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A Model for Art Therapists in Community-Based Practice

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A Model for Art Therapists in Community-Based

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Dylan D. Ottemiller & Yasmine J. Awais

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 Art Therapy: Journal of the American Art Therapy Association, 33(3) pp. 144–150, © AATA, Inc. 2016
A Model for Art Therapists in Community-Based Practice
Dylan D. Ottemiller and Yasmine J. Awais
Abstract
With growing trends toward preventative, community-
based health care, art therapists must expand their scope of
practice beyond the medical model and individual
psychodynamics in order to serve, include, and empower those
in need. In this article the authors review literature that
illustrates the unique qualities art therapists can contribute to
community-based work with their conflict resolution skills,
creativity, flexibility, and knowledge of group dynamics and
the effects of trauma on individuals and communities.
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Informed by overarching theories and the unique needs of the
community, driven by goals of social inclusion, empowerment,
and stigma reduction, a model is presented for art therapists
interested in working with communities to facilitate a process
that recognizes and acknowledges ways to reduce power
differentials and increase the building of trust and
relationships.
Wellness and prevention are growing trends in health
care (Substance Abuse and Mental Health Services Admin-
istration, 2014). As the medical model expands to include
physical and mental health more holistically, art therapy
will benefit from redefining itself as well (Kapitan, 2009).
Community-based art therapy offers a theoretical frame-
work that emphasizes community empowerment—rather
than a focus on individual psychodynamics—and provides
a vehicle for expression of community strengths and needs
(Golub, 2005). Several art therapists have emphasized the
need to expand their practice to community settings
(Hocoy, 2007; Kapitan, 2009; Talwar, 2016).
As art therapists expand their scope of practice they
broaden the definition of what art therapy is and can be.
This shift of definition allows for more diverse and inclusive
ways of practicing, which means that art therapists can offer
their services to a wider range of people through commu-
nity-based practices that embrace wellness and prevention,
thereby also reducing the stigma associated with traditional
mental health treatment. Along the way, art therapists can
learn through collaboration with community artists and
community members. In the pages that follow we will eluci-
date the theoretical underpinnings of community-based
work, highlight the work done by community artists and
Dylan D. Ottemiller is an art therapist at Sandhill Child
Development Center in Los Lunas, NM. Yasmine J. Awais is
Assistant Clinical Professor in the Art Therapy and Counseling
Program at Drexel University in Philadelphia, PA. Correspon-
dence concerning this article may be addressed to the first author
at dottemiller@gmail.com
144
art therapists, note similarities and differences between
community arts and community-based art therapy, and
emphasize the unique qualities that art therapists bring to
community settings. Furthermore, we will offer a concep-
tual model and recommendations for art therapists inter-
ested in engaging in community-based work.
Community Mental Health Needs
An estimated 20% of U.S. adults have a diagnosable
mental illness. Of those, only 38% receive mental health
services (Substance Abuse and Mental Health Services
Administration, 2011), leaving the majority of U.S. resi-
dents coping with a mental health diagnosis without the
help they need. One of the largest obstacles to mental
health treatment is the fear of stigma (Moon & Shuman,
2013; Oral, 2007). Negative outcomes associated with
stigma include increased depression and internalized
stigma, lower self-esteem and motivation for change,
decreased social interaction, and reduced help-seeking for
those coping with mental illness (Chronister, Chou, &
Liao, 2013; Perlick et al., 2001). High levels of social sup-
port can negate the effects of societal stigma by decreasing
internalized stigma, leading to more successful mental
health recovery (Chronister et al., 2013).
Because the medical model of treatment emphasizes
pathology and the amelioration of problems, it arguably
contributes to the stigma associated with mental illness and
treatment. Art therapy, like other fields that address mental
health concerns, is rooted in the medical model. There are,
however, art therapists—and community-based psycholo-
gists and artists—who have highlighted the interactions
between individuals and their social contexts, focusing on
creating social change through a culturally competent, col-
laborative, and strengths-based approach (Finkelpearl,
2013; Rappaport, 2000; Talwar, 2010). Their work has
advocated for access to resources, a voice in decision-mak-
ing processes, and a sense of community that allows indi-
viduals to improve themselves and their communities
(Evans, Kivell, Haarlammert, Malhotra, & Rosen, 2014). It
is informed by systems theory (Beresford, 2002), multicul-
tural counseling theory (Sue & Sue, 2012), empowerment
theory (Christens, Peterson, & Speer, 2011), relational-cul-
tural theory (Jordan, 2014), and critical psychology and
social justice theories (Evans et al., 2014; Nelson, Prillel-
tensky, & MacGillivary, 2001).
