Hermeneutic methods in art therapy research with international students

This paper describes a phenomenological approach to art therapy based onhermeneutic grounded theory methodology. The study investigated the lived experience of art therapywith international students from 10 world regions. Nineteen international students from an Australian university took part in 10 weeks of group art therapy. Data were hermeneutically analyzed across participants’ artworks, behaviour and spoken andwrittennarratives and core themesweredeveloped for eachparticipant.Where verbalizing in English as a second language (ESL)was often laborious, the aesthetic dimensions of participants’ artworks served as both an anchor and signpost for organizing thinking and expressing emotions. Furthermore, the images provided a context for exploring autonomy, identity and personal growth in relation to sojourn adjustment. This paper illustrates a method for analyzing synergistic processes in art therapy where translating thoughts and feelings into tangible form functions as a way of knowing through the universal language of human experience. Importantly it adds to our understanding of suitable counselingmethods for international student adjustment. © 2010 Elsevier Inc. All rights reserved. The current study is presented as an exploratory investigation into phenomenological art therapy counseling with international students. The research was undertaken at an Australian university, and represents my doctoral work. As both a researcher and university lecturer I have been approached by international students over the years regarding their difficulties adjusting to the demands of study or life in Australia. In the main, university faculties have offered support to assist students with study skills or to familiarize them with the host society. However, where cultural differences have prevailed over contrary philosophies, values, and ways of life, some students have failed to adapt or thrive. Contemplating art therapy with international students The cultural stigmas associated with counseling as a sign of weakness or internal disharmony have preventedmany from seeking mental-health support or for keeping with it if and when they do (Arthur, 2003, 2008; Pedersen, 1991; Pedersen, Lonner, Trimble, & Title 1996; Pope-Davis, Liu, Toporek, & Brittan-Powell, 2001). As Pedersen et al. (1996) have noted informal methods of counseling that focus on competent communication are important in counseling international students about their adjustment. Importantly, Arthur (2008) argues that counselors need to recognise that crosscultural transitions are unique for each student and that treating ∗ Correspondence address: PO Box 6162, South Yarra, Victoria 3141, Australia. Tel.: +61 3 9833 5299; fax: +61 3 9833 5299; Mobile: 0419 307 655. E-mail address: [email protected]. “international students” as a homogenous groupwould undermine their capacity for adjustment. A growing body of international student literature shows that sojourner students experience higher levels of maladjustment than their mainstream host counterparts. Pedersen and colleagues (1991, 1996, 2008) have contributed substantially to this literature, noting that anxiety, depression, role-confusion, and isolation are common among this student cohort. Trends emerging from this research have shifted toward understanding how psychological and socializationprocesses unfold in thehost society (Kitayama, Markus, Matsumoto, & Norasakkunkit, 1997) and how language apprehension, independence, and cultural differences contribute to poor adjustment (Swagler & Ellis, 2003). Recent research in Australia shows that socio-cultural factors contribute to silent or avoidant coping patterns among international students (Fermelis, 1995) from China (Guo, 2006) and Japan (Miyachika, 2005). Kernebone-Tobin (2002) found that greater language comprehension skills resulted in greater communication and adaptation in Australian international students. Albeit one’s degree of language comprehension and enculturationwould likely affect the particular adjustment demands. Being able to converse about one’s intentions, expectations, feelings, behaviour and cognitions contributes to greater understanding of one’s social and cultural environment (Beitman & Soth, 2006). Hence, talking to international students about the stress involved in adapting to a new environment often helps to normalize their feelings as part of the adjustment process, and in turn helps them feel better about themselves and the host environment (Thomas&Althen, 1989). Adaptation and adjustment to a host soci0197-4556/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.aip.2010.03.003 180 B. Davis / The Arts in Psychotherapy 37 (2010) 179–189 ety involves everyday encounters, such as the ability to engage in conversation, purchase goods, or negotiate services (Montuori & Fahim, 2004). Academic demands raise further concerns for international sojourners whose performance outcomes are linked to their immigration status (Arthur, 2008). Not knowing how to communicate effectively or ask for help contributes to hermeneutic breakdowns in sojourners that result in anxiety, depression, or isolation, which, if left unchecked, can contribute to more enduring forms of pathology (Montuori & Fahim, 2004). Positive emotion experience is crucial to adjustment for international students. Cooperative emotions based on positive feelings of trust and liking foster balance in relationships; where the lack of such feelings can contribute to anger or guilt (Strongman, 1996). For students raised in collectivist societies who are typically otherfocused rather than self-focused, positive feedback is important in knowing how they are doing (Nisbett, 2003; Organ, 1987). Moreover, a proclivity to “contribute to the wider group” necessitates opportunities to contribute prosocially, whereas the absence of doing so may lead to feelings of inadequacy or disempowerment. The inherent challenges in international student counseling are primarily two-fold: first, the reluctance for students to engage in help-seeking behaviours as earlier described; and, second, the limited availability of suitable counseling methods that can simultaneously embrace