gms | German Medical Science

Is art therapy a scientific discipline? In order to provide a picture of the current situation, it is first necessary to clarify which understanding of science we are talking about here. This understanding of science will explain the selection of publications used for the description of the current state. The definition of science is based on the approach of Kriz 1981 [1] from the framework he employs up to today (Kriz 2019, personal communication). Kriz is certainly one of the best known and most influential methodologists and method critics in German psychotherapy research. As a member of the Advisory Board for Psychotherapy, he has repeatedly cast minority votes and subjected its decisions to substantial criticism in terms of content and methodology and to criticism of its rule [2]; he did not stop at criticism, however, but in many respects played a decisive role in the application of humanistic psychotherapy for scientific recognition [3], among others in a professional politicts proposal, which in the end was turned down. His commitment to the “underdogs” in the scientific system of psychotherapy also extends to creative arts therapies, here too combined with substantial and constructive criticism [4]. A concept of science developed in this critical spirit should possess identification potential for this young science community, still in the middle of the process of self-discovery, in art therapy. All the more so, because Kriz places the concept of experience at the center of his thoughts. The concept of experience also plays a prominent role in the discussion about art in art therapy, as artistic experience [5], [6]. The concept of experience at the core of an understanding of science in art therapy would thus not only have the potential to dissolve the tension between art and science or scientific research, but also contribute to shape it fruitfully. And finally: The concept of science developed by Kriz is explicitly normative. Thus, in its orienting function, it is suitable for the enterprise to determine the state of the field.

The present contribution is intended as a discussion paper and is therefore best described as a well-informed essay. The sources consulted do not meet the criteria of a review or a systematic bibliographical analysis of the current art therapy literature. In order to exhaustively describe the state of a „scientific art therapy“, we would at least need to conduct a dissertation project. The aim of this contribution is rather to make a selection based on content and the experience of the author, analogous to a selective and stratified sample, which is meaningful for the purpose of this contribution. Thus, the aim is not to describe an entire landscape as exhaustively as possible, but to take a closer look at some of its characteristic landmarks, which together allow a useful determination of the position. The assessment of the situation thus gained is to be understood as an invitation to a hopefully profitable debate within the young scientific community of art therapy.

Kriz [1] understands human experience as a double experience in the here and now as well as in an insoluble interweaving with all previous experience, and in it again insolubly connected with the phylogenetic (tribal), sociogenetic (social), and ontogenetic (own, personal) background of every human being, which in turn are mutually interwoven and interdependent (pp. 16–17). Reality – not truth – is constituted from his point of view from the interaction of the experiencing system with the system to be experienced, in which first of all an ordering performance by the experiencing system is required (p. 18). Kriz thus distances himself epistemologically from an objective concept of reality as well as from the concept of truth, identifying as a representative of a moderate constructivism. The concept of reality as taking shape and being formed in interaction surely is not far from the way an artist may think about artistic creation and reality.

The specifically human quality of experience as personal experience is thus defined. It only becomes a specific social experience of people, when individual experience is passed on. For individual experience to be passed on, it requires a triad of changing the material world (e.g. through tool-making, p. 22), verbal communication about it, together with the accumulation of common experience with this change and the coordination and cooperation that arises from it, and finally the formation of typical actions and common activities that are bound to this material change (p. 22–23; emphasis corresponds to the original). This triad of change of the material world, the cumulative-experienced communication about it and the common action connected with it constitutes meaning: “The constitution of the world and reality is done in a meaningful way; and meaning [...] is especially created by common action” (p. 24). If, following Piaget, who understood himself at the core as a genetic epistemologist [7], [8], [9], thinking and thus also language is internalized action, this triad of meaning becomes even more clearly recognizable.

In this view, a vernissage is a prime example of the creation of social meaning: the artist communicates his artistic experience with and through a transformation of the material world (work of art). By doing so, the artist enters into social space, where this experience is negotiated and cumulated as well as coordinated with already existing experiences (e.g. art-historic classification), in order to finally constitute meaning together with and in the joint act of appropriation (exhibition tour, exchange and discussion of the works).

The meaningful patterns of experience and actions relevant for the common mastery of life that emerge in this way are transmitted by language through time and space. Societies based on the division of labour necessarily bring with them “provinces of meaning” ([1], p. 25) that are not shared by all. Specific modes of action deal with specific areas of matter that are handed down as specific experiences through an expansion of language by specific technical terms, making joint action possible. Examples of such provinces of meaning are crafts, art or even science. The limitation of the breadth of experience in the province of meaning of a science is contrasted with “a considerable possibility of deepening in this narrow area” (p. 26). Thus Kriz [1] understands science as a special continuation of the social process described above. In this context, science aims – in contrast to craft trades, for example – “at a systematic expansion of the specific knowledge base” (p. 26; emphasis added by the author), typically through specific questions, the use of specific perceptual devices and the use of a specific language and a specific knowledge base.

After a fundamental critique based on this understanding of science of both logical empiricism and critical rationalism, Kriz continues:

“In summary, it should first of all be emphasized that in the concrete researcher, individual, social and scientific components (of experience; author's addition) have always been interwoven. However, the focus of our consideration on individual components of experience should reveal,

1.

that social experience coordinates the aspects of individual experience particularely relevant to interaction between people in a meaningful way and that analogous scientific experience deepens and coordinates the social experiences relevant to a specific interaction,

2.

that experience, action and communication thus form an insoluble triad for both the everyday and scientific constitution of reality,

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that in the scientific process, which means a deepening and differentiation of (general) social experiences, together with the specific manipulation of matter, language has to provide the accumulation and synchronization of experiences and actions” (S. 28–29).

The basic function of science is to improve the living conditions (p. 29). Science is, therefore, only the case as a joint, meaningful enterprise, in which individual experiences must be brought in with necessity, in order to make a contribution to science.