Art therapists and artists have engaged in community-
based and social justice work for years, drawing from the
theoretical underpinnings mentioned above to address com-
munity mental health needs. Kapitan (2008) stated that
 OTTEMILLER/AWAIS
“when a whole community embraces the idea of art as a
healing technology and applies it to its own particular
needs, a thousand permutations become possible on how
art therapy may be defined” (p. 2). Art therapists and artists
have a unique and powerful means for engaging and healing
communities, reducing stigma, and generating social
change.
Goldbard and Adams (1987) defined community arts
as an approach to art making that involves collaboration
between an artist and non-artist community members with
the goal of encouraging people to affirm and build their col-
lective identity. Crucial components of this work include
trust and relationship building, collaboration and distribu-
tion of power, utilization of community strengths, and net-
working outside the community to obtain additional
resources. Important characteristics of artist leadership
include multidisciplinary training, skills in collaboration,
delegation and conflict resolution, knowledge of emotions
and the effects of trauma, and flexibility (Finkelpearl,
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2013). Community arts projects and programs that have
embraced and incorporated these concepts have succeeded
in addressing stigma and promoting empowerment, confi-
dence, and social inclusion (Hacking, Secker, Spandler,
Kent, & Shenton, 2008; Howells & Zelnick, 2009; Mar-
grove, Heydinrych, & Secker, 2013; Mohatt et al., 2013;
Stickley & Eades, 2013; Tebes et al., 2015).
Redefining Art Therapy: Moving Into the
Community
Practitioners of community-based art therapy have
emphasized similar components and characteristics of lead-
ership (Moon & Shuman, 2013; Timm-Bottos, 2006).
Community-based art therapy involves collaborative, thera-
peutic art making among members of a specific group, facil-
itated by a trained art therapist and aimed at expressing or
generating empowerment at large, reducing stigma, and
strengthening connections among participants (Hocoy,
2007). There is an emphasis on developing critical con-
sciousness to address issues of inequality, and work toward
social justice and acquisition of resources for underserved
communities (Talwar, 2010, 2016). Utilizing a social jus-
tice framework means that art therapists need to move away
from interventions focused on pathology to embrace well-
ness models that promote social change at the community
level. Art therapists have implemented community projects
and programs that have demonstrated an ability to reduce
stigma; decrease depression; increase empowerment, social
inclusion, problem-solving skills, and self-esteem; and build
community relationships (Allen, 2007; Argue, Bennett,
& Gussak, 2009; Feldman, Betts, & Blausey, 2014;
O’Rourke, 2007; Warner, 2001). Methods implemented
by these art therapists include community murals (Argue
et al., 2009), an open studio approach (Block, Harris,
& Laing, 2005), arts-based large group dialogue (Lark,
2005), mask making (Allen, 2007), installation (O’Rourke,
2007), and ritual (Warner, 2001). These projects vary in
length, permanence, media, and setting.
145
Art Therapists’ Unique Skills and Knowledge
The literature on community arts and community psy-
chology has highlighted important leadership qualities for
effectively engaging and supporting communities, many of
which art therapists possess. Because of their training, art
therapists acquire important attributes, such as relational
sensitivity, observational skills, awareness of group dynam-
ics, and proficiency in creating psychological safety (Moon
& Shuman, 2013). These skills contribute to the art thera-
pist’s ability to critically analyze social issues, problem solve,
and collaborate with a community (Frostig, 2011).
