Art TH Research

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Research
Introduction
to Art Therapy
New York London

Lynn Kapitan
Research
Introduction
to Art Therapy
Routledge Routledge
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Library of Congress Cataloging-in-Publication Data
Kapitan, Lynn.
Introduction to art therapy research / by Lynn Kapitan.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-415-87147-1 (hardback : alk. paper)
1. Art therapy--Research. I. Title.
[DNLM: 1. Art Therapy. 2. Research--methods. WM 450.5.A8 K167i 2010]
RC489.A7K355 2010
616.89’1656--dc22 2009053529
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Dedication
I dedicate this book to my students, who taught me to be courageous in heart and

daring of mind, and to pursue the questions that truly matter.
The following abstracts appear in Chapter 9, Models of Good Research: Conducting

the Study and Reporting Results, and are reprinted with permission from Art Therapy:
Journal of the American Art Therapy Association:
Barbee, M. (2002). A visual-narrative approach to understanding transsexual identity. Art Therapy:

Journal of the American Art Therapy Association, 19(2), 53–62.
Collie, K., & Cubranic, D. (1999). An art therapy solution to a telehealth problem. Art Therapy:
Doric-Henry, L. (1997). Pottery as art therapy with elderly nursing home residents. Art Therapy:
Henley, D. (2007). Henley, D. (2007). Naming the enemy: An art therapy intervention for children
with bipolar and comorbid disorders. Art Therapy: Journal of the American Art Therapy
Association, 24(3), 104–110.
Kearns, D. (2004). Art therapy with a child experiencing sensory integration difficulty. Art
Therapy: Journal of the American Art Therapy Association, 21(2), 95–101.
Morgan, C. A., & Johnson, D. R. (1995). Use of a drawing task in the treatment of nightmares
in combat-related post-traumatic stress disorder. Art Therapy: Journal of the American Art
Therapy Association, 12(4), 244–247.
Pifalo, T. (2006). Art therapy with sexually abused children and adolescents: Extended research
study. Art Therapy: Journal of the American Art Therapy Association, 23(4), 181–185.
Spaniol, S. (1998). Towards an ethnographic approach to art therapy research: People with psy-
chiatric disability as collaborators. Art Therapy: Journal of the American Art Therapy
Association, 15(1), 29–37.
Spaniol, S. (2005). “Learned hopefulness”: An arts-based approach to participatory action
research. Art Therapy: Journal of the American Art Therapy Association, 22(2), 86–91.
Contents
About the Author xiii

Acknowledgments xv
Introduction to Art Therapy Research xvii

Research as a Creative Archetypal Process xviii
A Brief History of Art Therapy Research xix
Conversations Between Science and Art xxi
Organizational Premises and Goals of the Text xxiii
References xxvii
PART I OVERVIEW OF ART THERAPY RESEARCH 1
1 Art Therapy Research Ideas, Tools, and Steps in the Process 3

Designing a Research Study 4
Step One: Identifying the Research Question 5
Step Two: Developing the Problem Statement 10
Step Three: Review of the Literature 12
Step Four: Determining Methodology 15
Step Five: Tools and Resources for Conducting the Study 19
Statistics and the Value of Measurement 20
Valid and Reliable Instrumentation 21
Art as a Research Tool 21
The Clinical Research Team 21
The Use of a Mentor 23
Step Six: Implementing the Study Within Ethical Boundaries 23
Step Seven: Reporting and Disseminating Results 25
Chapter Summary 26
References 26
2 How Art Informs Art Therapy Research 29

The Art Therapy Lens 30
The Ethics of Using Art as Data 33
Interpreting Client Art 33
Collecting Client Art 33
Exhibiting Client Art 34
vii
viii Contents
The Place of Art in Research Methodologies 35

Art Assessment: An Art Therapy Window on Science 38
On-Going Informal Assessment 39
Art Evaluation Procedures 39
Projective Drawing Tests 40
Art-Based Assessments 41
Extending Research Into Process, Outcomes, and Perspectives 42
An Inclusive Framework for Art Therapy Research 44
Chapter Summary 45
References 46
PART II ART THERAPY RESEARCH METHODS 49
3 Quantitative Models of Art Therapy Research 51

Purpose: Why? Cause-and-Effect Relationships 52
Manipulation and Measurement 52
Control 53
Randomization 54
Systematic, PrePlanned Structure 54
Experimental Models of Quantitative Research in Art Therapy 55
The True Experiment 55
Control Group Designs 56
Single-Subject Research 58
Quasi-Experimental Studies 59
The Quasi-Experiment 59
Ex Post Facto or Natural Experiment 61
The Research Protocol 61
Measurement and Statistical Analysis in Experimental Research 63
A Review of Validity in Experimental Research 65
Non-Experimental Descriptive Research 66
Correlational Research 66
Survey Research 67
Chapter Summary 70
References 71
4 Outcomes Research to Generate Evidence-Based Practice 73

Purpose: Results of a Process 75
Efficacy Versus Effectiveness 76
Method as an Extension of Good Clinical Practice 77
What Do We Mean by Treatment and Its Effects? 80
A Research Model for Evidence-Based Practice 82
Program Evaluation Research 84
Program Evaluation for Obtaining Grants and Funding 88
Contents ix
Chapter Summary 91
References 92
5 Investigating the Field: Participant-Observation 95

Action Research 97
Action Research Cycle 98
The Action Research Plan 99
Value of Action Research to Art Therapy 101
Case Research 103
Conducting a Case Study 104
Validity and Strategies for Improving Case Research 110
Ethnography 113
Key Informants 115
Field Issues 115
Ethnographic Interview 116
Phases of the Ethnographic Investigation 117
Validity Issues and Verification Strategies in Ethnographic Research 119
Critical-Orientational Perspectives on Ethnographic Research 120
Participatory Action Research 122
PAR Methodology With Art Therapy 125
Some Ethical Challenges of PAR in Art Therapy 129
Chapter Summary 129
References 130
6 Researching the Phenomena of Conscious Experience 135

Phenomenological Approaches to Research 136
Methods and Core Processes in Phenomenological Research 139
Validity in Phenomenological Research 143
Heuristic Inquiry 144
Core Concepts and Processes of Heuristic Discovery 145
Validity and Critique of Heuristic Inquiry 148
Hermeneutics 150
Method: The Hermeneutic Circle 151
Narrative Analysis and Therapeutic Interview Research 153
Conclusion 156
Chapter Summary 157
References 158
7 Art-Based Inquiry: An Emerging Paradigm in Art Therapy 161

Key Features of Art-Based Inquiry 164
Art-Based Research Methods: Framework of Artistic Practice 166
Artmaking as Data Gathering 167
Artmaking as Data Analysis 170
x Contents
Artmaking as the Presentation of Findings 172

Art Exhibition 173
Performance Art 173
New and Emerging Public Forums 174
The Relationship of Art-Based Inquiry to Other Research Paradigms 175
A Future Role of the Artist-Researcher in Scientific Research 177
Outcomes in Art-Based Inquiry and Art Therapy Research 179
Chapter Summary 180
References 181
PART III DOING ART THERAPY RESEARCH 183
8 Before You Begin: The Research Proposal and Other Ethical

Safeguards 185
The Institutional Review Board and the Definition of Research 186
Columbus’ Map: From Research Design to Research Proposal 187
How Your Reader Thinks 189
Elements of a Research Proposal 190
Introduction and Purpose 190
Context 190
Methods 192
The Role of Ethics in the Research Process 193
Multiple Roles 197
Confidentiality and Anonymity 198
Informed Consent 198
Deception and Disclosure 200
Chapter Summary 200
References 201
9 Models of Good Research: Conducting the Study and Reporting

Results 203
A Matter of Craft: What Artists Know About Good Research 204
How to Read a Research Report 206
The Different Logic of Quantitative and Qualitative Studies 212
Report Standards for Evaluating Research 213
Art Therapy Exemplars and Model Research Reports 214
Conducting Research to Achieve Quality Outcomes 238
Chapter Summary 239
References 240
Contents xi
10 Writing for Publication in Art Therapy and Other Scholarly

Journals 243
Why Publish? 244
Preparing a Manuscript for a Scholarly Journal 245
Converting a Dissertation or Thesis to a Journal Article 249
Other Scholarly Articles and Oral Presentation Venues 250
Authorship and Its Responsibilities 251
Strategies to Improve Coherence in Research Report Writing 253
Writing as Thinking 253
For Non-Linear Thinkers 254
Building Your Argument on Claims and Evidence 255
Connect With Your Reader 256
Professional Writing Standards: Make It Publishable 257
Peer Review: The “Eco-System” of Scholarly Communication 260
Overview of Submission and Review: Steps in the Process 261
Stumbling Blocks 265
Chapter Summary 266
References 267
Glossary of Research Terminology 269
References 279
Index 291
About the Author
Lynn Kapitan, PhD, ATR-BC, is founder and professor of the Graduate Art
Therapy program and chair of the Arts & Design Division at Mount Mary College,
Milwaukee, WI. She is the executive editor of Art Therapy: Journal of the American
Art Therapy Association, the leading scholarly research journal in art therapy for
which she has served continuously for the past 18 years as a peer reviewer, advi-
sor, editor, and publisher. An alumna of the Union Institute and University, she was
inducted into the prestigious Circle of Scholars for excellence in research. She is
a past president of the American Art Therapy Association and currently practices
community-based, cross-cultural art therapy in consultation with non-governmental
organizations in Central and South America. She has taught graduate art therapy
research since 1991 and has published and presented nationally and internationally
on the subjects of social action in art therapy, multicultural and professional issues,
creativity development in toxic work environments, strategic policy development,
and leadership.
xiii
Acknowledgments
This text was created from 18 years of conversations with the graduate art ther-
apy students enrolled in my summer research course at Mount Mary College in
Milwaukee, Wisconsin. The work would not have been possible without their con-
tributions of passionate questioning, hunting and gathering, and creating in art and
words. I deeply appreciate my faculty colleagues Patty Rass, Melody Todd, Karen
McCormick, Bruce Moon, Susan Loesl, Chris Belkofer, and Michele Burnie who
do so much excellent teaching and research advising to encourage excellence in our
students. Among the many art therapists who have supported the need for research
in the field, I wish to thank Frances Kaplan, Shaun McNiff, Randy Vick, Susan
Spaniol, Harriet Wadeson, Vija Lusebrink, and the members of the Editorial Board
of Art Therapy: Journal of the American Art Therapy Association who model such
care in their scholarly critiques of the research writings in the field. Special thanks
go to Cathy Malchiodi, who encouraged me with humor, friendship, and emotional
support throughout the many months of bringing this text to publication, and to my
colleague Holly Feen-Calligan, for her dedication and abiding friendship. Thanks
go to Alex Kapitan for her editorial skills and keen insight, and to Chelsea Kapitan-
Daniel for her loving patience. Finally, thank you, dear soul mate Eddee Daniel, for
loving me through the years and through all the crazy distractions of my profes-
sional life.
xv
Introduction to Art
Therapy Research
Research:
—scholarly or scientific
investigation or inquiry.
—to study thoroughly. From
Old French: To seek out, to
search again and again.
Inquiry:
—the act of inquiring, that
is, to put to a question, to
look into or investigate.
—a close examination of
some matter in a quest for
information or truth.
Quest:
—the act or instance of seeking
or pursing something; a search.
—from Latin: to seek,
to search for game.
Hunt:
—to pursue; to seek out, search for.
—to conduct a diligent
search, to seek.
What really matters? What do art therapists care about and want to see realized, beyond
all else, as their enduring work in this world? Research is a creative act of searching
for the knowledge that matters to artists making art, art therapists helping clients, and
student-practitioners finding their way toward mastery in their chosen field. The suc-
cessful outcome of the search is a kernel of value with transformational power: more
effective practices grounded on more precise knowledge, deeper understanding of the
impact of events or experiences on people’s lives, or new facts and awareness that build
a case for art therapy.
xvii
xviii Introduction to Art Therapy Research
RESEARCH AS A CREATIVE
ARCHETYPAL PROCESS
Research is a creative process. It begins with an act of creatively imagining how one
might go about discovering something new, or of verifying something taken to be true.
According to Leedy (1997, p. 5), research has eight distinct characteristics:
1. Research originates with a problem or question.

2. Research requires a clear articulation of a goal or purpose.
3. Research follows a specific plan or procedure.
4. Research is organized around a principal problem that usually is divided into
manageable sub-problems.
5. Research is guided by the specific research problem, question, or
hypothesis.
6. Research accepts certain assumptions.
7. Research requires the collection and interpretation of data to resolve the
problem.
8. Research is cyclical or, more exactly, is approached as a spiral of
investigation.
These principles differentiate research from other scholarly and creative activi-
ties. For example, research is not looking up facts in the library or on the Internet and
reporting on them; a researcher must interpret those facts in some way to illuminate
their meaningful relationship to a problem. Research is not simple reflection on a
question; it usually requires an actual plan. Quality research is constructed with care
in how the researcher frames the problem, collects useful data about it, and accounts
for the results. But nothing in this definition excludes creative activity from the con-
duct of research. Art therapy offers unique perspectives on research because of the
way art therapists think about and approach their creative work in the context of a
helping profession.
A contemporary challenge for art therapists has been to find paths of inquiry that
reflect their core values and allow them to see and to act upon the therapeutic enterprise
with both an artist’s and scientist’s ways of knowing. Braud and Anderson (1998) offered
three major motivations for conducting research that art therapists might consider. In
the first category, research is approached as a series of problems to be solved in order
to produce predictable outcomes. The second motivation, which embraces an attitude
of curiosity and wonder, is simply to understand the world. Research is a puzzle that,
when sufficient pieces are fitted together, reveals a larger picture to be apprehended.
The third motivation also is in service of wonder, but it is the wonder of surprise and
discovery. Research is less like a problem or puzzle to solve and more like a work of art
to be appreciated. Though not equally appropriate for every research question, all three
of these motivations are valid and can co-exist in art therapy research.
Introduction to Art Therapy Research xix
Another helpful metaphor for the creative path of inquiry is to imagine research as
a contemporary form of the hunting and gathering archetype (Kapitan, 1998). Our brief
era lived as modern humans has not eliminated instinctual patterns inherited from our
ancestors, the hunter-gatherers. The hunt is a search for knowledge rooted in a human
being’s primal relationship with the world. For art therapists it offers a vivid archetype
that characterizes much research. When art therapists begin to search for their own
instinctual responses to the challenges of practice, they reach naturally for the dis-
ciplines, tools, methods, and thought processes of art as well as traditional scientific
inquiry. They can engage in research as an extension of an archetypal creative process.
Both hunting and research constitute a dynamic interaction between individuals and
their surroundings; science and artmaking offer an identical interchange. Knowledge in
the hunting-gathering tradition has to do with how to act, what to hold on to, and what is
important to pay attention to in the face of life’s demands (Ortega y Gassett, 1943/1985).
Artists and scientists, therapists and researchers, and ancient hunter-gatherers have
always participated in this deeply human quest.
A BRIEF HISTORY OF ART THERAPY RESEARCH

Art therapists who enter the field today accept the importance of research. This is evi-
denced by the growing number of studies found in Art Therapy: Journal of the American
Art Therapy Association, The Arts in Psychotherapy, International Journal of Art
Therapy, and other scholarly journals in recent years; in updated standards that include
research as a required component in graduate art therapy education; and the advance-
ment of doctoral programs. The conversation has shifted away from reservations about
whether and how art therapists should conduct research, and toward its value. A brief
glance at the history of art therapy research publications in the United States can serve
to illustrate an emerging research tradition in the global development of art therapy:
1960s: The first journal in art therapy, Bulletin of Art Therapy, was published in
1968 and included an account of art therapy research activities. Re-named the American
Journal of Art Therapy, it chronicled diverse work in art therapy and encouraged peer-
reviewed publication by art therapists (Knapp, 1992).
1970s: Graduate students throughout the 1970s learned art therapy by synthesiz-
ing mid-20th century psychological theory and the art studio knowledge they brought
to graduate school. There was little published art therapy literature and, with a few
exceptions, the texts that existed in the United States were only newly available (see
Anderson, 1978; Betensky, 1973; Keyes, 1974; Kramer, 1971; Kwiatkowska, 1978;
Naumburg, 1966, 1973; Rhyne, 1973; Robbins & Sibley, 1976; Rubin, 1977; Ulman &
Dachinger, 1975). The initiation of The Arts in Psychotherapy in 1973 created the first
international venue for art therapy research publication. Rhyne’s survey of art therapy
xx Introduction to Art Therapy Research
research found, however, that two-thirds of all studies being published in the United
States and abroad were conducted by non-art therapists (Knapp, 1992).
1980s: The American Art Therapy Association (AATA) began publishing Art
Therapy: Journal of the American Art Therapy Association in 1983. A growing number
of research reports were becoming available to the wider field. But few art therapy gradu-
ate programs included a formal research course; the prevailing view at the time was that
graduate education primarily served to educate practitioners and that research was best
left to doctoral students. Absent a common language, art therapists worked solely from
the traditional research methodology of behavioral science. Qualitative research was
unknown outside the social sciences and was devalued as not actual research. At the end
of the decade, a dialogue between Maxine Junge and Marcia Rosal (1989) articulated the
prevailing attitudes and challenges of developing art therapy-specific methodology.
1990s: In the 15-year period from 1980 to 1995 art therapy literature greatly expanded
in both the United States and the United Kingdom, and a recognized body of art therapy
knowledge started to coalesce. To fill a need for information on research, A Guide to
Conducting Art Therapy Research was published by the AATA in 1992. By 1995, a
greater methodological variety of studies started showing up in Art Therapy. Because of
a pressing need for an empirical body of knowledge that would advance the profession,
however, the validity of all but experimental studies continued to be questioned. Support
for quality standards and greater diversity in research methods to address the needs of
practitioners emerged in national debates on education and practice standards.
At the end of the 1990s, Art Therapy published two groundbreaking issues dedi-
cated to art therapy research (Malchiodi, 1998a). Shaun McNiff published Art-Based
Research (1998a), the first text devoted entirely to art-based inquiry in art therapy.
McNiff felt that there was a lingering dependence upon other disciplines instead of
research that emerged from art therapy itself. Two years later, Frances Kaplan (2000)
contributed a second book-length treatment of the topic of research and articulated how
scientific approaches support an art-based theory of art therapy.
2000s: Recognizing the power of research to advance public awareness, the AATA
established a task force to update the research literature of the field (Vick, 2001). The
work of the task force was furthered when the groundwork was laid for the first national
clinical outcomes study, launched in 2005 (Kapitan, 2003b, 2005). In the United
Kingdom, with Art Therapy, Research, and Evidence-Based Practice, Gilroy (2006)
documented the growing necessity of research to validate art therapy practices within
the dictates of the British health care system.
When viewed in the context of a relatively young, evolving profession, art therapy’s
recent shift toward defining a research base is not unusual. Thirty years ago, the first
generation of art therapists were the leading voices in the field and—as also happened
in psychology, professional counseling, and social work—theory was built on the found-
ers’ own practices. This pattern was repeated as art therapy emerged and migrated to
diverse areas of the world. “Schools of thought” became organized and established in
Introduction to Art Therapy Research xxi
graduate schools and within related disciplines by the various pioneers of art therapy.
Translating these innovations into broader art therapy theories and practices was not
possible without a critical mass of practitioners collaborating with one another over
time and beyond their original training. As art therapy became an established academic
discipline, a second generation initiated this broader dialogue. Commitment to peer
reviewed research has generated common knowledge and evidence-based constructs for
practice. When elaborated within diverse cultural contexts and tested through empirical
research, these constructs finally will make it possible to form “approaches that emerge
from art therapy itself” (McNiff, 1998b, p. x).
Because research is dynamic, art therapy will continue to evolve. It is constantly reborn
in the fertile soil of shared understandings that transcend individualistic conceptions of
practice. As the figure in the figure-ground relationship with the profession of art therapy,
research has an impact on the evolution of ideas and practices that form the whole. Each
new contribution offers art therapists a critique of “received wisdom” in a newly changed
context. Yet these new understandings exist only because we are standing on the invisible
shoulders of those who came before and who helped create our new vantage points.
CONVERSATIONS BETWEEN SCIENCE AND ART

Despite the encouraging view that research in art therapy is alive and well, many art
therapists continue to feel ambivalent about it. Their ambivalence may be due in part
to the influence of modernist traditions of science as well as a postmodern backlash
against science that also is our inheritance. In the years leading up to the 1969 U.S.
launch to the moon, it seemed that no problem was too big for science to solve. Such
was the confidence that the public placed in modern science. But immediately after
this pivotal moment, other voices emerged to counteract prevailing views of scientific
dominance. Such events as the Vietnam War, the U.S. civil rights movement, and the
women’s liberation movement challenged the status quo and ushered in postmodernism
with its demands for other ways of knowing about the world and its problems.
The idea that there was one right way to conduct research endured for at least two
more decades, however. As Habermas wryly observed, “modernism is dominant, but
dead” (cited in Gergen, 1991, p. 11). Partly this was due to exponential growth in edu-
cational and medical research at the time. These industries needed quantifiable results
to justify spending vast amounts of publicly financed dollars. The enduring modernist
view of science maintained that all things could be known objectively and factually
without the mediation of language, culture, or symbol systems. Postmodern critics of
this view held that research knowledge is valid only within a given social or cultural
context. Something that is valid in one context should not be mistaken for truth in all
contexts. Art therapist Junge (1989) explained:
Our research questions come out of our worldview of what there is to be seen, and
we have learned that certain ways of thinking about things makes them visible. The
xxii Introduction to Art Therapy Research
researcher is not a wholly objective scientific being looking through a microscope but,
by her or his human choice to ask a question to focus on a particular phenomenon,
intervenes in the system and creates planned and unplanned change. (p. 78)
What we see depends upon what and how we choose to look at it. The reality
we believe we have “discovered” is more accurately a construction. This constructed
context is grounded in a particular historical time and social history, language, and
culture—all of which provide certain frameworks or lenses for apprehending reality.
With postmodernism, research shifted from solely external or behavioral perspectives
to consideration of the internal and interactive perspectives of subject and researcher
as well. Postmodernism asserts that reality cannot be separated into object and sub-
ject. Human beings cannot step outside their species-specific perceptions and view
reality from the place of the object. Thus, because we are all subjects, what we take
to be true can only emerge from our relationships of interaction with other subjects
and objects.
This understanding sits well with many art therapists who distrust the reductive
process of traditional science because of an artistic bias that makes reality “more real”
when colored with aesthetic, subjective experiences. Junge and Linesch (1992) con-
cluded that the processes of art and art therapy did not fit easily with scientific research.
Wadeson (1992) observed, “such [creative] work is of a very different nature from the
exacting methodological considerations of research design and implementation” (p.
1). McNiff (1998a, 1998b) decried “scientism” in art therapy, which he defined as the
erroneous application of scientific methods to artistic truths. A distrust of how science
could address the complexities of art therapy theory and practices, on the other hand,
has contributed to “science neglect” (Kaplan, 2000). In addition to postmodernism that
underscores the relativity of knowledge, Gantt (1998) identified gender bias, the popu-
larity of pseudoscience, and the perception of science as a destructive enterprise, as all
contributing to the field’s ambivalence toward scientific research.
Interestingly, these “science versus art” observations in art therapy parallel historic
developments in the social sciences in the 1980s and 1990s when proponents of qualita-
tive research were struggling for recognition. Heated debates pitted traditional scientific
research (popularly known as “quantitative”) against new paradigm research (“qualita-
tive”) and centered around the polarized imagery described below:
QUANTITATIVE QUALITATIVE
Taken for granted Alternative, “other”
Establishment Establishment protesters
Regular army Resistance
Big guns Reconnaissance
Male Female
Hard, firm, solid, real data Soft, fuzzy, weak data
Dry, unintelligible, meaningless data Thick, deep, grounded data
Control the variables; avoid dirty data Immerse in data; avoid drowning
Not really truth Not really science
Introduction to Art Therapy Research xxiii
Kaiser, St. John, and Ball, in their 2006 survey of art therapy research education,
expressed surprise that most art therapy graduate programs had a preference for quali-
tative methods; however, the images above suggest where the iconoclastic bias of art
therapists may be aligned. Art therapy has had its own historic, polarized debates on the
importance or place of art versus science, therapist versus artist, products or outcomes
versus processes, and philosophy versus pragmatism. It makes it difficult to sort out art
therapy research, I believe, because of a tendency to emphasize the binary poles of what
is essentially an interdisciplinary field. Fortunately, the classic qualitative–quantitative
debate of the social sciences has largely been resolved and there now is broad recogni-
tion that diverse approaches are needed and credible (Patton, 2002). In art therapy, the
discourse has shifted toward finding a balance between scientific and artistic thinking,
and beyond polarized ideas of theory and practice. By matching methods with research
purposes and questions, many avenues of understanding may be honored (Carolan,
2001; Gantt, 1998; Kapitan, 1998; McNiff, 1998b; Wadeson, 1992). Carolan concluded,
“Art, imagery and metaphor can serve as the primary means of integrating [all] our
approaches” (2001, p. 191).
ORGANIZATIONAL PREMISES
AND GOALS OF THE TEXT
My goal in creating this text was to provide an informative and useful guide for art ther-
apists who want to understand and evaluate art therapy research, and who are motivated
to carry out their own studies. As a pragmatic text, it is grounded in art therapy research
literature and surrounding contexts, providing guidance to students and practitioners
in research design via a broad survey of appropriate questions, methods, and ethical
values. The archetype of the “hunt” is threaded throughout to spark the imaginations
of art therapists and to help them access the different artistic and scientific logistics of
research design.
Because art therapy is an interdisciplinary field—born of art and social science, the
studio and the clinic—it is appropriate for art therapists to draw from other disciplines
in the conduct of research. A research tradition takes many years and many, many
researchers to build. Art therapy is a relatively small field compared to other social,
behavioral, biological, and psychological fields that have many more resources devoted
to research. Art therapists would be smart to use such knowledge for their own pur-
poses. I believe that the creative synthesis resulting from the effort will shape a research
tradition that is appropriate and natural to art therapy.
Art therapy research is not born in a vacuum and neither was this text. There has
long been a need for an up-to-date research manual; the complexities of creating one
text from many voices is daunting. I envisioned this project as a logical extension of
the past efforts of art therapy researchers, educators, and leaders in the field who made
significant contributions to the dialogue on art therapy research. Most notably, their
work can be found in the 1992 Guide to Conducting Art Therapy Research edited by
xxiv Introduction to Art Therapy Research
Harriet Wadeson, articles in Art Therapy that were authored by members of the AATA
Research Task Force, and published accounts that serve as exemplars of art therapy
research. A selection of these has been included in this text to preserve their expertise
and to provide useful resources for the reader.
My own role first is to serve you, the reader, as your friendly “tour guide.”
Having taught art therapy research to graduate students since 1991, I have been
hungry for a useful text that would help my students learn and think about research
in their own language of art therapy that resonates with their artistic worldview
and clinical experiences. In Part I, I present an overview of the basic tools and
practical steps involved in the design and implementation of an art therapy research
study, and areas of inquiry that hold particular interest for art therapists. Part II
describes quantitative and qualitative models through the “lens” of an art therapist
that illustrates their inherent logic as congruent with art therapy practice. In Part
III, the reader will be guided by the “how-to” of research: how to write an effec-
tive research proposal, how to meet standards of ethical conduct in carrying out the
study, how to evaluate and recognize good research, and how to report results and
publish your work.
My other role for readers of this text is to offer my perspective as the executive
editor of Art Therapy, one of the leading journals in the profession. Over the 18 years
that I have served nearly continuously in the various roles of peer reviewer, editor,
and publisher, I have had the privilege to evaluate hundreds of research reports and
to work closely with art therapists who have accepted the challenges of contributing
their research to the foundational knowledge of the field. I offer insights gleaned
from this experience with the hope that art therapists will use them well in research
of their own.
One of my duties as the senior editor is to read all of the manuscripts submitted
to Art Therapy. Several years’ worth of exposure to research created by art therapists
and a volume of feedback from the reviewers that evaluate the studies’ strengths have
shaped my perspective and underscored particular areas of need. To organize some of
the premises of this text, I put together a “wish list” for art therapy research that I hope
will inspire readers. Here is my “Top Ten list”:
10. End the old debate: To paraphrase Habermas cited earlier, the philosophical
debate on the need for art therapy research is dominant but dead. Art therapy would
be well served by embracing the middle ground and abandoning insistence on any one
paradigm as more important or more appropriate for the field. Qualitative research is
not inherently more creative than quantitative research. Quantitative research is not
inherently reductive. Art therapists need to learn both paradigms in order to effectively
address the questions that matter to them. Art-based methods can help bridge the dif-
ferent logic of scientific research and artistic inquiry. In this text, both the overview in
Part I and the specific methods chapters in Part II will lay the groundwork for moving
the field beyond these old debates.
9. No more fear of research: Twenty years of guiding research has taught me that
art therapists love research when they have the opportunity to apply it skillfully to their
Introduction to Art Therapy Research xxv
most pressing questions. Obstacles tend to be a lack of confidence, lack of knowledge

and skill, and fear of failure. The practice of art therapy is not too special, too compli-
cated, or too nuanced to yield its knowledge through systematic research. My hope is
that the pragmatic ideas, tools, and steps in this text will provide sufficient guidance to
inspire creative innovation and a can-do attitude.
8. Read more selectively: There are wonderful and amazing accounts of art ther-
apy found in many books on the subject. But most of these books are not peer reviewed;
their claims have not been subjected to evaluation and critique, and should not be taken
at face value. In today’s Internet age, we are awash in information. Art therapists who
want to make a contribution to the profession should learn to use a research database
to find the best and most current studies on which to build their own knowledge and
research. To promote higher standards for scholarship in art therapy, I provide pub-
lished exemplars of each research model.
7. Ask different questions: Art therapists have long been fascinated with finding
the keys to unlock the meaning of certain symbols or images that turn up in therapy. In
1995, former editor Cathy Malchiodi wrote that most research submitted to Art Therapy
at the time focused on surveys of “what other art therapists are doing or thinking, rather
than on clients’ experiences” and on “the content of art expressions” known as art-
based assessment (p. 218). Few studies examined the process of art therapy treatment
or its efficacy. The situation hasn’t changed much today. Much has not been examined
and many important questions need to be asked. Readers will find detailed discussion
of “researchable questions” in this text that are unique to art therapy and that lead to a
broad range of possible research approaches.
6. Craft better research designs: Quality research is made possible when art thera-
pists intentionally craft their studies to collect data from direct observation, to analyze
the data systematically, and to examine the validity of their findings against plausible
alternative explanations. There are many one-shot case studies in art therapy; little
research has been conducted with a large number of participants or in multiple sites.
Various chapters identify the basic elements of each kind of study and strategies for the
design and conduct of valid research.
5. Consider adding a control group to your design: On a similar note, many

art therapy research studies conclude that the findings are preliminary and need to be
validated with an outcome study or an in-depth qualitative investigation. The most com-
monly missing elements are a control group, frequent systematic measurement taken
over more than one session, and follow-up assessment of outcomes over a period of
time. Such critical components to improve quality are reviewed in each methods chap-
ter and in the overview of good research conduct in Part III.
4. Report research more clearly and completely: Reporting or publishing your

research also is a craft and need not be a mystery. Art therapists learn to write
up research in graduate school, usually as a case study or thesis. But they may be
xxvi Introduction to Art Therapy Research
unfamiliar with the requirements of a readable scientific report. A standard report

presents a clear rationale for the study, reviews the literature concisely, and pres-
ents the methods with enough detail to allow for replication. Results are readable
and clear; discussion places the results into an understandable context. Finally, any
report that involves art therapy should provide a clear description of what took place
as differentiated from art instruction, art-based assessment, or studio art activities.
Readers will learn how to read a research report and find art therapy exemplars of
such reports in Part III.
3. Replicate: I have often wondered why so many well-crafted studies are never
replicated to expand their original findings with new applications, populations, or adap-
tations. Perhaps art therapists, like many artists, are inspired by originality of expres-
sion; the thought of repeating a published research study may seem counterintuitive,
like copying someone’s creative work. Scientists, on the other hand, are always experi-
menting to see if they can get the same or different results in their lab as compared to
someone else. Even musicians commonly take songs and try them over and over with
different tempos, instrumentations, or riffs on a dominant motif. I would love to see art
therapists embrace and expand research through replication. Perhaps the many exam-
ples of published research provided in this text will acquaint readers with the scope of
studies already conducted that they may want to try for themselves.
2. Partner up—collaborate: So much research doesn’t happen because those

closest to the critical questions—the practitioners in the field—do not have the time,
knowledge, or skills required. Having developed artistic practice, our mathematical
skills may have atrophied and statistics is only a distant memory. Or we may not have
access to the kind of site we need. As is becoming apparent in other mental health and
arts-based fields, the kind of research that produces needed quality outcomes more
often than not is the result of a collaborative process. When art therapists start to form
research partnerships with other professionals, research foundations, organizations, and
agencies, the process of recognition and funding for art therapy’s value can result. A
special discussion on research collaboration is discussed in Chapter 1 and in methods
chapters that lend themselves particularly to collaboration.
1. Do it! Then publish it: If every art therapist made a commitment to conduct
one research study as part of his or her professional development, art therapy would
have an abundance of knowledge generated. Various art therapy conferences in recent
years have supported this kind of grassroots commitment to research. But how many
art therapists who present their work at conferences take the next step and write up their
research? Hopefully, the final chapter on writing for publication in Art Therapy will
help fill this gap.
Art therapists have much to offer the on-going advancement of human understand-
ing and knowledge. There is no doubt that the same creative skills art therapists use
in practice can be applied to the design and conduct of research to contribute unique
knowledge about the process, products, and outcomes of art therapy. I hope this text
Introduction to Art Therapy Research xxvii
will serve as a useful companion to that enterprise and will support art therapists
in creating, achieving, and disseminating their work for the collective benefit of the
profession.
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Carolan, R. (2001). Models and paradigms of art therapy research. Art Therapy: Journal of the
American Art Therapy Association, 18(4), 190–206.
Gantt, L. (1998). A discussion of art therapy as science. Art Therapy: Journal of the American Art
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xxviii Introduction to Art Therapy Research
McNiff, S. (1998b). Enlarging the vision of art therapy research. Art Therapy: Journal of the
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Art Therapy Association.
PART I
Overview of Art
Therapy Research
Art Therapy
Research Ideas,
Tools, and Steps
1
in the Process
… the top of the mountain, the
honorable kill the hunter makes,
or a philosophical problem, or
the quest for peace. One must
enter absolutely into the process
to be capable of enduring it to the
end. To engage in the presence of
the earth, of nature; to seek what
is never easy; to fail as well as
to succeed; to grow weary and
ragged in the search and yet to
persevere because the mountain
does, indeed, have a summit,
the war an end; to enter a depth
and a distance that go so far
beyond the ordinary routines of
a day, or a life, that they bring
you to the beginning, is to hunt.
—R. Rudner (1991, p. 75)
Research means to seek out, to search again; by their very natures humans are seekers
and searchers. When the researcher feels alive with the pursuit of desire to discover
something, the work becomes indistinguishable from the creative process that the art
therapist knows so well (Kapitan, 1998). Research yields knowledge that nourishes
one’s profession, influences its future, opens previously closed minds, and brings forth
new understandings not previously contemplated. Most important, research carries
on a scientific exchange of critical conversations that shape knowledge and skill. Art
therapists who undertake a research project help to advance the collective understand-
ing of art therapy, contribute to the knowledge base of the field, and help to improve
client care, quality, and efficacy of art therapy in the workplace (Anderson, 2001).
3
4 Introduction to Art Therapy Research
Given the creativity that art therapists apply to new directions in their artistic or
clinical work, it is puzzling to find, as Linesch did in 1995, that systematic inquiry is still
regarded by some as incompatible with art therapy. Art therapists may approach research
believing that they must fit into rigid models of social science research, a strategy that
echoes their attempts to fit into the traditional clinical world and underscores a sense of
powerlessness (Kapitan, 1998). The image of the alienated professional mirrors the client
whose actual experience with art therapy might not be located in statistics or be available
for measurement, prediction, and replication. But, as Deaver (2002) observed, art thera-
pists’ fears about research may be ungrounded: “in focusing on our clients and striving to
reason out the most effective approaches to working with them, we have in fact already
embarked on a form of art therapy research” (p. 23). Deaver wrote:
We know that art therapy is a human service profession in which trained art therapists
promote positive change and growth through artmaking. The artworks produced func-
tion as catalysts for self-discovery, thinking about old problems in new ways, interrupt-
ing a cycle of self-defeating behaviors, and other therapeutic or healing outcomes. The
approach, art tasks, and media are carefully chosen according to art therapists’ knowl-
edge of art therapy theory and techniques, psychological development, and the creative
processes involved in artmaking. Those of us with even a few years of experience are
convinced, because of what we see with our own eyes in individual, family and group
art therapy sessions, that art therapy can be effective in helping to resolve the situations
that brought people to us. Sometimes we are amazed by what happens in sessions, even
in awe of the power of art therapy to bring forth the changes we observe … But if ques-
tioned intensely about our work, we can rarely explain with any precision or confidence
how we understand the artwork produced in art therapy; what cognitive, psychological
or creative processes actually occur during the art therapy experience; or what factors
contributed to the successful outcome. Research may provide some answers. (p. 23)
DESIGNING A RESEARCH STUDY

Research planning is a creative process akin to architecture and other fields of design.
Whether planning a building or creating a Website, the designer makes a design that suits
the overall purposes of the project and follows inherent logical principles—such as the
laws of physics in the case of a building or, in the case of a Website, what is known about
the people who will be using it. Research studies aimed at explanation and prediction
require a carefully structured design that allows the data to be tested and logically linked
to the variables being examined. Research that is oriented toward discovery is designed
to maximize a researcher’s interactions with the data; the design is allowed to change in
order to accommodate new understanding as previously unknown variables or informa-
tion emerge.
A research design has to be worked out before conducting a study, but the process and
approach will vary for different art therapists. Sometimes a therapist has a clinical prob-
lem in the workplace that needs a solution or that sparks an interest in studying it more
1 t Art Therapy Research Ideas, Tools, and Steps in the Process 5
intentionally. Or there may be a creative problem that can only be worked out artistically
in the studio. Some art therapists start at the beginning by identifying a question, whereas
other art therapists may read about an existing study that they would like to extend with
their own knowledge and interest. This chapter presents an overview of the logical steps
that are involved in designing research regardless of the point of entry. These are:
1. Identifying the research question

2. Developing the problem statement
3. Reviewing the literature or what is known about it
4. Determining methodology
5. Locating tools and resources for carrying out the study
6. Implementing the study within ethical and other boundaries
7. Reporting and disseminating the results
For art therapists who prefer to use a non-linear thought process to work out a
design, I recommend using a concept map (Figure 1.1) adapted from Maxwell (2005) to
accompany the steps in the process of design. This schema helps you develop a research
plan by tacking back and forth among five interacting, non-hierarchical components.
Researchers may enter at any of these five points and go in either direction to flesh
out the study based on the relationship between purpose, context, questions, methods,
and validity. For example, you may have a good question and can think of methods to
address it, but have no idea why it is worth the time and energy. Paying closer attention to
the context surrounding the question, by reading or reflecting on source knowledge that
inspires it, will help you uncover your purposes. Once you are clear about the purposes
and context, you will be more able to refine the problem precisely and, in turn, be led to
methods that will reveal what you want to find out. The researcher who enters the design
process at the validity point may have access to an important art therapy program, for
example, but wonders about the risks involved for clients who might be asked to partici-
pate in a study. Clarifying these validity concerns and values will suggest methods that
are appropriate for the site and, in turn, will point to a more precise research question.
As you work with each step in this chapter, from research design to actually conducting
the study and reporting results, you may want to return to this conceptual map from time
to time and use it to refine your study.
STEP ONE: IDENTIFYING THE

RESEARCH QUESTION
Research questions usually come from an art therapist’s clinic, studio, or other
environments in the form of a problem or curiosity. Because creative problem solv-
ing is basic to an art therapist’s line of work, potential research questions are always
within reach. Focusing on your daily work, you may wonder why a particular client
Purpose Conceptual Context

What do I need? What is the terrain I am in?
What are the ultimate goals of my study? Where do I locate my hunt?
Why do I want to do this? What ideas, theories and
Why is this worth doing? concepts guide/inform the
Why should anyone care about study? What sources will I
the results? draw on? What do I already
know or have learned
Research Problem or Questions

What am I “hunting” for?
What specifically do I want to understand by doing this study?
What do I not know that I want to learn?
What questions will guide my study?
Name your topic: “I am studying…….

Imply your question: “…..because I want to find out…..
State your rationale: “…in order to understand…
Methods Validity & Ethics

How do I go about obtaining what I need? What makes this a “good” study?
What are the best ways others have used? What will it contribute?
What will I actually do to conduct the study? How will my findings support
What approaches and techniques will I use or challenge my ideas?
to collect and analyze the data? How might I be wrong?
What makes them appropriate? What are the implications of
what I might find out?
Who will benefit?
Why should I do this study?
FIGURE 1.1 Conceptual map for designing the study. [Adapted from Maxwell, J. A. (2005).
Qualitative research design: An interactive approach (2nd ed.). Thousand Oaks, CA: Sage]
is behaving differently before or after a particular art therapy intervention. Perhaps

you have discussed a particularly daunting clinical problem with your colleagues
and are considering a different approach. In your studio, your discoveries from an
art process may have given you insights that others might benefit from and want to
try out in their work.
Sometimes research questions appear from reading a study that gets you thinking
about how it might apply to your own practice—or that could be disconfirmed because
of a gap in the researcher’s findings or something that you sense may be true from your
own experience. You may be motivated to replicate the study to show this difference, or
to modify it in a way that captures your own interest. Art therapists who interact with
others in the field, either through reading professional journals, attending conference
presentations, or discussing cases with colleagues, often use these sources to improve
their practices or to follow their own curiosity about how art therapy works. You can
formulate a research question simply by extending or clarifying these reactions and
your interest in them.
IDENTIFYING A GOOD RESEARCH QUESTION

r What is my area of interest? What am I hungry for? What do I want to
know or find out?
r What do I notice? What especially attracts my attention in my work as
an art therapist?
r What is my goal?
r Who is my audience?
Art therapists convert their interests into a “researchable question” usually in stages:
by having an idea, thinking about the idea, exploring the idea in art or in clinical work,
discussing the idea with colleagues, checking it out in the existing literature, deciding
exactly what goals can be achieved through research, and finally, defining the question
precisely in order to create a working hypothesis (Bailey, 1991). In her overview of what
constitutes art therapy research, Deaver (2002) discussed some aspects of art therapy that
uniquely lend themselves to research, given the nearly limitless array of potential ques-
tions. As a springboard for generating research ideas, she organized four broad areas: (a)
the therapeutic relationship, (b) art as assessment or a measure of treatment outcomes, (c)
art as a process or intervention, and (d) art therapy as a profession (Table 1.1).
Deaver’s overview helps us think about possible questions in art therapy and
reminds us that a “researchable” question is one that serves a useful purpose and makes
a contribution to the profession. To be effective, a good research question has the fol-
lowing attributes (Bailey, 1991):
r It rests on a rationale or theory, addressing the question, “How will this

study contribute to the body of knowledge of art therapy?”
r It has significance, addressing the question, “Who cares?” or “So what?”
r It can be studied by identifying specific variables, addressing questions of
purpose such as cause and effect, discovery of meaning, or in-depth under-
standing of a specific condition or perspective.
r It can be conducted with available resources, considering such needs as help from
a research team, statistician, clinical supervisor, software tools, or databases.
r It can be conducted with available access to participants, addressing such
questions as whose participation is appropriate, where the study can take
place, and how consent can be obtained.
Beginning with a desire to know or to find out something, the art therapist gradually
formulates the focal question. In addition to the sources already described, art therapists
frequently use their own artmaking to surface their questions and to clarify their pur-
poses. Rhyne (1992) observed that research ideas come from the minds of people whose
curiosity urges them to question their own observations. Allen and Gantt (1992) encour-
aged the demystification of research by creating an art image of the research concern and
oneself as a researcher. I recommend creating art from the metaphor of research as hunt-
ing (Kapitan, 1998) and studying the image by observing closely its terrain, the various
TABLE 1.1 Developing art therapy research ideas

Art therapeutic relationship
Studies that address such questions as
t What are the actual effects of providing particular art materials and
artmaking opportunities to clients?
t Are important aspects of the therapeutic relationship reflected in the
client’s artwork?
t Is there a way to evaluate the effect upon the therapeutic relationship
of the therapist making art in the session with clients?
t What can we conclude about the client who regularly makes portraits
of the therapist?
t What sense can we make of our own artmaking in terms of our work
with a particular client or group of clients?
t How might regular self-exploration through artmaking be useful
clinically as well as personally?
Assessment: Art as a measure
t Studies on the potential of art to accurately and objectively measure a
range of attributes
t Studies that substantiate anecdotal or unsubstantiated claims with
empirically tested understandings
t Normative data on children’s development as reflected in their
drawings; cultural and developmental differences
t In addition to relationships between psychiatric conditions and their
manifestation in drawing, studies on other variables assessed with art
t Reliability and validity of artwork as a measure of acceptance of
diagnosis, course, and extent of illness and prognosis
Intervention: Art as a process
t Research on particular aspects of art therapy, such as the impact of
certain tasks or theoretical approaches on various kinds of clients, e.g.,
What art experiences may be most effective in an anger management
group for incarcerated youthful offenders?
t Research on the efficacy of particular art therapy applications in
treatment, e.g., What is the impact of media choice on particular art
directives?
t Research on the impact of the setting, the range of purposes or goals,
e.g., What is the impact of an artist-in-residence program on patients,
staff, and administration in a medical setting?
t Research that examines the usefulness of art therapy on such clinical
issues as acceptance of a terminal illness, recovery from surgery or brain
trauma, or in pain management.
Art therapy as a profession
Research that addresses such questions as
t How are multicultural education guidelines being implemented in
graduate art therapy programs?
(Continued)
TABLE 1.1 Developing art therapy research ideas (Continued)

t What are the demographic trends in the membership of AATA?
t What are art therapists’ understandings of the personal experiences
and philosophies that lead them to become art therapists?
t What are the markers of burnout among art therapists and what might
be effective preventative measures?
Source: From Deaver, S. P., What constitutes art therapy research? Art Therapy: Journal
of the American Art Therapy Association, 19(1), 23–27, 2002.
guises and tools of the hunter within that terrain, and the presence or absence of what you
are hunting for. The precision with which the art therapist’s artmaking may guide research
design becomes apparent when research is creatively imagined in these ways.
USING ART TO GENERATE THE RESEARCH QUESTION

r Create an art-based journal that contemplates these or similar ques-
tions: What am I hungry for? What must I have to satisfy my profes-
sional goals or hunger?
r Create in art an image of yourself as a hunter. Journal about what you
look like, the tools you are carrying, and the kind of terrain you are
in.
r Continue your art meditation with a series of images: What are you
hunting? What are the characteristics of the animal or image of the
hunt? How might those features inform your research purpose? Your
question?
r Try other metaphors: Imagine yourself as a miner who is digging for
something precious or essential (Kyale, 1996) or a traveler coming
upon a new land and seeking to understand it.
Clarifying your purpose: Next, you will need to refine the question by precisely
clarifying your purpose. When research is conceptualized within the context of how you
want to use it, you will be able to focus in on different aspects of a question, problem, or
phenomenon, in order to take action and use the information obtained in specific ways
(Kapitan, 1998). This conceptual purpose helps put to rest the assumption that certain
kinds of research are more valid or truer than other kinds. Distinctions of purpose
always drive the choice of question and method. Put another way, if you want fish for
dinner, you need to go to the fishing hole with a pole, bait, and plenty of patience. You
wouldn’t choose a shotgun to fish with or insist that a shotgun is the only way to gather
food. Different researchers have different purposes. These depend upon:
r How you view the phenomenon of interest

r Your background knowledge of the subject
r Your beliefs or assumptions about the inquiry
r How you approach and conceive of the process and implement it
Using the metaphor of the hunter-gatherer as researcher, if your purpose is to

advance the entire art therapy community, you must seek either a very large animal
or many smaller animals combined. A multi-site, national outcomes study is such an
animal. But if your purpose is simply to satisfy your own hunger, a small study will
do (Kapitan, 1998). In surveying the distinctive differences of purpose between, for
example, single-subject quasi-experimental designs and phenomenological studies, an
art therapist may ask, “What am I hunting and why? Which of these methods will work
for what I am hunting? Do I have the resources I need to carry out this kind of research?
What skills and strengths do I have and how can I use them effectively?”
STEP TWO: DEVELOPING THE

PROBLEM STATEMENT
The next step is to convert the question into a functional problem statement. In nar-
rowing in on the problem, the researcher often has to relinquish a broad topic of interest
or divergent pathways for a more specific, focal concern. It is important to consider what
the impact will be to have the problem addressed. Will it be worth the time, energy, and
resources needed to address this particular problem? Is it significant to you and to others?
Is it a real problem worth hunting for or is it a pseudo-problem that you already know the
answer to? A useful template that helps in creating the rationale for the study is to name
the topic by stating, “I want to study [x] in order to [y],” which implies the question, fol-
lowed by, “because … [z],” to surface motivations and purposes. For example, “I want to
study the use of art therapy with people who are visually impaired (x) in order to identify
a range of materials and processes that are most effective (y) because their needs have
been overlooked due to an emphasis on the visual experience in art therapy (z).”
FROM RESEARCH QUESTION TO HYPOTHESIS

r Why does the question excite you? Do you really want to know the
answer?
r Is it a simple question or does it have several parts?
r Is there an obvious theory base for the question?
r What is the specific problem you plan to address? Complete the follow-
ing: “I want to study ____ in order to ____ because ______.”
r What do you hope to accomplish by addressing this problem? Complete
the following: “The purpose of this study is … ”
r Is the problem significant? Why is your study important and to whom?
How will you answer the question, “So what?”
r What do you think might happen as an outcome of your research? The
answer to this question helps you formulate the hypothesis.
Once the problem is determined, it should be further refined so that it is stated as

clearly, precisely, and completely, in as few words as possible. A precise question or
problem functions in research like a laser beam or well-tuned instrument; without it,
your aim will be thrown off, misdirected, or will hit the wrong notes. Look critically
at the problem statement and edit, refine, and clarify that this is exactly what you are
hunting. Can anyone read it and know what it is you are after and why? If this is not the
case, then you probably don’t know what the problem is yet.
Leedy (1997) noted that most research problems are too complex to be solved
without sub-dividing them into smaller chunks. When the problem is correctly writ-
ten, these sub-problems come to light. They function as smaller, interconnected parts
that make up the whole of the main research problem. For example, if the main prob-
lem is
r “I propose to determine the factors that contribute to an art therapist’s effec-

tiveness in a domestic violence shelter.”
The sub-problems might be
1. Analyze how the setting contributes, either positively or negatively, to art

therapy treatment;
2. Identify the key variables that influence how an art therapist assesses, plans
for treatment, intervenes, and measures success in this setting; and
3. Define what is meant by “success” in this context.
Notice that each of these sub-problems is a self-contained, researchable unit and

includes a verb—in this case analyze, identify, or define—that ties the sub-problem
to a method or means for collecting and interpreting data (Leedy, 1997). If the main
problem is carefully stated, there should be no more than two to six sub-problems. (If
there are more than six sub-problems, then the main question is not focused precisely
enough.) Once the problem and sub-problems are identified, a logical structure exists
around which the design can be developed.
Next, the researcher tackles the scope of the search. This sets up the research con-
text of the problem and makes certain that it is neither too broad nor too limiting. Return
to the template, “I want to study ‘x’ in order to ‘y’ … because … ,” and now state not
only what you want to do but also what you don’t intend to do. You want to study art
therapy in a domestic violence shelter, for example, but you don’t want to study everyone
there, only a mother-child art therapy program. You don’t intend to study every shelter
but only a shelter that has a particular population you are interested in. Offer a clear
statement of all the assumptions you have that are taken for granted with respect to the
problem. Finally, re-state the problem as a testable hypothesis or research question. It
helps to have at least one hypothesis or question posed for the main problem and each
sub-problem.
STEP THREE: REVIEW OF THE LITERATURE

Once the purpose, goals, and problems are understood, the researcher should become
familiar with the “terrain” in which the study is located. What do you think is going
on out there that is related to your study? “Out there” means out in the world of art
therapy in “conversations” among your fellow researchers, clinicians, and artists, and
in published accounts in various journal articles, conference presentations, reports, and
abstracts about some of the same things you are thinking about. The context for your
study has to do with the concepts, assumptions, expectations, beliefs, and theories that
support and inform your ideas (Maxwell, 2005). Laying this groundwork saves time in
the end because it keeps you focused and helps you discover how other researchers have
handled similar issues. The quality of your awareness and thinking also is fine-tuned by
doing this contextual review of the literature.
If you are a practitioner, this step may recall images of graduate school and the long
hours spent searching in the library or trying to write a paper under the pressure of a
deadline or grade. It is very tempting, therefore, to skip this step and just start in on the
project. But the literature review is essential to make your study relevant, helpful, and
timely. Consider these good reasons (Bailey, 1991):
r You don’t want to waste your time repeating what someone else has already
done to answer the same research question.
r If someone else has studied the problem, you want to know what the chal-
lenges were, such as not being able to control certain variables or sampling.
r You may discover an existing study on the topic that you could replicate or
use as a model to be more effective in accomplishing your goals.
r Someone may have already studied a component of your question that you
may want to build upon.
r You may want to place your study into the context of similar studies so that
others can know how to perceive your work.
r You may want to increase your understanding of the theoretical base sur-
rounding your study as well as for others who will read about your study.
r You may find excellent reasons in the literature for why your study would be sig-
nificant and how you may want to address the problem or answer questions.
r You may be prompted to change your question, give it a different emphasis,
or change other aspects once you see how others have approached a similar
question.
r You may find some of your clinical impressions challenged or confirmed by
their documentation in the research literature.
To search out the literature, of course, you will have to use a library. But the library of
the 21st century is no longer a building; it has become a portal to vast scholarly informa-
tion systems housed in zillions of electronic bits, pages, files, databases, and consortia of
interlinked library and research holdings. Research literature has been digitized and stored
in massive databases that allow art therapists in Hong Kong to find and access a journal as
easily as students in Chicago. Your local university library has a rich array of powerful tools
to help you find what you need to know quickly and efficiently. Online library databases
(such as PsychINFO, Medline, CINAHL, and ERIC) are organized to locate abstracts,
peer reviewed articles, and research reports tailored to your specific needs. To take one
example, Medline is a database with over a million entries. You can search for classic
and recent research, cross-disciplinary studies, or documents with a limited circulation.
Sources found in scholarly journals like Art Therapy are especially important in conduct-
ing a literature search because the articles have been peer reviewed, meaning that original
research has been checked and verified by expert reviewers who are free of self-interest in
seeing the material published. If you are a student, access to this vast information system is
covered in your tuition; if you are a professional, you can arrange to have library privileges
at many institutions that support research. Other valuable online research tools exist to sup-
port professionals; PubMed is a wonderful online tool that offers access to Medline for free
and without the need of a library (see http://ncbi.nlm.nih.gov/pubmed).
On the downside of information technology are the shortcuts you may be tempted to
take if you are less familiar with how to use library or online research databases (includ-
ing Google Scholar; see http://scholar.google.com) than you are with general online search
engines like Google. The difference between articles found in PsychINFO or ERIC and
those found on a Web site on the Internet is that the former is more likely to be the product
of carefully reviewed scholarship. These reports also may appear on some Web sites but
usually are found behind the wall of costly pay-per-view access. Thus, it is worth learning
to use the library’s searchable tools for conducting your literature review (Table 1.2).
What should you do if you find only very little or no research literature for your
study? Likely the problem is that you are using keywords that are either too specific or
too broadly topical, for example, looking for research studies that precisely addressed
“studio approaches to art therapy in domestic violence” in the example given earlier.
More possibilities will appear if you unpack this focus and tease out the underlying
issues or approaches that logically fit with studies in closely related areas. One good
strategy for organizing such a search is to start by identifying topics or search terms
found in the professional literature for each of the sub-problems in your research prob-
lem statement (Figure 1.3). In the example above, topics might be domestic violence
treatment issues such as the effects of trauma on child rearing, negotiating the crimi-
nal justice system, or anger management; domestic violence program models in art
therapy; impact of the environment, space, or facilities on therapy; art assessments used
in domestic violence or similar programs; mother-child art therapy programs; treatment
interventions in domestic violence; art therapist self-assessment techniques for improv-
ing treatment effectiveness; and personal characteristics of art therapists working with
mothers and children, among other possibilities. Go to the library with this list and
begin collecting references from indexes, abstracts, bibliographies, and other reference
works. If you follow your research diagram and stick to each of your sub-problems, you
won’t waste time and be distracted with irrelevant literature. Gather together all the
studies that relate to each sub-problem and use these groupings to organize the logic of
the literature review. Later, when writing the review, you will be able to use each sub-
problem as your heading for that section of your discussion.
TABLE 1.2 Online research tools

KIND OF RESEARCH ONLINE LIBRARY WEB SEARCH TOOLS
RESEARCH DATABASES CATALOGS
TOOL
Examples PsychINFO, Medline, Your local university Yahoo; Google
ERIC, CINAHL; library, e.g., OhioLINK
PubMed Library Catalog
Contents Thousands of abstracts Records for books, Links to millions of
and full text articles periodicals, journals, Web pages on the
from hundreds of videos, government Internet
journals or periodicals documents, etc. Often
linked to state,
regional, and academic
library systems
Selectivity Selected and reviewed Selected and reviewed Except for Google
(quality by editors and by editors and Scholar, not
control) publishers, then publishers; then libraries selective. No quality
selected for inclusion make selections for control; anyone can
in databases to which purchase and inclusion put anything on the
libraries subscribe in their system Web
How to Keyword; also author, Author, subject, title, Mostly keyword
search article title, journal keyword, and others
title, subject
Organizing the Literature Search
Write the Problem Statement at the top of

the page
Make a list of Opposite each study

each relevant study you found and listed,
you found in the identify the particular
left hand column sub-problem you have
that it relates to and
why in the right hand
column
Write down the
APA citation
information for
each source
FIGURE 1.3 Organizing the literature search.

STEP FOUR: DETERMINING METHODOLOGY

Even in the most open-ended designs, the researcher must have some orga-
nized idea of how the data will be collected and interpreted in order to resolve the
research problem. Leedy (1997) offered four fundamental questions, below, to help
determine methodology.
DETERMINING THE METHOD (LEEDY, 1997)

r What data do I need?
r Where do I find the data?
r How will I get this data?
r How will this data be interpreted? What do I intend to do with this data
to solve the problem?
Although there are many ways to organize research designs, as presented in Part II
of this text, one of the most basic is to decide whether a quantitative or qualitative
approach will best achieve your purpose. As described by Deaver (2002) methods that
require the researcher’s objectivity and are generally concerned with “measuring, con-
trolling for variable, cause-and-effect relationships and seeking patterns or regularities”
(p. 24) are defined as quantitative. Qualitative methods are “characterized by impres-
sions, thoughtful analysis of observed themes, and reflections” and, in general, “by the
subjective responses of the researcher and research participants to the problem or situ-
ation under investigation” (p. 24). Deaver further explained
Quantitative research tends to employ deductive reasoning, proceeding from general

problem areas to specific hypothesis testing, in an effort to support theoretical assump-
tions. For example, an art therapist researcher explores the general theory of projection
by analyzing statistically whether or not a correlation exists between a diagnostic cat-
egory and particular characteristics of specific drawings. If the research is conducted
rigorously enough (i.e., in compliance with the rules of science) and a significant cor-
relation does exist, the researcher may add credence to the theory of projection in
art therapy. Qualitative research, on the other hand, is frequently inductive in nature.
The qualitative researcher examines an existing phenomenon and draws conclusions
about it, building theory as the investigator progresses. For example, an art therapist
researcher systematically investigates a client’s response to working in clay through
means of in-depth interviews. She analyzes both the client’s and her own responses
to therapy sessions and the post-session interviews, discovers consistent themes, and
draws some conclusions about clay work that may add to the theoretical underpinnings
of our clinical practice. (p. 24)
Deaver’s explanation touches upon the interaction of two basic elements: data,
which are the empirical observations made, and theory, which is the organization of
concepts that permit the interpretation of data (Elmes, Kantowitz, & Roediger, 1999).
The process of working from specific data or cases to create a general theory is known
as induction. Deduction moves in the opposite direction, when the researcher empha-
sizes a theory in predicting data or reasons from the general to specific cases. Deaver
also noted the different emphases that quantitative and qualitative methodology put
on objectivity and subjectivity. Research that aspires toward objectivity attempts to
minimize the effect of the researcher on data by controlling the conditions in which the
data are gathered (Carolan, 2001). Qualitative research allows for subjectivity but also
strives to identify the bias of the researcher and its effects.
Table 1.3 provides a general guide for the choice of research approach and design
decisions. Keep in mind that the division of quantitative and qualitative methodology
is somewhat artificial. There are many designs that are not strictly one or the other
approach, and many designs use a mix of methods. There may be crossover in the way
you choose to address certain aspects of the study. The purpose here is to use these
thinking and planning processes to help determine the best methodology that will serve
your purposes.
An important quality of research integrity is validity. In quantitative studies that
are associated with experimentation, validity is related to
r Measurement (Did the study measure what it purported to measure?)

r Internal validity (Did this treatment make a difference in this situation?)
r External validity (Can this study’s effects be generalized to other popula-
tions, settings, treatments, or other variables?)
In qualitative research, validity is based on the
r Context (how a particular piece of data fits with the whole picture)
r Perspective (where valid research is always a matter of relationship or the
standpoints of the participants)
Many problems with validity result from not precisely delineating the research
questions, purposes, and methods. Or the researcher approaches the research with a
desire to confirm the study’s major premises or hypotheses. Art therapists are espe-
cially vulnerable to this validity threat when they lack confidence or have become
somewhat defensive from working in environments where art therapy is devalued or
unknown. They may unwittingly collect data to address questions they already know
the answers to, or they may attempt to create data that will incontrovertibly “prove”
art therapy’s value. To counter this tendency, good researchers in whatever tradition
always adopt a “functionally skeptical” stance toward their research study and data. It
takes courage to not accept findings at face value and to pose potentially disconfirm-
ing questions.
Malchiodi (1992) described experimental biases that appear in the way some
studies are constructed or conducted, in how subjects are selected, and in apply-
ing inaccurate or inappropriately instruments to the research problem. Personal bias
such as the researcher’s unaware projections also may compromise a study’s validity.
TABLE 1.3 Choosing the research approach: quantitative or qualitative?

DESIGN OPTIONS AND CONCERNS
ISSUES QUANTITATIVE QUALITATIVE
What is the nature of Confirmatory, predictive Exploratory, interpretive
your research
question?
What is your goal or To deduce and test implications To induce or reach tentative
purpose? of preformed hypotheses hypotheses based on what is
observed
To explain and predict To describe and explain
To confirm and validate To explore and interpret
To test theory To build theory
What is the scope or To cover breadth To study depth
focus of your Known variables Unknown variables
study? Established guidelines Flexible guidelines
Context-free Context-bound
Detached view Personal view
What people and Individuals, groups, programs or program components, agencies,
environments can clinics and hospitals, organizations, community health centers,
you study? schools, universities, etc.
What tools will be Instrumentation such as physical In-depth interviews
used to collect the tests or assessments Interactive fieldwork
data? Observation Analytic memos
Questionnaire, surveys Observation
Review of records, art, or Questionnaire, surveys
artifacts Review of texts, art,
Patient records or artifacts
Patient and researcher
records of process
What can be studied Independent variable that is Units of analysis (people,
or measured? manipulated to observe its processes, and artifacts) as
effect (change) on the affected by an experience or
dependent variable condition
Fixed variables Unknown variables
Variables that already have Comparison of these units of
occurred analysis
Comparison of one or more
variables
How will you select Random selection Informative, small, or
your participants? Random assignment purposeful sample
Representative, large sample for Multiple cases linked or
generalization nested together
(Continued)
TABLE 1.3 Choosing the research approach: quantitative or qualitative? (Continued)

What type and Fixed, static design to control Open, flexible design to
degree of control variables discover emergent data
will be used? Experiment (control group) Non-experimental
Quasi-experiment (some or Descriptive
partial control)
Non-experimental
How will you Deductive (from general theory Inductive (from particular case
approach data to predict particular trends, or themes to general theory)
analysis or correlations, or causes) Interpretation
interpretation? Computation Content or thematic analysis
Statistical analysis Coding
Rating scales Pattern matching
Coding Explanation building
Time-series analysis
How will you Numbers Words or stories
communicate your Statistics, aggregate data Narratives, individual quotes
findings?
How will you Reliable and valid claims of Valid claims of trustworthiness
address validity? probability of the data and its
Rigor authenticity
Generalizability Triangulation of data
collection, multiple methods,
perspectives, or researchers
When will the study Fixed timelines Fixed vs. open timelines
occur? How much Pretest, treatment phase, Long-term fieldwork
time will you need post-test measures Exploratory vs. confirmatory
and how will phases
research activities
be sequenced?
What resources do People such as a research team, statistician or field supervisor,
you need? instrumentation or assessments; materials; computer programs
for data input and analysis; time; and access
How will the logistics Access to the site, subjects or people, and records
of the site be Need for liaison to the study participants, contracts, training,
handled? availability
How will ethical Informed consent, protection of human subjects, Institutional
issues be handled? Review Board, reactivity, presentation of the researcher’s goals
to participants, etc.
Every time we do research, we produce a disturbance in our own unconscious mate-

rial that may get projected into the world we are studying. Bias also may take the
form of “consensus collusion” (Reason, 1981), whereby a whole group of researchers
engage in groupthink in defense of their anxieties. Groupthink prevents individuals
from looking at certain areas of experience or behaviors that go against the accepted
norms of the group. A researcher in such a position may end up either “preaching to
the choir” in order to gain acceptance from the group, or defying groupthink and get-
ting pilloried as a heretic.
Reason (1981) offers some useful “heuristic guides” for enhancing validity. These
are not methods but simply are good practices or rules of thumb for developing critical
thinking skills. As you design your study, no matter the paradigm or methods used, see
if it can pass these tests, below.
CHECKLIST FOR ENHANCING VALIDITY (REASON, 1981)

–––– My design will produce findings that rest on valid measures or on
high-quality, discriminating awareness on the part of the researcher.
–––– My design requires me to engage in systematic proofs or in personal
and interpersonal development to maintain high quality awareness.
–––– Because valid research is not conducted alone, my study includes a
means to step outside myself and engage with people who will help
me challenge my biases and habits of thinking.
–––– My research is enhanced by systematic analyses or feedback loops.
I have structured my design to counteract cultural expectations/biases
that may get in the way of true scientific discovery.
–––– I have designed for internal and external threats to validity, or for
convergent and contextual validity through multiple methods, theo-
ries, perspectives, and/or comparative processes.
–––– My research can be replicated in some form. Others may build upon
my work and contribute to future knowledge.
STEP FIVE: TOOLS AND RESOURCES

FOR CONDUCTING THE STUDY
Conducting the study is the “hunt itself, using the proper tools, methods, and settings
appropriate for your particular pursuit” (Kapitan, 1998, p. 25). The tools of research are
not the same as its methodology, a point that is frequently confused by those who are
unfamiliar with certain tools and therefore view them with suspicion. A tool is simply
a tool and accessory to the research process, whereas methodology is natural to and
characteristic of the whole project (Leedy, 1997). Every profession has its unique or
specialized tools for carrying out its specific work. In art therapy, these tools include art
processes and products. Added to this toolbox are the general tools that most research-
ers, regardless of their profession, use to derive meaningful and insightful conclusions
from the data (Leedy, 1997). In many studies these tools include statistics and tech-
niques of measurement.
Statistics and the Value of Measurement

Statistics have two principal types of functions: (a) descriptive, which is to illuminate
the “contour” of the data and the relationship between groups of data; and (b) infer-
ential, which means certain inferences or judgments about the data may be suggested
when the data are compared to a model or standard. The researcher uses statistics to
account for the cause of the data’s configuration in terms of the research problem. The
primary service of statistics, in fact, is to help the human mind comprehend disparate
data as an organizing whole (Leedy, 1997).
However, this powerful tool is an abstraction in much the same way that the art
image on the paper is an abstraction and not the reality of a person’s life. We can use
an art image to illuminate the “contour” of a life concern and we can study the image
to infer certain things about the life concern. But we would not want to mistake the
artwork for the life concern to which it points. The same is true for statistics. Statistics
may show that the average U.S. American family has 1.8 children, but everyone knows
there is no such thing as a child whose existence is only 0.8 of a whole. Averages and
other statistical tools are mental constructs only; they provide a hypothetical platform
on which disparate data can become comprehensible and from which a theory can be
developed.
In quantitative models of research, the data usually are converted to numbers and
the results are communicated with statistical analysis. Whereas the language of numeri-
cal measurement may be alien to many art therapists, the practice of translating art
therapy into language and constructs that are accessible to related professionals and cli-
nicians on a treatment team is not. The purpose of mathematical translation in research
is an extension of this idea. By converting different kinds of data into numbers, certain
relationships among them can be more easily seen and interpreted. Measurement in
research is used to limit the data in order to examine them mathematically and according
to an acceptable quantitative or statistical standard (Leedy, 1997). All kinds and variet-
ies of phenomena—whether tangible, like objects, artworks, and natural phenomena; or
intangible, like emotional states, ideas, attitudes, and perceptions—can be “translated”
and measured with statistical tools that capture and make visible their elusive qualities.
When these measurements are seen in terms of mathematical relationships, the data
can be insightfully compared across different sources, timeframes, methods, groups of
people, and newly relevant research questions.
Critics of such measurement in art therapy research have proposed that it does
not yield to the complexity that is art, and that art therapists may prefer “allowing art
expressions to speak in and of themselves as opposed to being quantified and compared
to a pre-established system” (McLaughlin & Carolan, 1992, p. 50). But this misap-
prehends the fact that measurement is simply a tool and not an end in itself. Nor is it a
substitute for the reality of an art therapist’s work. Measurement is a research tool that
offers up information about the data, whether that data is art expression or some other
complex behavior. Behind the statistics are the data themselves to which the statistics
refer. The researcher always is interpreting and giving meaning to this data; statistics
simply are one tool used to do so.
Valid and Reliable Instrumentation

Art therapists have not always approached research with a critical eye toward standard-
ized instruments, preferring informal or self-invented means for collecting and interpret-
ing data. In some respects, this is like creatively re-arranging the words in a sentence and
then expecting people to understand what you are saying. Standard instrumentation is
like standard English: clear communication and shared meaning are only possible when
people use the same rules of grammar. In research, the choice of instrument to guide
data collection should be determined, at least in part, by its validity and reliability. You
want to find and use reliable instruments that will give you similar results consistently
and over time; your choice of a valid instrument is one that measures what it is supposed
to measure. It should measure what you are looking for based on the criteria set forth
in your study. For example, can a single drawing from a particular directive measure a
person’s spiritual beliefs or does it measure something else entirely, like what the person
wishes to be true or wants to be accepted by the evaluator? Standardized instruments
are used to control for these and other instrumentation errors and biases. These are usu-
ally in the form of surveys, checklists and questionnaires, physical measures, published
psychological tests and inventories, and some art assessments.
Art as a Research Tool

As discussed in detail in the following chapters, a unique tool or strategy in art therapy
research involves the art product and process of creating art in service of therapy. In
writing from the perspective of how art therapists may collaborate with social scien-
tists in their research projects, Musham (2001) observed that although the use of art
in research is not new, its promise remains unfulfilled. She stated that the fact that
most social science researchers do not know how to use art in research is unsurprising
because they rarely have a background in art education. Thus, they fail to appreciate
“both the revelatory powers of art and that it can be legitimate data” (p. 210). Musham
proposed that with their specialized training and experience, art therapists can make a
significant contribution to the research studies of social scientists and help them use art
more effectively and responsibly.
The Clinical Research Team

Although unfortunately rare in art therapy, much research in clinical and social sci-
ence fields currently takes place through collaborative teamwork funded by aca-
demic and private sector research grants. A clinical research team is another tool
art therapists and practitioners should consider to carry out their projects and to
gain valuable skills that will advance their professional knowledge (Musham, 2001).
The complications of carrying out research in a field setting become manageable
when members of the team are given responsibility for only those aspects that fall
TABLE 1.4 The clinical research team

Psychologist or Research Expert Knows how to design a valid and reliable study
Can apply statistical analysis
Can train other members of the team
Interprets the data
Can lend expertise in writing a scientific paper
and publishing the findings
Art Therapist Designs the intervention
Performs the intervention
Interprets the data
Writes up the artistic aspects of the study
Data Collector Secures signed consent from participants
Conducts the pre- and posttest
Sets up the control
Inputs data into the program
Liaison to the Study Participants Has a formal role of responsibility for the
agency or hospital (usually is a nurse or
doctor)
Has contact with the population under study
Has contact with other clinicians
Can provide access or help find a site where
the study can take place
Can recommend participation in the study
Institutional Review Board Protects the research subjects from harm
Protects the research team from liability
Provides human subject guidelines and rules
for compliance
Determines suitability of the study
Reviews and approves the research study and
team
within their unique expertise. The model described by Nainis (2007) in the model in
Table 1.4 is one example of how a research team may function and is fairly typical
in collaborative research.
In this model, the art therapist may be the one who carries out the experimental
variable or art therapy treatment while other members of the team secure a valid and
reliable study by providing expertise in such aspects as testing, inputting data, statisti-
cal analysis, or selecting the participants. Musham (2001) has described other roles
art therapists can take that are critical to the success of a research study where art is
used, especially when the principal investigator (PI) is not an art therapist. Theoretical
frameworks or the mechanics involved in art therapy may be poorly understood by
PIs, or they may not be aware of the wide range of art strategies that can be used in a
study. Art therapists may provide procedural and ethical oversight for the use of art, or
may offer strategies for helping research participants engage in art processes or handle
emotional reactions.
Participation in a clinical research team in the agency where you work or in col-
laboration with a university is a good solution for art therapists who can’t help but
“raise the image of the irresistible, larger, powerful and noblest of animals or questions”
in their research pursuits (Kapitan, 1998, p. 25). This is the much desired research study
that will bestow respect and recognition to a large audience, proving once and for all art
therapy’s value to a large audience. But in reality the efforts of many people are needed
to successfully pursue such an animal; “it takes a community of hunters collaborating
together to succeed” (p. 25). By taking one role on the research team, usually as the
facilitator of art therapy treatment, you will be able to use the strengths and knowledge
you already possess to satisfy your research goals and to make your study more man-
ageable in scale.
The Use of a Mentor

One other useful tool is having a mentor. “Many art therapists lack education and train-
ing in research methodology and some practitioners may fear that research methods
demand an overly structured or evaluative approach,” stated Deaver (2002, p. 23). By
networking with art therapist researchers or recent doctoral students, or by establishing
a supervisory relationship with an expert, you can be guided past stumbling blocks.
In both research and the hunter-gatherer tradition, working with a guide or “respected
elder” is an important means for passing down valuable knowledge and ensuring greater
success than would ever be possible alone.
STEP SIX: IMPLEMENTING THE STUDY

WITHIN ETHICAL BOUNDARIES
The final step before implementing the research is to describe how you will safe-
guard the rights of those who will participate in your study. This requires writing a
proposal that is submitted to review by a human subjects committee (often called an
Institutional Review Board or IRB) charged with overseeing research in the agency or
institution that you intend to access (see Chapter 8, “Before You Begin: The Research
Proposal and Other Ethical Safeguards”). Most academic and health care institutions
today have their own review boards for this purpose, although art therapy practitioners
may be employed in an agency that does not. In such a case, the art therapist researcher
should use an equivalent review and approval process, such as submitting the research
proposal to the highest-ranking official in the agency, who can affirm in writing that
the agency has reviewed, approved, and will support the study, and that the researcher
will be conducting the study in accordance with ethical guidelines. In addition to a
professional code of conduct, researchers must be familiar with privacy laws and with
federal-mandated rules for research with human subjects that require ethical review.
These forces have made a powerful impact on the ethics of research.
Patton (2002) listed some of the issues that must be brought into awareness before
implementing the study having to do with issues of harm, consent, deception, privacy,
and confidentiality of data:
r Explaining purpose: Can you explain the purpose of your study to others
in a way that is accurate and understandable? What details must you share
with those who will be participating in your study? What makes your study
worthwhile?
r Promises and reciprocity: Can you explain to your participants and
co-researchers why they should participate in the activities you have designed
for them? Have you made any promises in exchange for their participation
and can you honor these promises?
r Risk assessment: Can you explain the risks involved in participating in your
study? To what extent can people decide to opt out? What degree of psycho-
logical risk is involved? Are there other risks, such as possible political or
social repercussions for participating, or risks to participants’ family mem-
bers, peers, employers, etc.? How will you handle unknown risks that may
emerge in the study?
r Confidentiality: Can confidentiality be fully maintained? Are there any cir-
cumstances that limit confidentiality, such as the mandate to report child
abuse? How will the data be kept confidential and what degree and length of
time is involved in storing the data?
r Informed consent: Can you explain the study sufficiently to provide informed
consent? What kind of written consent is necessary to protect the rights of
both the participants and the researcher? What are the requirements of the
Institutional Review Board that will be involved?
r Data access and ownership: Who will have access to data or artworks that
are collected? Who will see the final report? What limitations on access are
necessary to protect participants? How will the data be recorded and stored?
Who owns the data or artworks?
r Safeguarding mental health: How will your participants be affected by your
study? How will you, as the researcher, be affected? Will any debriefing be
necessary after the data collection or analysis?
r Advice: Who will supervise and help you handle any ethical matters that
may arise in the study? Who will you go to for advice or to help deal with
difficulties?
r Data collection boundaries: Are there any conflicts in your role in collecting
data for the study? What limits should you set to protect your participants
from disclosing information beyond their original consent? Under what cir-
cumstances might you have to change or abandon the study?
STEP SEVEN: REPORTING AND

DISSEMINATING RESULTS
After conducting the study and gathering information, you will analyze the data using
the quantitative or qualitative methods identified in your plan. If your project was care-
fully conducted and you have valuable data, you are obligated to disseminate the results.
Two general principles are used to develop a published report: Adequate evidence
should be given to justify your conclusions and the logic of your study, and conclusions
should be transparent or explicit. You may want to refer to Chapter 9 for guidance on
what comprises a good research report, and Chapter 10 on how to publish your study in
a scholarly journal. The point here is that it is a serious responsibility not to end your
study without sharing your findings with others. Like the practical reasons for conduct-
ing any search for knowledge or hunt:
The hunter, though engaged in a quest that is enacted in isolation, knows that the ulti-
mate outcome of the hunt is to replenish the stores of food needed to feed the com-
munity. Likewise, the researcher is motivated not solely by the individual quest for
knowledge, but the recognition of connection to a community of professionals who
will benefit from the renewal of the basic scientific conversation the inquiry brings.
Once data has been collected and interpreted, the researcher must determine the
audience to be addressed, whether that is the self, peer professionals, policy makers,
the community, or other researchers. How the findings are presented can also take
a number of different forms, such as a research article, newsletter report, in-service
presentation, thesis, and so forth. Every hunter-researcher fulfills a larger function
of the community; when it is a matter of food or of survival, it is not a game, and it
is not entered into for power or out of arrogance and a belief in the superiority of the
hunter-researcher over the world of the pursuit … This giving attitude also prepares
the ground for future mentoring of peers and students in their research pursuits.
(Kapitan, 1998, p. 26)
The art therapist, in concluding a research study, usually has benefited from a
number of people who agreed to participate because they believed that doing so would
be worthwhile and would make a contribution to human knowledge. Thus, it is a shame
that so many research studies go unreported and unpublished. Often art therapists only
hear about a study through the good fortune of attending a presentation at a national
conference, a venue that is limited to very few attendees. In and of itself, this is not bad
because conferences are often the first place where research is reported and where art
therapists gather to discuss recent or on-going research activities. But it also happens
that unpublished findings sometimes are used to create theoretical or statistical models
that may or may not be reliable. The problem here is in reporting on studies that have
not been reviewed by independent evaluators for their claims of statistical or clinical
significance.
For art therapy research to benefit the greater good, we need to embrace the under-
standing that our ideas, once widely disseminated, have the potential to transform
knowledge (Kapitan, 2006b). We should not fail to ask, “Who else needs to know my
discoveries?” Research does not stop at generating knowledge in relative isolation, but
extends knowledge into useful practices in a multitude of directions. It does not mat-
ter whether the goal of the “hunt” is the artist’s or the scientist’s discoveries. One must
enter absolutely into the search in order to endure to the end (Kapitan, 1998). In all its
forms, knowledge is about how to act in the face of life’s demands. Such is the contribu-
tion that art therapy research may have in finding better ways of being in the world and
becoming more effective in our pursuits.
CHAPTER SUMMARY
Basic steps in research design:
1. ––––– Identify the research question.

