Background: Psychotherapy interventions increasingly utilize digital technologies to improve access to therapy and its acceptability. Opportunities that digital technology potentially creates for art therapy reach beyond increased access to include new possibilities of adaptation and extension of therapy tool box. Given growing interest in practice and research in this area, it is important to investigate how art therapists engage with digital technology or how (and whether) practice might be safely adapted to include new potential modes of delivery and new arts media.
Methods: An integrative review of peer-reviewed literature on the use of digital technology in art therapy was conducted. The methodology used is particularly well suited for early stage exploratory inquiries, allowing for close examination of papers from a variety of methodological paradigms. Only studies that presented empirical outcomes were included in the formal analysis.
Findings: Over 400 records were screened and 12 studies were included in the synthesis, pertaining to both the use of digital technology for remote delivery and as a medium for art making. Included studies, adopting predominantly qualitative and mixed methods, are grouped according to their focus on: art therapists’ views and experiences, online/distance art therapy, and the use of digital arts media. Recurring themes are discussed, including potential benefits and risks of incorporating digital technology in sessions with clients, concerns relating to ethics, resistance toward digital arts media, technological limitations and implications for therapeutic relationship and therapy process. Propositions for best practice and technological innovations that could make some of the challenges redundant are also reviewed. Future directions in research are indicated and cautious openness is recommended in both research and practice.
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Conclusion: The review documents growing research illustrating increased use of digital technology by art therapists for both online delivery and digital art making. Potentially immense opportunities that technology brings for art therapy should be considered alongside limitations and challenges of clinical, pragmatic and ethical nature. The review aims to invite conversations and further research to explore ways in which technology could increase relevance and reach of art therapy without compromising clients’ safety and key principles of the profession.
Digital technology is increasingly present in psychotherapy practice worldwide, enabling clients and therapists to connect remotely. This way of improving access to therapy is important for those who might not otherwise be able to benefit from treatment due to living in more remote locations or having disabilities or mobility problems preventing them to attend therapy sessions in person. Despite this general trend of expansion in telehealth provision, to include also psychotherapy services, relatively little is known about its use within art therapy practice (Choe, 2014; Levy et al., 2018). Research in the area focuses primarily on verbal therapies and more specifically on cognitive-behavioral therapy conducted online (Hedman et al., 2012; Saddichha et al., 2014; Vigerland et al., 2016) with some notable examples of work highlighting issues key to psychodynamic psychotherapy (De Bitencourt Machado et al., 2016; Feijó et al., 2018).
Art therapists support clients in engaging in creative processes to improve their psychological wellbeing. Due to incorporating art making within therapy process and the key role of triangular therapeutic relationship between the therapist, the client and the artwork (Schaverien, 2000; Gussak and Rosal, 2016), art therapy practice is arguably more difficult to translate to online situations. However, suggestions have also been made that art therapy is particularly well suited to distance delivery, partially due to increasing ease of sharing images via online channels and non-reliance on verbal communication, and also due to dealing with symbols, metaphors and projections, which can manifest irrespective of medium used (McNiff, 1999; Austin, 2009).
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Art therapy profession has not entered the digital world only recently. In fact, it has been critically engaged in often difficult discussions on the risks and potential of digital technology for art therapy practice for over three decades (Weinberg, 1985; Canter, 1987, 1989; Johnson, 1987). Back in 1999 the Art Therapy Journal dedicated a special issue to the links between computer technology and art therapy and has repeated a similar issue a decade later. In 2019, the Journal asked therapists and researchers to consider ways in which professional assumptions can be updated, modernized or reframed to meet contemporary needs.
The use of digital technology in art therapy is not limited to online communication tools but extends to the application of digital media for the purpose of art making, equally relevant to face-to-face practice. While distance art therapy could potentially widen the reach of therapy to include new groups of clients, expanding the range of therapeutic tools to include digital arts media might extend art therapy toolbox to widen access for those clients who might not otherwise engage in traditional art materials for a variety of reasons.
However, it has been argued that the process of digital media adoption in art therapy is slow (Carlton, 2014; Choe, 2014) and resistance to digital technology as well as concerns about the use of digital tools for art making in therapy have been reported in literature (Kuleba, 2008; Klorer, 2009; Potash, 2009). It has been even implied that art therapists themselves may be more conservative and hesitant in their use of digital media than their clients (McNiff, 1999; Peterson et al., 2005; Carlton, 2014). This cautiousness is stipulated to be informed by a heightened sense of responsibility for clients’ safety and wellbeing (Orr, 2016). Art therapists’ own emotional factors and biases were cited to be important barriers to adoption of technology (Asawa, 2009) while it has been suggested that therapists experience “conflict between the desire to promote art therapy and engage in technology and the desire to remain loyal to the field’s origins in traditional methods of communication and art media” (Asawa, 2009, p. 58).
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The use of digital arts media is unique to art therapy practice and is perhaps not yet sufficiently researched for that reason, despite its potentially enormous implications for art therapy practice (Kapitan, 2009). Lack of in-depth research on digital art making has been cited as a key barrier for practitioners to introduce digital arts media in therapy sessions (Klorer, 2009; Potash, 2009). Similarly, limited guidelines from professional associations and importance of more specific technology-oriented ethical codes for practitioners are frequently highlighted (Kuleba, 2008; Asawa, 2009; Alders et al., 2011; Evans, 2012).