Knowing how to handle situations where difficult emo-
tions or symptoms of trauma may arise is crucial in creating
a sense of safety for participants (Lawthom, Sixsmith,
& Kagan, 2007), and has been identified as a helpful skill
for artists working collaboratively with communities (Fin-
kelpearl, 2013). Art therapists are trained with an emphasis
on clinical knowledge and skills, and gain experience work-
ing with people who are coping with a range of mental
health diagnoses. Many art therapy graduate programs also
now include an emphasis on trauma-informed practice,
helping art therapists to recognize symptoms of trauma and
to be mindful and sensitive in their approach when working
with communities. Community-based artists may lack this
formal mental health training and knowledge, which may
result in situations for which they may be unprepared—for
instance, when people share experiences of trauma and
express difficult emotions (Lawthom et al., 2007).
Nelson et al. (2001) cited conflict resolution as another
important skill for project facilitators, needed when various
community members—or even outside funders—have dif-
fering visions, goals, or narratives to contribute to a project.
Art therapists possess skills in conflict mediation, resolu-
tion, and de-escalation that are invaluable in supporting
communities. Art therapists are also trained in group
dynamics and group process (American Art Therapy Associ-
ation [AATA], 2007), and have experience leading thera-
peutic groups. Facilitators of community projects must be
able to maintain an overall awareness of interactions and
potential conflicts among participants, while simultaneously
monitoring the emotional and practical needs of the indi-
viduals (Goldbard, 2006). This knowledge could readily be
applied to community settings, and could greatly enhance
the understanding and use of effective, emotionally safe
interventions among participants.
Providing services grounded in ethical practice is
another quality that art therapists possess and that artists
may not necessarily have. Art therapists bring a unique
understanding of the ethics of practice to community work
because they adhere to a specific ethical code (AATA,
2013). Wadeson (2000) highlighted that the art therapist’s
role in the community is that of facilitator, not therapist.
For this reason, art therapists should clarify their role by dis-
cussing and addressing participant expectations to avoid
misunderstanding of the relationship. Regarding confidenti-
ality, Wadeson suggested that everyone verbally agree to
respect what is shared, because the art therapist cannot
guarantee confidentiality. For community artists who are
 146 COMMUNITY-BASED PRACTICE
not trained and bound by ethical principles, conflicts, con-
fusion, and hurt may arise around inadequately explained
expectations, limitations, and goals. This is why it is crucial
for art therapists practicing community-based work to
engage in reflective thinking and discussion around their
agenda and how to clearly communicate it (Elmendorf,
2010). In order to effectively serve communities outside of
the traditional clinical setting, art therapists must consider
key ethical questions relating to their role, participant con-
sent, privacy, therapeutic goals, safety, and boundaries, and
be clear about their agenda.
Even within the clinical setting art therapists are often
tasked with balancing multiple roles, such as art therapist,
verbal therapist, supervisor, consultant, artist, or educator.
Moon and Shuman (2013) emphasized that art therapists
need to creatively navigate their multiple roles in commu-
nity-based open art studio programs—roles such as facilita-
tor, activist, artist, collaborator, and co-participant. They
stressed that art therapists inherently are integrative, skilled
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in functioning at the intersections of psychology and art. In
community-based work, the ability to manage multiple pro-
fessional identities can be essential, because the art therapist
may be collaborating with other professionals, designing
and creating the program, planning community events,
writing grants, and seeking funding.
Another essential component that art therapists bring is
the inherent belief that everyone has the innate ability to
create art. Art therapists often tell participants that no prior
artistic experience or skill is necessary. This principal belief
can be utilized to cultivate strengths and creativity as well as
to overcome oppression and stigma. The knowledge that
art therapists have is invaluable in working with communi-
ties coping with trauma, family issues and instability, and
mental health challenges.
Additional Skills Necessary for Effective
Community-Based Work
Although art therapists have the mental health knowl-
edge to work with communities, additional attention to
social justice is also important. To practice from a culturally
competent position is the basis of ethical practice as
endorsed by the art therapy education standards (AATA,
2007). Art therapists working in community settings, par-
ticularly those impacted by poverty and oppression, must
be aware of their own racial and cultural identity, privilege,
and bias, and how they impact ethical decision making
(George, Greene, & Blackwell, 2005). An understanding of
different cultural beliefs, values, traditions, and experiences
of oppression is essential for art therapists when working
with clients from backgrounds different from their own.
