Young Adults in Art Therapy: an Ipa Analysis
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Running head: YOUNG ADULTS IN ART THERAPY: AN IPA ANALYSIS Portfolio Volume 1: Major Research Project Experiences of Art Psychotherapy in Early Adulthood: An Interpretative Phenomenological Analysis Katerina Alexandraki June 2019 Submitted to the University of Hertfordshire in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology. Student number: 14116770 2 3 Acknowledgements A special thanks to the participants of this study, for generously sharing with me their experiences. I would like to express my gratitude to my first therapist, Evita Zafeiropoulou, who helped me make sense of my experiences through creativity. Thank you to my late mum, for all the pebbles we painted together in my early years and to my dad who has always supported my bold steps, even when these led me to a country away from him. Thank you to my partner, David, for supporting this work with all his resources. I am very grateful to my library buddies, for being on my side. I would like to thank my supervisors Dr Pieter Nel for welcoming my queries, concerns and celebrations, Prof Jonathan Smith for his rigorous supervision and Prof Dominik Havsteen- Franklin for his insights. 4 Contents Acknowledgements 3 List of Tables & Figures 9 Abstract 10 Chapter 1: Introduction 11 1.1 Overview 11 1.2 Personal and Epistemological Positions 11 1.2.1 Personal interest 11 1.2.2 Epistemological position 13 1.3 Therapies for Young Adults 14 1.4 Definitions of Art Therapy 15 1.5 Historical and Cultural background of Art Therapy 15 1.6 Approaches in Art Therapy 20 Chapter 2: Systematic Literature Review 23 2.1 Overview 23 2.2 Search Strategy 23 2.3 Overview of Papers 26 2.4 Participants 26 2.5 Evaluation of the Research 27 2.6 Synthesis of findings 38 2.6.1 The role of ‘context’ 38 2.6.2 Main themes emerging from Art Therapy intervention with young adult 39 2.7 Implications for practice 46 2.8 Conclusion 47 2.9 Rationale for Present Study 48 5 Chapter 3: Methodology 50 3.1 Overview 50 3.2 Design 50 3.3 Consideration of Methodologies 51 3.3.1 My epistemological position 52 3.3.2 Interpretive phenomenological analysis (IPA) 53 3.3.3 Phenomenology 53 3.3.4 Hermeneutics 54 3.3.5 Ideography 54 3.3.7 Limitations of IPA 55 3.4 Service User Involvement 56 3.5.1 Recruitment 56 3.5.1 Participants. 57 3.6 Ethical Considerations 58 3.6.1 Ethical approval 58 3.6.2 Informed consent 58 3.6.3 Confidentiality 59 3.6.4 Risk of distress to participants. 60 3.7 Impact of Recruitment on Study Design 61 3.8 Data Collection 61 3.9 Interview Procedure 63 3.10 Data Analysis 63 3.11 Quality Assurance 66 3.11.1 Sensitivity to context 67 3.11.2 Commitment and rigour 68 3.11.3 Coherence and transparency 69 6 3.11.4 Impact and importance 70 3.12 Acknowledging the 'Hermeneutic Turn' 70 3.13 Summary of Themes 71 3.14 Presentation of Outcomes 72 Chapter 4: Results 73 4.1 The Process of Engagement 73 4.1.1 Initial trepidation 73 4.1.2 Expanding the repertoire of engaging in art-making 74 4.1.3 Finding pleasure in immersing in art-making 76 4.1 Developing a Therapeutic Relationship 78 4.2.1 The intensity of surveillance 78 4.2.2 The challenge of trusting the therapist 79 4.2.3 Developing trust through feeling validated. 81 4.2 Making Sense of Presenting Difficulties through Making Art 83 4.3.1. ‘Juni’ 84 4.3.2 ‘Emily’ 88 4.3.3 ‘Cerys’ 93 4.3.4 ‘Daniel’ 96 4.3.5 ‘Niki’ 97 4.4 Reconnecting with Child Self through Art-Making 99 4.4.1 Fond memories of childhood emerging during art-making 99 4.4.2 Making sense of painful childhood feelings through reviewing the artwork. 100 4.4.3 Growing compassion for child self 101 4.4.1 Feeling the Impact of Art Therapy 103 4.5.1 Feeling enabled to express a full range of emotions. 103 4.5.2 Art Therapy as a learning experience 104 7 Chapter 5: Discussion 108 5.1 Overview 108 5.2 Summary of Findings 108 5.3 Discussion of the Research Findings 109 5.3.1 Participant's context and characteristics 110 5.3.2 The process of engagement 111 5.3.3 Developing trust in the therapeutic relationship. 113 5.3.4 Making sense of presenting difficulties through making art 115 5.3.5 Reconnecting with childhood through art-making. 118 5.4 Implications 123 5.4.1 Clinical implications. 