1. Walden University
COLLEGE OF EDUCATION
This is to certify that the doctoral study by
Patrick Varallo
has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.
Review Committee
Dr. Marilyn Robb, Committee Chairperson, Education Faculty
Dr. Mel Finkenberg, Committee Member, Education Faculty
Dr. Paul Englesberg, University Reviewer, Education Faculty
Chief Academic Officer
Eric Riedel, Ph.D.
Walden University
2012

2. Abstract
Art Therapy Programs With At-Risk Students in Public Schools
by
Patrick A. Varallo
MFA, Rochester Institute of Technology, 1993
BS, Buffalo State College, 1990
Doctoral Study Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Education
Teacher Leadership
Walden University
December 2012

3. Abstract
Educating and meeting the multiple needs of students at risk of low academic
achievement has been a growing concern for public schools in the United States. Many
at-risk students require alternative school-based interventions. This study examined the
operation, premise, and objectives of art therapy integrated in 14 school districts across
the United States. Guided by the theoretical orientation of school art therapy, this
grounded theory study aimed to determine how the targeted school art therapy programs
function and how art therapy may assist at-risk students. Semistructured interviews with
16 participants who conducted art therapy in public school settings yielded data which
were analyzed using emergent thematic coding and comparison. Findings indicated art
therapy was a separate auxiliary service operated by registered art therapists. Art therapy
was also used in art education classrooms by art teachers who were registered art
therapists. The major objectives of school art therapy included helping students readjust
socially, increase emotional regulation, improve self-concept, and improve academic
readiness. The research also found that misconceptions of school art therapy existed
among school faculty, school administrators, and the general public in districts where
school art therapy programs operated. A model of school art therapy was developed
which included the referral process, treatment, and assessment of students’ progress
toward academic readiness. Art therapy educators may use this model in their work with
at-risk students with emotional and behavioral issues; this model could, in turn, promote
at-risk students’ social adjustment and chances of academic success.

4. Art Therapy Programs With At-Risk Students in Public Schools
by
Patrick A. Varallo
MFA, Rochester Institute of Technology, 1993
BS, Buffalo State College, 1990
Doctoral Study Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Education
Teacher Leadership
Walden University
December 2012

5. Dedication
I would like to dedicate this dissertation to my wife Lori. She was consistently
supportive of my efforts throughout this journey. I would also like to dedicate this
dissertation to my three children, David, Francesca, and Olivia. They have been a steady
source of joy and encouragement.

6. Acknowledgements
I want to thank my parents Americo and Frances Varallo who came to the United
States believing in education as the key to change and success. I would also like to
acknowledge the support I received from my brothers Nick, Mark, my sister Cristina, and
my mother-in-law, Sandy. To my committee members, Dr. Marilyn Robb and Dr. Mel
Finkenberg, thank you for your insight, direction, and encouragement in moving my
research toward completion.

7. i
Table of Contents
List of Tables .......................................................................................................................v
List of Figures .....................................................................................................................vi
Section 1: Introduction to the Study ....................................................................................1
Research Problem ..........................................................................................................1
Research Problem Within the Local Context.................................................................3
Purpose of the Study......................................................................................................4
Research Questions........................................................................................................5
Definition of Terms........................................................................................................5
Conceptual Framework of the Inquiry...........................................................................6
Nature of the Study........................................................................................................7
Scope and Delimitations ................................................................................................8
Significance of the Study.............................................................................................10
Summary......................................................................................................................11
Section 2: Literature Review..............................................................................................13
Strategy for Searching the Literature ...........................................................................13
Educational Problem of Serving At-Risk Students............................................... 14
Purpose of Art Therapy in Schools....................................................................... 16
The Integration of School Art Therapy................................................................. 22
Art Therapy as a Psycho-Educational Intervention .............................................. 24
Art Therapy Research in Academic Environments............................................... 28

8. ii
Therapeutic Relationships..................................................................................... 35
Ethical Considerations of Art Therapy in School Environments.......................... 37
Summary of Literature Review....................................................................................39
Section 3: Methodology.....................................................................................................41
Research Method..........................................................................................................41
Study Inquiry......................................................................................................... 43
Context for the Study............................................................................................ 43
Role of the Researcher .......................................................................................... 44
Participants............................................................................................................ 45
Protection of Participants...................................................................................... 45
Data Collection ..................................................................................................... 46
Data Analysis ........................................................................................................ 48
Research Validity.................................................................................................. 49
Section 4: Results...............................................................................................................52
Assurance of Data Integrity .........................................................................................52
Findings of the Research Study ...................................................................................54
Operation of School Art Therapy.......................................................................... 55
Premise of School Art Therapy............................................................................. 55
Objectives of School Art Therapy ........................................................................ 56
Emerging Themes of the Operation of School Art Therapy........................................56
Settings of School Art Therapy............................................................................. 57

9. iii
Referral Process of At-Risk Students in School Art Therapy .............................. 63
Assessments in School Art Therapy ..................................................................... 63
Documentation in School Art Therapy ................................................................. 63
Art Material Use in School Art Therapy............................................................... 63
Emerging Themes of the Premise of School Art Therapy...........................................65
Participant Premise Explanation ........................................................................... 66
Premise Misconceptions ....................................................................................... 68
Emerging Themes of the Objectives of School Art Therapy.......................................68
Discrepant Cases and Nonconfirming Data .................................................................71
Summary......................................................................................................................72
Section 5: Discussion, Conclusions, and Recommendations.............................................73
Overview......................................................................................................................73
Interpretation of Findings.............................................................................................74
Interpretation of the Operation of School Art Therapy......................................... 75
Interpretation of the Premise of School Art Therapy............................................ 80
Interpretation of the Objective of School Art Therapy......................................... 82
Interpretation of the Discrepancies and Misconceptions of School Art
Therapy ..................................................................................................... 84
Practical Application Toward Social Change ..............................................................85
Recommendations for Action ......................................................................................89
Model of School Art Therapy......................................................................................92
Recommendations for Further Study ...........................................................................94