2. ––––– Develop the problem statement.
3. ––––– Review the existing literature related to the problem.
4. ––––– Decide on the methodology.
5. ––––– Locate tools and resources for collecting and analyzing the data.
6. ––––– Implement the study within ethical boundaries.
7. ––––– Report on the results and publish/disseminate the findings.
REFERENCES
Allen, P. B., & Gantt, L. (1992). Guidelines for getting started in art therapy research. In
H. Wadeson (Ed.), A guide to conducting art therapy research (pp. 23–27). Mundelein, IL:
Anderson, F. (2001). Benefits of conducting research. Art Therapy: Journal of the American Art
Bailey, D. M. (1991). Research for the health professional: A practical guide. Philadelphia, PA: Davis.
Deaver, S. P. (2002). What constitutes art therapy research? Art Therapy: Journal of the American
Art Therapy Association, 19(1), 23–27.
Elmes, D. G., Kantowitz, B. H., & Roediger III, H. L. (1999). Research methods in psychology
(6th ed.). Pacific Grove, CA: Brooks/Cole.
Kapitan, L. (2006b). The multiplier effect: Art therapy research that benefits all. Art Therapy:
Kvale, S. (1996). Interviews: An introduction to qualitative research interviewing. Thousand
Oaks, CA: Sage.
Leedy, P. (1997). Practical research: Planning and design (3rd ed.). Upper Saddle River, NJ:
Prentice Hall.
Linesch, D. (1995). Art therapy research: Learning from experience. Art Therapy: Journal of the
Malchiodi, C. (1992). Minimizing bias in art therapy research. In H. Wadeson (Ed.), A guide to con-
ducting art therapy research (pp. 31–36). Mundelein, IL: American Art Therapy Association.
Maxwell, J. A. (2005). Qualitative research design: An interactive approach (2nd ed.). Thousand
Oaks, CA: Sage.
McLaughlin, D., & Carolan, R. (1992). Types of research. In H. Wadeson (Ed.), A guide to conduct-
ing art therapy research (pp. 49–54). Mundelein, IL: American Art Therapy Association.
Musham, C. (2001). The potential contribution of art therapy to social science research. Art
Nainis, N. (2007). Developing a scientific research study for expressive art therapy. Presentation
at Northwestern Memorial Hospital, Chicago, IL.
CA: Sage.
Reason, P. (1981). Human inquiry. New York, NY: John Wiley & Sons.
Rhyne, J. (1992). How ideas are generated for art therapy research. In H. Wadeson (Ed.), A guide
Association.
Rudner, R. (1991). The call of the climb. Parabola, 16(2), 73–78.
How Art Informs

Art Therapy
Research
2
The wind howls outside and the
flames leap skyward inside. With
the ancient images on the walls
watching, we could try to spend
our time measuring the size and
shape of the cave, determining
the chemistry of its rock walls,
or performing calculations.
… But why? The spirit of the
hunter’s cave invites, maybe
demands us to contemplate
more profound matters. … As
the fire burns, contemplating
the shapes on the walls, as well
as the hunters that pursue them,
our mind seems drawn to link
symbols together into strings
of association. Do we tell the
stories or do they tell us?
—James Swan (1999, pp. 27–28)
One of the self-defining experiences for a professional art therapist is being asked the
question, “What is art therapy?” Invariably it happens just as I am settling into my air-
plane seat and the person sitting next to me asks what I do for a living. My seat partner
has no idea of the existential self-scrutiny this innocent question triggers. I fantasize an
art therapy research study called the Airplane Seat Partner Assessment (ASPA): How
will my seat partner react when I say “art therapist”? Will it be a measured look of
respect? Or incredulity that such a field exists? Twenty years ago, he would have handed
me a beverage napkin with a little stick figure drawn on it and expect me to tell him
what deep secret it revealed about his life. Today, it is much more common to find that
my seat partner has heard or read about art therapy, knows someone who was helped by
art therapy, or wants to share a personal insight about it. According to my ASPA “find-
ings,” art therapy has begun to penetrate the consciousness of the general public.
29
The question, “What is art therapy?” is defining for the art therapist because it
triggers reflection on the field’s uniqueness as well as hidden doubt. If art therapy
were more common, the question wouldn’t arise. It attracts a call for research to
discover or verify what makes art therapy what it is. The role of art has always been
at the center of the field’s long-standing attempts at definition. This chapter looks
at art in art therapy research from historical and contemporary views, and lays out
some of the special issues that accompany the art therapist’s unique contributions
to the world of research. The chapter concludes with a framework for art therapy
research that can be adapted to meet the breadth and diversity of questions, goals,
and purposes.
THE ART THERAPY LENS

Art therapy often is defined functionally as a set of interpersonal and art-based skills
used to help people come to terms with psychological, developmental, social, and behav-
ioral stressors that impede their health and wellbeing. This skill set requires knowledge
of art, psychology, and psychotherapy or professional counseling. Along a spectrum of
practice, from the clinic to the studio and in distinct cultural contexts worldwide, art
therapists have adopted eclectic theories that help to define their work. But the purely
functional definition is limiting because of the dynamic nature of theory and practice.
Art therapy isn’t always identifiable by what art therapists do. A therapist must be will-
ing to adapt methods, theories, and techniques to various client situations.
An alternative approach to definition is to identify the particular lens or worldview
that an art therapist brings to the therapeutic enterprise. Worldview is a very influential
but often overlooked concept in practice and in research. For example, on a winter’s day
after a snowfall, I enjoy the aesthetics of my local parkway transformed by the play of
light and shadow on the heavily laden trees. Having grown up with the deep snows of
North America, the scene comforts me whereas a visitor from the tropics might feel
delight or aversion. My fellow commuter may only see the snow through the dread of
having to drive through it; the guy in the snowplow looks at the snow functionally and
sees what he must do to remove it.
Worldview is useful to explain why a client would benefit from working with
an art therapist instead of a psychologist, social worker, or professional counselor
who may use art in treatment. One distinguishing characteristic is that an art thera-
pist’s professional preparation assumes a personal relationship with art developed
over time. Art therapists enter graduate school with a background in art. This primary
orientation affects how they view and approach therapy, how they interact with thera-
peutic concepts, what they are predisposed to value or pay attention to in therapy,
and how they interpret information from the clinical environment. In this respect,
art has a central place in the minds and actions of art therapists and is not defined
by technique alone. Other professionals who value diversity on the treatment team
2 t How Art Informs Art Therapy Research 31
often recognize that their art therapy colleagues look at things differently and have
distinctive insights.
In common with all other artists, the primary method of art therapists is to activate
the process of creation followed by reflective critique. The application of this basic
method in the context of therapy is what differentiates art therapists from other artists
as well as from other kinds of therapists.
AESTHETIC-RELATIONAL TOOLS OF THE ART THERAPIST

r Seeing, creating art and facilitating the process of creation
r Relating compassionately to the art images created and to the people
who are also seeing, creating, and relating to the art images created
r Attending to the therapeutic relationship, environment, and surround-
ing socio-cultural contexts
r Interpreting all of these components as to their meaning and signi-
ficance
The art therapy worldview helps us grasp the mind of an art therapist doing
research. Art therapists approach therapy from their unique aesthetic worldviews but
they use the same ethical principles, diagnostic categories, and standard of care that
other mental health professionals use in the setting or culture they share. Likewise,
art therapist researchers can be distinguished not by the uniqueness of their methods,
but by how they think and what they pay attention to. Perhaps because the profession
has not articulated its worldview to much extent, the question of how art therapists
can or should approach research—with both scientific and artistic integrity—has been
elusive. At a recent national research summit, for instance, an eminent behavioral sci-
ence researcher expressed frustration that art therapists seemed to be describing their
research in the “language of the rat scientists”; he wanted to see what it was that art
therapy uniquely offers (personal communication, B. van der Kolk, November, 2006).
How do art therapists formulate their problems and select what to pay attention to, given
the sensitivities of their aesthetic-relational worldview?
Daley (2007) explained that whereas scientific research calls for “reasoned
explanation, representational accuracy, and certainty,” in making art we strive for
“arousal, vividness, and interpretative creativity” (p. 1). When art therapists activate their
research concerns from an art therapy worldview, they call forth science and art. Daley
wrote, “it is not until people cultivate an awareness of their own aesthetic capability that
they then can take full advantage of the procedures of science” (p. 1). The art therapy
worldview uniquely predisposes art therapists to be effective researchers because in
order to accomplish the research task and communicate it to others we must use our
skills in attending to a life concern as we encounter it. Art therapy research primarily
involves the discipline of learning how to observe, how to place our observations in
context so that we can see more accurately, and how to return again and again to the
evidence we see in order to validate our understandings.
Learning to see, Daley asserted, is fundamental to both the scientist and the
artist. Great research is produced because of what a researcher was able to see. Ortega
y Gasset (1943/1985) compared a hunter’s attentive sense of sight to ordinary vision
with its attention to the preconceived. “Alert vision” is the hunter’s greatest tool, as
it is with scientists, artists, and researchers. When I am walking in woods with my
husband, a photographer by training, I can always sense when he’s using this special
sense of sight. He is not simply walking in woods; he is surrounded by a sensory flow
of colors, shapes, forms, patterns, textures, and contrast. He is attentive to the pre-
cise photographic moment when a certain experience can be captured and expressed.
Ordinary vision, by contrast, is “equivalent to being absorbed in one point of the vis-
ible area and not paying attention to the other points” (Ortega y Gassett, 1943/1985,
p. 129).
Among the many ways that art informs art therapy research, some key skills that
art therapists can draw on include
Composition: Both the artist’s composition and the researcher’s study design are
determined by certain parameters of the medium. The components of the subject are
placed within these boundaries and the artist or researcher makes decisions about its
focus, figure-ground relationships, depth of field, and viewpoint. A complex subject is
managed by creating a composition that sorts out and attends selectively to the most
important details. A good research design is like a good composition: it either “works”
or it doesn’t and fails to achieve its expected outcome.
Subject matter: Both artists and researchers learn to balance what they know
intimately about a subject with an attitude of objective distance or “disconfirming
hypotheses” in order to sharpen perception and see more clearly what is real and true.
For example, drawing a human face requires the artist to get past confounding, pre-
conceived ideas about facial features and focus on the study of the particular face of
the model being drawn. Artists train themselves to render an object more precisely by
breaking down the complex subject into contours, shapes, proportions, and so on. Like
researchers, they use perspective skillfully, at times moving in closely to render details
and at other times stepping back to gain objective distance and to take a measure of the
whole.
Representation: Artists and researchers use symbolic systems to portray aspects of
reality. Some forms of research use mathematical systems, some use verbal representa-
tion, and some use art imagery. Some artists may strive for detailed, realistic images
while others are impressionistic, conceptual, or “portray what they have seen through
abstract representations of reality” (Daley, 2007, p. 16). Likewise, the forms researchers
choose to work with greatly influence what can be found and communicated through
their findings.
The art therapy lens when extended to research accepts the benefits of being “cre-
ative as well as analytical, to be passionate as well as reasoned, to feel as well as to
think, and to arouse while offering explanation” (Daley, 2007, p. 1). This integrative and
interdisciplinary worldview approaches research as an essentially creative activity with
many benefits to the profession, art therapists, and their clients.
THE ETHICS OF USING ART AS DATA

The art therapy lens predisposes the art therapist to be ethically sensitive toward the
artworks created in therapy and in research. Where many social scientists see only inert
“data” that takes the form of an image, art therapists often extend their compassionate
regard for the ethical treatment of people they serve in therapy to the images created.
B. Moon (2006a) asked art therapists to consider the “rights of images” as a sensitizing
concept when making ethical decisions. He wrote:
Questions about the appropriateness of interpretation and labeling, the exhibition of

clients’ work, the documentation of art therapy sessions, and the ownership of finished
art products are given a profound sense of depth when art therapists seriously consider
the best interests of the artwork. (p. 59)
Interpreting Client Art

B. Moon’s (2006a) arguments against the use of art images as data for diagnostic
interpretation came from his clinical experience with therapists who use projective
assessment systems to interpret meaning in artworks. He observed parallels between
original artworks as a projection of their creator and art therapists’ interpretations of
meaning based on their own projections. Interpretive approaches to art therapy, of
course, must be used with an awareness of the possible harm to the therapeutic rela-
tionship that could occur when labeling or making judgmental interpretations about
an artwork. “How would you like to have another person authoritatively describe
what ‘you mean’? How do you feel when labeled? When explained by another?” asked
McNiff (1992, p. 184). Art therapists agree that there are many meanings to be found
in art products. As Rubin stated, they are “not to be found in neat formulas or simple
recipes, much as we might crave easy answers” (as cited in B. Moon, 2006a, p. 67).
At the same time, it is important for art therapists to distinguish between the clini-
cal and research uses of art in assessment. Scientists value the various aspects of the art
images created in art therapy because art supplies essential data for their investigations.
Social scientists study people in all their complexity and are not without compassion or
regard for their wellbeing. Throughout the research process and whatever the method-
ological framework chosen, how art therapist researchers view, describe, and interpret
artworks, and how they apply the knowledge gained, must be ethically sensitive to the
people and phenomena that contributed to the study.
Collecting Client Art

Art therapist researchers collect art images for various uses and must make ethical deci-
sions about their maintenance, storage, and disposal. With new technology, art therapists
can document artwork in digital form instead of keeping original artworks that belong
to clients or research participants. The rules of confidentiality and the protection of pri-
vacy, discussed elsewhere in this text, apply to the storage and use of images.
Exhibiting Client Art

Another area that art therapists must consider when using art in research is the exhi-
bition or display of client artworks. B. Moon (2006a) discussed the ethical responsibility
of art therapists to weigh the merits and potential benefits of displaying artwork created
in therapy along with their potential harm to clients. Researchers whose projects serve
public awareness of the mental health concerns or needs of marginalized people, for
example, may want to display the artworks collected from research participants. There
is power in becoming visible to others and participants may benefit from exhibiting
their work. But researchers are obligated to protect participants from exploitation and
sensationalism, or from adverse emotional pain that may occur for some clients who see
their work in public or read about it in published texts. Spaniol (1990) has outlined the
special considerations that should be taken when exhibiting artwork, with a focus on
co-equal planning, creating conditions that empower the participants, and safeguards
for any public disclosure of client information that may accompany the exhibition.
ETHICAL PRINCIPLES RELATED TO THE

USE OF ART IN RESEARCH
r Art therapists regard client artwork as the property of the client-artist.
Art may be released to the client during or at the end of treatment.
Clients are notified when copies of their artwork are retained as part of
the clinical record.
r Art therapists must obtain written consent from the client or legal
guardian before copying artwork in any medium; consent must be
obtained to keep artwork, copies, slides, videos, or photographs for
educational, research, or assessment purposes.
r Art therapists may not make or permit public use or reproduction of cli-
ent art therapy sessions, or third-party viewing of sessions (including
artwork) without written consent.
r Art therapists may use clinical materials (including artwork and video)
in teaching, writing, and public presentations if written consent from
clients has been obtained and if reasonable steps are taken to protect
client identity.
r Art therapists obtain written informed consent from the client before
displaying client art in any public place.
r Refer to the full text of the Ethical Principles for Art Therapists
(American Art Therapy Association [AATA], 2003).
THE PLACE OF ART IN RESEARCH

METHODOLOGIES
Art is a defining aspect of art therapy research but a collective understanding of its place
and value is still emerging as the field establishes its primary research practices. Based
on a broad survey of research texts on visual and arts-based research, Sullivan (2005)
identified three general strategies that various disciplines have used to place art into the
context of research activity:
1. Theory-driven research that relates the forms, themes, or issues found in art-
works to particular theories; a strategy from disciplines that have a tradition
of historical inquiry and art interpretation, notably art history, art theory, and
art criticism.
2. Research that uses visual means to gather and interpret data, where art is
seen as a form of cultural representation that can be analyzed within exist-
ing trends in the social sciences, notably sociology, visual anthropology, and
cultural studies.
3. Arts-based research found primarily in art education and characterized by an
emphasis on art as a set of practices grounded in sensory-based learning and
offering unique insight into human knowing and understanding.
Art therapy has followed similar trends as the profession historically grappled with
the place of art in art therapy theory and practice. Early theories were derived from the
practice of psychoanalysis and emphasized the interpretation of symbolic or uncon-
scious content or subject matter of a patient’s artwork, a trend that continues today.
Drawing explicitly from the methods of art history, Gantt (1992a) proposed that art
therapists conduct research on the formal elements of client artwork or undertake icono-
graphic studies of symbols used by specific client populations. In another example,
Junge (1994) drew inspiration from art history to inquire into the phenomenological
qualities of doorways painted by artists. The interpretation of art and art symbolism has
been an enduring feature of art therapy research and generally reflects the first category
above. This is art therapy research rooted in art historical and psychological frame-
works that allow art therapists to construct and deconstruct meaning from artworks
created by clients.
A second, parallel trend in art therapy research has resisted, re-interpreted, or
expanded on the first trend by emphasizing cultural and other influential social contexts
that surround the creation of artwork. In social science research, visual media often are
treated as “texts” to be documented or used as evidence of socio-cultural representa-
tion. Gantt’s (1992a) proposal for developing a global database of artworks created by
“members of particular social, national or diagnostic groups, with comments from the
artists and art therapist and pertinent demographic and diagnostic data” (p. 73) reflects
an anthropological view of art in research. Much art therapy research reported through
case studies and other practitioner observations is aligned with this orientation; the way
that social and cultural practices are conveyed through visual information like art is a
central theme in this approach (see for example, Riley, 1997).
According to Sullivan (2005), an expanded understanding of art has been achieved
in bridging the fields of art history/criticism and cultural studies. In recent years, the
“interpretive space” of art analysis has opened up to consider “the text itself, the pro-
ducer of the images, the surrounding context, and the position of the viewer” (p. xiv). The
social construction of art therapy is a relatively unexplored area of research, although
some of the ethical and political ramifications of artmaking and interpretation have been
studied (see for example, Lark, 2005; C. Moon, 2002; B. Moon, 2006a; Spaniol, 1998,
2000, 2005). The view that art therapy client groups are like micro-cultures in need of
culturally competent therapists has opened up inquiry in the socio-cultural aspects of
art therapy (see for example, Spaniol, 1998; Lumpkin, 2006). Kapitan and Newhouse
(2000) studied the socio-cultural implications of the contrast between art therapists who
were educated in the modernist tradition of art and a younger generation of art therapists
with postmodernist viewpoints. Hocoy (2005) and others have discussed the art image
as a medium through which art therapy and social action may be integrated.
The third area views art as a process of sensory-based learning and visual thinking
that can be applied to research, and was pioneered by the art education theorist Elliot
Eisner. In the field of art therapy this trend is exemplified by the writings of Allen
(1995), McNiff (1998a), and B. Moon (1995). Originally conceived as primarily a self-
study method of the artist-practitioner (see for example, McNiff, 1989), art therapists
are bridging art-based methods with the constructivist, pragmatic, and participatory
research concerns of the field (see for example, Wix, 1995). Despite many years of
philosophical discourse on art-based inquiry, however, there are few published research
reports to date.
The place of art in art therapy research echoes the field’s historical debates on the
place of art in the theory and practice of art therapy. The binary thinking that dominated
the field for many years, arguing the role of “artist” versus “therapist,” “art in therapy”
versus “art as therapy,” as well as the emphasis on the process of creating art versus the
product created, has given way to embracing a full complement of art and therapeutic
practices. To insist on methodological purity in research is unhelpful because the kinds
of questions art therapists ask are broad and reflect the complexities of the field. When
art therapists accept the idea that their field is interdisciplinary at base, they can be free
to produce viable research from a number of directions or art therapy traditions. Similar
aims can be achieved by following different but complementary paths.
To bring coherence to the broad functions and complementary roles that art has
occupied in art therapy research, the diagram in Figure 2.1 may be helpful. This schema
aligns different threads in art therapy research with particular knowledge claims. A
knowledge claim, or paradigm, is a set of assumptions that researchers use to guide
their inquiry (Creswell, 2003). On the vertical axis in the diagram is the familiar inter-
disciplinary continuum of the art and therapy that inform an art therapist’s practices,
identity, and worldview. The continuum of research that produces scientific knowl-
edge and of inquiry that produces artistic knowledge is shown on the horizontal axis.
Making this distinction is important because the aims of science and art in art therapy
Art
A B
Scientific Artistic
Knowing Knowing
C D
Therapy
FIGURE 2.1 Mapping art therapy knowledge claims.
research often have been confused and blurred. In her attempt to clarify the distinction,
Kaplan (2000) confirmed that “subjective and objective viewpoints … exist on a contin-
uum along which art and science approach each other” (p. 15). Furthermore, they have
“more than a speaking acquaintance … it seems that a union of the two is entirely pos-
sible if we can but be convinced it is worth the effort to bring them together.” Scientific
and artistic inquiry is placed along a continuum not because they are polar opposites
but rather to show where the knowledge claims of various art therapy researchers are
located. As art therapists become more skilled in using an interdisciplinary lens or
worldview, greater overlap or the union that Kaplan and others have envisioned may
become possible.
When we look at specific developments in art therapy literature, then, most research
activity has been in the scientific knowledge/art quadrant (A), characterized by efforts
to establish the scientific basis of using art for assessment. Gantt (1998) believed that
the simple fact of having a tangible art product to study makes our research easier, “just
as research is easier for the physical anthropologists who count bones and teeth than
it is for cultural anthropologists” (p. 9). McNiff (1998a, 1998b) also has proposed an
emphasis on the study of art in art therapy research but with an aim to produce artistic
knowledge about art therapy (quadrant B). His assumption is that art therapists who
study their own artworks and artistic practices will bring greater insight and artistic
sensibility to the work of therapy. Although there has been much focus on the meaning
of art in therapy, what art therapists actually do and how it affects clients has been little
studied (Malchiodi, 1998b). Art therapists have yet to make many research incursions
into the “therapy” end of the continuum, to establish either the scientific basis of the
therapeutic benefits of art therapy or its impact on the visual-perceptual knowledge that
is gained from creative expression of therapeutic concerns (quadrants C and D, respec-
tively). The science of the therapeutic process is clearly aligned with evidence-based
practice and treatment-outcomes research. The study of certain aspects in art therapy
that produce artistic insight is where much qualitative research is conducted into the
subjective experiencing of art therapy.
To summarize, the place of art in each of these four quadrants within the larger,
interdisciplinary worldview of the art therapist allows us to stand in different places
when asking our research questions, for example:
QUESTIONS RELATED TO THE PLACE OF ART IN RESEARCH

r How do we use art to produce scientific knowledge about art therapy?
r How do we use art products and creative processes to produce artistic
insights about art therapy?
r How do we use science to verify therapeutic practices, processes, and
outcomes of art therapy?
r How do we use art and creative engagement to inform our knowledge
of what happens in the therapeutic enterprise?
ART ASSESSMENT: AN ART THERAPY

WINDOW ON SCIENCE
Assessment is related to ideation—the process that jump-starts the formulation of a
hypothesis to test, a creative endeavor to explore, or a problem to solve in the course
of treatment. Scientists generate ideas in their quest for explanations and models that
account for natural phenomena. Artists generate ideas to explore certain aspects of the
world and their subjective experience of it, vivifying rather than reducing them to fun-
damentals. Gardner (1973) wrote that, unlike the artist, “the scientist does not create
an object in which aspects of [the self] are embodied so that the beholder can obtain
subjective information … instead he [or she] desires to have the message maximally
translatable so it can fit a variety of contexts” (p. 311). The scientist values the potential
of the art produced in therapy as a tangible record that can be investigated, decoded,
and plausibly explained. This distinct view of the art object helps to explain the fascina-
tion many art therapists have with art-based assessment.
In her writing on the subject, Gantt explained that historically, the scientific view
of artwork collected for assessment followed four principles: (a) the assessment should
apply broadly to any client, regardless of ability, interest, or intelligence; (b) it should
offer useful and valid information about the client without additional observation or
client input; (c) it should be repeatable over time and compared to obtain a longitudinal
view; and (d) standardized ratings used in an assessment should allow for comparison
across different clients or the same client at different times (Lehmann & Risquez, 1953,
as cited in Gantt, 1992b, pp. 126–127). Today, art therapists realize that the use of a sin-
gle drawing or set of directives will never meet all of these conditions because it reflects
an ever-changing context. Yet standardized approaches to assessment in art therapy are
important because they contribute to the on-going development of norms from which
to contrast and compare data. As Kaplan (2000) noted, art-based assessment originally
derived the clinical use of procedures that aided the development of treatment plans, as
well as collaboration between therapists and clients to dynamically assess the client’s
personally meaningful uses of art.
On-Going Informal Assessment

Standardized drawing assessments that are commonly used in research should be distin-
guished from on-going, informal assessments that many art therapists apply in the course of
their daily clinical work, a distinction that is often confused. Wadeson (2002) explained:
In a global way, therapists should be assessing continuously, evaluating how a patient

or client is progressing, what is changing, what remains constant. Assessment is a
minute-by-minute operation that pervades therapy … On-going assessment is a com-
parison of present behavior with past observations—for example, noting that a patient
who made only minimal black and white drawings is now using color and creating
more invested imagery …
Most important, [art therapists] must be able to determine what information they
need. For example, are they assessing suicide risk, trying to discover major clinical
problem areas, evaluating the capacity for insight, and so forth? And once they have
made that determination, they must explore the best ways to find the information they
seek. They may use an established method from the work of other art therapists (e.g.,
family-of-origin drawing to collect background data). Or they might use their creativ-
ity to respond to an immediate situation. (p. 169)
Wadeson (2002) observed that “often the most informative art expressions come
from the simplest and most obvious directives—a self-image, the family, present feelings,
a representation of an important relationship” (p. 170) and that in on-going art therapy
work directives often are not even necessary. In this sense, an art therapist incorporates
assessment into the moment-to-moment exchange of information taking place within the
therapeutic relationship. Experienced clinicians over time will develop consistent, infor-
mal ways of soliciting information as their clients create in art, checking and rechecking
their assumptions and conclusions, and adjusting treatment accordingly.
Art Evaluation Procedures

As early as 1983, Kramer articulated the utility of a relatively unstructured and
informal intake evaluation session that would document specific areas of func-
tioning based on a client’s interaction with art materials. Kramer was careful to
emphasize that the outline of art procedures she proposed was not intended to be
comparable to a psychologist’s battery of tests, or be used as more than an aid to
systematic thinking. Various procedures have been developed by art therapists that
ask for a sequence of artworks in different media and based on different directives.
Some request that the artist use specific processes, such as a scribble drawing, or
particular materials in a specific sequence such as Kwiatkowska’s family art assess-
ment (Gantt, 1992b).
But as Wadeson (2002) correctly pointed out, what art therapists today usually
mean by “assessment” is “the more formal procedure in which an assessment instru-
ment is used to produce a specific result, often a diagnosis. In this sense, formal assess-
ment offers a predictive potential” (p. 169). This distinction is especially confused
when art therapists create an evaluation procedure and then give it a formal name as
though it has been standardized and tested as valid and reliable. The purpose of for-
mal assessment is to provide descriptive, prescriptive, and evaluative data to aid in
planning treatment and evaluating whether one process is better than another (Gantt,
2004). Standardized art-based assessments are predictive only in so far as they meet the
psychometric requirements of reliability and validity. Currently, very few assessments
in art therapy meet these requirements, in part because of the large scale of the effort
required over many years.
Anderson offered insight into how research in formal assessment builds slowly over
time, using Gantt and Tabone’s research on the Formal Elements Art Therapy Scale
(FEATS) that was begun 20 years ago as an example:
Gantt and Tabone have built some of their art therapy research on a simple directive
from Viktor Lowenfeld in 1939: Draw a person picking an apple from a tree (PPAT).
As an intern supervised by Gantt, Tabone used the PPAT with some of his clients. He
and Gantt were both struck by the clarity of the PPAT and its obvious relationship to
the client’s diagnostic label. Gantt (1990) used the PPAT as a dissertation topic and
developed the Formal Elements Art Therapy Scale (FEATS). Eleven years later, the
two have amassed a database of 5000 pictures by psychiatric patients, with information
on specific symptoms and diagnoses. They also have about 1000 adult and child non-
patient drawings in their database (Gantt, 2001; Gantt & Tabone, 1998). (Anderson,
2001, p. 138)
Projective Drawing Tests

The argument for using standard art-based assessments in treatment is further com-
plicated by the history of projective drawing tests with which they are intertwined.
As detailed by Gantt (2004), projective drawing tests like the House-Tree-Person or
Rorschach rely almost exclusively on interpretations based in unsubstantiated personal-
ity theory. Such tests have assumed that a person’s enduring personality traits, needs,
and conflicts can be revealed in a single drawing, often produced in a paper-and-pencil
testing session. Their highly variable scoring systems give “the unfortunate impres-
sion that it is possible to determine meaning of a particular drawing by understanding
the meaning of individual symbols” (Gantt, 2004, p. 22). Gantt explained that “if one
plucks a part out of the whole, it becomes devoid of meaning. Context is key to under-
standing how the symbol functions. Yet this approach seemed to be what the researcher
of projective drawings used to develop testable hypotheses” (p. 22).
The validity and reliability of projective drawing tests have come under much
criticism. Research has shown that “despite hundreds of investigations there are no
well replicated relationships between specific drawing signs and either personality or
psychopathology” (Lilienfeld, Wood, & Garb, as cited in Wadeson, 2002, p. 168). For
the three most commonly used projective tests (Rorschach, Thematic Apperception
Test, Human Figure Drawing), neither validity nor reliability has been demonstrated.
The same can be said for the Kinetic Family Drawing, House-Tree-Person test, and
many art-based assessments found in the art therapy literature (Brooke, 1996). Kaplan’s
(2000) review of “sign-based interpretation” concluded that projective drawing tech-

niques should be discarded or used very selectively. Whereas some authors advise art
therapists to “give up the quest for a more strictly psychometric approach,” others sug-
gest using such assessments as no more than a clinical interview tool to learn more
about a client (Gantt, 2004, p. 20).
Art-Based Assessments
Kaplan (2000) concluded that formal aspects (as compared to “signs” found in the con-
tent of an art image) “have the greater claim to universality and thus offer the best basis
for constructing meaningful rating scales for art” (p. 90). The Formal Elements Art
Therapy Scale (FEATS), for example, shows promise in detecting major mental disor-
ders from drawings and may be a useful assessment for tracking improvement in client
functioning over time (Gantt & Tabone, 1998). The Silver Drawing Test of Cognition
and Emotion, first developed in 1983, assesses cognitive development in the context of
language deficits (Silver, 1996). A number of published studies have led to refinements
by Silver, with reliability and validity appearing to be positive (Kaplan, 2000). The
authors of the Diagnostic Drawing Series (DDS) have been archiving drawings from
a three-picture assessment to determine whether their graphic profiles can be obtained
for different diagnostic groups (Cohen, Mills, & Kijak, 1994). Kaplan cautioned that
the research on these standardized assessments is encouraging but the confounding
factors of art skill and cultural background, individual variations within populations,
and mind-brain disorders must be taken into account when these assessments are used
in treatment or research.
Although the jury is still out on the value of using formal art-based assessments
in practice because of their currently limited predictive utility, art-based assessment as
a research tool is not. Deaver (2002) underscored the need to substantiate some of the
claims of art therapy’s effectiveness that are routinely made by art therapists:
We art therapists are reliant upon assessment to direct our treatment efforts, to evaluate
the cognitive levels of at-risk students in our elementary classroom, to guide our media
choices when working with brain-injured adults on an emergency trauma unit, and to
know whether our art therapy group has been effective in meeting its goals and objec-
tives. But we are not close to where we need to be in terms of realizing art’s poten-
tial to accurately and objectively measure a range of attributes. Conclusions about or
interpretations of artwork are based largely on anecdotal reports on out-dated, limited
and culturally biased quantitative research. It is imperative that we substitute these
unsubstantiated claims with empirically tested understandings (Gantt, 1998; Kaplan,
1998). (p. 25)
A body of research is providing the field with art-based tools that can be used in
many different kinds of studies. Kaplan (2001) identified several productive areas of
inquiry where art-based assessment is needed to collect and describe aspects of dif-
ferent populations and treatment outcomes. She advised collecting samples of art from
diverse populations, such as cultural groups that may have attitudes and propensities for
art expression that affect treatment. For example, there are no existing studies for adult
clients with varying degrees of art training despite some research that shows a tendency
to conflate art skill with optimal functioning (Kaplan, 2001). There appear to be no
current normative data on children’s development or cultural differences as reflected in
children’s art (Deaver, 2002).
Kaplan (2001) pointed out that art therapists who do not want to undertake the
major work of developing a reliable and valid standardized assessment can have the
satisfaction of assisting the process by testing an existing assessment. This type of
study frequently involves comparing the assessment results for a particular popula-
tion with its scores on a more established measure. An example of such a study is one
conducted by Moser (as cited in Silver, 1998) in which scores on the Silver Drawing
Test of Cognition and Emotion for learning-disabled adolescents produced significant
correlations with their scores on the Weschler Adult Intelligence Performance Scale
(p. 144).
To summarize, art-based assessment has at least four functions for art therapists:
1. Informal, on-going assessment that is incorporated into the exchange of

information between the client and therapist, through the use of unstructured
or structured art directives that collect information leading to appropriate
treatment (Wadeson, 2002).
2. Informal or formal evaluation procedures that are not intended to be com-
pared to a battery of psychological tests but rather are a tool to aid systematic
thinking and to solicit information prior to or at different points of treatment
(Kramer & Schehr, 1983; Kwiatkowska, 1978).
3. Formal, standardized art-based assessment designed to establish descrip-
tive and some predictive information that, in a global sense, can be used in
treatment to aid problem solving, goals, and planning (Kaplan, 2001; Gantt,
2004).
4. Research-based standardized art assessment used to collect and describe
aspects of different populations with the goal of substantiating art therapy
claims and improving outcomes (Deaver, 2002).
EXTENDING RESEARCH INTO PROCESS,

OUTCOMES, AND PERSPECTIVES
As the former editor of Art Therapy, Cathy Malchiodi observed in 1998 that most
research papers submitted to the journal “involve some sort of data on the content of
imagery rather than the process of image-making, therapeutic techniques, or outcomes
studies” (p. 82) and the same is true today. Perhaps because art therapy often produces a
tangible product, much research has been devoted to the study of its meaning to an extent
that does not occur in other creative arts therapy fields. Important though the focus on
the study of art images may be, the profession has produced little empirical research on
the therapeutic end of the continuum, or “the process it takes to make [art images], the
interchange between art therapist and art maker, and most importantly why, when and
how artmaking is healing” (Malchiodi, 1998b, p. 82). As Malchiodi explained,
In my own search to understand why art therapy works, however, I find myself always
returning to the process of artmaking rather than solely seeking to find meaning in
the art expression itself. Most of my clients come to art therapy to benefit from the
process of artmaking, and do not necessarily want to receive an assessment, diagnosis,
or evaluation through art. Some have been making art on their own and wish to deepen
their experience through work with an art therapist, while others simply believe that
artmaking can help them in some way. Although understanding the content of images
may be part of therapy, the most important part is undeniably the process, regardless of
whether that process involves self-understanding, psychological transformation, stress
reduction, emotional reparation, symptom relief, or personal satisfaction. As McNiff
notes, art therapy “has given little systematic attention to assessing how a person feels
after treatment.” I would add that we do not give much attention to assessing how
people feel during artmaking and what brings them to art therapy in the first place.
(p. 82)
Art therapy assessment, in contrast to art-based assessment, emphasizes the out-

comes of treatment and the study of art’s impact as a therapeutic process. If art-based
assessment is like a camera taking a snapshot of a client’s art as related to diagnosis
or treatment, art therapy assessment is like a video camera, capturing the dynamics
of therapeutic and creative processes as they unfold. Kaplan (2001) suggested that an
important area for inquiry involves “finding out if art therapy treatment of a group
or individual is proceeding according to plan” by using systematic measures at vari-
ous intervals during treatment rather than anecdotal reportage (p. 144). Especially with
digital, virtual, and other technologies, there is great research potential in documenting
art therapy sessions and elucidating the process through visual means, particularly dur-
ing the therapeutic exchange (Riley, 1996).
Most clinicians recognize that standardized assessment is not translatable to all
treatment situations. Among other reasons, privileged relationships based on “the exam-
iner as expert” is at variance with a therapeutic stance that supports a non-judgmental
exchange between therapist and client where neither holds a monopoly on truth or
objectivity (Malchiodi, 2000). The meaning of art produced in art therapy changes,
as well, when one considers assessment from the perspective of the client or consumer
of art therapy. Taking the alternative stance of “client as expert” (Spaniol, 1998) can
yield much important data about the benefits of art therapy, such as a client’s beliefs or
perceptions about art; preference for art materials, directives, or themes; and goals and
intentions for therapy (Malchiodi, 2000). On the artistic end of the continuum, inquiry
into the elements of the creative art therapy experience, including the making of art by
the researcher, is an emerging context for research. As more art therapists incorporate
multiple perspectives into assessing the “interpretive space” where art image, client-art-
ist, therapist, and context intersect, long-held claims to art therapy’s value may finally
be evidenced in research.
AN INCLUSIVE FRAMEWORK FOR

ART THERAPY RESEARCH
In this review of the place of art in art therapy research, it becomes clear that art holds
different purposes and value depending upon the aims of the researcher. To produce
knowledge that is beneficial to the field, I encourage art therapists to embrace diver-
sity over a kind of methodological fundamentalism that requires allegiance to one
perspective. Art therapy is an interdisciplinary field with abundant research questions
that reflect its breadth and diversity. In the chapters that follow, a number of standard
methods for art therapy research are presented within an organizational framework
that I have adapted from Sullivan (2005). These categories are not rigid and are simply
intended to help identify focal points of methodological interest.
The diagram in Figure 2.2 shows four interconnected areas of art therapy research
arranged according to the art therapist’s aims and purpose, issues, contexts, and knowl-
edge claims or paradigms. In the center is “art practice” or the core processes of an
art therapist’s worldview. The border areas are domains of inquiry that are labeled
“empirical-analytic,” “critical,” and “interpretivist” to identify different research tradi-
tions and methods applicable to art therapy. Using Habermas’ logic (as cited in Sullivan,
2005) as a general guide, the empiricist’s interest is organized around the prediction
and control of social and natural realities; the researcher who takes a critical interest
is primarily concerned with transforming consciousness in order to maximize human
potential for freedom and equality; and the interpretivist is interested primarily in the
qualitative interpretation and understanding of human experience.
The empiricist paradigm of art therapy research is discussed in Chapter 3, “Quantitative
Models of Art Therapy Research,” and Chapter 4, “Outcomes Research to Generate
Evidence-Based Practice.” These two chapters present methodology that seeks causal,
explanatory, and predictive bases for generating knowledge from art therapy experience,
Empirical- Critical
Analytic
Art Practice
Interpretivist
FIGURE 2.2 Inclusive framework for art therapy research.

often with a focus on outcomes. They typically involve experimental, quasi-experimen-

tal, non-experimental, and mixed methods of quantitative and qualitative research. The
empiricist approach to knowledge examines the causes that influence outcomes and dis-
tills large ideas into manageable elements that can be tested (Creswell, 2003).
The critical paradigm of art therapy research is presented in Chapter 5,
“Investigating the Field: Participant-Observation,” with its broad purpose of critical
inquiry into the social constructions, narratives, and distinctive perspectives of groups
and individuals involved in art therapy. Research questions are informed by participa-
tion and observation in the field where art therapy services may be provided. Within this
paradigm are researchers who proceed collaboratively and view research participants as
co-participants or advocates for empowerment and change.
The interpretivist paradigm follows in Chapter 6, “Researching the Phenomena of
Conscious Experience,” using methods that help art therapists understand the process
of meaning making. The central role is experience as it is subjectively lived, felt, con-
structed, reconstructed, reinterpreted, and understood (Sullivan, 2005). Characteristic
methods require the researcher’s immersion in the research context as part of the attempt
to make sense of the meaning people derive from art therapy.
Finally, art practice as a source of inquiry is discussed in Chapter 7, “Art-Based
Inquiry: An Emerging Paradigm in Art Therapy.” In contrast to the previous chapters that
outline quantitative and qualitative approaches to research, here the main concern departs
from scientific research principles and focuses on how art itself may serve art therapists
as a vehicle for inquiry. It presents a provocative thesis that art-based practices may facili-
tate a synthesis art and science for the field. “Artist” is defined from different sources and
perspectives in art therapy: the artist-client, the artist-therapist, the artist-researcher, and
in the expanded contexts and media that push the definitions of art and art therapy.
Throughout Part II, Art Therapy Research Methods, the “art therapy lens” or world-
view is used as the primary means by which an art therapist approaches research design
and implementation. Common to all methods, the researcher observes and studies some
aspect of the process of art therapy. This is followed by systematic and structured forms of
critique and critical reflection, a process that bridges the scientific method with the tradi-
tional methods of the artist producing in the studio and their translations to the unique con-
texts of art therapy. The evidence, insights, new developments, and pragmatic knowledge
obtained all serve to substantiate what art therapists regard as essential to their world.
CHAPTER SUMMARY
1. Art therapists’ worldviews are distinguished by an active relationship
with art that affects how they approach therapy; interact with therapeutic
concepts, values, and predispositions; and interpret information from the
therapeutic environment.
2. The primary method of art therapists is to activate the process of creation
in the therapeutic environment followed by critical reflection. This basic
method, when applied to the context of therapy, differentiates art therapists

from other artists as well as from other kinds of therapists.
3. Art therapists have a unique sensitivity toward the art created in therapy and
in research. The ways that art therapist researchers view, describe, interpret,
assess, collect, release, and publicly display artworks must be ethically sensi-
tive to the people and artworks that contribute to the study.
4. Historically, the place of art in art therapy research has followed three gen-
eral strategies: (a) theory-driven art interpretation derived from the traditions
of art history, art and psychology theory, and art criticism; (b) art as a socio-
cultural “text” interpreted along the lines of sociology, anthropology, and
cultural studies; and (c) art-based inquiry from arts education that empha-
sizes art as sensory-based learning.
5. Art therapy research can be located along an interdisciplinary continuum
of art and therapy with complementary claims in both scientific and artistic
knowledge. This worldview allows art therapists to stand in different places
when posing research questions and problems.
6. Art-based assessment is historically associated with projective drawing tests
used by psychologists to assess personality and to determine diagnoses, and
currently includes (a) research-based standardized assessment to collect and
describe aspects of different populations, (b) formal and informal evalua-
tion procedures used by art therapists to develop treatment plans, and (c)
informal, on-going assessment incorporated into the exchange of information
between the client and therapist.
7. The art therapy profession needs empirical research on the therapeutic end
of the continuum to substantiate claims regarding the benefits of the artmak-
ing process, the interchange between art therapist and art maker, and overall
questions of why, when, and how artmaking is healing.
8. An inclusive framework for art therapy research places the core practices of
art therapy in the center around which empiricist, critical, and interpretivist
domains of inquiry may be organized to address the breadth and diversity of
art therapy research problems.
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PART II
Art Therapy
Research Methods
Quantitative
Models of Art
Therapy Research
3
In every quest on which the
wanderer takes on different
guises, each transformation
creates ever-expanding rings
of knowledge. The rise of the
trout is, for the fly fisherman,
a metaphor for this quest.
This kind of fishing is harder,
requiring an intimacy and
attention to minutiae, which is
maddeningly archaic. Fishing
with an artificial fly is a conceit;
it has no usefulness. But when
you catch trout on a fly and
let them go again, it is the
beginning of wisdom … the more
we interact with the trout the
more sensitive we become to
its precarious existence, which
happens also to be our own.
—P. V. Beck (1991, p. 29)
We start our search here because this is how research has been defined traditionally for
most of us in the past. Quantitative research frequently is identified as “scientific” or
as following the “scientific method.” But the scientific method is not limited to tradi-
tional research and, in fact, is the basic process that underlies all research: A question
is posed, it is converted into a problem or focal concern, a temporary hypothesis is put
forth, relevant data are collected and analyzed or interpreted to apprehend their mean-
ing, and a conclusion is reached within the limitations of the study. As a result, the
problem is either resolved or requires further inquiry. The scientific method is a way of
thinking that applies systematic methods of inductive and deductive reasoning to the
goal of acquiring knowledge and understanding.
51
A person makes an observation—that the fish are really biting in a certain

place, that adding a complementary color makes a painting more vivid, that creat-
ing a mandala seems to induce a meditative state, or that art therapy makes certain
people feel better in certain ways—and poses a hypothesis that points in a logical
direction of finding out more about it. The researcher sets up the conditions to
observe people creating mandalas and the quality of their emotional state while
doing so. An art therapist sorts out and tests an idea about a specific art therapy
treatment that seems to generate wellbeing under certain circumstances. A painter
tries out complementary color schemes to see, through trial and error, which combi-
nations are most successful in conveying a vivid expression. The fishing enthusiast
predicts from closely observing the environment that the fish will bite during a cer-
tain interval after a rain when the mosquito larvae are abundant. This empiricist-
analytic paradigm involves testing a hypothesis based on an observation, deducing
the implications of the problem, and testing these implications either to confirm or
disconfirm the hypothesis.
PURPOSE: WHY? CAUSE-AND-

EFFECT RELATIONSHIPS
Traditional scientific research, particularly if it involves quantitative methods, can be
characterized as an approach that usually aims to explain and predict cause-and-effect
relationships. The four main concepts that address this purpose and characterize quan-
titative research are (a) manipulation and measurement, (b) control, (c) randomization,
and (d) systematic, pre-planned structure.
Manipulation and Measurement

The research problem tests a theory that is composed of variables to be manipulated,
which in research simply means causing something to happen so as to determine an
effect. A variable is anything that can vary or change:
r Independent variable is usually the intervention and is manipulated by the

art therapist researcher to see its effect on a known situation while all else is
held constant.
r Dependent variables may be observed as a result of the intervention.
These observations are measured and statistically analyzed to see if the predictive
generalizations of the theory hold true (Creswell, 1994). Testable predictions can be made
only if they can be varied (the independent variable) or observed (the dependent vari-
able). If the art therapist has a research problem that lends itself to testing a hypothesis
3 t Quantitative Models of Art Therapy Research 53
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FIGURE 3.1 Variables in experimental research.
by isolating the relevant variables and controlling for any extraneous variables involved,
and if the data can be collected in a standardized way from a number of participants,
then a quantitative approach may be the best choice (Figure 3.1).
Gilroy (2006) explained that variables are “any measure or event that can be defined
and compared so as to assess their interaction and determine cause and effect” (p. 117).
In her example, the independent variable might be the relationship with the therapist
and the use of art materials that is introduced or varied to see if a client’s thoughts and
feelings (the dependent variables) were affected or changed. A hypothesis that 20 weeks
of individual art therapy will alleviate depression might be tested to see if the indepen-
dent variable of art therapy will affect the dependent variable of depression through
its presence (the treatment group) or its absence (the control group). A null hypothesis,
which the researcher would want to disprove, is that the reverse is true and there is no
cause–effect relationship.
Control
Control, another important characteristic of quantitative research, refers to a structure
that is used to eliminate anything that may influence or interfere with the study so that
whatever results are obtained can be reasonably expected to be caused by the manipula-
tion of variables and not something else. Some variables, such as the environment in
which art therapy is conducted or the kind of art material provided, are more easily
controlled than others, such as unexpected events that happen in participants’ lives.
Because it is not possible to control all variables, experimental research usually includes
a control group for a basis of comparison. Members of the control group experience all
the same daily events and vagaries of the setting as the participants in the experimental
group except for the independent variable, which only the experimental group receives.
When the purpose is to demonstrate a cause-and-effect relationship of independent and
dependent variables, research designs that include a control have a greater degree of
credibility than those that do not.
Randomization
Randomization is sometimes misunderstood to mean a haphazard selection of partici-
pants instead of the precise meaning it has in experimental research. If participants
are selected from a large group of people as being representative of a study popula-
tion because they all meet the selection criteria, and if they have an equal chance of
being placed in the experimental or the control group, then they meet the conditions for
random sampling. Randomization is also used in the process known as random group
assignment whereby a number is assigned to each study participant and then used to
select a random sequence of numbers to compose each participant group. Although
randomization is never perfect, it does increase a study’s validity and helps to mitigate
conditions such as attrition (participants dropping out of the study), maturation, and the
differences that people have in response to tests and treatments.
Another element in creating a sound quantitative study is the importance of sample
size, which is a consideration for detecting significant differences in the data produced.
In general, statistical power to detect the effects of an independent variable is increased
when the number of observations is large.
Systematic, PrePlanned Structure

Of course, human behavior is complex and not always predictable. Therefore, quantita-
tive models require circumscribed and carefully structured procedures that identify all
the interacting variables, hypotheses, theories, and concepts before proceeding. Once
inquiry begins, a fixed design is followed to reduce error and bias so that if the premises
are correct, the conclusion can be deduced from the data and assumed to be correct
rather than due to extraneous or untested variables.
Art therapy practice often requires the opposite mindset: spontaneous, inductive
reasoning and the flexibility to make creative shifts to meet the evolving needs of cli-
ents. Art therapists accept ambiguity and other complex shades of human experience.
Quantitative research, with its requirements of pre-planned, systematic procedures and
deductive logic, sometimes has been devalued within the profession as incompatible
with art-based practice. This much-debated argument has held back legitimate contri-
butions of knowledge to art therapy. Consider the fact that art therapists who welcome
spontaneity are equally adept at creating consistent structures and disciplined practices
that provide their clients with psychological safety. Providing a constant environment
while isolating a particular client concern to focus on, or selecting possible interven-
tions and assessing their effects, have their parallels in the scientific method. Likewise,
the processes of assessing, formulating, and comparing treatment outcomes across time
or client groups inform many skilled art therapists’ practices. Thus, within the inherent
methods of art therapy are foundational practices that may be applied to quantitative
models of research when the problems posed by art therapists warrant them.
EXPERIMENTAL MODELS OF QUANTITATIVE

RESEARCH IN ART THERAPY
In experimental studies, researchers develop and test hypotheses to predict a relationship
between two or more variables. The researcher typically takes one of three approaches:
to compare groups to see the impact of an independent variable on a dependent variable,
to relate one or more independent variables to the dependent variable, or to describe
various responses to the variables (Creswell, 2003). A null hypothesis means that there
is no relationship between the groups.
To identify and communicate the variations in experimental designs, Campbell
and Stanley (1969) developed a system of research notation commonly used today. In
the discussion that follows, the dependent variable is usually measured before (pretest)
and after treatment (posttest) so that comparisons can be made. An O represents the
researcher’s observations or measurements that occur at the pretest and posttests; X
represents the independent variable or treatment intervention.
The True Experiment

The true experiment requires a small-scale “closed” environment to control for all
known variables. Researchers create a mini-art therapy situation in a lab and observe
a representative sample of volunteers who are randomly assigned to two matched
groups: the experimental group and the control group. Each group is composed to
be alike in all of the characteristics that are critical to the experiment so that, math-
ematically speaking, the experimental group is identical to the control group. Then
a particular stimulus (the experimental variable) is added to the experimental group
but not to the control group.
r Example: The experimental group gets chocolate when they complete their
art therapy task and the control group does not. Which group prefers art
therapy?
Experimental research, according to Carolan (2001), is the approach that his-

torically has been most respected in the field of mental health and “is most often
implied when the question is asked, ‘Is there research to support that assumption?’”
(p. 193). A true experiment meets all three conditions of manipulation, control, and
randomized selection and assignment of participants to the experimental and control

conditions. The “randomized controlled trial” (RCT) is a large-scale experiment that
is favored in much health care research. It is discussed more specifically in the next
chapter as part of a larger discourse on evidence-based practice.
EXAMPLES OF EXPERIMENTAL RESEARCH QUESTIONS

r What is the effect of giving clients a choice of art materials on their
motivation to engage in art therapy?
r How does an after-school art therapy program relate to academic
achievement?
r How does a client’s perception of an emotional experience change
when expressed in drawing as compared to expressing the same emo-
tional experience in sculpture?
r What is the effect of using a stimulus drawing for clients with cogni-
tive disabilities as compared to a control group that was given no pre-
planned stimulus?
Control Group Designs

As described earlier, one major consideration is how to assign the participants with
respect to the independent variable. In the pretest posttest control group design, two
groups are carefully formed either by matching or through randomized procedures
(Figure 3.2). The experimental group is evaluated to obtain a baseline measure, sub-
jected to the experimental variable or intervention, and reevaluated (O-X-O). The
control group also is evaluated at the beginning and end of the experiment but is not
subjected to the experimental variable (O-O). A common criticism of this type of design
is that it is rarely generalizable to actual art therapy conditions. It may be too inflexible
or unfeasible to meet the administrative and time constraints of a treatment setting, and
withholding treatment for the control group may be unethical or may compromise the
standard of care. Notwithstanding these limitations, if an art therapist wanted to investi-
gate whether one kind of intervention was more effective than some other intervention,
and whether either kind was more effective than no treatment at all, a third group would
be added and the design would look like Figure 3.3.
Pretest/Posttest Control Group Design

Random Assignment Pretest Intervention Posttest
R O X O
R O O
FIGURE 3.2 Pretest/posttest control group designs.

Pretest/Posttest Control Group Design

R O X1 O
R O X2 O
R O O
FIGURE 3.3 Pretest/posttest control group with two interventions.
Solomon Four-Group Design

R O X O
R O O
R X O
R O
FIGURE 3.4 Solomon Four–Group design.
Posttest Only Control Group Design

R X O
R O
FIGURE 3.5 Posttest only control group design.
For some research problems, pretesting may introduce unintended effects that
influence either the independent variable or the posttest measurement. A variation on
the control group design that is used to minimize these effects is called the Solomon
four-group design. The experimental group is pretested, subjected to the experimental
variable, and reevaluated (O-X-O). Results are compared not only to a control group
(O-O) but also to a third group that received no pretest and only the experimental vari-
able (X-O), and to a fourth group that received no experimental variable and only was
subjected to the posttest (O) (Figure 3.4).
Another variation to control for the condition of pretesting, or for conditions where
pretesting is not possible, is the posttest-only control group design. In this case, the exper-
imental group is subjected to the experimental variable and tested (X-O) and compared
against a control group that is tested without the experimental treatment (O) (Figure 3.5).
Carolan (2001) explained that these designs minimize error, which in research means
something that causes the results to vary from the predicted outcome. He summarized:
The first design [pretest/posttest control group design] is the most commonly used
approach; however, it is susceptible to error due to the potential of the interactive effect
between the pretest and the intervention. The [posttest only control group design]
controls for that interactive effect; however, it is susceptible to error because the ini-
tial equality of the groups is based solely on the probability established through ran-
dom selection and assignment. There is no pretest to establish the baseline equality
of the two groups. … While the Solomon four-group design attempts to control for
Single-Subject Design
n/a O X O
O X O
O X O
FIGURE 3.6 Single-subject experimental design.
confounding variables, it is often difficult to carry out because it requires twice as

many subjects to carry out all four experimental conditions. (p. 193)
Single-Subject Research
Single-subject research design looks at cause-and-effect relationships by comparing each
individual’s pre- and post-intervention responses. This design is particularly useful when
a control group is not possible. “Single-subject” in this design means that the same par-
ticipants serve as both the experimental and the control sample (Carolan, 2001). Also
known as a time-series or ABA design, A refers to the baseline condition that is mea-
sured before an intervention begins and B represents the intervention. The researcher
measures the baseline condition of the behavior that needs to be changed (A), adds the
independent variable or treatment (B), and then takes repeated measures over time (A)
to compare with the first baseline data in order to see if the treatment effected a change
(Figure 3.6).
In some respects, this practitioner-friendly design is little more than a formal-
izing of the typical methods and practices that art therapists use daily on the job.
Measurements are taken prior to an intervention to predict the possible course of
behavior should no treatment be given. The research can then be compared to the
actual, observed behavior and to the prediction. The difference is in preplanning the
start of treatment based on a formal hypothesis and clearly–defined dependent, and
with selecting an assessment that best “captures” the cause-effect relationship. For
this reason, single-subject research is a useful model for looking at “components of art
therapy interventions in stages and consequently developing a clearer understanding
of what aspects of the therapeutic art process seem to have effects for a given sample
group” when repeated over time and with more than one client (Carolan, 2001, p. 195).
The main advantage is that single-subject designs closely follow actual art therapy
practice and provide a direct measure of its effectiveness under circumstances that can
be replicated with other clients (Gilroy, 2006).
The most difficult limitation is that the researcher cannot be certain that the changes
that occur in the treatment phase are actually caused by the treatment and not some-
thing else that went unnoticed or that was not under the direct control of the researcher.
It is possible that an effect is due to changes within individuals (maturation), events in
time (history), or repeated exposure to the measurement (testing), among other threats
to validity. To strengthen single-subject research, a common alternative on the ABA
design described above is the reversal design involving independent variable periods
(B) interspersed with baseline periods (A) where the independent variable has been
removed. If the behavior shows the change again, when the independent variable is
repeated, confidence in the cause–effect relationship is increased. For example, if an
art therapist conducted an intervention with a child with autism and observed that the
dependent variable—head banging—terminated on days when the child had art therapy
and resumed on days when no art therapy was provided, this would be a demonstrable
effect. Repeated observations over time show patterns in the data. Continuous or mul-
tiple baseline assessments also are used to help to rule out rival hypotheses, which a
single pre- and post-intervention assessment does not accomplish.
It is also important to use appropriate measures that are directly relevant to spe-
cific therapeutic goals and the dependent variable of concern. Diamond (1992) recom-
mended creating a measurement package that captures multiple perspectives, such as
teacher and parent observations, self-reports, test grades, and attendance records in
a single-subject design that provided art therapy to a group of adolescents at risk for
truancy. Diamond also advised using measures that are sensitive to small changes or
“traits” rather than standardized tests that provide “state” data that are highly stable
over time. Statistical data can be collected alongside visual, narrative, and other data
that are typically a part of an art therapy approach to treatment.
Gilroy (2006) believed that experimental, single-subject designs enable art thera-
pists to add robust contributions to the evidence base of art therapy in the short term,
and be evaluated by their ability to document what actually works in practice. Others
agree that single-subject research helps bring therapy and research closer together and
is considered reliable and robust enough for evaluating treatment efficacy (McLeod,
1994), as discussed in Chapter 4.
QUASI-EXPERIMENTAL STUDIES
The Quasi-Experiment
The quasi-experiment qualifies as a form of experiment if it manipulates the indepen-
dent variable to see its effects on the dependent variables but for whatever reason does
not include a control or randomization. In one kind of quasi-experiment, the behavior
of a group of people who have experienced a certain situation is compared with a bal-
anced but non-randomized control group of similar people who have not. If the two
groups are alike in every other way, then the difference can be inferred as being caused
by the imposed condition. This type of design is used when randomization is not pos-
sible, often because what is hypothesized to be the cause of the difference between the
two groups has already occurred (Carolan, 2001). Sometimes called natural experi-
ments, the variables are controlled through routine or naturally occurring practices
with client groups.
EXAMPLES OF QUASI-EXPERIMENTAL RESEARCH QUESTIONS

r A culinary example: Why is it that two cooking teams follow the same
recipe and seem to do everything exactly the same, but one of them
is always more successful? What is the factor that accounts for their
greater success?
r An everyday example: Why do so many parents insist that their child
should have Mrs. X instead of Mrs. Y for kindergarten? What are dif-
ferences between the two teachers that account for this preference?
r An art therapy example: Do people who have art therapy have fewer
symptoms of depression as compared to those with the same diagnosis
who do not? Do art therapists who create art over a certain period of
time improve in job satisfaction as compared to those who do not?
USING A DRAWING TASK IN THE TREATMENT OF NIGHTMARES

IN COMBAT-RELATED PTSD (MORGAN & JOHNSON, 1995)
Morgan and Johnson used an A-B-A-B design to measure the effectiveness of
drawing compared to writing in modulating the frequency, intensity, and sever-
ity of nightmares, in two subjects who were Vietnam combat veterans diagnosed
with posttraumatic stress disorder. The results indicated that drawing was more
effective in all areas. The authors suggested that trauma may impair the ability to
express emotional states through verbal language, but art may be more effective
as a means of expression.
A quasi-experimental design is still useful in demonstrating certain relationships

between variables or effects of treatment, but they lack either a control group or ran-
dom selection of participants, which make them easily influenced by factors outside
the researcher’s control. The most common problem in this design is that it is difficult
to balance the two groups precisely if the researcher does not have the means to con-
trol the formation of the groups to begin with. Some other, unknown factor also may
be more common in one group than in the other. The lack of random assignment is
what distinguishes the non-equivalent control group design (Figure 3.7).
Kunkle-Miller (1982), for example, was not able to randomly assign children and
adolescents who were hearing impaired and emotionally disturbed to an art therapy
Non-Equivalent Control Group Design

No O X O
No O O
FIGURE 3.7 Non-equivalent control group design.

group and a control group. Instead, she matched the students in both groups on IQ scores,
age, and severity of hearing loss. She wanted to substantiate that art could have a thera-
peutic effect on hearing-impaired children and she tested both groups of children for cre-
ativity, self-concept, and behavior. The children and adolescents in the art therapy group
improved significantly in terms of creativity on the free-choice activity and in terms of
behavior as measured by the Rubin–Kunkle–Miller Behavioral Inventory.
Ex Post Facto or Natural Experiment

In ex post facto (after the fact) analysis of some naturally occurring event or treatment,
sometimes called the interrupted time series experiment, the researcher collects data
from multiple observations before and after a naturally occurring event or treatment
for a single experimental group. This kind of study can be created following an event,
such as a hurricane or civil disturbance, by identifying and comparing data collected
before and after its occurrence and attributing the event as the cause of the change.
INCREASING CHEMICALLY DEPENDENT PATIENTS’ BELIEF IN

STEP ONE THROUGH EXPRESSIVE THERAPY (JULLIARD, 1994)
Julliard used a single-subject multiple-measure A-B design to measure the effects
of an art therapy intervention with five adults in treatment for addiction. The
study looked at the effects of an intervention designed by Julliard on the amount
of time the subjects spent thinking about their addition and the drug’s degree of
appeal. The intervention combined multimedia collage and role-playing. Pre- and
posttest measures were related to the subject’s progress on the first three steps of
a 12-step program. Results suggested a slight decrease in thinking about the drug
and a decline of intense emotion for most of the subjects.
THE RESEARCH PROTOCOL

If you are planning a quantitative experimental or quasi-experimental research study
and you have applied the logic of the scientific method to your research problem by con-
verting your question to a hypothesis, you would identify the independent variable and
diagram the dependent variables in order to see what your design should look like using
the X-O notation described earlier. Your study may be a classic experiment, an experi-
ment with a follow-up posttest, an omitted pretest, or a Solomon four-group design. If
it is a quasi-experiment, you would account for a lack of random assignment, lack of
control, and the use of single or a small number of participants, follow-up posttests, or
multiple pretests. The next step, then, would be to operationalize the design by develop-
ing a research protocol that fills in the basic design with your own specific variables,
participants, instruments, and procedures.
EXAMPLE OF AN ART THERAPY RESEARCH PROTOCOL

r Subject selection criteria: Adult (18 years or older) females and males,
chronic pain (5 years or more according to medical chart), no other
diagnoses (per chart), outpatients.
r Method of selection: Participants will be randomly selected from two
subpopulations of outpatients in a chronic pain program who meet the
selection criteria and are randomly assigned to either the experimental
group or the control group.
r Hypotheses: Art therapy treatment will lower stress reactions and
increase quality of life in adults with chronic pain.
r Dependent variables: Stress reactions and quality of life.
r Independent variable: Art therapy treatment.
r Procedures for treatment: Administer a planned art therapy program
with an emphasis on activities (see detail, attached to this protocol) that
induce a relaxation response to all participants in the experimental group
for one hour per weekly session over a total of 12 weeks. The program will
take place in the same room over the course of treatment and will be
co-facilitated by a board certified art therapist and a nurse practitioner.
The control group will attend a pain control support group with a focus
on verbal discussion with the same co-therapists as the experimental
group.
r Procedures for observation: Pretest—Individual participants in the
experimental and control groups will be asked to complete a standard-
ized pain inventory and quality of life questionnaire (see attached). The
tester will be a person unknown to the participants and not involved
in the chronic pain program. Posttest—Individual participants in the
experimental and control groups will be asked to complete the same
procedure as the pretest, and the same tester will collect the same mea-
surements (see data collection sheet, attached).
Having drafted your protocol and defined your terms and treatments, you have
the beginnings of a roadmap to give your study its necessary boundaries. The research
proposal, described in detail in Chapter 8, identifies operational design needs such as
limiting the scope of the study and providing the rationale for the selection criteria.
Above all, an effective research protocol is precise: All terms are defined and tied
to observable behaviors or measurements so that there is no room for error or misin-
terpretation were any other researcher to use the same protocol. Operations should
be defined for procedures as well as for concepts. In the example above, “art therapy
activities that induce a relaxation response” and “chronic pain program” would need
definition and specificity. What is the relaxation response? What art activities are
presumed to be helpful to induce relaxation? What is “quality of life” and how will
it be measured?
Along the same line of thinking, you should examine any assumptions on which
the research protocol is based. Assumptions typically are underlying beliefs or values
that are difficult to prove, such as the idea that art contributes to healing or wellbeing
or that a board certified art therapist is more likely to be effective in carrying out an art
therapy research protocol than a nurse practitioner. Procedural and ideological assump-
tions may affect how an experimental study progresses. For example, a client-centered
art therapist may approach a chronic pain group study very differently than a behavioral
therapist or medical practitioner. An art therapist may identify certain instruments to
measure the effect of the treatment, such as an art assessment, as compared to a behav-
ioral checklist that another researcher would assume to be most appropriate.
In identifying a study’s assumptions, the art therapy researcher attempts to think
through in advance all of the possibilities that may occur that could throw off the mea-
surements. For example, in one study an art therapist assumed that children would be
able to chart their own feelings on a simple graph before beginning the art therapy ses-
sion, but in fact the children were so excited by the planned activity that they all rated
themselves 100% “happy” in the baseline measure.
In summary, the research protocol should specify the following parameters of the
experimental or quasi-experimental study:
1. The study participants, as representative of an identified population

