This is the fourth edition of Ethical Issues in Art Therapy (2020) by Bruce L. Moon and also now Emily Goldstein Nolan, published by Charles C. Thomas. Moon has been at the forefront of Art Therapies development in the US for forty years, both as a practitioner and in the academic context. Nolan also practices and joined Moon at the Mount Mary University, Milwaukee, ten years ago. She speaks of Moon as her mentor and he refers to her as now carrying on the torch as a teacher, having joined him on this revision.
The context and feel of the book are American and academic, with reference throughout to the American Art Therapy Associations Ethical Principles for Art Therapists, and the Art Therapy Credentials Board Code of Professional Practice. Reference is also made to the British Association of Art Therapists Code of Ethics and Principles of Professional Practice for Art Therapists, and all three are in the appendices.
Ethics and the dilemmas we might face as art therapists face are both universal, individual and contextual, so there is still much to be gained in reflection on that which we might not have seen as relevant to our familial, cultural, organisational or national setting.
How do we respond when colleagues are discussing unidentified clients in a restaurant? What if your employer instructs you to mount an exhibition of clients work? What if a client wants to see your assessment of them? This book offers us a valuable opportunity to revisit or begin to consider such questions and what will support our answers, choices and actions.
The authors assert four primary goals for the text: to raise questions and provide information regarding ethical dilemmas; to present models on how to think about and resolve them; to provide a tool for instructors and supervisors; to provide artistic possibilities for exploring ethical dilemmas. There are fifteen chapters, all of which end with suggested artistic tasks. While each chapter could stand alone and might be the one to spark initial interest in the book, there is a sense of a journey throughout, as we simultaneously expand the breadth of our consideration and the depth of our engagement. Considerations of the client, the therapist and the profession intertwine and overlap.
To begin, the authors identify three modes of ethical thinking in Chapter One: deontological, antinomian and teleological, as relating to a legalistic, anarchic or critical way of thinking. Nolan anchors herself and consequently the book in the teleological perspective/approach/world. For her, this combines the guidelines and general principles of deontological thinking with the ultimate decision being unique and situational, as with antinomian knowing. Roughly speaking, each of us identifies with a philosophical approach that will inform and underpin our ethical choices as to when we comply, when we defy, when we stand together, and when we stand alone.
Unsurprisingly, our responsibilities to our clients are emphasised throughout, with specific priorities for the client set out in Chapter Two. This chapter considers informed consent, understanding of the process, mutual expectations, and risks and limitations, with a focus on confidentiality and records.
The studio /place is considered in Chapter 12, which focuses on safety, predictability, and art-making in the service of relationship building. Conscious thought regarding the use of materials and the modelling of artmaking is stressed. The mutual, almost circular, support in growth and expression provided by artmaking and relation making suggests a need to deliberately equate and balance them. The American context raises the question of the hours necessary to practice privately and obligations to develop treatment plans and document sessions.
Artwork’s rights, an interesting idea explored in Chapter Three, suggests that in sessions and exhibitions we inhabit and give voice to the artwork as autonomous. Moon states that "Imagicide is the intentional killing of an image through labelling it as one thing and thus restricting it" (p.60). More familiar is the consideration of the tripartite nature of ethics of interpretation, diagnostic inquiry and the potential for harm when labelling, assessing, and translating for others and the role of evidence-based practice. These issues are revisited in Chapter Eight, which notes the inherent creativity of research and what it can offer in communicating what we do, but also considers the pitfalls of trying to fit into prevailing orthodoxy.
Regardless of our methodology, we must respect and safeguard our participants and ensure their informed consent.
Awareness of self and others, sharing power with the client, and not colluding with others are issues strongly emphasised in Chapter 13 in the context of diversity. The authors explain culture as something we experience, perceive and ascribe to, remembering not to value politeness over people, and acknowledging difference, while watching for our own microaggressions. As Nolan states, ‘I view competence in this area of ethics as the baseline for working as an art therapist" (p.226). We bring ourselves in our entirety and so does our client, who we must protect from "pathologising".
Regarding art therapists ourselves, there is an interesting self-assessment of our values for group discussion at the beginning of Chapter Four, which recognises that as art therapists, we are artist, therapist, and human beings and asks to what degree is it necessary or possible to separate the professional from the personal? We model authentic presence and Moon suggests that Art Therapy is a vocation that obliges deep awareness of personal needs, so as not to impede upon the clients'. Key to this is our engagement with supervision, therapy, transferences and artmaking. We have a duty of care to our clients, but also ourselves and Chapter Five acknowledges the demands and stresses that accompany the meaning and rewards of our role. This "cost of caring" gives rise to an emphasis on self-care and the prevention of/response to burn out and secondary trauma. Importantly, the organisation's responsibility to provide an empathic supportive culture is also touched on.
Specifically, in Ch 7, the authors outline seven areas in which to be mindful of maintaining our boundaries: our role; time; place and space; money; clothing/appearance; language and physical contact. A common thread throughout is around the balance of power and whose needs are being met. Also stressed is a conscious awareness of the boundaries of art-making, both product and process, including the impact of our own participation. This chapter includes role-play exercises.
Our wider responsibilities to our profession are another recurring theme. While the specific context of this book is American, there is much of relevance here for IACAT members and non-members alike. In Chapter Nine, participation in an association is discussed as a responsibility. The separate but complementary roles of a member’s association and a credentials board are explained. Registration, legal and ethical obligations, the need for a shared understanding of principles, procedures, and adherence to the same as a member of a profession, not just as a professional, are all addressed. While the book is peppered with ethical dilemmas to consider, Chapter 10 focuses on an ethical violation, providing guidance here both for the individual and the supervisor regarding self-monitoring and the delicate act of balancing supporting with reporting. The administrative, educational and role modelling functions of supervision are outlined in Chapter Six and explored through the lens of both mentoring and developmental models.
The supervisor’s role with the art therapist carries a weighty ethical responsibility, shared by the educator, who must also act as a gatekeeper and role model. The fundamental importance of art-making is again named and supported, in keeping with the exercises throughout.
Finally, the book considers the impact of technology. How we promote our profession is explored in Chapter 13; being mindful of how the media can pitch us is covered here, along with safeguarding the client’s wellbeing in the context of internet usage and social media. Technology may have lessened the isolation of the Art Therapist, but Chapter 14 also considers concerns associated with maintaining our boundaries, due to online therapy and supervision.
Equating Art Therapy with an act of love, in Chapter 15 the final emphasis of the authors is to re-iterate their desire not to rid us of anxiety and responsibility but to encourage and empower us in our ethical process. While I did not necessarily connect with the emphasis on academic models and tools, I do feel this book raised questions and prompted and supported much conscious reflection in myself, my supervision and workplace. I was particularly heartened by the emphasis on artmaking and multiple tasks provided. However, I must confess that I did not manage to translate this into reality and found myself having a more cerebral response, no doubt compounded by the writing of this review. I would recommend reading this book and think it has much to offer all. In particular, students will benefit from the chance to engage and prepare for these ethical questions in advance, while those in educational and supervisory roles will find much to assist them. I personally look forward to now re-visiting this book to consciously engage with the embodied experience it offers.
Susan Kavanagh is an Art Psychotherapist who specialises in working with children and adolescents. She also works with adults, empowering and supporting them to be child-centred in their role.