Measurement and development of art therapeutic actions in the treatment of children and adolescents with psychosocial problems

Background: Many childhoods and adolescent psychosocial problems involve dysfunctional emotion regulation. A programme has been developed called Affect regulating Arts Therapies (ArAT) to address emotion regulation problems in children and adolescents. The theoretical concepts and techniques have been described in the ArAT programme, but insight into which specific therapeutic actions contribute to the benefits in clinical practice is still lacking. This study aims to construct a measurement instrument (checklist) to test whether the main therapeutic actions are applied in line with the ArAT programme. Method: To develop the measurement instrument, we performed desk research on existing documents and additional literature. In addition, developers were interviewed, and group meetings took place. Finally, to develop the instrument further and investigate the reliability of the measurement instrument, film clips from therapeutic sessions were used and scored by multiple raters. Results: Typical therapeutic actions were defined from attachment, trauma, affect-regulating, mentalising, art therapeutic theories and treatments, and could be divided into the three theoretical phases of the ArAT programme: tension regulation, attention regulation, and affect regulation. A first draft item list of 83 items was based on qualitative analysis. In three phases, the draft item list was reduced to 15 items, of which twelve items met reliability criteria. Conclusion: The therapeutic core of the ArAT programme lies in enhancing the self-regulatory abilities of children/adolescents through art therapeutic actions that target the regulation of tensions, attention, and affects. The set of 15 items is considered a starting point to further investigate the ArAT programme's treatment integrity. Plain-language summary: Many childhoods and adolescent psychosocial problems involve a high sensitivity to emotions and strong emotional reactions to stressful situations, also known as emotion regulation problems. A program has been developed called Affect regulating Arts Therapies (ArAT) to address these problems in children and adolescents. The theory has been described in the ArAT programme, but insight into what the therapist does in this therapy is unclear. This study aimed to create a questionnaire to check whether the main therapeutic actions are applied in line with the ArAT programme. To develop the questionnaire, we searched in existing documents and additional literature. In addition, ArAT developers were interviewed, and group meetings took place. Finally, to develop the questionnaire further and to investigate whether the questionnaire could be completed reliably by different people, film clips from therapeutic sessions were used and scored by multiple people. Typical ArAT therapeutic actions were found in different attachment, trauma, affect-regulating, mentalising, art therapeutic theories and, treatments. They could be divided into the three theoretical phases of the ArAT programme: tension regulation, attention regulation, and affect regulation. The first item list of 83 items was based on literature and interviews. In three phases, this list was reduced to 15 items, of which twelve items could be reliably observed. The therapeutic basis of the ArAT programme lies in improving the child's/adolescents ability to regulate their own emotions through art therapeutic actions. The set of 15 items is considered a starting point to further investigate the ArAT programme's extent to which the intervention is implemented as planned.