An Exploratory Study of Art Therapy Intervention in the Primary School: Perspectives of Children and Art Therapists by Doreen Roslyn Robinson This thesis is submitted to Cardiff University For the Degree of Doctorate in Educational Psychology January 2020 Dedication For my daughter and her optimistic nature, her encouragement and support has provided me with the sustenance needed to maintain effort and persevere, particularly at those times when I needed to remember that this was the next stage in my journey. Thank you for your listening ear. iii Acknowledgements Firstly I would like to express my thanks to the children and the art therapists who participated in this research, it was my pleasure meeting with you and getting to know you during this study. In addition thank you to the headteachers, staff and parents of the schools for their willingness to support this exploratory study.
I would also like to express my sincere thanks to Dale Bartle and Andrea Higgins who provided support and encouragement during the process of this research. Last but not least thank you to my partner for your patience throughout this study and accepting that when it is finally completed we will return to having a more fulfilling social life. iv Abstract An exploratory study was carried out to elicit the views of primary school children from the ages of eight to ten years. The aim of the study was to learn what the children thought about art therapy intervention in the school setting and to obtain their perspectives about any skills they learned and continue to use after attending art therapy.
Promoting children’s mental health has become increasingly in focus and many schools have employed art therapists to support children to help maintain their mental health wellbeing. The method used to gather the data for the research was semi-structured interviews with ten children. During the interview, the children used the “draw write and tell” approach to support their recall. Three art therapists participated in a focus group and provided another perspective about the children’s views.
Thematic analysis was employed to analyse the data from both the therapists and the children. Overall the findings of the study revealed that the children enjoyed therapy sessions and developed skills that they had utilised after they attended therapy. The therapists indicated that they valued working in the school environment because it was an enjoyable experience and there were advantages to working in the school setting such as the opportunity to communicate with school staff as well as link with parents. There were some constraints connected with art therapy sessions in the school setting which included sharing resources and waiting list of children that required art therapy intervention.
The outcome from the study indicated that there were areas that may benefit from further exploration which may have implications for EP practice. These include carrying out research into innovative approaches for supporting children to make informed decisions as specified in the United Nations Convention on the Rights of the Child (UNCRC), Article 13 (1989). In addition, the perceived reduction of art in the curriculum and its impact on children’s mental health and wellbeing which links to UNCRC Article 31. v List of Abbreviations AATA American Art Therapy Association AI Appreciative Inquiry BAAT British Association of Art Therapy BPS British Psychological Society CATA Canadian Art Therapy Association DfE Department for Education DECP Division of Educational and Child Psychology DOH Department of Health EP Educational Psychologist IPA Interpretive Phenomenological Analysis NHS National Health Service PHE Public Health England SENCo Special Needs Coordinator TA Thematic Analysis UK United Kingdom UKCCIS United Kingdom Council for Child Internet Safety UNCRC United Nations Convention on the Rights of the Child vi Contents Chapter 1 .2 An Outline of the study .3 Promoting Children’s Mental Health and Wellbeing in England .4 What is Mental Health? .5 Definitions of Wellbeing .6 Concern about Mental Health and Wellbeing .7 What is Resilience? .8 Risk Factors and Protective Factors .10 The role of the school in providing interventions .11 School-based interventions .13 A Sense of Belonging .14 School-based counselling .15 The Relevance of Children and Young people’s Mental Health and Wellbeing to .16 Outline of the Thesis .1 Introduction to Literature Review .3 Definitions of Art Therapy .4 A Brief History of Art Therapy.5 The Psychological Aspects of Art Therapy .6 Art Therapy with Children .7 Review of Studies about the Effectiveness of Art Therapy .8 Review of Studies that Include Art Therapy with Adults .9 Review of Studies that Include Art Therapy in the Treatment of Health-Related Conditions with Children .10 Review of Studies about Art Therapy in the Primary School Setting .11 Early Art Therapy Studies in the School .12 Art Therapy for Children with Learning and Social-Emotional needs .13 Art Therapy for Children with Social, Emotional and Mental Health Concern .14 Art Therapy Studies in the UK .16 Importance of Children’s Views .1 The Voice of the Child in Art Therapy .17 Art Therapists’ Perspectives about Art Therapy in Schools .18 EPs and the Voice of the Child .19 Reasons for Research with Primary School Children .19 Aims and Research Questions.20 Research Questions: Child Participants .21 Research Questions: Art Therapists .1 Introduction to the methodology .1 Ontology and Epistemology .2 Researcher’s Ontological and Epistemological Position .5 Limitations to Qualitative Research.6 Trustworthiness in Qualitative Research .1 Interpretative Phenomenological Analysis .2 Limitations to IPA .4 Limitations to Discourse Analysis .6 Limitations to using Thematic Analysis .3 Introduction to the Design .1 Recruitment of Child Participants .1 Assent from Child Participants .5 Inclusion and Exclusion Criteria.
Sample Size and Demographic. Semi-Structured Interviews .1 Limitations to Semi-structured Interviews .2 Interviews with Children.8 Using Visual Imagery to Support Interviews with Children .1 ‘Draw Write and Tell’ Technique. 2 Limitations to the ‘Draw Write and Tell’ Technique. Pilot Questions for the Semi-structured Interviews.10 The Drawing Session .12 Debriefing Child Participants .13 Safeguarding and Child Protection .14 Anonymous and Confidential Data .16 Recruitment of Art Therapists .17 Participants for Focus Group .18 Informed Consent: Art Therapists.19 Ethical considerations: Art Therapists .21 Focus Group interviews .22 Limitations to Focus Groups .24 Piloting the focus group questions .24 Focus Group with Art Therapists .26 Criticism of Appreciative Inquiry .27 Interview with Art Therapists .28 Focus Group Debrief Information .29 Analysis of Data .1 Inductive Versus Deductive Thematic Analysis .2 Familiarisation with and identifying interesting features of the data .3 Generating Preliminary Codes .4 Searching for Themes .6 Defining and Naming Themes .7 Producing the Report .1 Introduction to the Findings .2 Details of Data Presentation .2 Overarching Theme: Supportive in the School Environment .1 Main Theme: Appreciative of time and safe space .1 Subordinate theme: Convenient .2 Subordinate Theme: Impact on learning .3 Subordinate Theme: Insufficient Time .2 Main Theme: Feelings of Wellbeing.
