A Heuristic Inquiry Exploring the Cross-Cultural Therapeutic Alliance in Art Therapy Presented by Angela Bossut I would like to acknowledge the lives of countless Black men, women and children who have suffered throughout the history of our country bearing the inner wounds of racialized trauma while displaying an outer manifestation of the resilience and grace required to simply exist in America while Black. May the ideas put forth in this paper represent one step in the journey toward justice as the efforts of art therapists evolve to a more inclusive a n d d i v e r s e h e a l i n g c o m m u n i t y. A l s o , t h i s i s f o r m y f r i e n d M o s e s . 1 Introduction, Problem, and Purpose 2 Justification 3 Research Questions 4 Review of the Literature 5 Methodology and Research Design 6 Results and Summary Discussion 7 Limitations and Further Research Introduction, Problem and Purpose 1 • Therapeutic relationship/alliance one of the most significant factors in successful treatment • Foundational concept taught and practiced • Relative to many other research topics, little attention to cross-cultural therapeutic relationship • Gap between supply of BIPOC art therapists and need of diverse client base Introduction, Problem and Purpose 1 • Therapeutic relationship/alliance one of the most significant factors in successful treatment • Foundational concept taught and practiced • Relative to many other research topics, little attention to cross-cultural therapeutic relationship • Gap between supply of BIPOC art therapists and need of diverse client base • Need to improve cross-cultural training due to difference in White and Black experience in our country and more nuanced differences in specific regions or cities • Cumulative / racialized trauma from systemic injustice Introduction, Problem and Purpose 1 • Therapeutic relationship/alliance one of the most significant factors in successful treatment • Foundational concept taught and practiced • Relative to many other research topics, little attention to cross-cultural therapeutic relationship • Gap between supply of BIPOC art therapists and need of diverse client base • Need to improve cross-cultural training due to difference in White and Black experience in our country and more nuanced differences in specific regions or cities • Cumulative / racialized trauma from systemic injustice • Investigate race in the cross-cultural art therapy relationship • Engage in identity construction process that integrates increased attention to cultural humility and competency Justification 2 Cutler, I.S. (2019). Greensboro Massacre [Digital image]. Retrieved from https://www.wunc.org/post/greensboropastors-want-apology-1979-massacre North Carolina Office of Archives and History (n.d.). Whites kill negroes [Digital image]. Retrieved from https://www.npr.org/templates/story/story.php?storyId=93615391 Unknown. (n.d.). [Digital image]. Retrieved from https://www.democraticunderground.com/10023422302 Justification 2 Local environment and outer world • Wilmington history and 1898 Massacre • Southern city that remains segregated • Systemic injustices and structural racism in schools, services, neighborhoods • Distinct racial divide in quality of life that is not unusual in the south • Population of over 200,000 with only two currently practicing art therapists, both White women • Sustained social unrest and local/global protests against systemic injustice and recent killings of Black citizens • Local shootings and increased gang violence signifying racialized, cumulative trauma Justification 2 Inner world and acknowledgement of bias • Mother and grandmother who both childhood were pillars in community, grandma • Conflicted about messages from counselor at Rose HS, mom started upbringing that were normal for preschool for underserved families child in the South • Grandfather in the KKK, • Social justice worldview with indiscriminate use of N-word implicit bias to address • Divided Southern town of • Intention to explore and address in upbringing, e.g. Black and White current context country stores • Recognition in difference between • Free-spirited, questioning but interest in Thai vs Black cultures hesitant personality as a child, anger and frustration throughout Can art therapy praxis be improved by focusing on development of cultural competencies and applied social justice theory? Research Questions 3 Can art therapy praxis be improved by focusing on development of cultural competencies and applied social justice theory? Research Questions 3 How can art therapists cultivate cultural authenticity? Can art therapy praxis be improved by focusing on development of cultural competencies and applied social justice theory? Research Questions 3 How can art therapists cultivate cultural authenticity? Can artmaking and journaling improve and supplement cultural competencies? Can art therapy praxis be improved by focusing on development of cultural competencies and applied social justice theory? Research Questions 3 How can art therapists cultivate cultural authenticity? Can artmaking and