This includes an awareness of a culture’s previous exposure
to art, therapy, and art therapy in order to recognize what
materials, processes, and structures will be most effective
(Kapitan, 2015; Prasad, 2013). Although knowledge of
individual psychodynamics is helpful for this type of work,
art therapists need to also consider systemic, social, and cul-
tural factors (Talwar, 2010). Without doing so, the ability
to utilize the full potential of art therapy is not possible, as
noted above (e.g., as a means to ameliorate oppression).
Helguera (2011) suggested that artists working with
communities require interdisciplinary knowledge of sociol-
ogy, education, and ethnography to make informed deci-
sions on how to engage people within community settings.
It makes sense for art therapists to be held to the same
standards, particularly as art therapy is a multidisciplinary
field (e.g., psychiatry, art, human development, multicul-
turalism, psychology, among others). Knowledge of and
exposure to disciplines such as community psychology, crit-
ical psychology, community arts, social justice, disability
studies, and wellness models are important for the imple-
mentation of holistic, well-rounded projects and programs
(Hocoy, 2007; Moon & Shuman, 2013; Timm-Bottos,
2006; Yi, 2010). Even with an understanding of additional
fields, art therapists can benefit from embracing a position
wherein they are one of many groups that utilize the healing
power of art, and can collaborate with and learn from
others. This is also an area in which there is opportunity to
expand the definition of art therapy, by emphasizing the
inclusion of cultural sensitivity, social justice, and a systems
perspective to promote change at the community level.
Recommendations for Working With
Communities
Figure 1 presents a model illustrating key considera-
tions of best practice for art therapists interested in working
with communities. This model revolves around assessing
the needs of a given community by focusing on its strengths
and resources. Engagement in this kind of work is cyclical
and draws on theories that emphasize empowerment, social
justice, cultural considerations, and relationships, as well as
the unique set of qualities that art therapists bring to com-
munity-based work. This cyclical process reflects how these
theories and qualities influence goal setting, which, in turn,
impacts community outcomes. While determining goals,
the facilitator also acknowledges ways to acknowledge
power differentials and works to establish trusting relation-
ships with participants.
The model in Figure 1 highlights five key components
identified from the work of art therapists who have imple-
mented community-based projects. First and foremost,
goals should be established in collaboration with the com-
munity participants, taking into consideration the com-
munity’s needs. Typically, these goals should center on
outcomes based on community strengths, such as stigma
reduction, empowerment of participants, and an increased
sense of social inclusion for those who have been marginal-
ized in the community.
Second, in order to build trust and relationships it is
essential to lay extensive groundwork within the community,
getting to know community members, leaders, and organiza-
tions. Initiating a project design and meeting with the com-
munity needs to be enjoyable, interesting, engaging, focused
on the needs of the community, and structured in a way
that ensures momentum. Ideas for initially engaging the
 OTTEMILLER/AWAIS
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Figure 1. Community-Based Model for Art Therapists
community’s interest include the use of self-portrait photog-
raphy at a community hub, a story circle potluck, and the
collective building of community altars (Goldbard, 2006).
Third, as mentioned earlier, it is essential for art
therapists to be transparent and clear about the goals
they bring to the work, the limitations of what they can
or cannot provide, and what role the art therapist will
play in the project. This may also include education
about what art therapy is and what it is not. This sets
the stage for open communication throughout the pro-
cess. Fourth, continued collaboration and shared decision
making with participants and other service providers is
important throughout all stages of the project. Collabora-
tion is most beneficial when there is a focus on assessing
community readiness and needs and utilizing community
strengths and resources. In order to create a safe space
where everyone is respected, it is also important to be
aware of and avoid stigmatizing labels.
Lastly, decisions about how people want to be
referred to should involve a collaborative conversation
among facilitator and participants. Participants may like
to be referred to as members, collaborators, contributors,
participants, artisans, or artists. Likewise, art therapists
147
may refer to themselves by whatever term the group
decides on (e.g., artist, collaborator, member) as a means
of emphasizing that all have an equal role in the project.
On the other hand, art therapists may wish to be known
as facilitator, to establish their responsibility for maintain-
ing the structure and safety of the project. Art therapists
may avoid using the term therapist in order to reach
more people and avoid the stigma attached to such a
title. Art therapists working with communities, however,
have a unique opportunity to challenge and reduce the
stigma associated with therapy and mental health by edu-
cating others about art therapy.