Subordinate Theme: Positive Emotions .2 Subordinate Theme: Place for Reflection .3 Subordinate Theme: Release Negative Thoughts .3 Main theme: Feelings of Competence .1 Subordinate Theme: Improved Competence in Drawing .2 Subordinate theme: Understand and regulate emotions .3 Subordinate Theme: Self-Efficacy. Main Theme: Information about Art Therapy .1 Subordinate: Child Assent Inconsistent .2 Subordinate Theme: Parental Involvement .3 Subordinate theme: Therapist’s Involvement .4 Overarching theme: School Environment .1 Main theme: Impact of Art Therapy .1 Subordinate Theme: Safe Space .2 Subordinate theme: Wellbeing .3 Subordinate Theme: Developed skills.4 Subordinate Theme: Impact Delayed. Main Theme: Advantages .1 Subordinate Theme: Link between child and adults .2 Subordinate Theme: Work not complicated. Subordinate Theme: Resources .2 Children’s Perception of Art in Art Therapy .3 Subordinate Theme: Wait List .4 Subordinate Theme: Impact on learning .4 Main theme: Communication .1 Subordinate Theme: Referral .2 Subordinate Theme: Consent and Information.
125 Discussion of Findings.1 Introduction to Discussion .1 Supportive in the school environment .3 Work not complex .5 Appreciative of Time and Safe Space .8 Impact on Learning .10 Feelings of Wellbeing .12 Place for Reflection .13 Release Negative Thoughts .14 Feelings of Competence -Developed Skills.16 Improved Drawing Skills .18 Communication Information and Consent .22 Art Therapist involvement –link between child and adults .23 Children’s Perceptions about Art Therapy .1 Introduction to Conclusion .1 What do children see as the benefits of art therapy as an intervention in the primary school setting? .2 What skills do children feel they acquire having participated in art therapy? .3 Do children feel that they have sustained the skills acquired, following completion of art therapy?.4 How were children included in making the decision to participate in art therapy? .5 What are the advantages and limitations to children having art therapy in the school setting?.6 What are the skills that therapists hope that children will develop after participating in art therapy? .7 What information do therapists think that children receive before meeting the therapist and are children included in the decision to meet with a therapist? .8 What are art therapists’ views of the themes that emerged from the analysis of the children’s data? .1 Reflections on the research design and limitations .2 Recruitment of child participants .3 Recruitment of art therapists .4 Semi structured interviews limitations .5 Focus group size .6 Sample size of study .7 Analysis of data .4 Implications for education .5 Implications for educational psychologists .6 My Learning Journey .1 Implication for EP practice. 198 Braun and Clarke’s 15 point check list. 199 Examples of Draw Write and Tell prompts. 201 Prompts for Drawing Session and Semi-structured Interviews.
206 Thesis proposal submitted to Ethics with approved documents. 236 Focus group interview schedule. 240 Debrief Form: Focus Group. 241 Focus Group with Art Therapists: Flip Chart notes sheet 1.
244 Interviews with Children: Original transcript. 269 Focus Group Interview with Art Therapists: Original transcripts. 291 Examples of Codes with Data Extracts Child Participant. 295 Examples of Organising Codes with Post It Notes: Child Participants.
297 Initial Annotated Notes; Focus Group. 306 Example of Additional Codes with Extracts from Focus Group: Themes from children. 308 Exploring themes with data extracts: Child participants. 317 Thematic Map Child Participants.
318 Thematic Map Focus Group. 318 xiv List of Tables and Figures Page Table 1 Author’s interpretation of Maslow’s Hierarchy of Needs 18 Table 2 Inclusion criteria for literature search 23 Table 3 Child Participants with Gender Year Group and School 72 Table 4 Child Participants: Main Theme and Subordinate Theme1 96 Table 5 Child Participants: Main Theme and Subordinate Theme2 100 Table 6 Child Participants: Main Theme and Subordinate Theme 3 103 Table 7 Child Participants: Main Theme and Subordinate Theme 4 107 Table 8 Focus Group: Main Theme and Subordinate Theme1 111 Table 9 Focus Group: Main Theme and Subordinated Theme 2 115 Table 10 Focus Group: Main Theme and Subordinated Theme 3 117 Table 11 Focus Group: Main Theme and Subordinate Theme 4 123 List of Figures Figure 1 Flow Diagram of Literature Search 197 Figure 2 Final Thematic Map: Child Participants 317 Figure 3 Final Thematic Map: Focus Group 318 xv Chapter 1 Introduction Background The decision to carry out this study stems from having studied Art and Education before becoming an educational psychologist. I have been particularly interested in how art can be used to support children who have experienced trauma. In my role as an educational psychologist, it had come to my attention that many schools that were visited employed art therapists to support children that experienced a range of emotional difficulties.
This further generated my interest in the area of creative therapy interventions with children, particularly young children such as those in the primary school setting. In October 2004, I attended the conference ‘Crafting the Future’, in which creative therapists, including art therapists shared how they worked with children and adults. This allowed me to increase my knowledge about the work of creative therapists, particularly how they worked with children. The therapists who attended the conference called for research into the effectiveness of creative therapy interventions.