journaling improve and supplement cultural competencies? How can improved cultural competencies strengthen the cross-cultural therapeutic relationship? Cultural competence • ter Maat’s self questioning, Gipson’s and Talwar’s ‘Invisible veil’, Kuri knowledge and its origins • McGann “It is irresponsible and unethical for an art therapist to attempt to guide their clients through processes that they have not explored or resolved themselves” • Keselman and Awais power imbalances, Biscombe’s power differential through exploration of ‘othering’ in arts education • Karcher’s acknowledgement of privilege and Talwar’s call for decolonization and intersectionality Review of the Literature 4 • Qureschi’s absent presence in therapeutic treatment when race is avoided Color Blind Racial Ideology (CBRI) • (CBRI) or the denial of race (Burkard) • “I don’t see color” or “we’re all one race” as attempts to equate • Denies White privilege and Black experience, damages Tx relationship, limits empathy • Ultramodern articulation of racism (Neville et al) • Color-evasive or power-evasive leading to institutional racism, ignores racial identity • Hadley noted perpetuates the idea of racism as merely ‘individual acts of meanness’ Color Blind Racial Ideology (CBRI) Those who do not see themselves as Review of the Literature 4 racist still unwittingly support, enable, and benefit from racist systems and power structures, even in the in the therapeutic milieu. Theory and race in therapeutic relationship • Multicultural ideology (Burkard et al) • Racial identity (McGann, Hadley) • White privilege (DeGruy, Mayor) • Critical theory (Nolan): “A movement that challenges psychology to work towards emancipation and social justice and that opposes the use of psychology to perpetuate oppression and injustice” • ‘loving third space’ of multidimensional support – like Kramer’s ’third hand’ in art therapy • Dominant narratives (Hamrick & Byma, Hadley) Review of the Literature 4 • Liberation psychology (Chavez et al) emancipation from medical model built on recovery of historical memory by the oppressed Dialogue in building a cross-cultural therapeutic relationship • Cultural frame-switching and recognizing implicit cultural cues (Kapitan, Benet-Martinez et al) • Self-accountability in recognizing and dismantling racism (Hamrick & Byma) • • • • • Notice offense Acknowledge offense to self Acknowledge offense to others Ask how harm can be resolved Act to resolve and retain • Broaching and open dialogue (Day-Vines et al, Cardemil & Battle) Oblivious/uncritical Acknowledges White identity, conflicted Assumes racial stereotypes Intellectualized acceptance of race Honest appraisal of racism Internalizes multicultural nonracist identity Avoiding style, refusal to broach, posture of naivete and defensiveness, refuses to consider contextual dimensions of race, ethnicity, and culture Vacillates between avoiding and isolating broaching style, recognizes need but lacks skill, concerned about negative reactions from client Vacillates, broaches only once, doesn’t recognize relationship between cultural factors and culturally appropriate counseling interventions Continuing but incongruent broaching style, may broach subject of race but does so mechanically, can’t translate cultural factors into effective strategies and interventions Integrated and congruent broaching style, incorporates broaching as appropriate, accepts risks of broaching, culturally appropriate interventions Infusing broaching style, considers broaching integral, enduring commitment to social justice that transcends professional identity Racial identity functioning Attitude toward broaching Racial Identity Status Contact Disentegration Reintegration Pseudo-independence Immersion/Emersion Autonomy Note: “Broaching the Subjects of Race, Ethnicity, and Culture During Counseling”, by Day-Vines, N. L., Wood, S. M., Grothaus, T., Craigen, L., Holman, A., Dotson-Blake, K., & Douglass, M.J., 2007, Journal of Counseling & Development, Vol. 85, p. 407. Cumulative trauma and art therapy • KISS theory and visual language of victims (Spring) • • Kinesthetic-optical, Imaginal-emotional Sensory perceptual elements to Speech within a natural state of consciousness “victims produce an artistic language not produced by non-victims” • Internalized racism using art therapy response art to the art of holocaust victims discovered self-to-self and selfto-other dynamic (Leclerc & Drapeau) • Active duty service members (Jones et al) art therapy outcomes include feeling of safety, emotion regulation, integration of fragmentary trauma memories, increased brain plasticity • Avoidance of trauma (Dulin & Passmore, Kapitan) inversely related to positive outcomes in lifetime accumulated trauma Review of the Literature 4 • Art therapy treatment found by many to be beneficial for cumulative trauma (Orr, Naff, Gantt & Tinnin, Schouten et al, Hass-Cohen et al, Baker) Social justice theories and art therapy • Ethics of social justice in art therapy (Hinz) cultural ignorance equates to violation of human rights • Social action art therapy (Kapitan, Kaplan, Sajnaji) art therapists are social activists when commit to transformation of individual and the community • Participatory action art therapy (Kapitan et al, Hurley) tool for change and an emancipatory process • Response/ability (Sajnaji et al) means of reversing exclusion Relationship as mechanism for change • Active state of presence (Potash & Ho) facilitates meaningful change • Relational social justice (Potash) situates relationships as central to ethical decision making Phase 1 Methodology and Research Design 5 18 months, evolved, adjusted, struggled Phase 1 1 Phase 2 2 Data analysis 3 Data analysis 4 Data analysis 5 6 Phase 1 Phase 1 Phase 2 Data analysis Data analysis Data analysis Cross-cultural direct client contact in Thailand during 150 hour practicum experience Journaling Ongoing review of literature Methodology and Research Design 5 1 2 3 4 5 6 Results and Summary Discussion 6 Cross-cultural direct client contact in Thailand: goal to immerse in experience Phase 1 Phase 1 Cross-cultural direct client contact in Thailand during 150 hour practicum experience Cross-cultural direct client contact in Wilmington during 300 hour internship Journaling Journaling Phase 2 Data analysis Data analysis Data analysis Ongoing review of literature Methodology and Research Design 5 1 2 3 4 5 6 Results and Summary Discussion 6 Cross-cultural direct client contact in Wilmington: goal immerse in experience and begin to reflect on identity Phase 1 Phase 1 Phase 2 Cross-cultural direct client contact in Thailand during 150 hour practicum experience Cross-cultural direct client contact in Wilmington during 300 hour internship Painting over several weeks to produce 9 paintings using complementary colors, oils, palette knife Journaling Journaling Gestalt journaling Ongoing review of literature Methodology and Research Design 5 Data analysis Data analysis Data analysis Ongoing review of literature 1 2 3 4 5 6 Results and Summary Discussion 6 Painting over several weeks to produce 9 paintings using complementary Direct cross-colors, oils, cultural direct palette knife, gestalt journaling in 1st person: client contact in goal to begin to integrate experiences and Wilmington reflections on identity; use challenging materials to experience transformation; Phase 1 Phase 1 Phase 2 Data analysis Cross-cultural direct client contact in Thailand during 150 hour practicum experience Cross-cultural direct client contact in Wilmington during 300 hour internship Painting over several weeks to produce 9 paintings using complementary colors, oils, palette knife Transcribe and code excerpts from journals and paintings Journaling Journaling Gestalt journaling Ongoing review of literature Methodology and Research Design 5 Data analysis Data analysis Ongoing review of literature 1 2 3 4 5 6 Phase 1 Phase 1 Phase 2 Data analysis Data analysis Cross-cultural direct client contact in Thailand during 150 hour practicum experience Cross-cultural direct client contact in Wilmington during 300 hour internship Painting over several weeks to produce 9 paintings using complementary colors, oils, palette knife Transcribe and code excerpts from journals and paintings Tag coded excerpts using Expressive Therapies Continuum categories Journaling Journaling Gestalt journaling Ongoing review of literature Methodology and Research Design 5 Data analysis Ongoing review of literature 1 2 3 4 5 6 Phase 1 Phase 1 Phase 2 Data analysis Data analysis Data analysis Cross-cultural direct client contact in Thailand during 150 hour practicum experience Cross-cultural direct client contact in Wilmington during 300 hour internship Painting over several weeks to produce 9 paintings using complementary colors, oils, palette knife Transcribe and code excerpts from journals and paintings Tag coded excerpts using Expressive Therapies Continuum categories Analyze highest occurring ETC categories to distill and identify 5 general themes Journaling Journaling Gestalt journaling Ongoing review of literature Methodology and Research Design 5 Ongoing review of literature 1 2 3 4 5 6 Kinesthetic / Sensory Cognitive / Symbolic • • • • 172 coded entries 98 unique codes Applied to each of 6 categories of ETC High occurrence in one ETC category was used to identify latent meaning and four themes • One additional theme added due to high occurrence of use of words ‘flame’ or ‘fire’ Results and Summary Discussion 6 Outputs Perceptual / Affective Tag coded excerpts using Expressive Therapies Continuum categories Effort / results Results and Summary Discussion 6 Outputs Being seen or heard Balance / justice Wayfinding / direction Intensity Tag coded excerpts using Expressive Therapies Continuum categories Analyze occurrences of ETC categories to distill and identify 5 general themes Effort / results • • • Results and Summary Discussion 6 Outputs Being seen or heard Balance / justice Wayfinding / direction Intensity Balance between engaging in the work and remaining open and committed to the transformation Life-sustaining need to remain steadfast “peace that arises from