10. iv
Personal Reflection......................................................................................................95
Conclusion ...................................................................................................................98
References........................................................................................................................100
Appendix A: Interview Guide for Facilitators of School Art Therapy............................113
Appendix B: Participant Consent Form...........................................................................114
Appendix C: An Example Summarized Interpretation of a Participant’s Interview .......116
Appendix D: Explanation of Assessments Noted in the Study........................................120
Appendix E: Presentation Handout.................................................................................123
Curriculum Vitae..............................................................................................................124

11. v
List of Tables
Table 1. Themes and Patterns in the Operation of School Art Therapy........................... 57
Table 2. School Art Therapy Settings............................................................................... 58
Table 3. Assessments Participants Used in School Art Therapy...................................... 62
Table 4. Themes and Patterns of the Premise of School Art Therapy.............................. 66
Table 5. Themes and Patterns of the Objectives of School Art Therapy.......................... 69

12. vi
List of Figures
Figure 1. Data analysis stages of school art therapists’ responses.....................................53
Figure 2. Psycho-educational benefits of school art therapy .............................................88
Figure 3. Impact of school art therapy on social and academic success ............................89
Figure 4. Model of school art therapy................................................................................92

13. 1
Section 1: Introduction to the Study
Research Problem
Public schools across the United States, especially those in urban areas and those
serving students of low socio-economic status, are confronted with an increase in the
number of students who are at risk of academic and social failure. In such schools, there
is a need for services to assist students regain or obtain positive direction in their lives
(Hughes & Adera, 2006). Students at risk of academic and social failure may require
intervention strategies that motivate a desire to learn and encourage positive changes in
self-concept and social behavior (Schiller, 2008). The at-risk student may be plagued
with a myriad of problems making teaching him or her difficult (Mueller, 2001). Since
the passage of the No Child Left Behind Act of 2001, school districts have been
responsible for assisting all students in meeting academic standards. Public education
requires the development, implementation, and examination of curriculum and
intervention strategies appropriately structured to meet the needs of at-risk students.
School districts may experience difficulty dealing effectively with the academic, social,
and psychological needs of at-risk students in educational settings.
The term at-risk usually connotes an inability to achieve academic success due to
factors such as poverty, emotional instability, disturbing or disruptive behavior, family
discord, and negative academic records of accomplishment (Hughes & Adera, 2006).
Many at-risk students carry with them the burdens of emotional and psychological
disturbance. Schools may benefit from specialized services. Therapeutic interventions

14. 2
that reduce negative behavior and improve self-concept may develop students’ coping
skills (Stepney, 2001).
The task of serving at-risk students and developing intervention methods may go
beyond the curriculum demands of regular classrooms. Even experienced, well-trained
teachers may be unable to resolve at-risk students’ learning disabilities. The disruptive
behavior of at-risk students may include elements such as aggression, impulsiveness, and
defiance. The disruptive behavior may impede the learning process of the at-risk student
as well as the learning of other students in the classroom. (DuPaul, McGoey, Eckert, &
Van Brakle, 2001).
Schiller (2008), Griffin (2008), and Stepney (2001) noted the necessity of
alternative educational offerings to include group and individualized interventions for at-
risk students. Educational services that address not only academic concerns, but also the
psychological needs of each disadvantaged student, may be lacking in the majority of
school districts across the United States. Proven practices based on extensive research
should drive the selection of programs for at-risk students. Research-based theories that
afford insight into assisting at-risk youth may benefit teachers and staff.
The American Federation of Teachers (AFT; 2009) website provides information
on the characteristics of alternative placements for chronically disruptive and potentially
dangerous students. Establishing safe and orderly schools sometimes requires the
removal of students with persistent behavioral problems. As noted on the AFT website,
particular students, notwithstanding preventative measures and behavior interventions,
continue to demonstrate severe inappropriate behavior. Students who do not respond to

15. 3
specific behavior interventions are candidates for removal from regular educational
settings. Expulsion and suspension may be counterproductive for at-risk students and
may exacerbate misbehavior and increase the potential for delinquency and criminality.
Expulsion may result in leaving students unsupervised and preventing students from
developing positive coping mechanisms or learning how to improve their conduct.
Intensive, appropriate assistance and intervention provided in alternative placements,
may establish a setting where behavior remediation and academic direction can be
stimulated (AFT, 2009).
Individually tailored treatment plans may assist struggling students in developing
social skills, learning to process emotions, rejecting unacceptable actions, and lead to
psychological stability. Alternative schools, if equipped and staffed with highly
qualified, trained individuals to provide intensive intervention services, could offer viable
structured programs to assist at-risk youth in gaining emotional stability by
acknowledging and working through issues and problems (Stepney, 2001).
Though the use of creative art therapy to aid youth in overcoming emotional and
psychological obstacles is widespread, qualitative research on art therapy within public
education is limited (Hollopeter, 2008). Therefore, scholarly investigations may be
required to explore the operation and purpose of art therapy programs within school
environments.
Research Problem Within the Local Context
The local context of this study’s research problem is similar to the national at-risk
dilemma noted above. I examined the operation and function of 14 school districts’ art