The normative understanding of science presented above will be used in the following section as an orienting coordinate system for a snapshot of the current state of the scientific landscape of art therapy in the German-speaking world.

In summary, the scientific process of art therapy has to provide a – in turn coordinated – deepening and differentiation of specific interaction-relevant aspects of the social, meaningful coordination of individual art therapy experience.

The sudden illumination of the art therapy landscape follows the key terms of this summary. Before the deepening and differentiation of art therapy action as a separate scientific process becomes a topic, the field of social coordination of individual art therapy experience is first illuminated. The deepening and differentiation of this field that generates and constitutes the science of art therapy action, will then be discussed.

Social coordination is more than just communication and knowledge, it is more than contextualisation, it is mutual participation and coordination. Controlled subjectivity [10] helps in the run-up to social coordination, but in itself is not sufficient to qualify a research project as scientific. For example, a dissertation constitutes itself as a scientific contribution through the establishment of participation and agreement upon its defence in collegial debate; its preparation alone does not yet achieve this.

To enable participation and coordination in this sense, von Spreti deliberately refrains from copyright protection of the methods she presents ([11], p. 558). This distinguishes it from those art therapy approaches and methods that are protected by trademarks (e.g. [12], [13], [14]) or prescribe very specific formats and materials with which alone a method can be correctly performed [15]. The phenomenon of trademark protection is more reminiscent of demarcation and exclusivity than of mutual participation and coordination and may be an indicator of the still young state of the science of art therapy. The mothers and fathers of new methods and insights will be identified wit the science of art therapy when their concern for and their joy of meaningful coordination with each other is greater than the fear of possible plagiarism. On the other hand, there is already an entire culture of such joint protoscientific behaviour. The members of the professional group Music and Art Therapy in the Psychosocial Working Group in Paediatric Oncology and Haematology (PSAPOH, a working group in the Society for Paediatric Oncology and Haematology GPOH), for example, would probably not describe themselves as scientifically working art and music therapists, but the heart of their meeting in Heidelberg 2017 was to discuss together the painting series created by fatally ill children and adolescents. Here, and on comparable occasions, the social, meaningful coordination of individual art therapy experiences on a specific issue takes place. The achievement of these collegues is scientifically sound. The treasure trove of art therapy science is formed by such an exchange of experiences, and only a few of its jewels have come to light in the scientific public through research and differentiation.

Approaches to knowledge and methods: In principle, the young science of art therapy is also about the specific deepening and differentiation of common experiences in relation to already developed neighbouring methods of knowledge [16], and here too it is about the integration (or even better: dialectical dissolution) of opposites, as is fundamental in every intellectual development. It is not about the own, differing methods of cognition in polarising demarcation as with Majer, Niederreiter and Staroszynski in their editorial work with textbook claim to content ([17], p. 12). In their forewords, they contrast what they consider to be artistic approaches to knowledge that are worthy of dialogue with art and complex humanities approaches from the social sciences (p. 12 above) with scientific, classical-medical art therapy and psychotherapy research that instrumentalizes art and over-simplifies therapeutic events (pp. 10–11). In doing so, the authors see the kind of research characterized in this way as obvious and, moreover, under the spell of a medical understanding of treatment that has long since become obsolete, without proving where and with whom they establish this (p. 11). The authors briefly mention postmodern psychotherapy with a reference, without going further into it. However, the reference point that is truly exciting and worthy of dialogue would be the current state of the critical discussion of methods in international psychotherapy research (see for example [18]), which the authors do not take on. Here, the meaningful coordination of collective experiences in favour of polarising profile building is put at the back of the list. Petersen and Tüpker can be named as pioneers of this position [19], [20]; for a critical discussion see [21].

Kriz [4] also contributes substantial criticism of the real power relations and undesirable developments in health and social research, but with the concept of science described above he has created a scientific-theoretical ground for it. On this ground he makes a plea – not only for art therapy – for pluralism of methods and choice of methods depending on the question and the context of knowledge, and against a mixture of knowledge through artistic approaches with scientific methods while appreciating the knowledge potential of all approaches. Here Kriz offers art therapy a dialectically integrative approach to the discussion of methods.

Contents of knowledge and fields of experience: Here, the young science of art therapy finds itself in the privileged, but also strenuous position of being surrounded by a variety of related sciences with comparatively long traditions of experience. The challenge here is to define the interfaces with the state of research all round and to take up and further develop what is already available in terms of scientifically in-depth, socially coordinated experience. Once this resource is made use of, the richness of the manifold sciences of reference offers a great opportunity: relieved of the burden of having to generate all these insights and experiences itself, the young science community can turn its limited forces and resources to the specific questions that no neighboring discipline is investigating. In other words: it can turn to its own core questions.

The specific art therapy questions can again refer to the fields of experience (contents) and/or to the approaches (methods) that generate experience. At this point the focus is on the specific fields of experience.

In this context, the guiding question about the specificity of art therapy is: Which relevant aspects of the art therapy process did other sciences not investigate for us in an adaptable way? In my opinion, it is essentially the actions of art therapists and the specific competencies of art therapy brought to live therein, or more precisely: those aspects of art therapy action that differ from the actions of a psychotherapist on the one hand and from the actions of an artist on the other. This action of the art therapist, which cannot be substituted by other professions, generates the specific art therapy experiences from which the science of art therapy emerges through coordination and deepening. Both the training in art therapy and a genuine art therapeutic identity would be meaningless if these specific aspects did not exist, because there is a rich research to be adapted for both psychotherapy and art creation, its perception and effects.

This is based on the following premise: there is a specific art therapy activity that cannot be classified as either artistic or psychotherapeutic activity. The use of artistic procedures in professional action with an informed therapeutic responsibility at its core, justifies and generates precisely that specificity in art therapy action and the accordingly developed competences which cannot be subsumed elsewhere ([5], p. 19).

