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Training the creative arts therapist: Identity with integration
Tile Arrs in Psyc.horherupp,
Vol. 16 pp. I l-14. % Pergamon Press plc, 1989. Printed in the U.S.A.
TRAINING THE CREATIVE ARTS THERAPIST:
DIANNE
0197-4556/89 $3.00 + .OO
IDENTITY WITH INTEGRATION
DULICAI, MA, ADTR, RONALD HAYS, MS, ATR, and PAUL NOLAN, MCAT. MT-BC*
with any program which it is placed, Health Sciences fects perspective tions .
The most difficult issue facing educators of creative arts therapists in the 1980s and 1990s is how to continue to prosper in the present social and economic ambiance. Diminished financial resources available to support a mental health system in the United States have produced forces that demand that creative arts therapists collectively make a case for their efficacy and cost effectiveness. Accepting this premise leads to the conclusion that the graduates of creative arts therapy programs must be prepared to face that challenge. Therefore, a comprehensive ongoing program evaluation is required to continually measure progress in preparing students for this challenge. In assessing the academic and clinical qualifications required of the professiona therapist, three major goals in education emerge: (a) the graduate must be a competent team member and be able to maintain a professional and competent identity as a therapist; (b) the graduate must be taught the most updated concepts in the mental health disciplines, and trained and experienced with an increasingly widening population; and (c) the graduate must be trained to be at least a competent consumer of research and to be at least capable of participating with a research team. As educators, the authors have looked at these goals for graduates and continue to reevaluate whether we are meeting the goals. in this article we summarize the means of addressing these competencies. This represents only one view of the problems of growth and development of our profession in this period. As
Description
in any discipline, the context in in our case a university Mental Department and Hospital, afand to a degree defines limita-
of the Hahnemann
Program
The Creative Arts in Therapies graduate program at Hahnemann was designed to meet the clinical and research criteria necessary for the practice of contemporary arts psychotherapy. Current mental health clinical practice requires a level of sophistication beyond the technicianoriented activities therapist model, The development of advanced-level clinical capabilities grounded in psychotherapeutic foundations and applicable research skills has become the primary requirement in training the creative arts therapist. The Hahnemann program began as a master’s level program in art therapy in 1970 and added movement and music in 1974 and 1975. Fortunately, the design was implemented with training support by a National institute of Mental Health grant that gave the framers of the academic program the economic and philosophical luxury of responding to the challenge of training clinicians and including a research component within its concept. We could develop a program for students that had high clinical standards, was staffed by a multidisciplina~ team, and set criteria for investigative research that we believed met the challenge of the eighties.
*Diane Dulicai is Director, Dance Therapy Education, Ronald Hays is Director, Art Therapy Education, and Paul Nolan is Director of Music Therapy Education of the Creative Arts in Therapy Program of Hahnemann University, Philadelphia, PA. 11
DULICAI,
12
HAYS AND NOLAN
The Creative Arts Therapy Program is housed within the Department of Mental Health Sciences that functions within a health science university, and includes medical training in psychiatry, and graduate programs in clinical psychology, group process and group psychotherapy, and family therapy. This model closely parallels the interdisciplinary treatment team approach found within current psychiatric treatment facilities. All faculty hold academic appointments within the department, and most all of its members maintain clinical practice. The Master’s in Creative Arts in Therapy (MCAT) Program offers training within a specific modality (art, dance/movement, or music therapy) and core course work that provides understanding and integration with mental health science concepts and the other offered arts therapies. The broadening of the educational program began in 1983 with the establishment of a Master’s in Creative Arts in Therapy tract within the clinical psychology doctorate program (PSY.D.) and the doctorate research tract in psychology (Ph.D.). This has developed into a dual degree concentration that leads to licensing in clinical psychology with credentialing in the specific creative arts modality. Goals
in Education
I. To give students the competence to purticipate as tr~‘att~l~~lt team tTl~t~lb~r.~ with a clear prwfessional identity. For an educator to plan a
training experience that produces a clear professional identity, the definition of “who I am” must be clearly integrated in the relationship with a mentor in the students’ art therapy modality. Are we psychotherapists who use a creative mode of intervention or are we artists who use a psychotherapeutic mode to practice our art? This is a contentious issue, not without good reason. The creative process and healing replenishment of the art must be supported in the discipline of acquired knowledge. It is our belief that this is possible. The ability to become a respected and equal partner in the treatment team depends to a great degree on retaining the insight of our creative perspective. Ekstein and Wallerstein (1972) have addressed the issue of identity: . . . a sense of professional identity is an essential attribute in a profession such as psycho-
