Introduction by Croakey: Better regulation, accountability and support are required to enable art therapy to contribute more fully to community health and wellbeing, according to researchers Max Loomes and Henry Bowen.
As traditional mental health interventions become increasingly difficult to access, art therapy provides another avenue of psychotherapeutic intervention for patients. However, while art therapy has a strong evidence-base, the profession is largely unregulated.
“Not accurately monitoring individuals purporting to be ‘art therapists’ may also put the reputation of the field at risk, particularly if there is malpractice or consumer complaints or concerns,” Loomes and Bowen write.
Below, Loomes, dynamic researcher at UNSW and St Vincent’s Hospital and Bowen, Senior Researcher at Military and Emergency Services Health Australia, discuss the importance of regulating art therapy, including suggestions for credentialling the profession.
Max Loomes and Henry Bowen write:
At some point in our lives, we have all used art to help with our emotions or connect with others – whether it is finger painting with kids, listening to a heartfelt ballad, dancing in the rain, or painting our deepest, darkest feelings onto a canvas. While generally art can be cathartic, it also can be used an evidence-based, psychotherapeutic intervention for mental health concerns.
Art therapy involves predominantly visual mediums of art such as painting, sculpting, drawing, photography, and sometimes includes other creative arts forms such as dance and music therapy.
Countless peer-reviewed articles show that art therapy is helpful, especially for debilitating conditions like Post Traumatic Stress Disorder (PTSD). In fact, a recent World Health Organization investigation into arts and wellbeing found that “the overall evidence base shows a robust impact of the arts on both mental and physical health”. Without a doubt, art therapy has the potential to help those who need it most.
There’s been a growing awareness of the benefits of arts in health in Australia. This coincided with the release of ABC TV’s highly successful Space22, which followed seven strangers with lived experience of ill mental health and how they benefited and recovered by using arts-based activities.
Traditional ‘talking therapies’ have also become increasingly difficult to access, which has become a huge barrier to mental health during the during the pandemic period. As such, many are beginning to consider alternatives like art therapy.
While this is a fantastic move towards recognising art therapy as a valid form of evidence-based, mental health treatment, it also highlights quite substantial issues within the field.
Before art therapy can flourish, these issues must be identified and resolved.
The first core issue is that art therapy is an unregulated mental health profession in Australia. This means the title of “art therapist” is unprotected by policy and legislation. Anyone with any amount of training can call themselves an art therapist and provide services. While many have higher education degrees (for example, Master of Art Therapy), this is not always the case.
Effectively administering evidence-based treatments requires more than a weekend workshop. This is especially so when working with populations who may be at higher risk of self-harm, suicide, or harm to others. On the other hand, consumers may find it difficult understanding who is appropriately qualified when searching for an art therapist.
These points present a real concern for both the consumer welfare and capacity to find effective interventions. Not accurately monitoring individuals purporting to be ‘art therapists’ may also put the reputation of the field at risk, particularly if there is malpractice or consumer complaints or concerns.
Until now, the art therapy profession has been self-regulating, relying upon good faith and peer scrutiny.
Organisations like the Australian, New Zealand and Asian Creative Arts Therapies Association (ANZACATA), the peak professional body representing creative arts therapists, have advocated and endorsed joining their association to help attain a semblance of title protection, professional standardisation, and competence monitoring. Still, these organisations hold no formal power over budding art therapists.
In comparison, other peer and allied health professions, like psychologists, must complete a recognised degree credentialled through peak bodies like the Australian Psychology Society (APS) and also register with the Australian Health Practitioner Regulation Authority (AHPRA). Each year, their competence is assessed and there must be ongoing personal development. These same requirements are not necessary for art therapists.
As such, new legislation and protections are required.
Luckily, we don’t have to start from scratch. Other nations, such as the United States of America, have systems of credentialling already available that can used as a template. Therapists are required to join the Art Therapy Credential Board Inc to be registered and board-certified.
Registration currently requires at least a master’s degree in art therapy or in counselling that consists of substantial components of art therapy. Additional supervision is also necessary following graduation and commencement in the workforce. While considerable improvements could be made to this system, it still provides a sound guide for Australia and what needs to be done here.
Alas, those who may be practising art therapy without the appropriate degree may potentially be barred from providing their services under this new scheme. This may also be the case with art therapists who began without professionally recognised qualifications (Grandfather Clause) but now practice with decades of experience and personal development.
As a result, there will need to be proper facilitatory processes that consider pre-existing art therapists’ qualifications and credentials, while making it a necessity for new art therapists to fulfil registration and professional capacity. One way this could happen is through a standardised, national exam, though the structures needed for this are still lacking in Australia.
