The identity of the creative arts therapist: Guided by ethics

The Arts in Psychotherapy, Vol. 22, No. 4, pp. 283-295, 1995 Copyright 0 1995 Elsevier Science Ltd Printed in the USA. All rights reserved 0197-4556/95 $9.50 + [email protected]

Pergamon 0197-4556(95)00042-9

PERSPECTIVE THE IDENTITY

OF THE CREATIVE

MYRA F. LEVICK,

ARTS THERAPIST:

PhD, A.T.R.-BC,

The past 25 years have seen the birth of an American Art Therapy Association (AATA), tremendous growth and change in the education and practice of creative arts therapists in the field of mental health. Concomitant with this growth and development, the role of the arts therapist, along with other non-MD mental health workers, has been defined and redefined in a myriad of actions and responsibilities. Some of these expressions of our roles and identities have, in recent years, seemed foreign and even dis-

GUIDED BY ETHICS

HLM*

all facing, broadened my perspective of this theme to include not just recovery through activity for the student, client or patient we work with, but recovery for the therapist through activity. As an educator who started training creative arts therapists in 1967 and interfacing with all other professionals in this field, a paramount concern was always consideration of changes in our society and how this impacted on our development and credibility, our roles and responsibilities. In discussing my approach to this keynote task with an artist friend, she said she visualized a bridge. This was very interesting to me because bridges are often drawn by patients to symbolically represent past and future; bridge drawings also have been designed by Hays and Lyons (1981) for assessment and by Dulicai, Hays and Nolan (1989) as a metaphor for training. My friend envisioned a bridge in a beautiful pastoral setting, something many artists have painted. One such “The Tempest,” by Giorgione, sparked a response from me. John Canaday, when he was curator at the Philadelphia Museum of Art (1959) reported that the original meaning of the painting was lost and the title is an arbitrary one because no one knows what Giorgione called it, but it is very provocative. Not only does the bridge seem to be coming from nowhere on one side, but it is connected to what appears to be a solid rock on the other. And no one is on it. The young woman nursing the baby certainly appears uninterested in her surroundings, including

turbing . The spectrum of my thoughts and concerns were recently given voice in an invitational article celebrating the 25th anniversary of the American Art Therapy Association (Levick, 1994). A later invitation to give the keynote address at the 13th Annual Therapeutic Activities and Leisure Skills Conference, March 1995, provided both the opportunity and direction to re-organize and present my reflections and conclusions relevant to who we are and what we do. The theme of this conference was “Recovery Through Activity. ’ ’ As someone pointed out, we are mostly action-oriented therapists. Even those of us who have moved into the teaching and administrative arenas were originally engaged professionally in providing some form of activity for the people with whom we worked. And as administrators and/or teachers, I believe most of us have continued to maintain this orientation. These ruminations, along with the changes in medicine, mental health and education that we are

*Myra Levick, former Director of the MCAT Program at Hahnemann University, is a founder and first President of AATA. She is currently residing in Boca Raton, Florida and is a consultant to Dade County School District, on the Board of the Donna Klein Jewish Academy and guest lecturer at universities throughout the country teaching art therapy and psychology.

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the bridge and the young man gazing at her. Canaday spoke of her isolation and how this allows us to freely imagine whatever we will. I see her as symbolic of some of us-creative arts therapists nurturing ourselves in isolation of others. And unless we take action we will sit on the bank and never get across that bridge. I ask, why go across? Where are we coming from? And where are we going? The field of mental health has traditionally been dominated by medical doctors. The medical profession is in a state of enormous change; we see it around us. Now, more than ever we must bridge every gap we encounter and know who we are, what we have to contribute to identify our roles and responsibilities in relationship to each other and to those we may have to answer to. We must not remain isolated on the bank. Giorgione’s painting intrigued me because the foundation on one side is obscure. For the bridge to be solid and support us, the foundation must be a structure that will not fail us. And I believe the first layer of that structure for us must be training. As I noted above, The American Art Therapy Association celebrated its 25th anniversary this year. Past presidents, honorary life members, those receiving special service awards were each invited to write an article in response to two questions: How will the profession of art therapy change in the next 25 years and what is your vision of the 21st century art therapist? As the first president of that Association, and forgive the play on words, I have seen much water under the bridge. The recent confrontation with that historical past in my own discipline of art therapy greatly influences what I submit here. Some of the examples, concerns, recommendations given naturally emanate from those experiences primarily connected to art, music and dance therapy, the three graduate programs I directed at Hahnemann University. But I believe and hope to demonstrate that we share much with many others in the field of mental health in how we identify ourselves and how this identity is reflected in the roles we assume as responsible and ethical professionals-in the past, present and future. For me, training is the cornerstone of our development. Within that training, role definition is crucial. Certainly I do not presume to critically discuss the different training programs offered in the arts therapies. But all of us have been in the position of choosing one program over another-some for pragmatic reasons and others because we wanted a particular