This has to be proven – in a double sense: It can and must be proven. Taking up and carrying out this proof in many different ways will further create and develop art therapy as a specific science. For this specificity may be self-evident for identified art therapists, but it is by no means self-explanatory. Basically, therefore, the question of art therapy as a science is essentially about the science of art therapy action.

This specificity finds its correspondence in the core of professional responsibility in art therapy action; it applies to the suffering person who entrusts himself to art therapy ([5], p. 26), ([22], p. 153). This responsibility differs sufficiently from the core of artistic responsibility and should not be equated with it. In many, perhaps most cases, artistic and therapeutic responsibility can be concordant [6]; in the nevertheless discrepant cases, however, therapeutic responsibility is decisive for art therapy. This connection can already be seen in the choice of title for the work “Kunstbasierter Zugang zur Kunsttherapie” [art-based access to art therapy] [23]. The ethical field of tension constituted by this cannot be resolved unilaterally in favour of one side or the other without damage; it is up to the art therapists to shape it, and likewise it cannot be substituted by artistic or therapeutic action alone. The same applies to the relationship between the role of the therapist and the researcher when art therapists research their own actions [21].

The question of the state-of-the-art of young science is tantamount to the question of the experiences of art therapists with their actions, and how these experiences are communicated in their scientific community, meaningfully coordinated and deepened under specific questions.

In order to answer this question, we will first select the two current complementary textbooks or manuals of art therapy: Majer, Niederreiter and Staroszynski [23], and Spreti, Martius and Steger [24]. The task of these contemporary textbooks is to process, order and communicate the state of knowledge of the subject – in the spirit of the accumulation and synchronization of experiences and actions as a task of science [1]. If one reads the list of authors of both works together, one finds almost a complete collection of the hitherto relevant proponents of the German-speaking scientific community of art therapy. In view of the generational change already underway in the study courses of art therapy, many of the authors who are publishing here again look back on rich sources of experience from which their contributions can be drawn. This also makes the two works suitable sources for the question under investigation.

On the other hand, the more recent and most recently completed dissertations by art therapists are examined to determine whether and how they address art therapy action. These works must research and present the current state of knowledge with regard to their specific question in order to show the continuative, innovative nature of their own contribution. If, in a given case, these works deal with art therapy action, then, in the sense of the question of the current state of science, they are art therapy at the cutting edge with regard to the specific aspect they have investigated.

These two groups of sources will be supplemented with other German-language publications or with international publications from the German-speaking scientific community, particularly with regard to the diagnostic aspect of art therapy action. On the one hand, art therapy diagnostics as a separate topic is not directly reflected in either of the two textbooks, and on the other hand the author’s research focus in this subject area provides a useful overview of German-language literature. Only German-language sources have been used, because this article focuses on the German-speaking scientific community of art therapy.

The first source to be negotiated here is the edited work “Kunstbasierter Zugang zur Kunsttherapie” [art-based access to art therapy] [23] with some of its contributions, because without art there would be no art therapy. The contributions from this work, which are included below, were selected according to the central question of this work and the hints of the editors in their prefaces.

In the first article D’Elia discusses that the healing potentials of art do not automatically mean its exhaustion in actual effect ([5], p. 23; see also [25], p. 499). In this sense, art therapy interventions are defined as the intentional and concrete bringing to bear of the healing potentials of art. Consequently, the author calls for an art-therapeutic intervention doctrine with a “model that is suitable for making and formulating principles for the application [of interventions, author's conclusion] recognisable” (p. 21). And further: “However, if art therapists want to transcend the level of intuition and be able to justify their actions, they need to be able to assess the possible consequences of their intervention or omission” (p. 24). In my opinion, it should be added that art therapists can only exercise their therapeutic responsibility in the first place by assessing their intervention or omission. It is precisely in the transcending of intuition towards the reasoning that art therapy as a science emerges – not only, but necessarily also. D’Elia then and at the end of her contribution presents two approaches from music therapy and art education and examines them for their transferability to a possible artistic/art-therapeutic intervention model. In her opinion, there obviously does not appear to be an approach worthy of discussion from art therapy itself.

In his own way, Majer gives a further indication of the significance of the difference between potentiality and actuality by referring to art education literature to point out the difference between competence and performance: “Competences themselves are not considered empirically verifiable, since they only become accessible and experienceable as a phenomenon through their performance (implementation in action)” ([6], p. 51; emphasis and parenthesis in the original). The pair of terms competence and performance goes back to the linguist Noam Chomsky [26] and describes the difference between language knowledge and actual language use. However, the difference does not consist in empirical evidence; at best, it points to the difference like a symptom, but does not capture it itself: competence is a necessary but by no means a sufficient condition, especially for good, i.e. in our context therapeutically effective performance. This connection forms a parallel to d’Elia’s above considerations of the potential vs. actual effect of art. Art therapy competence and art therapy performance cannot and must not be put into one. Decisive for art therapy action is performance, i.e. the competence realized in concrete action, not only the competence for this. Thus, the question of art therapy action cannot be answered with the concept of artistic attitude as the specific harmony of all artistic abilities and competences ([27], p. 313), which, according to Majer, “is basically oriented towards an unforeseeable (aesthetic) form of knowledge” (Majer [6], p. 51, at the beginning of his differentiated model of artistic competence; parenthesis in the original). In his contribution, Majer explicitly and for good reasons devotes himself to the competence aspect and explicitly only to the artistic of all necessary art therapy competences (p. 53). The actually exciting question of how this attitude is transformed into concrete art therapy action (performance) remains open about this, even if aspects such as ability, willingness and motivation to implement the competence or also an attitude of co-learning ([28], p. 282) are understood as partial concepts of the concept of competence. The discrepancy between the ability to act and actual action remains. Even the recourse to the necessary accumulation of artistic experience [5], [6] cannot directly answer the question of art therapy action, since experience is condensed in the artistic attitude as the core of competence [27].