16. 4
therapy programs. Each of the districts had a similar problem of serving at-risk students
experiencing marginal academic success and social stability. Each of the school districts
offered art therapy as a school-based intervention that offered at-risk students an
opportunity to improve their academic performance and social skills. The geographic
locations of the school districts ranged across the United States. The settings and the
manner of art therapy varied. The school districts also ranged from urban to suburban
and rural. Though these differences were notable, the underlying mission remained
essentially similar across all districts: to help at-risk students with a nonconventional
service to remove obstacles from academic and personal achievement.
Purpose of the Study
The purpose of this research was to understand how school art therapy programs
across the United States operate and to document the use of existing school-based art
therapy programs. The research examined the operation and objectives of art therapy
implemented in schools to offer insight on the various approaches and theoretical
orientations.
Art therapy interventions offered in schools were examined through a review of
literature. Data were collected from interviews with facilitators and operators of school-
integrated art therapy interventions to offer insight on school art therapy. The design of
the interview questions inquire about the operation and purpose of each school’s
implementation of school-based art therapy. By exploring the facilitators’ understanding
of their particular program’s use of and objectives for art therapy, this grounded theory

17. 5
qualitative study analyzed the emergence of concepts toward the development of a
theoretical school art therapy model.
The intention of my research was to promote a school art therapy program within
my former school district as an intervention for at-risk students. The findings of this
research was also intended to inform the district’s teachers, administrators, community
members, and policy makers of the potential of utilizing school-integrated art therapy as
an intervention option. The research may also be important to educators across the
United States interested in incorporating art therapy. An operational model and
descriptions of the theoretical orientations of existing school art therapy programs are
presented in Section 5.
Research Questions
I attempted to ground the application, theoretical premise, and objectives of art
therapy as an intervention strategy with at-risk students in public schools. Research
questions included the following:
1. How do school art therapy programs operate?
2. What is the premise of school art therapy?
3. What are the objectives of school art therapy?
Definition of Terms
School art therapy program: Art therapy-based intervention program intended to
help at-risk students improve low academic performance, promote an increase in
emotional adjustment, and improve behavior (AATA, 2011).

18. 6
At-risk student: Student who is unsuccessful in education, not having obtained the
required skills needed to proceed to higher education or find a job (Tudor, 2007). The at-
risk student often exhibits marginal learning skills, illiteracy, comprehension difficulties,
and poor social skills (Mueller, 2001).
Creative art therapy: An intervention that uses art and the creative process to help
a person gain or restore mental health. Creative art therapy involves a creative approach
to gaining awareness, problem solving, revealing unconscious material, catharsis,
working through conflicts, and integration (Landgarten, 1981; Rubin, 2005).
Conceptual Framework of the Inquiry
The main idea of the inquiry was to conceptualize how school art therapy
programs operate, the premise of school art therapy, and the objectives of school art
therapy. The theoretical perspective underlying the use of art therapy in schools was
examined. I conducted interviews with participants who facilitate school art therapy. By
taking a grounded approach, I attempted to understand the function and objectives of art
therapy used in schools from the perspective of the facilitators operating the programs. I
drew upon the individual participants’ insights into operating and implementing art
therapy procedures and objectives in forming a theory of the purpose and process of
school art therapy.
Craig (2009), Rubin (2005), and Waller (2006) recognized school art therapy as a
stimulus toward the redirection of at-risk students’ emotional concerns and negative
actions. An analysis of the operative systems employed in schools required further
research. The study’s grounded theory method of inquiry allowed theories of art therapy

19. 7
use in school to emerge from patterns, themes, and perspectives, which arose from
interview responses of the participants. Theoretical sampling of participants focused the
inquiry. Seeking the opinions and knowledge of the professionals implementing an art
therapy program offered insight on the operative systems of educationally integrated art
therapy. Grounding the procedures and objectives of school art therapy offered a
conceptualization of operating a program. Comparisons of new and existing data of
school art therapy assisted in modifying a theoretical model (Glaser, 2005).
The literature review traced the use of art therapy as a creative tool affecting the
disposition of at-risk students. Broad research in the literature that examines school art
therapy programs with at-risk student participants is lacking. Further research
specifically addressing the use of integrated art therapy in public education was required
in order to understand the underlying assumptions and procedures of art therapy
programs.
Nature of the Study
The concept of the study was to research the procedures of art therapy programs
in schools to understand how they operate through the interview responses of people who
administer art therapy interventions. The study took a grounded theory approach that
constructed the fundamental ontology and purpose of school art therapy. I asked how art
therapy programs existed in schools. To discover a probable answer or potential theory,
I sought to understand the operative systems of art therapy in schools through what the
facilitators of such programs found important.

20. 8
The study had a constructivist nature; it involved methodical examination and
analysis of the responses of the individual participants (Charmaz, 2000). The
participants’ lived experiences as facilitators of school art therapy programs informed my
efforts to construct theories inductively that explained school art therapy operations. I
had the pragmatic goal of discovering the essential elements of operating a school art
therapy program.
Pragmatists agree research takes place in social contexts, and the qualitative
approach may include a theoretical lens of social concern. In this qualitative study, a
practical consideration was integrated with a social constructivist theoretical perspective
as a conceptual position supporting collaboration, development of understanding, theory
generation, and the significance of multiple participant interpretations (Creswell, 2003).
The study relied heavily on participant feedback and interpretations. Where
constructivist researchers are interested in the process of human engagement and
consequent results of interaction, pragmatists attempt to reach the best solution to a
problem, discarding processes that impede progress toward finding answers. In the
study, I pragmatically attempted to construct the operation, premise, and objectives of
school art therapy. Understanding the participants’ models of school art therapy
ultimately stimulated the development of a school art therapy program to assist at-risk
students achieve a better chance of academic, social, and personal stability.
Scope and Delimitations
The study examined the operation of art therapy programs housed in public
schools in the United States through the voice of the operators conducting school art