hard work” or inner rewards Tag coded excerpts using Expressive Therapies Continuum categories Analyze occurrences of ETC categories to distill and identify 5 general themes Effort / results Being seen or heard • • • • Balance between engaging in the work and remaining open and committed to the transformation Life-sustaining need to remain steadfast “peace that arises from hard work” or inner rewards • • Results and Summary Discussion 6 Outputs Balance / justice Wayfinding / direction Intensity Palpable frustration and desire not only to be present, but also given voice Witnessing of Black experience represents antiracist growth and need to offer attention to race in therapeutic relationship Need to listen and amplify Tag coded excerpts using Expressive Therapies Continuum categories Analyze occurrences of ETC categories to distill and identify 5 general themes Effort / results Being seen or heard Balance / justice • • • • • Balance between engaging in the work and remaining open and committed to the transformation Life-sustaining need to remain steadfast “peace that arises from hard work” or inner rewards • • Results and Summary Discussion 6 Outputs Palpable frustration and desire not only to be present, but also given voice Witnessing of Black experience represents antiracist growth and need to offer attention to race in therapeutic relationship Need to listen and amplify • • • Wayfinding / direction Intensity Need for equality, inclusion, and access Requires recognition of barriers Tension in power dynamic in therapeutic relationship Need to explore this dynamic in broader field Tag coded excerpts using Expressive Therapies Continuum categories Analyze occurrences of ETC categories to distill and identify 5 general themes Effort / results Being seen or heard Balance / justice Wayfinding / direction • • • • • • Balance between engaging in the work and remaining open and committed to the transformation Life-sustaining need to remain steadfast “peace that arises from hard work” or inner rewards • • Results and Summary Discussion 6 Outputs Palpable frustration and desire not only to be present, but also given voice Witnessing of Black experience represents antiracist growth and need to offer attention to race in therapeutic relationship Need to listen and amplify • • • Need for equality, inclusion, and access Requires recognition of barriers Tension in power dynamic in therapeutic relationship Need to explore this dynamic in broader field • • • • Intensity Commitment to the journey but a need for clear direction Parallels with journey of allies and accomplices Black authors and researchers lead provide direction and achieve equality Desire for change but uncertainty Intentionality in the journey even without clear direction Tag coded excerpts using Expressive Therapies Continuum categories Analyze occurrences of ETC categories to distill and identify 5 general themes Effort / results Being seen or heard Balance / justice Wayfinding / direction Intensity • • • • • • • Balance between engaging in the work and remaining open and committed to the transformation Life-sustaining need to remain steadfast “peace that arises from hard work” or inner rewards • • Results and Summary Discussion 6 Outputs Palpable frustration and desire not only to be present, but also given voice Witnessing of Black experience represents antiracist growth and need to offer attention to race in therapeutic relationship Need to listen and amplify • • • Need for equality, inclusion, and access Requires recognition of barriers Tension in power dynamic in therapeutic relationship Need to explore this dynamic in broader field • • • • Commitment to the journey but a need for clear direction Parallels with journey of allies and accomplices Black authors and researchers lead provide direction and achieve equality Desire for change but uncertainty Intentionality in the journey even without clear direction • • “fire” or “flames” appeared ten times in journaling and imagery clear in paintings Transformative process like being forged in a fire Intensity is required to address change needed in field specific to exclusivity and access Tag coded excerpts using Expressive Therapies Continuum categories Analyze occurrences of ETC categories to distill and identify 5 general themes Results and Summary Discussion 6 • Deeply personal results mirroring heuristic process step of “indwelling” (Moustakas, 1990 cited by Djuraskovic, 2010): “the [sic] process of turning inward to seek a deeper, more extended comprehension of the nature or meaning of a quality theme of human experiences” • Development of cultural competency became analogy for the art therapy method itself in which healing and transformation take place in act of artmaking with focus on evolution or process as opposed to end product Outcomes Painting 1, painted while listening to Joey Bada$$, “All American Bada$$” • Focus on cultural competency transformed to an awareness of cultural humility, defined by Dr. Louvenia Jackson as “a skill set and way of being that speaks to that missing piece of self-reflection