2. Selection criteria for how the participants are selected and assigned to groups
(random or matched)
3. The number of participants assigned to experimental and control groups
4. The dependent variable(s) in the study and the means and frequency of
measurement
5. The independent variable or treatment condition; how it is defined and
operationalized
6. The measurement instruments and reasons for their selection; considerations
for their validity, reliability, and proper implementation
7. Precise procedures for collecting the data
8. Precise procedures for analyzing the data and types of statistical tests used
9. Possible threats to internal and external validity
MEASUREMENT AND STATISTICAL

ANALYSIS IN EXPERIMENTAL RESEARCH
As described in Chapter 2, art therapists sometimes use informal or self-created assess-
ments in their research studies without sufficient concern for how the data from these
non-standardized measures can be analyzed. A better solution is to include at least one
standardized measurement in the study design in addition to creative art assessments,
interventions, or activities. Standardized tests can be obtained from major test compa-
nies and include a manual that describes how the test’s norms were established, their
degree of validity and reliability, and the type of subjects or participants for which the
test was designed.
A valid test measures what it claims to measure and a reliable test can be expected
to produce the same results over time (known as test-retest reliability) or with different
raters (known as interrater reliability). If more than one person is observing and record-
ing the data, each observer must be consistent in his or her ratings across time, groups,
or characteristics, and each observer must be consistent as compared to the other raters.
In all cases, raters should learn to administer the test exactly in the way it was intended.
Therefore, it may be valuable to work with a psychologist or health professional with
training in psychological testing.
The next step is the one most art therapists I know hate so much that they avoid
the entire realm of quantitative or experimental studies. Yes, statistics. But I also know
several statisticians who are nice, friendly people with a fascination for teasing out the
patterns that can be found in a mass of numbers. If you are afraid of statistics, a simple
solution is to get together with a statistician who can lend you a mathematical world-
view. There is an advantage in consulting with a statistician during the design phase of
your study especially. A statistician can advise on how to collect the data in ways that
support objective comparisons, how the data may be most effectively entered into a
database or spreadsheet, and which statistical tests or numbers may be best suited for
your data analysis.
A complete description of statistics is beyond the scope of this text but a basic
explanation may help to get you past a statistics block. In a quantitative study, data can
be converted to numbers and measured in four ways: nominal, ordinal, interval, and
ratio. When you assign a number to a non-numerical variable like a color or type of
response (e.g., 1 = blue, 2 = green, etc.; 1 = “yes,” 2 = “no”), you are using nominal data
and can record them on a scale. This type of data is non-parametric, meaning that the
data do not themselves have numerical value; there is no ordered relationship between
categories. All you are doing with nominal data is sorting objects or attributes into
categories. Ordinal data measure differences in magnitude by putting numbers into
a meaningful sequence like rank-order or a Likert scale (e.g., 1 = Strongly Agree; 2 =
Agree; 3 = Neutral, etc.). The limitation of ordinal data is that the intervals between
scores are not equal; for example, in an art scholarship competition, an art portfolio that
was ranked 7th is better than the portfolio ranked 8th, but the actual difference between
the two is not measured. The difference may be very little or substantial.
Interval scales are more powerful than nominal and ordinal data because they can
show properties of differences, order, and equal intervals. They are parametric and
order the data into intervals and actual amounts, such as an intelligence score or degree
of color intensity. Because they measure actual differences, they are useful for mak-
ing precise comparisons and predictions. A defining characteristic of interval scales,
however, is that they have no zero point. For example to assign “0” to an IQ score is
meaningless and does not reflect the total absence of intelligence. Ratio data, which are
the most complex of the four types of measurement scales, use intervals that include the
score of zero as a meaningful reference point.
The reason it is important to distinguish among these different types of data is
so that you will know what kind of statistics to use to analyze them. Of the two basic
categories of statistics, descriptive statistics can show how your measurements cluster
and form patterns, so they are used to calculate pretest and posttest observation and
measures (Creswell, 2003). These statistics can be used to give the variation or spread
of scores within each group, the central point around which the data cluster (known as
the central tendency), and standard deviations (SD) that show how the scores relate to
the mean (for example, a low SD if scores cluster near the mean or average score and
a high SD if they are distributed across the range). Much quantitative data is analyzed
using descriptive statistics, especially small-scale studies or when there is no control
group from which to make inferences or comparisons.
Inferential statistics are used to infer how data from one group relate to another
group. Researchers assess the degree of chance versus the actual effect of the experimen-
tal variable, and the likelihood of the change occurring again if the study is repeated.
The types of interferential statistical tests used include t tests, F tests, and tests for r that
help the researcher determine probability and make conclusions about the differences
or relationships between groups. For example, a level of p < .05 is an inferential statistic
that shows that there is a 5 percent or less chance that the change occurred based on
chance; a score of p < .01 shows even higher statistical significance because there is
less than 1 in 100 probability of the difference being due to chance. When a researcher
wants to compare more than two variables in a study, analysis of variance (ANOVA) is
a technique that compares the mean scores of three or more groups in the study; analy-
sis of covariance (ANCOVA) controls for initial differences between groups. Specific
parametric tests such as these are used when an experiment’s variables fall within the
normal distribution of the target population and can be measured in a way that gener-
ates interval or ratio data.
When the number of participants is small, when variables are measured in ways
that generate only nominal or ordinal data, when a sample is not considered represen-
tative and the variables probably are not normally distributed, then random selection
probably has not occurred and non-parametric statistics are used instead. According to
Bailey (1991) this situation quite frequently occurs in health science research because
variations of pathology or other treatment conditions are not distributed on a normal
curve in a target population and it is often difficult to find a large group of people with
the treatment condition under study. Inferences are difficult to make because random
sampling and control criteria have not been met.
A REVIEW OF VALIDITY IN
EXPERIMENTAL RESEARCH
Internal validity means that the outcome of your study is the result of the variable you
manipulated and not the result of something else. Research that is internally valid
allows you to make relatively secure statements about cause and effect. Evidence
that establishes internal validity would include better scores on a posttest than on a
pretest or the absence of the effects of maturation (the ordinary change that can be
expected over time due to maturation or other natural effects on a subject). Having
a variety of outcome measures and an absence of contamination from unreliable or
inconsistent testing instruments also improves validity. Quasi-experimentation has
less internal validity because of confoundings that are not under direct control of
the experimenter.
External validity means that your research findings or established cause-and-effect
relationship can be generalized or confirmed with other groups, in other settings, or
at other times, as long as the conditions are the same as those in the original study.
External validity is improved when you can show that there was no pretest interaction
(participants reacting differently because they know they have been pretested), placebo
effect, novelty effect, and so forth. Another aspect that can decrease external validity is
known as multiple treatment interference, which is the carryover effects from an earlier
treatment that make it difficult to assess the later treatment.
NON-EXPERIMENTAL DESCRIPTIVE RESEARCH

Some art therapy research studies are non-experimental but use quantitative methodol-
ogy. They can be characterized as not having an independent variable that is manipu-
lated to measure for a cause-and-effect relationship. In this category are correlational
studies and survey research.
Correlational Research
Correlational research studies the linear relationship between two or more vari-
ables without actually determining cause and effect. As in experimental research, the
researcher formulates and tests a hypothesis but does not attempt to simulate a cause-
and-effect relationship; there is no manipulation of independent variables. A hypothesis
is tested by measuring the differences between one or more variables and looking for
a correlating relationship. A well-known example is correlational research that deter-
mined the relationship between cigarette smoking and cancer:
Researchers aimed to determine whether the two were related and, if so, the
direction—positive or negative—of that relation. Studies in the 1950s and early 1960s
consistently found a moderately high positive correlation between cigarette smoking
and the incidence of lung cancer: the greater the number of cigarettes a person smoked,
the more likely that person was to have lung cancer. Knowledge of this relation allows
predictions to be made. Knowing how much a person smokes allows us to predict how
likely that person is to contract lung cancer. The prediction is not perfect, because not
everyone who smokes gets lung cancer, and not everyone who gets lung cancer has
smoked. Nevertheless, the predictions are good and the Surgeon General’s report in
1964 concluded on the basis of evidence that was mostly correlational in nature that
smoking was dangerous to health. (Elmes, Kantowitz, & Roediger, 1999, p. 85)
In the above example, the direction of the relationship showed a positive correla-
tion: an increase in one variable (smoking) is associated with an increase in the other
variable (lung cancer). A negative correlation would be an inverse relationship where
an increase in one variable is associated with a decrease in the other variable. The
strength of these relationships are analyzed with specific statistical tests that reveal
the correlation coefficient between –1 and +1 where 0 indicates no relationship and the
two extremes indicate a perfect positive or direct relationship (+1) or perfect negative
(inverse; –1) relationship.
Carolan (2001) wrote that correlational data are particularly important in assess-
ment, such as the Formal Elements Art Therapy Scale developed by Gantt and Tabone
(1998) that can measure the relationship between characteristics such as age and diag-
nosis and the formal elements in drawings. “Development of correlational research in
art therapy could have a broad range of positive effects including the development of
assessment instruments, contributions to accurate diagnosis, and use as a means of
establishing treatment plans” (p. 196). Carolan suggested that art therapists consider
designing correlational studies for such research problems as finding patterns of behav-
ior in the process of creating art, in the use of different art materials, and patterns
related to the image created.
ASSESSMENT OF AFFECTS: COMPARISON OF

RATINGS OF PRE-STRUCTURED IMAGES WITH
SYMPTOM CHECKLIST (VICK & STRAUS, 1997)
Vick and Strauss conducted correlational research that measured the relationship
among picture ratings, self-ratings, and scores on a Psychiatric Symptom Index
(PSI). 40 adult patients and 45 staff were asked to identify one of four target
affects in 20 drawings of people depicting various emotions. Results showed a
statistically significant positive correlation for the affects of anger and depression
between the drawings and the self-ratings. They found no correlations between
the instruments measuring the two other affects.
Survey Research
Surveys are a form of research that gathers information on a large population to address
a set of hypotheses about that population. A survey can numerically describe the trends,
attitudes, or opinions of a population by studying a sample of that population (Creswell,
2003). Surveys address “what” questions about a particular group at one point in time,
rather than “why”; in this sense they may be categorized as descriptive, cross-sectional
research. When researchers survey the same groups of subjects over an extended period
of time, they are conducting longitudinal research. Information collected from survey
research covers a broad scope and may include such topics or items as the respondents’
self-report of values, opinions, perceptions of events or conditions, motivations, and
attitudes. Specific information may be gathered to describe the demographics of age,
group characteristics, occupational data, and so on. Surveys may be conducted in per-
son, over the phone, or through handouts or mail, or over the Internet.
EXAMPLES OF QUESTIONS ADDRESSED

WITH SURVEY RESEARCH
An everyday example: How many of my neighbors think property taxes in
our community are too high?
An art-based example: To what extent is the digital camera replacing film
among fine art photographers? What are the motivating factors?
An art therapy example: What are the reasons for attrition from the art ther-
apy profession?
Surveys are a common feature in modern life, but not all surveys qualify as
research. At worst, a researcher may use a poorly designed survey to amass informa-
tion or simply to confirm the researcher’s biases. To be valid, survey research should
address a well-defined, specific research objective that is grounded on a review of the
literature and meets other conditions such as having clear relevance and significance
in the field of study. Leedy (1997) identified four features that are essential to good
survey research: (a) the study’s question should be a type that demands the technique
of observation as a principal means for gathering data; (b) the population is carefully
chosen and clearly defined within precise parameters; (c) attention is given to safe-
guard the data from the influence of bias; and (d) data are organized and presented
systematically to ensure that valid and accurate conclusions can be drawn from them.
Good survey research also strives to make sure the sample is comprised of appropri-
ate diversity characteristics.
Once the research design has been fully developed, a survey questionnaire is cre-
ated to collect the data. Because good survey development is complex, it is best to
consult a specialized text on survey design and treatment of data in accordance with
recognized standards. In general, you will need to think through the following steps
(adapted from Creswell, 2003; and Salkind, 1997):
1. Clarify the objectives of the survey: What are your purpose and reasons for
choosing a survey method? What population and aspects of the subject are
you interested in describing?
2. Select the sample: What demographics are relevant to your objectives? Are
there any variables that might alter how people will respond? How many
people will be in the sample and on what basis will they be selected?
3. Define the method for sampling, approach, and delivery: How will you
approach the participants in your sample? Will you use random or non-ran-
dom procedures? How will the survey be structured? What content areas will
it address? How will you formulate the questions to obtain the most useful
information? What is the timeline for administering your survey?
4. Assess for quality control: How will you secure randomness and minimize
bias? What sample size and rate of return of the questionnaire do you need to
ensure valid results?
5. Determine methods of data analysis: What specific steps will you take
to analyze returns and check for bias in the responses? What procedures
and scales will you use to organize the data? What steps are needed to run
descriptive (small sample) or inferential (large sample) statistics to obtain
the results?
Because the results of survey research are particularly susceptible to distortion

from interviewer or survey bias, the creation of a valid questionnaire is critically
important. Poorly designed questionnaires usually result in poor quality of data. As
described earlier in this chapter, it is very important to systematically study each
survey question and uncover any hidden assumptions, biases, or lack of clarity that
can throw off participant responses. Validity can be improved by pretesting your
questions on a pilot group of respondents to make sure that each item is clear, objec-
tive, relevant to the research problem, and will be favorably received and responded
to. For these reasons, survey questions tend to be limited to “yes/no” answers, mul-
tiple or forced choice, ratings on 5-point Likert scale, or short answers. To ensure
a large enough return on the questionnaire, it must be simple and easy to read, and
should not take too long to complete nor require too much energy on the part of the
respondent.
Carolan (2001) considered survey research as applicable for helping to recognize
the spectrum of the art therapy profession, to identify the scope of practice, as well as
to uncover trends, opinions, and beliefs concerning art therapy. Organizational survey
research can help to identify demographics, trends, and other areas that shed light on
the realities of art therapists and their clients.
MALE MAIL: A SURVEY OF MEN IN THE FIELD

OF ART THERAPY (TAVANI, 2007)
Tavani collected data from 112 male art therapists on a 12-item survey of atti-
tudes, perception, and experiences of being an occupational minority in a pro-
fession comprised mostly of women. Results were discussed in terms of gender
identity, gender associations to occupational titles, opportunities for professional
advancement, and other perceptions. A high response rate of 45% was seen as
indicative of a desire among men in the field to be part of a larger dialogue on
gender and art therapy.
CHAPTER SUMMARY
1. The scientific method is a basic process of systematic inductive and deductive
reasoning that guides all art therapy research, whether quantitative, or non-
experimental, qualitative, and/or art based.
2. Traditional scientific research can be characterized as an approach that
usually aims to explain and predict cause-and-effect relationships. Four
main concepts in quantitative research are (a) manipulation, (b) control,
(c) randomization, and (d) systemic, preplanned structure.
3. Experimental research deduces cause-and-effect relationships by studying
the effects of an experimental variable on a randomized group of people as
compared with a control group that did not experience the variable. In quasi-
experimental research, adjustments are made to account for variables that are
not under the control of the researcher.
4. A quantitative design is bounded and operationalized with a research proto-
col that fills in the basic design with precisely defined descriptions of specific
variables, participants, instruments, and procedures.
5. A valid test measures what it claims to measure and a reliable test can be
expected to produce the same results over time or with different raters. In
a quantitative study, data are converted to numbers and can be measured in
four ways: nominal, ordinal, interval, and ratio.
6. Descriptive statistics show patterns in the data and are used to calculate pre-
test and posttest observation and measures; inferential statistics are used to
infer how data from one group relate to another group, the degree of chance
versus the actual effect of the experimental variable, and the likelihood of the
change occurring again if the study is repeated.
7. Single-subject research in art therapy studies the effect of treatment on single
clients or groups that act as the own control and compare the results of a
baseline assessment that is repeated at the end of treatment.
8. Non-experimental descriptive research is used primarily to collect and mea-
sure data on an existing problem or situation, and includes correlational stud-
ies and survey research.
9. Correlational research studies the linear relationship between two or more
variables. Instead of determining cause and effect, the direction of the rela-
tionship may show that an increase in one variable is associated with either
an increase or decrease in the other variable.
10. Survey research is descriptive research that gathers information on a large
population to address a set of hypotheses about a particular group at one
point in time.
REFERENCES
Bailey, D. M. (1991). Research for the health professional: A practical guide. Philadelphia, PA:
Davis.
Beck, P. V. (1991). Wild trout. Parabola, 16(2), 26–29.
Campbell, D. T., & Stanley, J. C. (1969). Experimental and non-experimental designs for research.
Chicago, IL: Rand McNally.
Carolan, R. (2001). Models and paradigms of art therapy. Art Therapy: Journal of the American
Creswell, J. W. (1994). Research design: Qualitative and quantitative approaches. Thousand
Oaks, CA: Sage.
Creswell, J. W. (2003). Research design: Qualitative, quantitative, and mixed methods approaches
Diamond, P. (1992). The single-case study. In H. Wadeson (Ed.), A guide to conducting art ther-
apy research (pp. 97–116). Mundelein, IL: American Art Therapy Association.
Morgantown, WV: Gargoyle Press.
Gilroy, A. (2006). Art therapy, research, and evidence-based practice. Thousand Oaks, CA: Sage.
Julliard, K. (1994). Increasing chemically dependent patients’ belief in step one through expres-
sive therapy. American Journal of Art Therapy, 33(4), 110–119.
Kunkle-Miller, C. (1982). The effects of individual art therapy upon emotionally disturbed deaf
children and adolescents. In A. DiMaria, E. S. Kramer, & E. A. Roth (Eds.), Art therapy:
Still growing. Proceedings of the 13th Annual Conference of the American Art Therapy
Association (pp. 137–142). Alexandria, VA: American Art Therapy Association.
Leedy, P. L. (1997). Practical research: Planning and design (3rd ed.). Upper Saddle River, NJ:
Prentice Hall.
McLeod, J. (1994). Doing counseling research. Thousand Oaks, CA: Sage.
Salkind, N. J. (1997). Exploring research (3rd ed.). Upper Saddle River, NJ: Prentice Hall.
Tavani, R. (2007). Male mail: A survey of men in the field of art therapy. Art Therapy: Journal of
Vick, R. M., & Strauss, B. S. (1997). Assessment of affects: Comparison of ratings of prestruc-
tured images with symptom checklist. Art Therapy: Journal of the American Art Therapy
Outcomes
Research to
Generate
4
Evidence-
Based Practice
The first track is the end of a
string. At the far end, a being is
moving: a mystery, dropping a
hint about itself every so many
feet, telling you more about itself
until you can almost see it, even
before you come to it. The mystery
reveals itself slowly, track by
track, giving its genealogy early
to coax you in. Further on, it will
tell you the intimate details of its
life and work, until you know the
maker of the track like a lifelong
friend … Since I began tracking
at the age of eight, I have never
seen a track being made without
wanting to go over and examine
it. With each track I add a little
information to what I have been
able to gather so far. Bit by bit, I
learn to track more completely the
mystery at the end of every track.
—Tom Brown (1991, pp. 70–71)
Today in the fields of health care and education, it has become the norm to expect that
the services you pay for—whether treatment for an employee’s alcoholism or a degree in
art therapy—are effective, cost-efficient, and appropriate for your needs. But for those
art therapists who were trained prior to the 1990s when the era of managed care began,
73
this is a paradigm shift in thinking. There was a time when most health care decisions
were entrusted to the expertise of practitioners. Those who paid for services looked for
trustworthy evidence of expertise in such “inputs” as the therapist’s education, creden-
tials, or years of experience. But as health care costs began spiraling out of control, and
as client rights to make informed health care decisions grew, the focus shifted to the
outcomes of treatment as evidence of effectiveness. Art therapists have felt this change
to be an intrusion into their practices even as they welcomed the dismantling of a hier-
archical system that was patronizing to their clients.
While the “therapist as expert” has withered (Spaniol, 2000) in the current health
care climate, some art therapists have replaced it with an unexamined trust in the art
process to account for art therapy’s effectiveness. “Trust the process” (McNiff, 1998a,
p. 37) is a valuable training principle that art therapists utilize to develop constancy
in their relationship with art and art’s potential to empower the client. But it is not an
effective argument for art therapy’s value to clients. Beyond trust in and passion for art
therapy, there are many questions we have yet to ask about how art therapy works and
what is produced when the creative process and art media interact with client concerns.
How do we know what we’re doing is beneficial and whether it is effective? Shouldn’t
we help our clients by knowing what and how to deliver the best possible treatment with
the least disruption to their lives? Ethical practice, it would seem, demands it.
The new paradigm of evidence-based practice challenges the traditional practitio-
ner stance that has valued intuition and the “received wisdom” of anecdotal accounts
or mentors, and held that training, expertise, and experience are the sole basis on which
diagnosis or treatment decisions should be made (Gilroy, 2006). But because little
research is available on the efficacy of art therapy as an intervention, art therapists are at
a tremendous disadvantage and continue to struggle with what Fink (as cited in Sperry,
Brill, Howard, & Grissom, 1996) called “a stigmatizing, repetitive, anti-psychothera-
peutic diatribe” on the part of the general public, employers, and insurance companies
who rarely know what art therapy is. It is no secret that art therapy may not translate
well into the terminology of outcomes measurement. The absence of outcome-based
research does not equate with an absence of knowledge nor infers the ineffectiveness of
an intervention (Richardson, 2001). This is a difficult reality for individual art therapists
who usually know from clinical experience that art therapy helps their clients. Fink
(cited in Sperry et al., 1996) wrote:
They see patients who come in crippled, unhappy, anxiety-ridden, depressed and who
finish treatment in a state of excellent mental health, in a state of enthusiasm, optimism
and willingness to take risks. There has been no way to demonstrate this other than
anecdotally and through the occasional confession from a successful patient that they
have, in fact, had treatment and the treatment worked. (p. x)
As it accumulates, such anecdotal evidence reinforces the individual art therapist’s

conviction that art therapy works and adds frustration when the public demands account-
ability by measurable means. McNiff (as cited in Hervey, 2000) decried the need “to
justify what we do through behavioral and social science research methods” that presum-
ably place art therapists “under their dominion [and] that do not resonate with who we
4 t Outcomes Research to Generate Evidence-Based Practice 75
are” (p. viii). But if we return to the premise that specialized research tools like statistics
or rating manuals should be distinguished from methodology, which is characteristic of
the whole project (Leedy, 1997), then art therapy should be able to demonstrate outcomes
effectiveness without betraying its own unique character. As Gilroy (2006) wrote, art
therapy should “develop a pluralistic evidence base that has meaning for the discipline as
a whole” (p. 10). Perhaps, then, we may finally begin to demonstrate art therapy’s value.
Taking the idea of treatment-outcomes research further, if art therapists desired to
help not only their own clients but every client in every other art therapist’s practice,
their work could have tremendous impact due to the “multiplier effect”: Demonstrable
success in one population can create new perceptions in other treatment populations
and across a whole chain of interconnected funding and delivery sources for art therapy
services and needs (Kapitan, 2006b). Even a relatively small research study, when pre-
cisely focused on an existing need with a demonstrable benefit, can jumpstart a whole
movement of interacting demands for art therapy services in different quarters.
Practitioners know the results of their work and see them all the time. If the goal
of the intervention is to feel better, did it happen? How can you show that it did? Art
therapists are adept are designing creative interventions and there is no doubt that the
same skills could be applied to creating simple tools to measure their clients’ responses
(Kapitan, 2006b). In hundreds of settings all over, art therapists have partnered with
other members of the treatment team to show and articulate the results of their work.
PURPOSE: RESULTS OF A PROCESS

Outcomes studies focus on the results of a process and the kinds of objectives we want
art therapy to achieve. We ask, “Are we really doing what we say we are doing here? Is
there any evidence of what is working and what isn’t? Is there evidence supporting the
need for and benefit of this care?”
EXAMPLES OF QUESTIONS RELATED TO OUTCOMES

r A hunter asks, “Was the hunt successful? Will it feed the commu-
nity?”
r A teacher asks, “How do I know whether my students learned what I
attempted to teach them?”
r An artist asks, “Is my show a success and does my artwork connect
with my gallery audience in the way that I intended?”
r An agency asks, “Is the art therapy program effective and worth
continuing?”
r An art therapist asks, “Was the intervention successful? Did the art
therapy program help my clients stabilize and leave the hospital func-
tioning better in daily life?”
Julliard (1998) defined outcomes research as a systematic approach to measur-

ing short- and long-term outcomes of care, which include objective and subjective
characteristics of both clients and therapists or providers. Outcomes may be identi-
fied using quantitative, qualitative, or mixed methods of data collection and analysis.
The first generation of outcome studies in the 1990s examined such things as treat-
ment program quality, cost, and productivity from the perspective of major stakehold-
ers in health care, such as the provider, client, client’s family, employer, insurance
company, administrators, and government. The expectation today is that along with
other health care practitioners, art therapists know the evidence on which art ther-
apy practice is based and develop treatment accordingly. Julliard (1998) observed
that good outcomes usually mean improving the client’s functioning and quality of
life, reducing symptoms, achieving client satisfaction, and minimizing costs of care.
These same measures coincide with the goals of most clients in treatment (Sperry
et al., 1996).
EFFICACY VERSUS EFFECTIVENESS

When an art therapist is interested in evaluating treatment outcomes (individual, groups,
or programs), it is necessary to distinguish between two important questions:
r Can it work? meaning efficacy; and

r Does it work? meaning effectiveness.
According to Sperry et al. (1996), research scientists tend to focus on the first ques-
tion: “Can we demonstrate that this intervention produces better results (outcomes) than
a presumably inert (control) situation?” The preferred research method for address-
ing this question, as described in experimental research in the previous chapter, is
the randomized clinical trial (RCT) or pretest posttest control group experiment (see
Figure 4.1 as an example). The demand for measurable evidence of a treatment’s effi-
cacy is so great, in fact, that the results from this single research method have been
privileged over all other types of evidence that may be more appropriate to different
practices, services, and settings (Gilroy, 2006).
RCTs usually are controlled clinical trials that involve large numbers of subjects
who fit explicit health care criteria and are randomly assigned to an intervention
group or to a control group that might be given a placebo, no intervention, or a
standard treatment that is different from the experimental condition (Gilroy, 2006).
RCTs are regularly criticized because they require “the transfer of a research para-
digm devised for one domain (medicine) to another” (p. 83). They have significant
limitations in their appropriateness and practical application to art therapy. It may
not be possible for an art therapist practicing in an agency or clinic to have access
to large enough numbers of people such that two perfectly randomized or matched
groups—experimental and control—

Sponsored by grants from the can be formed and subjected to a sys-
National Institutes of Health, Monti tematic protocol over a sufficient period
et al. (2005) studied the efficacy of of time. Yet without random assignment
there is no way to control for the mix
mindfulness-based art therapy as a
of cases found in a given clinic. Actual
group intervention for cancer
clients typically are more widely dif-
patients. The RCT paired 111 women ferent in their responses to the same
with cancer diagnoses by age and treatment than the treatments are dif-
randomized them to either an 8- ferent from each other. The interaction
week art therapy group or a wait-list of therapist competencies, training, and
control group. Compared to the compliance with a given protocol dif-
control group, the art therapy group fers widely as well. A further problem
had a significant decrease in symptoms is that because evidence is obtained
of distress and significant only after treatment is completed, a
improvements in key aspects of controlled clinical trial is useful only
quality of life. for changing general systems or pro-
tocols of care (Sperry et al., 1996). To
be generalizable to actual practice, the
clients, therapists, and treatment settings must be representative and the outcome
measures must be clinically relevant.
Service-oriented researchers, therefore, tend to be less interested in efficacy and are
more pragmatically interested in effectiveness: “Does this intervention produce benefi-
cial results in a normal clinical setting with real clients?” To address this question, the
preferred method is a naturalistic study that demonstrates treatment effectiveness for
clients in average practice settings with typical art therapists. Naturalistic in this context
means that the study is conducted onsite and follows normal, every day treatment condi-
tions. Because the research study usually is organized around pragmatic clinical prob-
lems, Creswell (2003) advocated a mixed methods design that combines closed measures
with open-ended observations. The advantage of these approaches is that, in addition to
identifying patterns of responses to treatment, one can develop a clinical feedback system
for the status and progress of each case (Sperry et al., 1996). In this way, good research
and good clinical practice go hand in hand. The clinical relevance of the research can be
transformed from general understandings to practical applications.
METHOD AS AN EXTENSION OF
GOOD CLINICAL PRACTICE
Julliard (1998) identified the basic method of outcomes research as follows:
1. Identify the patient population and choose the problem to be addressed.
2. Select the outcomes to measure.
3. Gather data (addressing who, what, where, when, how often, etc.).
4. Assess the gathered data.
5. Identify and evaluate the impact or effects of treatment.
Art therapists will recognize that this method closely follows clinical practice and
is an outgrowth of the case study method. Good clinical practice, in fact, often seems
like a type of single subject experimentation in that the logic of the two enterprises
is very similar (Hayes, 1998). To increase the potential scientific value of art therapy,
art therapists need only take systematic, repeated assessments; specify the treatment
model; recognize the strategies they are already using in practice; and focus on using
them more systematically to improve clinical decision making. Finally, the art thera-
pist would look for evidence of a measurable effect, such as a change in behaviors,
attitudes, thoughts, feelings, or skills. From a research standpoint, by isolating the
effects of art therapy treatment from other factors that influence outcomes, it could be
established whether art therapy produces the best, most appropriate results for a given
situation.
Taking a question posed earlier, an artist who asks, “Was my show a success?”
might define and measure “success” by (a) keeping track of how many people attended
over the course of the show (a quantitative measure) and collecting their comments in
a gallery guestbook or feedback log (a qualitative measure), (b) specifying whether
expected professional or artistic objectives have been met, and (c) “looking for evidence
of an effect that can be measured for its magnitude” such as whether more people attended
after a review appeared in the local paper, or the degree to which people commented
on how much they liked, disliked, or were challenged by the work. Attendees might
be asked to record their opinions or values, their emotional responses to the work, and
demographic information that would identify some key characteristics of the viewers.
Likewise, an art therapist who asks, “Was the intervention successful? Did the art
therapy program help my clients stabilize and leave the hospital functioning better
in daily life?” would define what is meant by success and would collect measurable
data to show the effects (effectiveness) of art therapy treatment on the clients’ targeted
behaviors or concerns.
Before beginning an outcomes study, the researcher (or clinical research team)
develops a conceptual model of the most relevant factors and outcomes of interest (see
Chapter 1, research design, and Chapter 8, proposal writing). Some factors will play a
direct role, while other factors will influence treatment more indirectly. Each needs to
be captured and its role defined. Such a model does not have to be theoretical but should
simply explain what the art therapist believes already is occurring. It can be based on
direct clinical experience and a review of prior work. Thinking through the model is a
way to identify the factors that are most important.
Once these elements have been identified, they are operationalized with spe-
cific variables that can be captured in one or more measures. For example, in their
review of art therapy research literature, Reynolds, Nabors, and Quinlan (2000)
found only mixed support for the efficacy of art therapy and noted that in the few
randomized art therapy studies that existed, improvements in patient status could
not be specifically attributed to art therapy because art therapy interventions were
bundled together with other treatment modalities. Bell and Robbins (2007), in
response, created a conceptual model based on one specific claim that had yet to
be empirically supported in a controlled study: that the production of art can have
stress-reducing or relaxing effects. They designed a study that randomly assigned
one group to produce art for a given period of time and another group to view
and interact with completed artworks for the same length of time. Their specific
assertion was that the most salient factor in producing a therapeutic effect was the
production of art—as opposed to merely viewing art or having exposure to art. Bell
and Robbins (2007) explained:
Past studies of art therapy had not attempted to separate these effects; consequently
improvements in status could stem from the effects of viewing the completed
artwork rather than from its production. Furthermore, the use of an art viewing
condition was intended to produce a control group, which would be matched to
the experimental condition for expectations of enhanced mood (people commonly
associate the viewing of art with relaxation and stress-relief) and for the experi-
ence of completing a time-limited task (sorting art as opposed to producing art). If
art therapy has effects that go beyond those produced by viewing art, completing
a task, or simply expecting to feel relaxed, then participants in the art production
group should experience greater reductions in negative mood states than individuals
in the viewing and sorting condition. (p. 72)
Finally, as described in the pre-

vious chapter, a key ingredient in
Peacock (1991) conducted a single-case design
outcomes research design is the data
resulting in positive short-term art therapy out-
comes for a young woman who had been sexually analysis plan that, at least for quantita-
tive studies, is undertaken in consulta-
abused. Daily sessions over a period of ten days
were documented to show the client’s personal tion with a statistician. Fundamentally,
constructs for how she viewed her reality. Post-
the major question asked is whether the
treatment measures revealed decreased anxiety independent variable of greatest inter-
and depression, and improved self-esteem.
est (usually the art therapy treatment)
is significantly related to the depen-
dent variable (the observed result or outcome) after the effects of other factors have
been eliminated.
A review of the literature shows that art therapists have used various research
designs to evaluate the effectiveness of treatment. Rosal (1992) identified experimen-
tal and quasi-experimental group comparison treatment designs as the typical method
for studying outcomes. She also highlighted the practical value of single-case research
in actual practice settings (see example, Figure 4.2). But when the burden of demon-
strating effectiveness rests on a single case, the art therapist must carefully specify
the intervention and take repeated measures or assessments. A detailed, measurable
record of client progress over time must be documented and examined for factors that
might account for differences in expectable client progress if they occur. Baseline and
repeated assessments, taken under reasonably consistent conditions, also parallel good
clinical practice.
A single case that shows how art therapy helped an adolescent stay in school does
not tell us much. But when the same art therapy treatment is repeated over and over
with many adolescents who stay in school as a result, a credible pattern of evidence
emerges. Thus, the external validity of single subject research design as an outcome
study depends upon its systematic replication with many clients. Effective art thera-
pists come to know what works and why through a similar practice of replicating their
interventions over time and with many clients. At the same time, clinicians should not
expect clients to behave like experimental subjects. As Hayes (1998) observed, single
case research is dynamic and “interactive with only tentative hypotheses and readi-
ness to change if significant questions arise in the process. The data should be graphed
frequently and in various forms so that patterns can emerge and leads can be followed”
(p. x). As with good clinical practice, the researcher must be ready to let the client’s
data, or needs and goals of treatment, be the guide.
WHAT DO WE MEAN BY
TREATMENT AND ITS EFFECTS?
Treatment may be defined broadly as directing a change in the health environment of an
individual for the purpose of improving that individual’s health status (Hebert, 1997).
When designing a treatment outcome study, the researcher needs to think in terms of
client functioning and select carefully for the right outcomes to measure. Treatment has
two components that have a direct and presumed effect on the client:
r What was done or the process

r How well it was done or the skill involved
Both components affect treatment results for the client. Recalling the principle
that all kinds of phenomena can be translated and measured with tools that make their
essential qualities evident, the art product in therapy can be a measure of the treatment
intervention as well.
Various factors can be used as a basis of comparing either what was done or how
well the treatment was done. Typical dimensions of treatment that are used in outcome
studies are listed in Table 4.1.
Evaluating the impact of treatment raises special methodological issues in art ther-
apy research. One issue in outcome studies is treatment integrity, which is the extent to
which the intervention was carried out as intended (Kazdin, 1998). It is not enough to
name “art therapy” as the treatment intervention without also specifying the procedures
involved and whether they were carried out correctly or competently. To correct for this
validity concern, the art therapist should develop a treatment protocol or manual that
identifies and operationalizes the key ingredients of the intervention.
Kazdin (1998) recommended a simple checklist of “adherence measures” that
can help the outcome study describe and maintain treatment integrity when different
TABLE 4.1 Treatment–outcomes design strategies

STRATEGY EXAMPLE OF TREATMENT EFFECT STUDIED
Treatment A vs. No Treatment Is anxiety reduced to a greater degree among
inpatients who attend art therapy group
treatment as compared to inpatients who do
not attend art therapy?
Treatment A vs. Treatment B Which treatment is more effective for reducing
anxiety in inpatient psychiatric care: art therapy
or cognitive-behavioral therapy?
Treatment A + B vs. Does art therapy when combined with cognitive-
Treatment B alone behavioral therapy help to lower anxiety in
inpatient psychiatric care to a greater degree
than using cognitive-behavioral therapy alone?
Treatment intensity (amount Do twice weekly sessions of art therapy
of treatment per unit time significantly improve client social functioning in
or encounter), timing, and a geriatric long-term care facility as compared
duration to weekly sessions?
Do longer art therapy sessions improve
outcomes for individuals in psychotherapy
treatment?
Does early intervention of art therapy with
the children of battered mothers improve
their adaptation to the domestic violence
shelter?
Treatment setting (where and Is art therapy more effective for children at risk for
under what conditions learning failure when offered as part of the
treatment is provided) school curriculum or as an after-school program?
Comparison across providers Does an art therapy program provided by board-
of treatment (training, certified art therapists have better outcomes
experience, personal than one provided by mental health
characteristics) professionals without art therapy training?
Is a psychodynamic treatment in art therapy
more effective than an open studio approach to
individuals with mood disorders?
Are incarcerated male offenders more or less
responsive to art therapy provided by female art
therapists?
therapists are carrying out the same intervention to show effects. Developed for out-
come studies that compare different treatments, art therapists would find the follow-
ing list useful for identifying the salient characteristics of art therapy with greater
precision:
r List therapist behaviors that are unique to art therapy and essential to it. (If
art therapy is being administered appropriately, then certain aspects will be
present that are not found in any other approach being tested.)
r List therapist behaviors that are essential to art therapy but not unique
to it. (Certain aspects are expected to be present when art therapy is the
treatment under study, but these could be found in the other treatments as
well.)
r List behaviors that are compatible with art therapy but neither necessary
nor unique. (These are acceptable in that they do not negatively affect
the art therapy intervention but neither are they necessary in defining art
therapy.)
r List behaviors that are proscribed or not allowable in the treatment. (When
comparing two treatments, all of the unique and essential items for art ther-
apy likely would be proscribed for the other treatment and vice versa.)
A second issue is whether the intended impact of the intervention is clinically

important to the client, since statistically significant changes on one or more mea-
sures do not necessarily reflect important differences for a client’s functioning in
everyday life (Kazdin, 1998). Some of the measurements for clinical significance are
the same as those observed in clinical practice: whether the presenting problem has
been ameliorated and the client returns to normal functioning after treatment, the
degree of improvement in client symptoms as measured in pre- and posttests, whether
the client no longer meets diagnostic criteria present at the start of treatment, and/or
whether people who are in contact with the client report that the client has noticeably
improved (Kazdin, 1998).
As evidence-based practice in mental health care has evolved, outcome studies
frequently include both quantitative and qualitative data, with the latter used to iden-
tify clinically significant effects that otherwise may be difficult to measure. Treatment
effects often have quality dimensions that require description rather than measurement
or scaling. For highly individualized treatments, the assumption is that outcomes will
be qualitatively different for different clients. Under these conditions, art therapists may
argue for documenting the unique outcomes of individual clients rather than for mea-
sureable outcomes that are standardized across all clients.
A RESEARCH MODEL FOR

EVIDENCE-BASED PRACTICE
As discussed above, outcomes research is a clinical undertaking at the heart of which
is a clinical model of causation (Kane, 1997). Art therapists, who want to contribute
to the field’s outcomes evidence but don’t know where to begin, can start by docu-
menting and systematically describing particular clinical observations in case stud-
ies and single subject experiments. The next step, according to Gilroy (2006), is to
follow up these studies with small-scale research projects that develop and explore
the clinician’s innovative approach. This inductive research can then be tested with
an RCT and, in turn, followed with comparative RCTs to enable a construction of an
evidence-based model. Once these findings are produced, they are evaluated through
peer review publication and systematically distilled into guidelines to inform practice,
and eventually into standards of client care that are monitored through an auditing
process (Gilroy, 2006). Gilroy outlined three components of evidence-based practice:
research, guidelines for “best practices” based on accumulative research findings,
and audit or program evaluation that ensure their implementation. In the government-
sponsored health care system of the United Kingdom, the selection and delivery of
treatment interventions is explicitly tied to a hierarchical evaluation of evidence from
research, as outlined by Gilroy, below.
ART THERAPY LEVELS OF EVIDENCE (GILROY, 2006)

1. Evidence from at least one RCT or from at least one controlled, experi-
mental, or quasi-experimental study
2. Evidence from other research such as case studies, qualitative studies,
and art-based inquiry
3. Evidence from academically rigorous texts
4. Evidence from expert committee reports, or clinical experience of rec-
ognized authorities
5. Evidence from local clinical consensus or from user representatives
One example that follows Gilroy’s model of evidence-based art therapy practice
is taking place in the United States in the arena of trauma-focused art therapy. As
the number of case studies in the literature on the use of art therapy to reduce trauma
symptoms grew (see, for example, Backos & Pagon, 1999; Pifalo, 2002; Sweig, 2000),
studies appeared that tested some of their treatment assumptions, such as Pifalo’s that
combined with cognitive behavioral therapy on a small scale of 41 sexually abused child
participants in 1-hour sessions over 8 weeks. Chapman, Morabito, Ladakakos, Schreier,
and Knudson (2001) conducted an RCT that examined the efficacy of art therapy for
traumatized children; Lyshak-Stelzer, Singer, St. John, and Chemtob (2007) followed
by contributing an RCT exploratory study that showed statistically significant reduction
of posttraumatic stress symptoms. A review of the literature to distill best practices
and make recommendations for clinical guidelines for art therapy with posttraumatic
stress disorder (PTSD) was undertaken by Collie, Backos, Malchiodi, and Spiegel
(2006). Obviously, it takes organized team effort and time to accumulate such a body
of research, and in this case, the entire cycle from case studies to research to guide-
lines that are disseminated into treatment protocols is still emerging. Hopefully, as the
research foundation builds, art therapy will see greater replication of these studies and
the beginnings of established, evidence-based practice that can be further evaluated
and refined.
Gilroy (2006) stated that evidence-based practice is founded on clinical guidelines

that are drawn from research findings, clinical consensus, and continuing professional
development. These guidelines are used to adopt the best art therapy practices that
lead to the most effective outcomes. Evidence of effectiveness tends to be ranked from
the highest level (RCTs) to lowest levels, depending upon the degree of research rigor,
informed expertise, and clinical consensus. Clinical guidelines in the field of mental
health most commonly are either condition based (the particular issues associated with
specific client populations) or problem based (addressing how to deal with particular
situations) (Parry, as cited in Gilroy, 2006, p. 45).
In the example of Collie et al. (2006) above, the authors combed the research litera-
ture for evidence of “what works and why” in the treatment of PTSD with art therapy.
Their purpose was to distill all that was known about PTSD into a manageable form
that, if used consistently by art therapists working in the field of trauma care, would
improve both clinical outcomes and future research studies. The paper by Collie et al.
was significant because it brought together an expert panel that contributed specific
parameters of PTSD treatment that could be used to develop guidelines from (a) having
completed a thorough search in the art therapy literature that addressed the topic, (b)
critically appraising the literature by measuring how it compared to various levels of
quality evidence, and (c) linking the evidence with practitioners to discern the degree of
consensus on its practice. The field of art therapy could advance evidence-based prac-
tice by organizing cross-disciplinary panels of practitioners, researchers, and policy
experts in other emerging practice arenas to develop clinical guidelines of art therapy’s
effectiveness.
PROGRAM EVALUATION RESEARCH

Another arena in which outcomes research is increasingly becoming the norm is the
audit or evaluation of either a relatively small-scale treatment protocol or of a large-
scale agency or program that employs art therapy. In health care, “audit” is used to
mean a “problem-solving procedure that reviews services and identifies deficiencies so
improvements can be made” (Gilroy 2006, p. 60). As defined by Julliard (1998), such
quality assurance activities often involve a comprehensive, holistic evaluation of major
stakeholder perspectives (consumers or clients, providers, administrators, and the pub-
lic). The results are used to monitor and improve the treatment or program, and to make
determinations about its continuation or future development.
Gilroy (2006) distinguished program audit from larger-scale program evaluation,
believing that the former is not as methodologically robust as research, even though
both types of activity contribute to improving outcomes. Program evaluation has two
classic and distinct purposes:
r Summative evaluation looks at whether or not a program is effective, based

on standardized outcomes and controlled comparisons derived from rela-
tively large samples (Patton, 2002). This type of program evaluation typically
is carried over multiple sites where a service like art therapy is offered and is
used for standardizing treatment.
r Formative evaluation is the better choice if an art therapist is interested only
in improving a specific program. The purpose of this type of evaluation is
to help “form” or shape the future of a specific program being evaluated
(Patton, 2002). No attempt is made to generalize the findings beyond the set-
ting where the evaluation takes place.
FORMATIVE EVALUATION RESEARCH OF ART-BASED

SUPERVISION IN ART THERAPY TRAINING (FISH, 2008)
Fish used formative evaluation research to investigate student responses to art-
based supervision in which response art was used as a primary teaching and
learning method. 19 students in three consecutive semesters rated the experi-
ence on a 5-point Likert scale for 11 items on a questionnaire. Quantitative mea-
surements and qualitative commentary were analyzed to identify outcomes that
showed overall student satisfaction and effectiveness with response art as a tool
that supports the goals of supervision.
In essence, formative program evaluation asks the question: “What are we doing
and how can we do it better or more effectively?” Formative evaluations often combine
quantitative and qualitative data to assess program effectiveness, using such formats
as surveys, focus groups, illustrative case material, process studies, and examples of
individualized outcomes and quality issues. Evaluation research may be applied not
only to programs but also to specific policies, organizations, products, individuals, or
staff units.
Gilroy (2006) suggested three tiers of art therapy that can be evaluated: (a)
structures, such as physical environment, personnel resources, and equipment; (b)
processes, including demographics, referrals, treatments, assessments, and commu-
nication; and (c) results, in terms of patients and referral satisfaction, demographics
or indirect measures, symptom management, or other outcomes. Any of these aspects
can be isolated and identified as the “units of analysis” (Patton, 2002) to be included
in the study, for example, whether to focus on certain individuals as the unit of anal-
ysis or specific groups that participate in the program. The evaluation may focus
on program structures such as different formats used in delivering services, certain
project or activities, or operations. Or, a unit of analysis may be one or more groups
of people whose comparative worldviews or characteristics have important implica-
tions for the program’s effectiveness. For example, evaluation could study inpatient
versus outpatient units in a facility or, broadening the focus further, variations that
occur when the same program is offered in different neighborhoods, cities, regions,
or countries.
Particular activities, events, or incidents also may be the focus of an evaluation. An
art therapist or research team with an art therapy program in a residential treatment cen-
ter may choose to study the impact of a particular crisis that took place, or may look into
a demographic such as an increase in the incidence of runaways. The effects of a change
in personnel on a program’s clients may be the identified concern. Program personnel
who study their own outcomes produce important insights for the organization or pro-
gram itself. According to Patton (2002), the key issue in selecting appropriate units of
analysis, therefore, is to ask how the information generated by the study will be used.
Because such strategies used to produce in information-rich qualitative data, ran-
dom selection or large sampling is not required in formative evaluation. Program evalu-
ators are particularly interested in finding those “cases” that they can learn the most
from within the scope of the study. We can apply Patton’s (2002) case sampling typol-
ogy to evaluate different aspects and outcomes in art therapy (Table 4.2).
As with treatment outcomes studies, program evaluation requires careful planning
and a conceptual model to guide the study. In the case of a program self-study, two
distinct processes usually are required. First, the art therapist or research team gathers
documentation needed to catalogue the program’s resources and structures. These are
known as artifacts and are studied for their qualitative patterns of evidence. The second
process carries out the formal evaluation. Often this begins with a focus on the program
or agency mission and goals, perceptions of program strength and weaknesses, case
sampling data (as described above), and areas where new information may guide the
program’s future effectiveness. For each goal or expected outcome, the researcher may
identify “indicators of success” that would demonstrate having reached that goal. Once
these indicators have been identified, they can be operationalized as specific variables
captured in one or more measures. Qualitative and quantitative data may yield this
evidence, obtained from such measures as client satisfaction surveys, interviews with
agency representatives, focus group interviews, treatment plans, program materials and
operations, and so forth, which may be sources for identifying the variables that point to
program success as compared to where the program can make improvements.
As an example, a graduate art therapy program had consistently good outcomes in
surveys that measured their students’ achievement and satisfaction with their education.
Although gratifying, the program director felt that this picture of success was limiting; a
search for “negative cases” would put the data into a more useful context. She observed that
one variable shared by all who were highly satisfied with the program was the fact that they
had been successful graduates. For negative cases, the program director studied the profiles
of students who had not been successful and who had left the program prematurely. Patterns
in these data provided insight into how the program could be more effective with its most
vulnerable students. In a follow-up study conducted several years later, the program had two
sets of data that could be compared. Student retention had improved. Interestingly, the data
also showed that a stable market for employment correlated with favorable impressions of
the graduate program, despite that there seemed to be no causal relationship.
TABLE 4.2 Case sampling to fit purpose

SAMPLING TYPE PURPOSE EXAMPLE
Random cases To select for As a test of effectiveness, ask
representativeness an administrator to interview
randomly selected art therapy
clients
Purposeful cases To create an information-rich Purposely select the case of a
and in-depth study client that exemplifies the
most valued qualities of the
program; select cases that
illuminate “best practices”
Extreme cases To discern characteristics that Select an outstanding success
are salient as unusual or or a dramatic failure of the
special in some way that program to achieve its goals;
contrasts with the typical select a case that contradicts
what is expected
Intensity cases To show excellent but not Select, for example, the case
highly unusual examples of an excellent student versus
a poor student in a program,
or an excellent site where a
program is performing well
versus a site where it is
performing poorly
“Typical” client To illustrate what is usual, Study the characteristics of all
sample normal, or average clients in a particular timeframe
and create a profile of typical
features or characteristics they
share in common; then select
the case that fits the profile to
study in depth
Subgroup sample To facilitate comparisons Compare the outcomes of
different supervision groups
in the case of a graduate
program, or art therapy
groups in the case of a
clinical program
Wide-range To show, for example, the By studying variations in the
variation study of a group profile from data from year to year, or
year to year from group to group, patterns
can emerge that influence
outcomes. For example, does
a drop in the number of
clients have to do with poor
service or some other factor?
(Continued)
TABLE 4.2 Case sampling to fit purpose (Continued)

SAMPLING TYPE PURPOSE EXAMPLE
Wide-range To show, for example, the By studying variations in the
variation study of a group profile from data from year to year, or
year to year from group to group,
patterns can emerge that
influence outcomes. For
example, does a drop in the
number of clients have to do
with poor service or some
other factor?
Criterion sample For uses where all individuals Select a characteristic linked to
have the same characteristic a certain outcome, such as all
art therapy clients referred
from a certain source
Key players To highlight specific features For example, an in-depth study
of a program of the relationship between
the art therapist and other
members of the treatment
team with respect to a
particular outcome
Politically sensitive To improve treatment or Look at how effectively a
case program structures in a program recruits minority
particular, sensitive area students, or how effectively a
program addresses the needs
of the family of a hospice
client
PROGRAM EVALUATION FOR

OBTAINING GRANTS AND FUNDING
Art therapists often look for grants to fund art therapy programs or to create new employ-
ment opportunities. Here is where outcomes and program evaluation research are particu-
larly useful. By demonstrating an existing or pilot program’s outcomes through evaluation
research, art therapists can increase potential funding from a foundation whose mission
is aligned with those outcomes. Arrington and Anderson (1992) wrote that the key to
successful grant writing is to present the right idea to the right funding source at the right
time. Unfortunately, many proposals are vaguely or poorly focused because the entire
enterprise is not thought out systematically in advance. Outcomes research helps to frame
art therapy as an actual, effective product for its consumers and to identify key reasons for
why someone should be interested in funding it for continued success.
Most grant applications are terse and tightly focused, and follow a similar proposal
outline as discussed in Chapter 8. Arrington and Anderson (1992) advised looking for
funding sources that are geographically near to the art therapy program and that using
a successful grant or program as a model also increases success. Although grant writ-
ing is beyond the scope of this text, the following components of a grant proposal by
Arrington and Anderson provides a general idea of what to include:
1. Introduction/Abstract: This usually consists of a statement as follows: [Name

of institution] seeks [amount of $] from [Name of foundation] for [specific
program] for [specific time period]. Matching funds will come from [Name
of institution or corporation]. This project follows [number] of years of suc-
cessful programming at [Name of institution].
2. Problem Statement/Rationale: Sometimes called a needs assessment, this
is a clearly focused statement that documents a specific need and provides
a rationale for either the program to address the need or research that estab-
lishes that the need for the program exists.
3. Goals/Objectives: These are stated in quantifiable, measurable terms.
4. Capability Statement: The credibility of this section is strengthened by out-
comes and program evaluation research. Evidence of cost-effectiveness and
treatment success is important as is providing evidence of an effective orga-
nizational structure to carry out the program design, including the experi-
ence and skill of the practitioners.
5. Detailed Program Description: Here, too, program evaluation research can
yield a more effective proposal to attract funding. In a typical grant, this
section provides the plan of action, treatment plans, and timeline. Concrete
details are more easily provided when an existing program is evaluated and
improved before applying for grant monies.
6. Evaluation: Once a program has been evaluated for outcomes, it is easy to
apply the same logic to future evaluation as required in any grant application.
The foundation’s familiarity with art therapy should be taken into consider-
ation and the need for measurable outcomes should be assumed. Arrington
and Anderson (1992) noted that the funding agency will want to see tangible
outcomes from having funded the program or research, and plans for how the
results will be disseminated or promoted.
7. Future Funding: Plans for future funding are expected, which may include
client fees, or grants from other agencies or corporations.
8. Budget: A detailed accounting of all expenditures is required and should be
based on actual knowledge of the cost of services, supplies, and in-kind con-
tributions such as the provision of space, equipment, and staff support.
9. Financial Statement and Letter of Approval: This section is important if the
art therapist is representing a non-profit agency and both agency approval
and the financial viability of that agency need to be established.
10. References: The proposal narrative is a professional document and therefore
should be appropriately referenced.
11. Promotional Materials: These are helpful to establish professionalism,

credibility, and public presentation of the agency that the art therapist
represents.
12. Letters of Support: Testimonials from neutral (having no conflict of interest)
and highly visible persons are helpful. Federal programs may value letters
from the art therapist’s congressional representative; state arts councils,
AATA, or interested non-profit organizations may be appropriate for
individual applications.
Grant writing is a process that can encompass various research interests and can
develop valuable skills for the art therapist. Anderson (2001) described a small research
grant that funded an investigation into the efficacy of an art therapy program in a juvenile
detention center and showed that, although art-based assessments did not demonstrate
changes as a result from the program, clients did report a significant decrease in stress.
There also were fewer critical incident reports during the course of the program and
the staff gained a better understanding of how art therapy can help juvenile offenders.
Another grant that Anderson submitted to fund a pilot study to document the effective-
ness of art therapy in treating children who had been sexually abused led to funding for
a longer-term, larger study (Anderson, 2001). Anderson (2001) pointed out that because
grants may fund both outcomes research and art therapy program development, once an
art therapist learns how to write a grant proposal, it can easily be modified to fit other
grants as well.
Gilroy (2006) described how evidence-based practice is becoming the norm for
British art therapists seeking funds for their art therapy programs. Grants and other
forms of private and public funding demand a level of accountability for their success
but art therapists should not be daunted. Art therapists should be able to confidently
state that their work conforms to grant expectations because, as Gilroy described, they
will have demonstrated that they have
r Adopted clinical guidelines for standard practice

r Ensured that the guidelines are informed by research and/or serious pro-
gram evaluation
r Specified the client groups for which the services are most appropriate
r Monitored the outcomes of innovative treatments
r Audited the key elements of their practices (p. 41)
Outcomes research as it is carried out today across the many disciplines of health
care is targeted to “capture the attention of key audiences, that is, the policy makers
and managers—those whose interest is in effectiveness” (Gilroy, 2006, p. 36). One
strategy used in creating the groundwork for the first major clinical outcomes study
by the American Art Therapy Association in 2005 was an intentional collaboration
with non-researchers from the realms of governmental affairs and professional rela-
tions and known researchers in other fields. Not simply the generation of knowledge
but its dissemination throughout a network of legislators, funding sources, and the
public is what turns art therapy research into services for clients. Art therapy gains
“traction” and credibility when its strongest advocates are non-art therapist experts
and valued constituents who have directly benefited from art therapy (Kapitan,
2006b).
If, in your practice, you truly wanted to help not just your client but every art ther-
apy client in every other art therapist’s practice, how would you go about it? Imagine
how far-reaching your work would be if you cultivated this potent idea. Outcomes
research is pragmatic and focused on the concerns of real-life practice, building a case
for art therapy’s value in the world. It does not fail to ask: Who else needs to know my
discoveries? It does not stop at generating knowledge in relative isolation, but extends
knowledge into useful practices in a multiple of directions.
CHAPTER SUMMARY
1. As a matter of ethical practice today, art therapists are expected to be con-
versant in outcomes terminology and skilled in developing the best possible
treatment with the least disruption to their clients’ lives.
2. Outcomes studies focus on the results of a process, asking, “Are we really
doing what we say we are doing? Is there evidence supporting the need and
benefit of art therapy in this situation?”
3. Efficacy is a matter of whether a treatment can produce better results with
a control situation. Effectiveness looks at whether the intervention produces
beneficial results in a normal situation with real clients.
4. The goal in outcome studies is to isolate the effects of treatment from other
factors to determine whether the treatment was appropriate and produced the
best results for a given situation.
5. Research that contributes to evidence-based practice begins with case studies
and single subject experiments followed by small-scale research projects that
can be tested with randomized, controlled clinical trials. The findings are
systematically distilled into clinical guidelines and standards of care that are
monitored through an auditing process.
6. Program evaluation is a form of outcomes research that looks at the effective-
ness of the overall art therapy program. Particular units, activities, programs,
events, or settings may be the focus of the study.
7. Program evaluation is particularly useful for obtaining grant funding for
effective art therapy programs.
8. Outcomes research that is pragmatically focused on client care not only gen-
erates knowledge but disseminates it through a network of policy makers,
grants and funding sources, and the public, which turns art therapy research
into services for clients.
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Association, 17(4), 255–264.
Investigating
the Field:
Participant-Observation
5
The red fox runs in a circle when
he is chased by hounds. With his
den in the center, he will start
on a circle swing that measures
maybe a mile, sometimes more,
across the middle. All the time
he’s running, he’ll use tricks: back
tracking, running in water and
laying false trails; but he’ll stick
to the circle. As he grows tired,
he will make the circle smaller
and smaller, until he retreats to
his den. He “dens up,” they call
it. … Granpa always called off
the hounds when the fox denned
up. He said that when things
had got monotonous for ol’ Slick
he had gone so far as to come
and set on the edge of the cabin
clearing, trying to get Granpa
and the hounds to trail him …
—F. Carter (1991, pp. 30–31)
A young man enters the room agitated and unfocused. The art therapist greets him in
a calm, gentle voice and asks him to join the group, which is already in session. Seven
people are painting on canvas board with vibrant, acrylic paints. The therapist places
a freshly primed board in front of the young man and a jar of red paint. He makes two
strokes with the paint and suddenly leaps up from his seat, strikes the person next to
him, and bolts from the room. What happened and why?
There are several possible answers, depending on whether you puzzle it out as a cli-
nician or as a researcher—or both. It is unlikely that you would turn to an experimental
study for an answer despite that the scenario might have you thinking of many plausible
hypotheses that could be tested. You may wonder about the relationship between two
95
variables: the man’s agitation and the jar of red paint. But there are other variables,
too: Is the young man new to the group? Meeting the therapist for the first time? Never
painted before? What is the nature of his agitation? Obviously, much more information
is needed. As an art therapist, you would use your skills to obtain clinically meaningful
information to address the young man’s needs. As a researcher-clinician, you would be
interested in making sense of the young man’s story as a whole, to determine its most
salient characteristics. The theories or hypotheses you generate from the case (and other
cases that are like this one in particular ways) would be grounded on actual observa-
tions from the field.
In this chapter, I present frameworks for qualitative research that are generally
carried out as action-oriented, naturalistic field studies. This paradigm is based in
pragmatism (“What works?”) with its concern for real solutions to real problems.
Participant-observation is a term used to describe a basic orientation toward natural-
istic field studies. This research is always a blend of listening and looking, watching
and asking. It may entail formal and informal observations, intensive interview-
ing, small or large group projects, and the creation of art imagery. Practitioners
whose knowledge has been refined by first-hand experience with art therapy have a
natural affinity for field research. What differentiates ordinary art therapy activities
from field research, however, is the cultivation of heightened awareness and inten-
tional, informed actions that guide the research. Typically, participant-observation
research involves
r “Dual purpose”; the researcher simultaneously observes others while partici-

pates in the setting
r Explicit awareness of actions, agency, power, and attendant behaviors,
feelings, and perceptions that otherwise would be taken for granted in the
setting
r “Wide angle lens” that looks beyond the immediate focus of attention to dis-
cover hidden dynamics and aspects
r Repeating cycles of observing, experiencing, and reflecting
r Inclusive and cooperative methods that view research participants as co-
researchers when possible
r Emphasis on practical, hands-on problem solving and strategies for change
In participatory field research, researchers and participants generate distinct forms

of knowledge by grappling with the serious issues that affect them. Heron and Reason
(2001) asserted that such knowledge is valid and useful when it is grounded in experi-
ence, expressed through stories and images, and understood through meaningful mod-
els or theories. Action-oriented field research “manifests as a specific set of practices,
which emerge from the interplay between researchers, context and ideas” (Reason &
Bradbury, 2001, p. xxv). This chapter presents three major orientations in participant-
observation field research:
r First-person action research, which addresses art therapists’ inquiry into

their own practices in order to effect change
5 t Investigating the Field 97
r Second-person case research that inquires face-to-face or interpersonally

with others on mutual concerns in order to improve art therapy practice
r Third-person inquiry that is carried out in a wider community and includes
ethnographic inquiry and transformative participant action research
An overarching principle in contemporary field studies is a critical stance that is

concerned with maximizing human potential. The broad purpose of this paradigm is
the enactment of social change (Sullivan, 2005). Such thinking characterizes much
visual arts theory and practice and, by extension, is welcome in art therapy. The criti-
cal consciousness of the art therapist researcher is used as a tool to deconstruct social
structures that privilege those in power and to examine the situation of individuals
and groups who are marginalized by race, gender, economics, ethnicity, and the many
manifestations of mental illness not unrelated to the conditions of oppression. Change is
facilitated as individuals develop insight into their existing situations and are stimulated
to act (Guba & Lincoln, 1998)—whether individually on the part of the researcher or via
interpersonal, intercultural, and intersystemic encounters among research participants
involved in critical inquiry.
ACTION RESEARCH
Action research in the United States originated with classroom teachers who were dis-
satisfied with teaching practices derived from traditional scientific inquiry in the post-
World War II era of social change. Widespread educational policy developments in
the 1950s and 1960s expected teachers to use methods that had been developed under
laboratory conditions. In effect, skeptical teachers argued that educational practice
based on probability studies were not useful because they could not account for how
such practice would play out with the particular children in their classrooms and their
circumstances. Action research today is common not only in education but is also prac-
ticed in the arenas of organizational and community development and in health care.
Because art therapists similarly need to make creative adaptations to constantly chang-
ing conditions, client needs, and practice realities in the field, action research can be a
very effective tool in the practitioner-researcher’s on-going professional development. It
is highly compatible with the methodology of artmaking that also generates new under-
standings from the active processes of doing and making (Collie & Cubranic, 1999).
The purpose of action research is change. Strategies are identified and used with
deliberate intention to develop new insights that will effect change and thereby improve
practice. For example, in their study of computer-assisted art therapy, Collie and
Cubranic (1999) used action research to field-test art therapy methods with a group
of volunteers. The authors found that action research provided them with pragmatic
guidelines for improving group interactions in an emerging area of art therapy practice.
They acknowledged the difficulty in developing effective interventions when there is
no research available to support them. However, the reality for practitioners is that
they cannot wait until the research comes in; they have to provide services to clients.
“Learning what to do through doing—exploring problems in simulated settings and
simultaneously developing methods and techniques,” wrote Collie and Cubranic, “is a
logical and responsible way to proceed” (p. 187).
In today’s work environments, many art therapists find themselves more often react-
ing than responding to their clients’ needs. It is hard to rise above the time pressure,
fragmentation, and stress, and to adopt more effective strategies—especially in circum-
stances that seem to conspire against such change from happening. Action research helps
practitioners to slow down and discover the tacit choices they have made about their per-
ceptions of reality, their goals, and their strategies for achieving them (Friedman, 2001,
p. 160). Strategic action and reflection are valuable research tools art therapists may use to
improve their practical knowledge, skills, hands-on knowledge, and understanding.
EXAMPLES OF ACTION RESEARCH QUESTIONS

r A hunting example: How can I become a better hunter? How can I
improve my aim or sense of direction?
r An everyday example: Why am I getting so many speeding tickets
lately? Is it the police or is there something wrong with the way I am
driving?
r An art example: Why do my photographs look so uninteresting? Does
it have to do with lighting the subject? Depth of field?
r An art therapy example: I want to be more effective in my therapeutic
relationships but fear seems to be getting in the way. What am I afraid
of? When does fear seem to kick in and what happens as a result?
Action Research Cycle
ACTION n REFLECTION n ACTION
As with other forms of qualitative research, action research is cyclic. Using the
primary method known as reflexive critique, the action research cycle begins by
identifying a problem that can be resolved through strategic change. Taking time to
think about the problem, the first step is to formulate a hypothesis about what is cur-
rently happening and why. Then the hypothesis is tested by taking actions that you
expect will solve the problem. As the researcher, you carefully observe the outcomes
of these actions and take detailed notes and reflect critically on them. For example,
you may have observed that your adolescent art therapy groups have become highly
resistant to creating art in session. You think it may be due to the pressure they feel to
talk about their painful experiences. Testing your hypothesis, you stop asking for ver-
balization in the next session. You carefully observe and critique the effect that was
caused when you changed your directive; the purpose of reflection in action research
is to study in depth the impact of your actions on a given circumstance. A rigorous,
systematic critique of your own behavioral patterns generates new insight into differ-
ent strategies that may be more effective. As new insight and understanding emerge,
you intentionally adjust your actions, create new hypotheses and strategies, and test
them through another cycle of action followed by reflexive critique.
First-person action research is not unlike the kind of clinical assessment, thought-
ful decision making, and therapeutic adaptation that routinely characterizes profes-
sional work. What differentiates action research from the day-to-day practice of art
therapy are
r Heightened consciousness that is brought into awareness and then into action
r Carefully focused intentions of the practitioner to bring about change
r New awareness that surfaces insight from previously neglected strategies
or possibilities
r Rather than confirming existing knowledge or behaviors, actively changing
them to generate new directions
One important outcome of action research is that it can lead art therapists to change
their theories on which practice is based. As Friedman (2001) described it, the key dif-
ference between researchers and practitioners is that the former are “explicit” theoreti-
cians whereas the latter are “tacit” theoreticians. Practitioners may not have formally
theorized about their work, but they do operate according to implicit assumptions, val-
ues, beliefs, attitudes, and experiences that make up their “theories in action.” The
objective of action research, then, is to make these theories explicit so that they can be
critically examined and changed as needed.
The Action Research Plan

To raise action research above the level of daily work and to provide methodologi-
cal rigor, the art therapist action researcher develops and works from an action plan.
Several preliminary questions should be thought through and answered as specifically
as possible, as outlined below.
DESIGNING THE ACTION PLAN: PRELIMINARY QUESTIONS

r What is happening already?
r What do I think is going on?
r How do I—and others—perceive the situation?
r What is the rationale for this? What other possibilities are there?
r Who is being affected by the situation?
r What would I like to see change and why?
r What results do I wish to achieve?
From these and similar questions, the general problem set is clarified. Next,
write out a detailed, factual description of the situation from which to generate
your hypotheses. Because all subsequent reflection and action are based on this
description, you should depict the situation reflexively and as objectively as pos-
sible. Reflexivity is a basic practice of carefully studying your own experience to
account for the interpretations you’ve used to arrive at certain beliefs, practices, or
understanding.
DESIGNING THE ACTION PLAN: DEVELOPING THE PROBLEM SET

1. Create a reflexive and objective description of the situation you want to
change.
2. Reflect on underlying assumptions and judgments that form “tacit the-
ories” operating in the situation out-of-awareness.
3. Examine dialectic relationships, contradictions, or opposing forces at
work.
4. Consider alternative explanations and perspectives.
5. Develop hypothesis and set of actions to produce change.
Next, the action researcher studies the reflexive basis of the existing situation to
create an understanding of the tacit “theory of action”—what may be guiding your typi-
cal or out-of-awareness actions. When you’ve tested your theory, you may be surprised
to learn that it is not the same as what you always thought were the theories that guide
your practice. An “espoused theory” (Argyris & Schon, 1974) is how art therapists think
they act as compared to the actual behaviors that reflect their “theories in use.” You can
figure out your “theory in use” by describing your action research problem as shown in
Figure 5.1 (Argyris & Schon, 1978).
Action research takes a constructivist view of treatment effectiveness, arguing
that there is no single, objective reality on which to determine the best course of
action. The reality of the clinic is constructed from different perceptions and the
values we attach to them. In action research, reflexive critique is used to deconstruct
the art therapist’s existing understanding by intensely questioning what is assumed
to be true or has been taken for granted. Another strategy used to create an impetus
for change is called dialectic critique (Winter, 1989). The dialectical principle asserts
that internal change emerges from interacting elements that are contradictory and
interdependent. The researcher looks at how the various elements of the problem set
In a situation like “x” I usually do “z” In order to achieve “y”
Describe the conditions: Describe the strategy: Describe the goal:
FIGURE 5.1 Strategy to formlate a “theory in use.”

fit together in a system of cause and

Kapitan used action research to resolve an effect and then deliberately tests out
impasse with the Wisconsin state licensing board the contradictions.
that had refused the applications of qualified art
For example, an art therapist might
therapists. She identified the dialectic of two con-
hypothesize that, based on conversa-
flicting hypotheses: (a) that the board was com-
prised of hostile “gate-keepers” striving to keep
tions she’s had with the staff, the rea-
art therapists out, and (b) they were reasonable son her school art therapy program is
and open to dialogue, and simply lacked suﬃcient not being funded is because of the poor
information about art therapy. Assuming the perceptions people have about its value.
first hypothesis was wrong, she tested the second Upon closer scrutiny, however, she dis-
one—without success. Her subsequent reflexive covers that the special education staff
critique surfaced insight that the board’s percep- actually has been quite positive and
tion of her own self-interest was causing a con- even outspoken in their support of art
flict with their role in protecting the public. Hertherapy, as have administrators. Thus,
revised action plan found non-art therapist part-
she discovers that a discrepancy exists
ners to argue the case successfully.
between perceptions and actual behav-
iors among key people; some other force
is probably contributing to the problem.
Dialectic critique puts focus on the pattern of opposing forces that make up the history of
the situation (Winter, 1989). Without an analysis of the dialectics involved, the tendency is
to take a situation at face value. People tend to avoid looking at the inconsistencies of their
behavior in order to maintain equilibrium. Action research consciously stimulates change
by identifying practice “puzzles” and making the practitioner more aware of the gaps,
contradictions, and errors in their reasoning and behavior (Friedman, 2001, p. 162).
After the first cycle of action and reflection, then, the action researcher repeats the
steps to formulate a new hypothesis and to consider different strategies to guide action
in solving the problem. The action plan is revised and subjected to another round of
action and reflexive critique. If the action does not result in the desired outcome, what
other actions are possible?
IMPLEMENTING THE ACTION PLAN: TESTING HYPOTHESES

r Compared with my intended actions, what strategies did I actually put
into action?
r What were the outcomes of these strategies?
r To the extent that these outcomes were unintended, what might
account for any discrepancies?
Value of Action Research to Art Therapy

As a qualitative form of outcomes research, action research is very practical for prac-
titioners and may help to fill several important needs for the art therapy profession.
First, action inquiry produces grounded theory, which means theory that emerges from
systematic, comparative analysis grounded in actual observations in fieldwork (Patton,

