Towards a description of the elements of art therapy practice for trauma: a systematic review

Abstract

Background Post-traumatic stress disorder is a debilitating mental health condition that can occur when individuals are exposed to traumatic situations [American Psychiatric Association. (2013). Trauma- and stressor-related disorders. In Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub]. Art therapy has been growing in popularity and acceptance as a therapeutic intervention for trauma over the last 10 years [Nanda, U., Barbato Gaydos, H. L., Hathorn, K., & Watkins, N. (2010). Art and posttraumatic stress: A review of the empirical literature on the therapeutic implications of artwork for war veterans with posttraumatic stress disorder. Environment and Behavior, 42(3), 376–390. https://doi.org/10.1177/0013916510361874], however, there is a sparsity of rigorous, methodologically sound evidence supporting its use. One step towards developing rigorous effectiveness studies is to firstly consolidate an understanding of the elements of art therapy.Method A comprehensive systematic search of the literature was performed. Data was extracted to best understand the elements of art therapy using the elements articulated by Borrelli et al. (2005. A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. Journal of Consulting and Clinical Psychology, 73(5), 852. https://doi.org/10.1037/0022-006X.73.5.852) which include: Design, Training, Delivery, Receipt, and Enactment. The elements were mapped and narratively described.Findings A total of 44 studies met eligibility criteria and were included for data extraction and coding. Publications reported study design, treatment enactment, and treatment receipt; however, gaps were seen in the reporting of provider training and the delivery of treatment, prominently the lack of reported treatment delivery guidelines.Conclusion This study demonstrated that there is a lack of consistency in the reporting and use of practice guidelines regarding art therapy for trauma, which severely impacts the ability to determine best practice. However, considering that art therapy is focused on consumer exploration with therapist support, it is possible that the lack of guidelines is intentional, rather than incidental. Exploring practitioners’ intent around selection and use of practice guidelines is needed to better understand this phenomenon.Plain-language summary Post-traumatic stress disorder is a debilitating mental health condition that can occur when individuals are exposed to traumatic situations. Art therapy has been growing in popularity and acceptance as a therapeutic intervention for trauma over the last 10 years, however, there is still hesitation when considering art therapy as a valid treatment for trauma. Given that funding bodies and medical advisory institutions around the world are increasing their focus on trauma treatments that can demonstrate effectiveness, we need to have a better understanding of what represents good practice for art therapy before we are able to investigate the effectiveness. Without benchmarks for what best practice art therapy looks like, we cannot perform the high-quality studies needed to investigate the effectiveness of art therapy as a trauma treatment. This study performed a systematic search of the academic literature to best understand the elements of art therapy practice for trauma with the aim of consolidating and understanding practice consistency and standardisations in five elements: Design, Training, Delivery, Receipt, and Enactment. A total of 44 studies were included. This study demonstrated that there is a lack of consistency in the reporting and use of practice guidelines regarding art therapy for trauma, which severely impacts the ability to determine best practice and, in turn, to perform studies of effectiveness. However, considering that art therapy is focused on individual exploration with therapist support, it is possible that the lack of practice guidelines is intentional, rather than incidental. By extension, having one singular treatment protocol may not be effective for this type of intervention, as it is impossible to create a treatment manual for such an individualised treatment. It is recommended that the intent behind art therapy practitioners’ reporting and use of practice guidelines is further explored to better understand this trend.