Art of the matter

John Lapsley on Quebec creative arts therapies, and the bill that threatens them

The classic image of therapy as a conversation between the doctor and the patient on the couch may soon include a set of pencil crayons and a mandolin, with the advent of the creative arts therapies.

The creative arts therapies – art therapy, music therapy, drama therapy, and dance movement therapy – are a set of unique therapeutic practices that incorporate creative processes to potentially provide a clearer image than simple dialogue of a patient’s inner psychological and emotional state. These practices are not simply adjuncts, but require training and specialization.

Jen Marchand is a research assistant currently completing her master’s degree in Concordia’s art therapy program, one of the very few creative arts therapy programs in the country. She pointed out that the classic verbal therapeutic model may hit a wall with patients experienced in maintaining verbal defense mechanisms.

“They know how to ‘talk the talk,’” Marchand said. “Art therapy…opens up a completely different side of who they are.”

Josée Leclerc, practicing art therapist and director of Concordia’s graduate art therapy program, explained that art therapy has three components: the art therapist, the patient, and the image, with “many levels of communication” between all three elements.

Art therapy begins with the process of creation, which can be as simple as a client using artistic materials to “draw” how they feel today. During the subsequent reception process, both therapist and patient examine the patient’s image.

Leclerc stressed that this is not a clear-cut interpretative process and there is no “dictionary of symbols” in her desk drawer. Rather, in each client’s reflection process, unique insights emerge for both patient and therapist. “Unconscious material…that [the client] is not too aware of may manifest in the image,” Leclerc said. As the two reflect on the image, more often than not, “the image reflects back.”

Sandi Curtis, director of Concordia’s music therapy program, described a similar emphasis on creation in the music therapy process. While many associate music therapy with guided listening or “those ‘buy this CD and you’ll stop smoking’ [products],” Curtis said that actual music-making does the lion’s share of the work. This can be a challenge for the therapist, who must also be a skilled enough musician to make musical creation accessible to clients who may have no musical training. developmental or brain-related disabilities, or a combination thereof.

“While a music teacher could say, stay with me for twenty years and I’ll take you somewhere,” Curtis said, “a music therapist, that day, in that moment, that half hour, is going to connect with someone.”

Arts therapies can provide a tangible timeline of client progress by leaving a (sometimes literal) paper trail of a client’s creative output. The process can also circumvent language barriers, a powerful benefit in multilingual communities like Quebec.

Having a patient channel their emotions through images or song can obviously be very effective for patients with impaired verbal skills, such as those on the wide spectrum of autism. However, both Leclerc and Curtis stressed that art therapy is for people of all ages and in all walks of life.

“It’s not necessarily only the treatment of choice when verbal expression is lacking,” Leclerc said. “It can really be for any population…we have art therapists working in geriatry, in children’s hospitals, schools, community centres, rehab centres, and women’s shelters.”

“With any patient, it is a great tool to try to understand the specificity of the individual…and how I can best help them,” she continued.

Curtis agreed, citing businesses who have begun hiring music therapists for their wellness centres to help employees deal with time and stress management and quality of life issues.

“I’ve never met a person who hasn’t been affected, or made some connection, by music,” Curtis said.

Recent legislation, however, casts an uncertain light on the future of arts therapists. One of the functions of Bill 21, passed unanimously by Quebec’s National Assembly in June 2009 but still in the pre-implementation stage, is to reserve the practice of psychotherapy to qualified members of professional orders, which at present do not include arts therapy.

In many ways this is a beneficial move. Marchand lauded Bill 21 for preventing unqualified “nail polish psychotherapists” from adopting the title. Leclerc agreed that stricter regulations of the credentials and experience required of titular psychotherapists will ultimately protect potential clients.

Whether or not the bill extends the mantle of “psychotherapist” to arts therapists, however, remains to be seen. Although creative art therapists must currently meet the standards of Quebec’s Association des art-thérapeutes du Québec (AATQ), the group is not considered professional in terms of governmental regulation. Benefits of membership in a professional order (such as the Order of Psychologists) include high standards of practice and, thanks to membership fees, a stronger support network in place to legally and professionally protect both therapists and patients. Leclerc also added that many insurance plans (with good cause) are more likely to reimburse patient visits to recognized professionals.

Leclerc and Curtis are optimistic regarding a best-case outcome in which their programs’ graduates are recognized as order-qualified psychotherapists, based on the rigorous standards of Concordia’s Creative Arts Therapies department. Marchand will graduate with at least 800 hours of practical experience under her belt and students in the music therapy program must complete 1,200 hours of clinical practice under supervision. Between practical hours and the sixty-credit master’s degree course load, graduates emerge from their studies extremely well-equipped for practice, without having had to hunt for experience.

Even as the fate of arts psychotherapy hangs in the balance, Leclerc said the field is growing “incredibly” in Quebec, with a strong influx of applicants despite the programs’ stringent prerequisites. With the recent reorganization of Quebec’s mental health care system and the increased proportion of late-age afflictions such as strokes and Alzheimer’s disease (an unfortunate side effect of Canada’s greying population) the need for arts therapists has never been greater. Leclerc admitted that while graduates may need to “be creative” in finding jobs, there is no dearth of opportunities for an arts therapist.

Growth of the practice aside, Curtis also emphasized that the diversity of potential uses for arts therapy make the professions virtually impervious to hiring slumps. During a lull in the educational sector, for instance, arts therapies can easily migrate to the healthcare or employee-wellness sectors.

Curtis worried that low awareness of the opportunities available to arts therapists may lead artistically talented students to decide early on between their art and their careers. In arts therapy, students could be delighted – as Leclerc and Curtis were – to discover that they can synthesize their artistic talents with a practical and versatile career path.

“I think that for a lot of the population the psychiatric model has its limits,” Leclerc said. “The idea of engaging the so-called healthy, creative side of the mind…I think that the population in general really sees the advantages of that.”