2002). Currently, much art therapy follows “espoused theory” or descriptions of beliefs,
biases, histories, and interpretations that have not been empirically tested. Action
research produces empirical, field-tested outcomes data based on carefully observed
practice. The “theories in use” that are disseminated from action research could be
tested through large-scale outcomes studies that, combined with reports from individ-
ual practitioners, would provide a strong foundation for evidence-based practice.
Second, the same questions that guide large-scale outcomes research can be used
in action research on the level of individual practice. Because action research can be
conducted by any practitioner in any setting, and requires none of the resources usually
required in traditional scientific research, it is a model that can close the gap between
researcher and practitioner, making outcomes research highly accessible. Action research
promotes critical awareness of the relationship between knowledge claims and expertise.
The implication for the profession is that action research can teach critical, reflexive
thinking about research and practice that is closely grounded in outcomes effectiveness.
Third, as with ethnographic research and in larger-scale participatory action
research described later in this chapter, action research provides a model for clinical
practice that is based in the unique worldview of the art therapist while challenging that
worldview’s possible biases and preconceptions. Reflexive practice constantly brings
into awareness certain assumptions about the power relationship between therapist and
clients, inclusivity and privilege, the nature of the therapeutic enterprise, and other
questions upon which systemic change can occur.
GENERATING PRACTICE KNOWLEDGE IN SOCIAL

WORK EDUCATION: A TEACHER’S EXPERIENCE
IN HONG KONG (SUNG-CHAN, 2007)
An example of a first-person action research is by Pauline Sung-Chan, a social
work educator who has been systematically experimenting with experiential
learning theory to generate practice knowledge. Her paper presented the findings
of one of the author’s action research experiences that shed light on the distinct
frames that teachers and learners bring to their teaching-learning experience and
determine how well learners gain substantive knowledge.
AN ART THERAPY SOLUTION TO A TELEHEALTH

PROBLEM (COLLIE & CUBRANIC, 1999)
The authors, an art therapist working in collaboration with a computer scientist,
addressed the problem of how computer-assisted art therapy could be adapted to
fill the need for telehealth delivery methods that could reach people in their own
homes. The first phase of the study was to create and test a computer system for
AN ART THERAPY SOLUTION TO A TELEHEALTH

PROBLEM (COLLIE & CUBRANIC, 1999) (Continued)
distance art therapy. A team of 10 coresearchers were invited to use the system
and discuss in depth their experiences with it. The participatory design of the
action research study allowed the researchers to make changes between sessions
based on the recommendations and insights that emerged from the participant
interactions. Coresearchers then experienced the changes they had suggested and
provided further feedback to enhance the system. New and sometimes surprising
knowledge was generated regarding the people–computer interface and expres-
sive possibilities of computer-assisted art therapy.
CASE RESEARCH
If listening and reflecting on one’s own behaviors and actions is key in first-person field
research, then “speaking-and-listening-with-others” is the quintessential second-person
research practice (Torbert, 2001, p. 253). This interpersonal inquiry usually is
approached through one of three generic methods: (a) the single or “intrinsic” case
study (Stake, 1994), (b) several cases taken together, or (c) examination of a process that
occurs across a variety of cases. Valid case study research is created through detailed,
in-depth data collection and systematic analyses from multiple sources such as treat-
ment records, interview data, observations, documents, texts or artworks, and norma-
tive quantitative data. Ultimately, the researcher is interested in discovering what can
be learned from a particular encounter or encounters in the field that have bearing on
art therapy practice.
The mere mention of case research sends some art therapists into a vigorous debate
about its rigor. It is true that too often case studies are not research but simply the
observations of a therapist not actually engaged in a systematic process of valid inquiry.
As a result, subjective biases and assumptions often are embedded in the case record
and conclusions overdrawn. But those who claim that case research is weak because
its results are not generalizable confuse it with the goals of experimental research.
Case studies, if well constructed and based on systematic inquiry, can be generalized
provided that persons are the focus of study rather than variables (Gordon & Shontz,
1990b). Although case research is not effective for generalizing to larger populations,
they can generalize to theoretical propositions or to those people who share common-
alities of experience.
Case studies may be used to examine not only individuals but also any bounded
system. Patton (2002) defined a case broadly as the study of “a unit or units of analy-
sis,” such as individuals, groups, families, cultures, or people who share a common
experience or perspective. Cases may be geographically defined, such as a city, school,
neighborhood, village, region, or country. They may be organizations, projects, or units

within an agency, such as a particular treatment team or intervention program, and
organized around an activity such as a critical incident, celebration, crisis, time period,
or event (Patton, 2002).
Different researchers have different purposes for conducting case research. In an
intrinsic case study (Stake, 1995), the case is pre-selected; its purpose is not to illus-
trate some general problem but to learn something important about that particular case.
For an instrumental case study, the researcher starts with a question or problem that
can be more clearly understood by examining a case or cases in depth (Stake, 1995).
Another form, described by Gordon and Shontz (1990b), is collaborative or participa-
tory case research, in which carefully selected people are invited to self-examine how
they experience and manage an event or set of circumstances or situations that are
unique or important in life. The participants are considered to be “co-researchers” who
are regarded as expert informants because they know the topic first hand. For example,
in an art therapy study with a person who has aphasia, that person is approached as an
“expert” on what it is like to live with aphasia.
A suitable guideline in all case research is to frame the research problem as:
I WISH TO STUDY A PERSON WHO … BECAUSE …
“I wish to study a person who … ” is followed by a description of the intrinsic

condition, experience, or circumstance of interest. Next state your specific intentions of
the researcher and reasons for the study: “… because …”
You may, of course, apply the same question to any bounded system by substituting
“treatment team,” “neighborhood,” “elementary classroom,” “cultural event,” and so on
for “a person who … ”
Stake (1995) highlighted the importance of identifying particular issues to frame the
conceptual structure of the study. Framing the primary research question as an “issue”
will place the case in a larger context and will prevent the researcher from getting caught
up in personal, day-to-day content (Table 5.1). The template “I wish to study a person who
… because … ” is repeated as a second step, now to tease out the underlying issues that
may be present in the case. Such issue questions are dynamic and changeable, though;
issues will emerge, grow, and die as new observations come to light (Stake, 1995).
Conducting a Case Study

Carrying out a case study is much like being a detective. Sometimes the case researcher
is called an “investigator,” like the detective who arrives on the crime scene and pieces
the clues together to infer what happened. In a retrospective or historical case, the
researcher looks over past evidence and case records, and attempts to bring new insights
to bear on its interpretation. In a current or on-going study, case participants may also
TABLE 5.1 Examples of case research questions reframed as issues

1. A hunting example: “I wish to fish What strategies do experts use to
alongside my uncles because I want to catch fish under certain
learn how they know where the fish are environmental conditions? What
biting and why.” knowledge about fish is central to
their success?
2. An everyday example: “I wish to study How does the immigration
the life of my grandfather because his experience influence a family’s
unique experience with immigration psychological, social, and
influenced my family’s circumstances over economic behaviors over time?
several generations.”
3. An art example: “I wish to study a skilled What skills, knowledge, and
metalsmith because close observation of disciplined behaviors are required
the steps an expert takes in the process to be a successful metalsmith?
will help me get beyond the plateau of
skills I have achieved on my own.”
4. An art therapy example: “I wish to study How can art be used as a form of
a person who uses art to communicate communication?
his or her reality of living with aphasia
because I need this knowledge to create
a more effective therapeutic
relationship.”
become involved in piecing together the meaning of events, as in the case in a “life
review” in art therapy. Or the focus of the case may be here-and-now depictions of life
experience that are shared with the researcher.
Defining the problem: A case study problem usually is defined by considering how
certain people or groups deal with a unique or critical human decision and/or experi-
ence as guided by the question, and creating a detailed description of these conditions,
experiences, or circumstances of interest. A case study is an ideal choice for studying
unique events or people, or if you have access to clearly identifiable cases bounded by
time, place, and population, and you are concerned with in-depth understanding or
comparison (Stake, 1995).
Selecting the case or cases: Next, the researcher needs to identify the case or cases.
The choice depends upon the various perspectives of the problem, process, activities,
situations, or event that you expect the case to illustrate. Creswell (1998) recommends
selecting clearly identifiable cases with “maximum variation” in order to illustrate
diverse perspectives that in turn increase the value of the knowledge obtained. Selection
criteria (demographic or other specific identifiers) are developed to refine the research
question in order to guide the match between issues and appropriate cases. For example,
instead of framing the question as, “I wish to study an art therapy client in the inpatient
unit who is willing to be interviewed,” the researcher might state, “I wish to study an
art therapy client in the inpatient unit who is over the age of 50 and living with the
long-term effects of alcoholism.” Selection criteria may be applied to a single case,

more than one case from a single site, or to multi-site cases.
Defining roles: Relevant characteristics that you as the case researcher bring to the
study should be named and described as well. Personal biases or expectations about the
outcomes of the case that may influence the data are laid out as well. The precise nature
of the relationship between the researcher and the case must be identified, especially
if the participant is or is not part of the therapist’s active caseload (Gordon & Shontz,
1990b). This consideration is very important if you suspect that the role of facilitating
treatment could be at odds with your researcher’s role. Art therapists can manage this
concern in a number of ways that protect the research and the integrity of their thera-
peutic relationships. For example, you could study an inactive, earlier art therapy case
from a new perspective as a researcher. You might form a bounded research study group
whereby any therapeutic issues that arise are referred to a therapist who is not involved
in the study. Sometimes an art therapist will collect data within the context of on an on-
going therapeutic relationship and then adopt the role of researcher only after treatment
has ended and data analysis can proceed. Stake (1995, p. 103) advised the researcher to
clarify these role choices with respect to
r How much to participate personally in the case

r How much to pose as an expert
r Whether to be a neutral observer or a critical analyst
r How much to try to serve the needs of the readers of the case study
r How much interpretation to provide
r How much of an advocacy position to take
r Whether or not to tell the case as a story.
Identifying supervision or other helpers: A supervisor should meet regularly with

the researcher to monitor progress, review the case record, and advise the management
of the relationships between researcher and case participants. To keep the relationship
and progress of the inquiry clear, other case advisors may be called upon, such as a
research advisory or support group, or peer supervision group.
Introducing the project to the site and participants: All site-related procedures
should be identified as part of the data-gathering plan, including such details as gain-
ing access to sites or case referral sources, formal agreements and rules for continued
access to the site throughout the study, allocation of time for each phase of the study,
and intended audiences for the final case report. Relevant procedures and the potential
uses of the findings are discussed with the research participants. As in all research
with human subjects, the researcher must obtain written consent of all procedures
and assure participants of confidentiality and anonymity (see Chapter 8, on ethical
safeguards).
Documenting and gathering initial information: Initial interviews are used to
document the case participant’s relevant personal history, to assess how the participant
perceives the study problem or issue, to collect preconceptions about it, and to discuss
motivations for participating in the study (Gordon & Shontz, 1990b). From the initial
interview, preliminary conclusions about whether the participant is suitable for the case
study and how data collection may proceed should be discussed with a supervisor.
Data gathering through successive cycles: Data collection is usually extensive in
case research and draws on multiple sources of information. One choice to be made is
how much to rely on direct observation and how much to rely on coded data (Stake,
1995). Data is often “coded” or organized into categories that illuminate different
aspects of a certain issue. For example, if the issue is “engagement,” the categories may
be “active or passive,” “intense,” “mild,” or “no interest.” The researcher would identify
each instance in the data record that corresponds with the category, usually by marking
the transcript with a hatch mark or color code. Because it takes time to transcribe and
code responses, it may take several sessions of data collection before such information
can be “cycled back” to a supervisor or, in cooperative inquiry, to the co-researcher
for comment and clarification. Throughout the case study, the researcher continues to
develop descriptions of intrinsic events or moves into creative activities such as draw-
ing, painting, story telling, or art made in response to insights derived from previous
sessions.
SOURCES OF CASE DATA

r Interviews (open-ended and unstructured or semi-structured) with
individuals or as focus groups; with written notes and/or audio-tapes
or video-tapes and transcriptions; pilot or preliminary interviews with
follow-up sessions
r Observations (field notes or logs gathered as an observer and/or par-
ticipant in the setting, as an “outsider” or “insider”) on the subject as
well as in memos that preserve the context of what was seen, felt, or
experienced along the way
r Textual memos used to step back and reflect on coded data and capture
early hunches about their meaning, and conceptual memos that write
about categories of data and thoughts about their relationships as possible
theoretical developments
r Documentation of the researcher’s notes or journal, and such items as
clinical records, public documents (meeting notes, minutes, reports,
etc.), letters, journals or diaries, photos, videos, art, sounds, email, per-
sonal possessions or important objects, etc.
r Impressions and statements from other observers or participant-
observers, captured in observational memos
r Life histories and profiles, autobiographical and biographical information
r Test results and assessment
r Reflexive memos that capture self-observations and awareness of
emerging feelings and insights that have implications for making sense
of the data
LIVING WITH THE AIDS VIRUS: A REPRESENTATIVE

CASE (GORDON & SHONTZ, 1990A)
Gordon and Shontz (1990a) described a participatory case study with a 21-year-old
male (co-researcher) who had tested positive for the AIDS virus. Under supervi-
sion, they collected data on the co-researcher’s behavior, feelings, dream reports,
and artistic creations. The study design had two cycles of data collection and
confirmation that may be useful in future art therapy studies:
First Cycle/Exploratory: Collecting and examining personal history, domi-
nant issues, coping mechanisms, and critical incidents through sensory, behav-
ioral, and concrete forms of data such as interviews, observations, and formal
assessment. These were briefly summarized in a subsequent interview, clarified,
and checked for accuracy with the co-researcher.
Second Cycle/Expressive: This part of the inquiry was open to spontane-
ous or open-ended creative activities through metaphoric, symbolic, and intui-
tive forms of data such as dreams, art-based assessment, and art production. As
themes and motifs were identified, a variety of possible interpretations were con-
sidered and reconciled until an interpretation was mutually agreed upon.
Creating the “Portrait” of the Case: Once all the raw data are collected, Patton (2002)
recommends pulling everything together into a case record. All major information is
edited to remove redundancies, fitting the parts into chronological or topical order. In stud-
ies where data are complex or voluminous, this case record is used to create the final case
study narrative. The final narrative is a readable, descriptive picture or story that accurately
and holistically reflects all the major themes illustrated by the case. A valuable strategy
for art therapists in particular is to think about the case as if it were a portrait. Hoffmann
Davis (2003) wrote that “the research portraitist” works in similar fashion to an artist who
balances elements of context, thematic structure, relationship, and voice into an aesthetic
whole. The artist’s quest for coherence parallels the researcher’s concern with constructing
a narrative that truthfully and authentically portrays the central story of the case.
PORTRAITURE AS CASE METHODOLOGY

(Lawrence-Lightfoot & Hoffman Davis, 1997; Hoffmann Davis, 2003)
The artist-researcher stands before a subject in a relationship of mutual trust;
from the artist’s eye emerge the main forms that are central to this figure being
interpreted on the canvas of the research study. How will the artist organize emer-
gent themes into a central whole that makes sense to the viewer and is an authen-
tic portrayal of the subject of the work? Does everything fit? Does this look right?
Artist and subject reflect on the work together. In the organization of the central
shapes against a backdrop that illuminates the whole, the subject considers the
portrait and nods with a look of surprise, saying, “Yes, I can see that is me.”
PORTRAITURE AS CASE METHODOLOGY

(Lawrence-Lightfoot & Hoffman Davis, 1997; Hoffmann Davis, 2003) (Continued)
The artist has been measured in his or her portrayal, careful not to turn the
image into a treatise on a particular quality but more intent on portraying the per-
son he or she has come to know from days of looking, painting, and relationship
building. “This image is about you,” the artist shares, “but it is my vision of you,
so it is part yours and part mine.” The subject has allowed the artist-researcher
to look and see because the subject knew he or she would not be betrayed in the
artist-researcher’s expression of his or her vision.
After weeks of careful review of interview transcripts, artworks, field notes,
and other data, things start to come together and major themes emerge that seem to
authentically organize the researcher’s interpretation of the case. The artist-researcher
critiques and revises the selection and portrayal of form through a lens that is shaped
by an understanding of this particular subject and broader knowledge on which it
resonates. He or she has tested the themes across relevant dimensions and has cre-
ated a backdrop as if on the canvas of the portrait made out of the data selected from
a close study of the case. This backdrop illuminates a case portrayal as surely as the
negative space on a canvas makes its positive counterpart more vivid.
Attending as an artist does to aesthetic details such as metaphor, vivid
description, and cohesive comprehension, the research portraitist creates a bal-
anced whole that is grounded in rigor yet is accessible to others. Like any research
initiative, portraiture is driven by a research question or questions and the work
is informed by that question. The dialectic between the process and the product
of the carefully constructed case portrayal is used to bridge the distance between
the artist’s studio and the researcher’s fieldwork.
Second-order data analysis: Once the case study is written, analytic strategies may
be used to further analyze, compare, and interpret across several cases in order to gen-
erate cross-case themes, patterns, and findings (Patton, 2002, p. 452). The search for
patterns or recurring words, images, or themes usually is undertaken in order to locate
core consistencies across different cases. A common problem in data analysis, however,
is getting stuck on topical categories rather than uncovering deeper themes and issues.
To counteract this tendency, ask yourself: What is going on here? Are there discrepan-
cies in what people are doing and saying? What am I not seeing or hearing? What am
I taking for granted? How does the context (social, cultural, political, psychological,
familial, or organizational, etc.) influence what is occurring here?
The researcher also may look for linkages and the consistency within certain con-
ditions known as “correspondence” (Stake, 1995). For example, from the patterns in the
data, a researcher may see that the dropout of participants in a voluntary art therapy
group corresponds with their feelings of psychological safety, or that a discussion of
feelings is patterned on gender roles. The final stage of analysis confirms the patterns,
themes, and categories that emerge from the data analysis by testing for authenticity and
deducing relationships that exist among the concepts found in the case.
Concluding the study: To conclude the study, the researcher reviews the case with the
supervisor to identify consistencies that unify the research material or that reveal differ-
ent perspectives, interpretations, and questions (Gordon & Shontz, 1990b). In co-inquiry,
a case summary condenses the emerging themes into accessible language that is shared
with the co-researcher participants in a final interview. The co-researcher is encouraged
to reply, comment, and improve the summary and, in essence, validate the case summary
for accuracy. To write up the case into a publishable or professionally presentable report,
the researcher may find the suggestions offered by Stake (1995), below, to be helpful.
HOW TO WRITE A CASE REPORT WITH

MAXIMUM EFFECTIVENESS (STAKE, 1995)
r Open with a vignette to help readers connect with the case.
r Identify the issue, purpose, and method of the study, to provide the
reader with an understanding for why the case was selected.
r Describe the case and its context with enough detail to provide the
reader with a full understanding and the feeling of having been there.
r Present and develop the key issues so that the reader can grasp the com-
plexity of the case and so that the people involved are not “flattened”
into a stereotype, diagnostic label, or other simplistic treatment.
r Bring in confirming and disconfirming evidence as the case probes a
little further into the main issues and subsequent interpretations.
r Summarize the case by examining how the case changed or chal-
lenged prevailing ideas through new evidence.
r Close with a realistic scenario that reminds the reader about the rich-
ness or complexity of the case just encountered.
Validity and Strategies for Improving

Case Research
Although case research produces descriptive richness not seen in quantitative approaches,
it must surrender the objective strength of the latter’s insistence on observable, system-
atic measurement. In lieu of statistical tests, which tell the researcher whether an obser-
vation or pattern is significant, qualitative findings such as those found in case study
research are judged by their substantive significance (Patton, 2002, p. 467). Patton
explained that first, the researcher uses first-hand experience and intellectual rigor to
ensure that the findings are balanced and comprehensively grounded in the perspectives
of others. Second, the researcher takes into account the authenticity of the responses
of those who participated in the study. Third, the researcher considers the responses
of supervisors or others who reviewed the results. When all three sources agree, the
researcher can assume to have reached consensual validation of the study’s substantive
significance. For example, an art therapist creating the case study of a person with
aphasia who uses art to communicate examines the authenticity of the findings from
the perspective of direct experience with the coresearcher, and asks the coresearcher to
review the case study so as to verify whether an accurate picture of the coresearcher’s
experience of aphasia has been achieved and rings true. The case supervisor, likewise,
reviews the study to verify whether it stayed true to its focus, whether contradictions or
biases were addressed by the researcher, and the extent to which the study aligns with
the supervisor’s expert reading of the intrinsic interests of the study.
Despite these strategies, subjective bias is often a problem in case study research
and can interfere with validity. The researcher’s perspective may influence how certain
information is selected while suppressing, distorting, omitting, or failing to observe
or recall other important information. Two common strategies used to reduce bias are
triangulation and member checks. Triangulation generally means using multiple per-
ceptions to clarify meaning and to verify the repeatability of an observation or interpre-
tation (Stake, 1994). Member checking is a strategy that asks the research participants
to examine rough drafts of the case report where their involvement is featured. Both
strategies are used to open up the researcher’s perspective, although the researcher
should be cautioned that member checking and triangulation may at times create condi-
tions that strengthen rather than reduce subjective bias.
TRIANGULATION
Triangulation means collecting data in ways that allow for a convergence of at
least two pieces of data, either through different methods, over a long period
of time, or using different reports about the same event by two or more partici-
pants. Testing one source against another helps to eliminate inadequate alterna-
tive explanations.Stake (1995) identified four triangulation protocols:
Data source triangulation: Do the case findings remain the same at other times,
in other contexts, or when people interact differently? Observations and reporting
should carry the same meaning when found under different circumstances.
Investigator triangulation: Different investigators can be involved to look at
the same scene or phenomenon, for example, having two observers collect field
notes on the same art therapy session or asking two or more art therapists to
respond to client artwork with artwork or other interpretations.
Theory triangulation: The same phenomenon is described by different theorists
in similar detail, a strategy that helps uncover alternative explanations or disconfirm
assumptions.
Methodological triangulation: A review of records may be triangulated against
direct observation; what a case participant says in an interview may be reviewed
against art images created in session. Multiple approaches within a single study help
to illuminate or nullify some extraneous influences. For example, a comparison of
the researcher’s observations with a supervisor’s may reveal an entirely different set
of possibilities operating in the case that were not seen by the researcher.
Finally, Janesick (2004) identified the following qualities of an exemplary case

study that researchers can use to evaluate and improve their work to meet expecta-
tions of rigor:
r The case is significant: It reflects to an unusual degree a real-life situation

that others may not have been able to study previously, and it illuminates
issues that are important to advance the knowledge of both the researcher
and the profession.
r The case is complete: Interpretations of meaning are created from evidence
that is compelling, relevant, and thorough.
r The case study is engaging: A reader can readily imagine what took place through
the use of rich, descriptive language, art imagery, and vivid examples.
r The case is descriptive of who the participant(s) are, why they were selected
and under what circumstances, what the rationale was for doing the study,
what questions were addressed through data collection, and how findings
were interpreted.
r The research design is logical: Data are linked to the propositions that
guide the study (question, purpose, unit of analysis or study, rationale for
why the case is intrinsic), and criteria for interpreting the data look for
emerging points of tension or themes rather than a single over-arching
explanation.
r The study is valid: Data are collected from multiple sources; multiple per-
spectives are brought to bear on the analysis; interpretation is consistent with
the text and supported by data cited.
A SEARCH FOR HOME: THE ROLE OF ART THERAPY

IN UNDERSTANDING THE EXPERIENCES OF BOSNIAN
REFUGEES IN WESTERN AUSTRALIA (FITZPATRICK, 2002)
This case study examined the refugee experiences of Bosnian women
through individual interviews and 4 weekly group art therapy sessions
developed in response to dominant issues that arose in the interviews. A
range of simple art activities, including a visual lifeline, provided an explo-
ration of themes relating to home, journey, loss, and the challenges of bridg-
ing past and present. The author asserted that the “literal and symbolic act
of creating something out of nothing is crucial in activating and maintaining
inner change and recovery” (p. 157). The study concluded that art therapy
provides a powerful means for remembering, mourning, and reconstructing
experiences of trauma.
NAMING THE ENEMY: AN ART THERAPY

INTERVENTION FOR CHILDREN WITH BIPOLAR
AND COMORBID DISORDERS (HENLEY, 2007)
Treatment and diagnosis for the pediatric form of bipolar disorder presents a
clinical challenge given the differences from its adult counterpart and the various
comorbid forms that complicate presentation and developmental course. This arti-
cle discusses manifestations of early-onset bipolar disorder and offers a method
for implementing art therapy interventions based on a study of 184 sessions with
16 children over the course of 2½ years. Instrumental case vignettes are presented
to illustrate four forms of bipolar disorder, representative of 16 cases of children
aged 9 to 15 who received 32 trials of the art therapy intervention. Clinical assess-
ment, intervention, and artistic/behavioral outcomes are analyzed accordingly,
mainly within psychodynamic and object relations approaches to art therapy.
ETHNOGRAPHY
Ethnography is the study of how people conduct themselves in the context of their cul-
tures. Culture is a way that people come to see, interpret, transform, and communicate
their understanding of reality. In field research, ethnography can be “second person”
inquiry engaged in face-to-face encounters with people or “third person” inquiry with
organizational and community-based studies that embrace culture as a central element.
Historically, ethnographic anthropologists studied exotic and remote cultures through
the lens of “otherness” that was closely associated with Western colonialism, the effects
of which still persist today. The corrective influence of postmodern, feminist, anti-rac-
ist, and other critical theories, described later in this chapter, has moved ethnography
toward greater focus on the implicit power imbalances, privilege, and politics that may
be perpetuated in the ethnographer’s perspective.
The purpose of ethnographic research is cultural understanding. Eschewing the tra-
ditional role of the researcher as expert, ethnographers openly seek to be taught by people
who are approached as experts of their own culture (Bogdan & Biklen, 1982). Typically,
the research examines the cultural group’s day-to-day behaviors, customs and norms, and
life concerns. Ethnography may study the effects of particular social problems and devel-
opments within a culture, such as globalization, environmental degradation, consumer-
ism, or computer gaming. Art therapists who take an ethnographic approach to research
may want to study the cultural implications of certain therapeutic methods, treatment
delivery systems, assumptions about health and illness, or meaning given to art imagery.
The importance of understanding culture, especially in relation to change effects of all
kinds, is the foundation of modern, applied ethnography (Chambers, 2000).
According to art therapist Spaniol (1998), ethnographic-oriented researchers often

are concerned with effecting positive changes in people’s lives. They realize that the
very act of obtaining knowledge can create change because it brings to light what was
previously invisible. Visibility is especially important for marginalized groups; it can
be empowering and liberating. New knowledge about people within a culture can also
become a mandate for change, for individual art therapists as well as for the agencies in
which they work and the profession at large (Spaniol, 1998).
Basic questions in ethnographic research are
r What is the culture of this group?
r What are the cultural features that appear when asking certain questions of
people?
r How does a culture assimilate, adapt, or in some way respond to a given
circumstance?
Ethnographers typically address these questions by their unobtrusive immersion in
the culture of interest.
EXAMPLES OF ETHNOGRAPHIC QUESTIONS

r A hunting example: What are the cultural values expressed by families
who continue in the hunting tradition and pass hunting lore down from
parent to child?
r An everyday example: What “planet” is my teenage daughter living on?
Her world is unfamiliar to me and not the same as it was when I was her
age. What can I do to understand her better and the culture of her peers?
r An art example: What are the ethics of appropriating or using imagery
in my paintings that derive from a culture that is not my own?
r An art therapy example: What could I learn if I immersed myself in
a setting where people who are homeless gather to make art? What
might become visible to me that would help art therapists understand
something essential in their work?
Ethnographic research contains all of the key elements of participant-observation

already described: the researcher immerses in the culture of interest for an extended
period of time; learns and uses local, everyday language; actively observes as well as
participates in daily, routine, or extraordinary activities that define the culture; often
makes observations informally or by “hanging out”; records observations in field notes;
and uses both tacit and explicit information in writing and analysis (DeWalt & DeWalt,
2002, p. 4). Through these activities, the researcher attempts to uncover rich layers of
socio-cultural practices and to arrive at a core understanding of how certain behaviors
and values come into being (Finkelstein, 2005). Art therapists whose practices involve
them in a culture that is not primarily their own may find that their research and practice
questions are especially conducive to an ethnographic approach.
Key Informants
Typically, the art therapist conducting an ethnographic study will look for individuals
who are members of the cultural group that can provide useful insights as well as help
the researcher access valuable information. Spaniol (1998) described the “snowball-
ing” approach to selecting participants for her study, in which finding and interviewing
one key informant led that person to recommend another group member who, in turn,
identified others interested in participating with valuable perspectives to add. These
informants usually are not clients in primary treatment with the researcher, however,
given that the research aim of explicating cultural norms and behaviors could poten-
tially intrude on a client’s needs in a therapeutic relationship. Researchers are to be cau-
tioned, as well, that considerable time and relationship building within a setting may
be required before carrying out an ethnographic study. Ethnographers must be alert to
opportunities and practices that build trust, rapport, and confidence among those with
whom they share a cultural interest.
Field Issues
An ethnographic researcher is sensitive to how information is collected and shared, the
degree of collaboration that is needed to honor the voices and stories of the informants,
and any promises of reciprocity or tacit expectations that informants might harbor
through their participation. For example, in the course of an interview, the art thera-
pist might suggest that an art exhibition could be an outcome of the study—but is that
a realistic expectation or is it simply a suggestion designed to win the cooperation of
the informant? The researcher must be clear about roles as well—do the participants
understand what an art therapist is doing in their midst or do they mistakenly think
their participation will secure social services or other provisions for their families? The
impact of the art therapist on the people or setting should be such that it does not inter-
fere, disrupt on-going relationships, or cause harm, deception, or ill will. Reciprocity as
an ethnographic principle asserts that participants will not be exploited and will receive
something of value in exchange for their participation.
A significant issue in ethnography and all participant-observation research is the
tension between emic and etic perspectives. Etic refers to the perspective of those out-
side the culture, whereas emic is the perspective held by insiders. Some argue that
ethnographic research is best conducted by those who are not part of the cultural group
being studied because their perspective sheds light on what cultural group members
cannot see themselves. However, the etic perspective has been criticized for privileging
the voice and power of the researcher over the culture group members in creating cul-
tural texts or narratives. A middle ground is to take in both perspectives, being guided
and corrected by the first-hand experiences of insiders while also using the etic tools of
social science research.
Ethnographic Interview
Data are gathered by means of fieldwork observations, interviews, and artifacts that help
portray the cultural contexts under study. The primary methodological tool is the semi-
structured, open-ended ethnographic interview. The ethnographic interview is distin-
guished from other types of interviews or surveys in the fact that the questions derive from
the informant’s culture rather than from the language of the social scientist (Spradley,
1979). Spradley (1980) listed cultural dimensions that provide a useful initial framework
for guiding observations, organizing interviews, and analyzing the data collected:
r Space and Time: The physical, emotional, visceral, and psychological experi-
ence of the cultural setting is observed, being attentive to how and where events
occur or are sequenced in time. There may be unique features of the space or
orientation to time (past, present, and future). Some cultural expressions of belief
or certain behaviors may change over time or within different generations.
r Actors: The people involved may reveal how individuals, groups, or family
members interact within the broader cultural system. Intergenerational influ-
ences, norms, and practices in different contexts (educational, religious, social,
organizational, etc.) shape cultural behavior. Key actors may be observed par-
ticipating in events and activities within culturally significant roles.
r Act and Activity: The single actions that people do may be observed and
described, or a set of related acts or practices that have cultural meaning.
r Objects: The physical things that are present within a cultural context may
carry unique or specific meaning, or play an important role.
r Events: Some social activities that people carry out may be especially signifi-
cant and function as “windows” into cultural expression, such as celebrations,
organizational meetings or reunions, rites and rituals, or unexpected happen-
ings. Some events mark important transitions in a family or group life, such
as weddings, funerals, leaving home, welcoming new members, or difficult
turning points like a separation, accident, or illness.
r Goals: The things people are trying to accomplish may be described to reveal
different patterns of expectations and cultural norms for behavior.
r Feelings: The emotions felt or expressed in all of the above may be under-
stood for their relationship to cultural beliefs, values, and worldviews.
Spaniol (1998) observed that by accessing people’s thoughts, feelings, experiences,

and actions, the researcher will explore and gradually will attempt to describe their
reality. The details of how members think, feel, and make sense of their daily lives
combine into vivid portrayals of people’s lives. Meaning emerges only after long peri-
ods of deep immersion and familiarity with the collected data. Many of the data gather-
ing and analysis methods described earlier in this chapter, in action research and case
research, may be used in the ethnographic approach. Patton’s (2002) guidelines for
creating a detailed, information-rich case record are helpful when the “unit of analy-
sis” is a culture or group of people who share values, norms, attitudes, traditions, and
artifacts.
TOWARDS AN ETHNOGRAPHIC APPROACH TO ART

THERAPY RESEARCH: PEOPLE WITH PSYCHIATRIC
DISABILITY AS COLLABORATORS (SPANIOL, 1998)
Spaniol presented an ethnographic pilot study based on an assumption that people
with psychiatric disability can be regarded as members of a culture identified as
“disability culture.” It requires the art therapist-researcher to approach partici-
pants in an art therapy program as an anthropologist entering another culture—
with respect, humility, and a willingness to disregard professional biases as much
as possible. The evolution and implementation of a pilot study designed by the
author to develop and clarify the principles of the ethnographic approach are also
discussed. Results of the study derived from a thematic analysis of field observa-
tions and interviews are included to suggest possible directions for future research
using this method. The article concludes with specific recommendations for art
therapists who want to use this research approach.
IMAGE MAKING AND PERSONAL NARRATIVES WITH JAPANESE-

AMERICAN SURVIVORS OF WORLD WAR II INTERNMENT CAMP
(YATES, KUWADA, POTTER, CAMERON, & HOSHINO, 2007)
Although not explicitly described as an ethnography, this study contains many of
its key features. Through in-depth interviews and artworks, the authors explore
the cultural themes in memories recalled by six Japanese-Americans who were
interned during WWII. Everyday life in the camp was described as well as how
the internees dealt with the trauma of the experience. The authors identify seven
prominent themes: (a) stressful living conditions in camp, (b) art and creativity
for survival, (c) loss and deprivation, (d) separation or division of family and com-
munity ties, (e) disruption of identity, (f) resilience and reaffirmation of values,
and (g) the need for legacy and social justice. The study found that participants’
internalized shame from being labeled “enemy aliens” had evolved into an exter-
nalized concern for discriminatory actions against minority groups that were
marginalized by war.
Phases of the Ethnographic Investigation

Phases of the investigation follow that of case research as applied to interactions
with cultural informants and groups, beginning with gaining access to the site or
culture, defining power relationships and roles that are congruent with the demo-
cratic values of ethnographic research, and introducing the study to cultural infor-
mants. Participatory data collection activities and cycling written narratives back to
informants to review for accuracy are critically important elements of ethnographic

methodology.
Data analysis begins with writing a straightforward, factual description of the
cultural group, setting, and events, to answer the question, “What is going on here?”
(Wolcott, 1994). Next, this description is fleshed out by describing a chronology or
“day in the life” of a group or individual with progressive focus placed on critical or
key events or interactions that provide a structure around which to develop a “story”
told through different perspectives. Once these materials and descriptions are col-
lected and organized, Morse and Field (1995) suggest basic steps in the data analysis
process:
1. Comprehending or making sense: The researcher sorts the data and codes
them to identify major themes and/or uncover underlying stories, such as
reviewing the text of an interview and highlighting repeating word images
and actions, phrases, or ideas.
2. Synthesizing or “taking an average”: As the researcher studies and works
with the texts, individual stories begin to collect into composite descriptions
of people’s lived experiences.
3. Theorizing or “fitting” data to a model or models: Once certain themes, sto-
ries, or tentative explanations emerge, the researcher draws inferences from
the data and searches through various theories to find the best fit for the
data. The researcher also allows that the interpretation is the researcher’s
own (“This is what I make of it,” or “This is how the research experience
affected me”) (Creswell, 1998).
4. Recontexualizing or developing theory: Finally, the researcher attempts to
generalize the emerging theory by relating salient aspects of it to other
settings, situations, and populations. The researcher may create expres-
sive interpretations through storywriting, creative fiction, artworks, or
performance.
Creswell (1998, p. 183) recommended the thematic narrative structure developed

by Emerson, Fretz, and Shaw (1995) for writing the final ethnographic report: (a) intro-
duce the study in a way that engages the reader and links the study to wider issues in
art therapy; (b) introduce the setting and methods used to learn about it, how access
was gained, and how you (the researcher) managed your role in the cultural setting; (c)
present each analytic point with background information, excerpts or quotes from key
informants, and interpretive commentary to situate the point in the larger context; and
(d) conclude by reflecting on the study and relating it to a general theory, current issue,
or meta-commentary on the thesis or assumptions of the study.
Ethnographers often are interested in using evocative language to communicate
an empathetic, holistic portrait of the culture. They may use metaphors, illustrations,
examples, cases, vignettes, excerpted quotes, and narratives. The researcher strives for
vivid details, contexts, and emotions in order to convey a “thick description” of what
it feels like to witness the cultural group, as if the reader could vicariously experience
what the key players or researcher experienced.
Validity Issues and Verification Strategies

in Ethnographic Research
Like case researchers, ethnographers in the past did not always follow procedures that
helped to verify and strengthen their claims to knowledge. Also as in case research,
the most common procedure for improving validity in ethnography is the triangula-
tion of data sources. For example, the perspective of one key informant (such as a
teacher in a bilingual school) can be compared against other perspectives obtained
from people with different roles, functions, or experiences within the culture (such
as students, parents, or grandparents). In keeping with the collaborative principles of
contemporary participant-observation mentioned earlier, ethnographers use member
checks with co-researchers and cultural informants in order to monitor authenticity
and accuracy in their descriptions or reports of findings. Finally, the overall quality of
an ethnographic study can be checked with evaluation criteria (Spindler & Spindler,
1987), outlined below.
EVALUATION CRITERIA FOR ETHNOGRAPHIC

STUDIES (SPINDLER & SPINDLER, 1987, P. 18)
1. Observations are contextualized.
2. Hypotheses emerge in situ (directly from the site) as the study goes on.
3. Observation is prolonged and repetitive.
4. Through interviews, observations, and other eliciting procedures, the
native (emic) view of reality is obtained.
5. Knowledge is elicited from informant-participants in a systematic way.
6. Instruments, codes, schedules, questionnaires, interview outlines,
and so forth are generated in situ (directly from the site) as a result of
inquiry.
7. A transcultural, comparative perspective is frequently an unstated
assumption.
8. The researcher makes all implicit information explicit to informants.
9. The ethnographic interviewer does not predetermine responses by the
kinds of questions asked.
Despite increased interest in cultural aspects of art therapy, there are few pub-
lished examples of ethnographic research in the art therapy literature. Studies that
involve culture tend to be written solely from the perspective of an art therapist
“expert” treating members of a minority group. The literature is sparse on cultural
insight and heavy on art therapy program description or analysis of art images pro-
duced by participants. In consideration of the challenges of conducting ethnographic
research, I would speculate that art therapists are generally unfamiliar with cultural
anthropology or socio-cultural systems thinking. Ethnographic studies also require
extensive data collection and time in the field, making it difficult for practitioners
or graduate students to carry out a truly ethnographic study. On the other hand, the
“storytelling” approach in presenting ethnographic research appeals to the creative
sensibilities of art therapists. When expanded through visual-narrative methods such
as photography, videography, and other new media venues, ethnography may emerge
as a vibrant method for contributing to the cultural knowledge base of the art therapy
profession. A useful adaptation for art therapy, therefore, may be smaller scale stud-
ies where the art therapist adopts an “ethnographic lens” to collect or interpret data
combined with other qualitative methods.
The intensive nature of ethnographic research, given the immersion in the daily
context and patterns of an unfamiliar culture, may result in a researcher’s personal jour-
ney (Gilroy, 2006). Gilroy (2006) cautioned that reflexivity can be a difficult concern
to manage, such as needing to remain marginal to the experience and not getting taken
over by it, or taking ownership of how one’s own cultural history may influence percep-
tions and observations of the culture under study. Thus, the findings of an ethnographic
study must be understood to be limited in the sense that they are a construction based
on the researcher’s interpretation of the experience and its meanings.
CRITICAL-ORIENTATIONAL PERSPECTIVES
ON ETHNOGRAPHIC RESEARCH
Art therapist Susan Spaniol has made several contributions to the art therapy literature
that derive from the participatory values of ethnographic research and its challenges to
some of the dominant practices in the profession. In her 1998 article, Spaniol described
the evolution of her person-centered approach to people with psychiatric disabilities that
fundamentally reoriented her perspective on art therapy. Rather than helping patients
in need of a cure, she started seeing her clients as members of a micro-culture with
expertise to share about their condition. She wrote, “Each art therapy session is a trans-
cultural encounter because each individual belongs to a variety of micro-cultures such
as family, religion, occupation, age, gender and class” (p. 29). The ethnographic lens, as
applied to art therapy practice, requires the art therapist to set aside preconceptions and
to become sensitized to the reality of clients’ lives, treating clients with all the respect
and humility one would with any cultural group. Professional “helping” roles may need
to be relinquished in favor of egalitarian principles and broader conceptions of practice
beyond the treatment setting.
Likewise, I have described how the practice of cross-cultural art therapy called me
to put aside many assumptions of practice and think about the impact cross-cultural
encounters make possible (Kapitan, 2006a). By asking how research is oriented toward
power, agency, and voice, one may acknowledge differences between the power of the
researcher and the researched, the research process itself, and the power of those who
assume authority when writing and presenting the research. Who conducts the research,
who analyzes the data in what language, and where they are analyzed make all the dif-
ference in explaining the findings (p. 51).
These and other insights can be traced to “orientational” or “standpoint” perspec-
tives that question the particular view upon which research knowledge is constructed.
Standpoint is a concept that challenges the taken-for-granted assumptions of researchers
who approach a culture with a “view from above or a view from no-where” (Naples,
2003, p. 85). That is, researchers who “suspend” their cultural lens to view the other
may actually be creating an illusory truth at best and perpetuating racial oppression or
cultural imperialism at worst. Standpoint theories intertwine research with the politics
of advocacy and a political agenda for reform in order to challenge research assump-
tions that do not take into account issues of social justice.
Among the most influential theories today that expose these assumptions is queer
theory, which challenges the standpoint of gender and its taken-for-granted assump-
tion that gender is an innate condition rather than a constructed, on-going process of
negotiation with identity. Black liberation theory deconstructs the forces of oppres-
sion and the control of knowledge to reveal how race, class, and gender interlock
(Bell, 2001). Feminist perspectives center on women’s diverse situations and the insti-
tutions that frame those situations (Oleson, 1994). Critical theory is concerned with
empowerment, often with respect to the restraints placed on people due to their race,
class, and gender (Fay, 1987). Although space does not permit detailed discussion
here, all of these critical-orientational theories are worth studying in their attempt to
expose the often-implicit ideological or political perspectives that frame participant-
observation field research. Such critical inquiry is focused on helping people liberate
themselves from the constraints placed on them via mainstream conceptions, struc-
tures, and images.
In the art therapy literature, Spaniol’s (1998) descriptions of the sense of con-
nectedness and equality she strived to achieve between herself as a researcher and
her co-researcher participants illustrate one of the main principles of feminist inquiry.
As Spaniol alluded to in her account, an unresolved quandary of the ethnographic art
therapist is that “no matter how welcome [her] presence may appear to the ‘natives,’
fieldwork represents an intrusion and intervention into a system of relationships … that
the researcher is far freer than the researched to leave” (Stacey, 1991, p. 115). A femi-
nist perspective acknowledges the inherently unequal reciprocity with informants and
supports change-oriented, consciousness-raising activities particularly with respect to
power, privilege, and researcher reflexivity (Guerrero, 1999, pp. 16–17). As discussed
in the next section, some of the most promising research today is developing out of this
awareness in collaborations of culturally diverse activist groups making collective deci-
sions with others through sustained, democratically organized projects.
Art therapy research is well served when a critical lens is applied to any research
design before the study is carried out in the field. Knowledge, after all, is power. If we
broaden our epistemological framework, we can think of other types of power beyond
the traditional cognitive basis of knowledge that serves to objectify and control reality.
Park (2001) wrote that with reflexive and relational knowledge “people come to feel
that they are not alone but part of a larger whole that sustains them as connected social
beings. That is the power of solidarity” (p. 87).
QUESTIONS TO ORIENT RESEARCH VALUES TOWARD

EMPOWERMENT (METENS, AS CITED IN CRESWELL, 2003)
1. Did your research problem arise from a community of concern?
2. Did your research approach require quality time and commitment to
the people with whom you are conducting the research?
3. Does your design consider the ethical concerns of the participants?
4. Are your participants associated with discrimination and oppression?
How have they been labeled?
5. Can you improve the sample to increase participation from tradition-
ally marginalized groups that they may be adequately and accurately
represented?
6. Will the research process and outcomes benefit the community being stud-
ied? Will it open up avenues for participation in a social change process?
7. Will your findings be credible to that community? How will you com-
municate them effectively?
PARTICIPATORY ACTION RESEARCH

Why do we do research? Who benefits from the knowledge obtained? How is the knowl-
edge used? To grasp the central ideas of the “people’s research” known as participatory
action research (PAR), we begin with questions that challenge how research is created,
carried out, and disseminated. Traditionally, research is conceived by experts who think
up questions that are shaped into studies and carried out “on” people, their subjects. The
subjects are “subjected to” a variety of quantitative or qualitative procedures, producing
data that are analyzed by the researcher and taken away to be written up for someone’s
thesis or publication credit. Even when the researcher is a sensitive, caring art therapist
who believes that the study is in the best interests of the subjects or, by proxy, of the pro-
fession, those interests are defined by the researcher and not the subjects. As the senior
editor of a scholarly journal, I witness the unfortunate outcome of this process in the
research reports submitted, ranging from researcher-biased surveys on self-selecting
groups of people to detailed analyses of artwork produced in a single session by a single
individual generalized to whole categories of diagnoses, cultures, personality struc-
tures, brain functions, and psychological theories. While these are offset by many well-
designed studies, my point is that the natural trajectory of the thinking behind much
conventional research systematically excludes those who are being researched and turns
them into objects used by knowledge-producing and knowledge-consuming elites.
PAR turns this situation around: Those who traditionally are the subjects of the
research take the matter into their own hands and decide what problems are worth
investigating and how to go about analyzing their own situations and finding solutions.
PAR is distinct from other action research, especially with respect to the role that non-
experts play. In participatory research, “the silenced are not just incidental to the curi-
osity of the researcher but are the masters of inquiry into the underlying causes of the
events in their world” (Gaventa, 1993, cited in Fine, et al., 2003, p. 175).
Like other action research, the process of change is the main driver of PAR. PAR
is collectively organized action research in which ordinary people address common
needs arising in their daily lives and, in the process, generate knowledge (Park, 2001,
p. 81). Historically, PAR is grounded in the work of populist Brazilian educator Paulo
Friere who articulated the belief that “people have a universal right to participate in the
production of knowledge, which is a disciplined process of personal and social transfor-
mation” (1997, p. xi). Non-governmental organizations as well as groups organized by
disenfranchised or marginalized people are emerging as leaders in this research para-
digm, given that those who have been marginalized within their societies often know
the most about the social problems that exist and how they affect people’s lives. Friere
found that long-term social change is possible when local people actively participate in
a long-term process of critical consciousness-raising, described below.
PAR QUESTIONS FROM THE THREE DEVELOPMENTAL

STAGES OF CRITICAL CONSCIOUSNESS (FREIRE, 1997)
Naming: What are the most dehumanizing problems in our lives? Should
they be this way? How should they be?
Reflecting: Why do these problems exist? Who or what is to blame? What is
our role in this situation?
Acting: What can be done to change this situation? What should be done?
What have we done, or will we do?
PAR typically is organized via community-based social action projects that

are dedicated to understanding or evaluating their impact on the social issues and
problems of a community. One can find PAR operating in community counseling,
medical research, violence prevention, non-profit organizations, public policy, anti-
racist education, adult literacy campaigns, local development, and myriad other
projects throughout the world. In addition to standard social science research tools
such as questionnaires and interviews, PAR methods may take the form of street
theater, storefront galleries, group dialogues, town hall meetings, political organiz-
ing, educational camps or retreats, intercultural exchange programs, micro-eco-
nomic grants, women’s cooperatives, intergenerational day care centers, and video
or photo documentaries. Art therapists who are interested in research for social
change may be drawn to participate in these democratic, multicultural, multidis-
ciplinary action research groups. Golub (2005) observed that in social action art
therapy, the therapist can facilitate a process of artmaking “by which communities
name and understand their realities, identify their needs and strengths, and trans-
form their lives in ways that contribute to individual and collective wellbeing and
social justice” (p. 17).
To sort out the commonalities that unite the broad diversity of PAR, Hall (1981)
summarized three characteristic criteria: (a) PAR focuses on communities that have
traditionally been exploited or oppressed; (b) PAR is a process of research, education,
and action to which all participants contribute their skills and knowledge, and through
which all participants learn and are transformed; and (c) PAR works to address both the
specific concerns of the community and the fundamental causes of oppression with the
goal of achieving positive social change.
Added to these are basic principles outlined by Patton (2002, p. 185) that define
fully participatory research:
r The research project involves participants in learning research skills, establish-

ing priorities, focusing questions, interpreting data, data-based decision mak-
ing, and connecting processes to outcomes. Participation is real, not token.
r Participants own the inquiry. Community members own the results and
determine how the information will be used to address their concerns.
r Participants work together as a group with a facilitator who supports group
cohesion and collective inquiry.
r All aspects of the project are undertaken in ways that are meaningful and
make sense to the participants.
r The researcher acts as a facilitator, collaborator, and learning resource; par-
ticipants are co-equals.
r The researcher values the participants’ perspectives and expertise, and works
to help the participants understand each other’s perspectives and expertise.
PARTICIPATORY ACTION RESEARCH DESIGN

METHOD EXAMPLE (CHATAWAY, 2001)
In PAR, research design decisions emerge from the participating community or
group process. In Chataway’s PAR with a Native-Canadian community, the fol-
lowing general methods steps occurred over a period of 3 years:
1. Information gathering (immersion in the community)
2. Problem definition (creation of research questions)
3. Instrument design (interview schedule, dialogue group agenda)
4. Data collection (interviews, questionnaires, focus group, dialogue group)
5. Collective interpretation of results (written summaries, group discus-
sion, feedback on papers for publication)
6. Cycling back to earlier steps (refine and re-develop research ques-
tions, adapt instrument design, return to data collection and collective
interpretation)
7. Action steps (individual use of new skills and language, dialogue group)
8. Cycling back to earlier steps (based on the outcomes or goals of the
action steps)
PAR Methodology With Art Therapy

Although there is no single PAR methodology, the community development model
of PAR based on the research of Maguire (1987) and Dickinson (2003) can be illus-
trated through my experience as an art therapist PAR facilitator with Cantera (Centro
de Comunicación y Educación Popular), a nonprofit community health and education
organization in Nicaragua. Cantera’s mission is “to enable people, united in their diver-
sity, to be protagonists in building a more human, egalitarian and sustainable society”
(Cantera, 2007, para. 6).
Access and establishing relationships: PAR begins with establishing relation-
ships between the researcher and members of the community. Experience has shown
that the research will be successful only with strong rapport, mutual trust, and a
steady commitment held by all participants. Dickinson (2003) believed that mem-
bers of overlapping gender, ethnic, class, and global south/north groups benefit when
they practice cross-border learning and research, and my experience bears this out.
However, the economic and social inequities privilege members of the north to such
an extent that I cannot stress enough how important it is for any researcher to make a
long-term commitment to the community as part of engaging in PAR. The research-
er’s cultural competency should be well developed before undertaking PAR projects
as a matter of ethical principle. Golub (2005) described her preparations for engaging
in PAR that included intense language study; learning as much as she could about
the local community, the relationships between participants, and sponsoring agen-
cies; the sociopolitical contexts of the study; traditional and current roles of art and
healing; potential cultural risks of art expression; and the ramifications for the local
participants in engaging with a cultural outsider.
Although historically much research has originated in the dominant group and
exported to under-served areas, ideally the development and ownership of such inter-
ventions should originate locally in open dialogue among community members. In the
case of Cantera, community development projects were already well established before
I was approached by the organizers to incorporate art therapy into their research. In
other PAR projects, the researcher may be the one who initiates contact, either as an
“insider” member of the group or as an “outsider” who initiates and then works to shift
control and empowerment to the community.
The link between knowledge production and power, another key element of PAR,
must be made explicit especially when collaborating cross culturally. In my case, I
am accepted on the basis of my expertise as an art therapist, but I am also perceived
as a community outsider with privileges that are attached to my origins, level of
education, race and culture, and access to wealth, technology, and other resources.
Issues related to anticipated exploitation or abandonment reverberate throughout
our relationship. Therefore, one way that I have communicated trustworthiness is by
developing cultural competency and by making an abiding, long-term commitment
to Cantera, consistently returning every year to participate in on-going community
action and planning processes. As my working relationships with members of Cantera
have deepened over the past 10 years, I have been warmly embraced and this has
shifted my outsider status to some degree. But outsider and insider are not fixed or
static positions; they are constantly negotiated and re-negotiated in everyday interac-
tions (Naples, 2003).
Identifying organizational values and principles for research collaboration: PAR
in this model combines community development, social action, and popular education.
Freire (1970) defined popular education (from the root word “populace”) as a form of
education that raises people’s consciousness of the strength of their own communities in
action. Cantera supports community-based research by investing in local development
projects, particularly those that strengthen individual and cultural identities, attend to
the needs of at-risk children and youth, and support gender analysis and small-scale
economic development, among other projects.
Dialogue and group processes: Two key methodological links among all the activi-
ties that make up PAR, especially early in a project, are the facilitation of group process
and dialogue in particular. Dialogue impels people to come together and form a common
entity that is larger than the sum of its parts (Friere, 1970). Spaniol (2005) and Lark (2005)
identified the participatory dialogue format in art therapy as a structure that reduces barri-
ers to communication for groups of people with unequal power. One Cantera PAR project,
for example, brought diverse community participants together to address the causes of
increased violence in their neighborhood and to create an impetus for change. Structured
dialogues often are mixed groups of youth, elders, experienced leaders, campesinos,
highly skilled administrators, and women and men who come together to share experi-
ences and information and forge collective actions (Park, 2001, p. 81).
Action research through art therapy: The art therapy component that I have facili-
tated for Cantera’s PAR brings art and art therapy techniques to the dialogue process
and promotes community reflection on the individual, group, and societal levels of
their experiences. Art therapy is consistent with PAR because it is by definition action
oriented and often is used to identify issues and solutions (Spaniol, 2005). Art-based
reflection follows the action science method (action–reflection–action) by generating
insights and stimulating new consciousness, followed by subsequent reflections, percep-
tions, and practices for change. Rather than expect a certain, desired outcome, I have
found that as an outsider/facilitator, I must work flexibly with a range of art therapy
processes that are appropriate to the culture and Cantera’s sociopolitical contexts. For
example, a lack of art supplies once caused me to offer what became a rich experience
of poetry writing that is culturally significant in Nicaragua and from which community
members were able to identify differences in how they perceived a particular problem.
In another instance, a rural community used the planning structures of a public mural
to organize against a threat of losing their water rights. My PAR role as an art therapist
is to facilitate questions and answers from a collective process of reflection and action,
rather than to provide directives or answers. In her description of a social action project
in Brazil, Golub (2005) concurred that art therapy in these contexts provides a vehicle
or “forum for people to talk to each other and find their own ways of solving shared
problems” (p. 19).
Research dissemination and “empowerment evaluation”: Finally, the participants
disseminate their reflections, new learning, practices, and skills with all members of
the community. This is known as the “multiplier effect” whereby participants take
away the fruits of PAR and multiply them to other people and locales where they
will do the most good, in service to the common good over individual gain (Kapitan,
2006b). In this way, the research and the social transformations that result are col-
lectively owned. Cantera staff collect many of the materials produced in our col-
laboration and conducts formal evaluation of all its community development projects.
From reflection on a similar activist arts-based PAR project carried out in Guatemala,
Lykes (2001) generated criteria for evaluating the adequacy of PAR methods used, as
described below.
CRITERIA FOR EVALUATING PAR METHODS

AND OUTCOMES (LYKES, 2001)
1. Compatibility with existing, often extremely limited resources in the
local community, which affects the sustainability of the project
2. Ease of engagement via the method to reflect on and understand exist-
ing social problems and participant potential as social change agents
3. Viability as a resource for re-presenting social realities to potential audiences
of activists, policy makers, funders, and other potential collaborators
4. Potential for enabling and sharing multiple, indigenous practices
5. Capacity to facilitate the action/reflection dialectic when thinking
about the cultural practices that emerge in response to PAR
6. Minimization of risk to the participants
While the foregoing discussion traces one model of PAR in social action art ther-
apy, its principles are widely recognized by the field (Spaniol, 2005; Carolan, 2001;
Deaver, 2002) and embedded in art therapy practice. Golub (2005) referred to PAR
principles in her art therapy encounters with local agencies in Brazil, China, and
Denmark, and discussed some of the ramifications of participatory processes on sur-
vivors of repressive regimes and communities with whom she worked. Spaniol (2005)
described a PAR project that took the form of a conference between art therapists
and art therapy consumers who were people with mental illness and produced oppor-
tunities to collaborate in equal relationships and partnerships. PAR has been used
in primary care to develop a deeper understanding of mutual participation in the
therapist-client encounter in a variety of cross-cultural and other practice settings
(Marincowitz, 2003). Given the high level of premature closure among members of
minority or stigmatized groups who participate in counseling, the benefits of PAR for
evaluating and improving art therapy practice hold much value. Furthermore, PAR not
only contributes knowledge and understanding of the realities of people with whom
art therapists work, but its emphasis on self-empowerment can contribute directly to
the participants’ recovery processes.
“LEARNED HOPEFULNESS”: AN ARTS-BASED APPROACH

TO PARTICIPATORY ACTION RESEARCH (SPANIOL, 2005)
Spaniol’s paper describes a 2-day conference for art therapists and people with
mental illness who have experienced art therapy or make art for self-expression.
Designed as a “participatory dialogue,” the conference was a form of PAR devel-
oped by the Center for Mental Health Services in Washington, D.C., to foster
collaboration between mental health professionals and consumers. This study
documented the first of these conferences using artmaking to help disparate
groups share perceptions as equals and to begin to build partnerships. The arts-
based approach to PAR enabled diverse participants to build trust and begin to
create mutual understanding; art therapists began to integrate new perspectives
into their professional attitudes and practices as a result.
ACTIVIST PAR AND THE ARTS WITH RURAL

MAYAN WOMEN (LYKES, 2001)
“Creative Workshops for Children” constituted the core of a PAR program in
rural Guatemala developed with local health promoters, child-care workers, and
educators. The PAR project was designed to help child survivors of war move
from personal tragedy toward a shared experience with others that sought truth
in the face of the effects of organized violence on collective identity. Theater,
dance/movement, visual arts, music, and words were used to help the children
recover their natural capacities for play. The initial project inspired a women’s
group that grew to more than 60 with participants ranging from 16 to 65 years of
age. Two photography research methods allowed participants to record life stories
of indigenous cultural and agricultural practices, war and its effects, poverty, and
the complex challenges in recovering from trauma.
PAR: FROM WITHIN AND BEYOND PRISON

BARS (FINE ET AL., 2003)
The researchers describe a PAR project undertaken in a women’s prison in New
York that documented the impact of college on women in prison, the prison envi-
ronment, and on the women’s post-release outcomes. The dilemmas of conducting
PAR research under surveillance as a collective of inmate and university-based
researchers are presented. The concerns of women inmate researchers writing
from within prison are situated in this study within a broad, ethical community of
scholars working on critical issues of insider and outsider voices in the construc-
tion of knowledge.
Some Ethical Challenges of PAR in Art Therapy

It cannot be expected that PAR will proceed in a straightforward, emotionally
or intellectually satisfying manner that fulfills an art therapist’s altruistic needs.
PAR researchers quickly discover complex ethical dilemmas that challenge many
assumptions of power, agency, and control. In their PAR project with women
inmates, Fine et al. (2003) provide an excellent reflection on some of these chal-
lenges, for example:
We created among us a team of women scholars and yet … half of us go home at night;
half of us live in the prison. … The most obvious divide among us is that between free
and imprisoned, but the other tattoos and scars on our souls weave through our work,
worries, writings, and our many communities. Usually these differences enrich us.
Sometimes they distinguish us. At moments they separate us. (pp. 87–88)
PAR shifted these researchers’ questions, methods, analysis, and writing in unex-
pected ways. They concluded that building a community of shared skills, respect, trust,
and common language were crucial to the success of the project. But community building
did not mean consensus. To sustain the project—and any organization for that matter—
they needed to create a space for dissent and insider knowledge that often was perversely
misunderstood by outside researchers. The outside researchers came to understand the
research limitations of the insider’s dilemma of self-censorship and on-going survival in
an oppressive environment. The social realities and power issues among the PAR were a
constant challenge, often contributing to gradual diffusion of roles. The emotional load
of the project was often difficult to manage, and the question, “How do we ever walk
away?” caused a deep sense of loss when the project was completed.
Most PAR researchers, nonetheless, are very committed to this form of work
because of social activist values rooted in the power-sharing, participatory process
that can generate knowledge not obtainable in other ways. Action-based participant-
observation, on the levels of micro-culture and larger cultural groups and communities,
links social reform with empirical science. Art therapy faces a similar opportunity. Art
therapy makes contact with the person’s creative resources to effect change and creates
the conditions of psychological freedom and safety to do so. Art therapy, in this sense,
is a method of liberation and a practice for imagining social change.
CHAPTER SUMMARY
1. Many of the issues, concerns, and problems of practice can be addressed by
art therapists through participant-observation research that draws on their
first-hand experiences in the field and the cultivation of critical awareness.
2. An overarching principle in contemporary field studies is the critical stance
that is concerned with maximizing human potential for freedom and equality.
The broad purpose of critical forms of inquiry is the enactment of social

change (Sullivan, 2005).
3. Action-research is a systematic, first person method for inquiring into quali-
ties of a practitioner’s own practice for the purpose of effecting change.
4. Case research seeks to learn from and comprehend in all its complexity a
person or persons with intrinsic conditions or circumstances of interest to
the researcher. Groups of cases may be analyzed for cross-case patterns
or comparisons.
5. Good case research involves systematic cycles of comprehensive, purposeful data
gathering and analysis, checking for accuracy through input or feedback from
co-researchers or other advisors, and consensual validation of the findings.
6. Ethnographic research promotes cultural understanding, often inquiring
in the cultural implications of art therapy programs and practices through
immersion into a culture and/or ethnographic interviewing.
7. Standpoint theories offer a critique of the taken-for-granted assumptions of
participant-observation research and are used to help art therapists become
conscious to how their research is oriented toward power, agency, and voice
of the people involved in their studies.
8. Participatory action research is collectively organized by communities
empowered to examine their own experiences, define problems, and create
their own solutions with the goal of social change. Ideally, PAR is change-
oriented, inclusive, and egalitarian in its methodology.
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Researching the
Phenomena
of Conscious
6
Experience
I crunch my carrots without
remorse or even gratitude to
earth, sun, and farmer, or to
the mystery at the source of all
particular forms and colors of
things, the particular kinds of
nourishment stored up in every
living thing. To feel this would be
to be intensely alive, to experience
every meal as passionate
communion, as love—but it will
not happen by itself. No matter
how much I try, I cannot feel on
demand. But I can, if I remember
to ask it of myself, pay attention.
—Martha Heyneman (1991, pp. 11–12)
In her study of insecure attachment in school-aged children (2007), art therapist Sandy
Sheller asked four youngsters to create a drawing and a sculpture of a bird’s nest. The
Bird’s Nest Drawing is a projective art assessment that was developed by Kaiser (1996)
to identify and measure specific graphic characteristics of an individual’s secure and
insecure attachment representations. Sheller was interested in the Bird’s Nest Drawing
too, but for very different reasons. For her research, images of bird nests did not func-
tion to assess a condition but were a window into what it might feel like for children to
navigate the world without a sense of secure attachment to their parents or caregivers.
Rather than collect and compare data about insecure attachment, Sheller wanted to
know what the experience was like from the perspectives of the children themselves.
She wanted to see, feel, hear, and understand how these children were living their expe-
rience of insecure attachment. One child illuminated her sense of security by pointing
135
to a huge sun in her drawing and exclaiming, “It is hot! Looks like the [mother] bird
is about to melt … aahh … melting … in The Wizard of Oz, the witch melts, I think”
(Sheller, 2007, p. 124).
Throughout the art therapy literature, there are many stories told about clients.
There are, as well, stories told from the standpoint of clients themselves, in their own
words or through the interpretive frameworks of art therapists. As these stories accu-
mulate, we learn more about what happens in art therapy and how it is experienced. In
this chapter, the fundamental research model is the reflection on actual lived experi-
ences by the study’s participants. “Lived experience” in its most basic form involves
an immediate experience as it is lived directly, before a person has stepped back from
the experience to think about its meaning. Three common and closely related frame-
works are highlighted: phenomenology, which describes how people are oriented to
their lived experience; heuristics, which focuses on the process of personal discovery
that leads to new meanings and realizations from lived experience; and hermeneutics,
which describe how one interprets the “texts” of a life experience, including thera-
peutic narratives.
PHENOMENOLOGICAL
APPROACHES TO RESEARCH
Phenomenology inquires into the essence of what something is “really” like before
it is elaborated into an interpretation or theory. How do people make sense of their
experiences and how do they transform meaningful experience into consciousness?
Phenomenological research addresses such questions as
r What is this particular kind of experience like?

r What is the meaning of this experience for certain persons?
r What is the nature of … x …? What is the essence of … x …?
A “phenomenon” may be a feeling; a psychological or intellectual construct; an

experience of a significant event, relationship, or perspective; or an entity such as
an art therapy program. For example, an art therapist might pose such questions as,
“What essential feelings does an anorexic client experience?” “What is the nature of
anorexia and how is it experienced by teenage girls?” “What is the anorexic perspec-
tive and how does it influence a person’s identity?” Phenomenological research can
be distinguished from other methodologies by its emphasis on a way of encountering
these phenomena prior to any theorizing. Researchers are interested in the events,
subjects, and things of the world as they are immediately experienced. They are
keenly interested in what it is like to experience something pre-reflectively—before
doing any conceptualizing, classifying, or reflecting on it. Metaphorically, it is like
6 t Researching the Phenomena of Conscious Experience 137
clearing away all the brush that has grown up around a particular thing in order to
see it clearly, exactly as it is. Applied to art created in a therapy session, for example,
the phenomenological researcher would attempt to experience an image as directly as
possible and through all the senses without analytic or categorical frameworks that
often accompany art assessment. Phenomenological researchers maintain an attentive
and disciplined practice of thoughtfulness, what Heidegger (1962) called a mindful,
caring attunement to object of study.
Phenomenological research is a study of essences or core meanings about a com-
mon experience. It proceeds by systematically uncovering and describing the internal
structures of meaning (Van Manen, 1990). For example, the researcher does not ask,
“How are insecure attachment patterns graphically represented in a bird’s nest draw-
ing?” but takes a more philosophical stance: “What is the essential nature of a child’s
experience of attachment as revealed in the child’s bird nest drawing?”
EXAMPLES OF PHENOMENOLOGICAL QUESTIONS

r A hunting example: What is it like to hunt in the dark? What is the
essence of nocturnal hunting?
r A question from everyday life: What is the experience of going back
to school as an adult? How does the adult “really” experience that?
r An art-based example: What is the essence of collage?
r An art therapy example: What is the nature of Alzheimer’s disease as
experienced in the creative process or therapeutic relationship? How do
these particular clients experience art therapy?
These kinds of questions reframe inquiry from a focus on “why” or “how” to

the experience itself, or the “what” that is happening before any assumptions, expla-
nations, or predictions are organized around it. The insights that emerge offer the
fresh perspective of a direct contact with the world. To take an example from one of
the questions above, an art therapist may choose to use collage with a given client
or group based on the art therapist’s experience and observations, treatment goals,
and theoretical orientation. We typically think of collage as a therapeutic technique.
But our perspective subtly changes when we approach collage as a “phenomenon.”
What do we really know about collage? How closely have we observed this phenom-
enon? What do people actually experience when making collages? What essential
qualities make collage what it is and not something else? What remains constant in
various people’s psychological experience of collage after all the particular circum-
stances of their creations are cleared away? What can we learn when we systemati-
cally study any art therapy process or intervention from the standpoint of the persons
experiencing it?
Phenomenology is not concerned with explaining or predicting human experience,

but with generating plausible insights that bring us into direct contact with the world
(Van Manen, 1990). In this distinction, it is closely aligned with art therapists who prac-
tice phenomenological approaches to art therapy. Although this orientation may seem
unusual as a research methodology, it is common practice in art therapy to guide clients
in examining their own behaviors, thoughts, feelings, reactions, and insights, and in cre-
ating meaningful artistic expressions to connect with and ground their lived experience.
Art therapists understand that the essence or nature of a person’s experience, when
adequately described in either aesthetic or concrete terms, shows the quality and mean-
ing of the experience more fully than is otherwise possible. Because artists give shape
to lived experience, the products of art are, in a sense, lived experiences transformed
(Van Manen, 1990).
Phenomenological research relies on language to explicate meanings, but it has
pioneered particular types of language that more directly show the phenomenon in
all its qualities. Phenomenological inquiry has been described as a poetic activity that
deliberately creates evocative or authentic narratives instead of abstractly speaking
“of” or “about” an experience (Merleau-Ponty, 1973). Phenomenology originated as
a philosophy, but researchers have developed the scientific premises of the method,
described below, to satisfy scientific research requirements. Phenomenological
research is
r Systematic in that it uses specific, practiced modes of questioning, reflecting,

and focusing;
r Explicit in that it attempts to articulate, through content and form, the struc-
tures of meaning embedded in the lived experience; and
r Self-critical yet validated by others in that it continually examines its own
goals and methods to come to terms with the strengths and weaknesses of the
findings (Van Manen, 1990).
CONSTRUCTING PROFESSIONAL IDENTITY IN

ART THERAPY THROUGH SERVICE LEARNING
AND PRACTICA (FEEN-CALLIGAN, 2005)
A qualitative research project was conducted to study the collective identity of
a profession and an individual’s own sense of a professional role. A combined
service-learning and practicum was used as the site and involved 11 graduate
art therapy students over the course of one semester. Baseline, in-process, and
ending status assessments from a variety of measures were collected from each
participant and then subjected to a phenomenological analysis. Among the find-
ings, service-learning was found to nurture professional identity because it pro-
vides an environment that reflects the value and worth of the profession.
A PHENOMENOLOGICAL RESEARCH STUDY OF A CLIENT’S

EXPERIENCE IN ART THERAPY (QUAIL & PEAVY, 1994)
The research questions in this study were, “What is a client’s experience of
art therapy?” “How does a client experience art therapy?” One participant
was interviewed in the presence of artworks she had created during a 16-week
art therapy group. The researcher conducted a series of five interviews of 1 to
2 hours duration. The participant described her lived experience of the artworks
in art therapy, how they were created and discussed in treatment, and how she
experienced them as viewed in the context of the interview. Descriptions rather
than interpretations or explanations were sought from the participant. The study
illustrated the transition from inner experiencing to outer involvement in making
art, a relaxation of intellectual controls, and the process of becoming more open
and accepting of her experience through the analogies found in the images she
created. A significant limitation in the study was that only one participant was
involved; the findings would have been strengthened were a range of participants
(3 to 10, for example) included.
Methods and Core Processes in

Phenomenological Research
Moustakas’ (1994) descriptions of phenomenological research and the recent writings
of Giorgi and Giorgi (2003) offer useful methods to organize and conduct this type of
research. As with other research methods, the researcher conducts the literature review
and determines the original nature of the study, develops criteria for selecting par-
ticipants, and creates guiding questions or procedures for phenomenological interviews
and for obtaining records of lived experience (“texts” in the form of the research par-
ticipants’ words, art, videos, or other expressions).
The question: Because it is used as a focal tool that guides the researcher through
open-ended inquiry, how the question is framed is critically important. Finding the
exact wording can be a subtle process; changing the placement or choice of a single
word can produce an entirely different focus and results. Consider and compare these
questions: What is it like to have cancer? What is the essence of cancer as expressed
in the art of survivors? What is the meaning of cancer in the art and lives of survivors?
These questions each have slightly different emphases that will yield different qualities
of experience.
Epoche: A central principle and first step in the method is epoche, a word that
originally meant “to stay away or to abstain” from judgment. The researcher adopts a
particular mindset that begins with looking inside to become aware of personal biases,
assumptions, and preconceptions, and eliminating or at least gaining clarity about any
personal involvement in the subject matter. Epoche is a process of actively suspending
judgment to clear a space within oneself so that the object of study can be clearly seen.
By setting aside preconceived biases, prejudices, and predispositions, and allowing
things, events, and people to enter anew into consciousness, the researcher attains an
attitudinal shift. This same shift in awareness is found in the practice of “mindfulness”
or meditation. Meditation, when skillfully practiced, produces a state of full awareness
and deep stillness of mind. In addition to a sense of suspension of time and space, there
is a diminished or absent sense of “I.” It is this lack of self that allows a fresh clarity
of perception from which the researcher attempts to understand a phenomenon. Thus,
the validity of the phenomenological method rests on the skill of the researcher to
obtain a level of awareness from mindful observation that is beyond ordinary thought
processes.
Description of the phenomenon: The researcher begins with a description of an
experience to be understood psychologically, usually obtained by means of in-depth
interviews (Giorgi & Giorgi, 2003). The researcher is more interested in descrip-
tions of lived experience than the participants’ explanations or theorizing about it.
To manage the data, usually only a small number of people participate in a phenom-
enological study, all of whom have experienced the phenomenon. Transcriptions
of these interviews become the raw data of the research, along with artmaking,
artworks, poetry, choreography, and descriptions found in historical, biographical,
or other texts. Art therapists who have conducted phenomenological research may
combine verbal and non-verbal or artistic methods in the interviewing and data-
gathering process (see for example Kapitan, 2004; Linesch, 1995; Quail & Peavey,
1994; Sheller, 2007).
Bracketing or phenomenological reduction: The next step in the method is to enter
into a state of mind called the “phenomenological reduction.” The researcher “brackets
off” ordinary thoughts about the phenomenon of study and places them aside. The phe-
nomenon, cleared of ordinary thought, is presented as something to be contemplated
with detachment in the effort to eliminate the researcher’s bias as much as possible.
Giorgi and Giorgi (2003) explained:
When it is said that within the reduction everything that presents itself is to be accounted
for precisely as it presents itself, it is a strategy devised to counteract the potentially
biasing effects of past experience. When we encounter familiar objects, we tend to see
them through familiar eyes and thus often miss seeing novel features of familiar situa-
tions. Hence, by understanding that the given has to be seen merely as a presentational
something rather than the familiar “object that is always there,” new dimensions of the
total experience are likely to appear. (p. 249)
In phenomenological reduction, the researcher deconstructs the phenomenon so

that its essence can be uncovered and defined. A helpful explanation of this process
is to imagine that you are a visitor from outer space, seeing the phenomenon for the
first time. You have no prior reference point to make meaning of the data before you.
You perceive the bracketed phenomenon from this vantage of an open awareness and
describe it in its totality, giving a compete description of its essential qualities and
the various perceptions, thoughts, feelings, colors, shapes, and so on that comprise the
experience. This systematic method is one of pre-reflection, reflection, reduction, and

concentrated description aimed at uncovering its essence while always referring back to
its original sources. The process involves the following steps:
1. Epoche: Bracketing the topic or question.