The examination of the contributions of d’Elia and Majer thus leads to the necessity of sharpening the guiding question once again.

The question as to which experiences of the art therapists are communicated, meaningfully coordinated and deepened under specific questions with their actions in their scientific community, aims at art therapy action, and in it at the actualization of the artistic attitude as the core of art therapy competence in actual art therapy action.

Acting can be understood as a process evolving recursively between the ascertainment of a situation that is worthy of change, a diagnosis in the literal sense (ancient Greek , composed of dia = ‘through something’ and gnosis = knowledge, evaluation; in a sense a transparent knowledge), the action that influences it, an intervention in the literal sense (Latin: inter venire = to come in between, to intervene; see also [29], [30]), the re-examination of the situation that is still to be changed or has already changed, etc. In the simplest case, this process can be represented as a circle that closes after the first run through [31], [32]. A multiple run-through is – especially in the case of a successful change – better represented as a spiral, since not only the initial situation but also the influencing action changes with each run-through.

Art therapy action can thus be represented in essence as a process evolving recursively between art therapy diagnosis and art therapy intervention in the above-mentioned fundamental sense. The entire complexity and multilayeredness of the art therapy situation with all the people and influences involved in it is condensed as if through a burning glass at the moment when art therapy perception and diagnosis swings into art therapy intervention. And by setting an intervention, the intervention affects the whole complexity and multilayeredness of the art therapy situation – which in turn is condensed in art therapy diagnosing into the next intervention, and so on. This core model of art therapy action does not correspond conceptually, but structurally to the model of artistic competence presented by Majer ([6], p. 52).

The central question on the state of the art of the young science of contemporary art therapy action thus includes the sub-questions of art therapy diagnosing and art therapy intervention.

The scientific literature on art therapy diagnotics can be divided into three groups:

1.

Publications on the potential and competence of art therapy diagnostics: Included are all publications that thematisize foundations e.g from art and media development, concepts, instructions and procedures relevant for art therapy diagnostics. The motto for this group could be: ‘This is how art therapists should, must, can diagnose, and these aspects can or should be important in this process’. This publication group is certainly the largest of the three groups. Representative examples are the works of Sinapius [33] on intermediality, Staroszynski [28] on the significance of anime and comics for perception and aesthetic appropriation in the digital age, and Mechler-Schönach [34] on the concept of tenacious amazement as an attitude. Older approaches to art-therapeutic image analysis by Golombek [35] as well as by Henn and Keller [36] are certainly also relevant. In the sense of the central question of this work, these publications frame the actual art therapy diagnostics, but do not examine, record or describe it themselves.

2.

Publications that present, develop or evaluate instruments to support or supplement art therapy diagnostics: This group is much more manageable. These include instruments for art therapy image acquisition such as the observation catalogue for the systematic assessment of initial images by Gruber, Frieling and Weis [37], the Nürtingen evaluation scale for the assessment of patient images in the course of therapy and DAPA-D by Elbing and Hacking [38], the phenomenological image acquisition by Stuhler-Bauer and Elbing [39], as well as the process diagnostic instrument DoKuPro by Elbing and Hölzer [40]. The most recent example in this series is given by Schoch, Gruber and Ostermann [41]. With the exception of DoKuPro, these instruments exclusively deal with the finished images of the patients. As far as these instruments have been examined for reliability or validity, they come close to the actual art therapy action in that they prove that art therapists perceive and assess similar or comparable things through the lens of the respective instrument.

3.

Publications that directly examine art therapy diagnostics: The work of Gruber can certainly be considered pioneering work [37], [42]. He examined not only the comparability of the assessments of patient images, but also the assessments of the content of the art therapists themselves. He was the first in German-speaking art therapy research to introduce the discussion of the art therapists involved on their assessments as a research object and data source. Previously, Herrlen-Pelzer and colleagues [43] had also used a – albeit interdisciplinary – team to examine patient images, so that the specificity of art therapy is not apparent from this investigation. Reibrandt, Elbing and Wietersheim [44] take up the approach of the art therapy expert discussion in a small study and contribute a further indication of the quality of art therapy diagnostics. The most recent contribution, which uses a digital recording technique of the drawing process itself, is art therapy dementia diagnostics. In further development of the method of expert discussion, two art therapy dementia experts, under the participating guidance of a third art therapist experienced in research in other contexts, have explained, reviewed and further developed their previously implicit diagnostic criteria. The continuation of the project is planned, and the international publications by Heymann, Robens and others [45], [46] to date show that art therapy diagnostics can enter into dialogue with diagnostics in neighbouring disciplines on an equal footing. In addition, there are indications of an independent contribution of art therapy dementia diagnostics that goes beyond the current possibilities of neuropsychological dementia diagnostics [47], and which can only be hinted at here with the keyword of the seismographic function of art therapy diagnostics. The prospect that art therapy diagnostics can also be explained in other areas by art therapy experts does not seem unjustified.

In addition to the work of Majer, Niederreiter and Staroszynski [23], the work of Spreti, Martius and Steger [24], the chapters V Art as a therapeutic method, VI Trauma and creativity, IX Craft art therapy, as well as texts with subheadings in the contributions that refer to interventions were examined. In addition, the relevant art therapy dissertations of recent years were analysed. The contributions can be divided into three groups as above.

1.