123 5.4.2 For training 125 5.4.3 For service development 125 5.4.4 For Art Therapy research 126 5.5 Strengths and Limitations of the Study 126 5.6 Suggestions for Further Research 128 5.7 Final reflections 129 5.8 Conclusion 131 References 132 Appendix A: Details of Systematic Literature Review Search 143 Appendix B: Quality of the research utilised in the Systematic Literature Review 145 Appendix C: IRAS Ethical Approval 151 Appendix D: UH Ethical Approval Notification 153 Appendix E: Consent Form 154 Appendix F: Consent Form for young people under 18 155 Appendix G: Debrief Sheet 157 8 Appendix J: Risk Assessment Form 158 Appendix K:Participant Information Sheet 161 Appendix L: Interview Schedule 163 Appendix M: Example of analytical process from transcript to final themes and quotes 164 Appendix N: Cross-referencing of emerging themes across transcripts 179 Appendix O: Extracts from Reflective Diary 181 Appendix P: Evaluation of Present Study based on Guidelines for Qualitative Research 184 Appendix Q: Reflective artworks 186 9 List of Tables & Figures Table 1 Summary of inclusion and exclusion criteria 26 Table 2 Evaluation of Recommended Guidelines for the 36 Qualitative Research Papers of the Review Table 2 Evaluation of Recommended Guidelines for the 37 Quantitative or Mixed Methods Research Papers of the Review Table 3 Demographics of participants 58 Table 4 Super-ordinate and Sub-ordinate Themes . 71 Figure 1 Results when inclusion criteria broadened to all Art 25 Therapy interventions for young adults Figure 2 Juni’s artwork during her first session 84 Figure 3 Juni’s artwork during her seventh session 86 Figure 4 Emily’s artwork during her first session 88 Figure 5 Emily’s drawing during session six 90 Figure 6 Cerys’ first artwork. 93 Figure 7 Cerys artwork during session seven 95 Figure 8 Emily’s clay object 107 10 Abstract This study was concerned with exploring young people’s experiences of engaging in individual Art Therapy sessions. An exploratory research question was formulated and addressed using a qualitative methodology. Five young adults were recruited through voluntary organisations and art therapists in private practice. Participants took part in semi structured interviews, which were analysed using Interpretative Phenomenological Analysis. Five master themes were constructed from the data: From an initial trepidation, young adults engaged with art materials, enjoying parts of the process. They felt under observation by their art therapists, and they overcame the challenge of trusting their therapist when they felt emotionally validated and understood. They made sense of their presenting difficulties through their art-making, gaining further psychological insight. They felt connected with their childhood, recalling fond memories and feeling compassion for their child self. They considered the impact of Art Therapy sessions as a learning experience. These findings highlight the need for further research to explore further the process of making sense of difficulties through art, and the therapeutic value of connecting to one’s childhood. Art Therapy can be experienced as a rewarding learning process, that helps young adults express and process their difficulties. Its benefits should be therefore communicated to referrers, service users and service developers, as it is a therapeutic mode that may offer different experiences to talking therapies. 11 Chapter 1: Introduction The aim of art is to represent not the outward appearance of things, but their inward significance. (Aristotle) 1.1 Overview This chapter will initially introduce the reader to the researcher's personal interest in the subject matter and will discuss the epistemological basis for the conduct of this research project. The author will provide the definition of the term "Art Therapy" as perceived for this project, covering an overview of how Art Therapy developed as a profession in the United Kingdom. An orientation of the reader to main models used in Art Therapy will follow. A systematic review of the literature will be discussed, followed by the aims and questions of the research proposed. 1.2 Personal and Epistemological Positions 1.2.1 Personal interest. Every study of any phenomenon needs to consider the context in which these phenomena occur: Mooney and Moran (2002) quote Heidegger to highlight "that phenomenology must be attentive to historicity, or the facticity of human living, to temporality, or the concrete living in time" (Mooney and Moran, 2002, p.20). From this perspective, the research context, the personal biographies of researcher and participant will influence how they perceive and make sense of the phenomena under research (Peshkin, 1985). Having considered this, it is essential to provide background information regarding my personal interest in the subject of this study. 12 In my adolescent years, I had the privilege to be introduced to creative therapies. From the first moment of engaging with art materials to express my experiences, I enjoyed visually representing my thoughts, feelings and my emerging identity as a young woman. As a young adult, I attended a Drama Therapy group.