orientation or approach. In some fields, we know that professional entry is at the graduate level, in some it is at the undergraduate level and in some fields it is accepted at both levels. In many educational and clinical situations these differences present no problem. However, where there is a serious financial consideration, these differences may impact to a greater degree in terms of employment. Art therapy chose to make graduate training the professional entry level, as did dance/movement therapy. Music therapy for many years remained at the undergraduate level until faced with a strong group that advocated graduate training at the master’s degree level. The art therapy training program at Hahnemann University, the first leading to a master’s degree, was directed by an MD psychiatrist and most of the didactic courses were taught by the staff psychiatrists. The Director, the late Morris Goldman, and some of the (new) Hahnemann staff were the people who trained me before there were training programs. These professors did not give lip service to their support of the therapeutic arts. They acted on it. There were pluses and minuses in this process. On the one hand we were accepted as professionals, practitioners of a new and exciting discipline. On the other hand we were never intended to hold positions of authority. We reported to the director, our supervisors, all psychiatrists. The biggest plus was and is the fact that our students were taught the same principles of ethical responsibility that were taught the medical students and psychiatric residents. Our teachers wrote articles stating these principles. In 1973, Paul J. Fink, MD, then Director of the Division of Education and Training, Richard A. Newman, MD, Director of Residency Training Program and V. Michael Vaccaro, MD, Director of Group Psychotherapy, Hahnemann Medical College and Hospital each published an article in Philadelphia Medicine pertaining to our training program. Fink discussed art therapy training and described the field as “unique among the psychotherapies in that it is almost universally applicable, either directly or indirectly applied, and is devoid of the usual stigma associated to the one to one talking kinds of therapies” (1973, p. 239). He went on to say that it combines the best principles of psychological testing, individual verbal therapies, nonverbal methods of communication, harnessing and utilization of universal and/or individualized symbols and the personal creative potential of the

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patient. At the same time it avoids some of the rigidities and difficulties of older more formalized methods. But in the same year, these glowing terms were tempered with the statement that art therapy, as conceived “is a major form of adjunctive therat Hahnemann, apy and part of the total case of all patients” (Fink, 1973). At that time we did not object to being adjunctive. Given the general attitude toward adjunctive therapies, Dr. Fink was a strong advocate for us, placing us in an enviable position. In his paper he listed 10 behavioral objectives that should be the underlying goals of any art therapy program (Figure 1). As you can see, they are objectives that were applicable to residency training and could be applied to mental health training programs in other disciplines as well. In his article, Fink frankly described the criticism of our curriculum from other quarters as being too rigid, too psychoanalytic, too limiting and so on. I mention this here because it has bearing on what I wrote 21 years later. I confess, I had not read this paper in years until I retrieved it from my files in preparation for the keynote presentation. Fink’s belief in this educational construct is demonstrated by the replication of this model when he became Chairman of the Department of Psychiatry at Eastern Virginia Medical School. Not surprisingly, these programs are alive and well and continue to be held in high regard. I quote here another statement because it is relevant to the whole issue of identity and ethical responsibility. In his concluding remarks, Fink stated: The thing which makes art therapists different than other types of professionals in the mental health field is their opportunity for creative therapeutic work but with natural built-in limitations so that role definition is neither complicated nor worrisome. The art therapist does his thing. He is not seen as an interloper or someone who will take another worker’s job. The skills are self-evident and the person is usually most confident as an artist so the title and role seem to fit easily. (1973, p. 243) Should this not hold true for each of us in our specific disciplines? On the bridge foundation of training, I would add bricks that represent basic knowledge, competency, empathy, compassion, patience, limita-

ARTS THERAPIST The following behavioral underlying

objectives should be the

goals of any Art Therapy Program.

1. The student should be knowledgeable of psychiatric and psychoanalytic theory of Human Growth and Development. 2. The student should be knowledgeable of The Psychiatric and Psychoanalytic Theory of Psychopathology. 3. The student should be competent in the treatment of both children and adults. 4. The student should be competent in both Mental Health and Educational settings. 5. The student should be competent in individual, family and group Art Therapy techniques. 6. The student should have attitudes which make him/her a therapeutic agent--empathy, compassion, patience. 7. The student knows the limitations of Art Therapy and the relationship of the Art Therapist to other members of the Mental Health and Educational Teams. 8. The student has a firm picture of himself as a member of an allied health profession with specific skills to carry out specific therapeutic tasks. 9. The student will know skills of other therapies,particularly individual and group psychotherapy in order to be able to participate maximally in the activities of the milieu or The Team and in order to modify these skills for Art Therapy application. 10. Optional: The student should know the elements of dance and rhythm therapy and role playing in order to be a director of ancillary therapies if such positions become

available

to the graduate.

Figure

1. Training Objectives. From “What is art therapy training?” by P. Fink, 1973, Philadelphia Medicine, 69, 239-243. Copyright 1973. Reprinted with permission.

tions and relationship of self and educational teams. Newman (1973) addressed pervision of the art therapist. with the statement that “much

to other mental health the problems of the suYet he began his paper of what will be said in