2. Horizontalization: Spreading out the bracketed data and giving all statements
and perspectives equal value.
3. Determining clusters or meaning units: Re-reading the data “from within
the perspective of the phenomenological reduction and with a psychological
attitude, mindful of the phenomenon being researched” (Giorgi & Giorgi,
2003, p. 252). Whenever the researcher experiences a shift of meaning in
the reading of the description, it is marked in the transcript as a “meaning
unit.” Horizons that stand out are identified as invariant (essential) quali-
ties of the experience, while irrelevant, repetitive, or overlapping material is
eliminated.
4. Transformation of meaning units into psychologically sensitive expres-
sions: Meaning units that were originally in the language of the partici-
pant are now expressed with heightened sensitivity toward the phenomenon
being studied. Non-repetitive, non-overlapping statements are clustered into
themes.
5. Individual textural descriptions: Next, the clusters are tied together through
taking the invariant themes for each research participant and integrating
them into a summary description.
6. Composite textural description: Integration of all the individual textural
descriptions are then composed into a group description.
7. Imaginal variation: The researcher now comes to the heart of the method
known as imaginal variation. The researcher varies the frame of refer-
ence, trying out polarities and reversals, and divergent perspectives on
the phenomenon. As Giorgi and Giorgi (2003) described, the researcher
pays attention to what happens when a key dimension in the composite
description is removed or varied. If the meaning “collapses” as a result
of changing a key dimension, then the dimension is viewed as essential
for the meaning of the phenomenon to appear whole (Figure 6.1). If the
meaning is only slightly modified but still recognizable despite varying
the dimension, then it is considered to be not essential. From this method,
it is possible to identify the thematic structure that accounts for the phe-
nomenon and to search for vivid illustrations that may exemplify and
illustrate it.
8. Synthesis of meanings and essences: As a final step, the researcher carefully
describes the most invariant or essential meaning that belongs to the phe-
nomenon. In presenting the findings, the researcher summarizes and relates
the study to what was found in the literature review and potential future
research.
Giorgi and Giorgi (2003) describe, as an example, the essence of a

cup by means of imaginative variation: A certain cup is black, octag-
onal and made of ceramic. But is color essential for a cup to be a
cup? No, imagining a diﬀerent color would vary the dimension of
color but not its “cupness.” The material could vary, too, but only
so long as it remains non-porous. A non-porous material belongs
to the essence of a cup. The same process can be imagined for size,
strength, function, or aesthetics. The invariant aspect of a cup – its
essence – is that it is a container of liquids to be managed by hands.
FIGURE 6.1 Imaginal variation.
EXAMPLE OF PHENOMENOLOGICAL ANALYSIS

IN ART THERAPY (B. MOON, 2007)
In his article, “Dialoguing with dreams in existential art therapy,” B. Moon pres-
ents an art therapy adaptation of Moustakas’ (1994) method of phenomenologi-
cal reduction. Originally described as an effective art therapy intervention with
clients and their dreams, this basic process can serve research purposes in art
therapy phenomenological studies involving any vivid imagery. The “participant”
role (below) may be anyone involved in the phenomenological analysis, whether
researcher, co-researcher, or research study participant.
1. The participant creates the image of the dream or phenomenon of

interest.
2. The participant then creates a written record or “script” of the dream
or phenomenon as it appears in the art image.
3. The participant reads the script aloud to become aware of poignant
associations. A dialogue partner then reads the script aloud (slowly and
meditatively) so that the participant can hear it in another voice in order
to deepen the reflection.
4. The participant identifies the horizons or key elements of the visual
image and important phrases in the script.
5. With the image placed between them, the participant shares associa-
tions to the horizons while the dialogue partner makes note of them.
The dialogue partner then reads them aloud and identifies them with
the horizons in the visual image.
6. Clustering the horizons: The participant looks for connections among
the horizons and groups them accordingly.
7. Creating existential statements of concern: The participant creates a
sentence that summarizes each of the clusters as an existential concern.
These are then integrated into one summary statement or “existential
message” from the phenomenon to the participant.
Validity in Phenomenological Research

Phenomenological research fits comfortably with the hands-on, exploratory nature of
art therapy practice, but there are limitations that should be considered. The method
depends upon the researcher’s skilled use of a mindful, evenly hovering attention to the
object of the study, scrupulously setting aside researcher subjectivity that would color
the findings. This validity concern can be addressed by involving independent review-
ers who critique the logic of the phenomenological reduction. The research participants
may review the final report and confirm the extent to which it matches their experience
or evokes recognition of meaning. Moustakas (1994) called this “intersubjective valid-
ity” where findings are tested and refined through informant feedback.
Creswell (1998) offers some basic questions that researchers can ask themselves to
assess validity in their phenomenological studies:
r Is the final report an accurate portrait of the common features and structural
connections found in the data?
r Did the interviewer influence the contents of the participants’ descriptions in
any way? Do they truly reflect actual experience?
r Could other conclusions have been derived from the data? Has the researcher
identified these alternatives?
r Is it possible to go from the final description back to the transcriptions and
account for the specific connections made with the original descriptions of
the experience?
A common criticism of phenomenology is that, in focusing on the essence of a phe-

nomenon as it presents itself “in the moment” to the researcher and participants, impor-
tant contextual information might be missed about what led up to the experience or what
other factors might be associated with it (Braud & Anderson, 1998). Being highly indi-
vidualized and exhaustively detailed, phenomenological studies do not lend themselves to
replication so that little accumulative knowledge is produced (Gilroy, 2006). In response,
Giorgi and Giorgi (2003) emphasized that the final meaning obtained by the research
study is meant to convey what is psychologically essential about the participants’ particu-
lar type of experiences. It portrays a typical or general essence of the phenomenon, but
it is not to be viewed as universal to everyone who may have such an experience. These
authors are confident in the method because of its primary concern with obtaining precise
knowledge to the extent possible about an experience, which is science’s ideal.
ARTIST DISENCHANTMENT AND COLLABORATIVE

WITNESS PROJECT (KAPITAN, 2004)
Kapitan studied the disenchanted professional in a toxic work environment. She
hypothesized that when art therapists artistically explored the phenomenon of
their disenchantment, a deep connection with the essential nature of their artworks
ARTIST DISENCHANTMENT AND COLLABORATIVE

WITNESS PROJECT (KAPITAN, 2004) (Continued)
would be activated. In her interactive method, the participant and researcher
exchanged and responded to each other’s images created from the participant’s
in-depth phenomenological interview. Phenomenological reduction included ima-
ginal variation that transformed the everyday particulars of the interviews into
mythic images and stories to amplify the basic structural meanings. Participants
verified the findings by reading the stories and confirmed their accuracy in
reflecting the participants’ lived experience.
HEURISTIC INQUIRY
Heuristics, in the context of qualitative inquiry, is a term used to define a type of phe-
nomenological inquiry that includes the personal insights of the researcher (Patton,
2002). “Heuristic” is related to the word “eureka”; both mean to discover or to find.
The key element that defines heuristic inquiry is the use of self-awareness to engage
intensely in an experience so as to discover new, in-depth meaning about it. Heuristics
incorporate creative processes and self-examination into formal inquiry.
Typical questions in heuristic inquiry are ones that hold a personal challenge for
the researcher or curiosity in the search to understand oneself and the world in which
one lives (Moustakas, 1990):
r What is the nature of … x …? What is the meaning of … x …?

r What could a person discover about the experience of … x …?
r What is the impact of … x … on my experience as an art therapist?
EXAMPLES OF HEURISTIC QUESTIONS

r A hunting example: What is it about this group of people in my hunting
party that makes us want to be with each other every year?
r An everyday example: What is the meaning of the dream I had last
night? What can I learn from it?
r An art example: What can I discover if I immerse myself in the experi-
ence of painting in a natural setting?
r An art therapy example: What is the impact on a group of adolescents
in art therapy of taking photographs in their neighborhood? What is
their personal significance of that experience?
An internal frame of reference guides the heuristic study. Self-inquiry posits that
in-depth meaning and knowledge can only take place within and through one’s senses,
perceptions, beliefs, judgments, and sense of being. Art therapists and their clients who
create artworks for self-inquiry—to process an intense experience, explore a life concern,
or follow an idea in order to see where it leads—are using the basic processes of heuristic
inquiry. The art therapy literature is replete with examples of heuristic reflection through
art on intense personal and professional questions. One published example of an art ther-
apist’s systematic self-inquiry is Milligan’s (1996) presentation of 13 artworks created
over a 2-year period that chronicled her “journey of acceptance,” which she described as
a spiral staircase that slowly took her from darkness to light as she struggled to accept her
daughter’s transition in gender. As a research method, the heuristic process attains rigor
through intentional, systematic observation and in-depth interactions with co-researchers
(Patton, 2002). Its power lies in its potential to disclose certain truths, obtaining whole-
ness of knowledge that may begin in subjective experience and gradually develop into a
systematic description of a theory (Douglass & Moustakas, 1985, p. 40).
A key element of heuristic inquiry is the researcher’s intense interest and personal expe-
rience with the phenomenon (Moustakas, 1990). Throughout the study the researcher contin-
uously asks, “What is my experience with regard to this question?” (Bloomgarten & Netzer,
1998). However, heuristics is not about the self-inquiry of the researcher alone. Rather, it is
concerned with “the nature of human experience as represented by the experiences of the
researcher, often in connection with the experiences of others” such as clients (Gilroy, 2006,
p. 102). Giorgi and Giorgi (2003) asserted that the scientific integrity of any phenomenologi-
cal method is secured only by analyzing the experience of others. Acknowledging that heu-
ristic inquiry has been mistaken for mere self-reflection on a problem, these authors point
out the inherent problem of conducting research solely on one’s own experience:
How could I prove … that my concrete description was not unconsciously selected and
construed to prove that my theoretical analysis was correct? One could answer this
question philosophically and theoretically from a phenomenological perspective, but it
would not necessarily be effective from the perspective of empirical scientists. (p. 247)
Moustakas (1990) clarified that it is the combination of shared reflections on personal
experience and intensity that creates new discoveries and essential understandings. Typically,
data are gathered from a small number of participants who share an intense interest in the
phenomenon. Careful examination of the data result in a series of individual depictions cre-
ated by the researcher as well as a depiction of the researcher’s own experience. There often
is a sense of connectedness that develops between researcher and research participants in
their mutual self-inquiry into questions that search for discovery of meaning.
Core Concepts and Processes of Heuristic Discovery

The fundamental texts on conducting heuristic inquiry were written primarily by its
originator, Clark Moustakas (1990). Heuristic inquiry is characterized by its passionate
yet disciplined commitment to examine a question intensely and continuously until its
discoveries are thoroughly illuminated. It is carried out in six systematic steps that art
therapists will recognize as closely following the phases of the creative process:
1. Initial engagement: The discovery of an intense interest or passionate concern that

calls out to the researcher that may hold important social meanings and personal, compel-
ling implications is identified as the starting place of inquiry. There may be a feeling of
invitation to self-dialogue that evolves into a research question or focal concern. Initially
and throughout the study, inquiry may involve unstructured interviews or dialogues with
the researcher and participants, or activities that explore correspondences between an
art therapist’s and client’s artworks or experiences, active imagination with the products
of creation, or imaginative written and visual explorations (Gilroy, 2006). During initial
engagement, the researcher turns inward and reaches for subliminal or tacit awareness:
As art therapists understand well, what one knows about an experience is never limited to
one’s immediate awareness. Underlying and sometimes hidden aspects will contribute to
whole meaning when these dimensions interact with a person’s experience.
2. Immersion: Unlike phenomenology’s detached, clearing away of preconception,
heuristics accentuates connectedness and relationship. Indwelling is a heuristic process
by which the research participants turn inward with unwavering attention and focus
on some facet of experience to attain a deeper, more extended comprehension. An art-
ist who turns inward to process the loss of a family member, for example, may dwell
inside the whole of the encompassing feelings of the loss, and expand their meaning and
associations through art expressions until fundamental insights rise to the surface with
emotional clarity. Artwork created to illuminate the research question can be imagined
as a separate entity that is available for dialogue and relationship. For example, McNiff
(1992) described the technique of dialogue when engaged in a heuristic process of dis-
covering the meaning of art images he produced. This process of “living the question”
in waking, sleeping, and even dreaming, marks the immersion phase of the study when
everything in life seems to organize itself around the question and comes to be known
on intimate terms. There is a sense of heightened alertness and sustained focus on
everything and anything that is connected to the question.
3. Incubation: At the point of saturation, the question is put aside. This is a natural
shift that occurs when intense, concentrated focus reaches its height and triggers the
need for a temporary retreat from such unwavering attention. Metaphorically speaking,
it is as if the researcher’s mind has gone “off line” for a time. Nonetheless, while the
researcher refocuses on conscious, everyday concerns, the tacit dimension is pushing
the question into ever-deeper levels of the mind outside of conscious awareness.
4. Illumination: Suddenly, an “aha!” moment erupts into consciousness, often occur-
ring when the mind is in a state of relaxed concentration. Insights may arrive while in
the shower, driving on the freeway, or watching a child’s soccer game. The illumination
is an actual breakthrough into conscious awareness of the essential qualities that are
inherent in the question. The researcher may apprehend new or hidden meanings or may
suddenly see distortions that need to be corrected. To obtain illumination, the researcher
must be in a receptive state of mind without conscious striving. Gendlin (1962) identified
the “body shift” that is necessary to create this change in awareness. Fenner (1996) wrote
that in her heuristic study, her concentration on an image suddenly took on a different
momentum that signaled the shift in awareness that produced illuminating insight.
5. Explication: Once the central themes, qualities, and components of the question
are illuminated, the researcher begins a process of explication or “working through”
to bring critical thinking to bear on the study and to fully examine what has been
produced in order to understand its meaning. Having moved to discovery, now in the
explication phase, the researcher must put the findings into a critical context that can be
communicated to others. Concentrated attention in this phase creates a more complete
knowing of the key discoveries, bringing not simply imagination but logic to bear on
the inquiry in order to discern general patterns in the data that emerge from intensive
analysis (Gilroy, 2006). From individual depictions of the experience, the researcher
develops a core theme and a whole, composite depiction of the in-depth meaning that
has resulted from the study (Bloomgarten & Netzer, 1998).
6. Creative synthesis: Finally, being thoroughly familiar with the core themes and mate-
rial from which it developed, the researcher feels a sense of having mastered the matters that
illuminated the question. Here it is common to feel a nagging desire to externalize and
express this holistic understanding. Acting on this desire, the researcher is able to synthesize
the results of the study by creating a new form that makes clear the meaning discovered. For
example, in a heuristic study of the impact of violence on the capacity to create (Kapitan,
1997), the subject matter caused in me a pervasive disinterest in art until the final phase
when I became intensely curious about the process of monograph printing. As a result of this
intuition, I produced a series of artworks that synthesized the research into a single whole.
The heuristic researcher may go through the cycle, from initial engagement to explica-
tion, several times over the course of a research study. In studies that involve the participation
of co-researchers, they may go through all or most of these steps with the primary researcher.
In other studies, the researcher gathers data from the participants’ self-inquiry and then
applies the heuristic method as a form of data analysis. In a heuristic study of the personal
significance for a group of adolescents in an art therapy program taking photographs in their
neighborhood, for example, either the researcher’s self-awareness or the awareness of the
participants could be the main instrument. The adolescents could be asked to create visual
journals that document not only the pictures they take but also their personal reflections on
the experience. Depending upon the needs of the group, the adolescents could be invited
to inquire into the meaning of their journals and the experience as a whole until a creative
synthesis is reached. Alternately, the art therapist could conduct a heuristic analysis of their
visual journals through the art therapists’ own systematic process of reflection on them.
RESEARCHING EXPERIENTIAL SELF-KNOWING (LETT, 1998)

Lett used postcard-sized pictures of flowers as a stimulus for a heuristic study that
documented the process of movement from internal focus (in-dwelling) to external-
izations that formed new patterns of meaning for each participant. Five co-research-
ers, all practitioners of art therapy, participated in a series of audio-recorded dialogues
facilitated by the primary researcher. The main research method involved reflecting
on the artwork by speaking aloud into the tape recorder and then listening to the tape
while looking at the image, followed by further reflection and discovery of meaning.
ART IN BOXES: AN EXPRESSION OF MEANINGS (KAUFMAN, 1996)

Kaufman followed a heuristic model to systematically study the meaning of con-
tainers and the therapeutic implications for using boxes in art therapy. She created
a sculpture and kept a journal of her process that recorded her feelings, thoughts,
and associations after each work period. She then identified themes in three sepa-
rate viewings of the finished sculpture as correlated with her journal writing. She
attempted to understand the relationship between the themes and the sculpture
itself. The results were the identification of the overarching theme of the container
form as related metaphorically to taking an adventurous journey and art as a
means for transformation.
Validity and Critique of Heuristic Inquiry

Heuristics, a form of phenomenology, of which it is a part, is not a quantifiable method
of inquiry. The question of validity must be addressed with respect to the quality of
meaning that is its outcome. Does the ultimate depiction of the experience come from
one’s own rigorous, exhaustive self-searching? Does it comprehensively, vividly, and
accurately portray the meanings and essence of the experience? As in other qualitative
approaches, validity is enhanced by returning again and again to the original data to
check depictions of the experience for accuracy and sufficient meaning. The findings
should enable the researcher to verify, were the study repeated, that the explication and
creative synthesis actually portray the phenomenon investigated. Validity checks often
include returning to the research participants, sharing the findings, and asking them to
assess the comprehensiveness and accuracy of the findings.
McNiff (1998a) has cautioned art therapists to avoid the heuristic tendency toward
self-immersion or to use art products as objects for solipsistic self-reflection that easily
“spiral into labyrinths of personal feelings and fragments of thought” (McNiff, 1998a,
p. 55). To avoid getting caught in a “heuristic swamp” of endless self-reference, I sug-
gest the following guidelines:
r Clarify your purpose with a precisely focused, clear question before begin-
ning. It is difficult to design sound research when faced with the kind of
openness that is required in heuristics. A clearly focused question helps to
guide the researcher through the many twists and turns of the inward frame
of references.
r Consider carefully the choice of topic and adapt it to a limited, reasonable
scope. Sometimes the passionate desire for personal significance causes the
researcher to be uninterested in a simple study. A decision to resolve a life-
long question, for example, “What is the meaning of my mother’s death in my
life?” is too large and basically unanswerable in a research study.
r Create a detailed, sound design to anchor the open-ended process of per-

sonal discovery. A pared-down, simple problem is not enough to guide a valid
inquiry. Seduced by the question, some researchers dive right into heuristic
immersion without first mapping out systematic structures or other frames of
reference. The trouble begins when it is time to explicate the meaning and
there is no structure brought to bear on the researcher’s awareness outside of
the researcher’s own meanings. This problem is avoided by including trian-
gulation, member checks, and the perspectives of others that accompany the
intensive personal process of the researcher.
Heuristic inquiry rests on the value of the subjective, direct experience as it is lived.
Strategies such as self-study, shared collaborations, and critique of texts or artworks
produced in the creative cycle of inquiry may reveal important insights not recover-
able by more traditional research methods (Sullivan, 2005). Reflexivity, therefore,
is treated as “an asset not a liability and a necessity rather than a difficulty” (p. 56).
Critical insights derived from the method can be used as a foundation on which to build
other studies and hypotheses tested by other means. Bloomgarten and Netzer (1998)
described the value of such outcomes as “the inevitable expansion and deepening of
personal knowledge”:
The process leading to the discovery includes the researcher’s self-reflective explo-
ration and the uncovering of the co-researchers’ experiences in [their] own words.
In this personal engagement the art therapist is required to examine his or her own
experience with therapeutic artmaking and to trust his or her experience, intuition
and tacit knowledge … [The] research subjects become co-researchers who teach
about the power of art in healing. As professionals we need to practice listening to
others and honor their inner knowing. This trust in our clients’ self-knowledge and
ability to participate in their own healing is not only empowering for the clients, but
it teaches the researcher something about human relationships and the mystery of the
unknown. (p. 54)
HEURISTIC RESEARCH STUDY: SELF-THERAPY USING

BRIEF IMAGE-MAKING EXPERIENCE (FENNER, 1996)
Fenner conducted a systematic heuristic inquiry to discover personal meanings in
a series of 45 art images she created on a daily basis over a period of 2 months.
She conducted four 75-minute sessions of in-dwelling, by studying all 45 images
and “thinking aloud” to audiotape her verbal reflections on them followed by
creating a new image in response. She described the tape-recorded technique
as an anchor in circularity of in-dwelling process. Fenner later transcribed her
reflections and identified themes having to do with her process of creativity and
the means she used for getting out of a stuck period of inactivity.
HERMENEUTICS
Hermeneutics is the theory and practice of interpretation. The word derives from the
Greek god Hermes whose function was to communicate messages between gods and
mortals. Hermeneutic science involves “reading a text so that the intention and meaning
behind appearances are fully understood” (Moustakas, 1994, p. 9). The interpreted rela-
tionship between a direct description of a lived experience and the structures of meaning
that account for that experience is at the heart of hermeneutic methodology. Although
interested in lived experience, it departs significantly from phenomenology and heuris-
tics in its premise that the meaning we attach to something always is contextual—it
depends upon the cultural, historical, and scholarly contexts in which it was created and
subsequently interpreted (Patton, 2002). In hermeneutics, the researcher is interested in
understanding the conditions or context under which a human experience took place or
to know what the circumstances were that caused something of interest to be produced
(Bloomgarten & Netzer, 1998).
A hermeneutic approach that is formalized through research is especially useful in
a field like art therapy where the potential is high for misinterpreting a text or projecting
inaccurate meaning onto an image. Art therapists who insist on knowing the original
intentions of the person who created an artwork are, in fact, using a hermeneutic prin-
ciple. Hermeneutic research questions would be
r What are the conditions that produced “x” and make it possible to interpret
its meaning?
r What meaning did the person who produced “x” intend to communicate
and how is its meaning received in the context of culture, history, or other
contexts?
EXAMPLES OF HERMENEUTIC QUESTIONS

r A hunting example: What do the signs of someone hunting in this area
tell us about the presence of deer?
r An everyday example: What did my partner intend by putting that
cryptic note next to the coffee maker so I would see it first thing this
morning?
r An art example: How do we understand and interpret Van Gogh’s last
self-portrait, given the life circumstances that were occurring at the
time he painted it?
r An art therapy example: What was my client attempting to commu-
nicate with her artwork this morning? What dynamics of the group
session may have influenced the picture she created?
Lived experience Expression Understanding

≤ ±≤ ±
Lived experience is the The expression of lived An understanding that
starting point and focus of experience in texts, artifacts apprehends the possibilities
inquiry or images which objectify the that are revealed by the text or
experience images
FIGURE 6.2 Hermeneutic research formula.
In hermeneutics, texts (written or visual) that are created in one context are inter-
preted in another context through an interactive process that moves back and forth
between the interpreter and the phenomenon. Dilthey’s (1985) formula for hermeneutic
research identifies the interaction of three key elements:
r Lived experience that is the starting point and focus of inquiry

r Expression of this lived experience in texts, artifacts, or images, which objec-
tify the experience (story, poem, painting, dance, film, interview narrative, or
anything that expresses the lived experience)
r Understanding, not as a cognitive act but rather as an apprehension of the
possibilities that are revealed by the text (Figure 6.2)
Art therapists are sensitive to issues surrounding the interpretation of artwork pro-
duced in the unique conditions of a therapeutic relationship or environment. The pro-
fessional literature contains many case studies where art images created by clients are
interpreted according to a therapist’s theoretical orientation. Much has been written
about how art images reflect the personality or psychological self of the client, but much
less studied is how the unique context of art therapy influences the art produced and
its meaning. Hermeneutics offers a rich terrain for the researcher whose interest in the
interpretation of imagery goes beyond the presuppositions of theory and toward a study
of the contexts from which the imagery arose and is interpreted.
Ricoeur (1981), who asserted that psychoanalysis is essentially a process of herme-
neutic understanding, broadened the researcher’s notion of “text” as applicable to any
human action or situation. To interpret a social situation is to treat that situation as
“text” and then to look at it from some perspective, standpoint, or situational context for
the metaphors or structures of meaning that seem to govern the text. To interpret an art-
work, likewise, is to de-center the art image from the self of the artist and treat it as text
or object in context. The relationships between an artist and art image, the researcher
and the art image made by the artist, and the researcher and artist, can then be studied
for the meaning derived from these distinct perspectives.
Method: The Hermeneutic Circle

The main tool of hermeneutic research is the “hermeneutic circle” (Gadamer, 1976).
Hermeneutic approaches are referred to as a circle or spiral because of the premise
that the “knower and the known”—whether therapist and client, artist and art object,
researcher and participant—are interrelated at base. Any interpretation, therefore, will
involve a circle of understanding in which the interpreter’s perspective initially shapes his
or her interpretation but is open to revision and elaboration as it continues to interact with
phenomenon, and as the interpreter’s biases and standpoint are constantly re-evaluated.
A similar idea exists in any genuine relationship between two people. That is, one
dimension is the desire to see the world through the other’s eyes in order to appreciate
the truth of his or her experiences. The other dimension is the desire to bring one’s own
experiences into the relationship, to share one’s perspective, and thus to respond to the
other by trying to connect one’s own life to another’s (Tappan, 2001, p. 53). This idea of
two people trying to understand each other’s experience through exchanges of dialogue
is essentially the same as what is meant by the “hermeneutic circle.” Like artists and the
subjects they represent through portraiture, the process of interpretation is relational,
consisting of both the impulse to comprehend and the impulse to respond and connect
with what passes back and forth between subjects. Art therapy is itself a relational activ-
ity between client and therapist, client and artworks, and client, artworks, and therapist.
Just as therapists must strive to suspend their own premature interpretations to truly
listen and empathetically understand the communications of the client, in hermeneutic
research, the biases of the researcher are constantly surrendered in the dialogue in order
to “hear what the text says to us” (Gadamer, 1976, p. xviii).
Art therapist Linesch (1994) related the hermeneutic model of inquiry to the prac-
tice of therapeutic conversation and McNiff’s phenomenological method of metaphori-
cally dialoguing with images. As a research method, the steps are as follows:
1. The initiator (therapist, researcher, artist) establishes a connection with the
respondent (client, text, image).
2. Dialogue begins with open-ended questioning by the initiator that generates
visual and verbal responses from the respondent.
3. The initiator reflects upon his or her internal reactions to these responses,
which in turn generates deeper questions and subsequent responses.
4. Joint constructions of the meaning of the experience occur in the back and
forth spiral of the dialogue.
In Linesch’s (1995) study of five art therapists’ experiences with research, the herme-
neutic spiral was used to conduct an interactive interview with each participant, beginning
with interviewing and listening carefully to the respondents’ answers, paying attention to
the researcher’s own internal reactions, and asking respondents to draw the material dis-
cussed in order to diagram and create interpretative, shared metaphors. After the interviews
were transcribed, the data were interpreted via a phenomenological-hermeneutic process
of identifying patterns and metaphors to amplify their meaning. Linesch’s study explicitly
followed from her belief that “the crux of the psychotherapeutic event is the phenomenon
of dialogue, and interpretation is but a component of that dialogue” (1994, p. 185).
Linesch (1994) expressed the hope that by systemmatically embracing the processes
and principles of hermeneutic interpretation, art therapists can develop research methods
that are compatible with their clinical approaches. The hermeneutic spiral can be used as
a tool within other methodologies, such as phenomenological or heuristic inquiry, or can
stand alone as a focal process for any experience the researcher seeks to understand where
interpretation is necessary.
NARRATIVE ANALYSIS AND

THERAPEUTIC INTERVIEW RESEARCH
Hermeneutics originated in the study of written texts; narrative analysis is a research
method that extends this idea to include in-depth interview transcripts, life history nar-
ratives, historical memoirs, and creative nonfiction (Patton, 2002). “Personal narratives,
family stories, suicide notes, graffiti, literary nonfiction, and life histories reveal cul-
tural and social patterns through the lens of the individual experience” (Patton, 2002, p.
115), to which we may add artworks created within or outside of art therapy and other
forms of expression. Narratives, when included in art therapy research, explicitly honor
people’s stories as lived experience worthy of documentation and of study for their par-
ticular psychological, historical, or cultural contexts and meaning.
RESEARCH QUESTIONS FOR NARRATIVE

ANALYSIS (PATTON, 2002)
What does this narrative or story reveal about the person and the world from
which it came? How can this narrative be interpreted so that it illuminates and
provides an understanding of the life and culture that created it?
A narrative researcher approaches the participants in ways that are consistent with
other case studies or naturalistic field studies, and may use any number of the strategies
already described here and in the previous chapter. While the idea of “story” or narrative
intersects with these methodological discussions in this text, how narrative analysis uses
language carries a different connotation. As with other interpretivist approaches, the nar-
rative researcher attempts to amplify and convey meaning through evocative forms in a
way that clinical case material typically does not. The central idea of narrative analysis
is that “stories and narrative offer especially translucent windows into cultural and social
meanings” (Patton, 2002, p. 116). Art therapist Michael Barbee (2002), in presenting her
narrative research study that combined visual and narrative methods, explained:
… in this view, experience is the stories people live. In their telling, stories are reaf-
firmed and modified, and new ones are created. Story provides the parts—plot, motif,
connection, feelings—that make understanding and meaning possible (Carr, 1986).
Many partial stories are included and added to the life story, and these must have some
connection to the themes of the larger story and must not contradict them. These new
chapters contain landmark events, which date personal epochs. This process lends a
sense of coherence to the self … Such coherence is both an external social demand and
an internal psychological demand. (p. 55)
Narrative analysis traditionally has focused on life stories; in art therapy, clinical
stories that address a client’s “life review” made possible through image work is an area
with much potential for conducting formal narrative research. Narrative research also
has emerged as a specific approach to the study of organizations, with the implication
that the life of an organization can be conceptualized as a “story in the making” having
various possible interpretations, depending upon the perspective. Riley (2000) discussed
the profession of art therapy from this perspective and offered specific suggestions for
“re-storying” the profession’s narrative to embrace more liberating constructs in which
to situate the value and potential of art therapy.
Hermeneutic narratives and other methods that construct rather than uncover meaning
within human relationships are closely aligned with the relational approaches of phenom-
enology and of social constructionism. Art therapists have unique interpersonal expertise
in this area that can be applied to conducting research. They practice verbal and non-
verbal methods for tapping the potential of the therapeutic process to generate knowledge
every day, but art therapists have come to doubt their efficacy in research. Kvale (2003)
observed the paradox that the clinical knowledge obtained by qualitative interviews has
been accepted while the therapeutic interview method that actually produced this knowl-
edge has generally been rejected as unscientific. For example, Kaplan (2000) critiqued the
“metapsychology claims” of psychoanalysis, many of which have been refuted by recent
brain research, though not its clinical theories. The latter are based on direct clinical
observations obtained by means of the therapeutic interview. Kvale traced the pervasive
influence of the clinical interview on much of today’s focused group market research to
show that far from being unscientific, the psychoanalytic interview as a research method
has played a major role in the prediction and control of consumer behavior.
Given its introspective verbalizations and expressive activities, therapy can be
viewed as a hermeneutic discipline concerned primarily with the interpretation of
meaning and the actions or changes in behavior that result. Kvale (2003) explained that
the key aspects of therapeutic interviews actually are “pivotal for obtaining penetrating
knowledge of the human situation” rather than “sources of error in the quest for objective
facts” (p. 277). The therapeutic interview as a mode of research corresponds with the
hermeneutic and pragmatic focus on the conversation as a major source of knowledge.
A VISUAL-NARRATIVE APPROACH TO UNDERSTANDING

TRANSSEXUAL IDENTITY (BARBEE, 2002)
Barbee conducted a qualitative study to elicit the visual and verbal “gender sto-
ries” of a small group of individuals who identified as transsexual. Six participants
from a multiethnic volunteer sample recruited at a city clinic were asked to photo-
graph their gender story. These photos became the basis for a series of open-ended
interviews, leading to a narrative portrayal of the participants’ lived experiences.
The transcripts were examined for common themes, which were then compared
and contrasted with the literature. Findings revealed the importance of reviewing
individual meanings of transsexual experience, and photographs proved a valu-
able stimulus for eliciting these meanings. Barbee articulated a visual-narrative
approach to the theory of transsexual experience and its clinical implications,
offering a framework for treatment that does not pathologize their experiences.
Despite the importance of knowledge that may be produced in therapeutic inter-

views, there are a number of methodological pitfalls that threaten its validity as a
research method. These include ethical problems related to the private nature of
therapy, the lack of systematic documentation, and the tendency to overgeneralize
from selected cases (Kvale, 2003). Art therapists must always place the primary
needs of a client before any research aims. With respect to the limitations of case
studies, therapeutic inquiry today often combines narrative casework with journal-
ing, questionnaires, and research interviews with clients, or it may draw on cultural
material found in literature, artifacts from popular culture, films, and art. These uses
of multiple strategies help to correct for some of the shortfalls of prior therapeutic
case studies.
An often overlooked element that Kvale (2003) viewed as central to the ther-
apeutic interview’s efficacy as a research method is the extensive training that
therapists use in interacting with clients in open-ended, unstructured interviews.
A review of various social science research texts on how to conduct a qualitative
interview demonstrates the fact that many qualitative researchers are novices in
the art of relating to research participants as compared to experienced therapists.
Kvale suggested that the “tyranny of verbatim transcripts and formalized methods
of analysis” (p. 288) to some degree characterize novice behavior in the absence of
the context-driven sensitivities and intuitive judgments of more experienced inter-
viewers. Of equal value are the skills art therapists have in establishing rapport with
research participants, being sensitive to cultural practices, attending to non-verbal
information, flexibly adapting to the evolving nature of the interview, and draw-
ing on their ability to reflect and interpret multiple levels of meaning. This is not
to suggest that interpretations and knowledge claims need not be documented and
argued, as in any scientific endeavor, but that the quality of knowledge produced
in a therapeutic interview is produced in large part from the mastery of a qualified
practitioner-researcher (Kvale, 2003).
In art therapy, one of the most consistent applications of the therapeutic inter-
view to ground theory in the lived experiences of clients is found in the work of
Arthur Robbins. While many other art therapists have described their cases, Robbins’
distinction is his detailed documentation of the hermeneutic spiral of interactions
that took place between his clients, their artworks, and his own internal reactions
as the therapist that monitored the therapeutic process and organized its interpreta-
tions. McNiff (1998a) described his appreciation for Robbins’ research in illuminat-
ing the relational and psychological space within the art therapy experience, noting
that Robbins “introduced the ‘showing’ of many new elements into the art therapy
literature—the person of the therapist, the therapeutic relationship, and the therapeu-
tic space” (p. 105). The therapeutic relationship is perceived as an object of aesthetic
reflection by Robbins, thus integrating art and therapy, the two primary aspects of the
profession.
NAMING THE ENEMY: AN ART THERAPY

INTERVENTION FOR CHILDREN WITH BI-POLAR
& CO-MORBID DISORDERS (HENLEY, 2007)
Henley’s article discusses an art therapy intervention based on a qualitative study
of 184 art therapeutic interview sessions with 16 children over the course of 2½
years. Four case vignettes are presented, representative of 16 cases of children
ages 9 to 15 who received 32 trials of the art therapy intervention. Clinical assess-
ment, intervention, and artistic/behavioral outcomes are analyzed accordingly,
mainly within the psychodynamic and object relations approaches to art therapy.
Therapeutic interviews have been criticized for being subjective but, as described
elsewhere in this text, finely attuned subjectivity often is required to address certain
research questions. Kvale (2003) articulated four “kinds of objectivity” that the thera-
peutic interview satisfies from the perspective of research:
1. The reduction of bias, from the systematic cross-checks and verifications that
therapists learn as part of their intensive training to become aware of their
personal influence on the client;
2. Intersubjective agreement, or “member checks” when the therapist com-
pares his or her interpretation with the interviewee, and “peer checks” when
recordings from interviews are evaluated by supervisors or colleagues;
3. Sensitivity toward the nature of the object being investigated, in a sense, let-
ting the object speak for itself; and
4. An attitude of “allowing the object to object,” that is, an openness in the
therapeutic situation that allows participants to address their own concerns,
raise concerns, and resist the researcher’s interpretations.
Finally, Kvale (2003) identified some of the ethical tensions that occur in the dilemma
of mixing therapeutic and research interests in the same interview situation. The main goal
of therapy is change in the client; in research it is the advancement of knowledge that cannot
be allowed to interfere with therapeutic progress. Similarly, in a non-therapeutic research
interview, the researcher-therapist must suspend the impulse to confront participants with
new interpretations of themselves that they have not asked for or to instigate emotional
changes that cross the line into therapy. Indirect interviewing to get past the participants’
defenses in service of research knowledge violates the ethics of informed consent. A full
discussion of these and other ethical considerations is taken up in Chapter 8.
CONCLUSION
In reflecting on natural science methods, Dilthey (1976) wrote that we can explain
nature but human life we must understand. To correct for the historical imbalances of
traditional research, qualitative research developed along the lines of multi-method,

naturalistic, and interpretive approaches to understanding its subject matter. Among the
characteristic methodologies of qualitative research are those that require the research-
er’s first-hand immersion in the lived context of study with an attempt to make sense
of the meaning people bring to their experiences. It should be noted that due to their
intensive nature, these methods may not be appropriate to use in certain cultural con-
texts where such a focus may be perceived as intrusive or offensive to participants.
Likewise, inquiry into conscious experience may be therapeutically inappropriate for
certain clients who are too vulnerable or may feel threatened with new insights break-
ing into awareness. All forms of inquiry that seek to uncover in-depth meaning require
heightened ethical cautions concerning the potential psychological, social, political,
and cultural implications of participation in such inquiry.
In all these methods, the researcher functions as the main instrument of inquiry.
The subjectivity of the researcher, were it to enter controlled experimentation, would
of course bias or invalidate the results. But there is a different logic operating here.
Questions that seek to discover more or more deeply about the particular meaning a per-
son derives from an experience require a skillful, experiencing human being interacting
with them. As with traditional scientific research, validity rests in large part on honing
the precision and accuracy of the instrument. To produce valid results, the researcher
must develop a high-quality awareness that is systematically self-monitored, adjusted,
and checked by others.
In a recent editorial (Kapitan, 2007), I reflected on the qualitative thinking that per-
meates the daily work of art therapists. Every session potentially harbors the hallmarks
of a good qualitative researcher: the multiple, repeated controls of observing and inter-
preting behavior over time; the inductive processes of discovery and meaning-making;
the “data checks” with clients to calibrate mutual understandings. Creative imagination,
somatic and empathetic knowledge, and sensitivity toward social-cultural motivation are
artistic modes of thinking that art therapists share with the actual research behavior of
some of the country’s top social scientists (Kvale, 2003). As keen observers and inter-
preters of experiences that are significant to the people they work with and instructive
of the human condition, art therapists have much to offer in the interpretivist arena of
research.
CHAPTER SUMMARY
1. Reflection on the in-depth meaning of direct, first-hand experience charac-
terizes phenomenological, heuristic, and hermeneutics inquiry. Art therapists
commonly use reflective processes to discover the particular meaning a cli-
ent derives from an experience; this process can be formalized to address
research problems of human understanding.
2. Phenomenology seeks insight about the essence of an experience while
minimizing a priori assumptions about it. Bracketing the phenomenon from
ordinary experience and reductive processes for uncovering its essential

structures of meaning are the characteristic methods of phenomenology.
3. Heuristic inquiry focuses on the process of personal discovery that leads
to new meanings and insights, and includes the researcher’s self-reflective
exploration and the uncovering of the co-researchers’ experiences in their
own words.
4. Although interested in lived experience, hermeneutic inquiry departs from
phenomenology and heuristics in its premise that the meaning we attach to
something is contextual and depends upon the cultural, historical, and schol-
arly contexts in which it was both originally created and interpreted.
5. Narrative analysis is a research method that extends the hermeneutic idea of
text to include in-depth interview transcripts, life history narratives, historical
memoirs, family stories, artworks, and other creative expressions that reveal
cultural and social patterns as “storied” through the lens of the individual
experience.
6. Therapy can be viewed as a hermeneutic discipline due to its primary concern
with the interpretation of meaning and the actions or changes in behavior that
result. As a mode of research, the therapeutic interview corresponds with the
hermeneutic focus on the conversation or dialogue as the locus of knowledge.
7. In all of these approaches, the researcher functions as the main instrument of
inquiry. Because subjectivity guides the inquiry, validity rests on the quality
of awareness brought to bear on the data and procedures that minimize reli-
ance on a single perspective, interpretation, or data source.
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Art-Based Inquiry:
An Emerging Paradigm
in Art Therapy
7
My hand moves across the paper
in circles, as I explore the matter
further in my studio. Making my
body contours soft, my entire
attention is directed at connecting
with my heart through play. I
stroke the grey paper, sensing the
grainy feel of charcoal between
my fingers and the sensuous
mark it leaves on the surface. I
wait to receive, not knowing if
something will, in fact, emerge
from the formlessness that
begins my creative engagement.
From the outside, I look like
a middle aged woman at her
drawing board beginning a
pastel painting. But inside the
enchanted circle between me
and the paper, all categories
of artist, image, self and other
disappear as I am drawn in, my
senses alive and alert. I am gone;
I have taken myself away. For art
to appear, I have to disappear.
— L. Kapitan (2003a, p. 222)
Rob, a graduate art therapy student, is about to design a research project. He has been
thinking about the variety of experiences he has had in training to become an art
therapist, from classroom to the clinic. Like a hunter-gatherer, Rob is in pursuit of a
“researchable question” that he hopes will satisfy his professional hunger as he prepares
161
to enter the field. The further he explores art therapy research, the clearer he sees that
his primary questions are related to transforming his understanding of artistic prac-
tice. Rob came to art therapy with 10 years of studio experience in ceramics. He trusts
what his senses, mind, and body know about clay as an accomplished studio artist. But
still he feels ineffective, like a fish out of water, in the practice settings where he has
interned as an art therapist. His insight is that if he were to inquire systematically into
his thoughts, feelings, and newfound perceptions about art therapy through the visu-
al-motor-perceptual medium of ceramics, he would be able to draw on his artistry in
becoming a more effective agent in the context of therapy. Art is not solely a descriptive
or representational form but also is a valued means for constructing new knowledge. For
Rob, new knowledge about art therapy will be constructed holistically from the forms
he creates in art.
Art-based inquiry can be defined as the creation of knowledge using visual
means within a research perspective (Sullivan, 2005). Applied to art therapy, direct
engagement in art becomes the “site” for investigating certain research problems
and methods. This paradigmatic shift is founded on the principle that art prac-
tice is a form of thinking, problem solving, and investigation of direct percep-
tual evidence that, as in all research, lays the groundwork for concept formation.
Artmaking requires many, if not all, of the same complex cognitive operations that
are involved in creating models of scientific theory (Arnheim, 1969). Unfortunately,
this premise is not commonly accepted within scientific fields due to a number of
factors, not the least of which is the tendency to treat art and science education as
independent areas of study, with the former nearly extinct in U.S. schools. Lack of
visual training among researchers creates biases that privilege texts and measure-
ments as data, and marginalizes the realm of imagery, with drawings, paintings,
and other media regarded as mere illustrations rather than the site of primary data
and methodology.
As described in the first chapters of this text, art has a central place in the field
of art therapy and influences what art therapists value and pay attention to, how they
interpret clinical information, and how they help their clients resolve life problems.
As with other research paradigms, art therapists can apply the same knowledge and
practices they offer to clients to address the therapist’s research problems. Art-based
inquiry does not eliminate the practices and perspectives of the artist, but rather privi-
leges them—whether the artist-client, the artist-therapist, or the artist-researcher—in
the larger concerns of social science research. Some of the key purposes of art-based
inquiry include:
r To provoke, challenge, and illuminate rather than to confirm or consoli-

date knowledge
r To enlarge perception, thought, and feeling in order to perceive subtle rela-
tionships within complex wholes
r To imagine and perceive new possibilities or innovations that create new
knowledge, or to transform constructed knowledge
r To understand, as a research outcome, the individual and social transforma-
tive power of art knowledge in the practice of art and art therapy
7 t Art-Based Inquiry 163
EXAMPLES OF ART-BASED QUESTIONS

r A hunting example: How can I show others, in vivid form, the depth
of feeling I experience when confronted by the majesty of a full-grown
12-point buck?
r An everyday example: Why have I kept my mother’s collection of vin-
tage tablecloths? Is there some way that I can use or transform them
so I can preserve their meaning in my life and find enjoyment in them
every day?
r An art example: How do I create particular works that express the
importance of my Latina heritage?
r An art therapy example: How can I use art to persuade an audience of
school administrators that a school art therapy program is valuable for
with profound educational needs?
Imagine Rob in his studio, creating a series of clay vessels that each portray his relation-
ship to a particular client. This is not a superficial exercise; creating in clay is a disciplined
practice that will clarify his perceptions of clients that he has accumulated directly from his
environment but has not yet processed. Aesthetic knowledge, as an outcome of his inquiry,
occurs when information coming from his artwork interacts with information already stored
in Rob’s mind. The result of this conjunction may be a sudden expansion, recombination, or
ordering of previously accumulated information, which in turn produce a variety of emo-
tions, insights, and innovations (Csikszentmihalyi & Robinson, 1990)—in Rob as the pri-
mary researcher and in viewers of the artworks he will create and show to others.
Each time a new or unexpected direction arrives in his moment-to-moment cre-
ation with clay, Rob will take the opportunity to follow the lead of the material and
flexibly shift his purposes. He may sense the need to adjust a too-thin wall of clay and,
with sudden insight, empathically understand that his client had been communicating
a feeling of being stretched and vulnerable in recent sessions. Rob’s experiences from
working in ceramics give him in-depth somatic knowledge. His sensibilities that give
his clay forms their moving quality in turn reflect back to him a capacity to be moved
by the artwork he creates. Not unlike other forms of qualitative inquiry, his art practices
become a platform for awakening critical awareness toward his clients, deconstruct-
ing and reconstructing knowledge, and understanding the powerful psychological and
cultural agent that is art therapy. When art therapists engage in methods of artistic
inquiry, a deep connection with the nature of their art is kindled; this re-connection to
the sources of the work has the potential to transform art therapists’ relationship to the
self and the world in which they live (Kapitan, 2003a; McNiff, 1998a).
Rob’s art-based inquiry satisfies the criteria of Leedy’s (1997) definition of
research: It originates with a problem or question that guides inquiry and has a clearly
articulated purpose. It follows a specific plan or procedure that requires the collec-
tion and interpretation of data to resolve the problem. It accepts certain assumptions,
and its approach is cyclical, in this case, through the design of systematic feedback
from the production and critique of artworks. Such a method is not limited to this
one example of a ceramicist using his artistic knowledge to inquire into his percep-
tions of clients and their needs. An art-based approach has rich potential for a wide
variety of projects, and can be found in such studies as Evans and Dubowski’s (2001)
use of video in art therapy with autistic children, or Barbee’s (2002) collaborative
projects with clients that used photography as reflexive tools of self-representation.
Advocacy research also may be documented and presented to key audiences in visual
forms as videos, community or interactive art exhibitions, or interactive training
materials. The outcome that art-based inquiry produces is a direct understanding of
what happens when people make art to construct knowledge about art therapy.
KEY FEATURES OF ART-BASED INQUIRY

Art-based research has been advanced by Shaun McNiff (1998a) in art therapy but also
can be traced to Elliot Eisner, a prominent arts educator and researcher who refined and
formulated its concepts over many years in an extensive body of work. In 1981, Eisner
outlined several dimensions that differentiate art-based research from a traditional sci-
entific approach. The key features of art-based research, as conceived by Eisner (1981,
1991, 2002, 2003) and articulated by researchers Sandra Weber and Claudia Mitchell
(2004), can be summarized as follows:
Reflexivity: Artistic expression as a form of inquiry provides a medium for connect-
ing to the self, while at the same time distances the self in order to see something from
a new perspective. Critical vision followed by reflective action is a defining process in
the fine arts and in the practice of art therapy with clients. As a method for inquiry it
directly parallels the systematic measurement or feedback loops that are designed into
quantitative and qualitative research studies.
“All at Once-ness”: The imagery produced in art-based inquiry reveals what may be
hard to grasp in language or number. Art practice strives to capture the ineffable or hidden
aspects of the practitioner’s knowledge and to express them in a form that can be appre-
hended holistically. Consider, for example, the power of an iconic photograph to convey a
certain recognizable truth “all at once,” such as the little girl running from a napalm attack
on her village in Vietnam that came to represent a historical era and cultural memory in
the United States. Hervey (2000) asserted that artistic inquiry offers a way of discerning
the kind of “paradoxical, ineffable truth that we experience in our work and witness in the
lives of our patients and giving it a form that can be shared with others” (p. 13).
Sensory, Emotional, and Intellectual Attention: Art is heightened experience; art-
based inquiry seeks to discover “what we didn’t know we knew and to see what we
never noticed before” (Weber & Mitchell, 2004, ¶ 4). Art-based inquiry often involves
and provokes somatic responses. Eisner (1981) observed that its findings usually are
presented in “the creation of an evocative form whose meaning is embodied in the
shape expressed” (p. 69). Especially in a field like art therapy, the use of artistic modes
of representation in research increases the likelihood of finding a voice and making an
impact on others. The image as a powerful cultural and psychological change agent is a
principle of art therapy that may be utilized in art-based inquiry.
Holistic Communication: Art-based inquiry communicates holistically, simultane-
ously keeping the whole and the parts in view. This principle underscores the fact that
cognition is not limited to thinking mediated by language. Through metaphor and sym-
bol, visual media use perceptual and cultural codes to convey effective and economical
theoretical statements. Consider, for example, the research that goes into the creation of
a well-designed ad or billboard that packs a complex communication into a single image
apprehended in a glance. Visual forms condense complex information into spatial ana-
logues that display key features of phenomena (Sullivan, 2005).
Canonical Generalization: Through visual detail and context, art-based inquiry
shows why and how a study of one person can resonate with the lives of many. Unlike
scientific research, the nature of generalization in art-based research is concerned with
illuminating what is unique in time and space while simultaneously conveying insights
that extend beyond the limits of the situation. This form of generalization has been called
the “canonical event”: a sensory distillation of experience that performs a “heuristic func-
tion” beyond the single case by reminding us in vivid terms what such an experience must
be like (Eisner, 2003). The art therapy literature is replete with case examples of such
imagery that vividly conveys a client’s reality in art (see, for example, B. Moon, 1999).
New Ways of Seeing Something: Art-based inquiry provokes, innovates, and breaks
through emotional equilibrium or resistance, forcing us to consider new ways of seeing
or doing things. This common principle that gives art therapy its power with clients can
be transferred to research concerns. Because it produces art imagery, such inquiry may
be more accessible to the researcher and the study’s audiences than the usual academic
language of research. The palette from which an artist constructs an aesthetic com-
munication is composed of carefully selected and balanced elements that utilize the
organizing principles of visual perception.
Advocacy and Activism: Artistic inquiry makes the person social and the private
public, and therefore may incorporate an activist stance. A common feature of art is to
create an impact on the awareness of the viewer or audiences. An outcome of art-based
inquiry in art therapy may be the creation of a persuasive message in service of giving
voice or making visible the experiences of particular clients or client groups. Art-based
research is primarily concerned with what people find meaningful and from which their
worldviews can be altered, rejected, or made more secure (Eisner, 1981).
A contemporary challenge for art therapist researchers has been to find methods of
inquiry that are connected to the core practices of art therapy. Artistic practice is a way
of knowing and a means of discovery (Allen, 1995); artistic inquiry produces works that
serve as objects of intense aesthetic reflection and subsequent action (Kapitan, 2003a).
Art-based inquiry, according to McNiff (1998a), grows from “a trust in the intelligence
of the creative process and a desire for relationships with the images that emerge from it”
(p. 37). Hervey (2000) operationalized the definition of art-based inquiry as that which
uses artistic methods for gathering, analyzing, and/or presenting data; engages in a cre-
ative process; and is motivated and determined by the researcher’s aesthetic values.
McNiff (1998a) emphasized the art therapists’ relationship to the image as the
primary focus of art-based research. Other art therapists have broadened this emphasis
to include the practice of “therapeutic artistry” (Robbins, 1973; Kapitan, 2003a), the
conception of art therapist as a socially responsive artist in the therapeutic enterprise
(Kapitan & Newhouse, 2000), and the study of “those attributes of art that are unique
in the landscape of therapy” (Carolan, 2001, p. 203). Sullivan (2005) encouraged art-
based researchers to “more consciously deploy a range of creative processes as research
practices to fully investigate the contexts that surround complex human activities” (p.
61). The role of lived experience, subjectivity, and memory are all important agents
in knowledge construction; strategies such as self-study, collaborations, and textual
critique may reveal important insights not found by more traditional research methods
(Sullivan). Cole and Knowles described this approach as “arts-informed research”:
Arts-informed research brings together the systematic and rigorous qualities of sci-
entific inquiry with the artistic and imaginative qualities of the arts. In so doing the
process of research becomes creative and responsive and the representational form for
communication embodies elements of various arts forms—poetry, fiction, drama, two-
and three-dimensional visual art, including photography, film and video, dance, music
and multimedia installation. (2001, pp. 10–11)
ART-BASED RESEARCH METHODS:

FRAMEWORK OF ARTISTIC PRACTICE
Because “research” is commonly understood to mean investigations that contribute
to generalizable knowledge, I deliberately use the term “inquiry” to mean the wide-
ranging artistic methods that are used to contribute to art-based art therapy knowledge.
Art-based inquiry is distinguished by its use of the creative process, both to encounter
experiences of interest to the researcher and to represent them with expressive forms that
are effectively communicated to various audiences (Sullivan, 2005). Hervey’s (2000)
overview of the defining behaviors and steps involved in creating a work of art provide
a sound methodological framework for an art-based research project (pp. 48–49):
1. Initial awareness: In creating an artwork, an idea is singled out from its original
context for aesthetic reasons, along the lines of, “This is interesting. I want to explore it
further.” In the example of Rob’s inquiry, the vessel form was recognized as important
to the research question despite that Rob’s understanding was incomplete and required
creative work to fully explicate its meaning. Often the researcher’s attention is drawn
to the original image because of its metaphorical (rather than literal) connection to the
research question, which is also one of the distinctive qualities of art (Hervey, 2000).
2. Decontextualization and intentional re-creation: The image or idea then is
explored by re-creating it in an artistic medium, along the lines of, “I will work with this
idea some more, now with intention.” Here, systematically focusing attention, creative
action, and measured reflection drives the artist-therapist into research activity. Rob’s ini-
tial idea may stay within the original medium of ceramics, or he may transpose the same
sensations from clay into a new medium like painting, poetry, or video. His observation
of art therapy clients working in clay may take on greater alertness and curiosity because
their clay work has been removed from its original function in art therapy and now is
being perceived as part of Rob’s aesthetic experience and research problem.
3. Appreciation and discrimination: The artist then reevaluates the re-created art-
work for its value or effective expression. In Rob’s inquiry, a primary concern will be how
well his series of ceramic vessels address the research question. “Does this work?” as a
piece of art is overlaid with the search for its metaphoric relationship to the research ques-
tion or task (Hervey, 2000), such as, “How well does the creation of this particular clay
vessel resonate with my challenge to work with that particular client in art therapy?”
4. Refinement and transformation: The emerging artworks are adjusted and trans-
formed while discriminating assessment continues in a cyclical process until comple-
tion, along the lines of, “I will keep doing this until I am satisfied” (Hervey, 2000,
p. 48). This phase of the creative inquiry parallels the therapeutic “working through”
process of a problem or life concern in treatment.
5. Re-contextualization: The completed works are placed in an appropriate location
that will maximize their effectiveness in communicating with an audience, a form of dis-
semination that parallels publishing research in a scholarly journal. Rob’s ceramic vessels
may be shown in an art exhibition to a general public audience, for example, or be posted
on a Website hosted by a non-profit organization devoted to advancing public understand-
ing of the mental health needs of a particular population or community. Rob’s vessels might
serve as impetus for a new art-based inquiry project, such as a display in a clinical setting
where art therapy clients are invited to respond to them with artworks of their own.
With this as a general framework of the cognitive and other processes involved
in creating an artwork, we can look at how artmaking may be conceived as structured
inquiry in the collection and interpretation of data to resolve the research problem.
Hervey (2000) differentiated art-based methods from other uses of art in research with
a focus on artmaking as the primary method of inquiry for data gathering, data analysis,
and the presentation of findings.
ARTMAKING AS DATA GATHERING

The primary method in all of the arts begins with critical vision or inquiry into situations
with the intention of disrupting existing perceptions. Applied to art-based inquiry, this
data-gathering method involves the researcher or research participants’ intense engage-
ment in creative activities (materials, processes, and people actively creating) that struc-
turally guide the question. The hallmarks of the creative process—immersion, intense
preoccupation, and openness to experience without preconception—as described in the
previous chapter are all activated in data gathering. In designing art-based inquiry, the
research problem can be conceptualized as a creative problem in much the same way that
an art therapist might help a client with a psychological problem. For example, imagine
your research problem as something a client has brought to you in art therapy: What
treatment plan would you design for it? What would a “creative art-based treatment plan”
for your research problem look like? This technique is effective because of its congru-
ence with art therapy theory and practice: an art therapist can transfer to the research
problem the same principles that shape creative interventions in therapy. For example,
r Investigate client-therapist resistance by creating artwork using the process

of batik, wax encaustic, or other medium applied to resist the layering of
color on fabric or other ground
r Investigate family roles through client and researcher portraiture
r Investigate child attachment patterns via a process of sewing dolls, comforters,
or other transitional objects embellished with photo album transfer images
r Investigate the struggle of letting go of clients who are dying by creating a
ritual for honoring and giving away precious belongings
SOME EXAMPLES OF ART-BASED INQUIRY

Community mural-making to bring cohesion and resolve conflict in a
rural American town undergoing demographic change
Art-based explorations and performance of a fairy tale to convey the pri-
mary tensions of a therapeutic relationship
Artmaking as a form of ritual to help adolescents with disability experi-
ence the transition to adulthood
Art and dream images found in the healing pilgrimages of women survi-
vors of domestic abuse
The phenomenon of beauty in the lives of three women nursing home
residents explored through artmaking and art-based analysis via the
medium of performance art
Honoring the life review process of an elderly resident through artmaking
and in-depth listening
Examination of change in the forms and content of artworks created in the
transition from professional artist to art therapist
A study of retrospective and introspective portraits by three middle school
students who had experienced a traumatic, life-changing event
A review of sketchbooks created by students practicing cross-cultural art
therapy, culminating in an exhibition to portray the essence of a life-
changing experience
An in-depth study of effective art materials for blind and visually impaired
clients
In addition to creative methods that activate inquiry are new sites where art-based
inquiry may take place. Here art therapists may take inspiration from the fields of art
history, fine arts, and arts education, whose art practices no longer are confined to four
walls of a gallery or school. The roles of the artist, art therapist, and art are rapidly
changing and expanding in all directions. Important research practices that fully inves-
tigate the contexts surrounding human activity today are found in studios, galleries,
communities, on the street, and on the Internet (Sullivan, 2005) and have started to
come to the attention of social science researchers as well.
One outstanding example is the Image and Identity Research Collective (IIRC)
Website created by Sandra Weber from the Department of Education at Concordia
University (Montreal) and Claudia Mitchell at McGill University (Montreal). Their
interest is in developing interdisciplinary, image-based research methods and artistic
forms of representation. They state:
In our individual and collective project, we variously use video, film, art installations,
photography, performance, and fictional practice to research questions relating to gen-
der, age, body, popular culture, and/or identity. Many of our projects involve critical
self-study and collective inquiry. (2004, ¶ 2)
Some examples of their art-based research projects include: uses of photography

in memory work, literary forms, and live performances that raise critical questions or
to represent research and theory, and the exploration of self and identity through artis-
tic installations/productions. They have also produced documentary/artistic videos for
theorizing and reporting research.
As an example of art therapists using community exhibition sites for their research,
Aube, Meade, and Baeuchle (2006) reported an exhibition of 35 artworks from art thera-
pists displayed at Avila University (Kansas City, MO). Among the outcomes, the diversity
of artistic expression served to educate visitors on the multifaceted dimensions of art ther-
apy and various social functions that creating art serves. More than 90 viewers interacted
with the exhibition by creating artworks in response. On the Internet, art therapist Nadija
Corcos (2006) invited individuals from around the world to respond to pervasive threats
of terrorism by creating and witnessing images. These are posted on a Website that also
allows viewers to register their participation and response. Using such projects as the site
of systematically structured inquiry, rather than simply collecting data and reporting on
it, would help the art therapy field establish and build upon these outcomes.
IMAGISTIC EXCHANGE: NON-VERBAL COMMUNICATION IN

THE MOTHER/DAUGHTER RELATIONSHIP OF ARTISTS AND
ART THERAPISTS (MALIS, ALTER-MURI, & YOUNG, 2006)
Presented at the 2006 Annual Conference of the American Art Therapy
Association, the panelists described an art-based inquiry to explore the inter-
action and relationship between mothers and daughters through an “imagistic
exchange” and collaborative artmaking between mother and daughter/art thera-
pists. The focus was on family and family-in-relation to women artists. The col-
laborative effort of bringing this work to the public in the form of a cofounded
gallery was outlined as another outcome of the study.
ARTMAKING AS DATA ANALYSIS

Creative vision is followed by reflexive action where the art therapist influences
or is influenced by changing dynamics of experience that are the result of artmak-
ing. The forms that objectify the experience in art-based inquiry are the art prod-
ucts—artworks and aesthetic reflections, and responses to the artwork in the form
of narratives, poems, songs, and other artworks—generated by the researcher’s or
research participants’ creative actions. These guide and verify their experiences, but
also require interpretation to illuminate for others the meanings and understandings
contained in the experience. Such data analysis can be carried out using a vari-
ety of interpretive art responses and frameworks that evoke and amplify meanings
aesthetically.
Sullivan (2005) outlined several practices that I have adapted in Table 7.1 to show
how they can be used by art therapists to investigate the knowledge produced by their
art inquiries. Analytic actions that further understanding of the researcher’s creative
vision from the data gathering phase of the study are used to reframe, encounter, and
critique the insights obtained. These “practices of understanding” (Eisner, 1998) may
involve transformation (where the researcher’s insights constantly undergo change
through further artmaking), construction (integrating theory and practice as a result
of new awareness and insight), conceptualization (where the knowledge that emerges
from artmaking is translated into personal, cognitive, and cultural systems), and con-
textualization (where artistic understanding comes from viewing the insights with dif-
ferent personal, educational, social, and cultural perspectives). Reflexive practices may
be used to “work against” existing or taken-for-granted theories in order to see the data
in new ways. Note that all these constructs are accepted in qualitative social science
research, though they may not be commonly perceived in the visual arts as processes
of inquiry.
Some interpretive frameworks that art therapists have used in art-based data anal-
ysis include the hermeneutic spiral (Linesch, 1994) and McNiff’s (1992) process of
dialoguing with images. In these hermeneutic approaches, the researcher initiates a
metaphoric dialogue with elements of an artwork and the work as a whole to reflect on
critical points of view that may be imagined through them. The method begins with
and continually returns to a careful observation of the physical qualities of the image:
What is it that I see? What happens when I shift my perception? What is dominant
and attracts my eye? Where does my eye go from there? What have I overlooked? The
art-based process of critique, familiar to most artists, operates on the same principles
and is, at base, an interpersonal form of dialogue with images. Critique as a therapeutic
process has been advanced in art therapy as well; the same structure is suitable for art-
based data analysis.
Robbins (1989) described a “psychoaesthetic dialogue” (see pp. 198 –223 for exam-
ple) that reflects on the nuances of the therapeutic process while simultaneously tracks
the emotions and inner images of the therapist in order to arrive at various junctures in the
dialogue. Robbins’ description of empathic contact (pp. 111–121) offers an interpretation
TABLE 7.1 Strategies of art-based analysis

PRACTICES OF ARTISTIC DATA ANALYSIS METHODS FOR FRAMING,
UNDERSTANDING ENCOUNTERING, AND CRITIQUING AESTHETIC INSIGHTS
1. Transform Knowledge created from Example: Painting on a single
insights that constantly canvas throughout a period of
undergo change with time while focusing on a single
further artmaking research question that originated
in art therapy practice
2. Construct Knowledge produced from Example: Creating an altered

integrating theory and book that uses the structures of
practice as a result of new page layout, illustrations, written
awareness and insights text, chapters, fold-outs, etc., to
from artmaking work through insights from art
therapy practice and readings in
the literature on a given research
problem
3. Conceptualize Knowledge from artmaking Example: Creating an item of

that is translated into ritual clothing that expresses
personal, cognitive, and various levels of meaning from
cultural systems the death of a loved one and
aesthetically conveys its
significance
4. Contextualize Knowledge from different Example: Asking others to

personal, educational, respond artistically to an artwork
social, and cultural or installation made to express
perspectives brought to an insight about a given research
bear on insights produced or therapeutic problem, such as
from artmaking the generational cycle of
addiction
REFLEXIVE ARTISTIC DATA ANALYSIS METHODS THAT “WORK AGAINST”

PRACTICES EXISTING THEORIES TO SEE PHENOMENA IN NEW WAYS
“Seeing through” Apply creative insights and Example: Writing case notes from
constructs art therapy knowledge to an adolescent art therapy group
existing data and contexts in the form of a screenplay that
that are open to imagines the art therapy session
alternative and imaginative as a scene at a gallery opening
options with viewers commenting on the
artworks collected from the
study
(Continued)
TABLE 7.1 Strategies of art-based analysis (Continued)

Reflection on Respond to data with Example: Responding to artworks
strategies and further reflection on and created in a study by critiquing
concepts review of strategies to strategies and concepts through
consider other approaches visual diagrams of brainstorming
and concept mapping
Creative dialogue Reflect on significance of Example: Giving artworks

meaning through a created for a study a voice by
dialectic between the imagining what they would say
researcher and the in a song or ballad, or at the
phenomenon of study family dinner table
Question content Issue-driven reflection that Example: Reflecting on the
and contexts continuously questions the artworks created in a journal
content and contexts as written from the perspective of a
problems are revealed viewer imagined as a young
child asking simple questions of
her parents or teachers
of aesthetic experience by imagining, “What would it be like to be inside this picture?”

