The Situation of Art Therapy by Dr. Karin Dannecker

The history of art therapy in Germany can be viewed either as being a long or a rather short one. I tend to say that we are stll at a very early stage of development which I will define in a little while. There are collegues who lay the roots in almost antique epochs pointing out that art has always been the need of every culture to define and understand oneself being in our world. It would take quite long to name all historical, philosophical and educational figures that are used as a kind of predecessors for art therapists. The historical focus of art therapy teachers depends very much on their own background. A few coming from philosophy seem to rely more on philosophical art history than on present knowledge in art and its relationship to psychotherapy. I see the beginning of the developments towards art therapy in the liberalisation omovements at the second half of the last century. With the opening of the psychiatric asylums psychiatrists had observed that their patients seem to have an urge to express themselves by using pieces of newspaper, wood or other materials to draw and paint and create sculptures. Painting studios were established where these patients could work with simple artistic media.

The event of Prinzhorn’s book: “Artistry of the Mentally Ill” in 1922 in Germany and the following excited reactions by artists like Dubuffet, Klee, Kandinsky etc. seems to be an opening key argument for not only artists but also medical people to bring the art of outsiders into a new light. The traditional romantic attitude that mentally disturbed or ill people are the real artist geniuses is still prevailing in some approaches. The “Artist from Gugging” near Vienna as well as other gifted and promoted patients from institutions had fallen on fruitful ground in the form of exhibitions and books from the 80’s on. Whereas the term ‘art therapy’ was already coined in the 1940’s in the United States and Great Britain as a valuable adjunct to medical treatment it first took a much slower development in other countries. I remember conferences where artists working in hospitals presented the work of the patients with great enthusiasm: every move with a brush on paper was a sign of liberation, idealized and solely taken as comparable with modern abstract art. Questioned about possible therapeutic effects or needed cooperation with other therapists like doctors or psychologists the answer was purposefully negative: any exchange with medical or psychological people would deepen the stigma already put on the patients as patients and would prevent uncensored creativity to grow.

But most collegues believe that for the artist who wants to enter the field of art therapy it is of tantamount importance to learn about the theory and practice of psychotherapy and to be able to integrate it with his or her knowledge about art. I am working at an art school myself to establish an art therapy program. During our ‘pioneering activities’ at this academy our experience has been that professors from the painting and sculpture departments presented great scepticism: they express fears, that art therapy at an art school would diminish the clear art (reine Kunst) when it is applied in therapy. Unfortunately they do not seem to be well informed about our actual work. Just recently students suggested that we do a project to find out more about the artists’ inhibitions and reluctances towards art therapy. I think it is worthwhile to create a research project about this issue.

We can be more optimistic when we turn to the medical fields for support: in Berlin I can name many clinics which have employed art therapists, even when they have no formal training (which is not yet possible). Those art therapists get payed poorly, although their background is often an academic training like art studies, art education, psychology etc. Medical doctors seem to acknowledge the limits of the solely scientific-technical approach. Especially in psychiatric and psychosomatic fields the so-called non verbal therapies are appreciated as valuable adjuncts to the other forms of treatment. I have been invited to several medical congresses to present art therapy either with rheumatology patients with whom I had worked or psychiatric patients. (I must admit I had the phantasy on these congresses that among all the papers with index foils and statistical data I felt that the many doctors were happy and relieved to see real human products in the art works presented: a somewhat exotic adjunct. But I tell to myself: why not take such a presentation based on art therapy theory and practice as one way to enter the mind or other healers!)

Nevertheless there seems still to be a lot of mistrust about the seriosity of art used in therapy. By comparison, with the need for repeatable scientific research constructs in medicine, the processes and products in art therapy cannot be reproduced and measured. This causes sometimes typical fears among medical people and traditional psychotherapists towards art therapy, while on the other hand they forget that medicine can be viewed also as some form of art. Peter Peterson, a gynaecologist, talks about four major misunderstandings about the use of art in therapy: the specifity of medical treatment and the specifity of the reactions are counter to the unspecific results of artistic therapies: cause and effect-mechanisms have to be looked at as being different from medical science. The lack of exact indication in art therapy as opposed to concrete physical and pharmacological treatment indication poses an “unbearable risk”. Which is true in the sense that art lacks an exact definition as well as art therapy. No one art therapy situation can be compared with the art therapy situation with another patient. Artistic therapies water down the scientific research in psychotherapy, because the scientific principle of reproductability and measurability of the phenomena is hurt. Peterson suggests to counterpose these criteria to criteria from psychosocial research: reproductability corresponds with tracability (Nachvollziehbarkeit); objectivity corresponds with controlled subjectivity and intersubjectivity; experiential empirical situations correspond with overplaced empirical behaviour and experience, especially spontaneous behavoir in art therapy. The consequences are an intensified perception, an autonomous therapeutic process and therapeutic dialog.