21. 9
therapy. Several states have enacted licensure requirements for those seeking to practice
art therapy and an increasing number of universities are offering degrees in art therapy.
Leaders in hospitals, clinics, schools, and social service agencies have embraced art
therapy as a practice they perceive as supportive of their mission.
Few studies exist to inform community stakeholders, researchers, and educators
about the process, objectives, and operative systems of art therapy in educational
environments. To raise awareness of school art therapy operations and objectives, the
study used a grounded theory method of inquiry. Innate to the methodology of grounded
theory are the delimitations of theoretical sampling in the target population of participants
and theoretical selectivity in data coding toward the conceptualization of theories (Mills,
2006). I attempted to recruit facilitators as participants from existing school art therapy
programs. My intention was to interview as many knowledgeable participants working in
the field as possible. A goal of 10 to 20 participants was set. Participants provided
correspondence rich in information, individual perceptions, and personal experiences.
The delimitations of school art therapy facilitators as participants offered the study a
more focused approach at delineating, constructing, and reconstructing theoretical
conceptualizations of model art therapy programs in schools.
The study was limited to school districts using art therapy and the operators of
those programs who were willing to volunteer. Though limited settings reduce the
potential for multiple setting analyses, a need existed to examine the direction of art
therapy in American schools. Research that traces the operative systems of school art
therapy has the potential to guide future research and implementation of school art

22. 10
therapy programs, as well as the reconstruction of theoretical assumptions regarding
school art therapy.
Significance of the Study
Obtaining information on viable procedures for helping at-risk students succeed is
important for several reasons. First, the study may become a significant source of
information for school districts and educational professionals interested in implementing
art therapy and understanding how school art therapy works. Second, the implementation
of school art therapy may help at-risk students academically. Programs equipped to meet
marginal students’ needs decrease the likelihood of academic failure (Barley et al., 2002).
Third, an understanding of different types of interventions affecting an at-risk student’s
improvement may serve to decrease over generalized teaching practices, concepts, and
principles (Baker, Gerstein, & Lee, 2002). Fourth, providing a study that collects data on
art therapy as an intervention with at-risk students in school may prompt further research
into alternative approaches to teaching and learning for low-performing students. The
study derived meaning and importance through rich interaction, which occurred in
semistructured interviews with the operators of school art therapy programs.
Studies that document and validate school art therapy programs’ efforts to assist
at-risk students may add to the literature examining the value of services that go beyond
academic ideals and are designed to meet the demands of the whole student. As an
intervention, art therapy could be used on a more national and global scale to aid students
in need of alternative support which may not be offered in the regular public school
setting. The study was intended for researchers, teachers, policy makers, and community

23. 11
members who are concerned about policies and intervention practices for at-risk learners.
Hargreaves (2003) promoted educational efforts that support the development of
students’ ability to solve problems in a global economy. Through the study, I ultimately
sought to develop school art therapy to assist marginal and difficult students in gaining
the ability to manage their actions and attitudes in educational environments.
Educating and helping at-risk students has been an increasing burden for the
United States that is significant within the context of this study’s local school districts.
Traditional academic settings may contain obstacles for at-risk students and require
identifiable changes and appropriate services that connect students to educational settings
and allow them to find fulfillment (Rumberger, 2001). Social change may require
avoiding mainstream assumptions about the principles of education and could indicate
the need for a more responsive philosophy that provides each student with an opportunity
for enlightenment and life betterment (Lindsey, Roberts, & Campelljones, 2005). This
study may lead to future research and promotion of services that may include art therapy
in aiding at-risk students in fostering attitudes toward education as a powerful means of
attaining and living a successful life.
Summary
This qualitative study examined the operation, purpose, and objectives of public
schools’ art therapy programs. Section 1 provides an overview of the research problem,
the purpose of conducting the research, the framework of the study, operational
definitions, possible delimitations, and the significance of the study. Section 2 provides a
review of the literature relevant to the research problem and substantiates the rationale,

24. 12
themes, and historical and current published information on the study of school-based art
therapy as an intervention modality. Section 3 explains the research method, research
questions, role of the researcher, participant selection and protection, data collection, and
data analysis. Section 4 presents the data production and collection process, including an
analysis, interpretation, and discussion of data findings and research results relevant to
the development of a theoretical model of school art therapy. The final section presents
conclusions found to be significant in the examination of art therapy programs in schools.
Model programs may be important to school districts interested in implementing school
art therapy. Recommendations based on indications found in the study are presented in
the final chapter.

25. 13
Section 2: Literature Review
Strategy for Searching the Literature
The review of literature in the study presents numerous study approaches
and accounts that feature art therapy as the primary intervention modality in
treating and helping at-risk students. The review addresses the application of art
therapy in school environments, the premise of art therapy as an intervention, and
the use of art therapy as an intervention method in assisting at-risk youth in
achieving healthier and more productive lives. Research that gave an account of
the usage of art therapy was examined, contrasted, and analyzed in order to
decipher current trends, themes, and theories.
Major databases were searched for information regarding the use of art therapy
with students. Key words used in the search process included at-risk students, art therapy
with at-risk students, art therapy in schools, art therapy with children, art therapy with
adolescents, and art as an intervention with at-risk students. The databases consulted
included those of the Education Resources Information Center (ERIC), Sage, ProQuest,
and EBSCO.
This literature review contains three major areas. At the beginning of the
review, there is a brief overview of the study’s research problem, research
questions, intentions, and objectives. The main purpose of this literature review
was to examine art therapy theories and use in schools with at-risk students. The
context of school- based art therapy is discussed and includes a review of findings
of empirical studies of school- based art therapy. The summation of the literature