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this paper could apply to the supervision of any psychotherapist” (p. 245). Aside from the fact that he saw art therapists as more trusting of their intuitive feelings than examining concepts from a cognitive perspective, his paper dealt with more general principles and problems that are present in supervising students from all mental health disciplines. His strongest caveat was not to turn supervision into therapy. This certainly applies to all students working with disturbed populations. He objected to the terms supervisor and supervisee, stating they suggest a superior and inferior position. Newman would prefer to consider supervision consultation between colleagues. And he posited duties of the consultant under two classifications: to protect and to encourage. Under protection, he listed ambition for patients and ambitions for therapy, onslaught against their own defensive structure as therapists, fantasies of what patients are, from one’s own moral structure that might interfere with the therapeutic technique and, finally, the demands students make on themselves. Newman would require consultants to encourage a sense of responsibility, trust their own intuition, use their own feelings, avoid the usual supervisor/supervisee relationship and build a “total model of the patient so that they will not be sidetracked by minor issues” (1973). These points are eloquently elaborated in his paper and apply to everyone training to be a therapist. Supervision, or consultation, in Newman’s words, is an integral part of training and becomes another brick in the structural support of our bridge. The responsibility of the art therapist is the topic of the paper written by Vaccaro (1973). A quote by the French philosopher, Jacques Maritain, serves to set the tone of this article: Art taken in itself tends to the good of the work, not to the good of man, and its transcendent end is beauty, an absolute which admits of no division . . . . however, the painter (artist) is not the art of painting, nor is merely a painter. He is also a (person), and he is a (person) before being a painter. (Vaccaro, 1973, p. 253) Vaccaro further identified his focus in the first paragraph where he referred to the newly formed Art Therapy Association in the process of “formulating guidelines for training; validating research; and of promulgating an ethical code of professional conduct for its members. ” Vaccaro described art therapy as a branch of psychiatry, an “ancillary form of psycho-

therapy which utilizes the material and techniques of the arts as a nonverbal means of communication between the therapist and patient (or groups of patients). ” He saw the competent art therapist as “expert” in the therapeutic relationship. And in this role he ascribed to the art therapist the same responsibilities and moral obligations that the psychiatrist has to his patient. Vaccaro felt that describing art therapy as a branch of psychiatry “provides greater latitude of clinical activity and experimental work. ” He gave the art therapist-not the psychiatrist-the important task of defining the “nature and operation of their limits.” He stated “ethics in its strictest sense is defined as the science of moral duty. In its broader sense, it is a search for an understanding of the ideal human being.” In concluding, he was very clear about the role of the art therapist, who, because he is a therapist, “must share in the psychiatrist’s traditional role of assuming responsibility for the total care of the patient.” In his view, “the elaboration of its ethical code will in large measure determine the ultimate success or failure of” art therapy (1973, p. 256). I add the final brick to the foundation of our bridge-ode of ethics. And as I continue, we will see that I have already noted some points that reflect this code and others below will reinforce this code. When these papers were written in 1973, I had years before been made an Assistant Professor and Director of the program at Hahnemann. I authored the introduction to these papers and am credited with preparing this particular issue of Philadelphia Medicine (Levick, 1973). The position of Director was not achieved because all barriers between non-MDs and MDs were eliminated at Hahnemann. It was, in fact, the result of a tragic event and academic default. In less than a year after the program had been initiated at Hahnemann under the leadership of Dr. Goldman and Dr. Fink, Dr. Goldman, at age 39, died suddenly of a coronary. He was an extraordinary man and it took all of us many months, many group meetings and much grieving to recover from this professional and, for some of us, personal loss. Finally, before the beginning of the second school year, we met in the office of the Dean of the Graduate School. “We” included Dr. Fink, Dr. Van Hammet, the then Chairman of the Department of Psychiatry, the Dean, Dr. Bondi, myself and other members of the Graduate School Council who were Chairmen of programs in the medical school. I well remember Dr. Bondi asking the psychiatrists present “who was going to direct this (art therapy) program?” Each one responded that

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in fact he knew very little about the structure or organization of the program, less about art therapy. Dr. Bondi, with whom I had worked closely to organize the program initially and maintain it after Dr. Goldman’s death, confronted the heads of the psychiatric department and suggested it was time to allow a nonMD to assume the title of Assistant Professor and Director. This was met with shock, and relief. In 1968 I assumed those roles. Support never wavered and continues to this day. It was a significant step forward, albeit uphill. Although the creative arts therapies continued to be identified as adjunctive or ancillary therapies, the interaction between creative arts therapists and educators with special populations, and the future of these therapies, was a major point of discussion at the American Art Therapy Association’s annual conference in Virginia Beach in 1977. The presenters included music therapists Richard Graham, Edwin Hammer; psychodramatist Robert W. Siroka; dance therapist Judith Bunney; the healing roles of the arts Michael Jon Spencer; poetry therapist Sherry Reiter; art therapists Don Jones, Felice Cohen and myself. These papers were published in The Arts in Psychotherapy, Vol. 5, No. 1, 1978 (b). They raise many provocative questions regarding identity issues, limits, boundaries, accountability for treatment. Graham urged that we move with the times, modify our theoretical structures from the psychoanalytic to the Behavioral approach and be able to serve in all settings (Graham, 1978). Bunney, who represented the creative arts therapies on the President’s Commission on Mental Health, initiated by Roslyn Carter, cited a landmark event-the inclusion of the creative arts in the National Bill 94-142 on Education for the Handicapped. Occupational therapy and other therapeutic modalities were already included in Individual Educational Profiles (IEPs). But Bunney pointed out that our future was on the line and yet to be explored by the President’s Commission on Mental Health (1978). The other presenters spoke to the state of their respective modalities and concerns for the future. The question of research was raised and this, all agreed, is critical if we are to be accountable. Michael Spencer, who was the Executive Director of Hospital Audiences, distinguished between bringing the arts to hospitalized patients and utilizing the arts for therapy (1978). Hammer (1978) proposed a model for interdisciplinary approaches to therapy for the developmentally disabled and psychiatrically handicapped. He emphasized that “if roles can be identified in