therapy, and its acquisition must be considered one of the important training goals. (p. 66) . . to be externally identified as a psychotherapist, to being accepted as such by the general public and by other professionals . . . and to being identified as what one wants to be. The internal side has to do with the process . . . of identification with teachers of psychotherapy. (pp. 77-78)
Once identity of creative arts therapists is defined, the selection of faculty and supervisors can be made by reflection of such an identity. Selection of the clinical training placement is also guided by factors that are conducive to the development of the creative arts therapists’ identity as a treatment professional. Developing faculty within a university hospital provides a means of observing an arts therapist’s work from a clinical as well as academic perspective. The integration of academic knowledge with clinical experience within the educational program provides the foundation for continuous growth as a therapist. As the new therapist develops in the period from graduation through the first years of experience, the professional identity is cultivated and supported by interaction with more experienced clinicians. The use of other area treatment resources exposes students to philosophical diversity within health care. However, reaching out to diverse settings is rather difficult; hence we appreciate the necessity to provide monthly supervision meetings in which a part of the agenda includes a component of continued clinical and academic support and challenge for the supervisors. An ongoing assessment of the students’ growth allows us to respond more promptly to their needs. The quality of supervision improves in direct relation to the quality of supervisory meetings. The students’ assignment in terms of hours, types of experience, strengths, and weaknesses can then be individually prescribed. The student evaluation form was developed through this model and represents the competency/role model idea criteria inherent in the clinician’s repertoire. 2. To give students the most current clinical und theoretical information avuiluble within the mental health curt system and to have students continually intr?fixce with other professionals.
Students need to see themselves as a part of the system rather than outside it. As they understand
TRAINING
THE CREATIVE
the unique perspective offered by the creative arts therapies to new investigations, students will perceive their involvement as primary rather than adjunctive. For example, current discussions in neuroscience concern the effects of Alzheimer’s Disease on the functioning of a patient. Creative arts therapists should be part of such discussions and should be reading the new material and integrating it wherever possible with their modality. Students are the beneficiaries of increased knowledge, by ident~~ation with the educator addressing it and by being aware of their unique perspective in reinforcing their identity within a team. 3. To give students competence in research. The rationale is less complex for the justification of a strong research base within a creative arts therapy training program than for the two previous goals. These professions can not continue to survive without addressing efficacy and cost efficiency questions. The early professional development of the creative arts therapies defined clinical expertise and standards of practice that concentrated almost entirely on a curriculum that produced clinicians. Each individual creative arts association supported additional curricula that gradually established research preparation by varying levels of expertise. However, they have not followed the course of growth found in other mental health training programs that offer a clinical or research tract. Although the arts therapy field receives endorsements from other allied health professionals, it should not depend on others to develop a research base and integrate findings with other models. Interdisciplinary integration of research results may be superseded by the cross fertilization outcomes available within the combined profession. Art, dance/movement, and music therapies need to address theoretical issues that might define the nature of their collaboration. Do art, music, and dan~e/movement share some theoretical underpinnings that affect their clinical outcome? If so, what are they? WouId a collaboration of effort among these modalities profit all three through the combination of efforts developed by each? The authors have decided that the answer is positive and have highlighted this collaborative effort over the past 15 years through faculty and student research (Fink, Levick, Hays, Johnson, Dulicai, & Briggs, 1984; Hays, Dulicai, & Briggs,
ARTS THERAPIST
13