One of the benefits of credentialling and title protection is that it may encourage the Australian government to put art therapy on the Medicare Benefits Schedule (MBS).
While many people concerned with equitable health reform are urging new funding models that support holistic and integrated continuity of care which move away from a ‘fee-for-service’, until such systems are put in place, having art therapy on the MBS would assist with providing a cost-effective option for those who want to access this intervention.
Australian consumers already have access to a wide range of services via Medicare for mental health, including 10-20 psychology sessions, community programs through hospitals, and sometimes bulk billed psychiatry sessions.
In the current mental health crisis, it is clear that more varied support is needed from different mental health professions and interventions.
Work is already happening within the space towards legitimising other health professionals like counsellors and psychotherapists, so why not include arts therapy?
About the authors
Max Loomes: Provisional (Clinical) Psychologist studying at the University of Technology Sydney, and currently works as a dynamic researcher at UNSW and St Vincent’s Hospital. Max has a strong interest in activism in everyday life and through his clinical work. He is also a firm believer that trauma research should be done with those who have lived experience as they are the true experts in the field.
Henry Bowen: Senior Research Officer for Military and Emergency Services Health Australia. Their research is focused on building and sustaining wellbeing, and they have a keen interest in adjunct treatments which have translational outcomes and implications, such as creative arts, physical activity, and human-animal interaction. They are involved in developing collaborative, multidisciplinary trauma-informed research projects which influence clinical practice, treatment delivery, and policy and legislative decision making.
Read Croakey’s extensive archive of articles on mental health and wellbeing.
The establishment of the new College of Creative and Experiential Therapies within PACFA is an exciting step forward for therapists who use more than verbal methods in our work. Being under the umbrella of PACFA provides assurance that practitioners working in diverse creative and experiential approaches all meet the rigorous membership standards of PACFA, whilst maintaining a specific identity as creative and experiential therapists with additional skills and abilities to work in these ways. We also benefit from the Australian focused advocacy work that PACFA is persistently involved in, including access to counselling and psychotherapy through the Medicare better access scheme and other public health initiatives.
It’s great to see these two authors interested in ‘Art Therapy’ – noting one is a psychologist and one a health researcher. Some of the points are valid but some are missing accuracy and complexity. For example, Social Work in Australia is not a regulated title, it is a self regulating profession. So, Social Work sets a precedent for formal government recognition of a self regulating profession. There is a huge amount of confusion between the terms ‘regulation’ and ‘recognition’. Did you know that NASRHP is the National Association for Self Regulating Health Professions and it is the equivalent body to AHPRA for self regulating rather than government regulated professions? I agree with Cathy Malchiodi’s points that following the US model is not necessarily the best idea as it is fraught with its own problems. Looking to an international organization to regulate and represent the interests of Creative Arts Therapists here in Australia has also been shown to have many challenges, not least because they cover Australia, New Zealand and Asia, an area of some 50 countries all with their own legislation and health systems!
Thank you for your excellent points and thoughtful response here — becoming a self-regulating profession would be an excellent option for art therapy, especially considering the diversity of creative arts therapies and the diversity of the current workforce. However, that also presents its own issues around not being a protected title, which being a government-regulated health profession would offer and is considered gold standard for a health profession. It is a real balancing act – the flexibility of a self-regulating profession verses the legislative protections of a government-regulated profession! We wrote about aiming for government-regulated, as that would allow for the protection piece, but we agree that self-regulation would be incredibly suitable for this profession (and as the definition and engagement of self-regulating professions shifts in within the Australian health care system, may actually be a long term preferred solution) — that said, we think moving towards government regulation after becoming a self-regulating profession may be the best course of practice because it offers legislative protections. We also agree that the American system is fraught with their own legislative issues, as Cathy Malchiodi pointed out – however the Australian setting may allow us to pursue federal level support, bringing about consistency across the country, something that is much more difficult in the US, which is currently pursuing state-by-state legislative support (although that might be coming from a place of pure hopefulness!)
One thing we didn’t get a chance to unpack is the needed cultural change around arts therapies perception within healthcare, and how other health professionals understand and value art therapies; legislative protections around the role would also be helpful as part of that cultural shift within health care settings and communicating with other health professionals.
We agree that becoming self-regulating would certainly be a massive boost for the recognition of art therapy as a profession in Australia, but that regulation should certainly be pursued as a longer goal (acknowledging that this longer goal may be many, many years off!)