ARTS THERAPIST terms of the needs of the client, integrated services may begin to emerge.” This was particularly interesting to the Hahnemann creative arts faculty. The original art therapy program had been expanded to include dance/movement and music therapy graduate training. It was in process when Fink wrote his paper on training in 1973 and suggested (in training objective #IO, Figure 1) that our students should know the elements of dance, rhythm therapy and role playing so that should they ever become directors of ancillary therapies they would be able to implement a comprehensive program. Fink, like Hammer, was by no means implying that an arts therapist could be a jack of all trades. The objective for Hammer was for therapeutic arts therapists to know and respect each other’s skills, to identify needs of their populations, recognize which approach or approaches would be most suited, and to work together for the benefit of the patient. This was and is the philosophy of the Master’s of Creative Arts in Therapy program at Hahnemann University. It is a philosophy that I believe should be part of any multidisciplinary approach. In this program there was and is an art, dance/movement and music therapy Director (Levick, 1978a). Although the students take core didactic courses together and some combined workshops, their skills courses in their modality are separate and taught by qualified experts in their individual fields. This program is described in detail in an article by the then directors, Diane Dulicai, ADTR, Ronald Hays, A.T.R. and Paul Nolan, MT-BC (1989). Their subtitle is “Identity with Integration” and demonstrates the need for therapeutic arts therapists to be competent in their chosen area, knowledgeable of the skills of their peers in other disciplines and open to referring and sharing where the needs of the patient indicate this. I concurred with Dr. Graham that we must “move with the times,” but to embrace one theoretical approach over another does not necessarily benefit the people we are trying to help. However, back in the 70s and 8Os, the word eclectic was not acceptable in any specific theoretical milieu. As we struggled with our core curriculum in a predominantly psychoanalytic community, we recognized that different patient needs dictated different treatment approaches theoretically as well as in the therapeutic arts. This will be addressed again later. But it is important here to note that in the late 70s many of us were also struggling to define our identity within the parameters of role definition and ethical responsibility to our patients on a different level from

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our MD directors and supervisors. Although there has been progress, I do know that even today these boundaries and roles are ignored. I cite an article that appeared just last year on the front page of the Wall Street Journal describing a new, exciting programan artist in Baltimore obtained a very sizable grant to bring artists into a nursing home. Not only was this program described as unique, but different from regular art therapy programs that “just have people sit around in groups and paint.” In addition, the article quoted the originator of this program, praising how the artists she engaged to work one on one with the elderly could deal with their own demons in this setting. This was an appalling article. It not only distorted the professionalism of an established and now respected discipline, it exploited the nursing home residents for the needs of the participating artists. Unbeknownst to each other, I and another art therapist wrote to the Wall Street Journal. Our letters were not published-no surprise. We then both simultaneously wrote to our Newsletter protesting the lack of monitoring of ethical and moral responsibilities within our association. Back in 1979, our sometimes ambivalent mentors did confirm our value and contribution to the field of mental health. Funded by the Maurice Falk Medical Fund, a day and a half meeting about the creative arts therapies was held in June of 1979, sponsored by the American Psychiatric Association. The conference report was published in Hospital and Community Psychiatry, 1979 and was written by Barbara Armstrong, the Assistant Editor. Armstrong referred to the arts therapies as the emerging therapies following on the heels of “psychologists, psychiatric social workers and psychiatric nurses to win recognition as legitimate, autonomous mental health professionals.” However, her review of the field was not optimistic. She quoted the task panel on the arts of the President’s Commission on Mental Health, which stated that “the arts have not been sufficiently used to understand, let alone treat, the patient” (Armstrong, 1979). She noted that we could not get third-party payments; the most frequent point of entry was through jobs in prisons or state hospitals or other places that more established professionals shun. She continued to report that our job descriptions were often so broad that no distinction is made between the very different talents and skills needed in each of the fields. The President’s Commission did commend the arts for being able to reach psychotic patients on a nonverbal level, but generally this task force did not serve