I think that not only from the medical fields there are influential misunderstandings about art therapy. It seems obvious that at least in Germany the term ‘art’ in therapy has not been defined clearly yet. As little as every creative expression is art, as little every creative expression is therapeutic. Least every creative expression in therapy is art therapy. The differentiation of the term art in therapy is still part of many discussions. To circumvent this problem some training institutes have called their approach ‘Gestaltungtherapie’ (shaping or forming therapy??), or ‘painting-therapy’, or ‘therapy with artistic media’, or integrative therapy, including other forms like dance, movement, poetry etc. Each time one uses the term ‘art therapy’, it is necessary to define it according to the school where she or he is coming from.

Education in art therapy is not based on liable standards yet in Germany. Only two universities offer art therapy, both working towards a diploma program. Among the two there is the Hochschule der Kuenste where I am teaching. Due to the many changes in Berlin with poitical and financial restraints the Berlin Senate has not signed the proposed diploma study program yet; we are still waiting including many students.

Some other institutions are part of academic fields like special educaton, art education and social pedagogy. There is an Anthroposophic school which has the status of a Fachhochschule (college level), and another Fachhochschule for art therapy with undergraduate training. Standards of admission vary widely. There are about 15 private institutes. The legal situation is open: professional groups are working towards establishing liable standards for admission and training for all institutions.

It can be said that the chance to be acknowledged as a psychotherapeutic approach art therapy training would be best on university level. But this fact causes many problems among all art therapists, since many stem from private, non-academic training institutes. In 1991 a commission, installed by the government to estimate every psychotherapy field to consider legal registration, recommended that for legal registration art therapists must present more scientific research and empirical data; generally only psychoanalysis and behaviour therapy were supported for legal acceptance. The access to such professions was to remain for medical doctors and for psychologists.

Meanwhile there are several art therapy associations in the German speaking area: Int. Gesellschaft, DGKT, DFKGT, Berufsverband fuer Kunst-, Musik- und Tanztherapie – Europaeischer Dachverband fuer kuenstlerische Therapien e.V./ First European Association of Arts Therapies. On the European level only a very few collegues know of EABONATA (European Advisory Board of National Art Therapy Associations) or are part of it. There is also very little known about the international Networking group ING, founded in America.

Now I want to share briefly with you the report of a recent meeting with the former president of the European Associaton of Pyschotherapies EAP, Herr Dr. Alfred Pritz from Vienna. This Association seems to have a major input in the development of all forms of psychotherapy in Europe. A number of European psychotherapists founded this association in 1990 with a declaration about the principles of psychotherapy in Strassbourg, France. The goal of EAP is to integrate scientifically trained psychotherapists of different approaches in Europe. Its understanding is that of a professional association (Berufsverband) which represents the interests of all associated groups including their interest towards institutions, offices and financial agencies like health insurance companies etc. I suggest that we will inform ourselves further abouty the usefulness of further connection to EAP.

You might know that in Austria there is a rather new special law for psychotherapy professions. It allows not only medical or psychological applicants to become qualified as psychotherapists but also people from other fields. This legislation seems to be a goal of EAP to be reached for every European country. The major advice that Dr. Pritz and others have given is to build lobbies at every level, also in politics. Only in this way art therapy can rech legislation and acknowledgment. But we still need to build a strong body of theory and be clear about the different understandings which are existing in art therapy. And this is another strong advice: We must accept different approaches since they are already there. We must present a unity with inner scientifically firm diversity. This might be hard since the building of “schools” often creates enemies instead of collegues.

For our meeting I would like to say my wish for a goal which I think we can reach here: to formulate a kind of a resolution which will show us the way how we can integrate the work in art therapy already done in every country and making some good plans for the future.