and accountability” (Jackson, p. 19) Painting 2, painted while listening to “This is Nina Simone” Results and Summary Discussion 6 Outcomes • Results and Summary Discussion 6 Outcomes Manifest meaning found in cross-cultural direct client contact experiences combined with sustained effort to build upon knowledge from literature review; this was made visible in paintings and gestalt journals where latent meaning was uncovered Painting 3, painted while listening to and watching “Wilmington On Fire” documentary on the 1898 Massacre • Results and Summary Discussion 6 Outcomes Project complicated by the increased and ongoing social unrest and protests, as a result organically followed Talwar’s (2015) framework of intersectionality in building my professional identity: recognition that identity can change, desire to address inequality, acceptance that identity should be grounded in intersectionality Painting 4, painted while listening to Bill Moyers’ 1976 documentary “Rosedale: The Way It Is” about Black families in White suburb of Rosedale NY Results and Summary Discussion 6 Outcomes • Self-reflection on the 5 themes of intensity, wayfinding, balance/justice, being seen and heard, and effort and results helped me to achieve integration of my own inner conflicts • Evolved in multicultural ideological awareness – understanding my client’s as well as my own heritage Painting 5, painted while listening to Jane Elliott’s Blues eyes/Brown eyes antiracism exercise • Themes form foundation of identity and practice built on instinctive desire to remain open to client’s inner truth that may not fit their outer narrative Painting 6, painted while listening to interviews with Cliff Joseph, art therapist, artist, and advocate Results and Summary Discussion 6 Outcomes Results and Summary Discussion 6 • Wayfinding speaks to journey to inner truth • Intensity speaks to urgency of the cause • Balance/justice & effort/results speak to commitment and transformation • Being seen or heard speaks to giving voice as allies and accomplices not only in clinical milieu but in broader system based in social action theoretical approach Outcomes Painting 7, painted while listening to GirlTrek podcast on Audre Lorde • Results and Summary Discussion 6 Outcomes Themes lay foundation for empathetic professional identity that can be used as a bridge between my White experience and a client’s non-White experience in which we meet in held space, ‘loving third space’ of Nolan’s critical theory, and of being seen and heard through artmaking and in the therapeutic alliance Painting 8, painted while listening to Gary Clarke Jr, “This Land” • Results and Summary Discussion 6 Therefore, based on definition of ‘justice’ as “the principle or ideal of right action,” the results of this research can be interpreted as self-evident and noteworthy according to social action art therapy theory defined as “working to create social change, elevate awareness of social problems, provide community service, understand the origins of socially unacceptable behavior, offer instruction in socially oriented interventions, and increase sensitivity to the social context of trouble individuals” (Kaplan) Outcomes Painting 9, painted while listening to Lecrae, “All Things Work Together” • Unexpected result from painting #6 while listening to Cliff Joseph, early influential Black art therapist, internationally notable artist, and activist • Painted with red and green from all sides of painting • Once completed, turned painting around to find a natural top and bottom orientation • Clear image of profile of young Black boy • Immediately called to mind my friend Moses • Upon further review mood descriptions in journal entries clearly shifted from more anxious to relieved • Outcome: visually processed and integrated a subconscious childhood traumatic memory • Heuristic inquiry is itself self-limiting and uncomfortably focused on my White experience • Coding bias • Research design decisions, e.g. challenging materials, Black/White culture specific, using Dedoose • Applying ETC theory to gestalt journaling combined with painting Limitations and Further Research 7 • Heuristic inquiry is itself self-limiting and uncomfortably focused on my White experience • Coding bias • Research design decisions, e.g. challenging materials • Applying ETC theory to gestalt journaling combined with painting • Broader review of literature, field scan, and needs analysis on this topic • Mixed methods deeper exploration of themes identified here or to cultivate new themes • Pilot testing of cross-cultural interventions to improve training frameworks and treatment protocols • Gestalt journaling and paintings with larger sample group • Analysis of cultural representations in artmaking conducted by non-White researchers Limitations and Further Research 7 • Investigation into possible visual code-switching or pathologizing of non-White cultural norms Direct crosscultural direct client contact in Wilmington Questions, comments, input AP News (2020, June 19). 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