A challenge identified in early stages of discussion on the use of technology in art therapy was the need for increased collaboration between art therapists, designers and developers in order to device technological solutions suitable to art therapy practice (Gussak and Nyce, 1999). Limited attempts to develop art therapy-specific electronic devices to date lacked in-depth input from art therapists at the technical stage and, in consequence, appropriate integration of the established processes of art therapy with technology (e.g., Mihailidis et al., 2010; Mattson, 2015). In effect, art therapists who incorporate digital arts media in their practice elect to use painting apps not necessarily suitable for art therapy practice. There is also an ongoing debate on the tactile nature of art materials being lost if art is made using digital tools and potential impact on clients (Kuleba, 2008; Garner, 2017). A similar discussion concerns the therapeutic relationship and specifically whether it could be recreated in distance therapy (Klorer, 2009; Potash, 2009).
Despite these indicated debates on the usefulness of digital technology for art therapy practice and polarized opinions, some scholars and practitioners have advocated for increased efforts to incorporate digital art-making in the therapy process suggesting rising and permanent role of technology in art therapy (McNiff, 2000; Kapitan, 2007; Thong, 2007). Given the rapidly growing interest in digital technology applications to art therapy practice, research has been developing relatively slowly and has not yet been systematized. Doing so would help paint an inevitably complex picture of how art therapy is currently engaging with digital technology and how it might make the best use of the opportunities it presents and critically address challenges early in the process.
What Is Shared Nothing Architecture? Definition
In order to identify key topics important for practitioners and areas for further research, we aimed to capture and synthesize available research literature that explores the role of digital technology in the current and future art therapy practice (understood here as within-session work with clients). More specific research questions were:
Through our own experiences in research and practice and following some initial literature searches we were aware that the area we set to explore is complex and relatively novel. Thus, we anticipated that any published research accounts were likely to include a variety of study designs, appropriately to the overall exploratory character of research in the area and in line with research in arts therapies in general, which tends to draw upon diverse methodologies and beyond qualitative and quantitative paradigms, to include also arts-based approaches. We chose an integrative review framework as a guide to allow us to undertake a well-rounded but flexible evidence synthesis that would present a breadth of perspectives and combine methodologies without overvaluing specific hierarchies of evidence (Whittemore and Knafl, 2005). Integrative review is an appropriate method at early stages of systematizing knowledge on a developing subject area (Russell, 2005; Souza et al., 2010) and as such
The use of digital arts media is unique to art therapy practice and is perhaps not yet sufficiently researched for that reason, despite its potentially enormous implications for art therapy practice (Kapitan, 2009). Lack of in-depth research on digital art making has been cited as a key barrier for practitioners to introduce digital arts media in therapy sessions (Klorer, 2009; Potash, 2009). Similarly, limited guidelines from professional associations and importance of more specific technology-oriented ethical codes for practitioners are frequently highlighted (Kuleba, 2008; Asawa, 2009; Alders et al., 2011; Evans, 2012).
A challenge identified in early stages of discussion on the use of technology in art therapy was the need for increased collaboration between art therapists, designers and developers in order to device technological solutions suitable to art therapy practice (Gussak and Nyce, 1999). Limited attempts to develop art therapy-specific electronic devices to date lacked in-depth input from art therapists at the technical stage and, in consequence, appropriate integration of the established processes of art therapy with technology (e.g., Mihailidis et al., 2010; Mattson, 2015). In effect, art therapists who incorporate digital arts media in their practice elect to use painting apps not necessarily suitable for art therapy practice. There is also an ongoing debate on the tactile nature of art materials being lost if art is made using digital tools and potential impact on clients (Kuleba, 2008; Garner, 2017). A similar discussion concerns the therapeutic relationship and specifically whether it could be recreated in distance therapy (Klorer, 2009; Potash, 2009).
Despite these indicated debates on the usefulness of digital technology for art therapy practice and polarized opinions, some scholars and practitioners have advocated for increased efforts to incorporate digital art-making in the therapy process suggesting rising and permanent role of technology in art therapy (McNiff, 2000; Kapitan, 2007; Thong, 2007). Given the rapidly growing interest in digital technology applications to art therapy practice, research has been developing relatively slowly and has not yet been systematized. Doing so would help paint an inevitably complex picture of how art therapy is currently engaging with digital technology and how it might make the best use of the opportunities it presents and critically address challenges early in the process.
What Is Shared Nothing Architecture? Definition
In order to identify key topics important for practitioners and areas for further research, we aimed to capture and synthesize available research literature that explores the role of digital technology in the current and future art therapy practice (understood here as within-session work with clients). More specific research questions were:
Through our own experiences in research and practice and following some initial literature searches we were aware that the area we set to explore is complex and relatively novel. Thus, we anticipated that any published research accounts were likely to include a variety of study designs, appropriately to the overall exploratory character of research in the area and in line with research in arts therapies in general, which tends to draw upon diverse methodologies and beyond qualitative and quantitative paradigms, to include also arts-based approaches. We chose an integrative review framework as a guide to allow us to undertake a well-rounded but flexible evidence synthesis that would present a breadth of perspectives and combine methodologies without overvaluing specific hierarchies of evidence (Whittemore and Knafl, 2005). Integrative review is an appropriate method at early stages of systematizing knowledge on a developing subject area (Russell, 2005; Souza et al., 2010) and as such