Contributions on the competence and potential of art therapy intervention: Included are all contributions that deal with the foundations, concepts, instructions and procedures for art therapy intervention. The motto for this group could be: ‘So can, should, should art therapists intervene’. Again and certainly this group of publications is the largest of the three groups. Buland and Gottschild [48] stress the necessity of careful guidance by experienced therapists and the avoidance of aberrations and dangers by gentle interventions, without describing how such an action actually looks like (p. 141). Instead, they offer their view of the art therapy process as a creative game for orientation. Similarly, Meffert [49] describes art therapy accompaniment through care and attentiveness, making available knowledge of materials and form as well as her own perceptions and offers of reflection (pp. 42–43), whereby she offers the idea of the self as a handicraft enthusiast as an orientation. Rentrop and von Spreti [50] give under the subheadings ‘Art Therapy and Identity’ and ‘Art Therapy and Mentalization’ indications of what art therapy interventions make possible, but at best only indicate the interventions themselves. McGlynn [51] proceeds similarly in describing art therapy as a space for negotiation, whereby it becomes most concrete in the description of this space for the safe confrontation with aggressive impulses, without, however, describing interventions linked to it. Instead, she refers to the sensitivity of the artist and therapist in the balance between intuition and ratio as a desideratum. Comparatively concrete descriptions of the procedure are contained in the publications on the progressive therapeutic mirror image of Waser and Schattmayer-Bolle [52], [53]. Regarding the role of language in art therapy, Schattmayer-Bolle states, among other things, that “art therapy, according to Benedetti, is a psychotherapy that does not exclude amplifying or reconstructive interpretations, but rather uses them as soon as the patient’s ego state permits” ([53], p. 184). In the chapter ‘Hand-Werk Kunsttherapie’ [the craft of art therapy] Spreti [11] first of all describes the framework, prerequisites, competences, attitude, and basic recommendations. Then she describes in a differentiated and systematic way five art therapy procedures in the sense of an instruction manual and shares her experiences with this procedure.

2.

Publications that present, develop or evaluate instruments for the supportive or supplementary description of art therapy interventions: At DoKuPro the responsible art therapy working group decided at the time not to include art therapy interventions in the instrument. In my opinion, IiGART (Schulze [54]) is the only instrument presented in the German-speaking world that systematically depicts aspects of art therapy intervention. It is a complex instrument for recording the interactions in an art therapy group, including the art therapists and the patient works; at its core, IiGART uses a psychological model of the quality of interaction and therefore describes art therapy intervention not in terms of content, but rather in terms of the location and quality of the intervention in the entire interaction process depicted. However, the actual investigation of art therapy intervention with IiGART is still pending (Schulze, personal communication 2019).

3.

Publications that directly describe or systematically investigate art therapy intervention: In principle, doctoral projects can provide the necessary space to make art therapy intervention a scientific subject. Therefore, all findable dissertations of the last twelve years by German-speaking art therapists who have researched art therapies in practice were used.

A total of ten dissertations were examined; in most cases the art therapies researched were carried out by the therapists themselves. None of the ten works directly asks for art therapy interventions or examines them or the experiences of the art therapists with them as an object of research. The dissertations were therefore examined for documented or reported interventions as an incidental finding, as it were, as a scientific by-catch in the net of the various research questions.

Eight papers investigate the perception and/or experience of patients in art therapy [13], [55], [56], [57], [58], [59], [60], [61], eight works examine or report on the patients’ works or their creative process [55], [56], [58], [59], [60], [61], [62], [63], seven works describe interventions in terms of concepts, intended procedures or tasks [13], [55], [58], [59], [60], [62], [63]. None of these studies examines or discusses the question of adherence to the concept in its implementation; Pöppel [62] approaches this topic in so far as she refers to the three times her project has been carried out in formative evaluation. Two studies contain summary reports on interventions that have been carried out [60], [61]. Two studies report concrete interventions and/or experience with concrete interventions on a significant scale [60], [63]. Three other works report anecdotally, i.e. isolated concrete interventions or the experiences of the art therapists with them (Ganter Argast [57] on one page; Pöppel, [62] on one page; Widdascheck [61] on about seven pages).

Ameln-Haffke [55]. The empirical part of the study focuses on the patients’ works and working process with video documentation (focus on the resulting picture; pp. 205–209). Art therapy work is discussed with the claim to serve as a manual (p. 103), with a conceptual pre-selection of material and methods (combined receptive and actively shaping approach), a description of the structure and sequence of sessions and a requirement profile for the role of the art therapist (pp. 98–111; 139). Art therapy action itself is not researched at any point; the guideline interviews deal exclusively with the patient’s actions, perception and experience in relation to the picture templates or his own pictures. At best, the guideline interviews themselves conducted in each session can be regarded as documented interventions.

Fritsche [56] evaluates interviews with visual artists in their studios on the creative process, as well as with clients of an art therapy studio group and explicitly does not investigate art therapy intervention, but wants to draw conclusions for those (p. 10).

Ganter-Argast [57] has developed and evaluated a questionnaire that surveys the perception and assessment of patients and therapists regarding art therapy in the group and the experience of art therapy intervention; however, the intervention itself was not examined. In the qualitative individual case study, some interventions are only represented mediated by the patient’s reported experience, whereby the evaluation also focuses on the experience of the therapeutic relationship (pp. 181–182).

Hopf [13] uses patient interviews not to examine the interventions she has developed, but rather their evaluation by patients as helpful or effective, as well as critical feedback on the concept and procedure (pp. 133–136). Furthermore, the expectations of the patients regarding art therapy were surveyed at the beginning (p. 141). The transcripts of the interviews show that no questions were asked about the interventions themselves (appendix pp. 268–310).

In her extensive empirical study with video documentation, Kortum [58] focuses on the works and working process of the patients. Interventions are not evaluated. Art therapy action is addressed in terms of a conceptual pre-selection of material and methods as well as a requirement profile for the role of the art therapist (pp. 114–120). The evaluated feedback from children and parents refers to aspects of the setting (without pressure to perform, p. 226) and material offers or methods (p. 225–227); concrete interventions themselves, however, remain unrecognisable.