Similarly, I have advised art therapists in supervision to re-imagine a given art therapy
session as a painting and to reflect on how its composition and other formal elements
could be manipulated to create a more congruent therapeutic and aesthetic whole.
Kidd and Wix (1996) provided examples of an archetypal approach to reflection
on art images based on James Hillman’s writings that may be applied to art-based data
analysis. Imaginal techniques are used to evoke dream-like qualities in the viewer’s
contemplation of artworks. These written meditations help the researcher amplify and
ponder metaphoric connections, establish new relationships between one component in
the image to another, and heighten what is seen and felt in the experience of viewing
artworks. Responsive artmaking (B. Moon, 1999), in which the art therapist responds to
an artwork with additional artworks that amplify meaning, is another way to interpret
and illuminate meaning using an aesthetic framework. Forms of reflection may include
poetry, myths or stories that play with the images’ content and form (Kapitan, 2003a),
songs that give the artist and imagery an authentic voice (B. Moon, 1998, pp. 32–49),
and performance (McNiff, 1989).
ARTMAKING AS THE
PRESENTATION OF FINDINGS
Art-based methods may also be used to present the findings of the inquiry, including
traditional, interactive, or virtual art exhibitions; art performances; published cata-
logues or art writings and blogs; or other art-based media, sites, and events. Validity
in art-based inquiry is obtained through public critique, as has always been the case
in the field of fine arts. As Sullivan (2005) observed, “the arts routinely put theories
and practices up for empirical critique through the critical review. Arenas for debate,
disagreement and consensus are obtained through peer review and historical legacy”
(p. 48).
Art Exhibition
The art practice that is most clearly identified with presentation in the visual arts is the
art exhibition. This process brings together artists, curators, art writers, academics,
educators, institutions, and communities, “each with a particular reflexive response to
artwork” (Sullivan, 2005, p. 207). In art therapy, exhibitions of art therapy-produced
artworks brought into public viewing are increasingly common, though not without
their ethical challenges. In museums, galleries, institutions, or cultural spaces, it is pos-
sible to bring together various constituencies in a range of ways and for a variety of
purposes that explore particular issues surrounding artworks, communities, and col-
laborations. Thus, art exhibitions are a site for presenting art-based research findings
and for verifying them with public critique.
Designing a research project, from start to finish, around the structure of an exhi-
bition gives the art therapist the opportunity to develop a focused program of inquiry;
curating an exhibition around a designated theme “brings together artistic responses that
can take any number of forms, and these images can be investigated as a discrete source”
(Sullivan, 2005, p. 211). With sufficient planning, it is possible to consider the benefits of
dissemination to wider audiences that can access the exhibition through the Internet.
At Mount Mary College (Milwaukee, WI), graduate art therapy students may elect
to present their research study findings in a culminating art exhibition. The exhibition
project requires a selection of completed artworks that present how the research find-
ings interacted meaningfully with the student’s evolving professional knowledge and
mastery of art therapy. Although they conduct their studies using any of the methodolo-
gies presented in this text, students also use the structures of preparing for an exhibition
(developing the theme, selection of artworks, creating new artworks, exhibition design,
use of space, etc.) to guide a culminating cycle of data analysis and creative synthe-
sis. The art exhibition requires an artist statement and written documentation of the
research in the form of a contextual essay that anchors the artworks in the history, lit-
erature, theory, and practical applications of art therapy. The contextual essay provides
critical analysis that not only clarifies the basis of the research claims but also judgment
as to whether scholarly research competencies were achieved.
Performance Art
Pushing the boundaries of art-based inquiry further, performance art is an adaptation
of contemporary arts practice that takes on a greater range of textual forms and content
than an exhibition. Performance art may “pick up on critical perspectives that embrace
the self, agency, information, and the politics of practice” (Sullivan, 2005, p. 207). How
art therapists manage their reflexive experience and attain knowledge within their prac-
tice settings offers considerable potential for art performance since meaning can be seen
to take place through enactment and action. Garoian (1999) viewed performance art
as representing “an aesthetic dimension wherein socially and historically constructed
ideas, images, myths and utopias can be contested and new ones constructed as they
pertain to the artists’ experiences of reality and their desires to transform that reality”
(p. 10). The language, methods, and processes of creating texts from political and cul-
tural inquiry and performing them are an exciting outgrowth of the crossover between
performance art and ethnography as well. Denzin (2003), for example, has extended the
traditional social science principles of ethnography into the critical pedagogy of “per-
formance ethnography” and calls for a “performative social science.”
Art therapy students at Mount Mary College who elect this art-based research
option demonstrate mastery of art therapy through a performance-based, in-depth artis-
tic exploration of a significant research concern in art therapy. Performance art kines-
thetically activates the students’ embodied understanding of their research findings and
deepens their reflections on clinical practice integrated with art therapy knowledge. Art
performance offers both an experiential form of data analysis and final creative synthe-
sis. As with student art exhibitions, a student’s performance is supported by a written
contextual essay that refines audience feedback and anchors the researcher’s competen-
cies in the history, literature, theory, and practical applications of art therapy.
THIS TREE HAS NO ROOTS: IMAGES OF AN

ABANDONED ADOLESCENT (B. MOON, 2006b)
This Tree Has No Roots, presented at the 2006 Annual Conference of the
American Art Therapy Association, is a responsive art performance in the form
of an extended poem that metaphorically explores an art therapist’s relationship
with an adolescent client who has had multiple foster homes, several residential
treatment placements, and inpatient psychiatric hospitalizations. The presentation
interweaves clinical art therapy processes, poetry, and original music in an effort
to reveal the inner experiences of both the art therapist and client as they struggle
to form a meaningful relationship in the context of the art therapy studio.
New and Emerging Public Forums

To encourage the production of art-based inquiry, existing forums will need to be open to
its publication or presentation (Hervey, 2000). For the past several years, the American
Art Therapy Association has included performance art as an ideal venue for showcas-
ing the findings of artistic inquiry at the annual conference. Notable examples of art-
based inquiry in this forum by have been presented by Bruce Moon, whose client- and
case-focused performances synthesize and present therapeutic outcomes while evoking
a range of emotions from conference attendees. Moon’s performances often combine

painting, text in the form of original songwriting or poetry, and musical instrumenta-
tion. Digital technology is creating emerging new forms for documenting and dissemi-
nating artistic inquiry, for example, B. Moon’s Acoustic Memory Project (2002), which
is an oral musical history of art therapy in the United States on the legacy of association
founders, and Voices from Nowhere (2003), a collection of original songs created from
Moon’s art therapy experiences with culturally disenfranchised people.
As another example, Taylor, Wilder, and Helms (2007) described their presenta-
tion of personal audiovisual responses (video shorts) to a folk-rock music video. Using
an autoethnographic arts-based research approach, they visually and metaphorically
inscribed their own “video bodies” with text and images to explore personal and
cultural reactions to the music video. They remind us that just as the microscope
and the camera gave scientists and artists new ways to see what otherwise would be
invisible, each form of expression—whether poetry, weblog, visual art, video, per-
formance, or more traditional social science texts—reveals some new dimension of
the research interest.
Many creative possibilities are emerging in new multimedia and online formats
that have yet to be exploited by art therapist researchers. Online multimedia electronic
journals are able to move past the expense and the limits of publication with links to
exhibition art, videotaped art performance, integrations of voice-over, music, art imag-
ery, and dance accompanied by research text support. New media formats also make
possible greater degrees of collaboration with non-profit advocacy groups and organiza-
tions in mental health care than have been possible in the past.
THE RELATIONSHIP OF ART-BASED INQUIRY

TO OTHER RESEARCH PARADIGMS
Although McNiff (1998a) posited that art-based inquiry would help art therapy move
beyond the limitations of positivist science, Carolan (2001) pointed out that human
sciences have already moved beyond the positivist paradigm with its postpositivist,
constructivist, critical theory, participatory research, and other models of methodol-
ogy, stating that art-based research approaches “can live in all of these paradigms”
(p. 203). The opportunities for incorporating art-based methods into other art therapy
research continue to expand. Research in art therapy that is concerned with in-depth
understanding of human experience may draw from a mix of art-based inquiry and
hermeneutic, heuristic, and phenomenological methodology. Art-based inquiry can be
described phenomenologically because artmaking is a form of direct experience. It can
be strengthened by the systematic structures of action-research with its emphasis on
changing the consciousness of the researcher, and art-based inquiry is being incorpo-
rated into participatory action research. The “hermeneutic circle” is a useful structure for
guiding artistic inquiry as is heuristic inquiry’s cycling through the stages of the creative
process. Methodologies that are dependent upon the experiences of the researcher may
incorporate artworks to provide a distinct vantage point outside the self and in dia-
logue with others. Mixed methods research that combines quantitative measures with
qualitative data can easily incorporate art and artmaking as data, analysis, or presenta-
tion of findings.
In this text, a framework for art therapy research methodologies locates the place
of art as a central and defining concern around which a broad enterprise of questions,
methods, and purposes may be generated. The art practices of art therapists, clients, and
communities share permeable boundaries with each of three main research paradigms in
addition to art-based inquiry: the empiricist-analytical purposes of experimental, quasi-
experimental, and outcomes research; the critical purposes of field-based action-research,
case research, and ethnographic and participatory action research; and the interpretivist
paradigm of phenomenology and other reflective inquiry practices. Sullivan (2005) fur-
thered this notion by aligning each of these major social science research paradigms with
the three main “thinking practices” of the visual arts (Table 7.2).
Thinking in a medium: This perspective, commonly known through the “visual
thinking” research of Arnheim, describes artistic thinking primarily as a consequence
of thought and action that is given form in a creative product (Sullivan, 2005, p. 125).
The art product is an outcome of artistic thinking and therefore the site for addressing
empirical research questions such as the symbolic functions of art in art therapy and
the psychological properties of media, artworks, and the ways that people give form to
meaning. In art therapy research, how artist-clients “think in a medium” evidenced in
the artworks they produce is the focus of much empirical-analytical studies (described
in Chapters 3 and 4).
Thinking in a language: Artistic thinking is also socially mediated. Rather than
focusing on the product or behavioral outcomes of art therapy, art therapy research-
ers may have questions and aims that emphasize the process. The “language” of art
TABLE 7.2 Sources of visual knowing

MAIN RESEARCH
VISUAL KNOWING PARADIGM EMPHASIS METHODS AND PURPOSES
Thinking in a medium Empiricist Forms Perceptual–conceptual
Symbolic product
Artwork
Thinking in a language Interpretivist Ideas Narrative discourse
Image as text
Art process, paths to
understanding
Thinking in a context Critical Situations Critical purpose
Mediated, cultural context
Environments of artmaking
Source: Sullivan, G. (2005). Art practice as research: Inquiry in the visual arts. Thousand Oaks, CA:
Sage.
and narrative constructions with images and objects seen as texts may be studied in
order to discern their meanings (Sullivan, 2005). Artmaking often documents personal
journeys and narratives. Art therapy research that studies art as a language of ideas and
interpretations may be located in the interpretivist paradigm (described in Chapter 6).
One example of art-based inquiry that involved “thinking in a language” is Barb Fish’s
(2006) image-based narrative method that follows the image’s life story, as told by the
artist who created it and through direct dialogue with the images.
Thinking in a context: The importance of context in cognition, learning, and under-
standing is a hallmark of post-positivism science. The art object, once thought to be
primarily an iconic symbol of a fixed time or place, or informational record, is now
much more loaded with multiple references (Sullivan, 2005). Sociocultural cognition
takes into account the ways in which thinking occurs in an interacting system of the self,
others, and artifacts. Sullivan observed that thinking in a context, the concern of much
critical or orientational research (described in Chapter 5), means that the binary idea
that art is either a process or a product must be abandoned. Both process and product
represent interacting complex systems of skills and understanding.
A FUTURE ROLE OF THE ARTIST-

RESEARCHER IN SCIENTIFIC RESEARCH
Research has radically altered the society we live in and will continue to do so. Art-
based inquiry is not without controversy and its adoption by the profession may pro-
duce negative side effects, given the imperative to demonstrate art therapy’s value in
the larger realms of social science research and health care. The art versus science
debate in art therapy research is part of a larger historical problem of the arts failing
to find a viable role in the growing importance of scientific and technological research
to shape society. Wilson (1996) observed that artists have participated only as “dis-
tant commentators, sniping from the audience, often without deep understanding of the
world views and processes of scientific research” (¶ 6). Rather than confine art-based
art therapy research to artistic practices that stand outside or in opposition to scientific
research, another route would be to value and promote art-research cross fertilization.
Art therapists could become, as Wilson wrote when contemplating the role for art-
ists in research settings, more “curious about scientific and technological research and
acquire the skills and knowledge that will allow them to significantly participate in
these worlds” (1996, ¶15).
An educator in the field of conceptual design, Wilson worked for many years
as an artist-developer for several technology companies and as an artist-in-residence
in corporate research centers. He witnessed many good ideas that were abandoned
and devalued because they did not fit with prevailing research paradigms currently
in favor. From his years as a “shadow researcher” he concluded that when artists par-
ticipate in research teams, they add an invaluable perspective that can help drive the
research process in unexpected, critically important new directions. Applied to art-

based inquiry described here, several traditions of the arts uniquely equip art therapists
for taking an important role in traditional or emerging health care research. Art thera-
pists have certain dispositions that can augment the research process in several ways:
1. Artistic tradition of iconoclasm: In health care or community development,

art therapists may be more likely to take up lines of inquiry devalued by oth-
ers, to define new kinds of research questions, to provide unorthodox inter-
pretations of results, or to point out missed opportunities for development.
2. Social commentary values: Art therapists are likely to challenge or to inte-
grate wide-ranging cultural issues in their research, and to explore and artic-
ulate wider-ranging implications of the research undertaken.
3. Artistic valuing of creativity and innovation: Art therapists can offer new
perspectives applied to inquiry, and may be more likely to incorporate cri-
teria such as celebration and awe than commercial or scientific enterprises;
they may approach problems differently than scientists and engineers on the
research team.
4. Interest in communication: Art therapists could bring scientific possibili-
ties to a wider public than peers in other fields, and help to communicate
findings in effective and provocative ways through exhibitions and other
art-based presentations.
Similarly, researchers have started to become acquainted with artistic work that
has pushed scientific advances in new directions (Wilson, 1996). When one considers
how many research developments would not have come to light of day had the research-
ers relied only on traditional research, we might begin to think of art-based research not
as a set of methods set apart from science but as an innovative or critical perspective
brought to bear on the research enterprise. But art therapists can only serve this function
by learning the knowledge, language, methods, discipline, and information networks
that are instrumental in their fields of interest, and preparing themselves to participate
fully in the world of research.
Wilson has incorporated research developments explicitly into his artistic practices.
He reads science journals, participates in online forums, and attends science confer-
ences. He engages researchers in discussion about their findings and shares his artistic
perspectives with them. He has experimented artistically with emerging technologies
that have contributed valuable insights to the research team. In promoting a model of
interdisciplinary, art-based research, Wilson (1996) made the following recommenda-
tions that are applicable to art therapists:
r Pay attention to research and scientific topics in popular and professional

media. Develop the ability to look beneath the surface presentation and think
about unexplored research directions.
r Acquire background knowledge and skills related to science and technology
topics either through formal or informal means.
r Engage with the information sources scientists use to learn about emerging
fields or theories, such as scholarly professional journals, conferences, and
trade magazines, many of which are free to research practitioners.
r Learn about relevant online information resources such as mailing lists,
newsgroups, Web sites, and research databases that have become so crucial
in scientific communication.
r Develop new kinds of mutually beneficial collaborations with non-profit and
for-profit corporations, universities, and other research organizations.
r Patrol the frontiers of social science research to identify future trends that
could benefit from artist/research inquiry.
r Invite researchers along with artists as key presenters in art shows, galleries,
and publication commentaries.
Art therapists have a unique worldview that predisposes them to investigate a range
of art-based questions and problems from the primary sources of knowing the world
artistically. Art, science, and therapy will benefit greatly from their contributions.
OUTCOMES IN ART-BASED INQUIRY

AND ART THERAPY RESEARCH
Art therapy research that produces scientific knowledge aims to eliminate rather
than embrace ambiguity, to gather verifiable evidence, and to fit the findings into a
larger theoretical framework (Kaplan, 2000). Whereas scientists strive for objectiv-
ity, artists cultivate their idiosyncratic subjectivity by provoking and moving audi-
ences through art’s communicative power and unique perspectives. In agreement with
Higgins (1996), Kaplan (2000) saw artistic endeavors as “structured inquiry” that
illustrates rather than validates general principles. Inquiry that tests hypotheses and
builds on previous research is a sound practice, but Sullivan (2005) reminds us that
scholarship also is about ideas. Artistic inquiry challenges the art therapist by “the
need to create and then use this new awareness as the critical lens through which to
examine existing phenomena” (Sullivan, 2005, p. 49). Thus, art-based inquiry adds
to the knowledge base of art therapy as new ideas are presented to help art therapists
see in new ways.
As Eisner (1998) described, “artistic works can help us understand because their
creators understood and had the skills and imagination to transform their understanding
into forms that help us notice what we have learned not to see” (p. 51). In this sense, the
outcome of art-based inquiry is not to confirm probability nor plausibly explain, but to
present the possibility of new understandings of art therapy issues. Art-based inquiry
does not solely confirm existing knowledge but advances innovations in theory and
practice. At the same time, the research aims of the field are broadly encompassing. Art
therapy research is enriched when art-based methods and processes are incorporated
into studies that yield artistic or scientific knowledge, and empirical or pragmatic
solutions to complex therapeutic problems. Art therapists who are science-aware and
informed in ways that seek out opportunities for collaboration along the borders of the
art-science interface can add yet another set of potential outcomes made possible when
art practice in art therapy is embraced as intellectual and imaginative inquiry.
CHAPTER SUMMARY
1. Art-based inquiry uses art practice within a research perspective to illumi-
nate or construct knowledge. Direct engagement in art practice becomes the
“site” for research problems and methods. Art-based inquiry privileges the
practices and perspectives of the artist.
2. Some of the purposes of art-based inquiry are (a) to provoke, challenge, and
illuminate rather than confirm or consolidate knowledge; (b) to enlarge per-
ception of subtle relationships within complex wholes; (c) to imagine new
possibilities; and (d) to understand the transformative power of art knowledge
in the practice of artmaking.
3. Key features of art-based inquiry include (a) critical vision followed by reflexive,
creative action; (b) giving form to ineffable experience; (c) embodied response
and heightened sensory, emotional, and intellectual attention; (d) communica-
tion of complex information through metaphor and spatial analogues; (e) gen-
eralization by way of vivid and particular experience that resonates for many;
(f) innovation and breakthrough; and (g) making the private public through
persuasive messages that give voice to particular groups or people.
4. The steps used in creating an artwork—initial awareness, intentional re-
creation, discriminating critique, refinement and transformation, and re-
contextualization through public viewing (Hervey, 2000)—provide a general
methodological framework for art-based inquiry.
5. Hervey (2000) differentiated art-based methods from other uses of art in
research with a focus on artmaking as the primary method of inquiry: (a) art-
making as data gathering, (b) artmaking as data analysis, and (c) artmaking
in the presentation of findings.
6. In designing art-based inquiry, the research problem can be conceptualized
as a creative problem in much the same way that an art therapist helps a client
with a psychological problem.
7. The roles of the artist and the visual image are changing and expanding in all
directions, and include new sites for art-based inquiry such as studios, galler-
ies, communities, on the street, and on the Internet.
8. Approaches to art-based data analysis involve practices for understanding
and reflection, and include metaphoric dialogues with art data, written med-
itations on images, responsive artmaking, and other forms of critique and
reflection.
9. Art-based presentation methods include traditional, community, interactive,

or virtual art exhibitions; art performances; published catalogues or art writ-
ings; or other art-based media and events. Validity in art-based inquiry is
obtained through public critique, as has always been the case in the field of
fine arts.
10. Art-based inquiry can be integrated into empiricist-analytical research; criti-
cal perspectives of field-based research; and phenomenology and other reflec-
tive inquiry practices. Each of these paradigms is aligned with the dominant
“thinking practices” of the visual arts: (a) thinking in a medium, (b) thinking
in a language, and (c) thinking in a context.
11. In the growing importance of scientific and technological research to shape
culture, art therapists may realize a largely untapped role as artist-research-
ers who are science-aware and informed in ways that seek out opportunities
for collaboration along the borders of the art-science interface.
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Moon, B. L. (1998). The role of responsive art making. In The artist as therapist with adolescents
(pp. 22–53). Springfield, IL: Charles C Thomas.
Moon, B. L. (1999). The tears make me paint: The role of responsive artmaking in adolescent art
therapy. Art Therapy: Journal of the American Art Therapy Association, 16(2), 78–82.
Moon, B. L. (2002). The acoustic memory project. [CD recording]. Mundelein, IL: Author.
Moon, B. L. (2003). Voices from nowhere. [CD recording]. Mundelein, IL: Author.
Moon, B. L. (2006b). This tree has no roots: Images of an abandoned adolescent. Performance pre-
Robbins, A. (1973). The art therapist’s imagery as a response to a therapeutic dialogue. Art
Psychotherapy, 1(3/4), 181–194.
Robbins, A. (1989). The psychoaesthetic experience. New York, NY: Human Sciences.
Taylor, P. G., Wilder, S. O., & Helms, K. R. (2007). Walking with a ghost: Arts-based research,
music videos, and the re-performing body. International Journal of Education and the Arts,
8(7), 1–27.
Weber, S., & Mitchell, C. (2004). About art-based research. Retrieved February 10, 2010, from
http://iirc.mcgill.ca/txp/?s=Methodology&c=Art-based_research.html
Wilson, S. (1996). Art as research. Retrieved February 10, 2010, from http://userwww.sfsu.
edu/~swilson/papers/artist.researcher.html
PART III
Research
Doing Art Therapy
Before You Begin:

The Research
Proposal and Other
8
Ethical Safeguards
What we may still fail to
appreciate is the place wildness
occupies in the human spirit.
All too often, we assume we can
excise the need for it from our
character without disturbing
anything else. That’s not too
surprising. After all, it’s the
way we have dealt with every
other unruly facet of nature
we’ve encountered. … Whether
we recognize it or not, our hunt
is still going on—the same
restless search to the horizon
has brought us from the plains
of the African Pliocene to where
we are now. If we’re far removed
from wilderness, we may not
even recognize the root of the
feeling, but that makes very little
difference—we still can’t leave it
behind. Now and then it demands
a free rein in an empty place,
a long run in the tall grass …
Without that, it will subside at
last into pacing the perimeter of
our circumscribed lives, without
direction or rest, looking for
a way out and finding none.
—Chris Madson (1991, p. 66)
185
Throughout history humans have always pursued the successful interchange of the indi-
vidual or family group with its surrounding environment. Knowledge obtained from
this interchange informs one how to act and what to pay attention to in the face of life’s
demands (Kapitan, 1998). On the spiritual level, research fulfills a function of “complet-
ing the circle of ‘I’ and my environment” (Ortega y Gassett, 1943/1985) practiced in a
context of respect for the universe and a continuing search to understand and relate to it
in some deeper way. Integrating ethics into research is the process of ensuring that your
work is guided by a deeply respectful partnership between your aims and the phenom-
ena and people you are involving in your study. This is the main reason behind writing
a research proposal, which is a requirement of any university, foundation, or agency
sponsor. In this chapter, I outline the issues involved in translating your research design
to a proposal that communicates your intentions to others so that the rights of research
participants are safeguarded. Because writing a proposal forces you to reflect on what
you actually plan to do, it is also a vehicle for thinking through potential ethical issues
you might encounter, and these are discussed here as well.
THE INSTITUTIONAL REVIEW BOARD

AND THE DEFINITION OF RESEARCH
As discussed later in this chapter, research today requires compliance with ethical stan-
dards and with federal, state, and institutional policies that protect the rights of human
research participants. The group of people responsible for the oversight of research activ-
ities being sponsored by the institution is called the Institutional Review Board (IRB).
When it comes to the authority of an IRB, the heated philosophical debates in art therapy
about what is and isn’t research fall by the wayside. U.S. federal rules (adopted by 17
federal departments and agencies under the jurisdiction of the Department of Health
and Human Services, 2001) define research as “a systematic investigation, including
research development, testing and evaluation, designed to develop or contribute to gen-
eralizable knowledge” (45 CFR 46.102[d]). Accordingly, research activities conducted
by art therapists that typically require some level of IRB review and approval include
formal investigations, experiments, and quasi-experiments; pilot and exploratory stud-
ies; survey research; and social action projects involving service or other community
programs. IRB review is required in any testing of drugs, devices, or products used with
humans, and when data are collected through the manipulation of a participant’s envi-
ronment or through interpersonal interactions. Special protection is expected in research
involving vulnerable subjects, including children and people with mental health issues or
restrictions on their freedoms. As defined by the federal rule, research does not include
classroom instruction or simulations that teach research methods, activities designed to
improve teaching quality, quality assessment, or the study of certain publicly available
data sets. If the knowledge obtained is particular to the people being studied, such as
is found in many artistic, biographical, heuristic, or narrative activities, it usually does
8 t Before You Begin 187
not fall within this definition of research. However, these and other types of art therapy
research may fall into gray areas because of the lack of specificity in the federal rules.
When in doubt, it is always better to submit your research proposal to the IRB and
receive its approval than to attempt to conduct research without it.
The IRB that is responsible for reviewing your research proposal—whether that
of a university or therapeutic agency or both—will have standard procedures for deter-
mining whether your study is exempt from their review, can be expedited, or is reviewed
in full. Many institutions now require their students, instructors, practitioners, and
approved researchers to complete training in human subjects research through tutorials
that are widely available online.
COLUMBUS’ MAP: FROM RESEARCH

DESIGN TO RESEARCH PROPOSAL
With these review and approval purposes in mind, let’s begin with the problem of the
research proposal. Translating the research design into a proposal is not a mechanical
process and requires a major shift of thinking. Unlike the plan itself, the main purpose
of the research proposal is to communicate your research plan to others. A research
proposal is meant to inform a reader quickly and accurately what is being planned.
From having read the proposal, a non-expert should be able to know whether the study
is worth doing and whether the researcher has the solid knowledge and skills needed
to carry it out. Maxwell (2005) breaks down the purpose of a proposal into four main
concepts:
1. Explain: You know what you want to do, now explain it to others. This can be
difficult. The challenge usually isn’t about failing to have a good design but not
being clear in how you are communicating it. Clarity is everything; the lack of
clarity dooms more research and grant proposals than any other reason by far.
2. Justify: Those who read your proposal want to know not simply what you
plan to do but why you want to do it. Some art therapists have written that
we shouldn’t have to “justify our research to ‘external’ decision-makers”
(McNiff, 1998a, p. 33), but this is only true for the introspective inquiry of
individuals who have no intentions of interacting with others. People who
sponsor or participate in your study have a right to know what they are get-
ting into and your reasons for involving them.
3. Propose: The purpose is to propose research, not carry it out in the pages of
the proposal through extensive elaborations on philosophy, theory, and the
contents of the library database on your topic. Maxwell (2005) observed, as
well, that sometimes the researcher writes the proposal about an intended
outcome (a thesis or dissertation, a funded program or employment, etc.)
instead of the research plan that will produce the desired outcome.
4. Make sense to non-experts: The people who read your proposal have not
done all the thinking and reading you have done, and are not likely to be
experts on your topic. They may not be art therapists. Therefore, it is impor-
tant to present your design in a way that is clear to a non-expert.
Because valid research is not conducted alone, the readers of the proposal are
members of those audiences that have an authorized stake in your study. It is sometimes
a bit of a shock, after weeks of solo work thinking up the research design, to suddenly
have to articulate that design to others. These readers or audiences will include some or
all of the following:
r Your research instructor and/or advisor, if you are a student

r Personnel at the site where you plan to conduct the research, such as access-
granting administrators, supervisors, co-therapists, related professionals on
the research team with specialized expertise, or other agency personnel
r The Institutional Review Board (IRB), which is a committee of the host
research institution (university or the agency itself) with the responsibility to
review and monitor any research activities it sponsors
r You, the researcher, and any of your peers or colleagues who can read the
proposal to help you step back from your design and evaluate its merits
It may be helpful to use the checklist below to clarify your understanding of these
readers and their needs, and return to this checklist periodically as you draft, develop,
and revise your proposal:
CHECKLIST FOR WRITING AND REVISING FOR READER NEEDS

r Who are your readers?
r What do they expect you to do for them?
r How much do they already know about you and your topic of study?
Do they have the same, less, or more background knowledge than you
have? What do they expect you to discuss about the topic?
r Do they already understand your problem, your question, and approach?
Will they take the matter seriously or do you have to persuade them?
r How will they respond to your design, methods, hypothesis, or possible
solutions? What arguments might they have against your design?
r Have you made your rationale for all of your design decisions explicitly
clear or will they need to see more of your process or steps that lead up to
them? Have you offered enough detail or will they need to see more?
r Is your language focused, professional, and clear or are you confusing peo-
ple with meanderings and irrelevant discussions that waste their time?
How Your Reader Thinks

As someone who has read hundreds of graduate research proposals and has written
many proposals professionally, I will share what goes through my mind when I am in
the role of a reader. As your reader, I want the information presented clearly and in as
straightforward a manner as possible. There should be no extraneous information or
riffs on your childhood or how you discovered art therapy. To be blunt, I don’t care and
the odds are that I’ve heard it all before. I will not be impressed by elaborate descrip-
tions or literary quotations. Stream-of-consciousness writing or long paragraphs that
blend together will exasperate and annoy me. A proposal is not meant to be an artis-
tic creation or fascinating piece of expository writing. My whole goal is to determine
whether your plan makes sense, so putting your energy into creative writing, however
excellent, will be wasted on me.
The writing should be terse and uncluttered so that I can move quickly with ease
from topic to topic, and follow the logic of the research design. I expect professional
language; any slang will make me skeptical because it communicates immaturity or a
lack of seriousness. Likewise, the professional jargon you have picked up in art therapy
might be understandable to me, but it won’t be to most any other reader whom you
need to access through your proposal. Terminology should be defined so that there is
no misunderstanding in how you are using certain concepts. The language should be
clear, precise, and sharp. Well-organized, clear writing is the product of clear thinking.
Therefore, the clearer and more coherent your proposal is, the more likely I will be
persuaded that you have thought through the research study and are prepared to carry
it out effectively. For this same reason, the proposal must be clearly organized. A judi-
cious use of sub-headings helps me move through the proposal and locate key parts of
the design.
As mentioned above, one challenge that graduate students in particular face
is the shift in their academic skill set from writing the outcomes of their research,
such as the typical library research paper written at the end of a course, to writing
a plan to do (future) research. Your proposal should be about your study, not solely
about the literature or the general topic of your study. It sometimes happens that as
soon as you close in on a juicy question and its possibilities for exploration, you sud-
denly find yourself diving into a review of the literature review, checking out every
book in the library, taking copious notes, and gradually losing focus on proposing
rather than doing the research at this juncture of the process. Because the proposal
requires you to present a sufficient review of the research literature to give the study
its context, it is easy to immerse yourself in library research and be drawn by the
irresistible creature further and further into the enchanted forest. However, if you
take the time to plan the research study first and have worked out the details of each
component in the design, writing the proposal is relatively easy to do because it
should follow the same logic.
ELEMENTS OF A RESEARCH PROPOSAL

Research designs and research proposals oftentimes are approached as if they were
the same thing. This may be because writing a proposal causes you to think through
the different elements of a study in greater detail than in the initial planning stages. In
my experience, it is worthwhile to work out a detailed conceptual map of the research
design first and then translate that map to a proposal. In this way, you can preserve the
creative process of designing research and not have the more linear structure of pro-
posal writing interfere with the full range of your ideas. Although every university or
foundation has specific requirements that are beyond the scope of this text, proposals do
have certain common elements. Returning to Maxwell’s (2005) interactive design com-
ponents (discussed in Chapter 1), the research study can be aligned with the structural
format of a general research proposal as shown in Table 8.1.
Introduction and Purpose

Generally speaking, most proposals are introduced with a concise statement that estab-
lishes the research concerns and rationale. The most common error in introducing the
study is failing to get to the point (Locke, Spirduso, & Silverman, 1993). All that is needed
are the basic facts; more detailed explanations about the problem come later. Somewhere
in the introduction, you must take care of the most pressing concern of your reader: the pri-
mary target for the study, or focal statement of purpose. Once stated, the reader can settle
into your proposal and follow along with your design. But now another concern will pop
up: “Why bother with that question?” This forms the basis of your rationale for conducting
the study. For many proposals, the introduction ends by arriving at concise, simple, and
clearly stated hypotheses or formally stated research questions. A brief description of the
scope or boundaries of the study also is provided in order to focus your reader’s attention
on the precise area of your interest within what may be a much larger topic.
Because clarity is so important, make sure you define any specialized terminol-
ogy related to the study and that you are using it precisely. Sometimes this includes art
therapy terms and concepts that you may erroneously assume everyone already knows.
The basic rule is that each word should mean the same thing to both the researcher and
the reader (Locke et al., 1993). For example, the dictionary definition of “empathy” is
not the same as its clinical definition. Empathy can be a general concern or a specific
therapeutic function. A research study that has empathy as a variable needs to commu-
nicate precisely how it will be used by the researcher.
Context
The context or background of the problem is developed in the literature section. If
you have conducted a methodical search for literature (described in Chapter 1), then
TABLE 8.1 Elements of a research design and proposal

RESEARCH DESIGN RESEARCH PROPOSAL IRB CRITERIA
Purposes Introduction The study is worthwhile
Research problem or Statement of purpose The scientific logic is sound

questions Rationale/significance
State the problem and
hypothesis
Assumptions/limitations that
define scope of the study
Conceptual context Context The design and scientific logic

Review of the literature upon which the study is
Related clinical, based is sound
professional, and
sometimes personal
context
Methods Methods and timeframe The methodology is sound,

Subject population and will achieve the purposes,
research approach and is safe for participants
Data collection
Data analysis
Validity Validity (why it is a well- Benefits to participants

designed study) and how outweigh risks,
ethical issues will be confidentiality and consent
handled are provided
Return to purposes Expected results and Sound logic flows from

implications purposes to implications and
benefits of the study
References References Study is grounded on quality

research
Supplemental material Risks and benefits, consent,

Consent forms confidentiality, and other
Assessment tools or protections are detailed in
instruments the consent form
Interview guides, etc. Instrumentation is provided
for review and evaluation
creating the context surrounding the problem and sub-problems will be relatively easy.
Your literature review will be more coherent if you work from an outline. One method
for determining how to organize the literature review is to study published research
reports (see Chapter 9) to give you an idea of how an author synthesizes a large amount
of background information into relevant and concise statements. As a guideline, select
only those studies that provide a foundation for your proposed research and make their
relevance entirely clear, noting the explicit ways in which they have bearing on your
study (Locke et al., 1993). Identify literature that provides the historical context for your
study and the most recent published research (current–10 years).
Methods
The methods section identifies procedures for selecting participants, processes, instru-
ments and techniques for measurement, how the data will be collected, and an explana-
tion of a systematic process used for data analysis. One dilemma that many art therapists
have when proposing a qualitative study is how to present ideas that are open to discov-
ery and change, or pre-reflective in the case of phenomenological studies. Qualitative
designs often are at odds with most quantitative designs that require airtight, carefully
laid plans designed around unchanging variables. One way to address this dilemma is to
think of the proposal as a “contract” between the researcher and the audiences that will
support or grant access for the study. Most quantitative designs are “closed contracts”: a
known hypothesis is tested through following a specific protocol while minimizing con-
founding or unforeseen variables. Many qualitative designs are “open contracts” that
allow for change as certain data emerge and come to light. Nevertheless, all research
follows a contract that specifies to the greatest extent possible what can be expected to
occur: the level of risk involved, types of activities, participant selection and participa-
tion, assumptions and questions that will guide the inquiry, and so forth.
To clarify this point, I like to offer the example of Christopher Columbus’ journey to
the Americas in 1492. Chris’ plan was “qualitative” in that it was open to discovery. He
really had no way of knowing beforehand what he was going to run into and must have
been hard-pressed to spell out precise or specific outcomes that could be expected. But he
didn’t venture out blindly. He had a hypothesis made from well-informed, educated logic:
If he sailed west, he would not fall off the end of the earth but eventually would bump into
a land mass somewhere on the other side of the world. He had his main problem to solve in
this quest and a number of sub-problems he had to anticipate. To carry out his plan, Chris
needed to be sponsored by someone who was willing to accept the risks in order to get
a good return on the investment. Chris didn’t go up to Queen Isabela and say, “Give me
money, ships, men, and equipment, but don’t expect me to tell you what I am going to do
with them. It’s a mystery. You’ll just have to ‘trust the process’ with me on this.” Like any
researcher writing a proposal, Chris had to tell Queen Isabela what he planned to do, to the
greatest extent possible; account for how things might evolve and change; and convince her,
the same as any funding agency, that he had sufficient knowledge and skills to be success-
ful. He had to have done his homework and know what he was talking about. He had to get
straight to the point before the Queen of the Realm lost interest or changed her mind.
If Queen Isabela were the head of the National Institutes of Health (NIH), the most
likely reason she would have for turning down Chris’ proposal would be that it wasn’t
convincing that sailing west would produce anything useful or was important to do.
Or the methods Chris proposed were seen as questionable and unsuited to his purpose
or objectives. Risks to his co-researchers might have seemed fairly high and he would
have been asked to disclose how he would deal with the mental health of his sailors who
Topic of Study/Research Problem

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FIGURE 8.1 Sample research proposal evaluation.
believed they were sailing into oblivion, or to consider the consequences of his actions
on the native people he “discovered.” Another common weakness is vague or nonspecific
areas in the proposal, making it hard to evaluate whether the plan is sound (Figure 8.1).
Finally, the Queen would need to be persuaded that Chris knew what he was talking
about and had sufficient knowledge and experience to take on such a venture.
THE ROLE OF ETHICS IN THE

RESEARCH PROCESS
It is easy to get so caught up in research proposal writing, or frustrated with the whole
enterprise of having to explain yourself in order obtain approvals or funding, that
you lose sight of why plans are laid out in advance. Ethical issues sometimes are
delegated to the margins of the research planning process or included as an after-

thought. Unfortunately, a range of ethical dilemmas may appear once the researcher
begins carrying out the day-to-day tasks of the study. A brief review of why proposed
research is subjected to review and approval will help us understand the central impor-
tance of ethics.
The view that scientific research is intrinsically neutral and beneficial disap-
peared with the revelations at the Nuremburg trials of Nazi “medical experiments”
and the role of leading scientists that led to the dropping of the atom bomb (Punch,
1994). In medical science, the infamous Tuskegee Syphilis Study helped to initiate
a movement to protect the rights of human subjects. In the 1960s Americans were
shocked to learn about the Central Intelligence Agency’s involvement in LSD experi-
ments that administered the drug to unsuspecting subjects and resulted in at least
one suicide. Milgram’s (1963) classic psychological experiment required unwitting
participants to think that they were causing “pain” to others in a laboratory situation.
Punch (1994) wrote,
In a sense, we are all still suffering from the sins of Milgram. His laboratory experi-
ments, allied to the negative reactions to revelations about medical tests on captive,
vulnerable, and non-consenting populations, led to the construction of various restric-
tions on social science. Academic associations have formulated codes of professional
conduct and of ethics, and some research funding is dependent upon the researchers’
ascribing to ethical guidelines. This codification presents a number of dilemmas, par-
ticularly for researchers who engage in fieldwork. (p. 89)
Most of these concerns have to do with issues of harm, consent, deception, privacy,
and confidentiality of data. Any research that involves interacting with people will affect
them in some way. In this sense, a research study is an intervention of some kind. A
method aimed at discovery, for example, will be experienced as a directed, reflective
process that may lay open thoughts, feelings, and tacit knowing not already in some-
one’s awareness. Some degree of risk, therefore, always accompanies research. For this
reason, researchers must have an ethical framework within which they design, propose,
and conduct a study.
Punch (1994) wrote that in addition to ethical codes, three historical develop-
ments evolved to correct some of the ethical arrogance and bigotry of earlier, now
notorious research. The women’s movement of the 1970s brought forth a type of
scholarship that emphasized identification with non-exploitative relationships and
critiqued research in ways that exposed power imbalances and racist assumptions.
At the same time, the evolution of participant-observation field research created new
types of collaborations that regarded research “subjects” as co-researchers. To with-
hold or deceive them in any way would undermine the very processes being stud-
ied. Finally, government funded research began to require any institution receiving
federal funding to establish an institutional review committee. These committees,
known as Institutional Review Boards (IRBs), have the federal-mandated respon-
sibility for determining whether the benefits of a study outweigh the risks, whether
consent procedures have been carried out, and ensuring that no group of people has
been unfairly treated or left out of potentially positive benefits of a study’s outcomes
(Beyrer & Kass, 2002).
This is the reality surrounding your research study. But rather than view it as an
onerous set of rules imposed from some distant group of regulators, it is valuable to
use the process of communicating your proposed study to others as an opportunity to
uncover your own ethical perspective on the research process (Hesse-Biber & Leavy,
2006.) and to develop your practice of integrity. Reflecting on the questions below will
help you create a conscious framework to guide you when making the ethical decisions
that accompany your research proposal.
ETHICAL FRAMEWORK (ADAPTED FROM

HESSE-BIBER & LEAVY, 2006)
What moral and ethical principles guide my work and life beyond the pro-
fessional code of ethics that I am bound to as an art therapist?
What is my “ethical standpoint” on the research process?
Where do my ethical obligations to those I am researching start and end?
How do ethical issues enter into my research problem?
Traditional societies also are guided by an ethical code that requires members
always to speak and think respectfully of everything in their environment and to not
behave arrogantly or superior to anything in the world in which they live (Kapitan,
1998). As Koyukon (Native Alaskan) elder Catherine Attla said:
There’s a really big law we have to obey. That law is respect. We have to treat every-
thing with respect. The earth, the animals, the plants, the sky. Everything. What
enforces that law is the world itself, not other humans … If you mistreat a part of the
world—if you’re disrespectful toward it, if you don’t approach it with humility and
restraint—you suffer, you pay consequences. In [this] way of seeing the world, the
enforcement is always around you. “There’s always something in the air that watches
us,” meaning that everything we do, no matter where we are, we are always subject
to these rules, because everything around us is aware of what we are doing. (cited in
Nelson, 1991, p. 36)
This discussion helps to keep in mind the difference between an “ethical code of
practice” and ethical values. Every research study has an ethical substructure that is
best attended to holistically. Ethical rules cannot possibly cover everything that may
arise in conducting art therapy research, so paying attention to underlying values is
a key integrity practice for making the right decisions when circumstances warrant.
This practice of thinking and judging what your ethical obligations are throughout the
research process creates a sensitizing safeguard for both the researcher and the par-
ticipants (Patton, 2002). A historical source for practicing research integrity, known as
the Belmont Report (U.S. Department of Health, Education, & Welfare, 1979), sets out
three basic principles that guide most research today:
r Respect for persons: Based on democratic values, this principle raises the
question of autonomy and recognizes that people with limited capacity to act
autonomously and to make decisions freely must be protected.
r Beneficence: Ethical researchers consider the benefits and potential to cause
harm of their studies, and weigh the risk to the individual against the poten-
tial benefit to society.
r Justice: This principle raises the question of fairness in how the risks and
benefits are distributed across groups and individuals. For example, do the
research participants benefit or only the researcher and his or her society? Are
participants denied beneficial treatment as a control condition of the study?
ONLINE RESOURCES ON HUMAN SUBJECTS RESEARCH ETHICS

Online Ethics has accessible literature and information on “the responsible con-
duct of research” in science as well as case studies, reports, discussion groups, and
ethics codes from various professional societies in different countries. See: http://
onlineethics.org
The United States Congress established the Office of Behavioral and Social
Science Research (OBSSR) in the National Institutes of Health (NIH) in order to
promote social science research and integrate it more fully in the NIH. See: http://
obsr.odnih/gov
The Department of Ethics at the NIH has a listing of detailed reports and
studies on human subject protection and ethical issues on recruitment, vulnerable
populations, technology, clinical research, and multinational capacity building.
See http://bioethics.nih.gov
The U.S. Department of Education has general information on the protec-
tion of human subjects, details of the regulation governing protection, and many
excellent materials such as the Belmont Report and an Institutional Review
Board Guidebook. See http://www.ed.gov/about/offices/list/ocfo/humansub.
html
The American Psychological Association has continuing education resources
on ethics, ethics codes, and a draft of “universal ethical procedures” that focus
on global principles and values for developing standards that are appropriate for
different cultural contexts. See http://www.apa.ethics/homepage/html
Among the many ethical dilemmas that researchers encounter in research, three of
the most common are issues surrounding confidentiality, informed consent, and the role
of the researcher in research paradigms where boundaries may become blurred. The
latter is a unique practical challenge for art therapists who conduct research in the same
setting where they may be working as practitioners. It can be said that most agencies
and schools are uncomfortable with their interns or therapists conducting research on
clients, for good reasons. If you have ever been a parent or person with a family member
who is vulnerable (due to age, mental health, or other circumstance) and being cared
for in an institution, you will know the concerns about the risks involved. The primary
purpose of schools is to educate their students; the primary purpose of a nursing home
is to provide a safe residence to ameliorate the problems of advanced aging or medical
dependency. Research that furthers knowledge and improves care is welcome but not
if there is any potential for harm in any way. Neither do agencies care to subject their
clients to research that has no discernible purpose, use, or value to the agency and the
people in its care.
Multiple Roles
Various professional or clinical commitments can create ethical dilemmas due to the
multiple roles one may bring to the setting. The relationship between therapist and cli-
ent (or between instructors and students) is unequal in power and agency despite that
egalitarian values may be a cherished ideal. Informed consent can cross the line into
perceived coercion if the research participants feel that they cannot truly decline con-
sent without penalty or loss of an anticipated benefit. For example, students may per-
ceive that their grade may be influenced if they decline to participate in a professor’s
study; a client’s medical or mental health condition may interfere with self-autonomy.
Some clients may fear you won’t like them or help them anymore, or that you will tell
their family members or other staff, if they don’t agree to your study. Signing a consent
form, thus, truly is not the same as freely giving informed consent. Researchers should
be sensitive to their power in the helping relationship and to protect their clients from
feeling obligated to participate and sign over their consent.
If your primary role is that of an art therapist or educator in the agency where
you will be conducting your study and if your clients (or students) are going to par-
ticipate as research subjects, then this role supersedes all others. You are responsible
for safeguarding the integrity of the therapeutic contract—the physical and emotional
space, timeframes, roles, goals and objectives, assessment, activities, and treatment
interventions—that your clients depend upon for their health, wellbeing, and recovery.
If your study has aspects that contribute favorably to the therapeutic contract, they can
be included and should not pose ethical problems as long as they are within the normal
standard of care. Any aspect of the study that holds risk of compromised treatment must
be kept apart.
For this reason, some art therapists design studies whereby data collection and data
analysis are kept separate and made distinct in how the impacts of the setting, timing,
or role are handled. For example, an art therapist may collect data through case notes
and observations while maintaining an ethical stance as a therapist. But analysis of the
data collected takes place outside the container of therapy—by assigning analysis to a
researcher who is not the primary therapist, by adopting a retrospective role after the
therapeutic relationship has terminated, or by engaging in forms of analysis such as in
action research where both the means and ends are introspective and congruent with the
goal of directly improving treatment. Some art therapists work as researchers in agen-
cies where they have no direct involvement in therapy.
Confidentiality and Anonymity

Confidentiality means that research participants and any identifying information about
them need to be protected from disclosure. This principle relates to the research par-
ticipants’ autonomy and right of privacy. “Direct identifiers” include names, addresses,
and phone numbers; email addresses; social security and other personal identity num-
bers; numbers that identify medical records, health care plans, bank accounts, licenses, or
certificates; fingerprints; and full-face photographic images. Researchers must carefully
minimize potential “indirect identifiers” as well. These include detailed geographic infor-
mation such as a state, county, or ZIP code; names of organizations to which the person
belongs; educational institutions attended; exact occupations or positions held; exact places
of origin; places and dates of admission or treatment; and detailed income information. In
general, any single variable in a data set that applies to fewer than five individuals is con-
sidered a potential indirect identifier (National Institutes of Health, 2003).
The third aspect of confidential information that can create ethical concern has
to do with sensitive information that may harm participants if released. For example,
information on the psychological wellbeing of a participant or litigious issues could
compromise that person’s employment. Other sensitive information might be sexual
orientation or practices, data on substance abuse, or disclosures of high-risk behav-
iors. IRBs require special protections in studies that collect such data. Detailed infor-
mation on safeguarding privacy in accordance with the Health Insurance Portability
and Accountability Act (HIPAA) in health care research can be found on the National
Institutes of Health Website (www.nih.gov).
Informed Consent
Informed consent is another critical area that presents ethical considerations beyond
simply having research participants sign a consent form. Participants have the right to
fully know what the study is about, how results will be used, whether their participation
is voluntary and can be stopped at any time, and how their identity will be protected
(Hesse-Biber & Leavy, 2006; Figure 8.2). Participants may unwittingly compromise
their informed consent when they feel social pressure or fail to understand what they
are being asked to give consent to. Such failures may happen if the consent form is
obtuse or vague in describing the particulars of the study. Or it may present such a
blanket statement about permissions given to the researcher as to be meaningless, such
as keeping artwork indefinitely or making use of the data for unspecified future “edu-
cational or professional” purposes. In the hopes of gaining consent so that the research
can proceed, the researcher may “soft-pedal” the study or fail to completely disclose
the full extent of the procedures, risks, and benefits involved. A notorious example is
the consent letter that was used to follow up with unsuspecting subjects in the Tuskegee
SAMPLE CONSENT FORM

Research with Human Subjects Consent Form
Date:
Study of:
Dear Research Participant:
I am conducting a study of [name the topic] as part of my [name degree program or agency
employment and city/state]. The purpose of my research is to [name purpose] in order to [name
research goal]. Information about this research project will [name intended contribution to
advance knowledge in a given area].
During this study, you will be [interviewed, assessed, observed—use applicable and spe-
cific wording]. The study will involve [describe type of sessions or interviews; specify the time-
frame]. The sessions will be [audiotaped, videotaped—if appropriate or necessary] and you will
be asked to [specify, such as “create artworks that will be photographed and used as part of the
research outcomes”]. The results of the research may be presented to others for their informa-
tion. However, all responses will be kept confidential and your name or any direct or indirect
identifying characteristics will not be used in any report regarding this research. You are free to
decline to participate at any time. After the research is completed, I will forward to you by mail
a summary of my findings.
The following are possible discomforts or risks that may be reasonably expected:
Participants who are unaccustomed to [specify process, such as “creating artworks,” “inter-
viewing or creating in a group,” “being asked to imagine pictures or scenes and then drawing
them,” etc.] may feel uncomfortable. Some [imagery, group processes, areas of reflection,
etc.] remind people of good or bad memories, and may stir strong or unpleasant feelings.
The benefits that may be expected (although they may not occur and unexpected feelings
also may develop) include [specify].
If you have any questions about this study, please feel free to contact me at [phone]. If I am
not immediately available, I will return your call as soon as possible. Thank you for your interest
and willingness to participate in my study.
Sincerely,
[your name]
I, ___________________ consent to participate in the study of [specify] being conducted
by [researcher’s name and/or agency]. I have reviewed and fully understand the contents of this
consent form. I understand that I may refuse to participate or withdraw from the study at any
time. I understand that all my responses will be kept confidential. I have been given a copy of
this consent form.
Signed:
Date:
Witness to participant’s signature:
Date:
FIGURE 8.2 Sample consent form.
Syphilis Study that stated, “You will now be given your last chance to [participate in] a
second examination. This examination is a very special one and after it is finished you
will be given special treatment …” (cited in Hesse-Biber & Leavy, 2006, p. 85). The
participants were never told that they had syphilis and the consent letter made no men-
tion that the “special treatment” was a spinal tap.
Deception and Disclosure

Deception is closely related to informed consent. Although it is hard to believe that
anyone today would carry out the heinous deception described above, deception may
evolve innocently enough from naïveté or unexpected events. Gans (1982) believed that
deception is inherent in participant-observation. He observed that once a researcher
gains entry, people tend to forget about it and let down their guard, but the researcher
never does. Assumed to be giving to others when participating, “he is not really doing
so and, thus, deceives the people he studies,” Gans wrote. “He pretends to participate
emotionally when he does not; he observes even when he does not appear to be doing
so” (p. 59).
The practice of informed consent cannot be separated from the underlying ethic
of authentic democratic and moral values. Many excellent sources are now available
online to guide the researcher in responding to these and other dilemmas of research.
A true ethical problem is one that involves a real choice for a person or a problem
that may lead to having different values placed on actions and their consequences
(Broudy, 1981). Mutual respect, non-coercion and non-manipulation, and support
for democratic values are basic principles that should guide ethical conduct. As you
reflect on actions you or others intend to take in a research study, consider the pos-
sible consequences of them and then ask yourself, “Could I live with this?” If not,
“Why does it bother me?” And finally, “If I were in that person’s situation would I be
satisfied having this action impinge upon me in this way?” In sum, to be ethical in
research is to understand that we are in an on-going reciprocal relationship with one
another at all times.
CHAPTER SUMMARY
1. A research proposal is an ethical contract between the goals of the researcher
and the people involved in a study.
2. The main purpose of the research proposal is to provide a means for com-
municating the research plan and presenting that plan to others. Readers are
members of the audiences that have an authorized stake in the study.
3. The introduction of the proposal usually establishes the aims and scope of the
research, rationale, and hypotheses or formally stated research questions. The
background context of the problem is developed in the literature section.
4. The methods section identifies methods for selecting participants, processes,
instruments and techniques for measurement, data collection, and an expla-
nation of the data analysis.
5. A “closed contract” design follows pre-established procedures. “Open con-
tracts” allow for change as certain data emerge. But all research must specify
to the greatest extent possible what can be expected to occur.
6. Most ethical concerns in research have to do with issues of harm, consent,

deception, privacy, and confidentiality of data.
7. Institutional Review Boards (IRBs) have federal mandates to determine the
risks and benefits of a study, and to monitor consent and the fair treatment of
human subjects.
8. Because ethical codes cannot cover every contingency, researchers should
be guided by underlying values of mutual respect, non-coercion and non-
manipulation, and support for democratic principles.
REFERENCES
Beyrer, C., & Kass, N. (2002). Human rights, politics, and reviews of research ethics. Lancet,
359(9328), 246–251.
Broudy, H. S. (1981). Truth and credibility, the citizen’s dilemma. New York, NY: Longman.
Gans, H. (1982). The participant observer as a human being: Observations on the personal aspects
of fieldwork. In R. G. Burgess (Ed.), Field research: A sourcebook and field manual (pp.
55–61). London, England: George Allen and Unwin.
Hesse-Biber, S. N., & Leavy, P. (2006). The practice of qualitative research. Thousand Oaks,
CA: Sage.
Locke, L., Spirduso, W., & Silverman, S. (1993). Proposals that work: A guide for planning dis-
sertations and grant proposals (3rd ed.). Thousand Oaks, CA: Sage.
Madson, C. (1991). The wilderness within. Parabola, 16(2), 65–67.
Oaks, CA: Sage.
Milgram, S. (1963). Behavioral study of outcomes. Journal of Abnormal and Social Psychology,
67, 371–378.
National Institutes of Health. (2003). Protecting personal health information in research:
Understanding the HIPAA Privacy Rule. Retrieved February 15, 2010 from http://priva-
cyruleandresearch.nih.gov/pr_02.asp
Nelson, R. (1991). Exploring the near at hand. Parabola, 26(2), 35–43.
Ortega y Gassett, J. (1985). Meditations on hunting. (H. B. Wescott, Trans.). New York NY:
CA: Sage.
Punch, M. (1994). Politics and ethics in qualitative research. In N. K. Denzin & Y. S. Lincoln
(Eds.), Handbook of qualitative research (pp. 83–98). Newbury Park, CA: Sage.
U.S. Department of Health and Human Services. (2009). Code of federal regulations, Title 45,
Public welfare, part 46, Protection of human subjects. Retrieved February 15, 2010 from
http:www.hhs.gov//ohrp.osophs.dhhs.gov/humansubjects/guidance/45cfr46.htm
U.S. Department of Health, Education, and Welfare. (1979, April 18). The Belmont report.
Retrieved February 15, 2010 from http://www.hhs.gov/ohrp/humansubjects/guidance/bel-
mont.htm
Models of
Good Research:
Conducting the Study
9
and Reporting Results
The Cook Ting cut up an ox for

Lord Wenhui with dance-like
grace and ease. “I go along with
the natural makeup, strike in
the big hollows, guide the knife
through the big openings, and
follow such things as they are
… I’ve had this knife of mine
for nineteen years and I’ve cut
up thousands of oxen with it,
and yet the blade is as good as
though it had just come from the
grindstone. There are spaces
between the joints, and the
blade of the knife really has no
thickness. If you insert what has
no thickness into such spaces,
then there’s plenty of room …
That’s why after nineteen years
the blade of my knife is still as
good as when it first came from
the grindstone.” “Excellent!”
said Lord Wenhui. “I have heard
the word of Cook Ting and
learned how to care for life!”
—Watson (1968, pp. 50–51)
When alive with the desire of the pursuit—whether to work more effectively with a
client or group, to find the cause of patterns of events in a practice setting, to change
203
an organizational dynamic, to take advantage of a fleeting opportunity to market a pro-

gram, or to finally capture the elusive goal of professional success—all art therapists
are and can be researchers (Kapitan, 1998; Anderson, 2001). In the conduct of a good
research study, an art therapist is like the hunter who wrote,
I’m after something: something tangible, something that is moving away from me, and
something I must have. It is as simple as that. To not pursue the thing one wants would
be a waste of one’s life. (Bass, 1991, p. 54)
For the art therapist researcher, the ability to conduct a study with confidence is
enhanced by knowing how others have pursued and managed questions of their own.
The professional literature in this respect is a meta-story of art therapists sharing what
they’ve learned and modeling successful and not-so-successful research. As guides
they offer many clues to follow and pitfalls to avoid. The practice of searching out and
reading articles and reports with a critical eye, using research databases, and tracking
developments from researcher to researcher, all are important for conducting research.
It is also invaluable for the practitioner whose ethical duty is to be familiar with devel-
opments in the field that benefit clients. This chapter looks at what makes good research,
whether the aim is to read critically when consuming research or to conduct a research
study and report its results.
A MATTER OF CRAFT: WHAT ARTISTS

KNOW ABOUT GOOD RESEARCH
Good research usually is described as having achieved a certain degree of rigor: rigor
in the design of research, in the conduct of the study, and in how it is reported or pre-
sented to others. An unfortunate word, rigor conjures associations with rigor mortis
that sets in after your life departs or rigorous exercise that leaves you panting for breath.
The dictionary defines it as follows: hardness, hardship, severity, harshness, trial and
tribulation; a “rigorist” is someone who is draconian, strict, severe, and ironhanded.
Wonderful. Against this backdrop, why would anyone want to do “rigorous” research?
But buried among these definitions is the simple word “correct”—what is meant by
rigor in the conduct of research. To conduct rigorous research is to attend to integrity
and correctness in all procedures.
Art therapists can acquaint themselves with “correctness” in research by recalling
the ancient roots of their discipline in the making of traditional art and craft. Consider
this description of an artist working on the potter’s wheel:
First, she must prepare the clay so it is even and free of air pockets. She kneads or
“wedges” it with a rhythmic motion of her whole body. Now she throws the lump of
clay onto the wheel, wets it and spins it fast, enclosing the resisting, thumping mass
in her hands as she leans strongly into it … If she is firm and centered in herself, the
9 t Models of Good Research 205
clay becomes centered; a smooth mound, spinning around the still axis of the wheel.
She thrusts wet thumbs into the center, opens it, and, with a few deft motions, draws
up a thin-walled cylinder … Behind the magic is the subtlety of the potter’s skill, her
attention to the varying speeds and pressures needed, her delicacy of touch as the thin
wall rises, softens and becomes more and more sensitive to the forces acting upon it.
Leaning on the air in defiance of gravity, the wet clay reaches its limit of tolerance.
Gently the wheel is brought to a stop. (Remde, 1991, pp. 47–48)
It is evident that in making a pot of good quality, the potter is guided by knowing
the correct way to throw on the wheel. There will be variation from potter to potter,
and different forms of pottery require different throwing techniques as well. But with
practice every potter learns the limitations of a material that cannot be shaped against
its nature. Just as ethics is the “right way of doing things,” so traditional art has ascer-
tained a means of operation in “the right way of making things” (Coomaraswamy, 1991,
p. 9). Remde continued:
She walks a thin line between success and failure. There are many steps in the craft,
many elements to be brought into right relationship. Each step must be given close
care and attention. Each step must be related to the whole. There are failures along
the way, so many that the potter becomes inured to them. She simply starts again.
(p. 48)
The “thin line between success and failure” also is characteristic of conducting a
research study. Just as a potter learns not to get too attached to a pot that is forming
under her hands on the wheel, a researcher learns that the study may confirm or dis-
confirm expectations and that the sought-after ideal is rarely achievable. Unexpected
conditions, participants dropping out of a perfectly composed sample, loss of access to
a field site, data that do not show significance—these and many more developments will
contribute to how well a study attains its ideal goal. Usually, compromises or trade-offs
must be made. But far from being a waste of time or “failure,” someone hopefully will
read your results and “start again” in the tradition of replication and the re-calibration
of practice and understanding. Like the potter who learns from every lost or hopelessly
wobbly pot, researchers learn to achieve correctness in their craft with the transmission
of information from study to study and from researcher to researcher.
A craftsperson will tell you that there are many styles of working that have greater
or lesser validity. As is true in research, traditional methods often are valued because
they have stood the test of time and are more widely applicable to a variety of needs or
conditions. Calligraphers in the Arab tradition are taught precise ways to make a “good
tool,” how to make ink “without fuss,” the kind of paper and colors to use, and the
proper way to trim the nib of a pen. They are required to “study the letters, to look at
the ‘strengths and weaknesses’ of the letters,” and to prepare everything before begin-
ning so that they can avoid mistakes and give the matter their full attention (Sulzberger,
1991, p. 27). It is a demanding craft, as rigorous and as satisfying to the maker as any
good research study.
In the evaluation of a research report, readers can follow the example of artists and
learn to look with a caring yet critical eye at the strengths and weaknesses of how all
the elements of a study are arranged and carried out, to ascertain their right relationship
or integrity. In this sense, evaluating research is less a matter of being critical “of” the
researcher and researcher’s report than one of appreciating the degree of correctness
that the researcher was able to achieve in the study, however difficult its execution.
HOW TO READ A RESEARCH REPORT

Despite the professed value of published research, it is unlikely that art therapists are
spending much of their free time reading research reports. Locke, Silverman, and Spirduso
(2004) identified two main barriers that people encounter in reading research reports:
problems with the research and problems with the reports themselves. Many people find
social science research, including art therapy, to be too complex or difficult to understand,
uninspiring, or having no practical use. When the results are minimally significant or the
hypothesis is disconfirmed, it is easy to dismiss the study as having little value. A report
filled with numbers and pie charts may be alienating to an art therapist who is more
familiar with the human face of case records. The problem here is in understanding how
researchers think about their craft: to be credible, researchers must create a concise but
detailed account of their activities and “come clean” with every possible variation that may
have affected the findings. This reporting may create the impression that the researcher is
an unimaginative number-cruncher, or that in calling attention to its limitations the study
was “wrong.” In the immediate reading of a single study, it may look as though little was
accomplished. But knowledge is built incrementally this way, step by step and over long
periods of time. Many research reports, when put together, can point to something along
the trail of knowledge that other researchers will pick up and follow.
To complicate things further, not all research is created equal. Research reports that
are published in a scholarly journal like Art Therapy: Journal of the American Art Therapy
Association have credibility because they have been subject to peer review. Every one of
its articles has been read by independent reviewers or “referees” who are unknown to the
researcher and who help the editor decide whether it can be published. Sometimes they
will reject a report because the study has a major flaw that led to unfounded conclusions.
But other times the study’s weaknesses are overcome and put into context by the way
the researcher has handled the data or reported the problems, showing their significance
nonetheless. There may be valuable information reported that contributes to art therapy
knowledge despite the limitations of the research. In such cases, the decision to publish
weighs in favor of making the information widely known for the benefit of others.
The other problem identified by Locke et al. (2004) is the hard work of reading
what seem to be incomprehensible reports. After all, why can’t they be written in plain
English? Art therapy spans a broad range of theories and the use of specialized terms
that sometimes make sense only to the researcher and a subset of art therapists who
learned the same theory. The rest of us may wonder whether we are lacking in some
specialized training or special cognitive skills. Locke et al. (2004) wrote that nearly
every reader comes to the research report “with two unspoken questions, ‘Is this good
research?’ and ‘How am I supposed to tell whether it is or not?’” (p. 4). To deal with this
conundrum, these authors recommend approaching the research report step by step and
asking five basic questions, below.
CRITICAL QUESTIONS FOR READING A

RESEARCH REPORT (LOCKE ET AL., 2004)
1. What is the report about?
2. How does the study fit into what is already known?
3. How was the study done?
4. What was found?
5. What do the results mean?
What is the report about? You can locate the purpose of the study and its general char-
acteristics by reading the abstract and first part of the report. The abstract should state what
kind of a study was conducted under what conditions, who was involved, and what was found.
The author’s goal or purpose statement usually is located in the introduction where you will
find key concerns for a qualitative study or, for a quantitative study, the hypothesis that was
tested. When reading, consider how you would design a study to test the same hypothesis or
address the concerns of the author. When you bring together the abstract, purpose statement,
and hypothesis or key concepts, you should have a clear idea about the report.
How does the study fit into what is already known? The purpose of the literature
review is to provide a reader with the answer to this question. Unlike what you may find
in books, in a journal report the literature will be brief and concise because its purpose
is to provide the rationale for the study, not to discuss the literature in depth. Like a laser
beam, the author should focus on relevant and important findings from other studies,
especially those that are recently published. Sometimes the review provides a rationale
for the study’s use of certain methods, such as the choice of a particular treatment inter-
vention or the decision to interview a participant having a particular perspective. The
author’s responsibility here is to synthesize what is known on the topic and present the
thinking that puts the study into context. How the study contributes to new knowledge
in art therapy is another important question.
How was the study done? This question is addressed by the methods section of the
report and is key in determining the credibility of the findings. Overall, there should be
explicit logic in the match of question, purpose, and method. There should be enough
information that you would know how to replicate the study if you wanted to do so.
Whether quantitative or qualitative methods were used, the sample (subjects or par-
ticipants) should be described to include demographic information and characteristics
that are relevant to the study, how they were selected, and why. The size of the sample
(number of participants) should be stated and is especially important for the purpose
of generalizing because a large sample is needed if the researcher intends to arrive at
statistical significance. Generalizability via a large sample, however, is not the purpose
in qualitative studies. These usually have a small number of participants because of the
volume and quality of data that can be generated in an in-depth study.
You should be able to identify the independent, dependent, and control variables.
How were they selected and what procedures were used to safeguard against researcher
error or bias? Did the researcher’s method actually test the hypothesis? In a qualitative
study, key concepts and their relationship to the choice of methods will be identified
instead of variables. How the researcher defines and operationalizes certain terminol-
ogy should be apparent because of their implications for the findings. For example, there
is a difference between a person having experienced a trauma and one who was diag-
nosed with posttraumatic stress disorder (PTSD). Whether the research included study
participants who were diagnosed with PTSD or not would be an important distinction in
a study about the use of art therapy for people who had experienced a traumatic event.
The methods section also will contain a description of how data were gathered and the
use of instruments or processes. The choice of measurement will depend upon the logic of
the hypothesis and variables or key concepts under study. There should be some descrip-
tion of these instruments to acquaint the reader with their validity (whether they measure
what they intend to measure) and reliability (whether they measure consistently when used
repeatedly). In a qualitative study, the description of data collection will include such things
as interviewers and art directives or processes and their intent. In any kind of report, the
reader should know with some detail what was done and how it was documented.
Finally, the methods section will describe the means of data analysis. If statistics
were used, they should be clearly and concisely described, and the levels of significance
stated. For the reader to make sense of the data, the researcher should descriptively
summarize the findings and show the relationships between the variables. In a qualita-
tive study, data analysis usually is a matter of how the researcher coded words or stories
and found themes or patterns.
What was found? This is the results section of the report, at best presented in a
straightforward manner without discussion about why they occurred (that is for later,
in the discussion section). The data are summarized and shown in relationship to how
the research questions were answered. Quantitative reports will show whether or not
the hypothesis was supported. Usually this is in the form of numbers and statistics
presented in concise tables or graphs. Depending upon the aims of the study, descrip-
tive statistics will show (a) the frequencies, means or medians, and standard deviation
or ranges for one variable; (b) the relationship between two or more variables through
numerical patterns such as the chi-square, correlation statistics, or the results of a mul-
tiple or logical regression; and (c) the difference in means between two groups, such as
the results of a t-test or ANOVA. If inferential statistics are used, then a p-value will
be stated that indicates the probability of the finding occurring by chance instead of
through the relationship between the variables or between the control and experimental
group. The statistical significance of the results is important to prevent drawing conclu-
sions when the sample size is too small to justify them.
In an outcomes study, it is important to know not only the statistical significance of
the relationship between variables but also the strength of the treatment intervention or
effect size (ES). The ES can be calculated from taking the standardized mean difference
between the experimental group and the control group. An effect size of 0.6, for example,
means that the average score in the experimental group was .06 standard deviations or 73%
higher than the average score of the control group. Sometimes, an ES will be interpreted
as “small” (0.02 to 0.03, for example), “medium” (0.05, for example), or “large” (0.08 or
larger), using conventional criteria developed by statistician Jacob Cohen. But it is impor-
tant not to take ES out of context; in practice, a small effect might indicate a clinically
significant difference in the treatment of a difficult condition. Clinical significance, in this
sense, refers to changes in a client’s condition that are important to the client.
In a qualitative study, the researcher will select examples from the data record to
show typical or meaningful patterns that address the research question and that con-
tribute new or confirming understandings of the condition, event, or experience being
studied. These are usually presented as excerpts or quotes, case vignettes or composite
descriptions of the research participants, or units of analysis. The researcher will orga-
nize the results section around major themes identified so that, as in the case of a quan-
titative study, the reader will be able to see the relationship of material selected and the
research questions. In any kind of study, you can test the logic by considering how you
would interpret the results and their implications before going on to read the discussion.
What does it mean? As a critical reader, by now you may have your own idea about
the study and can compare it with what the author presents. This question is addressed
in the discussion and conclusion sections of the report. Locke, Silverman, and Spirduso
(2004) recommend four things to look for here: (a) what the author identifies as mean-
ingful in the data just reported; that is, what is most important and how it squares with
what may have been expected; (b) a discussion of any limitations or difficulties that were
encountered that may have affected the findings, such as a low response rate on a survey
or participants dropping out of the study; (c) how the study contributes to the larger field
or literature; and (d) the extent to which the conclusions match the findings reported in
the previous section.
The reader should be guided in the discussion section to consider, as the researcher
did, whether the research problem was answered or not. If the study can be generalized,
to what extent is that possible or appropriate, given the results reported? Sometimes
researchers overstate the conclusions or neglect to mention confounding variables in
the hope of matching statistical and clinical significance (practical value). Conclusions
usually need to be qualified by the limitations provided in the discussion section and the
reality of the study. They must be based on sufficient data and not veer into speculation
or impromptu theorizing (Table 9.1).
It may seem that containing all this “correctness” or rigor in a single research report
is a tall order and sometimes it is. Tolman and Brydon-Miller (2001) observed that the
advantage that quantitative researchers have of presenting “shorthand ways of refer-
ring to problems and solutions that have no parallel in qualitative research” is seldom
acknowledged (p. 18). For example, once you understand what is meant by the purpose
of “random assignment,” “variables were held constant,” or “significance” between
groups, you may scan a report for these widely accepted elements of rigor or stamp of
quality approval. But this shorthand can also allow the author to avoid calling attention
to possible confounding variables, breakdowns in the procedures, or imperfect matches
between variables and the real world they are meant to signify. Such mistakes or data
“massaging” are harder to hide in qualitative research because there is less presumption
of objectivity and greater demand for detailed explanations of less familiar methods. It
takes a lot of space and words to report on the findings of a qualitative study because
TABLE 9.1 Checklist for critical review of research reports

REPORT ELEMENT WHAT TO LOOK FOR
Title Is the title clear and concise? Does it accurately indicate the content
of the study?
Authors Have you seen the work of this author or authors cited by others in
their research? Not all authors are well known, but this may
strengthen credibility.
Abstract Does the first sentence concisely state the purpose of the article?
Does the abstract describe what was done, with whom, and to
what effect? What were the results?
Introduction What are the key concepts, research problems, or sub-problems in
the study?
What are the purpose or goals of the author?
Are the studies that are cited in the literature review relevant?
Does the study logically extend or challenge what is already
known?
Is the literature cited adequately critiqued for how it bears on the
study?
Are weaknesses, gaps in knowledge, or biases explained?
How have concepts, terms, and variables been operationalized and
defined?
Is a rationale given for the choice of research method?
What is the hypothesis or major question guiding the study?
Method Is the method described in detail? Is it appropriate or might it
produce an alternative, logical explanation for the phenomena?
Are the subjects or participants, sample size, selection procedures,
and exclusion criteria adequately described? Are they appropriate
for the study?
Are the relevant variables recognized? What about extraneous
variables?
Are controls adequate? How is bias controlled or accounted for?
Are treatment procedures described and consistently applied?
How are ethical issues handled?
What instruments or processes were used? Can you judge the
validity or reliability of them based on the information given?
What were the procedures for data analysis? Were they adequate?
Results Has a summary of relevant data been presented in a table or graph
form? Are statistics or other data accurately interpreted?
Are clear and credible case examples or textual analysis provided in
the case of a qualitative study?
Is the analysis logical and perceptive?
Are art images selected and discussed in terms of relevance to the
study’s aims and premises?
(Continued)
TABLE 9.1 Checklist for critical review of research reports (Continued)

Discussion Has the research problem been answered?
Are predicted hypotheses supported by the data and analysis?
To what extent is generalization possible, if warranted?
How do the results generalize or apply to theory or practice?
How does the author account for the study’s limitations?
Did the research go as planned? How might change have affected
the findings? If an open-ended study, what emerged in the data
analysis that had relevance to the question?
Conclusion Is the problem re-stated?
Do the conclusions emerge or follow logically from the findings?
Does the author avoid speculative statements?
Is a concise concluding statement provided? Is it justified?
Does the research have clinical significance or value?
References Are references provided for every study cited?
Are they accessible? Would you be able to locate the references
cited if you needed to review them for your own research?
Appendices Are survey instruments, interview guides, or other information
provided? If not, can the author be contacted to provide them if
needed?
everything has to be put into context and explained accordingly. For this reason, quali-
tative research tends to be underreported in journals, and exemplary studies or models
may be difficult to find. This absence of reporting may create the false impression that
qualitative research is not as “good” or rigorous as quantitative research.
The concise and linear presentation of information in a research report may give
you another false impression that conducting research is a disembodied, mechanical
undertaking. Because of hindsight and the need to present exactly what others need to
know, the messy reality of working with people and studying their experiences does not
usually come through in a report. To help art therapists recognize this reality, Anderson
(2001) described her own seasoned experience of conducting research:
My quest has led me down many paths. Along the way, I learned how hard it is to
conduct research without interfering with client treatment and at the same time being
accountable … In one project jointly funded by a counseling center and a univer-
sity research grant, literally everything went wrong: A colleague did not screen the
clients sufficiently, the glazes did not work, the videographer dropped out, and the
photographer set his camera at the wrong ASA for half of the photographs that were
to document the artwork created by the clients. The research design, which had taken
6 months to set up, failed because the actual collection of hard data based on pencil
and paper measures was sabotaged. Fortunately, the one factor that succeeded was
the most important part of the project—the actual art therapy treatment of the two
groups of clients. Because a combination of quantitative and qualitative data was
used, the effectiveness of the group art therapy was documented through interviews
with clients and their individual therapists. (p. 136)
THE DIFFERENT LOGIC OF QUANTITATIVE

