Facing our shadows: understanding harm in the arts therapies

Abstract

ABSTRACT This paper examines what harm reveals about psychoactive power in the arts therapies. A 20-year sample of fitness-to-practise cases brought to the UK statutory regulator (the Health and Care and Professions Council) was examined to establish the prevalence of practitioners who cause harm which was low (0.165%). Transcripts of sanctioned cases were used to construct a grounded theory of how harm is mediated in arts therapies practice. This revealed service users enter arts therapies with damaged self-trust in the expectation that they can trust the professional. In non-harmful therapy, trust in the professional is then used to boost self-trust in the service user. In arts therapies practice, the arts create powerfully emotionally salient elements to aid therapy which can affect both service user and arts therapists’ attachment systems to fulfil this task. Harm was enacted when the arts therapist used the power of that trust to isolate the relationship and introduce their own needs through arts therapies practices. This increased service user dependency on the arts therapist and further decreased their self-trust resulting in harm. Harm was only possible where the arts therapist’s self-reflection failed and they distorted theory to self-justify their actions and refute all feedback to the contrary. Plain language summary This paper examines harm in the arts therapies (art, drama and music therapies as regulated by the Health and Care Professions Council (HCPC)). Harm is understudied but important because it tells us how things can go wrong and also indicates where areas of strong psychoactive power may operate in therapy which can also help people. Arts therapies have been regulated by the HCPC for 20 years and we found there were 77 cases brought against arts therapies practitioners with a total of 16 cases that led to HCPC sanction. We used a grounded theory method of analysis to try to understand how harm was mediated in those harmful arts therapy practices because it is an established form of qualitative research used to construct a theory of social action using examples drawn from real-world examples. We found that service users enter arts therapies with damaged self-trust in the expectation that they can trust the professional. In non-harmful therapy, trust in the professional is then used to boost self-trust in the service user. Within arts therapies, the arts support access to powerful emotions which underpins the building of trust, an element essential to good therapy. However, harm happened when the arts therapist used the power of that trust to isolate the relationship, introduced personal issues and used the service user for their own needs. This increased service user dependency on the arts therapist, detrimentally affecting their sense of self-trust and resulting in harm. Harm was only possible where the arts therapists’ self-reflection failed and they distorted theory to self-justify their actions and refute all feedback to the contrary.