Only at the very end of her extensive work does Pöppel [62] present her intervention model of a receptive-productive art therapy with ADHD children between eight and eleven years of age, which has been tested and further developed three times. Pöppel shares her experiences by describing all the conceptual elements of the project in concrete terms and by communicating which therapeutic effects can occur through precisely this way of designing the project elements (pp. 196–202). She thus communicates her specific experiences in the form of recommendations and possibilities and thus indirectly. Only in isolated cases does she communicate her experiences directly (example on p. 201).

Seifert [59] describes her approach to treatment in a differentiated way with introductory topics, forms of organization and a phase model of the process (pp. 89–95). The focus of the survey is on patient data, in particular image analysis and behavioural observation of the patients. In addition, group processes and interaction structures in the group are observed (p. 108). Actual interventions are neither collected nor reported.

Watermann’s questions [60] focus on the patients’ subjective experience, subjective evaluations, and experience of the effects. The perception of specific interventions as beneficial is questioned (p. 86). The forms of conversation used are described in detail in their usual way of implementation (pp. 52–59), as well as the setting, time structure and phases of the typical course of a session, and the methods and working methods used in their usual application (summary report form). Watermann provides concrete examples to illustrate this. In the example on page 65, first sentence, the intervention can only be deciphered fromthe description of the patient’s behaviour.

In the two examples on page 66, interventions are hidden behind passive formulation or behind the report on patient behaviour. The example ‘Bridge’ on page 67 shows an incomplete but concrete task as far as it is comprehensible. The example ‘art project’ on pages 67–68 refers to the meaning of the interventions, from which the interventions themselves are hinted at and perceived. Interventions are not recorded with the specially developed instrument for observing and evaluating art therapy processes; the examination aspects “agreements” and “relationship between art therapist/patient” come closest to this (p. 103). In the qualitative evaluation of the patient interviews, helpful interventions are worked out from the patient’s point of view with category formation. Two in-depth exemplary case histories (pp. 200–253) report concrete interventions in the form of a progress report, together with a description of the preceding situation and the patient’s subsequent behaviour. The focus here is on the patient and his or her process of change.

Widdascheck [61] follows the question of how intercultural conflicts manifest themselves in art therapy work, or rather, what specific possibilities art therapy offers for overcoming these conflicts (p. 67). The design of the framework, the artistic work of the patients and its intensity as well as descriptions of art therapy interventions as “mediated relationship design” are communicated (p. 70). In summary, three groups of interventions are presented (pp. 77–78): joint observations of the work with the art therapist as the unknowing and the patient as the knowing, mediated shaping of the relationship (keeping the clay object moist even over a long period of time or the procurement of materials as gestures of care), as well as technical advice on how to promote the intensity of the artistic work. A detailed individual case offers a phenomenological description of the artistic work process with expressions of the patient at the centre; concrete examples of the above-mentioned interventions can be found on pages 164–165. Before that, interventions are only reported unsystematically and then only in the context of verbal dialogues. Actual interventions can be read on about seven of 188 pages. The recently published publication [64] contains – certainly for reasons of shortening – in the passages taken from the dissertation numerous prescriptive instructions for implementation, but hardly any actual descriptions of interventions.

Towards the end of his dissertation, Wolski [63] presents an individual art therapy case study from the field of paediatric oncology. For selected therapy sessions, he describes the concrete material specifications and tasks for the design, which are adapted to the process and state of the illness; the focus of the presentation is, in concordance with the topic of his dissertation, an analysis of the images thus created. As a further intervention, he describes his active participation in the design of each session with reasons and the way it is carried out in consultation with the patient (pp. 213; 225–226).

The handbook by Spreti, Martius and Steger [24], with the subtitle ‘Wirkung – Handwerk – Praxis’ [Effect – Craft – Practice], first of all suggests that art therapy intervention and the experiences made with it are presented. Of the fifty-five contributions in this volume, twelve contain descriptions of interventions in the broadest sense. On closer reading, two contributions do not contain any intervention descriptions that the reader can really perceive (Hartwich; Hölmer, [65], [66]). Of the remaining ten contributions, two describe classic play therapy interventions (Dannecker; Breuer-Umlauf [67], [68]). In the remaining eight contributions there are boxes with case vignettes, mostly headed 'case study', in varying degrees. The main focus of their descriptions is usually on one or more concrete sections of a course of therapy, which are embedded in notes on the patient and the previous and further course of treatment. Illustrations of the artwork enrich the descriptions to varying degrees until the artworks, together with the mostly psychodynamically interpretive comments of the respective authors, occupy the largest space [25]. The case vignettes usually have an illustrative function for the main text. Art therapy intervention itself is treated very differently in the main texts and the associated case vignettes. The differences concern both the choice of levels of action (from the macro-level of a concept with several sessions to the micro-level of a concrete intervention, which can also consist of only one gesture) and the way of presentation. Here the spectrum ranges from passive formulation to the use of the “we” form (in both cases the actual intervention is not clearly recognizable or assignable) to the “I” form, which only makes interventions clearly recognizable. The first-person form and the associated, sufficiently comprehensibly described, specific art therapy intervention can be found in four contributions (Bonnländer; Haberkorn; Riedel; Spreti [25], [69], [70], [71]). All the interventions described are directed at a single person. An intervention that is directed at the group is not reported, except for tasks.

