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Arts Therapies – A Research Based Map of the Field

Karkou, Vicky & Sanderson, Patricia (2006). Arts Therapies – A Research Based Map of the Field. London, UK: Elsevier (307 pages).

Reviewed by Lucy O’Grady, University of Bergen, Norway

The relationship between music therapy and other arts therapies is not a ‘hot’ topic at this point in the development of music therapy-specific literature. Apart from some focused exploration of the issue from Smeijsters and Cleven (2006), Faire and Langan (2004) and myself (O’Grady, 2010), it may be fair to say that music therapists are at this time sufficiently occupied with the complexities of their own discipline, let alone the complexities of the arts therapies as a whole. Perhaps a ‘hotter’ topic at this point in music therapy is that of developing indigenous theory and this is where a research-based map of the arts therapies could be a timely contribution. In order to discover what is unique to music therapy, we may be well-served to ask what is shared and what is different across all arts therapies. The book, Arts Therapies – A Research Based Map of the Field, is based on this very premise.

The book really should be called Arts Therapies ‘in the United Kingdom’ – A Research-based Map of the Field since it is based on interviews and survey questionnaires of over 580 arts therapists practicing in the United Kingdom. However, it is only the title which is slightly misleading since in their introduction the authors acknowledge this scope which is defined both by the research sample and reference to predominantly British literature. The authors define the arts therapies field as consisting of four separate disciplines: 1) Music Therapy (MT), 2) Art Therapy (AT), 3) Drama Therapy (DT), and 4) Dance Movement Therapy (DMT). The authors claim to be the first to try to delineate through empirical research the commonalities and the differences between these four arts therapies in terms of theory and practice. The authors also acknowledge the methodological complexity of doing so, however they suggest that it is worth the attempt in order to clarify misconceptions, advance the progress of the profession(s) and to promote collaboration between different arts therapists while strengthening the theoretical positions of each discipline. The authors are clear that their book does not represent a suggestion that all four arts therapies should become one; instead, there is the clear implication throughout that each arts therapy can be strengthened through consideration of the other. Through these ambitious aims, the authors identify three main audiences for the book: arts therapists, lay readers, and other health professionals.

The book is divided into two main sections, with four chapters in each. Section 1 considers the field as a whole in terms of its historical development, boundaries and definition, common features and common theoretical frameworks. Section 2 addresses the arts therapies as separate modalities and focuses on the uniqueness of each discipline, illustrating through case examples presented in table format. The authors state that they do not intend to offer in-depth accounts of each discipline in this section, but enough that the reader may have “the possibility of a first, comprehensive understanding of the field” (p 4). Each chapter follows a clear format, with the overall structure and key issues highlighted at the beginning of the chapter and much of the text illustrated through tables and diagrams.

Chapter 1 presents an overview of the professional development of the arts therapies as a whole. The role of western traditions in the development of arts therapies is largely emphasised, while the use of the arts by shamans and within indigenous cultures is mainly relegated to pre-historic times. The emphasis on western historical influence is reiterated in chapter 2, where arts therapies are delineated from traditional therapies such as acupuncture based on the assumption that “arts therapies are a product of western society” (p. 36). This rather simplistic emphasis and brevity of discussion begins to clarify just how large and potentially over-ambitious the scope of this book may be. In this sense, the first chapter seems most to serve the lay person or the beginner-reader. A potentially more interesting discussion for arts therapists in chapter 1 concerns how up until now the different disciplines have been separate due to the fear that merging them would develop practices with questionable depth in understanding the art form and thus questionable therapeutic value. This idea is supported recently by Gold, Wigram & Voracek (2007) whose statistical analyses indicated that clients showed greater health improvement when music therapy was limited to discipline-specific music therapy techniques and did not include media from other arts therapies disciplines. The authors of the book note exceptions to the current status of separate arts therapies disciplines through the ‘expressive arts therapies’ movement in the USA and the Institute for the Arts in Therapy and Education in the UK. They do not mention the Netherlands as another major exception to the rule, where the different arts therapies are served by the professional Dutch Association for Creative Therapy (Smeijsters & Vink, 2003). Nevertheless, the first chapter in the book highlights an interesting trend across the arts therapies, in that the most common area for arts therapists to work in terms of client difficulties is with emotional\behavioural issues (59%).