AND QUALITATIVE STUDIES
From the critical review of research reports you can learn to recognize how a carefully
structured set of procedures is used in a quantitative study to test and logically link the
variables being examined. Analysis typically moves from the general to the specific and
from an existing premise or hypothesis to a logical conclusion. Qualitative studies have
different purposes that are oriented toward discovery or understanding a phenomenon
rather than testing it. These studies are set up to maximize interactions with the data
that emerge; the research is allowed to change to accommodate new understanding
as previously unknown variables or information come to light. Analysis in qualitative
design tends toward inductive methods that move from the specifics of a situation to
broader understandings plausibly revealed by the data. These differences should be kept
in mind when critically reading reports.
It is a common mistake to evaluate a qualitative design on the logic of quantitative
studies and vice versa. Qualitative studies, for example, involve a small sample size
because the aim is to produce holistic understanding through multiple sources of data.
The findings are purposely complex and not intended to generalize to a population as in
the case of quantitative studies, although some application to other settings is possible.
This absence of generalizability does not make them inadequate as research, only inad-
equate substitutes for quantitative research. In the same way, an experiment does not
generalize to an in-depth understanding of a given person’s reality. Another complaint
is that open-ended designs are “not rigorous” or “invalid,” which is true only within
the logic of quantitative studies. These differences may seem obvious yet the error in
judgment is persistent. For example, sometimes researchers will discuss the results of
their qualitative study defensively if the data were collected from a small number of
people. They fear the judgment of generalizability even though their purposes do not
require it.
It is important, therefore, to recognize the broad range of research assumptions
and methods that exist when evaluating the quality and credibility of findings, particu-
larly in qualitative research. Daley (2007) posed a useful guiding question, “Analysis
for what?” to keep these important distinctions in mind. Scientific analysis has roots in
two traditions:
r Nomothetic, meaning based in laws and regularities, and

r Idiographic, which is concerned with what is unique and variable.
A nomothetic approach in case research, for example, would be concerned with

gathering data from many people in order to establish patterns of common mean-
ing and experience. An idiographic approach might look instead at a particular
individual and how that person makes choices or navigates his or her relationships
in relationship to a given condition. Daley (2007) aligned this distinction with the
tensions between insider accounts of those who are experiencing the phenomenon
under study, known as the emic perspective, and the outsider or etic perspective of
the researcher who is studying that experience. “The way we align ourselves with
these perspectives has profound implications for how we conduct analysis” (p. 213).
Daley continued:
When we ask the question, “Analysis for what?” the distinction between emic and
etic raises a fundamental question about how we think about the products of our
research efforts and the degree to which they represent outsider and/or insider per-
spectives. How we think about the products of our analysis is contingent on our
epistemological beliefs. If our beliefs are rooted in a positivist or postpositivist para-
digm, then a leaning toward an etic perspective is consistent with those beliefs. If,
on the other hand, our approach is social constructivist or postmodern, then there is
a blurring of the boundaries between etic and emic whereby research accounts are
viewed as “interpretations of interpretations” (Gertz, 1973, 1983) or second-order
stories. (pp. 213–214)
A final distinction Daley (2007) made in the logic applied in qualitative and quan-
titative research is related to description, analysis, and interpretation. Those meth-
odologies that seek to illustrate in-depth meaning or first-person experiences tend
to emphasize “thick” description rather than explanation as a primary analytic aim.
Analysis, by definition, focuses on the process of identifying and separating something
into component parts, whereas interpretation focuses on the process by which we make
meaning of those parts (Daley, 2007). Analysis and interpretation have a discursive
relationship that allows the researcher to attach significance to the data and use them to
construct theory and knowledge.
REPORT STANDARDS FOR

EVALUATING RESEARCH
The American Educational Research Association (AERA) has developed valuable
standards for researchers, authors, reviewers, and editors in disseminating quan-
titative and qualitative research, which can be found on their Website (www.aera.
net). The general expectation is that researchers will provide adequate, accurate, and
unambiguous evidence that support the conclusions and justify the outcomes of the
study (AERA, 2006). As discussed above, research reports should be “transparent” by
explicitly stating all methodological procedures and the underlying logic from which
each component is organized. Standards help scholars and practitioners “understand
each other’s work, prepare that work for public scrutiny, and enable building upon
that work and other potential uses” (AERA, 2006, p. 2). Each report must be cred-
ible so that others may build upon it with complete confidence. Therefore, research
reporting must be free of distortions, falsifications, and fabrication of data or results,
and must attribute the writing and ideas of others. Research should be accessible so
that other researchers can verify, replicate, or analyze the findings in carrying out
future research.
These expectations exist because research scholarship is part of a collective
enterprise. Its foundation is not intellect or technical skill but simple honesty. Locke,
Spirduso, and Silverman (1993) summarized:
If scholars did not have what Jacob Brownowski (1965) called “habit of truth,” there
could be no accumulation of reliable knowledge, and thus no science. The rules for
this habit of conscience are absolute: no compromises, no evasions, no shortcuts, no
excuses, and no saving face. Planning, conducting, and reporting research make sense
only so long as the social contract among scholars is honored—everyone tells the truth
as well as he or she can know it. (p. 25)
ART THERAPY EXEMPLARS AND

MODEL RESEARCH REPORTS
The model research reports that follow in this section were selected with several uses
in mind. First, I looked for a wide variety of distinct research designs and approaches
found in the professional literature of art therapy. I wanted to show that such research
in art therapy exists and I hope they will encourage a beginning researcher’s study
of the creative fit between ideas, goals, and research approaches. Second, I expect
that these accounts will provide some balance of reality against the cleanly logical
descriptions of research found in Part II of this text and various methods books.
While chosen for their excellence, readers can see that none of them are perfect nor
without limitations. Yet each accomplished the goals of their authors and were suc-
cessfully peer reviewed and published. They contributed new evidence or thinking,
or grappled with significant questions. For students of research, they may inspire
more careful reading or critique of published research. For art therapists conduct-
ing research, they will illustrate how others have constructed their studies and their
degree of success.
Finally, the following model research studies can be used, as well, to assist begin-
ning researchers in learning how to read and evaluate empirical articles. Each study has
been evaluated using the reporting standards of the AERA (2006) as a guide. These are
shown as a checklist along with the title, author/date, abstract, brief description of the
approach and key structures, and commentary. Readers can read the synopsis (or the
original article itself) and compare their responses with the discussion provided of the
article’s strengths and weaknesses.
Obviously, there were many excellent reports to choose from; the inclusion of these
reports is not meant to imply that there weren’t others of equal quality. Some of the
studies selected are “classic” rather than recent; their content should not be construed
as reflecting current thinking in art therapy. The overall purpose is not to be critical of
these authors and researchers but to draw the readers’ attention to key elements in the
report and to stimulate thoughtful analysis.
APPROACH: EXPERIMENTAL (RANDOMIZED CONTROLLED TRIAL OR RCT)

Author/date Monti, D. A., Peterson, C., Shakin Kunkel, E. J., Hauck, W. W.,
Pequignot, E., Rhodes, L., & Brainard, G. C. (2005).
Title A randomized, controlled trial of mindfulness-based art therapy (MBAT)
for women with cancer
Abstract (synopsis): This treatment outcomes study sought to show the efficacy of a
psychosocial group treatment option for cancer patients called “mindfulness-based art
therapy” (MBAT). A randomized control group study, 111 women who had been diag-
nosed with cancer were paired by age and randomized to either an 8-week intervention
group (2 and ½ hour sessions) for mindfulness-based art therapy or a wait-list control
group. Of the total 111 women, 93 (84%) completed both the pre- and post-study mea-
surements. Significant decrease in symptoms of distress as well as significant improve-
ments in health-related indicators or quality of life were found in the MBAT group as
compared to the control group.
Hypotheses: Do cancer patients who receive an 8-week group intervention of MBAT
along with usual medical care have greater reductions of distress, anxiety and depres-
sion than patients who receive medical care alone? Do the participants receiving MBAT
with medical care show improved health-related quality of life than patients who do not
receive MBAT?
Sample: 111 adult women diagnosed with cancer, between 4 months and 2 years of
onset. Excluded from the sample were patients with terminal prognosis, psychiatric
diagnosis of major mood disorder or psychosis, or significant cognitive deficits.
Data collection: Pre- and post-intervention measurements using standardized instru-
ments (Symptoms Checklist Revised and the Medical Outcomes Study Short-Form
Health Survey); art therapist-led, standardized protocol of an 8-week art therapy pro-
gram based on mindfulness skills development plus weekly homework of meditation
practice with audio taped guide. The data compared 7 experimental and 7 control
groups over 16 months of sessions.
Data analysis: Pre- and post-scores (weeks 0 and 8) were analyzed using repeated
measures and analysis of variance (ANOVA) to compare mean scores of the control
and intervention groups. Effect size was calculated for the week-treatment interaction;
recruitment period was a random effect. Repeated within-subject measures were ana-
lyzed within a covariance structure (ANCOVA).
Results confirmed the hypothesis showing that the MBAT intervention was statisti-
cally significant in decreasing symptoms of distress. The MBAT intervention showed
significant increase in mental health, general health and vitality, and social functioning
as compared to the control group.
Limitations: Only short-term effects were assessed. Control group received no inter-
vention; a comparison of art therapy and a control group that receives supportive, non-
art therapy treatment would help isolate the specific variable that makes art therapy
effective for this population.
STANDARD DESCRIPTION OF STANDARD

Y Clear problem statement
Y Review of relevant literature
Y Rationale of conceptual, methodological or theoretical orientation
Y Clear logic of inquiry
Y Sufficient description of overall design
Y Description of what was studied, number in sample, and how
selected/sampled
Y Access, selection, consent processes described
Y Roles of researcher and participant in data collection described
Y Groups described in detail, how assigned, process and rationale
Y Features of interventions described in relation to controls or
comparison groups
Y Data collection: how, when, by whom and for what purposes; precise
and sufficient for replication
Y Development of measurements or classifications described
N Classification scheme described and illustrated with example
Y Frequencies shown in table, chart, appendix, or other
N Coding, inter-coder reliability or audit checks described
Y Quantitative data analysis: Relevant statistics frequencies; key data
elements from scales and composites; sufficient detail to show
appropriate use, validity, and reliability
Y Quantitative procedures used to address problem: Descriptive and/or
inferential statistical analyses conducted that are essential to the
conclusion; deviations that may compromise validity of the findings
are identified
Y Clear statement of conclusions
Y Ethical decisions explicitly stated; agreements; biases stated
Discussion: Although there are a number of case studies and published accounts of
the benefits of art therapy with cancer patients, there are few controlled studies. The
Monti et al. study contributes preliminary evidence of the benefits of art therapy by
carefully controlling for treatment integrity (a standardized art therapy process was
provided by a competent expert), measurements, and selection/assignment of partici-
pants. Replicating the study with different art therapists at multiple sites would help
to further identify the specific, essential features of art therapy treatment that are
beneficial to cancer patients.
APPROACH: EXPERIMENTAL OUTCOMES STUDY

Author/date Pifalo, T. (2006).
Title Art therapy with sexually abused children and adolescents: Extended
research study.
Abstract: This article reports the outcome of a four-year follow-up of a pilot study
using a combination of art therapy, cognitive behavioral therapy, and group process
to address the therapeutic issues related to childhood sexual abuse. All group partici-
pants were evaluated using the Trauma Symptom Checklist for Children (Briere, 195),
commonly used in trauma centers, before and after their participation in an 8-week
group cycle. The results of this extended research study support the combined use of
art therapy (AT) and cognitive behavioral therapy (CBT) as an effective intervention to
reduce symptoms most often associated with childhood sexual abuse.
Hypothesis: Does the combined use of art therapy and cognitive behavioral therapy for
group treatment reduce symptoms from childhood sexual abuse?
Sample: Following the results of an earlier pilot study (Pifalo, 2002), a broader same-
site sampling was conducted involving 41 children, ages 8-10, 11-13, and 14-16 years
old, with histories of sexual abuse referred for treatment.
Data collection: Participants met 1-hour weekly for 8 weeks in art therapy groups
using a treatment model that combined art therapy with cognitive behavioral therapy.
Group members were evaluated pre- and post-participation using the Trauma Symptom
Checklist for Children (Briere, 1995).
Data analysis: Changes in the clinical sub-scales of the measure were subjected to
statistical procedures (Fisher t-values and their corresponding p values).
Results: A statistically significant reduction of symptomatology was shown on the
scores on 9 of the 10 clinical subscales (anxiety, depression, anger, posttraumatic stress,
dissociation-overt, sexual concerns, sexual preoccupation, and sexual distress), and a
trend toward becoming more open to trauma-focused topics based on the underresponse
(denial) validity scale. The intervention effect was large for posstraumatic stress, dis-
sociation-overt, and sexual concerns scales. Three of the critical item scores (desire
to hurt others, mistrust, and sum critical items) achieved statistical significance in the
direction of reduced pathology. Findings confirm hypotheses.
Limitations: Study design did not include a comparison group, although it did compare
favorably with the 2002 pilot study of the same design. Because art therapy was com-
bined with CBT, it is impossible to determine what was the specific effect contributed
by art therapy. While promising, the results could be due to generalized improvement
or increased treatment attention.

Y Rationale of conceptual, methodological or theoretical
orientation
Y Description of what was studied, number in sample, and
how selected/sampled
N Access, selection, consent processes described
N Roles of researcher and participant in data collection
described
N Groups described in detail, how assigned, process and
rationale
N Features of interventions described in relation to controls or
comparison groups
Y Data collection: how, when, by whom and for what
purposes; precise and sufficient for replication
N Classification scheme described and illustrated with
example
Y Coding, inter-coder reliability or audit checks described
Y Quantitative data analysis: Relevant statistics frequencies;
key data elements from scales and composites; sufficient
detail to show appropriate use, validity, and reliability
Y Quantitative procedures used to address problem:
Descriptive and/or inferential statistical analyses conducted
that are essential to the conclusion; deviations that may
compromise validity of the findings are identified
N Ethical decisions explicitly stated; agreements; biases stated
Discussion: This brief report described follow-up research that builds on an earlier
study (Pifalo, 2002) and therefore focused primarily on presenting the statistical results
of the data. Replication would require the reader to refer to the earlier study. Both stud-
ies showed relevant outcomes that clearly indicate the effectiveness of a short-term,
cognitively structured art therapy group for children and adolescents with childhood
sexual abuse. Limitations include the relatively small sample size and a lack of random-
ization. Although only one measure and no comparison group were used, the broader
same-site study results corroborate earlier findings of the same study design.
APPROACH: SINGLE-SUBJECT EXPERIMENTAL DESIGN

Author/date Morgan, C. A, & Johnson, D. R. (1995).
Title Use of a drawing task in the treatment of nightmares in combat-related
PTSD
Abstract: Treatment of nightmares in two Vietnam veterans with posttraumatic stress

disorder (PTSD) was conducted comparing a drawing task with a writing task. Our
hypothesis is that the isomorphism between visual imagery and the visual modality of
nightmares may provide a more effective means of transforming and integrating the
traumatic material into normal cognitive schemas. In a 12-week intervention in which
drawing and writing were alternated, both subjects reported reduction in frequency and
intensity of their nightmares in the drawing condition. This study provides support for
more extensive study of art therapy methods in posttraumatic stress disorder.
Hypotheses: Can a specific and pervasive symptom of PTSD (nightmares) be impacted
by art therapy, specifically a drawing task? Does the isomorphism between visual imag-
ery and the visual nightmare provide a more effective means of transforming and inte-
grating the traumatic material into normal cognitive schemas?
Sample: Two volunteer subjects were Vietnam veterans, ages 42 and 44, who met the
criteria for a diagnosis of PTSD. Both subjects were high school graduates with no prior
experience of art therapy or art beyond elementary school, nor had any learning dis-
ability or problem with written or verbal expression. Both were in an inpatient 16-week
PTSD program and reported the presence of combat-related nightmares that occurred 4
or more times for 1 month prior to the study.
Data collection: The 12-week study involved four 3-week intervals that alternated draw-
ing and writing in an ABAB or BABA format. During writing intervals, the subjects
recorded their nightmares in detail soon upon awakening. During drawing intervals,
the subjects used oil pastels to draw their nightmare in detail after awakening. A self-
report rating scale of 4 variables (frequency and intensity of the nightmare, startle upon
awakening from the nightmare, and difficulty going back to sleep after the nightmare)
was used on a weekly basis throughout the 12-week trial.
Data analysis: Raw data was subjected to a 2-factor ANOVA (subject x modality) that
compared differences between the 2 subjects and changes within each 3-week interval
to indicate the cumulative positive or negative effect of each intervention. Qualitative
data was obtained from the subjects’ self-report.
Results: Both subjects experienced fewer and less intense nightmares, and less dif-
ficulty returning to sleep or startling upon awakening, with the drawing intervention as
compared to writing. The subjects also reported more frustration with having to write
the nightmare.
Limitations: Small sample with only one measure used, a self-report.

Y Rationale of conceptual, methodological or theoretical
orientation
selected/sampled
N Roles of researcher and participant in data collection described
N Groups described in detail, how assigned, process and rationale
comparison groups
Y Data collection: how, when, by whom and for what purposes;
precise and sufficient for replication
Y Quantitative data analysis: Relevant statistics frequencies; key
data elements from scales and composites; sufficient detail to
show appropriate use, validity, and reliability
Y Quantitative procedures used to address problem: Descriptive
and/or inferential statistical analyses conducted that are essential
to the conclusion; deviations that may compromise validity of
the findings are identified
Discussion: This study illustrates the value of a single-subject design to identify

outcomes when repeated and compared with more than one matched subject. A com-
parison of two modalities, drawing and writing, tests the assumption of art therapy’s
effectiveness as a primarily visual intervention that could provide relief of PTSD
nightmares. The findings in this report were discussed in context with current trauma
theory and lend credence to art therapy’s effectiveness. The study would have been
strengthened with a standard psychometric measure in addition to the self-report
scale. The results showed statistical significance in reducing nightmare frequency
and intensity, and the participants’ self-reports corroborate the statistical findings
to an extent that suggests clinical significance as well. Because the intervention is
limited to modality or art medium and a self-report measurement tool, it can be eas-
ily replicated and also varied by comparing the effects on different types of clients
with PTSD.
APPROACH: SINGLE-SUBJECT EXPERIMENTAL DESIGN

Author/date Kearns, D. (2004).
Title Art therapy with a child experiencing sensory integration difficulty
Abstract: An increasing number of students diagnosed with difficulties such as atten-

tion deficit disorder and Asperger’s syndrome are being seen in schools. Sensory inte-
gration difficulties may be part of the symptomatology of these disorders. These may
result in difficulties with both classroom behaviors and academic performance. This
single-case study investigated the effectiveness of art therapy with a 5-year old white
male with sensory integration difficulties. Art therapy focused on pre-art activities
using three media. Teacher ratings assessed classroom behavior for improvement. Each
of the varied media sessions was compared to control sessions where a non-art experi-
ence was offered. Results indicated an increase in positive behaviors after art sessions
as well as postponement of the first incident of negative behaviors. Art therapy was
found to be a useful intervention.
Hypothesis: Does individual art therapy focused on multimodal, stimulating art activi-
ties increase the participant’s ability to focus and conform to classroom expectations?
Sample: 5 year-old single participant with problematic socialization and classroom
behaviors
Study design: ABAB with A representing the no-treatment condition and B represent-
ing the experimental variable of art therapy as a treatment intervention.
Data collection: Pre-test and post-test measures of drawings using the Formal Elements
Art Therapy Scale (FEATS; Gantt & Tabone, 1998), teacher rated classroom perfor-
mance every 30 minutes over the course of the study; 12 control sessions, 10 easel paint-
ing sessions, 9 clay sessions, and 9 finger painting sessions of 20 minutes duration each.
Data analysis: Average number of target behaviors as compared with presence or
absence of art interventions; pre- and posttreatment assessment of drawings on 5-point
subscales.
Results: Confirmed hypothesis that behavior improved on mornings that included art
therapy.
Limitations: Single subject design does not allow generalization to a population or
allow comparison of different therapists delivering the intervention.

(Continued)
(Continued)
Y Description of what was studied, number in sample, and how selected/
sampled
Y Features of interventions described in relation to controls or comparison
groups
Y Classification scheme described and illustrated with example
N Quantitative data analysis: Relevant statistics frequencies; key data
N Quantitative procedures used to address problem: Descriptive and/or
conclusion; deviations that may compromise validity of the findings are
identified
Discussion: A strength of this study is the clear logic of the design that was carefully
controlled to isolate the treatment effects as they might influence the normal course of
the participant’s school day. Teacher-rated behavior took place without the teacher’s
knowledge of the scheduled art therapy sessions. The ABAB design allowed for com-
parison of treatment vs. no-treatment effects for this single subject. A large number
of sessions over 10 weeks allowed comparison of sufficient data collection. The data
collection is described in detail to allow for replication, however, data analysis proce-
dures are more difficult to follow. The researcher assumes the readers’ familiarity with
the FEATS subscales and the significance of the ratings obtained. The choice of sub-
scales and their significance was not described. The data was not subjected to statistical
analyses. The same person (the researcher) who carried out the treatment also rated the
drawings. Treatment results focused on type of art media and their comparative impact
on the subject’s behavior but results that relate to therapist facilitation skills were not
included in the study. The design does not allow for generalization to a population but
does test the hypothesis that art activity may be helpful early in the day for children
experiencing sensory integration problems in a classroom.
APPROACH: QUASI-EXPERIMENTAL RCT MIXED METHODS

Author/date Doric-Henry, L. (1997).
Title Pottery as art therapy with elderly nursing home residents
Abstract: An art therapy intervention using an eight-session pottery class based on the
Eastern Method throwing technique was implemented with 20 elderly nursing home resi-
dents, with the aim of improving their psychological wellbeing. Quantitative evaluation was
based on Hebl and Enright (1993) and employed a quasi-experimental design measuring
the participants’ self-esteem, depression, and anxiety compared with 20 nonparticipating
elderly residents of the nursing home. Qualitative evaluation included client self-evalua-
tions, case progress notes, journal notes, and photographs. Following the intervention, the
participating group showed significantly improved measures of self-esteem, and reduced
depression and anxiety at posttest relative to the comparison group. Implications for art
therapy intervention with institutionalized elderly and further research are discussed.
Hypotheses: Does the experience of throwing clay forms on a potter’s wheel improve
self-esteem and reduce depression for elderly residents of a nursing home? Can the
therapeutic effect of working with clay be evaluated using standard psychometric
measures?
Sample: 20 elderly resident participants and 20 elderly resident nonparticipants in the
same nursing home were selected according to interest and at least a minimal physical
capacity for the intervention.
Data collection: Qualitative data was collected from pre- and post-intervention
interviews with all participants, observational case notes following each participant
through an 8-week pottery intervention, randomly organized by participant number,
participant questionnaire self-report. Quantitative measures included pre- and post-
intervention scores on the Coopersmith Self-Esteem Inventory (Coopersmith, 1981) the
Beck Depression Inventory (Beck et al., 1961), and the State-Trait Anxiety Inventory
(Spielberger et al., 1983).
Data analysis: To determine the similarity between the 2 groups on the dependent vari-
ables before intervention, a 2-sample difference of means test (t-test) for independent
samples compared the intervention group with the control group at pretest for each of
the measures. A matched sample t-test compared pretest and posttest differences of
means on each of the dependent variables for both the intervention and control group to
determine changes in self-esteem, depression, and anxiety.
Results confirmed the hypothesis and showed significantly lower levels of depression,
increased self-esteem, and reduced anxiety for elderly potters as compared to the con-
trol group. Further analysis indicated that for participants who initially scored high in
all three measures the intervention showed no significance, whereas participants with
initially low scores on depression, self-esteem, and anxiety improved significantly.
Participants increased independence throughout the 8-week study.
Limitations: Nonrepresentative, small random sample

sampled
Y Features of interventions described in relation to controls or comparison
groups
N Qualitative data analysis: Conventions used to collect data described to
characterize interactions or actions, rationale provided
Y Quantitative procedures used to address problem: Descriptive and/or
inferential statistical analyses conducted that are essential to the conclusion;
deviations that may compromise validity of the findings are identified
Y Qualitative procedures that affected subsequent data collection,
substantive categories used to identify patterns occurring repeatedly or
consistently; or in-depth interpretation of a text
N Qualitative iterative processes clearly described to develop claims, seek
confirming/ disconfirming evidence, gather additional evidence, trying
out claims
Discussion: The mixed method study design provides both causal comparisons and
information-rich cases selected to illustrate the range of physical functioning, creativ-
ity, and emotional needs of the participants in the study. The report also discusses the
impact of the study on the researcher, the challenges of conducting such a study in
an institution, and common problems that needed to be overcome. The study attends
to possible replication concerns, and discusses implications for future research. The
effects of the therapist’s interactions were not included in the study’s outcome measures.
The same design could be used for other art media.
APPROACH: DESCRIPTIVE SURVEY RESEARCH

Author/date Vick, R. M. & Sexton-Radek, K. (2005).
Title Art and migraine: Researching the relationship between artmaking and
pain experience
Abstract: This research project extends a previous study (Vick & Sexton-Radek, 1999)
in examining the relationship between artmaking and pain among 127 migraine suf-
ferers. A basic overview of migraine symptoms and treatment is presented along with
a discussion of concepts relating to “migraine art” in order to provide a context for
this project. Surveys dealing with headache history, pain experience, and artmaking
practices were mailed to 371 participants in a national migraine art competition; both
quantitative and qualitative data were analyzed. Participants reported that artmaking
was more likely to trigger headaches than alleviate them and that both the quantity
and quality of studio work declined during headache episodes. In addition, participants
identified numerous art materials and practices they felt precipitated migraines and
noted avoidance strategies they used to manage their headaches. The implications of
these counterintuitive findings for art therapy are discussed.
Hypothesis: Does artmaking alter the frequency duration or severity of migraine head-
ache pain?
Independent variable: artmaking; dependent variable: effects on migraine headache pain
Convenience sample that combined data from two surveys and totaled 127 migraine
sufferers. Cohort 1 comprised data from 1998 sample and was compared to Cohort 2
data from 2001 sample.
Data collection: 2-page questionnaire appended to the report
Data analysis: Descriptive statistics provided frequencies and percentages for the major
headache variables and demographics; percentages provided for self-reported visual
symptoms and migraine impact on artmaking.
Limitations: Only one measure (author-designed survey); follow-up interviews were
not described. Survey data relies on self-report.

selected/sampled
(Continued)
(Continued)
comparison groups
Y Qualitative data analysis: Conventions used to collect data described
to characterize interactions or actions, rationale provided
N Quantitative procedures used to address problem: Descriptive and/or
conclusion; deviations that may compromise validity of the findings
are identified
substantive categories used to identify patterns occurring repeatedly
orconsistently; or in-depth interpretation of a text
N Qualitative iterative processes clearly described to develop claims,
seek confirming/ disconfirming evidence, gather additional evidence,
trying out claims
Discussion: This study explored the widely held claim that “art heals” by collecting
self-reported data from artists who suffer from migraine headaches. Results showed
that for many respondents, artmaking may actually trigger migraine pain instead of
ameliorate it. An extensive literature review is provided to familiarize readers with
the medical condition of migraine headaches and treatment. Conclusions raise impli-
cations for art therapy theory and practice. One weakness in the report is that there is
no description of how qualitative data was coded or categorized; no examples were
provided. The key concept of “artmaking,” a broad and general category, was not opera-
tionalized or defined for survey respondents who may have had divergent ideas and
practices. Although a large sample was collected, survey research that depends upon
respondents’ self-report of their behavior is limited when no other measures are used to
compare perceptions with actual behavior. However, as descriptive research, the study
provided a sound basis for discussing the accuracy of the claim “art heals” and raises
important questions for future art therapy research.
APPROACH: REPRESENTATIVE CASE RESEARCH

Author/date Henley, D. (2007).
Title Naming the enemy: An art therapy intervention for children with bipolar
and comorbid disorders
Abstract: Treatment and diagnosis for the pediatric form of bipolar disorder presents
a clinical challenge given the differences from its adult counterpart and the various
comorbid forms that complicate presentation and developmental course. This article
discusses manifestations of early onset bipolar disorder and offers methods for imple-
menting art therapy interventions based on a study of 184 sessions with 16 children over
the course of 2 and ½ years. Four case vignettes are presented, representative of 16 cases
of children ages 9 to 15 who received 32 trials of the art therapy intervention. Clinical
assessment, intervention, and artistic/behavioral outcomes are analyzed accordingly,
mainly within the psychodynamic and object relations approach to art therapy.
Research problem: To what extent is a structured art therapy intervention (the
“Naming” intervention) effective in furthering the therapeutic progress of children with
early onset bipolar disorder?
Sample: Four case vignettes are described as representative of 16 children, ages 9-15,
who participated in art therapy sessions over the course of 2½ years with the author.
The vignettes illustrate treatment issues and outcomes for (a) a child with classic early-
onset bipolar disorder, (b) a child with a mixed type of bipolar disorder with intense
mania, (c) a child with attention deficit disorder and hypomania, and (d) a child with a
diagnosis of Asperger’s syndrome and bipolar disorder.
Data collection: A total of 184 sessions were recorded that included the “naming”
intervention adapted from Fristad, Gavazzi and Soldano (1998) that sought to disen-
tangle symptoms and help the child gain objective distance from the core self.
Data analysis: Artistic/behavioral therapeutic outcomes as recorded in case notes,
clinical assessment, and intervention were analyzed using primarily a psychodynamic
and object relations approach to art therapy.
Results: The “naming” intervention furthered the goal of integration, ego structure,
and client autonomy, with very few instances of splitting along the lines of the polarity
of naming the metaphoric enemy or friend in the child’s internal object relations.

N Sufficient description of overall design
(Continued)
(Continued)
sampled
N Features of interventions described in relation to controls or comparison groups
N Development of measurements or classifications described
N Frequencies shown in table, chart, appendix, or other
N Qualitative procedures that affected subsequent data collection,
out claims
Discussion: Although not conducted as a research study per se, Henley’s case study illus-
trates how an art therapist can identify, assess, and describe in a rigorous research report
therapeutic outcomes that contribute to a greater understanding of art therapy’s effectiveness
with certain clients. Henley’s systematic study of a specific art therapy intervention over 184
sessions reveals a therapeutically effective and artistic approach to clinical treatment. Case
details are sufficiently provided to illuminate major features, challenges, and client experi-
ences interacting with both the art therapy intervention and the art therapist. Because early
onset bipolar disorder has received little attention in the literature, Henley’s casework fills
in needed gaps with nuanced effect. A researcher could apply the same intervention with
children having the same diagnosis to replicate and compare treatment outcomes.
APPROACH: ETHNOGRAPHIC PILOT STUDY

Author/date Spaniol, S. (1998).
Title Towards an Ethnographic Approach to Art Therapy Disability: People with
Psychiatric Disability as Collaborators
Abstract: This article presents an ethnographic model of art therapy research. The
model is based on an assumption that people with psychiatric disability can be regarded
as members of a culture identified as “disability culture.” It requires the researcher

to approach informants who are in art therapy as an anthropologist entering another
culture—with respect, humility, and a willingness to disregard their professional biases
as much as possible. Basic principles of the ethnographic method are described and the
concept of disability culture is introduced. The evolution and implementation of a pilot
study designed by the author to develop and clarify the principles of the ethnographic
approach are also discussed. Results of the study derived from a thematic analysis of
field observations and interviews are included to suggest possible directions for future
research using this method. The article concludes with specific recommendations for
art therapists who want to use this research approach.
Research problem: What can we learn by approaching people with psychiatric disability as
members of a “disability culture”? How might this concept inform art therapy practice?
Key concepts: Disability culture, person-centered art therapy, treatment-related issues
understood through nonhierarchical alliances outside the therapeutic relationship
Sample: 5 individuals with psychiatric disability known to one another in the local
community
Selection: “Snowballing” approach: participant recommendations to find “expert”
informants
Controls: Access, rapport, and minimized intrusion were established by adopting a
non-expert role and by participating in an art therapy session by invitation. Naturalistic,
in-home interviews with participants enlisted as co-investigators.
Data collection: Field notes; transcribed audiotapes of semi-structured ethnographic
interviews
Data analysis: Interviews were coded and synthesized into composite descriptions of
themes
Validity: Consensual validation obtained through use of more than one data source and
perspective, and verification of the report by one of the study participants and a non-
participant with psychiatric disability

sampled
(Continued)
(Continued)
N Features of interventions described in relation to controls or comparison
groups
Y Qualitative data analysis: Conventions used to collect data described to
Y Qualitative iterative processes clearly described to develop claims, seek
out claims
Discussion: The author stated that her explicit purpose was to illustrate the ethnographic
approach to research, but the example of the pilot study is sufficiently detailed to rep-
licate with other groups or populations. The strength of the study is in the first-person
disclosures provided of how a sample of 5 people with psychiatric disability experi-
enced art therapy and their recommendations for adapting art therapy to fit their needs.
Cross-case analysis resulted in 4 major themes that were verified by the participants
and an independent data check with a non-participant individual who had a psychiatric
illness. Spaniol reflected on her own experience in conducting the study, especially its
challenges to professional boundaries. She made several recommendations for attaining
rigor in the method.
APPROACH: PARTICIPATORY ACTION RESEARCH

Author/date Collie, K. & Cubranic, D. (1999).
Title An art therapy solution to a telehealth problem
Abstract: Telehealth refers to the use of telecommunications technologies to increase

equality of access to health care. In this paper, we describe a gap that exists in the
area of telehealth and propose that computer-supported distance art therapy can fill the
need for telehealth delivery methods that, like text-only Internet services, can reach
people in their own homes and, like teleconferencing, can include both audio and visual
communication. We refer to an action research study we conducted in which we worked

collaboratively to design and evaluate a computer system that supports distance group
art therapy and argue that art therapy is uniquely suited to telehealth for reasons related
to the history of art therapy, the nature of the art therapy process, characteristics of
visual art as a medium of expression, particular qualities of computer images, and psy-
chological effects of using a computer.
Research problem: The use of computer-supported distance art therapy as a solution to
the audio and visual limitations of such telehealth delivery formats as videoconferenc-
ing and Internet communication. The resulting art therapy method can be accessed by
people in their homes with increased means for capturing nuanced verbal and nonverbal
expression and real-time synchronous communication.
Sample: Ten co-researchers with different but related professional knowledge bases
from the community were involved in testing the art therapy computer system’s features.
Participants were selected according to selection standards of focus group research
(Morgan, 1993).
Data collection: Two groups of 5 participants engaged in two 2-hour simulated distance
art therapy sessions in order to experience the author-designed computer system from
both the therapist and client perspectives, and followed by face-to-face art therapist-
facilitated group discussions about the experience.
Data analysis: Transcriptions of the group discussions and notes by the researchers were
subjected to content analysis based on focus group research and action research methods.
Data were grouped according to frequency and intensity of telehealth themes; comments
from those who had extensive experience art therapy clients were given more weight.
Results: Five themes emerged: ease-of-use and lack of inhibition, silence and social
protocols, protection against misrepresentation, qualities of computer images in relation
to art therapy, and feelings of mastery and control. Some anticipated concerns were dis-
confirmed. In general, distance art therapy was determined to be viable for overcoming
the limitations and expanding telehealth delivery systems.

N Sufficient description of overall design
sampled
(Continued)
(Continued)
groups
out claims
Discussion: The lack of detail in the method in this study was due to a decision on the
part of the authors to refer readers to another source where the full scope of the study
design can be found. The theoretical model on which the computer system was designed
(narrative therapy) is articulated and integrated into the study. Results are illuminated
with a full treatment of the themes that emerged with clear authority from the partici-
pants as is typical in participatory action research. Readers gain a clear sense of the chal-
lenges and potential of the project to solve some of the limitations of telehealth formats
and to consider an unusual application of art therapy in a computer-assisted program.
APPROACH: PARTICIPATORY ACTION RESEARCH

Author/date Spaniol, S. (2005).
Title “Learned hopefulness”: An arts-based approach to participatory action
research
Abstract: This paper describes a 2-day conference at Lesley University for art thera-
pists and people with mental illness who have experienced art therapy or make art for
self-expression. Designed as a “participatory dialogue,” the conference was a form of
participatory action research (PAR) developed by the Center for Mental Health Services
in Washington, DC, to foster collaboration between mental health professionals and
consumers. Although a number of such dialogues have been held since 1997, this was
the first to use artmaking to help disparate groups share perceptions as equals and begin
to build partnerships. The arts-based approach to PAR enabled diverse participants to

build trust and begin to create mutual understanding; art therapists began to integrate
new perspectives into their professional attitudes and practices.
Research problem: The skillful use of art therapists’ abilities to listen and to create
can contribute to collaborative partnerships with those who use art therapy services,
and co-construct new visions of treatment that focus on the needs and hopes of human
beings rather than their disabilities. A major goal of the study was to amplify voices
rarely heard through the communicative power of art.
Sample: Thirty-four art therapists, people with mental illness who use the arts for self-
expression and recovery, and family advocates attended a 2-day conference. An equal
number of art therapists and consumers attended.
Data collection: Goals were to begin to build relationships on the first day by sharing
experiences and identifying areas of concern, and on the second day to begin to build
alliances and identify concrete action steps. The participatory dialogue format fol-
lowed the guidelines of the CMHS National Advisory Council for Consumer/Survivor
Subcommittee. Leadership and other tasks were shared equally; people engaged in
drawing and round robin sharing, among other activities.
Data analysis and results: Common themes and issues that emerged from the dia-
logues were identified; a list of specific recommendations for art therapy programming
was generated by all participants and were described as major study outcomes: rec-
ommendations for suitable activities and programming needs, and a desire for further
networking opportunities. A final report that was based on audiotapes and written notes
was created and mailed to all participants for feedback. A manual based on the recom-
mendations was written, published and disseminated.

sampled
groups
(Continued)
(Continued)
out claims
Discussion: This study provides a detailed account of the major features of participa-
tory action research and offers an understanding of its application to art therapy. PAR
is clearly identified and described in the study as not a “particular research method but
rather a diversity of approaches” (p. 86). There is sufficient detail presented to consider
using a similar approach for other groups or communities that are served by art therapy.
APPROACH: PHENOMENOLOGICAL ART-BASED CASE STUDY

Author/date Van Lith, T. (2008)
Title A phenomenological investigation of art therapy to assist transition to a
psychosocial residential setting
Abstract: This study sought to investigate the use of art therapy to assist a young person
with mental illness making a transition from long-term inpatient care to a psychosocial
residential rehabilitation setting. A phenomenological art-based case study method was
used to investigate a lived experience of this transition. The participant attended 11 art
therapy sessions and used a visual journal daily over a six-week period shortly after
the move to the new setting. Data analysis identified themes and visual features that
appeared repeatedly in the images and enhanced the description of the participant’s
experience. Results showed that the transitional process of moving into a community
setting involved a journey of learning, self-development and maturation. Art therapy
helped the process of transition, especially through the use of a visual journal that
functioned as a continuous outlet for expressing and exploring the inner self.
Research problem: What is the lived experience of a young woman making the transi-
tion from a psychiatric inpatient ward to a residential rehabilitation setting as recorded
in daily visual journaling?
Sample and selection: Single participant diagnosed with borderline personality disorder
Data collection: (a) daily visual journal completed over 6 weeks of individual art therapy
with participant reflection, (b) artwork from the art therapy sessions, (c) session notes from
the researcher, and (d) post-session reflective responses to the participant’s artworks
Data analysis: Coding and clustering of recurrent themes in text descriptions and
repeated visual features in artworks, corroboration of core qualities across data sources,
and researcher in-dwelling
Validity: Text-based and visual themes from data analysis were verified by the partici-
pant and caseworker.
Limitations: Case study design would be enhanced with additional cases of the same
nature.

sampled
groups
N Data collection: how, when, by whom and for what purposes; precise
Classification scheme described and illustrated with example
out claims
Discussion: The strength of study is in the presentation of thematic material organized

to show an art therapy client’s clinical concerns with making a major transition in her
life. Although all of the features of a phenomenological report are present, the review
of the literature presents broad issues drawing from very few studies, and the descrip-
tion of both the treatment process and reflective texts are not sufficient for replica-
tion. Results seem to rely heavily on the researcher’s subjective experience of the case,
although it was stated that the participant verified the data obtained. Descriptions of the
participant’s experience are richly detailed to illustrate key concerns. The discussion
section effectively places the case into the context of research literature and draws clear
conclusions regarding the beneficial aspects of art therapy.
APPROACH: NARRATIVE, ART-BASED INQUIRY

Author/date Barbee, M. (2002).
Title A visual-narrative approach to understanding transsexual identity
Abstract: Clinical literature regarding transsexualism has historically focused on

pathology including assessment for medical interventions and follow-up studies on
these procedures. Clinicians encountering this literature may gain very little empathy
for the individual experience of being transsexual. The present study was conducted
to elicit the visual and verbal “gender stories” of a small group in San Francisco.
Participants were asked to photograph their gender story. These photos became the
basis for open-ended interviews, leading to a narrative portrayal of participants’ expe-
riences. The transcripts of interviews were examined for common themes, which were
then compared and contrasted with the literature. Findings revealed the importance
of reviewing individual meanings of transsexual experience, and photographs proved
a valuable stimulus for eliciting these meanings. A visual-narrative approach to the
theory of transsexual experience and to clinical treatment is suggested, in the hopes of
providing a framework for working with transsexual clients that does not pathologize
their experience.
Research problem: To obtain an in-depth understanding of the transsexual experience
from a less stereotypic or biased perspective as can be found in the clinical literature;
to document meaningful “gender stories” and individual narratives, and related visual
self-expression of transsexual individuals.
Sample: Six participants recruited from a city clinic that specializes in hormone treat-
ment for transsexual individuals. The study sample consisted of 4 male-to-female and 2
female-to-male transsexuals having diverse ethnic, cultural, economic, and geographic
backgrounds.
Data collection: Three meetings with each participant consisted of a introductory
interview with questionnaire, a photography assignment to illustrate the participant’s
“gender story” with 2 follow-up interviews to review interview transcripts and photo-
graphic portrayals in order to fill in the details of the gender story.
Data analysis: Transcriptions of the interviews were created and summarized into
themes. Individual visual-narrative portrayals were created from demographic data, 12
photographs, and a narrative of meaning-laden themes that described the individual’s
transsexual identity. Collective themes were obtained by comparing across all 6 stories
with emphasis placed on consistent patterns, connections, and both individual and col-
lective meanings. Themes that emerged were reviewed and compared to the literature.
Results: Nine themes appeared in the transcripts of all individuals: 1) concern with
appearance, 2) transsexual identity development, 3) transsexual etiology, 4) experiences
of transitioning, 5) gender and sex roles, 6) experiences of discrimination, 7) activism,
8) sources of community and support, and 9) experiences with mental health profes-
sionals. The most frequent theme was visual self-presentation in terms of desired sex
and gender.

sampled
N Roles of researcher and participant in data collection described
groups
out claims
Discussion: This study is comprehensive in establishing the problem and its history
in mental health care. A thorough review of the literature is provided as an overview
and also in corroboration with the study findings. The researcher obtained detailed,
nuanced portrayals that were handled with empathy. Discussion of the researcher’s
insider-outsider status and other sensitive ethical issues are not included, however,
nor are data analysis procedures described in sufficient detail to replicate the study.
The study succeeds in presenting a post-modernist perspective, asserting that “all
of us are constantly creating and interpreting narratives that make meaning of our
lives” (p. 61)
CONDUCTING RESEARCH TO
ACHIEVE QUALITY OUTCOMES
It may seem surprising to focus this chapter on the study of published research reports
as a strategy for conducting your research instead of offering step-by-step procedures.
The foregoing chapters reveal that how you conduct your research greatly depends
upon your choice of methodology and its systematic application to your goals and prob-
lems. As with any craft, both novices and experts study the experiences of others that
have gone before them to gain insight into potential obstacles and challenges they may
encounter in their own practices. Much can be learned from the careful analysis of
how other researchers approached their problems, designed their studies, and obtained
results within the context of necessary or emerging limitations.
In addition to studying the published work of others, researchers can improve the
conduct and quality outcomes of their studies through mentoring and participation in
research roundtables or study groups. In Great Britain, art therapists have benefited
from the Art Therapy Practice Research Network (ATPRN), which promotes large-
scale data gathering and research documentation. In the United States, the American
Art Therapy Association has included “research roundtable” discussions at its annual
national conference where individual researchers network and learn about each other’s
work. Mentoring from an experienced art therapy researcher or from those who have
research skills in different disciplines and backgrounds is a good way to obtain practical
tips and suggestions.
Experienced researchers will tell you that conducting a research study requires
methodical, efficient, and effective organization of your time and resources. Successful
researchers who produce quality outcomes pay attention to time and project management.
They have established systems for organizing the data in both hardcopy and electronic for-
mats, and work to increase their computer literacy skills for effective library and database
searching, and for data management and analysis. Knowing the constraints of time, bud-
gets, and energy, they try to work smarter, not harder. They are effective networkers who
use a range of communication skills to improve potential access to sites and participants,
and to locate and work effectively with other members of the research team. They know
that the likelihood of their research findings being disseminated and used to build knowl-
edge of art therapy is increased with efficient and well-developed writing skills. Effective
researchers, therefore, conduct their studies with political, institutional, organizational, and
clinical ends in mind. They pay attention to how they want their research to be used and
they work on their presentation, public speaking, and publishing skills in order to increase
the potential for their research to be replicated, used, and adopted by others.
Ultimately, then, a good researcher in the conduct of a study is like a good hunter,
artist, or craftsperson. Beckford (1997) wrote that one “should be young, strong, active,
bold and enterprising; fond of diversions and indefatigable in the pursuit of it”; “quiet,
patient and without conceit”; as well as sober, exact, “civil and cleanly” (p. 122). Whether
researcher or artist, craftsperson or hunter, your “voice should be strong and clear” and
you should have an excellent ear and an alert eye. Young in spirit, researchers apply
their craft by working toward obtaining a creative and ethical balance in their lives that
they extend to those who participate with them in their studies. May your own spirit be
as strong in the conduct of your research pursuits.
CHAPTER SUMMARY
1. Researchers can learn about conducting good research by evaluating the
research of others and tracking developments in the professional literature.
2. Rigorous research means attending to quality and correctness in all
procedures.
3. A report’s abstract and introduction should provide a clear idea about the
research conducted, its purpose, and hypothesis or key questions.
4. The purpose of the literature review is to provide a reader with the context of
the study in light of what is already known or open to question.
5. The research design should be logical and there should be enough informa-
tion in the methods section—participants, variables and controls, data gath-
ering, and analysis—to replicate the study.
6. The results section summarizes the data in relationship to the research ques-
tions. Quantitative reports will show whether or not the hypothesis was
supported.
7. The discussion and conclusion sections describe the meaning of the data,
limitations or difficulties encountered, how the study contributes to the lit-
erature, and how the conclusions were reached.
8. It is a common mistake to evaluate a qualitative design on the logic of
quantitative studies and vice versa. The differences should be kept in mind
when evaluating different kinds of research reports and their analytic
assumptions.
9. Research reporting requires accurate evidence that supports the conclusions

and transparency in stating procedures and the logic of the design. The public
and other researchers depend upon the accuracy of published accounts.
10. In addition to studying the published work of others, researchers can improve
the conduct and quality outcomes of their studies through mentoring and
participation in research networks.
11. Conducting a research study requires methodical, efficient, and effective
organization of time and resources.
REFERENCES
American Educational Research Association. (2006). Standards for reporting on empirical social
science research in AERA publications. Educational Researcher, 35(6), 33–40.
Bass, R. (1991). Why I hunt. Parabola, 26(2), 54–56.
Beckford, P. (1847). Thoughts on hunting, in a series of familiar letters to a friend. London,
England: Henry G. Bohn.
Coomaraswamy, A. K. (1991). The use of art. Parabola, 26(3), 4–10.
Oaks, CA: Sage.
Henley, D. (2007). Naming the enemy: An art therapy intervention for children with bipolar and comor-
bid disorders. Art Therapy: Journal of the American Art Therapy Association, 24(3), 104–110.
Locke, L., Silverman, S., & Spirduso, W. (2004). Reading and understanding research (2nd ed.).
Monti, D. A., Peterson, C., Shakin Kunkel, E. J., Hauck, W. W., Pequignot, E., Rhodes, L., &
Remde, G. (1991). Close to the earth. Parabola, 26(3), 46–49.
Sulzberger, J. (1991). Some notes on Arab calligraphy. Parabola, 16(3), 26–29.
Tolman, D., & Brydon-Miller, M. (2001). From subjects to subjectivities: A handbook of interpre-
tive and participatory methods. New York: New York University Press.
Van Lith, T. (2008). A phenomenological investigation of art therapy to assist transition to a psy-
chosocial residential setting. Art Therapy: Journal of the American Art Therapy Association,
25(1), 24–31.
Vick, R. M., & Sexton-Radek, K. (1999). Interplay of art-making practices and migraine head-
ache pain experience. Headache Quarterly Current Treatment and Research, 10, 287–291.
Vick, R. M., & Sexton-Radek, K. (2005). Art and migraine: Researching the relationship
between artmaking and pain experience. Art Therapy: Journal of the American Art Therapy
Association, 22(4), 193–204.
Watson, B. (1968). (Trans.). The complete works of Chuang Tzu. New York, NY: Columbia
University Press.
Writing for
Publication in
Art Therapy and
10
Other Scholarly
Journals
Going hunting requires following

the steps of the hero’s quest:
a retreat from conventional
society, surrendering to a sense
of intuitive calling that leads
one into mysterious realms,
undertaking certain tasks which
may involve danger. Deep
emotions—excitement, awe,
sadness—are faced, powers are
taken on, strange teachers appear,
personal transformation unfolds,
heroic deeds are performed, and
finally the hero returns as the
“changed one” to serve the needs
of the community and infuse
fresh spirit into the lives of all.
—Joseph Campbell (1968)
Think of research as a fishing line thrown into a river of potential benefits, where a well-
designed study hooks a little fish that, in turn, attracts a larger fish to feed many people.
Even a relatively small research study, when precisely focused on an existing need with a
demonstrable benefit, may produce outcomes that trigger a whole movement of demands
for art therapy services (Kapitan, 2006b). Here is a case in point: A few years ago, the
American Art Therapy Association recruited experts in academic research to be paired
243
with experts in governmental affairs, professional relations, and art therapy practitioners
in a target population that was likely to grow (Kaiser, Dunne, Malchiodi, Feen, Howie,
Cutcher, & Ault, 2005). The target was art therapy for veterans with posttraumatic stress
disorder (PTSD). The thinking behind it was that art therapists who worked with vet-
erans were reporting success but few funding sources knew about it. Even if they had,
there was little hard evidence that government and other agencies could use to justify
putting scarce resources into art therapy. How could the efficacy of art therapy as a pre-
ferred treatment for veterans be shown and its results more widely known?
The usual thought process, I believe, would be to recognize that the research sup-
ported art therapists working with veterans but fail to take that thought further. Every
client receiving art therapy would have benefitted from such research because of the
“multiplier effect”: Demonstrable success in a target population creates new percep-
tions up and down a whole chain of interconnecting funding sources and generalizes to
all other kinds of art therapy services and needs (Kapitan, 2006b). If art therapy helps
a combat veteran suffering from PTSD feel better, would it help non-veterans with
PTSD, or abused women or children, or at-risk adolescents, or elders? If it helps veter-
ans in the United States returning from the war in Iraq, would it benefit other survivors
of war and trauma around the globe? The value of even a single study can be enhanced
through the multiplier effect—but only if it is published and used by others.
WHY PUBLISH?
Research that benefits every art therapy client requires scrutiny from peers outside and
within our ranks who have a stake in what we are doing. Perhaps it is this stepping beyond
the comfort zone that prevents many art therapists from writing up their formal or infor-
mal research. In hundreds of settings all over, art therapists routinely partner with other
members of the treatment team to articulate the results of their work. But sharing that
knowledge in order to multiply its effects is often a crucial missing step in the field of art
therapy. In a less individualistic profession it would be unthinkable to withhold knowledge
that would benefit other people. Valuable ideas and knowledge grow exponentially in col-
lectivist societies, particularly where resources are scarce. This is because they have cul-
tural systems in place to carry resources to where they will do the most good, and because
there is a mindset of service to the common good over individual gain (Kapitan, 2006b).
The hunter-gatherers understood this principle well. Although engaged in a quest
enacted in isolation, the hunter knew that the true purpose of the hunt was to replen-
ish the stores of food needed to feed the community (Kapitan, 1998). Likewise, the
researcher should be motivated not solely by an individual quest for knowledge, but a
connection to those who will benefit from the renewal of the basic scientific or artistic
conversation the inquiry brings. Just as the ethical hunter asks the animal for its life
to nourish others, so too research participants offer the gift of becoming a part of the
researcher’s work. Once that gift is given and the data have been collected and inter-
preted, the hunter-researcher is deeply obligated to the study participants to use and
10 t Writing for Publication in Art Therapy and Other Scholarly Journals 245
disseminate the findings for the best possible purposes. Not only is it the researcher’s
ethical responsibility, this giving attitude provides for the transmission of knowledge to
serve future generations of hunter-researchers.
The connection between the public sharing of knowledge and an art therapist’s
personal or professional power is worth contemplating. Activist poet Jimmy Santiago
Baca once described what it felt like to be cut off from the great river of knowledge due
to his illiteracy. When he learned to read and write as a young adult, he was astounded
at how much power language carried. Putting his knowledge into words allowed him to
confront and understand his life, “even to wring from it some compelling truths” (Baca,
2001, p. 5). Language opened the way toward a future that was based on compassionate
involvement with others and a belief that he “belonged.” Baca considered what he was
coauthoring with society, and challenged his readers to do the same by actively voic-
ing a contribution of lasting impact. When I think of all the important work that art
therapists haven’t yet recorded, I share Baca’s wry observation: “We’re in this together,”
he said, “but you’re just not saying it” (as cited in Stahura, n.d.). This chapter looks at
strategies art therapists can use to improve their skills in research writing and attempts
to de-mystify the process of writing for publication for all who are interested in making
a lasting, quality contribution to their profession.
PREPARING A MANUSCRIPT FOR

A SCHOLARLY JOURNAL
Scholarly journals provide a forum for researchers to share and build upon their find-
ings for the benefit of the public and other scholars and professionals. Unlike trade
magazines, scholarly journals contain primary research articles that are peer reviewed,
which means that experts have evaluated the findings for accuracy before publication.
Of the different types of articles, a research article is a primary source that reports the
results of empirical research conducted by the author or authors of the report. A review
article is considered a secondary source because it summarizes the work of others,
usually evaluating a number of studies on a particular subject in order to identify major
trends or conclusions that can be drawn from it. Theoretical articles present new or
established abstract principles upon which knowledge in a subject like art therapy can
be related. A journal may also publish book or video reviews, news items on emerging
or preliminary research, editorials, commentary, and opinion pieces.
As discussed in Chapter 9, a critical study of published research reports can guide
a researcher in writing for publication. A basic, empirical research article, which is
the focus of this chapter, consists of eight parts in the following order: (a) title and
author(s), (b) abstract, (c) introduction and review of relevant literature, (d) methods,
(e) results, (f) discussion, (g) references, and (h) tables and figures. The format is set
up in this way to aid the process of review, editing, and publication. It may be help-
ful to use the image of an hourglass to comprehend both the breadth and depth of
scientific writing necessary within the confines of this basic structure. As detailed
below, the paper should start out broadly by presenting an overview of the primary
areas of inquiry and the study’s significance in the introduction, then narrow a little
to present a succinct literature review. It narrows further to derive research questions
or hypotheses, followed by a very tight description of the method used in the study.
The results section begins with a very narrow statement of what was found, followed
by broadening the discussion in which the findings are compared and contrasted
with previous findings, and ending with some broad conclusions about how the study
advances the area of inquiry.
To assemble a manuscript, one good strategy is to lay out a simple eight-page
sequence and then fill in the “hourglass” with a detailed outline of the content:
1. Cover page: The cover page identifies the title, author name(s), author affiliation
(place of work), a running head or keywords to appear on each page of the manuscript,
and a short title that may be used as a running head to identify the paper in the editorial
process. The title should be precisely focused to convey the content of the article; there
should be no extraneous words that carry no meaning. Think carefully about how the
title may be indexed in an electronic database; if keywords are included, the article will
be more likely to be discovered in searchable databases.
2. Abstract: The abstract is a concise and comprehensive summary of the report.
In addition to presenting the major points of the report, the abstract contains key-
words to aid other researchers in finding the published report in a research or library
database. For this reason, the abstract must accurately reflect the content and com-
ponents of the text, and be free of an author’s opinion or evaluative comments. The
abstract serves to communicate at a glance what the study entailed, which often
determines whether someone will be interested in reading the article or citing it in
a literature review.
ELEMENTS TO INCLUDE IN AN ABSTRACT

r Self-contained, accurate, and concise description of the article’s
content
r Thesis or problem statement that was addressed in the study
r Type of research design and methodology used (including procedures,
test names, treatments in experimental studies)
r Specific population and/or pertinent descriptors of the participants (num-
ber, age, etc.)
r Results or findings (including statistical significance and effect sizes in
experimental studies)
r Conclusions and implications of the research
3. Introduction and literature review: This page begins the actual text of the manu-
script. A few introductory paragraphs that identify the study and broadly discuss its sig-
nificance to the field should end with a brief thesis statement that identifies the research
problem and its importance. The relevant context of the study is provided with a review
of the literature, which should be narrowed and precisely focused rather than exhaus-
tively discussed. The logic that links previous works or relevant theories and practice
implications with the current problem should be made clear to a reader. Recent studies
that have bearing on the subject and rationale for the study must be included. A clear
hypothesis or problem statement concludes this section.
4. Methods: The typical sequence for presenting the methods is to describe the
participants, the criteria and sampling method for their selection, the number of par-
ticipants involved, procedures for informed consent, the location of the study, and a
statement of the achieved sample size along with a brief discussion of how it differed
from the target population. Then identify the apparatus and all measures used. End this
section by identifying the main research method or paradigm, and provide details of
the procedures involved to collect the data and carry out the study. Qualitative research
follows a similar sequence, except that to familiarize readers with the methodology, a
more detailed description of data collection and analysis may be needed in the discus-
sion of procedures.
5. Results: The data that were collected and analyzed are succinctly summarized
and limited precisely to what was found without interpretation in this section. Results
should be transparently accurate and unbiased, without omissions of important data.
From the results presented, readers should be able to decide whether the results justify
the conclusions made. Tables are commonly used to display numerical data and for
qualitative studies, they can aid in the organization of excerpted data that illustrate
themes or issues. In a manuscript, these appear on separate pages that are appended to
the text. Specific requirements for reporting inferential statistics in a research report
and other report standards can be found in the Publication Manual of the American
Psychological Association, 6th edition (2009).
6. Discussion and conclusion: This section begins by linking the findings to your
hypothesis and then broadens the scope by discussing and interpreting the results as
compared to those found in other studies, as well as implications for future research.
Findings that do not confirm the hypothesis or the findings of others should be noted,
along with limitations that qualify the study’s results. The conclusion presents some
broad statements about how the study contributes to knowledge in the area of inquiry.
7. References: The references begin on a separate page and must follow the guide-
lines set forth by the American Psychological Association (APA) publication manual or
Website. It is important to review these carefully because they are complex and often
are the source of many errors. New electronic formats for sources complicate the refer-
ence list further and should be checked.
8. Figures and tables: These are placed last in the manuscript, on a separate page.
Each figure is numbered in the order that they appear in the text. Tables require concise
captions that communicate the contents. The APA manual should be used for guidelines
on organizing data into tables and figures.
Of course, a manuscript will have more than eight pages but this eight-page struc-
ture will aid in creating the outline and making certain that the manuscript contains
all the required elements in the order necessary for publication. A review of the critical
questions that shape the readers’ understanding and critique of each section, as detailed
in the previous chapter, should guide the development of the written report.
CHECKLIST FOR GOOD RESEARCH REPORT WRITING

r Title: Clear, concise, accurately indicates content of paper; keyword
searchable
r Abstract: Concisely states purpose, describes what was done with
whom and to what effect, and results found; keyword searchable
r Introduction: States research problem or key concepts, author’s goals
and purposes, rationale for the research method, and hypotheses or
main guiding question; includes clear thesis statement within first three
paragraphs
r Literature: Relevant, adequately critiqued for how it bears on the
study; explains weaknesses and gaps in knowledge and biases
r Method: Described in detail (subjects, sample size, selection crite-
ria, relevant variables, extraneous variables, adequate controls, biases
stated or controlled, treatment procedures described and consistently
applied, valid instruments, data analysis procedures) appropriate, logi-
cal, ethical
r Results: Summarized in text and tables, accurate statistics and/or clear
and credible case examples or textual analyses; logical and perceptive
analysis; artwork is relevant and discussed in context
r Discussion: Research problem is answered, hypothesis supported or
not by data and analysis, generalization is stated if warranted, results
are applicable to theory or practice, limitations are accounted for, devi-
ations or emergent issues are identified
r Conclusion: Problem is re-stated, follows logically from findings,
avoids speculation or overstatement, concise concluding statement,
significance stated
r References: Provided for every study cited, accessible for readers or
other researchers, APA style, error-free
In reporting research, you are responsible as well for addressing the ethical deci-
sions you made that shaped the design and implementation of the study (AERA, 2006).
Some of these may include:
r Consent or waiver of consent from participants

r Confidentiality agreements and guarantees
r Agreements with respect to gaining access to a site or research data
r Compensation, if provided, and how it was handled

r Data protection and safeguards
r Techniques used to mask or change data (identity of locations, institutions,
etc.) to prevent disclosure of private information
r Reporting any conflicts of interest or biases of the researcher
Converting a Dissertation or
Thesis to a Journal Article
A special challenge for recent graduates is to craft a publishable article from a lengthy
manuscript like a dissertation or thesis. The work that you have created in the con-
text of earning a master’s or advanced degree represents a major investment of time
and exhaustive interest. Adapting your research study to the smaller scale demands of
a scholarly journal can be difficult but not impossible. The foregoing discussion can
guide you in precisely focusing on the substance of your research within the format of a
report. In general, you will need to trim down the length and volume of the information
you were required to include in your thesis or dissertation, and you will need to be much
more selective with your findings.
One writing strategy is to choose the most significant finding or findings from
your study and build the “hourglass” outline of your article around it. For example,
go through your manuscript and list each finding. Then go back over the list, crossing
out the least important findings and rank ordering the rest according to significance.
Identify the top finding and consider how closely related or far apart the top finding
is from the next three or four on your list. This will help you discern which findings
need to be included in your journal article. Begin organizing the eight-page outline
of your report by starting with the broad significance of your study based on this key
finding or findings.
You may have been required in your studies to demonstrate your scholarly skills
by conducting a relatively exhaustive search for literature in related areas of inquiry.
However, the reading audiences of a journal are less interested in the details of what
you learned in the course of your research than they are in the value of your study
itself. You do not have to prove that you read every text on the subject, so limit your
reference citations to only those that shape the particular context of your findings.
Similarly, a thesis or dissertation committee may have insisted on descriptive detail
of basic research design considerations in your methods section to demonstrate your
learning or skills. In a journal article, it is more important that your methods are
precisely and narrowly described. For qualitative studies, Patton (2002) advises bal-
ance: there should be enough description of the study and its methods to understand
the interpretation of data, and enough interpretation for readers to appreciate the
description.
Another challenge in adapting a dissertation or thesis is to discern what conclusions
can be drawn that are substantive rather than comparatively trivial in the context of a
journal article. Because you have invested so much energy in the project, you may be
tempted to omit uncomfortable data or overstate your claims with an emotional exuber-
ance that will strike reviewers and readers as naïve or unscientific.
The difficulty in trimming the overall length of the thesis to adapt it to an article is
that you may have become very attached to certain sections or arguments, especially if
they were challenging to write in the first place. You may have struggled with several
draft revisions, so your final document represents a major achievement. Therefore, I rec-
ommend that you approach the journal article as a new creation that has been “mined”
from the rich abundance of its parent document—the thesis or dissertation. Once you
have completed writing the journal article, if it is still too long, it is best to give it to
another scholar or faculty mentor to edit more ruthlessly than you have been able to do
yourself. It may surprise you to discover that you don’t miss the material that was edited
out because the new article has an integrity all its own.
Students who have succeeded in conducting exemplary research often are
encouraged to take this extra step and write up their research for a scholarly jour-
nal. Believing that their participation was valuable, the research participants may
have given consent out of the expectation that the results would be shared with oth-
ers. On the other hand, not all master’s papers or scholarly work results in original
research. Thus, part of the researcher’s responsibility is to self-evaluate the quality
and significance of the study, and to determine how and whether the results should
be disseminated. Research has a “shelf life” and a study can fade in relevance fairly
quickly as time goes by. To keep up momentum, I advise letting the thesis or disser-
tation rest for a few months after graduation, and then re-connecting with a mentor
or a group of coauthors. Set up a series of deadlines for completing the report, and
begin by creating the basic outline described above. Before you know it, you will
have a paper worthy of consideration for publication and can be satisfied that its
value will not be lost.
Other Scholarly Articles and Oral

Presentation Venues
In addition to the formal research report, most scholarly journals publish content in
a variety of categories such as theoretical or practice-focused papers, viewpoints on
professional issues or insights, and informed opinion pieces. In general, a theoretical
or practice paper follows the same basic format as a research report: a clear introduc-
tion to the goals of the paper; review of relevant literature; problem statement; methods
of analysis or practices used to address the problem, dynamic, or issue; discussion or
examples presented to illustrate the goals of the paper; expected outcomes or proposed
solutions; and implications for the field of art therapy. Opinion and viewpoint pieces
tend to be shorter and more focused on a specific concern or insight but they, too, are
expected to present arguments that are grounded in the literature or prevailing ideas of
the field.
Art therapists may present their research orally at local and national conferences
and symposia, which is another important means for dissemination. Conferences serve
to connect researchers with appreciative audiences who offer dialogue and critique.
Unfortunately, too few of these oral presentations make their way into published art
therapy literature. As gratifying as it may be to present your study in such a forum, the
audience is small as compared to the global reading audiences of a scholarly journal
and its archived research collection. In most professions, oral presentations of research
are thought to be preliminary until they have been written up and accepted in a peer-
reviewed publication. Therefore, it is important to use the feedback from a presentation
as motivation for revising it into an article.
As with converting a thesis or dissertation to a publishable article, writing from an
oral presentation has its particular challenges. Because considerable written effort went
into its initial creation, sometimes the presenter submits the oral presentation paper “as
is” to the publication. These papers are rarely accepted without revision. The “voice” of
the author in an oral presentation is affected by the chemistry of presenting before a live
audience; an effective presentation may include spontaneous digressions and tangents
of interest to the audience, question and answer portions, and a looser organization
of material that incorporates input from co-presenters or other research. This is great
inspiration for a live audience but impossible for readers of a publication to follow.
Therefore, it is important to approach the oral presentation as valuable material for a
more formally written report and to follow the same guidelines in this chapter to make
your work publishable.
AUTHORSHIP AND ITS RESPONSIBILITIES

Determining authorship in a research report, and the number and order of authors
when there are more than one, may seem like an arcane mystery. In general, the order
of authorship represents the magnitude of contribution to the overall project. The first
author is the person who made substantial professional contributions that are integral
to the paper, such as developing the research design, writing substantial portions of the
article, developing conceptual models or assessments, contributing to data analysis,
and interpreting results (Fine & Kurdek, 1993). Usually the author who submits the
paper to a journal is designated as the “corresponding author” (although sometimes
another author accepts this role). The corresponding author takes the responsibility of
communicating with the publication’s editors and reviewers. Other authors are listed
if they have made substantive professional contributions either to the writing or to
the study’s data gathering and analysis. In long-term projects, it is not uncommon for
new investigators to be added to on-going protocols, and therefore to the authorship
of the paper, so that all contributions to the project are publicly acknowledged when
the research is disseminated.
In longer-term projects, as well as within the context of the faculty-student rela-
tionship, authorship should always be viewed as an ethical decision-making process
that is best handled in the early stages of a research project and continuously through-
out. In most social sciences, students are listed as a first author on milestone projects
such as a thesis or dissertation. Fine and Kurdek (1993) recommend that when faculty
and students collaborate on a paper, they should agree on the tasks and contributions
that warrant authorship credit beforehand so that both parties have sufficient informa-
tion to be able to give consent. The same principle is generally true for determining
authorship order among the members of a research team, the composition and degree
of contribution of which can change over time. As a general rule, to be included as
an author on a scholarly publication, one’s contribution should be professional and
intellectual or creative in nature, and is integral to the completion of the paper (Fine
& Kurdek).
In the interest of ethical fairness, authorship should be granted only when credit
is due and, by extension, not be granted when such credit is undeserved. In the former
situation, a student whose work is used but not credited by a professor is harmed by the
ethical failure of the mentorship relationship to model professionalism and standards of
scholarly research. In the latter situation, a faculty mentor may seek to be included as
an author on a paper to enhance the reputation of the university, which is exploitative if
the credit is undeserved. Likewise, if a student who did not make a professional contri-
bution to the paper is included as an author, then the student’s true competence may be
masked and undermined in the long term. The same ethical guidelines can be used for
determining authorship among peers or colleagues on a paper.
It also is important to distinguish authorship from those who have acted in the
role of participants in the research contributions in a paper. These participants usually
are acknowledged in an editor’s or author’s note rather than being listed as authors.
People who were surveyed and contributed their thoughts or writing on a subject usually
are considered a part of the data collection. In general, authorship is reserved for those
whose contributions are professional in nature, and who have designed the research and
organized or written the report.
An author’s name that appears in a publication exists “in perpetuity” and thus it is
critically important to follow the ethical and professional standards on which research
knowledge is founded. Authors are responsible for certifying that the information
derived from the research and presented in the manuscript is accurate and honest. It
should go without saying that the ideas, words, and contributions of others must be
cited and not taken for one’s own. Most researchers carefully qualify their findings to
avoid overstatement or claims of greater significance than the research actually sup-
ports. They do not invent results or sources, of course, or fail to identify counterclaims
and limitations. They protect the rights of human subjects and do not identify anyone,
either directly or indirectly, in a way that could cause harm.
Finally, the importance of professionalism in scholarly writing should be men-
tioned. Particularly in a small field where it is not unusual to be personally acquainted
with other contributing authors and researchers, scholarship demands a degree of objec-
tivity when reviewing the work of others. It is important to set aside biases and to sepa-
rate the person of the writer from the person’s ideas when critiquing another’s work. Art
therapists can avoid another pitfall by recognizing that earlier work is simply “earlier”
or historically situated; it is not “bad” for failing to take into account what could only
be learned from later developments in the field.
STRATEGIES TO IMPROVE COHERENCE

IN RESEARCH REPORT WRITING
Writing as Thinking
Writing up a research report requires putting things into a linear sequence without the
creative flourishes or leaps of logic that many art therapists so thoroughly enjoy. Unlike
such genres as creative nonfiction or personal journal writing, the straightforward form
of a research report is intentionally designed to present factual information to other
researchers and consumers of research. Science writing should not be viewed as beyond
the reach of art therapists, however. A practitioner applies the same skill when present-
ing a case or creating a task analysis to assist a client by breaking down a task into its
simplest components.
In his classic text, On Writing Well (1980), Zinsser insisted that a complex sub-
ject could be made as accessible to a reader as a simple subject. It is just a matter of
“putting one sentence after another” (p. 114). One simple assignment that he gave his
students to practice this skill was to describe in detail how something works. Try, for
example, explaining step by step how to use a scissors. It won’t matter how you feel
about the scissors, or whether there is a surprise ending to how the story of a scissors
plays out—no, just the clear, unadorned facts and a logical sequence of the steps are
important, deduced from precise observation and written in accurate, clearly defined
language.
Zinsser (1980) found that describing how something works is a breakthrough assign-
ment for writers who have trouble disentangling their thoughts and ideas. The exercise
accomplishes two important goals in science writing: First, it forces you to think through
and make sure that you know how something works. Second, it requires you to explain
clearly enough for a reader to understand and be able to apply your method. Writing the
first draft of a research report is related to the first goal, which is to think through the
entire research study—purpose, problems and hypotheses, review of related research,
methods of collecting and analyzing the data, and the results obtained—in order to put
it all into a logical sequence. As such, writing is thinking and an extended form of data
analysis. You write the first draft for yourself but the second draft must be written for
the reader. Having written down and thought through the whole study, now, for the sec-
ond draft, step away and look at the study from the perspective of the reader who knows
nothing about it. Zinsser (1980) believed that this principle of science writing applies
to all nonfiction writing: Writing a good research report is a matter of “leading a reader
who knows nothing, step by step, to a grasp of the subject” (p. 116).
To use the writing process as a means for thinking about a study rather than sim-
ply discussing it, Creswell (2003) recommended an exercise of writing four drafts of a
single passage in one hour (one new draft every 15 minutes). The aim is not to polish
your sentences but to use each draft to invest greater thinking in the cycle of writing,
reviewing, and rewriting until you truly understand and can explain what you have
found from the study and want others to understand as well.
Most writers find that to perform this kind of “thinking through” their work,
they need a distraction-free environment and a daily, confidence-building commit-
ment that exercises their writing muscles. These ideals can be difficult for practitio-
ners who have research or practical knowledge they want to write up but little time
or focus to do so. Some art therapists practice by writing their ideas and observations
in diaries or visual journals, or by creating altered books that involve thinking in
the synthesizing media of visual and textual collage. These texts can be mined for
research ideas or refinements of qualitative data. Without such supports, writing
can be a daunting task. For example, I once advised an art therapy student who was
terribly intimidated by her thesis and a fear of failure that caused a painful writing
block. I asked her whether there was any time in her life when she had experienced
success with a difficult skill. She told me that during high school she had been a
state champion cross-country runner. Together, we devised a thesis intervention that
metaphorically paralleled the same practices she had used to succeed as a runner.
Every week, she devoted certain days to “sprints” or brief writing periods alternated
with days on which she would either rest entirely or “go the distance” by writing a
complete draft. She surrounded her writing desk with her trophies and ribbons, and
she never started a session at the computer without first putting on her tracksuit and
favorite athletic shoes.
For Non-Linear Thinkers

