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Fri, 08/15/2025 - 14:31
Edited Text
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). AP changes writing style to capitalize “b” in Black. The Associated Press. https://apnews.com/71386b46dbff8190e71493a763e8f45a
AATA (n.d.). Ethical Principles for Art Therapists. Retrieved from https://arttherapy.org/wp-content/uploads/2017/06/Ethical-Principles-for-Art-Therapists.pdf
ACA (n.d.). Code of Ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf
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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
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