Sarbia [72] concludes her contribution to the perception of images as an art therapy practice with the question: “How do I as a therapist manage to reflect with the patient on pictorial works without falling back into the naive state of innocence in front of all theory and emptiness of content? (S. 197)”. In 2018, under the subtitle “Die kunsttherapeutische Werkbesprechung in der Praxis” [“The Art Therapeutic Work Discussion in Practice”], she reports the systematically recorded messages of the patients, but nothing about the therapist’s interventions [73].

Dannecker [67] refers in the same volume under the subtitle “Intervention and intersubjectivity in art therapy” to Kramer’s work, in order to refer to concrete descriptions of interventions. Her own considerations focus in the following with a concrete play therapy intervention description in a short case study on the “moment of encounter with the Other in art” as a “crystallisation point of aesthetic experience” (p. 347) and emphasises its characteristics of unintentionality, unpredictability and difficult describability. To approach this, she proposes microanalyses with video recording.

Connert and Mayer-Brennenstuhl [74] give three case studies; the first and most concrete one of them describes the actions in the passive, so that the interventions themselves become at best indirectly apparent (pg. 369). The remaining examples describe the [temporary] construction of a place that makes art possible.

From Hartwich [65] only the general introduction of the patients to media and procedures can be taken as an art therapy intervention; a further intervention is hinted at in the context of the case study in a passively formulated half sentence (p. 249).

Riedel [71] gives a comparatively extensive and detailed account of three case vignettes for the Dialogical Image Discussion. In the first two of them Riedel describes concretely her intuitive, specifically art-therapeutic intervention and her experiences with the effects of the interventions (pp. 303-308). On page 308 Riedel points out the seismographic function of the image: trauma becomes visible before it can be formulated verbally.

Haberkorn [70] gives a field report which, in the brevity of the article, provides a fairly clear insight into art therapy action and the art therapy interventions embedded in it. His art therapy interventions are mostly communicated implicitly, but also explicitly some times (p. 453).

Hölmer [66] on the other hand describes the artistic development of the participants and is content with short references to competent and attentive care (p. 457) as well as to a “permissive attitude accepting the artistic work”, which he illustrates by an example of the expression of aggression with sound in the effect on the participant, without communicating his own intervention (p. 460).

Breuer-Umlauf [68] gives as a case study a three-year therapy course on 2,5 pages, from which her play and psychotherapeutic interventions are presented in detail in a spotlight manner in addition to their continuous non-directive orientation (pp. 463–464). As a transcript excerpt, the author communicates the verbal farewell.

Behrmann [75] presents a case study to illustrate concrete art therapy interventions in the form of artwork and imagination exercises, whose use he briefly explains and whose effects he comprehensibly describes in the further course (pp. 473–477).

Bonnländer [69] gives a detailed description of the process with selected situations from a two-year course, in which she describes her interventions, predominantly of art therapy (pp. 481ff).

Eckart and Faltin [76] report in a passive form on art therapy tasks (pp. 492–494), their description focuses on the creative processes of the persons accompanied.

Von Spreti [25] emphasizes the special function of artwork as a substitute for verbal communication in borderline patients. As intervening action, she mentions mindful, attentive and value-free accepting of the patient, the creative processes and works, verbal mirrors of the development, (p. 500), verbal exchange on the basis of psychodynamic understanding (p. 501) and at the same time abstaining from explaining the pictures to the patients (p. 507). The author describes five case vignettes. Three vignettes contain exclusively the psychodynamically oriented explanation of the work processes and patient pictures, thus basically the art therapy diagnostics of the pictures. The other two vignettes are also essentially determined by the above-mentioned explanations; however, they each contain a specific art therapy intervention (pp. 503, 505), as well as two general psychotherapeutic interventions (p. 505). In the case study on p. 536, Spreti [11] reports with the understanding of aggressive behaviour as a taking of a relationship and a corresponding answer not a specific art therapy but a psychotherapy intervention.

In some cases, the phenomenon occurs that interventions are described, but the way they are presented impairs the formation of a common experience. Riedel [71], coming from psychoanalysis, mentions in both case studies in which interventions occur her intuition as the decisive impulse for the ways of acting described (pp. 304–305). Thus, the diagnosing impulse that triggers the action remains in the unsaid/unsayable and withdrawn from the common formation of experience. In another way Dannecker [67] also hides her art therapy intervention by describing a concrete, but play therapy designed moment of special encounter, which in her opinion also cannot be consciously brought about as an intervention (p. 346). Both authors thus show their intervention, but in such a way that their experience can hardly be transferred into a shared experience and thus is withdrawn from scientificization. The view from art on art therapy intervention can also be used to hide important things while presenting, and by doing so withdraw them from the common formation of experience. Coming from the side of art, Bonnländer [69], for example, gives a consistently phenomenological description of her intervention from the outside, whereby the intervening part of her art therapy action and the point in time in the flow of events are clear. By leaving her own diagnostic process in her art therapy action almost completely undirected, she simultaneously hides her art therapy action in its completeness through the way she communicates. The reader learns only half of her actions, so to speak. The artist/art therapist Hölmer [66] declares the studio itself an intervention (p. 460); consequently, he does not reveal his own actions in it. If artistically or psychodynamically oriented ways of constructing reality serve to conceal art therapy in the way of revealing it, they do not serve art therapy. Spreti [25] (p. 503) is the only one in the handbook under investigation to describe an art therapy intervention in concrete terms as decidedly art therapy and to provide reasons for it.