us well. There are a variety of reasons for this, much too complex to consider here. Armstrong went on to discuss our “Identity Dilemmas.” She saw arts therapists dealing with a dual identity-performing artist and art therapist--creating a conflict for the artist unwilling to compromise his or her artistic integrity for the therapeutic process. She noted that the two psychodrama institutes had strict standards for training, while the Art Therapy Association did not. For her article, Armstrong met with Shaun McNiff, the then Standards Chair of the AATA. He informed her that the less strict training standards for art therapists was a conscious effort to maintain a strong commitment to keep the field of art therapy open to those people who perhaps don’t follow the straight hierarchical order of education (a commitment that has come to haunt us, as I will discuss later). At the same time dance therapy was becoming more precise in their standards, the Music Therapy Association was demanding an internship and setting up a retrieval system for research. But the report and this article did motivate the leaders of the different arts therapies to become more aggressive in promoting our qualifications. Now, two more bricks need to be added to the structure of our bridge-standards and research. In spite of the negative perspective, we did have our strong supporters. Armstrong cited Bertram S. Brown, MD, former Director of the National Institute of Mental Health, who believed the therapeutic use of the arts will be “possibly the most important social movement of the 1990s” (Armstrong, 1979). In the same issue of Hospital & Community Psychiatry, Dr. Israel Zwerling, the then new Chairman of the Department of Mental Health Sciences at Hahnemann published an article titled, “The Creative Arts Therapies as Real Therapies.” In this paper, Zwerling (1979) made an important distinction between diagnosis and treatment. He acknowledged that, when the arts therapies were primarily used for diagnosis, there was little concern as to whether they were real therapies or adjuncts. He referred specifically to art, music and dance therapies because they were the ones he had observed the most. In this four-page article, Zwerling gave many cogent reasons and impressive examples as to why we should be identified as real therapies. He listed the criteria for every psychotherapist-removing, modifying or retarding existing symptoms, of attenuating or reversing disturbed patterns of behavior, promoting positive personality growth and development, be a trained person. With a number of case examples, he demonstrated how these

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criteria are met. Zwerling was very resolute in pointing out that every therapist in this field, including psychiatrists, are sometimes adjunct therapists and sometimes primary therapists. And he negated the singling out of the non-MD as exclusively adjunct. This paper is a must for our students. We were there and treasured this much-needed support. I am confident that every therapist has experienced the frustration of being identified as ancillary when in fact you know you have served as the primary therapist. Zwerling, never one to hesitate to say what he thought, closed his article with the admonition that mental health professionals who set out to cure diseases, and especially those who know that the diseases they are treating will be cured once they have balanced serotonin levels, or when they have made the unconscious conflict conscious, or when they individuated a family member from the undifferentiated family ego mass will make little use of other therapeutic arts. He added that those who organize programs to treat people rather than to cure disease will find arts therapists invaluable (1979, p. 844). Having had the privilege to work with Dr. Zwerling for the 10 years before his retirement, and supervise staff within many programs under his leadership, I know that everyone on the treatment team, regardless of discipline, was an equal member and equally responsible. But our graduates as well as many other professionals in this field have learned the real world does not always have a Dr. Zwerling as a chairperson or advocate. Concerns about professional identity are certainly not mine alone. Over the past two decades there have been numerous articles and conference presentations. More often these have centered around credentials, entry level of training and changing times. To document this, I refer the reader to conference proceedings from the various arts Associations. As one example, at the conference where my keynote address was delivered, the session that followed was titled “The Future of Professionalism in Therapeutic Recreation” (Medical College of Pennsylvania, 1995). In 1994, The Arts in Psychotherapy published an article on this

‘The American Art Therapy Association, Association for Drama Therapy, American Psychotherapy and Psychodrama.

ARTS THERAPIST subject by a respected colleague. I refer to it here because it not only weakens our structure, but is a denigrating perspective. Dr. David Johnson, a drama therapist and former Chairperson of the National Coalition of Arts Therapy Associations (NCATA) titled his paper “Shame Dynamics Among Creative Arts Therapists. ” He proposed that many of the difficulties that creative arts therapists and their Associations “are having stem from an underlying dynamic of internalized shame that is now interfering with our progress.” Johnson is a brilliant writer and does his homework well before trying to make his point. His premise is based logically (according to him) that we are a shamed culture, that artists, therapists and mostly women are humiliated throughout their careers. America, he purports, is fundamentally a “masculine, pioneer spirit.” I further quote, “the body, the abstract and the unconscious are suspect, are all feminine or, worse, homosexual, which is the perceived antithesis of the primary American Cultural norms” (p. 173). So much for the feminist movement. He went on to state that these attitudes and behaviors of other professionals we work with, particularly doctors and nurses, form a significant threat to our identity. He did give a number of examples that are undoubtedly familiar to all of us: having a patient taken out of an activity because a doctor is ready for his or her session with another patient, workmen being allowed to interrupt an activity session, no permanent space in which to conduct our activities, and so on. He concluded that this treatment causes shame and therefore we have become immobilized, isolated, unable to compromise, fragmenting our organizations Johnson had a vision, one I shared with him: that the National Coalition of Arts Therapies Associations’ would “join together in a larger multidivisional entity that will save money, increase power and serve its membership” (Johnson, 1991). This has not happened. His reason for this failure is shame of who and what we are, “that (this shame) has hindered our professional development in “internal problems within each discipline, problems in our associations and in our relationships with other mental health professionals” (1994, p. 176). I do agree that we have some of these problems,

National Association for Music Therapy, American Association for Music Therapy, National Dance Therapy Association, National Association for Poetry Therapy, American Society of Group