1983; Levick & Dulicai, 1979; Levick, Dulicai, Briggs, & Bullock, 1979). It is our belief that a binary education model (research or clinical tracts) will not enhance our ability to meet the challenges of health care in the eighties and nineties. We must train clinicians to be capable of investigating their own work. Finally, in continuing to create programs that meet the ever changing problems graduates face, the issue of assessing our efforts is prominent. Acquired competencies of the graduate should be able to be traced back to the development of an ideal role model. Growth and change within the ideal role model are dependent on a concept that is multifaceted, continuous in life, and is supported by data as symbolized by the Moebius strip. THEMOEBlUSSTRIPMODEI
For practical purposes the supervisor represents one end of a feedback strip. Experienced academic and research personnel, whose focus is more theoretical and analytical, can provide the continually expanding thinking in mental health practice and reverse the feedback strip. As the Moebius strip turns on itself as it returns to the center from each direction, the students’ assessments of their experience in academic and fieldwork represent another view, or, as it were, the other view of the entire strip. This model includes the ongoing process of the understanding of experience and information by the receiver and giver, as the practical and analytical integrate wholly in a tight matrix of assessment from which the student, staff, and patient benefit. References Ekstein, R., & Wallerstein, R. (1972). The teaching and leaming of psychotherapy. New York: International Universities Press. Fink, P., Levick, M., Hays, R., Johnson, D., Dulicai, D., & Briggs, C. (1984). Creative arts therapies. In T. B. Karasu (Ed. ), The psp-hiutric. thempies (pp. 747-780). Washington, D.C.: American Psychiatric Association.
14
DULICAI,
HAYS
Hays, R., Dulicai, D., & Briggs, C. (1983). The creative arts in the rehabilitation process. In K. Williams (Ed.), The rhnnging role qf’ r~h~biljtuti~n medicine in the manugrmeilf o_#’~~s~~~t;[ltr;(, /?~~ti~t?t,~(pp. 90-106). New York:
Human Sciences Press, Levick, M., & Dulicai, D. (1979). Interfaces of creativity in therapy. Arts in Psychotherapy. 6, 1X1-153,
AND
NOLAN
Levick, M., Dulicai. D., Brig@, C., & Bullock, L. (1979). The creative arts therapies. In W. C. Adamson & K. S. Adamson (Eds.), A hu~z~b~~~~~fhr .speci& Ieurning disubiliti~s (pp. 361-389). New York: Gardner Press.
Vol. 16 pp. I l-14. % Pergamon Press plc, 1989. Printed in the U.S.A.
TRAINING THE CREATIVE ARTS THERAPIST:
DIANNE
0197-4556/89 $3.00 + .OO
IDENTITY WITH INTEGRATION
DULICAI, MA, ADTR, RONALD HAYS, MS, ATR, and PAUL NOLAN, MCAT. MT-BC*
with any program which it is placed, Health Sciences fects perspective tions .
The most difficult issue facing educators of creative arts therapists in the 1980s and 1990s is how to continue to prosper in the present social and economic ambiance. Diminished financial resources available to support a mental health system in the United States have produced forces that demand that creative arts therapists collectively make a case for their efficacy and cost effectiveness. Accepting this premise leads to the conclusion that the graduates of creative arts therapy programs must be prepared to face that challenge. Therefore, a comprehensive ongoing program evaluation is required to continually measure progress in preparing students for this challenge. In assessing the academic and clinical qualifications required of the professiona therapist, three major goals in education emerge: (a) the graduate must be a competent team member and be able to maintain a professional and competent identity as a therapist; (b) the graduate must be taught the most updated concepts in the mental health disciplines, and trained and experienced with an increasingly widening population; and (c) the graduate must be trained to be at least a competent consumer of research and to be at least capable of participating with a research team. As educators, the authors have looked at these goals for graduates and continue to reevaluate whether we are meeting the goals. in this article we summarize the means of addressing these competencies. This represents only one view of the problems of growth and development of our profession in this period. As
Description
in any discipline, the context in in our case a university Mental Department and Hospital, afand to a degree defines limita-
of the Hahnemann
Program
The Creative Arts in Therapies graduate program at Hahnemann was designed to meet the clinical and research criteria necessary for the practice of contemporary arts psychotherapy. Current mental health clinical practice requires a level of sophistication beyond the technicianoriented activities therapist model, The development of advanced-level clinical capabilities grounded in psychotherapeutic foundations and applicable research skills has become the primary requirement in training the creative arts therapist. The Hahnemann program began as a master’s level program in art therapy in 1970 and added movement and music in 1974 and 1975. Fortunately, the design was implemented with training support by a National institute of Mental Health grant that gave the framers of the academic program the economic and philosophical luxury of responding to the challenge of training clinicians and including a research component within its concept. We could develop a program for students that had high clinical standards, was staffed by a multidisciplina~ team, and set criteria for investigative research that we believed met the challenge of the eighties.