Summary and Statement

Art Therapy was a term first used in Britain and the United States in 1941/42 during the post-World-War-II rehabilitation movement. Two strands developed: one as a sensitive form of art teaching and the other as an aspect of psychotherapy through art.

Extensive clinical results from more than five decades of development show that art therapy provides an important treatment intervention for children and adults suffering from a range of mental and physical disorders. More and more it proves to be indispensible to the needs of the modern European health and social care services. Its flexibility enables it to be adapted to the diversity of ethnic cultures which make up Europe. The question of identity is inherent in the making of art itself: it is well known that paintings, sculptures, music, dance and poetry are ways of searching the other part of one`s self, the unknown piece of personality - which can become form and expressed, objectified reality by making a piece of art work. Art therapy can help people to find and reconstruct personal and social identity on a very fundamental level.

Throughout the 1940s, many artists became interested in using their skills with patients in hospitals and clinics. There was, though, no official statement for the 'art therapist' and artists were employed under many different titles with varying salaries. During the 1960 and 1970s art therapists were employed in Britain and a few other European countries in the National Health Service on an 'ad hoc' basis, but salaries and conditions of service were very poor. This is currently still the situation in most European countries.

From the beginning the development in each country was directed towards establishing mostly post graduate training in art therapy in order to give impetus to a movement for greater professional credibility and to push for art therapists to have a proper career and salary structure. In Britain the British Association for Art Therapists and the training centers achieved this goal in 1982 and the Diploma in Art Therapy was recognised by the Department of Health as the qualifying course for working as an art therapist in the National Health Service. In this regard Britain is the major pioneer in Europe in establishing the profession with educational standards, a code of ethics and salary scale.

In the other countries various levels of professional achievement have been attained. Due to the difficulties of language, distance of places of key members in the European countries the stages of development differ widely. In 1991 EABONATA was founded, a networking group (European Advisory Board of National Art Therapy Association). But because of the above mentioned difficulties in networking internationally EABONATA was endagered in its existence.

The contemporary art therapists share the value of art as therapy with the focus on these prerequisits: art therapists should have a considerable understanding of visual art processes and an ability to communicate with a wide range of clients, both individually an in groups. Art therapists should have a sound knowledge of psychodynamic theory and practice, and be able to work with the conscious and unconscious material that emanates from the art work within the therapeutic relationship.

The definition for art therapy can be as following: Art therapists provide a secure environment, e.g. private room or studio, a variety of art materials - paint, clay, collage etc., and themselves. Clients may use the material in any way they wish with the aim of communicating thoughts and feelings in the presence of the therapist. Although this process can be strange at first (most clients are not familiar with using art in this way) it has proved to be very helpful for clients suffering from a range of distressing conditions. They may be acutely or chronically mentally ill or mentally handicapped, children or adults - including the very young and the very old. The therapist encourages the client to respond to the art product and the therapist is aking to a dialoge. Art therapy can be a very powerful process which may enable long buried feelings to come to the surface and be acknowledged.

In our workshop we found three principal problems which we hope to be solving in the future:

1). the question of networking: the need for continuous communication is recognised; research results, books, articles should be translated - this means to share information widely.

A forum for contact of the members of associations, practicing art therapists and other interested people sould be established. The need for a European Journal of art therapy seems to be great: a journal with a mutual language (English) with a translation into the mother tongue of each country. Attemps will be made to create a journal from each member of the workshop in his or her country, e.g. finding a publisher, funding money, etc.. Also contact to institutions of the European Union, governing health commissions, will be made to be informed about legal, insurance and other issues.

2). The research itself: we plan to set up research protocolls; this means to design mutual research projects, which will be carried out in the different countries. One suggested topic for research: To trace the attitudes of a variety of institutions, organisations, people within health issues in respect to art therapy.

3). The question of funding: financial support from different resources must be established to enable all art therapists to cooperate, exchange students, training teachers, research projects. Reasonable and effective conditions must be created to be able to continue and deepen our work which has begun in the formation of EABONATA.

All participants of the workshop agree to continue to work together with the hope that the next meeting will be in the fall in Munich during the next seminar.

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The Situation of Art Therapy by Dr. Karin Dannecker