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but I do not agree it is because we are a shamed profession. It is incomprehensible to me that any one of us is ashamed of our chosen profession, no matter how difficult it may be to assert ourselves in the workplace. The very notion of shame serves only to crack and weaken the structures we have all worked so hard to build and must continually strengthen. Obviously, as noted before, I cannot speak for all of the creative arts therapies and other therapeutic arts/activities professions with the same knowledge that I address the issues as I see them in the field of art therapy. However, because of my long association with members of the broad spectrum of disciplines in the field of mental health, I believe many similar problems have existed in the past within all of these professions and, with those more mature than we, have been resolved in some areas. When drafting my response to the questions from the American Art Therapy Association (How will the profession change in the next 25 years? What is your vision of the 21st century art therapist?) I realized I could not predict an answer to the first question and the answer to the second at this time is a wish. I reported above that Armstrong, in her article on the Creative Arts Conference in 1979 quoted our Standards Chair who said our training regulations varied. They did and they do. As I look back I realize how naive and unprofessional we were. As a member of the Ad Hoc committee to form the Association, the first President of AATA and the first to direct a graduate training program, I bought into and supported the notion that diversity creates strength. That is a fantasy. I believe our diversity in approved training has fragmented the field of art therapy. All art therapists do not speak the same language. This was brought sharply to my attention when I was asked, in 1987, to consult with the art therapists at Dade County School district to develop an art therapy assessment. Working with 11 art therapists from 8 different approved graduate art therapy programs we had 8 different orientations and as many different ways of understanding basic psychological constructs. Before we could attend to the task we were charged with, Janet Bush, the Director of that program in the schools, and I spent a year teaching a basic theoretical construct to develop a common language (Levick, 1989). In my response to the questions from AATA, I reflect on the past (1994). Over the years I have come to know the many faces of art therapy in practice. But now there are new faces that, in addition to speaking differently, bear little resemblance to the images I know of art therapy

as a therapeutic process in mental health. I truly wonder if we were training our students to recognize the needs of our patients. Or, like the artists in Baltimore, facing their own demons while painting with their elderly partners, are our students seeking their own gratification? These I realize are harsh sentiments and in my paper I offered them as evidence of my concerns, not criticism (Levick, 1994). The pioneers of the field conceptualized art therapy in the 1940s as a nonverbal form of psychotherapy. In the 1990s there are art psychotherapists, art therapists and others who say psychotherapy as a basis is out. On a positive note, after a decade of debate, a certification examination was prepared and given for the first time in 1994. I believe that debate, conflict and delay have emanated from the many diverse programs. Those of us who pushed for a certification examination did so because we recognized the professionalism of such disciplines as occupational therapy and music therapy that for many years have required their graduates to take such an examination. A certification examination will drive the discipline to develop a solid core curriculum. I further believe a code of ethics and responsibility for the people we treat is formulated by knowledge of how and why we treat impaired populations in the field of mental health. Moreover, I believe this knowledge must incorporate basic knowledge of normal and abnormal development in order to transform our creative arts skills into a treatment approach. Yes, eclecticism is important to meet different needs of different people. But ethically and morally we can only become responsibly eclectic when we build our skills on sound basic theoretical constructs. The model for this is the medical profession, whose members we must cultivate as our peers, not our superiors as we assume our role as a professional member of this milieu. Figure 2 illustrates the building bricks I think are necessary to secure the bridge and define our identity as we cross over to join our peers. The first is training, with core curriculum sharing the foundation, and the others, role definition, basic knowledge, competency, empathy, compassion, patience, relationship of self to other disciplines on the treatment team, supervision/ consultation, standards and research layered on top, until we seal our structure with a code of ethics. Webster’s Encyclopedic Dictionary defines ethics as a system of moral principles; rules of conduct recognized in respect to a particular class of human actions. This is hardly a new concept. Ernest Harms, psychologist, practitioner, researcher and the founder

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SUPERVISION/ CONSuLTATlON

--

BASIC KNOWlEDCE ROLE DEFINITION

Figure 2. Training

Components

of the International Journal, Art Psychotherapy, wrote a paper in 1970 on ethics titled “The Philosopher’s Stone.” He told us that a few centuries ago scientific insight was considered to be deeply related to ethical experience. Symbolically, if one were to achieve a deeper insight into the world and the nature of man, one had to find the Philosopher’s Stone. This incorporated an inner ethical development and a spiritual development. Without these one could not achieve an essential understanding of reality. Harms (1970) saw society relegating these beliefs to the mythical past and replaced by scientific objectivity. But he did not buy this and he asked “What personal and human attitudes can improve a man’s ability to perform scientific tasks?” He set out to investigate his hypothesis, prepared a questionnaire for a selected group of individuals, including scientific practitioners, researchers, surgeons, natural scientists, Quakers, Free-

(Levick,

1995)

masons, history students, directors of schools and laboratories. From over 100 interviews, which he believed would be representative of a much larger sample, Harms concluded that he could not offer a conclusive picture of a basic opinion about the relationship between ethics and scientific activity. However, the results did provide the first insight into the present condition of what he termed, “ethics in science,” and that “a great variety of ethical perspectives exists in the fields of science. ” He believed that ethics (then) was active primarily in abstract forms, but must be the subject of a description of processes in concrete terms. In essence, he stated that what scientists of five hundred years ago called the “Philosopher’s Stone is not a myth of the past. It has its modem form and ought to find expression in an ethic of scientific behavior” (Harms, 1970). How has our understanding of ethical behavior

MYRA F. LEVICK grown in 25 years? The American Psychological Association published a manual on professional liability and risk management (Bennett, Bryant, VandenBos & Greenwood, 1990) that is relevant to all of us. I call attention to three important sections:

gists for psychologists makes it no less relevant for all of us. I recommend it regardless of whether the reader is a student, educator, practitioner or program director in the field of mental health.