26. 14
review discusses ethical considerations in school art therapy and the significance
of the therapeutic alliance in working with at-risk students.
Educational Problem of Serving At-Risk Students
Academic and social failure of at-risk students is an educational problem
confronting academic institutions across the United States. Low achieving
students may lack adequate services to recover from potential academic failure.
(Hughes & Adera, 2006). Curriculum adjustment and modifications in regular
school settings are necessary, though not always efficacious, in satisfying the
many learning, social, and psychological needs of marginalized students. Over a
decade ago, Howard (1998) warned of the lack of sufficient educational
procedural systems in place to prevent failure and dropout. Students experiencing
societal, personal, and academic problems are still present and continue to require
alternative intervention operations that promote resilience, positive self-concepts,
and consequently, acceptable social behavior, leading toward the potential to
succeed academically. Appropriate social adjustment and social functioning may
be improved in at-risk students when interventionists consider the psychological
aspects of adolescent development affecting personal identity, emotional stability,
and judgment (Schiller, 2008).
Without productive intervention to resolve conflict and decrease disruptive
behavior, at-risk children might continue to experience emotional distress and act
out disruptively (Lindt, 2006). Many at-risk children have been exposed to
unfavorable life circumstances and may be prone to bringing opposition and

27. 15
discord into classrooms and schools (Gibbons, 2010). At-risk students who
withstand environmental stress may experience difficulty functioning under the
demands of school environments (Camilleri, 2007). Students experiencing stress
in school environments require excessive amounts of teachers’ time. In this
situation, time may be taken away from other learners while the teacher is
involved in disciplinary actions with maladjusted or disruptive students (Mayorga
& Oliver, 2006).
At-risk students endure multiple emotional struggles that may include depression,
anxiety, low self-esteem, and difficulty controlling anger. At-risk students’ emotional
instability can manifest as oppositional defiance, deviance, inappropriate behavior, social
maladjustment, criminality, and aggressive tendencies (Silver, 2008). At-risk students
may face traumatic life disturbances that may include dysfunctional families, parental
absence, violence, and drug abuse. The U.S. Department of Health and Human Services
(2000) suggested that biological, psychological, and external risk factors potentially
create negative conditions for human development and increase the possibility of
emotional, social, and behavioral disturbance. Academic institutions are inadequate in
providing mental health intervention services that have been shown to be effective in
aiding emotional and social development (Brener, Weist, Adelman, Taylor, & Vernon-
Smiley, 2007). The New Freedom Commission (2003) expressed that schools have the
potential to play a vital role in meeting the emotional health needs of students.

28. 16
Purpose of Art Therapy in Schools
The major objective of art therapy in schools is to assist students
experiencing academic failure. Academic issues may be due in part to emotional
strife causing maladaptive behaviors. The following section contains information
on a variety of ideas, studies, and programs that enlighten art therapy’s use in
school settings. Edith Kramer introduced the use of art therapy in child
communities during the late 1950s. Kramer described the art therapy process
with children with emotional and developmental disturbance as sublimation
where impulsive energy is diverted from its primitive aim to more culturally
acceptable directions (Malchiodi, 2003). Children’s socially unacceptable
behaviors such as aggression, oppositional defiance, and disturbing conduct gave
way to ego-enriching and socially appropriate behavior after art therapy
participation. Kramer reported on the change of behavior and growth of ego
dynamics of children experiencing emotional distress when they participated in
creative and productive acts of art making (Rubin, 2005).
School art therapy programs often attempt to thwart negative behavior and
decrease emotional outbursts. Disruptive behavior not only has an impact on the
at-risk student’s well being, but also negatively affects and jeopardizes academic
settings and overall learning for the rest of the student body. Public schools may
lack the necessary psychological services to support at-risk students’ emotional
needs (Sutherland, Waldman, & Collins, 2010). Socially compassionate settings
encourage students to overcome feelings of inferiority, promote students’

29. 17
emotional stability, and dissuade students from engaging in destructive or
delinquent behavior (Lemberger & Nash, 2008). School art therapy programs
attempt to increase at-risk students’ feelings of belonging. By providing services
that encourage trust, relationships, and caring, art therapists attempt to provide an
environment that allows students to express themselves through creative work.
The importance of therapeutic relationships rests in respect for cross-cultural
differences. In environments that are culturally sensitive, people may have better
chances at establishing trusting relationships (McNiff, 2009).
Another primary objective was for art therapists to work with children at
developing self-awareness through the integration of creativity and art making in
therapy (Collins, 2008). The idea was to increase children’s reality awareness so
that they might choose their actions more wisely with socially acceptable
behaviors. Self-awareness was believed to prevent social aggression and violence
(Froeschle & Riney, 2008). Collins (2006) described the school art therapy goal
of creating a nurturing environment to help children understand their conditions in
order to process their feelings less aggressively.
School art therapy objectives center on helping troubled students become
less likely to fail socially and academically. Through human relationships that
provide stability and personal connection, the art therapists could provide services
in educational settings that aid students’ development. Typical goals of school-
based art therapy programs include helping students develop socially, form
individual and group identity, and improve self-esteem and awareness.

30. 18
School art therapy was also incorporated to help students resolve conflict,
reduce disruptive behavior, and redirect opposition into positive outcomes while
attending to a student’s psychological, social, and individual needs (Bush, 1997).
School-based art therapy programs attempt to provide structure, boundaries,
encouragement, and expectations to help disruptive students achieve balance and
learn to cope more effectively with the many challenges they face.
Multiple methods of school art therapy can be offered to encourage
students to examine their perceptions about themselves and others. The medium
of literature helped students identify, understand, and empathize with another
person’s point of view or feelings (Jackson, 2006). Drama therapy, a form of
role-playing and acting, can be employed to help students gain control over their
impulses and develop increased insight into the effects their actions have on
another person (Malchiodi, 2008). Poetry therapy targets at-risk students’
emotional development in a nonthreatening, school-based creative venue that
identifies and explores sources and consequences of factors that contribute to
behavioral and emotional disturbance (Tamura, 2001). A creative arts method
can assist troubled students resolve conflict and decrease negative behavior in a
public school. Gibbons (2010) used an art activity that was brought into
classrooms as a part of the curriculum structure. Gibbons believed that the use of
creativity to expose, reflect, and visually reinforce concepts of trust, forgiveness,
and positive coping skills could particularly help at-risk students who were prone
to oppositional behavior. Gibbons conducted research that indicated school-based