cultural diversity while targeting universal mental health issues. However, therapeutic gains require shared understanding where clients and counselors can develop mutual trust, empathy, cultural sensitivity and awareness of what a client values most (Arthur, 2008; Orlinksy & Howard, 1986; Sue, Zane, & Young, 1994). In many respects the limited capacity for western counselors to fully grasp the perceptions of their non-western clients seems obvious. For a therapist would not be expected to fully comprehend the tacit world views of someone from a different culture in which she or he has not been raised or well-versed in. Yet, within the scope of multicultural counseling, international students offer unique opportunities to develop ways in which to bridge the cultural gap and provide support for their adjustment. Art therapy research Phenomenological research into art therapy has only emerged over the last several decades alongside various studies in cultural art therapy that together have informed this study. This research espouses to hermeneutic methods (Guttmann & Regev, 2004; Linesch & Carnay, 2005), therapist introspection (Coseo, 1997), transition and adjustment (Van Lith, 2008), and case study designs to explore international student adjustment (Denny, 1968) and the personal meaning of art therapy (Quail & Peavy, 1994). Overlapping with these studies are qualitative investigations from the multicultural art therapy literature, advocating therapeutic art as a form of traditional healing (Henderson & Gladding, 1998; McNiff, 2004) and health promotion (Davis et al., 2001; Davis, McGrath, Knight, & Davis 2004), or as a therapeutic modality in conventional practice as a means for establishing self-insights (Kramer, 2000; Rogers, 1993; Rubin, 2005), a voice for cultural identity (Coseo, 1997; Denny, 1968; Lark, 2005; Lumpkin, 2006), visual grammar for shared family experiences (Huss & Cwikel, 2008) and competency in art therapy practice (Hocoy, 2002; Linesch & Carnay, 2005; McNiff, 1984/2009; Wadeson, 1980). Of these studies, only one reported on a single case study design where art was used therapeutically with a student sojourner. Denny (1968) while working with an Asian international student introduced art therapy “with an eye to learning more about her than she could reveal to us through words alone” (p. 96). As the student embodied essential meaning through the art task and image, Denny was alerted to her struggles and better able to guide her efforts toward emotional freedom. Van Lith (2008) in assessing adjustment to a residential setting used a single case study design toexplorepsychosocial implications ina16-year-oldpatient with bipolar disorder. Findings showed that as difficult emotions emerged through the art experience, Van Lith was able to use visual language to guide her patient’s self-exploration and identity. Importantly, the creative process assisted the patient through maturation processes that led to a sense of agency and personal development in aiding her adjustment. A study undertaken by Lark (2005) similarly showed how art as a communicative resource moved participants beyond dialogical difficulties into a richer understanding of respective world views. In an intervention for community leaders and artists to engage in interracial dialogue, Lark developed the “Talking, Race, Engaging Creatively (TREC)” program where she introduced metaphors and symbols to penetrate deeply held beliefs and attitudes. These served to transcend language and cultural barriers in attempting to grasp their commonalities and differences. Importantly, the study showed how art facilitated thought organization in second language speakers beyond relying on words. From a professional perspective, Linesch and Carnay (2005) developed a culturally sensitive trainingprogramtoassess therapists’ attitudesandbehaviour in multicultural counseling relationships. In a week-long training program, student participant dyads worked to find their cultural voice aswell as enhance their cultural awareness and cultural identity. Although these studies differ in their context, they commonly share notions regarding the therapeutic power of art in providing both a personally and culturally sensible voice where clients can find ways to “say what needs to be said in therapy” (Rubin, 1984). In addition, they highlight the need for cultural sensitivity, self-awareness and openness as standards for developing cultural competencies and appropriate treatments for clients from multicultural backgrounds (Arthur, 2008; Pedersen, Draguns, Lonner, & Trimble, 2008). The research enquiry The importance of undertaking the current research was to provide a culturally sensitive and sensible program for outreach with international students whomay otherwise suffer silently. The broad aimwas to open the door through the language barrier using art to communicate through the universal language of emotions. A secondary aim was to enhance selfhood, autonomy, and cultural identity through imagery that would facilitate a grasp of participants’ intrinsic values. Third was to provide a group context for learning where participants could normalize experience and grow personally throughpsychosocial and communicative sharing. From apragmatic stance, itwas hoped that the relaxed atmosphere of the art sessions would help to reduce any stigma attached to the idea of seeking mental-health assistance. In attempting tounderstandhowphenomenological hermeneutic methods would contribute to research, the initial research question was: “What is the lived experience of a participant in a series of art therapy sessions?” In narrowing the focus to more specifically investigate the lived experience of art therapy with international students: 1. How do the therapeutic strategies of art therapy foster communication between counselors and student clients from varied cultural backgrounds? (Can contemplating, making and reflecting on art enhance communication and emotional insight in students who speak English as a second language (ESL)?) 2. How does the translating of thoughts and feelings into tangible form assist international students to explore their emotions? (The liberating effects of art serve memory and recognition in