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This thesis addresses the hypothesis “ Intragroup cultural differences between client and therapist will adversely affect client – therapist consonance in their perception of arts therapies group treatment” The literature review of intercultural psychotherapy, arts therapies and congruence research is contextualised in a discussion of the arts therapies in the UK, in particular group therapy in psychiatry. The discussion of the evolution of a multi modal research design incorporates an ethnographic perspective. The researcher shows how the setting and two pilot studies as well as the Evidence Based Practice initiative influenced the design. The main concepts in the research question are defined and the sample analysed within its local context. Helping and hindering factors in arts therapies group sessions are identified through cluster analysis of questionnaires and focus groups. The next stage of the analysis examines which client, therapist and treatment variables are shown to affect dissonance. Five case studies show the interaction of these variables for individual clients. The concluding chapter discusses the findings and critiques the methodology, as well as providing recommendations for further research. The hypothesis of the research is found invalid; cultural background variables alone do not create client-therapist dissonance. The findings show that client, therapist and treatment variables interact to create dissonance. Client diagnosis, stage of treatment and cultural background interact with their experience of the arts therapies medium. In an arts therapy group context the structuring of the group and the interpretation of the arts expression as symbol or index, will interact with client and therapist cultural background variables. The intragroup variations are migration history, nationality, religious orientation and first language spoken. Cultural difference with the therapist affecting dissonance was evident for those clients who were third generation English / British and who had grown up and were still resident in an non-urban area (small town or village in a predominantly agricultural region) with little cultural diversity. Intergroup difference affected attrition for one client, influenced more by peer than therapist dissonance. Treatment interruptions, the theoretical orientation of the therapists and peer dissonance interact with the client-therapist dissonance. Recommendations for practice are formulated from these findings. These concern adjusting practice to allow for a greater emphasis on expression and play, differing client perceptions about symbolism and the establishing of an early therapeutic alliance.

This research explores the experiences and practices of Medical Art Therapists; specifically, how working with clients in a medical setting, often as a part of a multidisciplinary team, impacts the work of an Art Therapist. Researchers reviewed the general literature regarding children and adults’ experiences of hospitalization and utilization of psychosocial services. Medical Art Therapy literature is reviewed next, emphasizing work with children, families, and adults. Informed by the literature, researchers invited Medical Art Therapists to participate in a focus group and/or follow-up survey. Researchers conducted a focus group in which participants discussed their experiences and created response art. A survey was then sent to focus group participants and other respondents who were unavailable for the focus group. Researchers identified four categories that emerged from the survey data: “art as self-expression,” “categorization of Art Therapy,” “considerations specific to the medical setting,” and “range of utility” of Medical Art Therapy. Researchers used these categories to analyze data from the focus group and response art. An additional category emerged from these two data sets: “personal experience.” The response art naturally offered another category for analysis: “features of the art.” Researchers compared findings across all data sets and discovered meanings by setting these findings in the context of the general and Medical Art Therapy literature. Further research is warranted to support expansion in the field of Medical Art Therapy.

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