31. 19
art therapy practice to have a positive impact on reducing conflict and decreasing
disruptive behavior. Art created during Gibbons’s intervention centered on
themes of belonging, communication, friendship, and resolving conflict.
Stepney (2001) and Bush (1997) are leading advocates of art therapy as a
primary intervention strategy in public school settings. Stepney introduced her
findings after integrating an art therapy program in an alternative school.
Stepney’s findings and report were optimistic and indicated that art therapy was
beneficial in aiding at-risk students’ progress toward healthier and more
productive lives. In the study, I am attempting, like Stepney, to introduce art
therapy as the foundation of an arts intervention program in a public learning
environment as a viable option for helping at-risk students decrease negative
behavior. Stepney wrote about introducing art therapy into public educational
settings by informing readers, in a methodological fashion, of the premise of art
therapy in schools. She explained the developmental stages of adolescence, the
impact of emotions on learning, the history of alternative schools, and the position
of art therapy in schools, and she created an actual implementation guide to
commence an alternative school art therapy program. She developed a structure
that gives art therapists a handbook of ideas and prompts for the implementation
of a school art therapy program. Stepney’s work includes a series of art therapy
directives intended to evoke the at-risk students’ cognitive and emotional
expression to redirect negative actions and damaging self-perceptions. Stepney
offered a tool kit of ethical art therapy practice in educational environments as

32. 20
well as information on the advantages of art expression with at-risk youth and
insight into the responsibilities of school art therapists.
The Miami-Dade County Public Schools have integrated a unique art
therapy program that is conducted and received as a clinical therapeutic tool
separate from art education. The art therapy program in the Dade County
Schools, established in 1979, offers both primary and adjunctive art therapy to
students in crisis or at risk of emotional disturbance (Bush, Isis, Siegel, &
Ventura, 2010). The Miami-Dade School System recognized the validity of art
therapy services in aiding at-risk students’ social and emotional problems and
poor academic performance. Miami-Dade’s school art therapy program was
based on the belief that art therapy in any setting, whether academic, institutional,
or private, is to be conducted ethically in special environments that adhere to the
dynamics of therapeutic intervention. Traditional therapy in group or individual
formats often occurs in physical surroundings that are private, foster openness and
freedom of expression, and promote safety and confidentiality. The nature of art
therapy in the Miami-Dade Schools was not only beneficial in assisting a troubled
student process disturbing emotions, but also advantageous as a diagnostic
assessment tool that offered a prognosis of the student’s emotional condition and
cognitive capacity (Levick, 2009).
The Miami-Dade School System’s art therapy program provided a
noteworthy example that clearly indicates the intentions of a school-based art
therapy program. The concept of integrating art therapy was to improve at-risk

33. 21
students’ behavior and raise their self-esteem. The purpose of art therapy in the
Miami-Dade School System was to address the variety of issues troubled students
experience. By improving their insight into and understanding of themselves,
including their perceived identities, weaknesses, and family and personal
histories, students learned how to avoid unacceptable behaviors and resolve their
problems. Art therapists assisted students through the provision of studio time
where creativity stimulated a sense of well being. Individual and group art
therapy became a psychotherapeutic dimension of the school day where
developmental concerns were addressed to increase the student’s social,
psychological, and personal stability.
There are important considerations in distinguishing art therapy as an
instrumental intervention in a public school setting in aiding at-risk students
(Stepney, 2001). Credentialing at the state level is necessary to ensure licensure
or certification for individuals pursuing careers in art therapy. Practitioners of
school art therapy should be required to complete specified graduate-level
programs combined with experience and practical skills for preparation to
implement and conduct school art therapy. Art therapists must become advocates
in explaining the contribution art therapy provides to students in public school.
Development of national guidelines for school art therapy programs is necessary
to diminish the negative stigma and biases associated with psychotherapy. A
difference exists between school art therapists and art therapists who practice in
hospitals or clinics. The role of the school art therapist is to help at-risk students

34. 22
alleviate social and emotional stress that causes learning problems and poor
academic achievement. Educational and developmental welfare are the primary
concerns that school art therapists target through specialized skills and service.
Empirical studies that examine the significance of the process and objectives of
school art therapy are lacking. Policymakers, community members,
administrators, and teachers must be presented information concerning the
benefits of school art therapy. Art therapists must become national ambassadors
who research, promote, and market the advantages of incorporating school art
therapy (Stepney, 2001).
The Integration of School Art Therapy
In most traditional schools across the United States, art is considered an
elective within the overall curriculum. Many students select multiple art
education and art studio classes as a less structured part of their curriculum that
acknowledges self-discovery, self-expression and the positive effects of the
creative process. Art therapy in schools differs from art education; it is
specifically established to assist marginal students in improving their academic,
social, and behavioral standing and may be conducted in a fundamentally
therapeutic vein (Bush, 1997).
The connection between art therapists and art educators was examined by
Loesl (2010) to understand the function of art therapy in school-based settings.
Often, art therapists perform clinical duties in art education contexts. Clearly,
there is a professional difference between art therapy and art education. However,

35. 23
the boundary becomes less clear when students in potential crisis develop artwork
containing disturbing content within regular art education frameworks. The art
teacher may be confronted with artwork laden with visual imagery that may
reflect trauma, family discord, or even suicidal or homicidal ideation.
Some art therapy programs are integrated into school settings within
regular art education classes and differ from clinical models that are auxiliary,
psychotherapeutically based departments within an academic setting. Educational
systems may be apprehensive about removing students from regular classes to
attend art therapy (Albert, 2010). Albert offered that more school systems would
be in favor of supporting art therapy milieus blended into art education classes as
a built-in alternative within an art education activity. In an art-as-therapy model
within an academic environment, the goal is to achieve an art product that reflects
comprehension of specific issues of design and development of subject matter that
meets particular criteria. The thought process and identification of the related
emotional content that may have stimulated the creation is sought after in art
therapy integrated art classes (Albert, 2010).
Societal issues have an impact on the development of children. Family
problems, poverty, violent neighborhoods, substance use, and the daily reality of
stressful living can take a toll on a student’s ability to cope effectively in social
circumstances and on a personal level. Nelson (2010) described the development
of an art therapy based program in the Jersey City Public School System. The
primary goal of the art therapy based program was to assist at-risk students’