Some art therapists do not have linear minds; they think in circles. For these writ-
ers, too, writing is thinking—but that thinking tends to move in many directions at
once, exploring intuitive connections or mining tangents for their creative possibilities.
Some of us don’t know how a process works until we have thoroughly played with each
element as we think about it; we worry about the structure of how it all goes together
later. For intuitive or circular thinkers who have written a draft that needs systematic
organization, Linton (2000) developed a simple process called “retrospective outlining”
that is especially useful. It is comprised of three steps:
Step 1: On one piece of paper, copy every heading and subheading exactly in the
order that they appear in the draft. Then count up and record the number of pages and
paragraphs contained in each section and subsection. This will give you an idea of how
you have structured the piece in terms of the number and types of levels and whether
they logically support the aims of your paper. It also will tell you how much weight you
have given to each section, whether these sections are balanced, and the overall flow of
the piece.
Step 2: Next, read through each section and write a keyword or phrase in the mar-
gin that identifies what its main idea or focus is about. Then read each paragraph and
give it a keyword or short phrase in the margin that describes the main point. Now write
a table of contents comprised only of these keywords and the sequence in which they
appear. By studying this outline and comparing it to the information you have from
step one (logic, value, and weight of each section and the flow of the piece as a whole),
you should be able to notice any redundancies, tangential information, misplacements,
omissions of important information, and so on.
Step 3: Now you can begin to fill in gaps, delete, shape, and reorder the draft to
improve the logic and flow of information. Check your detailed outline against the
inclusion and placement of any elements that are required in a research report. Add
what is missing and reorder those elements that are not properly placed. Everything
should be ordered in such a way that the meaning of the whole piece builds logically and
flows to the conclusions you want your readers to take away from the report.
Building Your Argument on Claims and Evidence

Clear communication is the prime directive of scientific writing. The “argument” that
you put forward is not expected to be argumentative; rather, it resembles a persuasive
conversation about something you want others to accept as credible or true, which is
called a “claim,” and the reasons or evidence that supports it. A good research report is
built upon claims that are substantial, plausible, and specific. The evidence that support
them must be relevant. Booth, Colomb, and Williams (1995) identified six tests of sup-
porting evidence that most likely lead a reader to accept a research claim. The evidence
must be (a) accurate or reliable, (b) precise, (c) sufficient, (d) representative of the study
population, and (e) authoritative in the sense of being derived from (f) credible sources
(p. 97).
A final consideration in making a sound argument is to seriously consider and
present any qualifications that could limit the extent to which a claim may be true.
Some authors take this step only reluctantly or not at all, feeling that any counterclaim
will undermine their argument and set them up for failure. But a carefully qualified
argument is a more credible one; it serves to safeguard the transparency and honesty
upon which scientific knowledge is constructed. Qualifications may include a descrip-
tion of limiting conditions and scope, contradictions or confounds in the data, and
alternative claims that another researcher or reader may believe to be true. A good
argument will anticipate the objections a reader may have and will not shy away from
honest scrutiny of where there may be holes in a research study. Readers appreciate
such careful scrutiny because it communicates that the researcher is committed to
unbiased truth.
To construct a coherent argument for your paper, Zinsser (1980) suggested that
you imagine writing the research report as if it were an upside-down pyramid. At
the bottom is the one basic fact that a reader has to know before learning anything
else. The next sentence broadens that fact, building on to it with more information
and making the pyramid wider and wider until gradually you can move from the
basic facts to their significance. For example, McCullough (2009) examined the use
of transitional objects in the case of a young adolescent named Jay (a pseudonym).
The basic fact upon which her argument rested was that Jay had spontaneously
brought action figures to his art therapy sessions and elaborated on them with the art
materials she offered. This was interesting. But why was McCullough’s observation
important enough to publish in a journal? Jay’s choice of bringing action figures to

art therapy was given significance by the broader fact that he happened to be cop-
ing with an extreme stress of his parents going through a divorce. Fine, but don’t
most 12-year-old boys play with action figures, whether or not their parents are
divorcing? True enough, but McCullough claimed that in this case the boy’s action
figure functioned as a transitional object (Winnicott, 1971). How was McCullough’s
case research different from what is already known about transitional objects in
therapy? More typically seen with very young children, McCullough reasoned that
this 12-year-old boy may have needed something to help him regress to an earlier,
more secure time in his life in order to integrate the new psychological reality of
his parents living apart. The reader can begin to see the whole context, but what
was the purpose? McCullough wrote that Jay’s narrative “makes a strong case for
conducting more research on the therapeutic use of transitional objects and com-
munication through metaphors as coping mechanisms for children of divorce” (p.
24). The triadic relationship that developed between Jay, the therapist, and his art-
works allowed him to express his stories as well as invite the therapist into a world
he had created where he did not have to feel powerless in the face of his parents’
separation.
Connect With Your Reader

McCullough’s (2009) study is a good example of how, through the use of a case narra-
tive that in no way diminishes the accuracy or logic of the author’s argument, the reader
can easily imagine what it was like to be the art therapist in the room with Jay, her cli-
ent. In constructing the logic of the research report, it can be effective to use your own
experience to connect readers to something in the study that may touch their own lives.
A randomized control group study that compared art therapy with activities therapy
treatment (Lyshak-Stelzer et al., 2007), for example, was made compelling by the sig-
nificance of its findings, which may advance the readers’ own art therapy practices or
help them develop new programs.
Art therapists use familiar metaphors, visual imagery, or creative interventions to
help readers understand unfamiliar scientific theories or facts. Pifalo (2009) used the
visual metaphor of “mapping a maze” to explain and support research on recovery from
trauma, specifically among adult women following a disclosure of sexual abuse within
their families. Henley (2007) illuminated the treatment and differentiation of mood
disorder symptoms among children with early-onset bipolar disorder through an art
therapy process he called “naming the enemy.”
Finally, there is no reason not to write like a person instead of a scientist examin-
ing a specimen. Just because you are dealing with a scholarly subject doesn’t mean you
have to present it as dry and depersonalized. As an editor who reads many research
reports and manuscripts, I often have been put to sleep by researchers who write as
if they themselves are another unchanging control or variable in their studies. They
seem to believe that for their research to be credible they must not convey anything that
reflects the warmth of a human being. Ideas and findings should be presented clearly
and directly, but they also should be compelling or interesting. The reader will appreci-
ate a report that is written in good plain English and in a voice that communicates your
passion and involvement in the subject.
PROFESSIONAL WRITING STANDARDS:

MAKE IT PUBLISHABLE
After draft writing to think through and create a coherent argument that connects with
the reader, it is time to polish the writing to make the paper readable. A publishable
paper is written in a professional voice and presents ideas critically rather than casually
or as mere conversation. Word choice should be based on conveying information with
precision and accuracy. A well-focused research report is terse; lengthy, complicated
sentences should be edited so that 20 words are not used to express a 7-word idea. This
makes it easier for readers to grasp the total significance of the article.
There are several excellent texts that writers use to help them polish their writ-
ing and craft good sentences. One much underused source for art therapists is the
Publication Manual of the American Psychological Association (2009). In addition
to the authoritative reference and citation system for complying with “APA style,” the
manual has several excellent chapters on expressing ideas well, improving grammar
and punctuation, and addressing special formatting concerns.
In general, you should use the active rather than the passive voice whenever
possible, and select tense and mood carefully. Gender-neutral language is preferred
except when referring to a specific person. When describing people, it is important
to be sensitive to bias, clichés, judgment, and inaccurate generalizations. Avoid label-
ing people and presenting labels as nouns (e.g., “the homeless”) instead of adjectives
(e.g., “people who are homeless”). The principle of putting “people first” is especially
important when writing about patients with various diagnostic conditions. For exam-
ple, “patients with schizophrenia” is preferred over “schizophrenic patients” because
such a condition is something that one has, not what one is. With respect to nouns that
identify cultural groups, these change over time so you should find out and use the
most currently acceptable terms. A good strategy for reducing bias and judgment, as
recommended by the APA, is to read over a section of your writing while substituting
your own group identifiers for the groups you are describing. If you wouldn’t want
to be described in this way, then further revision is needed. A review of the follow-
ing APA guidelines (2009, pp. 71–77, or see Guidelines for Unbiased Language at
www.apastyle.org) will sensitize your writing about the people in your research report
(Table 10.1).
TABLE 10.1 Using APA style to craft good sentences

APA GUIDELINE EXAMPLES
Make subject and verb Poor: “The data was reviewed to determine if a participant
agree. felt confused about their role.”
Better: “The data were reviewed to determine whether a
participant felt confused about his or her role.”
Use the active, not Note: Use “he or she” and “his or her” sparingly to avoid
passive voice. Clearly tiresome repetition
identify who is doing Poor: “Several interviews were focused on perceptions of the
the action. field.”
Better: “I interviewed three art therapists and asked them to
describe their perceptions of the field.”
Use precise, active verbs Poor: “The therapist’s decision had to do with the
instead of nouns to development of a program and its attraction to adolescent
express key actions. drop-outs.”
Better: “The therapist decided to develop a program that
would attract adolescents who were at risk for dropping
out of school.”
Use parallel structure Poor: “The author described the purpose of the research,
when creating lists of how they collected and analyzed the data, and results
related items. found, making several recommendations for future
research.”
Better: “The author described the purpose of the research,
data collection and analysis, results, and recommendations
for future research.”
Use as few prepositional Poor: “In the study, in which the interviews of the two
phrases as possible. groups of participants were recorded with a video camera, I
analyzed the data through a qualitative method.”
Better: “I videotaped interviews from the two participant
groups and analyzed the qualitative data.”
Do not assign human Poor: “The data looked like the program was enjoying
qualities to inanimate success.”
objects or concepts. Better: “The data indicated that the program was
successful.”
Place descriptions right Poor: “Lying on the table, I saw the child’s coiled clay pot.”
beside the thing they Better: “I saw the child’s coiled clay pot lying on the table.”
describe.
Avoid jargon, clichés, Poor: “The victim’s mom presented with an incredible display
slang, and hyperbole. of anger.”
Better: “The client’s mother seemed to be very angry.”
(Continued)
TABLE 10.1 Using APA style to craft good sentences (Continued)

Replace overused Poor: “Several fairly good studies have some really
adjectives with precise interesting findings.”
descriptors. Better: “Among studies that examined the role of creativity in
regulating mood, Smith (2007) found that depressed
adolescents benefited from short-term art therapy
treatment.”
Use non-sexist, Poor: “In general, a doctor expects his schizophrenic patient
culturally sensitive to take her medication.”
language. Better: “Doctors generally expect people to take their
medications, especially those patients who are diagnosed as
having schizophrenia.”
Use past tense when Poor: “McNiff (1992) says that art is healing. He goes on to
referencing the say that art is beneficial for groups. ”
literature. Better: “McNiff (1992) wrote that art is healing and
beneficial for groups.”
Limit the use of “we” Poor: “We are not interested in creating community in our
to the authors of the society.”
study and their direct Better: “Some participants believed that community is not
experience. valued in U.S. society.”
Trim excess words from Poor: “Ironically, it was never my intention as an art therapist
sentences to achieve a to study this issue formally, nor to be either an advocate for
terse, concise style. or promoter of the use of art assessment tools in a research
design.”
Better: “I have never been an advocate for art-based
assessment in research.”
1. Describe at the appropriate level of specificity (e.g., use a specific age range
instead of a broad category; avoid loaded clinical terms; identify by spe-
cific (“Japanese”) rather than broad region of origin (“Asian”); do not include
information that may be irrelevant to the study such as marital status or level
of education).
2. Be sensitive to labels (e.g., use group references that people prefer to be iden-
tified by; do not categorize people as objects such as “the elderly” or “border-
lines”; avoid emotionally laden terms such as “victim” or “abnormal”).
3. Acknowledge participation (e.g., replace the impersonal word “subjects”
with “participants” or “respondents”; use active voice such as “the students
completed the survey” instead of “the survey was completed”) and use non-
discriminatory language in gender, sexual orientation, racial and ethnic iden-
tity, disabilities, and age.
PEER REVIEW: THE “ECO-SYSTEM” OF

SCHOLARLY COMMUNICATION
Professional journals like Art Therapy: Journal of the American Art Therapy
Association play a key role in generating the field’s scholarly communication—the
system through which research and other writing is created, peer reviewed, dissemi-
nated, and preserved for future scholars (Association of College & Research Libraries
[ACRL], 2003). The art therapy research literature found in scholarly journals is a
“meta-story” of shared and tested knowledge that represents years of creating quality
art therapy programs, recording their impact in large and small ways, posing ques-
tions, observing patterns of meaning, adjusting goals and procedures, and pointing
to something along the way that other art therapists may pick up and follow in their
own research or build on through their practices (Kapitan, 2009). As with the tra-
ditions of hunter-gatherers, knowledge is created collaboratively and incrementally
this way, step by step and over long periods of time. Within a journal’s pages and
between the lines, readers may glimpse how scholarly communication nurtures rela-
tionships among colleagues, mentors, fellow clinicians and their clients, and coop-
erating peers. Each contributor to a scholarly publication expands the reach of art
therapy’s impact.
When you decide to “close the circle” and submit your manuscript to a scholarly
journal, it passes through a system of peer review comprised of people who examine
it from different perspectives. Unlike much theory and practice of art therapy that is
unpublished or is published in trade books, journal articles are peer reviewed in order
to meet a high standard of quality. Research scholarship is part of a collective enter-
prise; the public and the work of other researchers depend upon the accuracy of these
published accounts. Peer review is a recognized benchmark of quality and ensures that
published research studies are appropriately designed and that their findings are valid
and reliable.
As volunteers who serve on a journal editorial board, peer reviewers are a crucial
support in the dissemination of research and make an important contribution to the pro-
fession. Although the editors often invite reviewers to serve in this role, some journals
actively seek reviewers via links on their Web sites or through recommendations made
by authors, peers, and colleagues. Most journals have regular reviewers as well as those
who serve “ad hoc” or as needed on the basis of having particular expertise. Thus, one
avenue that researchers, junior faculty, and practitioners who are interested in publish-
ing should consider is volunteering to be a peer reviewer. Serving on a review board
puts you in touch with the most timely research “conversations” with the field, exposes
you to current writing and thinking in the field, and provides an opportunity to mentor
or help authors improve and publish their work. It is evident that peer review strength-
ens the profession from both sides.
But quality means different things to the different players in the collective “eco-
system” of a scholarly journal. Authors and researchers want to be published in a quality
journal that has impact and connects their work to audiences as broadly and as quickly
as possible. Reviewers are experts who volunteer their time reviewing submissions and
providing valuable feedback to authors. They look for studies or well-written papers
that will help build the knowledge base of the profession. Editors are responsible for
selecting and producing good content for the publication; your paper will attract the
interest of the editor if it is original and has potential for making an impact on how
art therapists see and understand the nature of their work. Publishers are interested in
attracting the best editors and reviewers for your paper, and with promoting a publica-
tion that satisfies the needs of the readers. Readers look for quality in terms of articles
that will affect their professional lives and advance their work (either their own research
or the practical application of what they read) (Morris, 2008). Their time is precious, so
they will read and appreciate your paper if it contains current, interesting, and relevant
material.
A crucial link in the peer-reviewed journal’s eco-system are the libraries that pro-
vide access to your paper through their subscriptions and research databases. Journals
with impact are electronically accessible to hundreds of thousands of readers all over
the world. Libraries have limited budgets and therefore are highly selective in their
subscription decisions; your paper will expand the reach of art therapy if it appears in a
quality publication with highly relevant content. Value for libraries means usage: your
paper must be “findable” in various databases so that library patrons can quickly locate
and use its content. With electronic database and full-text availability for most journals,
students and other researchers are now able to dramatically increase their awareness
of peer-reviewed literature by searching for your article in libraries the world over and
using it to advance their knowledge.
OVERVIEW OF SUBMISSION AND

REVIEW: STEPS IN THE PROCESS
1. Choose the Publication: If you have a paper you want to publish, one of your first
decisions is to consider whether it is appropriate for Art Therapy or some other schol-
arly journal. Usually a journal will only accept original submissions that are not under
consideration by another periodical or publisher. Look for the publication’s editorial
mission located on its Website or in the inside cover of a journal issue near the “mast-
head” where the publisher, editors, and reviewers are named and listed (Table 10.2).
The editorial mission and its guidelines for submission will give you an idea of the
manuscripts they publish. This is important because even though you may have a great
paper, it is not publishable in every journal; it has to fit within the scope and interests
of the readers. To get a sense of the journal’s reach and quality, it is worthwhile to see
who is listed on the masthead and to read articles from some of the issues. Most journal
Web sites also have detailed information to guide authors in creating a manuscript and
readying it for review.
TABLE 10.2 Example of a scholarly journal’s publishing mission and scope: Art Therapy:
Journal of the American Art Therapy Association
t What does Art Therapy t Quantitative research reports (e.g., experimental,
publish? quasi-experimental, single case research, non-
experimental descriptive such as survey and
correlational research; treatment outcomes studies;
meta-analyses)
t Qualitative and mixed research reports (e.g.,
evaluation research, case studies, phenomenology,
ethnographic, participatory and other action
research, hermeneutic, art-based research)
t Theoretical, analytical, interpretive, and practice-
based papers that integrate research with practice or
professional problems and issues of interest to the
field
t Viewpoints and commentaries that present original or
insightful perspectives on the theory, practice,
experience, and informed opinion on issues with
implications for the field
t Book and video reviews
t Content for special issues, call for papers
t What doesn’t Art Therapy t Articles that are more appropriate for a newsletter:
publish? timely events taking place in an employment setting,
professional chapter, or sponsoring agency; review of
programs and the contributions of people to them;
informally written reflections or factual reports;
board and committee activities of a professional
association or its sponsored events and policy
developments
t Articles that are primarily journaling, poetry,
personal art reflections, or creative fiction writing.
These may be excellent but the journal is essentially
an academic research publication
t Book chapters; previously published articles; limited
historical reviews; travelogues; interviews with
prominent authors
t Studies with major design flaws; sub-standard or
ethically challenged research; prominent biases;
articles with culturally insensitive, libelous, and
inflammatory language
t What criteria does Art t Appropriate for the journal (meets the editorial
Therapy use to evaluate a mission and contributes to scholarly communication)
manuscript? t Follows APA style and format requirements
t Good writing quality
t Quality content
t Significant to the field of art therapy
(Continued)
TABLE 10.2 Example of a scholarly journal’s publishing mission and scope: Art Therapy:
Journal of the American Art Therapy Association (Continued)
t What are the most t Poorly organized; poor or insensitive writing
common reasons for not t Not grounded in review of current and significant
accepting a manuscript? research (references are missing, inaccurate,
inappropriate, or dated)
t Not APA (in both reference citations and professional
writing style requirements)
t Not clearly significant to field (e.g., art therapy is
only tangential to the report, material is too basic for
a professional audience, findings are limited to trivial
or self-referential concerns, etc.)
t Not original (re-interpretation of previous research or
the works of others without adding to their
significance)
t Research design flaws, such as omission of effect
sizes in quantitative studies, failure to build in
controls (or triangulation in qualitative research), or
claiming greater significance than is evident from the
data analysis
2. Do a “Mini” Review: Before submitting your paper, it is a very good idea to ask one
or more trusted colleagues to read your manuscript to spot obvious errors in data, to make
sure that your thesis is clear and supported by your findings, and to ensure that it is written
for a professional audience. This step functions like a “mini” peer review and gives you the
benefit of an actual reader’s perspective. As a reader, your colleague will be able to show
you where the writing that you clearly understand doesn’t come across as clearly to someone
else. Because you are close to your paper, it can be easy to miss the obvious or implicit logic
that a reader needs to be able to follow. Use your colleague’s feedback to refine the paper.
If you have problems with writing, another good strategy is to ask someone with excellent
command of the English language to copyedit your manuscript before submission.
3. Eliminate Any Formatting Errors: Next, review the journal’s author guidelines
for submission and review. Check very closely to make sure that your manuscript is
complete and in order. Remove information in the headings or body of the manuscript
that could identify you or any of the authors. Common problems that will cause a
journal editor to send your paper back to you without review are (a) failure to conform
to APA format and style in reference citations and manuscript preparation, (b) exces-
sive length, (c) excessive number of figures or tables, (d) missing or incorrectly written
abstract, (e) the author’s name or place of work appears in the body of the text, and/
or (f) the manuscript does not conform to the journal’s submission categories. A well-
formatted manuscript conveys professionalism and is much more likely to be sent on to
the reviewers if there are no irritating typographical, spelling, or obvious grammatical
errors. It is also worth spending some time reviewing the APA publication manual or
Website (www.apastyle.com) for correct reference citations because most people have
only a general grasp of the style guidelines and these frequently change.
BEFORE YOU SUBMIT YOUR PAPER: SOME TIPS

r Read articles in the journal you are considering and assess whether
your paper aligns with its editorial mission, goals, and contributions
to the literature. Does your paper clearly fit into one of the journal’s
submission categories?
r Ask a trusted colleague to read your paper and give you critical feed-
back. Use the feedback to refine the paper and make corrections.
r Check for errors in the study or the manuscript itself.
r Is your thesis statement clear and supported by your findings? Is the
paper written for an international professional audience?
r Review the APA manual and the journal’s author guidelines for correct
manuscript format, writing, and style requirements. Does your paper
conform to APA style in text citations and reference list? Does it con-
form to any restrictions on the number of figures and charts, or word
limit?
r To make sure it conforms to the blind review process, check that the
author’s name and institution of affiliation are not found in the body of
the text.
r Organize any necessary documentation, such as consent forms, copy-
right permissions, or data from the study.
4. Submit the Manuscript: If you are submitting your paper to Art Therapy: Journal
of the American Art Therapy Association, go to its Website (www.arttherapyjournal.org)
to find information on the submission and review process. Locate and click on the link
to the electronic submission system. You will be guided through a series of easy, point-
and-click steps that require you to provide detailed author information, select the sub-
mission category and keywords, and upload the manuscript, tables, and figures. When
your submission is entered successfully, you will get an automatic email acknowledging
its receipt. It will be checked by a technical assistant to make certain that it meets pub-
lication specifications and then sent to the editor for a preliminary review.
5. The Peer Review: The review process takes time as most editors and reviewers
are working professionals who volunteer for a journal while juggling many other duties.
It usually takes two or more months for your manuscript to be reviewed. That is because
many steps are involved, and the most popular journals have a volume of submissions
that compete for reviewer attention. The amount of time depends upon the number of
submissions waiting for review, the availability of certain reviewers with expertise to
match your paper’s subject, and the time taken up in communications between editors and
reviewers. An editor will read your paper and select reviewers who have the expertise to
provide evaluative feedback and a recommendation for its publication. To ensure impar-
tiality, these reviewers usually are “double-blinded,” meaning that they do not know the
name of the author or the other reviewer. The editor also checks that no reviewer lives in
the same geographic area nor is affiliated with the same institution as the author.
The reviewers will read and evaluate your paper according to such criteria as appro-
priateness for the journal, quality of content, originality, and significance to the field of
art therapy. They will assess its overall strengths and weaknesses, and may make writ-
ten suggestions for improvement. Finally, an editorial decision will be made based on
reviewer recommendations. You will receive a letter communicating that (a) the journal
will publish the paper, (b) revisions are necessary before considering it for publication,
or (c) the paper cannot be published for various reasons.
6. Working With the Publication Decision: If you receive a rejection letter, take
heart from the fact that rejection rates are high for most journals, especially for a first
submission. Your article or research study may not be a good match for the journal’s
reading audiences. Often, the research is sound but the report needs to be better orga-
nized or more solidly developed, or should be written more clearly. Or, you may be
informed that even though the paper cannot be accepted as is, the reviewers agree to
review it again if you revise it. Although not a guarantee of future acceptance, the rec-
ommendation to revise usually comes from the reviewers’ desire to support the manu-
script’s potential for publication. Follow their suggestions closely, keeping in mind that
their opinions are informed by publication experience. Revise and resubmit the manu-
script, following the same steps, and include a cover letter stating how you addressed
the reviewers’ evaluative feedback.
7. An Accepted Manuscript: If your paper is accepted for publication, you may be
asked to make some minor revisions and to submit the paper one last time along with
publication-ready figures and artwork. If not requested earlier, the copyright for the
article is signed over to the publisher with a form that accompanies your final version of
the manuscript. Accepted manuscripts await publication while the editors make selec-
tions for each (usually quarterly) issue of the publication. In the case of Art Therapy,
the content will be balanced among full-length articles, brief reports and viewpoints,
research, and timely issues affecting the field. You will be informed as soon as the edi-
tor or publisher knows when your paper will be published. Prior to production, the edi-
tor and copyeditors will do fact-checking and editing of your paper, and they may ask
you to review corrections and respond to queries. Finally, you will be asked to approve
a “galley proof” that shows how your article will appear in print. No changes to the text
by the author are allowed at this stage. Because these are the last steps before printing,
delays in returning the manuscript or proof file may result in delayed publication.
Stumbling Blocks
The point in the submission and review process that can be the most daunting is when
the editor returns your paper and you learn that revisions are needed for it to be publish-
able. Because you put so much energy into writing a sound manuscript, it may be hard
to take when others find your paper lacking. Constructive critique sometimes doesn’t
feel very constructive; it is important not to take the feedback personally or to think that
the editors and reviewers were too biased to accept your paper on its own strengths. In
my experience, the old journalism adage, “The reader is always right,” offers a kernel of
insight here: reviewer feedback tells you precisely where your message, however sound,
simply did not connect with a reader. For example, if the reviewer says, “This isn’t
clear,” the problem is with stating your point more clearly, not with whether the reviewer
is sensitive enough to understand it. If the argument isn’t credible or didn’t work for a
reviewer, it likely won’t be understood or accepted by many of the journal’s reading
audiences. Improve the message or the means, and you will improve the likelihood that
a reader will receive and respond positively to it.
A good strategy for dealing with this situation is to let the feedback “cool” for a few
days and then go back and read it again. What at first may appear to be major revisions
often are fairly simple to revise after you have gone through reviewer recommenda-
tions point by point. Or the feedback may suggest that it is worth the effort to go a little
farther in strengthening your paper to make it all the more valuable to the field. In any
event, set a firm deadline for completing the revision and re-submitting the revised
paper. Experienced authors will tell you that it is important to get past this stumbling
block quickly because otherwise the “rejected” paper can languish unattended and your
passion for the study will die. Revise the paper carefully, accepting those recommenda-
tions that clearly support your goals and intentions of the paper, and resubmit the paper
with a letter that briefly explains how you handled each point in the revision.
If you have taken the important step of writing up your research so that others
may learn or be guided from it, you have made a choice that many other art therapists
unfortunately have not made. I hope you celebrate everything that has led you to this
point and do not give up. Your research is part of the “meta-story” of a community of art
therapists who are working, creating, imagining, thinking, and collaborating with one
another to put out into the world the importance of an idea that art is healing.
CHAPTER SUMMARY
1. Writing for publication is an important means for sharing the results of art
therapy research and knowledge in order to multiply its benefits.
2. A researcher is ethically obligated to the study participants to use and
disseminate the findings for the best possible purposes. Taking this step
also allows for the transmission of knowledge to future generations of art
therapists.
3. A basic article consists of eight parts: (a) title and author(s), (b) abstract, (c)
an introduction that includes a review of relevant literature, (d) methods, (e)
results, (f) discussion, (g) references, and (h) tables and figures. This format
aids the process of review, editing, and publication.
4. Authorship comes with certain responsibilities and is reserved for those who
designed, organized, and either wrote or edited material submitted by others.
5. Research reports follow a straightforward form designed to present fac-
tual information, but this does not mean the writing has to be dry or
uninteresting.
6. Draft writing is a process of thinking through the research and putting it in

logical order followed by explaining things clearly enough for a reader to be
able to understand it.
7. Clear communication is the prime directive of scientific writing. A good
research report is built upon plausible claims that are substantiated by the
evidence and qualified as necessary.
8. A publishable paper is written in a professional voice; it is precise, accurate, and
concisely written so that readers can easily grasp the total significance of the
article.
9. Peer review is a recognized benchmark of quality and ensures that published
research studies are appropriately designed and their findings are valid and
reliable.
10. An editor assigns reviewers to read and evaluate a manuscript for publication.
Manuscripts that do not pass the peer review do not fit the submission catego-
ries of the publication or need substantial revision. An author may be asked to
revise and resubmit the manuscript, or it may be accepted for publication.
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Glossary of Research
Terminology
A
Abstract is a brief, concise summary of a research report placed at the beginning of a
journal article and used in keyword searches.
Action-research is an applied research method for finding solutions to problems,
issues, or qualities of the practitioner’s own practice for the purpose of effect-
ing change.
Art-based inquiry is a method for illuminating or constructing knowledge from
the practices and perspectives of an artist. Direct engagement in art practice
becomes the “site” for research problems and methods.
Assessments, art-based are standardized procedures used in research to collect and
describe artwork from different populations or treatment outcomes, and the
formal and informal procedures used by art therapists to develop treatment
plans or to dynamically assess a client’s personally meaningful use of art.
Authorship in a research report is determined on the basis of who has made a substan-
tive contribution to the research, either in conducting the study or by writing
the report itself.
B
Baseline is the pre-experimental condition that is used as a basis of comparison.
Between-subjects design is an experiment where two groups are randomized or
matched and each is subjected to a different level of independent variable.
Bracketing is a method in phenomenological research of systematic detachment from
the phenomenon of study. The researcher “brackets off” or clears the phenom-
enon from ordinary thoughts and places them aside. The practice of bracketing
allows the researcher to contemplate the essential qualities of the phenomenon
without the influence of prior knowledge and assumptions.
269
270 Glossary of Research Terminology
C
Case research is a type of qualitative research that seeks to comprehend a person or
persons, places, or events in order to shed light on a particular condition, char-
acteristic, or circumstance that is of interest to the researcher.
Central tendency is a statistical technique used to find the midpoint around which a
mass of data is distributed by means of such measures as the mode, median,
and mean.
Clinical research team is an interdisciplinary group of professionals who pool their
expertise and skills in order to carry out a research study with greater success
than would be possible as individuals. Research in a field setting is made man-
ageable when each member of the team is responsible for only those aspects
that fall within his or her unique expertise.
Closed contract describes a research design that is not open to change. The proposed
study is designed to test a known hypothesis by following a specific protocol
in order to minimize any confounding or unforeseen variables.
Confidentiality is a research ethic in which the researcher does not disclose to third
parties information from study participants without permission.
Control is a means for creating comparisons by holding all other variables constant
and within assigned parameters.
Controlled trial is an experimental design in which the effects of treatment on a group
with a particular condition are compared with another group that does not have
the condition.
Correlational research studies the linear relationship in both the degree and direc-
tion between two or more variables without necessarily determining cause and
effect.
Critical paradigm in research is primarily concerned with transforming social con-
sciousness of reality in order to maximize human potential.
D
Data are the facts or empirical observations of what is taken to be true.
Data analysis is a method by which the information collected is interpreted and their
meaning is extracted.
Data collection is a method by which relevant information is sought to illuminate,
resolve, or test the central problems, hypotheses, or premises of the research
study.
Deduction is a process of reasoning from the general to the particular; the researcher
uses a general theory to predict data and test hypotheses.
Delimitation is a description of the limits within which the study is conducted, that is,
what the research problem is not concerned with.
Dialectic critique is a process of data analysis in action research that examines change
as a product of the interaction of interdependent and contradictory elements
in a system.
E
Effect size determines the effect of the independent variable by calculating the degree
to which a null hypothesis is wrong.
Effectiveness means the degree to which an intervention or treatment is likely to pro-
duce beneficial results when used in a normal situation with real clients.
Efficacy means the degree to which an intervention or treatment can produce better
results than would be found in a control situation without the treatment.
Emic is a cultural perspective that is based on an insider’s account of an experience.
Empirical describes research that is based on direct observation or experiment.
Empiricist paradigm of research is primarily concerned with knowledge obtained
from the prediction and control of social and natural realities.
Epoche is a phenomenological method of systematically examining personal biases,
assumptions, and preconceptions, in order to eliminate as much as possible the
researcher’s personal involvement in the subject matter of the study.
Ethics is a set of norms in the design and conduct of research that is based on respect
for the integrity and wellbeing of the participants and the avoidance of harm.
Ethnographic interview is the primary methodological tool of ethnographic research;
it is a semi-structured, open-ended interview comprised of questions relating
to a person’s culture.
Ethnographic research is an in-depth, naturalistic study of a cultural group.
Etic is a perspective that is based on an outsider’s examination of a cultural
experience.
Evaluation, formative examines the effectiveness of a specific program in order to
make improvements and changes, or to provide a basis on which to make stra-
tegic future plans.
Evaluation, summative examines a program’s effectiveness by comparing its outcomes
to other programs and standards derived from large samples. Summative evalua-
tion is a method often used for standardizing treatment in multi-site evaluations.
Evidence-based practice is an approach that is grounded on the rankings of certain
kinds of research that verify treatment effectiveness and inform clinical guide-
lines and standards of care.
Experiment is a systematic study in a controlled or “closed” environment where all
known variables can be controlled or manipulated in order to study their
effects.
G
Generalization is a research principle concerned with whether the findings obtained
from the study can be applied to similar populations, settings, or treatments,
despite variations.
H
Hermeneutics is the theory and practice of interpretation. It is dialogic, between a
researcher and a text or object, moving back and forth between the context in
which the text or object was made and the contexts of its interpretation.
Heuristic inquiry focuses on the process of personal discovery that leads to new mean-
ings and insights, and includes both the researcher’s self-reflective exploration
and the coresearchers’ explorations of their own personal experiences through
introspection.
Horizontalization is a phenomenological method of data analysis in which data that
have been bracketed and reduced to their essential qualities are spread out for
examination by giving equal value to all statements and perspectives.
Human subject means a living person about whom a researcher is interested in obtain-
ing information either through interaction or intervention, or identifiable pri-
vate information.
Hypothesis is a construct of reasoning about a problem by formulating logical supposi-
tions about it.
I
Imaginal variation is a principle of phenomenological data reduction in which the
researcher considers the effect of removing or changing a key dimension in
the description of the phenomenon. If the meaning “collapses” as a result of
changing a key dimension, then the dimension is considered essential for the
meaning of the phenomenon to appear whole.
Induction is a process of reasoning from particular data or specific cases to the gen-
eral in an effort to build theory based on observations as the investigation
proceeds.
In-dwelling is a heuristic method in which the research participants turn inward with
a sustained focus on some facet of experience in order to discover an in-depth
understanding of it.
Informed consent is a research participant’s voluntary agreement to participate. The

process of informed consent requires the researcher to openly disclose and
explain all aspects of a study to its participants so that they may freely decide
to participate.
Inquiry is an act of looking into or investigating a matter of concern or question.
Institutional Review Board is a specially constituted group that provides oversight
of the research sponsored by its institution in an effort to protect human
participants.
Instrumental case study examines a research question from the perspective of a par-
ticular case in-depth.
Inter-observer reliability is the degree to which two different people are able to accu-
rately categorize the same observations or data.
Interpretivist paradigm of research is primarily concerned with the qualitative inter-
pretation and understanding of human experience.
Interrupted time series experiment is a research design that collects data from mul-
tiple observations before and after a naturally occurring event or treatment
experienced by a single experimental group of participants.
Intrinsic case study is used to examine a researcher’s intrinsic interest in a particular
case rather than to use it to illuminate a general problem.
L
Longitudinal study (also called a developmental study) is a research design that
extends over a long period of time, often for the purpose of identifying or
predicting trends.
M
Matched group design is an experimental study comprised of randomly selected
groups that are paired to share as many characteristics as possible.
Maturation is the process of change over time due to growth, attrition, or some other
factor not related to the experimental condition.
Mean is a measure of central tendency and is obtained by dividing the sum total of
scores by the number of scores.
Measurement is a set of procedures used to make comparative judgments in research
by assigning numbers to objects or their attributes.
Median is a measure of central tendency that describes the midpoint in a distribution
or array of figures.
Member checking is a strategy that asks the research participants to examine for accu-
racy drafts of the case report where their involvement is featured.
Methodology is a characteristic lens through which a researcher views the purposes
and problems of a research study, a mode of thinking that guides the entire
enterprise from how data will be controlled and acquired to how the results
will be obtained and interpreted.
Minimal risk to a research participant means that the probability of harm or discom-
fort from participating in a study is no greater than would be ordinarily expe-
rienced in daily life or during routine psychological tests.
Mixed design allows for both quantitative and qualitative data, or a mix of closed and
open strategies and questions, depending upon the pragmatic concerns of the
research problem.
Mode is a measure of central tendency that is the most frequent score.
Multiplier effect is a principle by which a research study may achieve exponential
impact when disseminated through a network of interconnecting interests.
N
Narrative analysis is a research method that honors people’s stories as documented
data that can reveal social, psychological, culturally meaningful patterns.
Natural experiments examine the effects of naturally occurring events (such as a disaster
or routine treatments) or particular variables that are present in them.
Naturalistic observation is a discovery-oriented approach to data collection that min-
imizes researcher intervention.
Non-experimental descriptive research is a design that collects and measures data
on an existing problem or situation, and includes correlational studies and sur-
vey research.
Null hypothesis is a construct that experiments seek to disprove, which is that there
is no difference or relationship between groups on a variable; the independent
variable will have no effect on the dependent variable.
O
Open contract describes a research design that is allowed to change as the study
unfolds and certain data emerges that has bearing on the subject or direction
of the study.
Operationalize is a part of the research design process in which the researcher
defines the parameters of the study through the operations that will be carried
out.
Outcomes research examines the effects, characteristics, and benefits of treatment in

a given situation.
P
Participant-observation is a naturalistic field strategy characterized by the extent to
which an observer also participates in the setting being studied.
Participatory action research (PAR) is collectively organized by communities who
are interested in examining their experiences, defining problems, and creating
their own knowledge and solutions with the goal of social change. Ideally, PAR
is change oriented, inclusive, and egalitarian in its methodology.
Participatory case research is a form of collaborative inquiry between a researcher
and a case participant or informant who provides insight into an important
issue or circumstance.
Peer review is a benchmark standard for publishing research based on a review by
experts in the field to ensure that the study is appropriately designed and its
reported findings are valid and reliable.
Phenomenological inquiry seeks insight about the essence of an experience, views,
or perspectives of participants while minimizing a priori assumptions about
them.
Phenomenological reduction is a procedure of data analysis in phenomenologi-
cal research where the essential structures of the data are uncovered and
described.
Phenomenon is an entity, construct, or an experience of a significant event, relation-
ship, perspective, emotion, or issue.
Positivism is a theoretical perspective grounded on the principle that there is an objec-
tive reality and that only direct or observable experience is valid when making
knowledge claims.
Post-positivism is a theoretical perspective that takes into account the limits of scien-
tific judgment and causality in explaining human behavior.
Posttest-only control group design is an experiment in which the experimental group
is subjected to a treatment and compared against a control group that is tested
without the experimental treatment.
Pretest posttest control group design is an experiment involving two groups that are
formed either by matching or through randomized procedures.
Principal investigator is the person designated as having the primary responsibility
for the design and conduct of a research study.
Program evaluation is a form of outcomes research that looks at the effectiveness of an
overall program or its particular units, activities, programs, events, or setting.
Protocol is a fixed set of procedures that are followed precisely so that multiple research-
ers can obtain similar results from a study. The research proposal submitted to an
Institutional Review Board is also sometimes referred to as a protocol.
Q
Qualitative is a research paradigm that is characterized by exploratory or interpretive
analysis of observed themes and reflections, and inductive reasoning to arrive
at in-depth understanding.
Quantitative is a research paradigm characterized by measuring and controlling for
variable, cause-and-effect relationships, and deductive reasoning to arrive at
predictive explanations.
Quasi-experiment is a controlled experiment in which some or all of the variables are
“selected” or naturally occurring instead of randomly assigned, which means
that they are not under the control of the researcher.
R
Random sampling is a process to ensure that the sample taken from a population is unbi-
ased; each person has an equal chance of being selected for the sample.
Randomization is the process of assigning subjects to conditions so that the characteris-
tics of the sample approximate the characteristics of the total population.
Range in statistics is the spread of data or difference between the highest and lowest
scores.
Reflexive critique is a process of data analysis in action research that formulates new
hypotheses as the result of examining actions taken to solve a problem.
Reflexivity is a process of inquiry that involves an on-going examination of self-aware-
ness; political, social, and cultural consciousness; and ownership of perspec-
tive on the part of the researcher as well as the participants.
Reliability is the principle of consistency in research instruments. A reliable instru-
ment measures what it is supposed to measure and obtains similar results con-
sistently and over time.
Replication is the process of repeating a study in order to test whether comparable
results would occur under the same conditions and procedures.
Research is generally defined as scholarly or scientific investigation or inquiry. The
U.S. federal law defines research as a systematic investigation, including
research development, testing, and evaluation, that is designed to develop or
contribute to generalizable knowledge.
Reversal (ABA) design is a small-n (small number of subjects) design in which a
baseline condition of the subjects is measured and an experimental treat-
ment or intervention is then delivered, followed by a control period or return
to the baseline condition when the intervention does not occur.
Rigor is concerned with precision and accuracy in research, with attention to integrity
and correctness in all procedures.
Risk assessment is a procedure for evaluating the probable degree to which a research
study may expose participants to the potential for harm.
S
Sample is a representative selection of the target population so that results may be
generalized to the whole population or yields knowledge about a population of
concern. In statistics, sample means a subset of a population.
Significance refers to the degree to which an experimental finding may be due to
chance.
Single-subject research involves pre- and posttest measures with the same group
serving as both the experimental group (treatment period) and control group
(non-treatment period).
Solomon four-group design is an extension of the control group design that controls
for the effects of pretesting.
Standard deviation is a statistically descriptive measure of how scores relate to the
mean, whether clustered around the mean or distributed across the range.
Standpoint theories critique the taken-for-granted assumptions of participant-observation
research with respect to power, agency, and voice of the participants.
Statistics, descriptive are procedures used to organize, summarize, and illuminate the
“contour” of the data and the relationship between groups of data.
Statistics, inferential are procedures used to make certain inferences of reliability and
generality about the data when compared to a model or standard.
Statistics, nonparametric are procedures used to interpret data that are not distrib-
uted along a normal curve.
Survey research is a method that gathers specific information on a large popula-
tion in order to describe trends or to address a set of hypotheses about that
population.
T
Tacit knowing is a principle of heuristic research that acknowledges a person’s knowl-
edge and understanding obtained through an inner search for meaning.
Theory is the organization of ideas and concepts that permit prediction, description,
and/or interpretation of data.
Treatment is a set of procedures used to direct a change for the purpose of improving
an individual’s health or wellbeing.
Triangulation is a qualitative process of data collection or analyses using multiple meth-
ods, sources, perspectives, or theories to improve the validity of the findings.
U
Unit of analysis is a sampling limit that highlights a particular characteristic or set
of characteristics that have important implications for the study’s purpose
and problems. A unit of analysis may be an individual, group, program, or
community; specific cases, activities, time periods, setting, etc.
V
Validity, construct is the degree to which a construct, meaning an abstract concept or
idea, can be measured.
Validity, contextual describes how a particular piece of data fits with the whole con-
text of the research problem.
Validity, external is a determination of the degree to which the research is representa-
tive of real life and can be generalized from the sample to other cases.
Validity, internal is the degree of freedom from bias in determining results or causal-
ity, for example, whether the independent variable or treatment made a differ-
ence in the situation under study.
Validity, intersubjective is a construct in qualitative research where the findings are
tested and refined through informant feedback.
Validity, of perspective is a construct in qualitative research where validity is enhanced
by the relevance of the participants’ viewpoints.
Variable, confounding is a secondary variable that interacts with the independent
variable under study to the extent that it cannot be claimed with certainty that
the independent variable produced the desired effect.
Variable, control is the independent variable held constant in an experiment.
Variable, dependent is the effect that may be observed as a result of an intervention,
manipulation, or change of a condition.
Variable, independent is usually the intervention or manipulation performed in order
to see its effect on a known situation while all else is held constant.
W
Within-subjects design is an experimental design where all participants receive all
levels of the independent variable, that is, the performance of each participant
is compared across different conditions.
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Index
A decontextualization, 166
definition of, 162
AATA, see American Art Therapy Association domestic abuse, survivors of, 168
ABA design, 58 emotional attention, 164
Abuse examples, 163, 168
child, mandate to report, 24 future role of artist-researcher, 177–179
domestic, 168 hermeneutic circle, 175
sexual, 79, 256 holistic communication, 165
substance, 198 iconoclasm, 178
Action research, 97–103 Image and Identity Research Collective
action research cycle, 98–99 Website, 169
action research plan, 99–101 imagistic exchange, 169
example, 102 intellectual attention, 164
value of action research to art therapy, 101–103 interpretivist paradigm, 176
AERA, see American Educational Research key features, 164–166
Association knowledge construction, 166
Aesthetic knowledge, 163 lived experience, 166
Alert vision, 32 new ways of seeing something, 165
American Art Therapy Association (AATA), outcomes, 179–180
9, 90, 243 performance ethnography, 174
American Educational Research Association practices of understanding, 170
(AERA), 213, 214 psychoaesthetic dialogue, 170
American Psychological Association (APA), purposes, 162
193, 247 reflexive action, 170
citation information, 14 reflexivity, 164
publication manual, 247, 263 relationship to other research
style, 257, 258 paradigms, 175–177
APA, see American Psychological Association researchable question, 161
Art-based inquiry, 161–182 research methods, 166–167
abuse, domestic, 168 responsive artmaking, 172, 180
advocacy and activism, 165 sensory attention, 164
aesthetic knowledge, 163 shadow researcher, 177
“all at once-ness,” 164 sociocultural cognition, 177
artifacts, 177 strategies of art-based analysis, 171–172
artmaking as data analysis, 170–172 structured inquiry, 179
artmaking as data gathering, 167–169 summary, 180–181
artmaking as presentation of findings, 172–175 therapeutic artistry, 166
art exhibition, 173 transformation, 170
new and emerging public forums, 174–175 video bodies, 175
performance art, 173–174 visual knowing, 176
arts-informed research, 166 Artifacts, 17, 86, 116, 117
canonical event, 165 Art information, 29–48
canonical generalization, 165 aesthetic-relational tools, 31
child attachment patterns, 168 alert vision, 32
conceptualization, 170 art assessment, 38–42
construction, 170 art-based assessments, 41–42
contextualization, 170 art evaluation procedures, 39–40
creative art-based treatment plan, 168 on-going informal assessment, 39
critical vision, 167 projective drawing tests, 40–41
291
292 Index
artmaking clinical, 99, 113, 156, 227

healing with, 43, 46 discriminating, 167
political ramifications, 36 domestic violence programs, 13
art therapy lens, 30–32, 45 formal, 40
client as expert, 43 ideation and, 38
client identity, protection of, 34 instruments, 67
continuum of research, 36 needs, 89
critical paradigm, 45 on-going, informal, 39
definition of art therapy, 30 projective art, 135
Diagnostic Drawing Series, 41 projective systems, 35
domains of inquiry, 44 repeated, 79
empiricist paradigm, 44 risk, 24
Ethical Principles for Art Therapists, 34 self-created, 63
ethics of using art as data, 33–34 standardized approaches, 38
collecting client art, 33–34 AT, see Art therapy
exhibiting client art, 34 ATPRN, see Art Therapy Practice Research
interpreting client art, 33 Network
extending research into process, outcomes,
and perspectives, 42–43 B
Formal Elements Art Therapy Scale, 40, 41
ideation, 38 Belmont Report, 196
inclusive framework for art therapy research, Bias
44–45 consensus collusion, 18
interpretive space, 36, 43 cultural, 41
interpretivist paradigm, 45 instruments controlling for, 21
mapping of art therapy knowledge claims, 37 interpreter, 152
meaning of individual symbols, 40 personal, 16, 106
micro-cultures, 36 researcher, 16, 68
research methodologies, 35–38 sensitivity to, 10
self-scrutiny, 29 strategies to reduce, 111
sensory-based learning, 36 survey, 69
Silver Drawing Test of Cognition and Bipolar disorder
Emotion, 41 early-onset, 113, 227, 256
socio-cultural representation, 35 pediatric form of, 113, 227
summary, 45–46 Black liberation theory, 121
trends, 35 Bracketing, 140, 157
visual thinking, 36
Weschler Adult Intelligence Performance C
Scale, 42
worldview, 30 Canonical event, 165
Artmaking Case research, 103–113
conferences using, 128 conducting of case study, 104–110
disparate groups, 232 participatory, 104
healing with, 43, 46 units of analysis, 103
migraine pain and, 226 validity and strategies for improving, 110–113
political ramifications, 36 Cause–effect relationship, 58
relationship between pain and, 225 CBT, see Cognitive behavioral therapy
responsive, 172 Central tendency, 65
social action art therapy, 123 Children
Art therapy (AT), 217 at-risk, 126
Art Therapy Practice Research Network attachment patterns, 168
(ATPRN), 238 autistic, 59, 164
Assessment(s) battered mothers, 81
art-based, 41, 42 bipolar disorder, 113, 227
art as measure, 8 of divorce, 256
cause–effect relationship, 58 hearing-impaired, 61
Index 293
insecure attachment in, 135 thinking aloud, 149

normative data, 8, 42 transsexual identity, 154
sensory integration difficulty, 221 tyranny of verbatim transcripts, 155
sexually abused, 83, 90, 217 visual journals, 147
survivors of war, 128 Consensus collusion, 18
Trauma Symptom Checklist for Children, 217 Coopersmith Self-Esteem Inventory, 223
Client art, display of, 34 Critical paradigm, 45
Client identity, protection of, 34 Critical theory, 121
Cognitive behavioral therapy (CBT), 217 Critical vision, 167
Conscious experience, 135–160
anorexic perspective, 136 D
baseline assessments, 138
bracketing, 140, 157 Data checks, 157
creative cycle of inquiry, 149 Data source triangulation, 111
data checks, 157 DDS, see Diagnostic Drawing Series
epoche, 139 Deductive reasoning, 15
expression of meanings, 148 Descriptive statistics, 65, 70, 209
hermeneutic circle, 151–152 Diagnostic Drawing Series (DDS), 41
hermeneutic inquiry, 158 Dialectic critique, 100, 101
hermeneutics, 150–152 Direct identifiers, 198
heuristic inquiry, 144–149
body shift, 146 E
core concepts and processes, 145–147
creative synthesis, 147 Emerging paradigm, see Art-based inquiry
indwelling, 146 Emic perspective, 213
validity and critique, 148–149 Empathy, 190, 236
identity, 136 Empiricist paradigm, 44
imaginal variation, 141, 142 Epoche, 139
informant feedback, 143 Ethical safeguards, see Research proposal and other
informed consent, 156 ethical safeguards
in-process assessments, 138 Ethics
insecure attachment, 135 framework, 195
intersubjective validity, 143 impact of on research, 24
journey of acceptance, 145 importance of, 194
lived experience, 136, 138 informed consent, 156
member checks, 156 integration of into research, 186
metapsychology claims of psychoanalysis, 154 Online Ethics, 196
method, 151–152 questions, 114
narrative analysis and therapeutic interview study design, 6
research, 153–156 Ethnography, 113–120
objectivity, kinds of, 156 basic questions, 114
peer checks, 156 cultural understanding, 113
phenomenological approaches to research, definition of, 113
136–144 field issues, 115
methods and core processes, 139–142 interview, 116
validity, 143–144 investigation, 117
phenomenological reduction, 140, 141, 144 key informants, 115
poetic activity, 138 language, 118
projective art assessment, 135 performance, 174
self-awareness, 144 phases of investigation, 117–118
self-reference, 148 pilot study, 228
shared reflections, 145 tension between emic and etic perspectives, 115
study of essences, 137 triangulation of data sources, 119
summary, 157–158 validity issues and verification strategies,
synthesis of meanings and essences, 141 119–120
textural descriptions, 141 Etic perspective, 213
294 Index
Evidence-based practice, outcomes research to Feminist perspectives, 121

generate, 73–93 Formal Elements Art Therapy Scale (FEATS),
artifacts, 86 40, 41, 67, 221
audit, 84 Formative evaluation research, 85
case sampling, 87–88 Functional problem statement, 10
childhood sexual abuse, 83, 90
condition based guidelines, 84 G
credibility, 91
efficacy versus effectiveness, 76–77 Gallery guestbook, 78
feedback log, 78 Gender identity, 69
formative evaluations, 85 Glossary, 269–278
gallery guestbook, 78 Google Scholar, 13
good clinical practice, method as extension Grant writing, 89, 90
of, 77–80
grant applications, 89 H
Likert scale, 85
managed care, 73 Habit of truth, 214
mental health care, 82 Health Insurance Portability and Accountability
multiplier effect, 75 Act (HIPAA), 198
needs assessment, 89 Hermeneutic circle, 151, 152, 175
negative cases, 86 Heuristic inquiry, 144–149
paradigm shift in thinking, 74 body shift, 146
peer review publication, 83 core concepts and processes, 145–147
posttraumatic stress disorder, 83 creative synthesis, 147
problem based guidelines, 84 indwelling, 146
problem-solving procedure, 84 validity and critique, 148–149
production of art, 79 HIPAA, see Health Insurance Portability and
program evaluation for obtaining grants Accountability Act
and funding, 88–91
program evaluation research, 84–88 I
program mission, 86
purpose, 75–76 Iconoclasm, 178
received wisdom, 74 Ideas, see Research ideas, tools, and process
research model, 82–84 Ideation, 38
results of process, 75–76 Identity
sexual abuse, 79 anorexic perspective, 136
summary, 91 collective, 128
summative evaluations, 85 disruption of, 117
treatment and its effects, 80–82 gender, 69
treatment integrity, 80 professional, 138
units of analysis, 85 transsexual, 154, 236
External validity, 66 IIRC Website, see Image and Identity Research
Collective Website
F Image and Identity Research Collective (IIRC)
Website, 169
FEATS, see Formal Elements Art Therapy Scale Imaginal variation, 141
Feedback Imagistic exchange, 169
audience, 174 Indirect identifiers, 198
clinical system, 77 Induction, 16
cooled, 266 Inferential statistics, 65, 70, 208
coresearcher, 130 Information, see Art information
informant, 143 Information technology, downside of, 13
log, 78 Informed consent, 197, 200
as motivation, 251 Inquiry, see also Art-based inquiry
reviewer, 265 art practice as source of, 45
systematic, 163 creative cycle of, 149
Index 295
domains of, 44 professional, 21, 173

heuristic, 144–149 quality, 155
body shift, 146 research and, 3
core concepts and processes, 145–147 search for, 25
creative synthesis, 147 sharing of, 244, 245
indwelling, 146 skill set, 30
validity and critique, 148–149 source, 5
structured, 179 surprising, 103
systematic, 4, 103 teacher, 222
Institutional Review Board (IRB), 23, 194 tested, 260
authority, 186 value of, 105
description, 188 wholeness of, 145
ethical issues handled by, 18
federal mandates, 201 L
Guidebook, 196
proposal review by, 23 Language
purpose, 22 APA style, 259
responsibility, 194 co-inquiry, 110
Internal validity, 65 deficits, 41
Internet, articles found on, 13, see also Web sites ethnographic research, 114
Interpretivist paradigm, 45, 176 evocative, 118
Interrater reliability, 64 gender-neutral, 257
Interrupted time series experiment, 61 narrative analysis, 153
Intersubjective validity, 143 phenomenological inquiry, 138
Interval scales, 64 power, 245
Interview(s) of rat scientists, 31
ethnographic, 116 study, 125
in-depth, 15 thinking in, 176
participant-observation research, 107 translating art therapy into, 20
research, 153–156 trauma and, 60
Investigator triangulation, 111 Lived experience, 118, 136, 138, 155, 234
IQ scores, 61, 64 collaborative witness project, 144
IRB, see Institutional Review Board frameworks, 136
hermeneutics and, 150
K knowledge construction and, 166
narrative analysis, 153
Knowledge obtaining records of, 139
accumulative, 143 phenomenological research, 138
advancement of, 156 transsexual identity, 154
aesthetic, 163 LSD experiments, 194
artmaking, 171
art therapist, 4 M
background, 178, 188
claim, 36, 37, 102 MBAT, see Mindfulness-based art therapy
construction, 162, 166 Member checks, 156
control of, 121 Mentor, 23
correlational research, 66 Methodological triangulation, 111
elicited, 119 Migraine art, 225
empathetic, 157 Mindfulness-based art therapy (MBAT), 215
environment and, 186 Model(s), see also Quantitative models; Reports
insider, 129 clinical research team, 22
obtaining, 114 domestic violence program, 13
penetrating, 154 evidence-based practice, 82–83
personal, 149 inquiry, hermeneutic, 152
potential to transform, 26 interdisciplinary research, 178
pragmatic, 45 lived experience, 136
296 Index
PAR, 126 data source triangulation, 111

quantitative, 20 dialectic critique, 100, 101
scientific theory, 162 dialogue processes, 126
social science research, 4 disruption of identity, 117
Multiple treatment interference, 66 empowerment evaluation, 126
Multiplier effect, 127 espoused theory, 100, 102
combat veterans, 244 establishing relationships, 125
common good and, 127 ethnographic lens, 120
treatment-outcomes research, 75 ethnography, 113–120
basic questions, 114
N cultural understanding, 113
definition of, 113
Naming the enemy, 113, 227, 256 field issues, 115
National Institutes of Health Website, 198 interview, 116
Natural experiments, 59, 61 key informants, 115
Needs assessment, 89 phases of investigation, 117–118
Nominal data, 64 validity issues and verification strategies,
119–120
O feminist perspectives, 121
informant’s culture, 116
Online Ethics, 196 instrumental case study, 104
Online research tools, 14 interviews, 107
Ordinal data, 64 intrinsic case study, 104
Organizational survey research, 69 investigator triangulation, 111
Outcomes, see Reports knowledge-producing elites, 122
Outcomes research, see Evidence-based practice, learned hopefulness, 128
outcomes research to generate lived experience, 118
member checks, 111
P methodological triangulation, 111
minority groups, 127
PAR, see Participatory action research multiplier effect, 127
Participant-observation research, 95–133 naming the enemy, 113
action research, 97–103 naturalistic field studies, 96
action research cycle, 98–99 non-governmental organizations, 123
action research plan, 99–101 participatory action research, 122–129
example, 102 ethical challenges, 129
value of to art therapy, 101–103 methodology, 125–128
artifacts, 116 participatory case research, 104
artmaking, conferences using, 128 peer supervision group, 106
bipolar disorder prison, 128
early-onset, 113 problem definition, 105
pediatric form of, 113 problem solving, 96
black liberation theory, 121 puzzles, 101
case research, 103–113 reflexive critique, 98
conducting of case study, 104–110 research dissemination, 126
participatory, 104 role definition, 106
units of analysis, 103 second-order data analysis, 109
validity and strategies for improving, second-person research practice, 103
110–113 snowballing approach, 115
case selection, 105 social action art therapy, 123, 127
consciousness-raising activities, 121 solidarity, 121
correspondence, 109 standpoint theories, 121
critical-orientational perspectives, 120–122 study conclusion, 110
critical theory, 121 substantive significance of findings, 110
cycled back information, 107 summary, 129–130
data gathering, 107 systematic inquiry, 103
Index 297
theories in use, 102 interrupted time series experiment, 61

theory triangulation, 111 interval scales, 64
triangulation protocols, 111 IQ scores, 61
visual-narrative methods, 120 Likert scale, 64, 69
Participatory action research (PAR), 122 measurement and statistical analysis, 63–65
Participatory dialogue, 232 multiple treatment interference, 66
Peer(s) natural experiments, 59
checks, 156 nominal data, 64
mentoring of, 25 non-equivalent control group design, 60
reviewed articles, 13, 251, 260 non-experimental descriptive research, 66–69
reviewed research, xi correlational research, 66–67
review publication, 83 survey research, 67–69
supervision group, 106 ordinal data, 64
Performance art, 173–174 organizational survey research, 69
Performance ethnography, 174 poorly designed questionnaires, 69
Phenomenological reduction, 140, 141, 144 posttest-only control group design, 57
PI, see Principal investigator pretest posttest control group design, 56
Posttraumatic stress disorder (PTSD), 60, 83, Psychiatric Symptom Index, 67
219, 244 purpose, 52–55
Practices of understanding, 170 control, 53–54
Principal investigator (PI), 22 manipulation and measurement, 52–53
Process, see Research ideas, tools, and process randomization, 54
Projective art assessment, 135 systematic, preplanned structure, 54–55
Projective drawing tests, 40–41 quasi-experimental studies, 59–61
PSI, see Psychiatric Symptom Index ex post facto or natural experiment, 61
Psychiatric Symptom Index (PSI), 67 quasi-experiment, 59–61
Psychoaesthetic dialogue, 170 random group assignment, 54
Psychoanalysis randomized controlled trial, 56
early theories derived from, 35 ratio data, 64
hermeneutic understanding, 151 research protocol, 61–63
metapsychology claims, 154 reversal design, 58
PTSD, see Posttraumatic stress disorder Rubin–Kunkle–Miller Behavioral Inventory, 61
Publication, see Writing for publication sample size, 54
scientific method, 51
Q Solomon four-group design, 57
state data, 59
Quantitative models, 51–71 summary, 70
ABA design, 58 test-retest reliability, 64
bias, influence of, 68 time-series design, 58
cause-and-effect relationships, 52–55, 58 validity in experimental research, 65–66
central tendency, 65 Questionnaire(s), 17
chronic pain program, 62 data collection, 223
dependent variables, 52 formative evaluation research, 85
descriptive statistics, 65, 70 poorly designed, 69
empiricist-analytic paradigm, 52 quality of life, 62
experimental models, 55–59 rate of return, 69
control group designs, 56–57
single-subject research, 58–59 R
true experiment, 55–56
external validity, 66 Random group assignment, 54
Formal Elements Art Therapy Scale, 67 Randomization, 54, 59
gender identity, 69 Randomized controlled trial (RCT), 56, 76, 83, 215
independent variable, 52 Ratio data, 64
inferential statistics, 65, 70 RCT, see Randomized controlled trial
internal validity, 65 Reflexive action, 170
interrater reliability, 64 Reflexive critique, 98
298 Index
Reports, 203–241 transsexual identity, 236

artmaking Trauma Symptom Checklist for Children, 217
disparate groups, 232 Research, introduction, xvii–xxviii
migraine pain and, 226 archetype of hunt, xxiii
relationship between pain and, 225 collaboration, xxvi
art therapy exemplars and model research contemporary challenge, xviii
reports, 214–238 control group, xxv
Art Therapy Practice Research Network, 238 creative archetypal process, xviii–xix
bipolar disorder debates, xxii
early-onset, 227 evidence-based constructs, xxi
pediatric form of, 227 history, xix–xxi
checklist for critical review of research reports, 1960s, xix
210–211 1970s, xix–xx
childhood sexual abuse, 217 1980s, xx
conducting research to achieve quality 1990s, xx
outcomes, 238–239 2000s, xx–xxi
consensual validation, 229 “how-to” of research, xxiv
Coopersmith Self-Esteem Inventory, 223 modernism, xxi
correctness, 209 motivations, xviii
craft, 204–206 organizational premises, xxiii–xxvii
descriptive statistics, 208 peer reviewed research, xi
emic perspective, 213 questions, xxv
empathy, 236 schools of thought, xx
ethnographic pilot study, 228 science and art, xxi–xxiii
etic perspective, 213 scientism, xxii
experimental outcomes study, 217 Researchable question, 7
Formal Elements Art Therapy Scale, 221 Research ideas, tools, and process, 3–27
gender stories, 236 access to participants, 7
habit of truth, 214 artifacts, 17
idiographic traditions, 212 art therapy research ideas, development of, 8–9
incomprehensible reports, 206 catalysts for self-discovery, 4
inferential statistics, 208 child abuse, mandate to report, 24
lived experience, 234 choice of research approach, 17–18
migraine art, 225 conceptual map for study design, 6
mindfulness-based art therapy, 215 consensus collusion, 18
naming the enemy, 227 deductive reasoning, 15
nomothetic traditions, 212 discovery, 4
number-cruncher, 206 distinctions of purpose, 9
participatory action research, 230, 232 domestic violence program models, 13
participatory dialogue, 232 ethical boundaries, 23–24
peer review, 206 functional problem statement, 10
phenomenological art-based case study, 234 goal of the hunt, 26
posttraumatic stress disorder, 208, 219 Google Scholar, 13
quantitative and qualitative studies, logic heuristic guides, 19
of, 212–213 in-depth interviews, 15
quasi-experimental RCT mixed methods, 223 induction, 16
questions, 207 information technology, downside of, 13
reading, 206–211 knowledge yielded, 3
representative case research, 227 literature review, 12–14
research roundtable discussions, 238 literature search, organization of, 14
rigor, 204 metaphor, 10
scientific analysis, 212 methodology, determination of, 15–19
single-subject experimental design, 219 non-linear thought process, 5
standards for evaluating research, 213–214 online research tools, 14
summary, 239–240 peer reviewed articles, 13
telehealth, 230 peers, mentoring of, 25
Index 299
personal bias, 16 sample research proposal evaluation, 193

principal investigator, 22 soft-pedaling of study, 198
problem statement, development of, 10–11 stream-of-consciousness writing, 189
qualitative research, 15, 16 substance abuse, 198
quantitative research, 15 summary, 200–201
reliable instruments, 21 Tuskegee Syphilis Study, 194, 198–199
researchable question, 7 universal ethical procedures, draft of, 196
research question, identification of, 5–10 vulnerable subjects, 186
results, reporting and disseminating, 25–26 word meaning, 190
risk assessment, 24 Responsive artmaking, 172, 180
study design, 4–5 Results, see Reports
study tools and resources, 19–23 Retrospective outlining, 254
art as research tool, 21 Risk assessment, 24
clinical research team, 21–23 Rubin–Kunkle–Miller Behavioral Inventory, 61
mentor, 23
statistics and measurement, 20 S
valid and reliable instrumentation, 21
sub-problems, 11 Scientism, xxii
summary, 26 Self-discovery, catalysts for, 4
systematic inquiry, 4 Shadow researcher, 177
valid instrument, 21 Silver Drawing Test of Cognition and Emotion,
Research proposal and other ethical safeguards, 41, 42
185–201 Social action art therapy, 123, 127
Belmont Report, 196 Sociocultural cognition, 177
closed contract, 200 Solidarity, 121
contract, 192 Solomon four-group design, 57, 61
data collection, 197 Standpoint theories, 121
definition of research, 186–187 Stream-of-consciousness writing, 189
direct identifiers, 198 Survey bias, 69
elements of research design and Systematic inquiry, 4, 103
proposal, 191
empathy, 190 T
ethical standpoint, 195
ethical values, 195 Telehealth, 230
ethics, role of in research process, 193–200 Test(s)
confidentiality and anonymity, 198 Diagnostic Drawing Series, 41
deception and disclosure, 200 projective drawing, 40–41
informed consent, 198–199 -retest reliability, 64
multiple roles, 197–198 Silver Drawing Test of Cognition and Emotion,
how reader thinks, 189 41, 42
indirect identifiers, 198 Weschler Adult Intelligence Performance
informed consent, 197, 200 Scale, 42
Institutional Review Board, 186–187 Theory(ies)
knowledge obtained, 186 addressing question, 7
LSD experiments, 194 black liberation, 121
mutual respect, 200 critical, 121
Nuremburg trials of Nazi medical espoused, 100
experiments, 194 standpoint, 121
Online Ethics, 196 triangulation, 111
personal identity numbers, 198 Time-series design, 58
research proposal, 187–189 Tools, see Research ideas, tools, and process
context, 190–192 Transsexual identity, 154, 236
elements of, 190–193 Trauma Symptom Checklist for Children, 217
introduction, 190 Treatment integrity, 80
methods, 192–193 Triangulation protocols, 111
purpose, 190 Tuskegee Syphilis Study, 194, 198–199
300 Index
V manuscript preparation, scholarly journal,

245–251
Valid instrument, 21 converting dissertation or thesis to journal
Verbatim transcripts, 155 article, 249–250
Video bodies, 175 other scholarly articles and oral
Visual knowing, 176 presentation venues, 250–251
Visual thinking, 36 manuscript submission, 264
meta-story, 260
W mini peer review, 263
multiplier effect, 244
Web sites naming the enemy, 256
American Educational Research Association, peer review, 260–261, 264
213 posttraumatic stress disorder, 244
American Psychological Association, 247, 263 professionalism, 252
articles found on, 13 professional writing standards, 257–259
art shown on, 167 publication decision, 265
design, 4 public sharing of knowledge, 245
Image and Identity Research Collective, 169 qualifications, 255
journal reviewers, 260 reason for publishing, 244–245
National Institutes of Health, 198 retrospective outlining, 254
publication’s editorial mission, 261 sexual abuse, disclosure of, 256
witnessing images, 169 strategies to improve coherence, 253–257
Weschler Adult Intelligence Performance Scale, 42 building your argument on claims and
Writing for publication, 243–268 evidence, 255–256
accepted manuscript, 265 connecting with reader, 256–257
authorship and its responsibilities, 251–252 non-linear thinkers, 254–255
bipolar disorder, early-onset, 256 writing as thinking, 253–254
checklist, 248 submission and review, 261–266
compassionate involvement, 245 summary, 266–267
cooled feedback, 266 survivors of war and trauma, 244
corresponding author, 251 thesis intervention, 254
dissertation, 249 tips before submission, 264
early-onset bipolar disorder, 256 transitional object, 256
feedback as motivation, 251 use of APA style to craft good
formatting errors, 263 sentences, 258–259
gender-neutral language, 257 voice, 257
hourglass outline, 249 voice of the author, 251
hunter-gatherers, 244 Web sites, 260
journal publishing mission, 262–263 writing as means for thinking, 253
manuscript assembly, 246 writing strategy, 249

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Downloaded by [Library and Information Center of the Lithuanian University of Health Sciences] at 03:37 10 December 2013

New York London

This edition published in the Taylor & Francis e-Library, 2011.

International Standard Book Number: 978-0-415-87147-1 (Hardback)

Library of Congress Cataloging-in-Publication Data

Visit the Taylor & Francis Web site at

ISBN 0-203-85513-2 Master e-book ISBN

I dedicate this book to my students, who taught me to be courageous in heart and

The following abstracts appear in Chapter 9, Models of Good Research: Conducting

Barbee, M. (2002). A visual-narrative approach to understanding transsexual identity. Art Therapy:

About the Author xiii

Introduction to Art Therapy Research xvii

PART I OVERVIEW OF ART THERAPY RESEARCH 1

1 Art Therapy Research Ideas, Tools, and Steps in the Process 3

2 How Art Informs Art Therapy Research 29

The Place of Art in Research Methodologies 35

PART II ART THERAPY RESEARCH METHODS 49

3 Quantitative Models of Art Therapy Research 51

4 Outcomes Research to Generate Evidence-Based Practice 73

5 Investigating the Field: Participant-Observation 95

6 Researching the Phenomena of Conscious Experience 135

7 Art-Based Inquiry: An Emerging Paradigm in Art Therapy 161

Artmaking as the Presentation of Findings 172

PART III DOING ART THERAPY RESEARCH 183

8 Before You Begin: The Research Proposal and Other Ethical

9 Models of Good Research: Conducting the Study and Reporting

10 Writing for Publication in Art Therapy and Other Scholarly

About the Author

xviii Introduction to Art Therapy Research

1. Research originates with a problem or question.

Introduction to Art Therapy Research xix

A BRIEF HISTORY OF ART THERAPY RESEARCH

xx Introduction to Art Therapy Research

Introduction to Art Therapy Research xxi

CONVERSATIONS BETWEEN SCIENCE AND ART

xxii Introduction to Art Therapy Research

Introduction to Art Therapy Research xxiii

xxiv Introduction to Art Therapy Research

Introduction to Art Therapy Research xxv

most pressing questions. Obstacles tend to be a lack of confidence, lack of knowledge

5. Consider adding a control group to your design: On a similar note, many

4. Report research more clearly and completely: Reporting or publishing your

xxvi Introduction to Art Therapy Research

unfamiliar with the requirements of a readable scientific report. A standard report

2. Partner up—collaborate: So much research doesn’t happen because those

Introduction to Art Therapy Research xxvii

xxviii Introduction to Art Therapy Research

4 Introduction to Art Therapy Research

DESIGNING A RESEARCH STUDY

1 t Art Therapy Research Ideas, Tools, and Steps in the Process 5

1. Identifying the research question

STEP ONE: IDENTIFYING THE

6 Introduction to Art Therapy Research

Purpose Conceptual Context

Research Problem or Questions

Name your topic: “I am studying…….

Methods Validity & Ethics

is behaving differently before or after a particular art therapy intervention. Perhaps

1 t Art Therapy Research Ideas, Tools, and Steps in the Process 7

IDENTIFYING A GOOD RESEARCH QUESTION

r It rests on a rationale or theory, addressing the question, “How will this

8 Introduction to Art Therapy Research

TABLE 1.1 Developing art therapy research ideas