Anticipated Challenges
Balancing power and respect for autonomy is a poten-
tial—or even expected—obstacle in this work. One cannot
ignore the inherent power dynamics that exist when an out-
side professional enters a community to facilitate a project.
It is important to acknowledge and address differences in
power from the beginning, rather than pretend that they do
not exist (Talwar, 2016).
 148 COMMUNITY-BASED PRACTICE
Additionally, a perception exists that art therapists
focus primarily on pathology. Many artists working within
marginalized communities are clear that their focus is on
making art, not providing therapy. When community
artists or community members hear “art therapist,” they
may resist collaboration because of stigmatized associations
about therapy and mental illness, problems, or being in
trouble (e.g., being mandated to participate in therapy by a
judge). This misunderstanding of intent is likely influenced
by unfamiliarity with the various theoretical perspectives in
art therapy or possibly with prior negative experiences with
therapy or counseling services. Thus, art therapists inter-
ested in such collaboration would benefit from clarifying
that their intent is to provide a safe space for exploration
and recognition of strengths, empowerment of participants,
cultivation of resilience, and sharing of experiences—all
goals that are also typically embraced by community artists.
By creating new associations about therapy through educa-
tion and practice within the community, art therapists can
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effectively reduce the stigma that surrounds therapy and
expand its definition to include strengths-based and well-
ness-focused programs.
If the art therapist is not already part of the commu-
nity, gaining entry into the community and building trust
may present another challenge. It can be difficult and
uncomfortable to enter a community in which one may be
seen as an outsider. This is why it is important to network
with other professionals and colleagues who may already
have a connection within the community. It is also helpful
to first engage with community leaders, who can then help
in building trust among members of the larger community.
Goldbard (2006) suggested hosting an initial art-making or
potluck event to establish presence and to assess the needs
of the community. Art therapists might consider engaging
in this type of work within their own community, where
they have already established trusting relationships. As chal-
lenging as the initial engagement phase may be, patience
and immersion are critical to the overall success of commu-
nity projects (Tebes at al., 2015).
Conclusion
Working from a holistic, wellness, and strengths-based
perspective shifts the focus from trying to provide services
to individuals to encouraging people to support one another
and giving power back to the community. Community-
based art therapy strives to engage many people with the
goal of changing the environment, which in turn has a posi-
tive impact at the individual level. For art therapists work-
ing in traditional clinical settings, there is potential for
implementing voluntary participation, nondirective
approaches, and collaborative group decision making, with
an emphasis on artist identity (Morris & Willis-Rauch,
2014).
In addition to expanding practice, we also encourage
art therapists to further support community-based work by
contributing to empirically based research. Randomized
controlled trials often are considered the “gold standard” of
formal research, but these types of studies are often done
where there is ample funding, such as in research hospitals
or universities. By its very nature, community-based art
therapy is often conducted in nonprofit settings by those
with minimal or uncertain funding. Thus, art therapists or
other researchers interested in further studying the impact
of community-based art therapy projects may benefit from
broadening their view of what constitutes good research
and consider qualitative research, mixed methods research,
or program evaluation as more viable options. Participatory
action research is one particularly promising method; it is a
“dynamic process that develops from the unique needs,
challenges, and learning experiences specific to a given
group” in which essentially “you get the people affected by
a problem together, figure out what is going on as a group,
and then do something about it” (Kidd & Kral, 2005,
p. 187). This allows for evaluation of a project, while simul-
taneously engaging a community in a way that embraces all
the key components of community-based work (i.e., con-
tinuous collaboration and utilization of resources).
As the field continues to grow and expand, art thera-
pists have the opportunity to witness, participate in, and
even guide future directions for practice and expand the
definition of art therapy. Expanding the scope of practice to
create and maintain community and individual wellness has
the capacity to improve many lives, prevent negative out-
comes, lead to a healthier society, and save money on future
physical and mental health services. The framework we pro-
vide for art therapists to utilize in implementing commu-
nity-based art therapy practices and research is a first step
toward empowering communities and meeting growing
needs related to the impact of trauma, mental health chal-
lenges, and oppression.
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