36. 24
development of positive characteristics necessary to cope effectively with difficult
lives. The integration of the art therapy intervention attempted to promote at-risk
students’ self-esteem, social skills, moral strength, ability to deal with emotions,
and increased confidence.
According to Ballengee-Morris, Carpenter, Sessions, and Taylor (2006),
when art therapy is integrated into a curriculum, the art therapy no longer
becomes an entity apart from the pedagogy of educational settings. Student needs
are met through curriculum that weaves into lesson planning themes, topics, and
discussions that identify broad concerns related to students’ issues and
circumstances. The therapeutic art process incorporates educational goals while
observing the students’ personal expressions, their self-esteem, past experiences,
coping mechanisms, and emotionalism (Stewart & Walker, 2005).
Art Therapy as a Psycho-Educational Intervention
The use of art therapy with children allows for the expression and representations
of troubles causing conflict. The art therapist plays an integral role in helping the
troubled child express or contain powerful feelings through the creative process (Waller,
2006). Waller added the kinesthetic response occurring during the art making may be
pleasant causing psychological enhancement and helping children’s self-perceptions
change. Art making has the potential in school settings to promote affirmation and
development of students’ identities and may help challenged students recover and
promote their positive human development (Kay, 2008). Many troubled youth suffer
from posttraumatic stress causing a profoundly negative effect on their ability and

37. 25
volition to learn (Shumow & Perry, 2006). Without various types of psycho-educational
interventions, the likelihood of continued failure for troubled youth exists. The American
Art Therapy Association (2011) described school art therapy as a psycho-educational
process that concentrates on the use of art materials to communicate and explore
individual life circumstances, issues, desired behavior, and emotional concerns of
students in need. Schools are often unequipped in affording at-risk youth with
interventions and engagement strategies that reverse negative conduct, improve academic
pursuits, address emotional concerns, or instruct basic life skills. Art therapy based
interventions in schools have the potential to address the substantial deficits and
emotional deprivation at-risk youth may experience (Stepney, 2001).
Creative art therapy recognizes the difficulty people experience, especially
children, in discussing traumatic events or disturbing life circumstances. Art
therapy, surpassing the confines of traditional talk therapies, naturally distances
the victim and their trauma through metaphorical, visual expressions that re-visits
the disturbance or issue in a safe, problem-solving, self-reflective way (Langner,
2009). The at-risk student, burdened by potential exposure to negative
environmental situations, may require preventative measures that decrease the
debilitating consequences of social, personal, and academic deficiency. Art
therapy may become a reparative process that exposes trauma, in an expressive
form, to be examined and resolved (Appleton, 2001). Visual expression of
disturbing events may be less menacing or less oppressive than verbalizing the
traumatic occurrence. Art therapy with students seeks to gain empowerment over

38. 26
the disturbance while appropriately containing the trauma through visual work
that cognitively identifies an idea or experience (Moon, 1999).
At-risk students in school environments can be much like the captive
audiences of juveniles sentenced to detention centers. There may be a lack of
invested interest to commence participation. However, Hartz and Thick (2005)
reported that once engaged in the therapeutic art intervention, adolescents in
juvenile justice systems improved behavioral conduct, responsibility, and
improved insight over their self-management and their collective interests.
The most troubled at-risk students often experience difficulty controlling
their anger. Settings that tempt rivalry and inadvertently encourage a pecking
order of leadership that delineates alpha members from the weaker, bullied
members may be common environments that at-risk students endure. According
to Long and Soble (1999), art therapy with children in school experiencing anger
management problems helped children through sublimation of their feelings and
through the act of sharing their art with one another. The art therapy process
acted as a socially compliant procedure that built trust and slowed destructive
mannerisms. Art therapy was reported as efficacious in helping bullied children
develop confidence, increase self-esteem, and improve assertiveness while
helping aggressive children internalize feelings and communicate their emotions
with less confrontment allowing expression through the artwork (Saunders &
Saunders, 2000).

39. 27
Art therapists working in schools have the potential to provide therapeutic
services as an intervention source with any student in need of support. Research
indicated art therapy in schools had a positive influence on improving students’
ability to process trauma through increased communication in the form of visual
expressions (Gonzalez-Dolginko, 2002; Morena & Rippey, 2003). Visual self-
expression innate to the art therapy process helped at-risk students improve social
stability and increase self-esteem (Hartz & Thick, 2005; Klorer, 2005). School art
therapy as a psycho-educational intervention was found effective in supporting
and improving children’s emotional processing and repairing ineffective coping
and damaged defense mechanisms (Rousseau, 2000). Art therapy in academic
settings was useful in decreasing challenged students’ negative behavior,
improving self-concept, improving overall conduct, and improving academic
performance.
At-risk students often display negative behavioral symptoms that include
aggression, hostility, impulsivity, and oppositional defiance. The creative process
inherent to the art therapy function is an individual interpretive process that
reforms information, ideas, and subject matter into personalized, meaningful
expressions that can safely represent associated feelings (Rubin, 2005). Even in
the social confines of academic settings where students are likely to share and
often confront ideas, creations, actions, or opinions, the art therapy process and
subsequent art pieces created becomes an appropriate venue that not only fosters
but also prompts theme recognition and identification from co-participants. The