In Chapter 2 the authors discuss the boundaries of the field in relation to the therapeutic arts (arts in health), arts education, other therapies and other health practices, a discussion which then culminates in a definition of the arts therapies as a whole field. One of the differences between the therapeutic arts and the arts therapies, reiterated throughout the chapter, is that the therapeutic arts emphasise the product while the arts therapies value instead the process. This is arguably an outdated assumption and an unnecessary split between process and product, since there are examples of artists working in health who also recognise the importance of process and attempt to balance the two (O’Grady, 2010). The privacy and inward processes of arts therapies as well as their dyadic or small-group constituents are also emphasised in this chapter, which is interesting to consider in the light of Community Music Therapy discourse where “out and around processes” (Stige, Ansdell, Elefant & Pavlicevic, 2010) are also valued and whole communities may be worked with (Stige, 2002). After discussing the boundaries of the field, the authors in this chapter examine past definitions of each arts therapy and track changes in emphases over time. For example, from 1989 to 2004 MT definitions are interpreted as changing from a humanistic emphasis to more of an acceptance of a diversity of approaches and practices. Chapter 2 culminates bravely by presenting a definition of the arts therapies as a whole field.

The third and fourth chapters are among the most valuable in the book because of the interesting commonalities they present. In chapter 3 the authors suggest that there are five main assumptions common to MT, AT, DT and DMT: 1) the ‘arts’ are defined in broad terms, 2) there is a focus on the process, 3) there is a belief in the preverbal development of engagement in the arts, 4) the arts are holistic and, 5) the arts offer therapeutic potential. Furthermore, the authors suggest that the main features across the arts therapies are an emphasis upon creativity; imagery, symbolism and metaphor; non-verbal communication; the triangular relationship between the client, the art-form and the therapist; the therapeutic relationship as both transferential and real; and finally, the formulation of therapeutic aims that reflect overall psychotherapeutic orientations of either behaviourism, humanism or psychoanalysis. This final idea is developed further in chapter 4, where six theoretical trends are identified across MT, AT, DT and DMT:
1) Humanistic, 2)Psychoanalytic\Psychodynamic, 3) Developmental, 4) Artistic\Creative, 5) Active\Directive – which the authors relate to Wheeler’s (1983) first level of music psychotherapy as well as to behaviourism, and 6) Eclectic\Integrative. The prevalence of these particular theoretical approaches for different client groups is identified. For example, the psychodynamic\psychoanalytic approach is predominantly used for clients with mental health issues. In terms of developing indigenous theory in music therapy or across the arts therapies, the artistic\creative theoretical trend is perhaps the most relevant but is also presented by the authors as the least theoretically developed so far.

As an arts therapist (music), I find the second section less interesting to read. Perhaps this is because the focus upon the idiosyncracies of each particular arts therapy in terms of its pioneers and their myriad collection of diverse and sometimes unrelated theoretical ideas renders it difficult for me to gain a coherent, concise picture of the uniqueness of each arts therapy. I cannot imagine which of the identified audiences would benefit most from this section. Instead, I find the introductory page to each chapter where key issues are highlighted the most helpful and interesting part of Section 2.

The idiosyncracies of MT are addressed first as Chapter 5. In this chapter it is interesting to learn that in some ways MT leads the arts therapies, since it was the first discipline of the arts therapies to form a professional body and also receive early recognition. The authors explain that this may be in part due to the high value accorded to music in western traditions compared with other art-forms. It is also interesting to learn that music therapists in the UK predominantly work through improvisation and with children who have learning difficulties. The authors link this to the early pioneers of music therapy in Britain, Alvin and the Nordoff-Robbins partnership. The authors also highlight their findings that there are comparatively few music therapists working with people whom they label ‘normal neurotics’ and few in private practice. They also emphasise the divide between active and receptive techniques in music therapy as well as the importance of the ‘iso’ principle, an idea which dates back to Plato and that, in music therapy, relates to matching a person’s mood with music. Of interest to the move to develop indigenous theory in music therapy, the authors also suggest that “MT, in comparison with other arts therapies, draws less heavily upon related fields in order to provide a theoretical justification of its practice” (p. 124). Case examples, presented in table format, from Oldfield, Bunt, Ansdell, Sobey, Levinge and Odell-Miller are used to highlight different theoretical approaches to music therapy that have developed from Alvin, Nordoff and Robbins, and Priestley. The authors also briefly discuss GIM and behavioural approaches to music therapy but suggest that these are less popular in the UK. A similar format is used for the following three chapters, of which I will only highlight a few points concerning the relationship between the arts therapies. This is because for those readers who are interested in learning about each discipline in particular rather than how they relate to each other, I recommend reading this book or, for more depth, other books that are focussed on the particular arts therapy discipline of interest.

