Affect regulating art therapy for children and adolescents experiencing psychosocial problems

Background: The program Affect regulating Art(s) Therapy(ies) (ArAT) has been developed to address self regulation problems in children and adolescents with psychosocial problems. Therapeutic actions are hypothesised to be applied sequentially across three treatment phases: a tension regulation phase, an attention regulation phase, and an affect regulation phase. This study aimed to investigate whether the theoretical framework describing the phases of the ArAT program is observable in practice. Method: We collected film recordings of ArAT sessions. These recordings were viewed and rated using a checklist to explore whether the therapeutic actions were present. Results: There were no discernible differences in therapeutic interventions across the treatment phases. Therapists frequently utilised therapeutic actions from the tension and attention regulation phases throughout all stages of treatment. Moreover, the frequency of applied therapeutic actions were consistent across all treatment phases, with tension regulation actions being the most frequently applied and attention-improving actions and affect-regulating actions being the least frequently applied. Conclusion: The supposed phasing of the development-oriented ArAT program could not be detected in this research, indicating the need to reconsider the stage-wise description of the program. Art therapists need to recognise that reducing stress seems to remain important during all treatment phases. Plain-language summary: An art(s) therapeutic program called ArAT has been developed in the Netherlands for children and adolescents with psychosocial problems. ArAT aims to improve the self regulation of emotions so that children and adolescents can better regulate their feelings and therefore have fewer psychosocial problems. The therapist's therapeutic actions are theoretically supposed to be performed in three phases: a tension-regulating phase, an attention-enhancing phase, and an affect-regulating phase. This study aimed to examine whether the phasing could be observed in practice in this way. For this, we have collected films of ArAT sessions from practice. These were examined whether the therapeutic actions were detectable using a checklist. No differences were discernible in the three different phases. What was striking was that the therapists most often use tension-regulating and attention-regulating therapeutic actions. A similar pattern also became visible within each phase: stress-regulating therapeutic actions were used most, then attention-regulating therapeutic actions and affect-regulating actions were used least. The presumed phasing of the developmental ArAT program could not be observed. This suggests that we should think again if and how we describe the different phases of the program. The least used are therapeutic actions intended to develop thinking and talking about feelings. For art therapists, reducing stress seems important during all treatment phases for children and adolescents with psychosocial problems.