1. How do professional ethics and practice guidelines affect us? The authors remind us that what we learn in the early days of our career often lose definition as we grow older. Everyday pressures lead us to view ethical issues as abstract concepts that are ingrained. We go along year after year providing services without consciously reviewing how we provide those services. They give many case examples to demonstrate these points. In conclusion they stress that any professional situation, if not properly handled or if it leads to injury or damage (real or perceived), may result in malpractice litigation. 2. This section asks: What do practice guidelines and ethics really mean? A set of practices and implicitly recognized principles of conduct evolve over the history of every profession. They guide the relationships of the members of that profession’s maturity and serve the best interests of everyone involved. For the purpose of their discussion, the authors defined ethics as I quoted above from the dictionary. Note that each principle within an ethical system is a rule that fulfills the intent of that code. As a specific example, they refer to “thou shalt not kill” and, in a general way, “the providers of these services maintain the highest standards of their profession.” To illustrate this portion they discuss some specific principles in relation to practice and ethical behavior. All cogent and clearly written. 3. This section is their discussion on what is professional liability. Their response to their question is focused on a discussion of why we should be concerned today about professional liability and the law. This is very important for us to consider in these changing times. It is also important because some of us in every discipline in the field of mental health have been called to testify in court. The whole area of expert witness is the subject for another paper, but cannot be separated from our ethical principles and liability. The fact that this manual (Bennett et al, 1990) was written by psycholo-

Because every professional group has written its code of ethics in one form or another and/or are always redefining it, we at Hahnemann found it was not easy to find a text upon which to base a sound course of ethics. I confess, for years we taught the relationship between identity, role and ethics in a fragmented fashion, using articles such as Dr. Vaccaro’s or Codes of Ethics from our own disciplines and those of other professional organizations to see relationships to other professionals in this mental health community. In addition to the manual published by the American Psychological Association, cited above, I am sure other disciplines have evolved approaches that are singularly distinctive and also appropriate for other fields of study. In 1984, the Directors of the Creative Arts in Therapy Program at Hahnemann sponsored a symposium that heralded a celebration of identity. In concluding this paper, I would like to chronicle some of the thoughtful, cogitative, reflective statements that emerged. These are recorded in the Proceedings of this conference, a publication I, the faculty at Hahnemann and others have since been using as a text for a course in ethics, integrating role identity (Levick, Briggs, Dulicai & Hays, 1984). This symposium was conceptualized in part because of our growing concerns about role identity, certification, licensing and so forth, and, equally important, because at that time we had in our midst three well-known and recorded supporters of the arts in therapy. Dr. Zwerling was still Chairman of the Department of Mental Health Sciences at Hahnemann; Dr. Paul Fink was back in Philadelphia and, by a strange quirk of fate precipitated by the typical political chaos of hospitals and universities, Dr. Bertram Brown, who I quoted above from the Washington conference, was the recently appointed President of Hahnemann University. We could not let this opportunity pass. The theme of the symposium was “Looking Ahead, Planning Together: The Creative Arts Therapies as an Integral Part of Treatment for the 90s (using Dr. Brown’s statement from the 70s). The format was three panel sessions and afternoon small group discussions. A further structure was imposed. The moderators and panelists were invited, not to write a paper just related

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294

to the theme, but to address the following tions:

MYRA F. LEVICK three ques-

What are the current obstacles that keep the creative arts therapists from becoming visible members of the mental health professions, and what steps need to be taken to overcome these obstacles? What are the unique contributions of the creative arts therapies to the field of mental health sciences? What can be gained from the interface of the creative arts therapies, psychology and psychiatry? The moderators of the three panels were, of course, Dr. Brown, Dr. Zwerling and Dr. Fink. The symposium was publicized throughout the country and well-known representatives of the fields of psychiatry, psychology and all of the therapeutic arts were invited panelists (Figure 3). The Proceedings of this three-day happening were taped and recorded by three graduate students, edited to 126 pages and published by Hahnemann University. The responses range from frustrated to interesting and astonishing. To select a few segments to give the reader a sense of what proved to be a very provocative and productive meeting is difficult. The most dynamic interchanges took place in the afternoon sessions and resulted in questions we all must respond to: What makes us what we are? How can we enhance our legitimacy and our uniqueness? Can we share and network among the arts therapies without losing boundaries? How do we each define our professional identity? What are the interrelationships among the art forms, as well as the limitations of each? How do professional relationships parallel personal relationships, including inherent risks as well as benefits? What is the responsibility of each discipline to communicate in a language that can be understood by other mental health professionals and the general public? There were many more questions and many responses. What follows are those I believe briefly and succinctly speak to this perspective. I quote Walker: “So I think you need to find a way to embody cognitive terms and ways to cognize body terms. You need to find metaphors, not only for the bridges across, but for the elevators and shafts inside the in-