Chapter 6 presents AT as a unique arts therapies discipline. The authors highlight how art therapists in the UK emphasise psychoanalytic\psychodynamic thinking and value much less an artistic\creative theoretical framework. The authors also discuss the heated debate in AT surrounding directive vs. non-directive approaches which stems from the move to distinguish AT from the more directive use of arts in occupational therapy.

Chapter 7 focuses upon DT as a unique arts therapy. It is interesting to learn in this chapter that a relatively large proportion of DTs in the UK work with people who do not present an apparent difficulty (more than 10%). The authors suggest that this may be partly due to the verbal nature of DT which makes it better suited to clients with some degree of cognitive\physical\emotional skills. It is also interesting to learn that DTs place more emphasis on humanistic theories and artistic\creative principles and are less in agreement with psychoanalytic\psychodynamic thinking than other arts therapists. In chapter 8, it is interesting to learn that DMT is the most recently established arts therapy in the UK and that these arts therapists place a comparatively higher value on humanistic understandings of their work.

The authors offer a concluding chapter in which they suggest that arts therapists from each separate discipline can look to the strengths of the other disciplines in order to work on the weaknesses of their own. For example, they suggest that “MT can offer knowledge and experiences of undertaking extensive research work in MT practice and creating a public profile that can be useful for all arts therapists. In terms of clinical practice, the relative aversion of music therapists to eclectic\integrative principles can remind arts therapists that within a postmodern era that values diversity, it is important to retain a clear sense of professional identity that is not in danger of fragmentation or diffusion and at the same time does not lose essential flexibility” (p. 276). Furthermore, the authors’ conclusions point toward the need to explore commonalities and distinctive practices amongst different arts therapies in order to begin to develop indigenous theory for each discipline.

Due to the ambitious scope and variety of intentions underlying this book, the three identified audiences (arts therapists, lay readers and health professionals) are not consistently addressed throughout. Different audiences may prefer different parts of the book. For example, chapter one may be particularly useful for lay people or prospective arts therapies students, whilst chapters 3 and 4 may be of most interest to arts therapists who are wondering how they might collaborate with other arts therapists. The second section may also serve this purpose but is probably most useful for other health-care professionals who are questioning the relevance of the arts therapies to their own work or which arts therapy may be particularly appropriate in their workplace. I suggest that the key issues highlighted at the beginning of each chapter in the second section will be the most helpful in this regard. More obviously, this book will probably be of most interest to arts therapists, lay readers and health professionals in the UK, however it is also a useful starting point for considering the commonalities and differences amongst the arts therapies in other parts of the world. For music therapists in any country, the fact that this book is grounded in research makes it a useful tool for continuing the development of indigenous music therapy theory and for considering our part in the development of indigenous theory for the arts therapies as a whole.


Faire & Langan (2004). Expressive Music Therapy: Empowering Engaged Citizens and Communities. Voices: A World Forum for Music Therapy. Retrieved February 8, 2010, from http://www.voices.no/mainissues/mi40004000159.html

Gold, C., Wigram, T., & Voracek, M. (2007). Predictors of change in music therapy with children and adolescents: The role of therapeutic techniques. Psychology and Psychotherapy: Theory, Research and Practice, 80m 577-589.

Smeijsters, H., & Cleven, G. (2006). The treatment of aggression using arts therapies in
forensic psychiatry. The Arts in Psychotherapy, 33, 37-58.

Smeijsters, H., & Vink, A. (2003). Music therapy in the Netherlands. Voices: A world
forum for music therapy
, Retrieved 01/10/2009, from voices.no/country/monthnetherlands_september2003.html

Stige, B. (2002). Culture-centered music therapy. Gilsum, NH: Barcelona Publishers.

Stige, B., Ansdell, G., Elefant, C., & Pavlicevic, M. (Eds.). (2010). Where music helps:
Community music therapy in action and reflection
. Surrey: Ashgate.

Wheeler, B. (1983). A psychotherapeutic classification of music therapy practices. Music
Therapy Perspectives, 1
(2), 8-16.

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