*Diane Dulicai is Director, Dance Therapy Education, Ronald Hays is Director, Art Therapy Education, and Paul Nolan is Director of Music Therapy Education of the Creative Arts in Therapy Program of Hahnemann University, Philadelphia, PA. 11
DULICAI,
12
HAYS AND NOLAN
The Creative Arts Therapy Program is housed within the Department of Mental Health Sciences that functions within a health science university, and includes medical training in psychiatry, and graduate programs in clinical psychology, group process and group psychotherapy, and family therapy. This model closely parallels the interdisciplinary treatment team approach found within current psychiatric treatment facilities. All faculty hold academic appointments within the department, and most all of its members maintain clinical practice. The Master’s in Creative Arts in Therapy (MCAT) Program offers training within a specific modality (art, dance/movement, or music therapy) and core course work that provides understanding and integration with mental health science concepts and the other offered arts therapies. The broadening of the educational program began in 1983 with the establishment of a Master’s in Creative Arts in Therapy tract within the clinical psychology doctorate program (PSY.D.) and the doctorate research tract in psychology (Ph.D.). This has developed into a dual degree concentration that leads to licensing in clinical psychology with credentialing in the specific creative arts modality. Goals
in Education
I. To give students the competence to purticipate as tr~‘att~l~~lt team tTl~t~lb~r.~ with a clear prwfessional identity. For an educator to plan a
training experience that produces a clear professional identity, the definition of “who I am” must be clearly integrated in the relationship with a mentor in the students’ art therapy modality. Are we psychotherapists who use a creative mode of intervention or are we artists who use a psychotherapeutic mode to practice our art? This is a contentious issue, not without good reason. The creative process and healing replenishment of the art must be supported in the discipline of acquired knowledge. It is our belief that this is possible. The ability to become a respected and equal partner in the treatment team depends to a great degree on retaining the insight of our creative perspective. Ekstein and Wallerstein (1972) have addressed the issue of identity: . . . a sense of professional identity is an essential attribute in a profession such as psycho-
therapy, and its acquisition must be considered one of the important training goals. (p. 66) . . to be externally identified as a psychotherapist, to being accepted as such by the general public and by other professionals . . . and to being identified as what one wants to be. The internal side has to do with the process . . . of identification with teachers of psychotherapy. (pp. 77-78)
Once identity of creative arts therapists is defined, the selection of faculty and supervisors can be made by reflection of such an identity. Selection of the clinical training placement is also guided by factors that are conducive to the development of the creative arts therapists’ identity as a treatment professional. Developing faculty within a university hospital provides a means of observing an arts therapist’s work from a clinical as well as academic perspective. The integration of academic knowledge with clinical experience within the educational program provides the foundation for continuous growth as a therapist. As the new therapist develops in the period from graduation through the first years of experience, the professional identity is cultivated and supported by interaction with more experienced clinicians. The use of other area treatment resources exposes students to philosophical diversity within health care. However, reaching out to diverse settings is rather difficult; hence we appreciate the necessity to provide monthly supervision meetings in which a part of the agenda includes a component of continued clinical and academic support and challenge for the supervisors. An ongoing assessment of the students’ growth allows us to respond more promptly to their needs. The quality of supervision improves in direct relation to the quality of supervisory meetings. The students’ assignment in terms of hours, types of experience, strengths, and weaknesses can then be individually prescribed. The student evaluation form was developed through this model and represents the competency/role model idea criteria inherent in the clinician’s repertoire. 2. To give students the most current clinical und theoretical information avuiluble within the mental health curt system and to have students continually intr?fixce with other professionals.
