income countries with limited resources in mental health care. This paper considers contemporary issues in the refugee mental health field, including developments in research, conceptual models, social and psychological interventions, and policy. Prevalence data yielded by cross-sectional epidemiological studies do not allow a clear distinction to be made between situational forms of distress and frank mental disorder, a shortcoming that may be addressed by longitudinal studies. An evolving ecological model of research focuses on the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the background disruptions of core psychosocial systems, the scope extending beyond the individual to the conjugal couple and the family. Although brief, structured psychotherapies administered by lay counsellors have been shown to be effective in the short term for a range of traumatic stress responses, questions remain whether these interventions can be sustained in low-resource settings and whether they meet the needs of complex cases. In the ideal circumstance, a comprehensive array of programs should be provided, including social and psychotherapeutic interventions, generic mental health services, rehabilitation, and special programs for vulnerable groups. Sustainability of services, ensuring best practice, evidence-based approaches, and promoting equity of access must remain the goals of future developments, a daunting challenge given that most refugees reside in settings where skills and resources in mental health care are in shortest supply.
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This article addresses the complex academic and social adjustment issues of newcomer youth of refugee background at a high school in Newfoundland and Labrador, a province where the newcomer population is small but the percentage of refugees in relation to all newcomers is high. Data for this qualitative study include documents from educational authorities and ESL teachers, field notes of classroom observations, qualitative survey questionnaires from 15 newcomer students, and interviews with 6 students of refugee background and 3 teachers. We found that these refugee youth were challenged due not only to language difficulties and educational gaps, but also to differences in educational systems, school cultures, and student-teacher dynamics between their previous school- ing and what they encountered in Newfoundland. They had to cope with social isolation and different practices of body language, dress code, personal hygiene, and sexual orientation. The study also identified inadequacies in the current curriculum, teacher in-service education, and diversity initiatives in the school system. Cet article porte sur les enjeux complexes liés à l’adaptation académique et sociale que vivent de jeunes réfugiés dans une école secondaire à Terre-Neuve-et-Labrador, une province où les nouveaux arrivants sont peu nombreux mais où le pourcentage de réfugiés parmi les nouveaux arrivants est élevé. Les données pour ce e étude qualitative incluent des documents provenant d’autorités scolaires et d’enseignants d’ALS, des notes découlant d’observations en classe, des ques- tionnaires qualitatifs auprès de 15 élèves nouvellement arrivés, et des entrevues auprès de 6 élèves réfugiés et de 3 enseignants. Les résultats indiquent que les jeunes réfugiés sont confrontés non seulement à des difficultés linguistiques et des lacunes d’éducation, mais également à des différences dans les systèmes éducatifs, dans les cultures scolaires et dans la dynamique entre les élèves et les enseignants qui distinguent leurs expériences pédagogiques précédentes de celles qu’ils vivent à Terre-Neuve. Ils devaient faire face à l’isolement social et aux pratiques différentes relatives au langage corporel, au code vestimentaire, à l’hygiène personnel et à l’orientation sexuelle. L’étude a également identifié des lacunes dans le pro- gramme d’études actuel, dans le perfectionnement professionnel des enseignants et dans les initiatives scolaires portant sur la diversité.
Art has the political potential to create change on both an individual and systemic level. The realization of this comes through in a therapeutic practice that is anti-oppressive and accounts for power in relationships and institutions. As a child and youth care practitioner and an art therapist, we have respectively used cultural humility as a conceptual framework with which to undertake radical youth work. This framing of youth work acknowledges the power in relationships between adults and youth as being a colonial construct and uses relational practice as a means of deconstructing it. By reflecting on our experiences in practice, we propose a set of critical tools, from the healthcare framework of cultural humility, for working with underserved populations. By highlighting the populations we work with as being underserved, we acknowledge that their oppression is a result of the systems in which they exist, and which fail to serve them equitably.
With the increase in Syrian refugees entering Canada, there is a growing need to provide appropriate mental health care to meet specific requirements for support and practical assistance. There have been art therapy groups designed to accommodate the mental health needs of Syrian refugee children at COSTI Immigrant Services (COSTI, 2013 COSTI. (2013). Art therapy program for refugee children. Retrieved from [Google Scholar]) and Turtle House (Turtle House Art Play Centre, 2016 Turtle House Art Play Centre. (2016). Syrian Refugee Pilot Project. Retrieved from [Google Scholar]), located in Toronto, Ontario, and at the Saskatoon Open Door Society (Issa, 2016 Issa, O. (2016, December 22). Syrian kids adapt to new life in Canada through art therapy. Retrieved from [Google Scholar]), based in Saskatoon, Saskatchewan. However, there are few art therapy groups designed for the refugee population of Syrian women. If art therapy groups are designed and implemented in a way that is culturally informed, they have the potential to impact positively on participants' mental health. Embroidery is an example of an art medium that is culturally appropriate for Syrian women, and if used as a therapeutic tool, its cultural relevance could be conducive to a positive adjustment period and the reduction of trauma symptoms. This paper discusses the importance of culturally informed art directives, the potential of embroidery as a therapeutic medium for Syrian refugee women, and the apparent lack of existing art therapy groups for Syrian women in Canada.
This review provides an updated evaluation of the emerging body of literature on the value of the arts in healthcare settings. Internationally, there is growing interest in the use of the arts in the healthcare context supported by the number of research studies reported in the nursing and medical literature. There is evidence that arts interventions have positive effects on psychological and physiological outcomes on patients in a hospital environment. A critical review of the literature between 2011 and 2016 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: cultural activities, outcomes and healthcare settings. Initial searches identified 131 potentially relevant articles. Following screening and review by the research team, a total of 69 studies were included in the final review. The majority of studies examined the effect of music listening on patients/service users (76.8%). These studies were primarily quantitative focusing on the measurable effects of music listening in a surgical context. Overall, the studies in the review support the growing evidence base on the value of the arts in a variety of healthcare settings for patients/service users. The review findings suggest that now is the time for different voices and art forms to be considered and represented in the research on arts in healthcare. Further research is also required to strengthen the existing evidence base.