According to the sources examined so far, the following finding emerges: Actual art therapy intervention and the experiences of the art therapists generated through it are communicated little in the written communication of the art therapy scientific community on closer examination of the chosen means of representation, and then only partially in a truly comprehensible way. Rather, there are ways of representation which frame the actual art therapy action. Two further aspects further strengthen this finding. On the one hand, art therapy diagnostics is much more clearly outlined in the literature, even if it is still in its infancy, as can be seen from the above inventory. On the other hand, art therapy diagnostics is justified by its initiating and indicating function for art therapy intervention, because this is where its purpose is fulfilled. So, if art therapy intervention is not clearly visible, art therapy diagnostics will ultimately come to nothing. On the other hand, the range in the manner and quality of presentation of art therapy intervention as established here, again creates a problem that is well-known in the literature and has been discussed several times: the diversity hinders and complicates a meaningful coordination of the experiences communicated – up to the point of possible failure. In her dissertation, Lauschke [77] has almost completely researched and systematically evaluated the history and the current state of art therapy especially for the application of eating disorders in inpatient and day-care settings. In the focal point of this specific field of application, Lauschke encounters basically the same problems in terms of writing and research of art therapy action. It also summarizes the proposals which have been published for some time in Germany and internationally in order to further develop the quality of the publications and thereby make them accessible to a meaningful coordination. In her dissertation, Jakobs had already found similarly alarming results for the field of oncology [78] (pp. 333–334).

The chosen focused approach in this paper, can certainly only cast one of many possible lights on the state of the young science of art therapy. Whether the readership will attribute significance to the position identified will depend on how meaningful the assumptions about science appear to them; or how meaningful the differentiations made are for them, e.g. between prescriptive and descriptive presentation of art therapy interventions, or the choice and treatment of sources. Taking this into account, however, a picture of the state of affairs emerges which reinforces and complements existing descriptions of problems. For the decisive features of the above-mentioned problem situation have not only once been systematically recorded and proven on a scientific level [77], [78], and suggestions and appeals for a first-order solution (e.g. minimum standards for the writing of case reports and case studies [77], [78]) have not had any substantial effect for almost twenty years up to the current sources examined here. In my opinion, a continuation of this problem situation is tantamount to a serious danger for the further development of the young science of art therapy. The established members of the scientific community of art therapy, as they are depicted in the two mainly investigated textbooks, have not visibly processed the urgent and repeated appeals, apart from the few exceptions mentioned above. This reflects once again the above-mentioned phenomenon of the demarcation expressed in trademark protection as a cultural characteristic of the art therapy community: the urgently needed coordination of experiences with actual art therapy action, which is certainly lived by professional practitioners in various contexts, is hardly mirrored in publications. This statement in no way discredits the respective value and merit of each individual substantial and innovative scientific contribution to art therapy, as can be found in the sources used here. However, when viewed as a whole, the publications examined reveal a figure to the author, a figure that frames art therapy action, but does not really capture it.

In my opinion, and having spoken to Paul Watzlawick, it is time to discuss second-order solutions [79]. The first proposed solution consists in the call to place the solution of this problem confidently and courageously in the hands of the young generation of art therapy scientists, and to evaluate precisely the own irritation about a different or unfamiliar approach to art therapy topics as an indication of that which is sufficiently different and urgently needed for a new approach to problem-solving. For if the applicants for vacant professorships and positions assign themselves with little friction to one of the approaches represented up to now, there is a great danger that they will only bring more of the same, which has contributed to the establishment of the problem situation that has been worked out. For one thing is certain: the protagonists and previous approaches of the group of old ancestors in the German-speaking art therapy scene, who are already in the process of leaving the scene, will not (be able to) solve this problem.

The second proposed solution aims to develop a culture of joint meaningful coordination of experience as a scientific basis. Future conferences and congresses could develop forms of exchange, centred around manageable groups of experienced art therapists who have prepared themselves on a focus and are now exchanging their experiences. The groups would have to be small enough not to offer an attractive basis for self-expression instead of exchange of experiences. Scientifically active art therapists would then be only a few, but highly interested onlookers with clearly regulated and limited speaking rights, which would be supervised by a moderator. The exchange is documented in a previously agreed upon way. Ideally, the group would be so engrossed in their exchange that they would forget the onlookers’ presence. Conventional lectures and workshops would then only be a marginal phenomenon.

The third proposed solution aims at an independent foundation of the young science of art therapy. In order to give art and psychodynamics a good place, art therapy must (learn to) show itself in what it does. To do this, it needs its own approach to its core, namely, to concrete art therapy action in practice. The starting point for this could be the often mentioned phenomenon that is inherent in art therapy, that both the formative action and the emerging and finally created artwork already communicate what can only later enter into the conscious perception of the formative, and then also into the consciously executed action ([71], p. 308; [11], p. 508; [80], p. 513). The genetic epistemologist Piaget [7] has described this phenomenon and the processes connected with it in detail in another context and has included it among his key concepts of centering and decentering. In this context, Völker refers to the phenomenology of gestures by Flusser (1993; in Völker [80], p. 513). Finally, Deuser [12] has developed a psychodynamically informed phenomenology of haptics using the example of the haptic sense, which systematically describes the above-mentioned phenomenon, arranges its subphenomena and thus makes them accessible for a foresighted art therapy diagnostics and intervention. With this, he presents a phenomenological theory of intervention anchored in concrete perception, the basic features of which would have to be examined for their transferability to other art therapy processes in further sensory modalities. The comprehensibility in concrete perception also enables and facilitates the meaningful coordination of the experiences thus gained in the scientific community of art therapy and their deepening and differentiation in further research.

The proposed solutions, as well as other solutions not considered here, are not mutually exclusive, but rather complement each other. If the young science of art therapy action will itself clarify in this way, it should be able to overcome the difficulties described above with reasonable effort. Especially the recently founded Scientific Association of Creative Arts Therapies (WFKT) is called upon to create and develop the cultural breeding ground for the lived coordination and consolidation of experiences with arts therapies.

The author declares that he has no competing interests.

This article is the written long version of the farewell lecture on 05.07.2019 from the University of Applied Sciences Artistic Therapies (HKT) of the Nürtingen-Geislingen University for Economy and Environment, Faculty of Environment, Design and Therapy.