Students need to see themselves as a part of the system rather than outside it. As they understand
TRAINING
THE CREATIVE
the unique perspective offered by the creative arts therapies to new investigations, students will perceive their involvement as primary rather than adjunctive. For example, current discussions in neuroscience concern the effects of Alzheimer’s Disease on the functioning of a patient. Creative arts therapists should be part of such discussions and should be reading the new material and integrating it wherever possible with their modality. Students are the beneficiaries of increased knowledge, by ident~~ation with the educator addressing it and by being aware of their unique perspective in reinforcing their identity within a team. 3. To give students competence in research. The rationale is less complex for the justification of a strong research base within a creative arts therapy training program than for the two previous goals. These professions can not continue to survive without addressing efficacy and cost efficiency questions. The early professional development of the creative arts therapies defined clinical expertise and standards of practice that concentrated almost entirely on a curriculum that produced clinicians. Each individual creative arts association supported additional curricula that gradually established research preparation by varying levels of expertise. However, they have not followed the course of growth found in other mental health training programs that offer a clinical or research tract. Although the arts therapy field receives endorsements from other allied health professionals, it should not depend on others to develop a research base and integrate findings with other models. Interdisciplinary integration of research results may be superseded by the cross fertilization outcomes available within the combined profession. Art, dance/movement, and music therapies need to address theoretical issues that might define the nature of their collaboration. Do art, music, and dan~e/movement share some theoretical underpinnings that affect their clinical outcome? If so, what are they? WouId a collaboration of effort among these modalities profit all three through the combination of efforts developed by each? The authors have decided that the answer is positive and have highlighted this collaborative effort over the past 15 years through faculty and student research (Fink, Levick, Hays, Johnson, Dulicai, & Briggs, 1984; Hays, Dulicai, & Briggs,
ARTS THERAPIST
13
1983; Levick & Dulicai, 1979; Levick, Dulicai, Briggs, & Bullock, 1979). It is our belief that a binary education model (research or clinical tracts) will not enhance our ability to meet the challenges of health care in the eighties and nineties. We must train clinicians to be capable of investigating their own work. Finally, in continuing to create programs that meet the ever changing problems graduates face, the issue of assessing our efforts is prominent. Acquired competencies of the graduate should be able to be traced back to the development of an ideal role model. Growth and change within the ideal role model are dependent on a concept that is multifaceted, continuous in life, and is supported by data as symbolized by the Moebius strip. THEMOEBlUSSTRIPMODEI
For practical purposes the supervisor represents one end of a feedback strip. Experienced academic and research personnel, whose focus is more theoretical and analytical, can provide the continually expanding thinking in mental health practice and reverse the feedback strip. As the Moebius strip turns on itself as it returns to the center from each direction, the students’ assessments of their experience in academic and fieldwork represent another view, or, as it were, the other view of the entire strip. This model includes the ongoing process of the understanding of experience and information by the receiver and giver, as the practical and analytical integrate wholly in a tight matrix of assessment from which the student, staff, and patient benefit. References Ekstein, R., & Wallerstein, R. (1972). The teaching and leaming of psychotherapy. New York: International Universities Press. Fink, P., Levick, M., Hays, R., Johnson, D., Dulicai, D., & Briggs, C. (1984). Creative arts therapies. In T. B. Karasu (Ed. ), The psp-hiutric. thempies (pp. 747-780). Washington, D.C.: American Psychiatric Association.
14
DULICAI,
HAYS
Hays, R., Dulicai, D., & Briggs, C. (1983). The creative arts in the rehabilitation process. In K. Williams (Ed.), The rhnnging role qf’ r~h~biljtuti~n medicine in the manugrmeilf o_#’~~s~~~t;[ltr;(, /?~~ti~t?t,~(pp. 90-106). New York:
Human Sciences Press, Levick, M., & Dulicai, D. (1979). Interfaces of creativity in therapy. Arts in Psychotherapy. 6, 1X1-153,
AND
NOLAN
Levick, M., Dulicai. D., Brig@, C., & Bullock, L. (1979). The creative arts therapies. In W. C. Adamson & K. S. Adamson (Eds.), A hu~z~b~~~~~fhr .speci& Ieurning disubiliti~s (pp. 361-389). New York: Gardner Press.