teriors” (1984, p. 73). Hammer told us we needed to be arrogant-we need to mobilize the awareness of where we are better than the rest of the team-be like psychiatrists and psychologists who arrogantly say, “Look, we’ve got something to teach you; come to our seminars then we, reciprocally, will begin to come to yours” (p. 99). Zwerling said, “There’s a small statue of a child ballerina by Degas at the head of the stairs on the first floor of Jeu De Paume. I know what happens to me when I look at it. I’ve not cried as much, but the same kind of thing happens to me when I hear the Philadelphia Symphony Orchestra or watch the Joffrey Ballet Company or when I sing or when I dance. I want a guarantee that this will still happen if I’m in treatment with an arts therapist” (p. 18). And, lastly, a poem from Markham, entitled “Outwitted,” quoted by Lemer at the closing of the symposium: He drew a circle that shut me outHeretic, rebel, a thing to flout. But love and I had the wit to win: We drew a circle that took him in. (1984, p. 117) The components of our structure (Figure 2) give us the tools to make the bridge and “elevator and shafts” suggested by Walker. With those tools we will have the skills to draw our circle that will bring others in. And in that circle, creative arts therapists, given the tools I have proposed, will turn to each other as Johnson (1994) entreated. References Armstrong, B. (1979). The creative arts therapists: Struggling for recognition. Hospital and Community Psychiatry, 30, 845847. Bennett, B., Bryant, B., VandenBos, G., & Greenwood, A. (1990). Professional liability and risk management. Washington, D.C.: American Psychological Association. Brown, B. (1979). In B. Armstrong, The creative arts therapists: Struggling for recognition. Hospital and Community Psychiutry, 30, 845-847. Bunney, J. (1978). Dance therapy and notes on task panel on “The role of the arts in mental health.” Art Psychotherapy, 5, 7-9. Canaday, J. (1959). Metropolitan seminars in art. New York: Metropolitan Museum of Art. Dulicai, D., Hays, R., & Nolan, P. (1989). Training the creative arts therapists: Identity with Integration. The Arts in Psychotherapy, 16, 11-14. Fink, P. (1973). What is art therapy training? Philadelphia Medicine, 69, 239-243. Graham, R. (1978). Music therapy. Art Psychotherapy, 5, 5-6.

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Hammer, E. (1978). Interdisciplinary approach to therapy and education for the developmentally disabled and psychiatrically handicapped. Art Psychotherapy, 5, 25-30. Hammer, E. (1984). In Looking ahead, planning together. Proceedings of a Symposium Sponsored by the Creative Arts in Therapy Program. Philadelphia, PA: Hahnemann University. Harms, E. (1970). The philosopher’s stone. ETHICS, An Znternational Journal of Social Political Philosophy, 80, 222-226. Hays, R., & Lyons, S. (1981). The bridge: A projective technique for assessment. The Arts in Psychotherapy, 8, 207-217. Johnson, D. R. (1991). Taking the next step: Forming the National Creative Arts Therapies Association. The Arts in Psychotherapy, 18, 387-394. Johnson, D. R. (1994). Shame dynamics among creative arts therapists. The Arts in Psychotherapy, 21, 173-178. Lemer, A. (1984). In Looking ahead, planning together. Proceedings of a Symposium Sponsored by the Creative Arts in Therapy Program. Philadelphia, PA: Hahnemann University. Levick, M. F. (1973). Introduction to art therapy. Philadelphia Medicine, 69, 237. Levick, M. F. (1978a). Response to paper by Dr. Edwin Hammer. Art Psychotherapy, 5, 31-33. Levick, M. F. (1978b). Conference on the future of the creative arts in therapy. Art Psychotherapy, 5, 3-4. Levick, M. F. (1989). Reflections: On the road to educating the creative arts therapists. The Arts in Psychotherapy, 16, 57-60.

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Levick, M. F. (1994). To be or not to be. Art Therapy, 11, 97100. Levick, M. F. (1995, March). Keynote Address: Recovery through activity. 13th Annual Therapeutic Activities and Leisure Skills Conference, Marriott Hotel, Philadelphia. Sponsored by Medical College of Pennsylvania and Hahnemann University. Levick, M. F., Briggs, O., Dulicai, D., & Hays, R. (1984). In Looking ahead, planning together. Proceedings of a Symposium Sponsored by the Creative Arts in Therapy Program, Hahnemann University, Philadelphia, PA. McNiff, S. (1979). In B. Armstrong, The creative arts therapists: Struggling for recognition. Hospital and Community Psychiatry, 30, 845-847. Newman, R. (1973). Problems on the supervision of the art therapist. Philadelphia Medicine, 69, 245-25 1. Spencer, J. S. (1978). The healing role of the arts 11: An agenda for action. Art Psychotherapy, 5, 19-23. Vaccaro, V. M. (1973). The responsibility of the art therapist. Philadelphia Medicine, 69, 253-256. Walker, H. (1984). In Looking ahead, planning together. Proceedings of a Symposium Sponsored by the Creative Arts in Therapy Program. Philadelphia, PA: Hahnemann University. Zw$rling, I. (1979). The creative arts therapies as real therapies. Hospital and Community Psychiatry, 30, 841-844. Zwerling, I. (1984). In Looking ahead, planning together. Proceedings of a Symposium Sponsored by the Creative Arts in Therapy Program. Philadelphia, PA: Hahnemann University.