40. 28
likely accurate self-expression that is revealing may become a similarly mutual
experience a co-participant had endured. Powerful relationships can occur
because of shared experiences and the expression of emotions through art therapy
pieces. The nonverbal attributes of art therapy may become an intervention that
validates and safely externalizes trauma-inducing events into an intense cathartic
experience of reflective art making (Appleton, 2001).
Art Therapy Researchin Academic Environments
Studies that explored the implementation of school art therapy programs in
educational settings were lacking. Research studies of art-based activities with at-risk
students were examined to aid in the progression of this qualitative study. The following
studies are connected by themes that validate the significance of art therapy used in
educational settings as a viable option in improving students’ emotional welfare and
potential academic gains. Though methodologies of each individual’s particular study
was unique, an emerging concept of art therapy in schools indicated positive psycho-
educational consequences for at-risk students.
Art therapy used in schools is relatively new and is recognized by the American
Art Therapy Association (2011) as an intervention intended to be provided by registered
art therapists. Art therapy intervention, however, may be delivered in schools by
professionals who are interested in art as beneficial with troubled youth. For example, in
one study the interdisciplinary collaboration of art teachers and school counselors was
examined as an intervention modality with at-risk elementary students from eight schools
in Tennessee (Jackson, 2003). The research qualitatively studied the implementation of

41. 29
art therapy-based experiences that offered a form of non-verbal communication with at-
risk students in need of social, emotional, and developmental advancement. A focus
group was used as the primary data collection source. Art teachers and school counselors
from the eight schools were the participants in the study and made up the focus group.
The focus group specifically studied the combined attempts of art teachers and school
counselors in establishing protocols for identifying at-risk students, in-service training for
regular classroom teachers, and the logistical concerns of providing an art therapy
experience for at-risk students. Data analysis consisted of the researcher and an auditor’s
review of the transcribed audiotapes and field notes. The study found that schools have
the potential to establish the use of art making under the auspices of an art educator
combined with the counseling efforts of the school counselor as an intervention with at-
risk students. Jackson found the use of art therapy as a collaborative measure between art
teachers and school counselors as effective in helping at-risk students. Jackson’s study
may question the delivery of art therapy only by registered art therapists. The element of
school psychology infused with art education may indicate the potential collaboration of
the art making process and counseling as components of school art therapy. Though the
ethical practice of school art therapy better vested through practitioners trained in art
therapy, the idea of using art as a therapeutic medium was indicated as beneficial with
troubled youth.
The literature review found art therapy in academic settings useful in assisting at-
risk students. Jackson provides an example where the use of art making in and of itself is
beneficial. Hollopeter (2008), however, found that at-risk elementary students when

42. 30
presented with an intervention of school-based art therapy by a registered art therapist,
improved their emotional development and social stability which had a positive impact
on their academic improvement. Her research used a sequential mixed methods case
study design to examine the implementation of an art therapy program. Traditional art
therapy utilizes the art as therapy concept as well as the art as a vehicle to describe
potentially harmful issues. A directive art therapy approach was used with participants in
Hollopeter’s study. Directive art therapy offers directions to stimulate visual formations
that may give insight to a disturbance or sublimation of the distress. This more clinical,
art therapy type intervention examined the directive responses, perceptions, and art works
of 21 elementary student participants in one school. The participants’ explanations of the
artworks, as well as the therapist’s reflections and interpretation typical in art therapy
evaluation, were used as a main source of information. The faculty and the
administrators were surveyed on their perceptions about the at-risk students’ behavior,
social skills, and emotional development. Conclusions from the research indicated that
after the art therapy program, at-risk students’ behavior, socialization, and intrapersonal
skills showed improvement (Hollopeter, 2008).
Art therapy with children tends to use a non-verbal and often nonthreatening
approach of art psychotherapy to address circumstances causing problems and improve a
child’s sense of identity (Rubin, 2005). Rastle (2008) examined the effects of an
individual art therapy based counseling intervention with two male at-risk students ages 5
and 13 in a private school in a Midwestern city. She investigated the impact of school art
therapy on at-risk students’ behavior and self-esteem. Her research used a mixed

43. 31
methods approach consisting of a qualitative case study that documented the events of 12
individual art therapy sessions with each of the participants, once a week, over a 12 week
period. The quantitative phase consisted of pre and post surveys given to the participants,
the participants’ parents, and the teachers of the participants. The qualitative method
used descriptions of the art therapy sessions to explore potential meaning. Like Jackson
(2003) and Hollopeter (2008), Rastle also studied the visual art responses from directive
type art therapy where the student artwork revealed their choices of subject matter and
visual art responses. The quantitative pre and post surveys were developed to understand
any significant indications of behavior and self-esteem change. The art psychotherapy
approach used expressive art making as a venue to explore the participants’ perceptions
of their feelings, identities, and choices. The art therapy intervention in a school setting
had an impact on participants’ change in behavior. Both the teachers and the parents of
the participants indicated positive behavioral changes in the at-risk students after starting
the school art therapy program. The researcher noted the positive attributes of art
therapy’s non-verbal, visual method as significant in allowing children to express their
feelings, frustrations, and recognition of change in a nonthreatening way (Rastle, 2008).
The intention of school art therapy is to help students experiencing trouble refocus
and become more directed academically (Bush, 1997). McKelvey (2003) studied an
intervention of school-based art therapy with fourth, fifth, and sixth grade elementary
students in a Midwestern public school who were experiencing difficulty from the
September 11, 2001 terrorist attacks. The idea was to use art therapy as a way to help the
students understand and express their feelings related to the 9-11 events. The first art

44. 32
therapy sessions began on September 13, 2001 and lasted one school year. Individual art
therapy was implemented with three at-risk student participants and group art therapy
was delivered to a guidance class of 21 students. The art therapy intervention was also
introduced to meet the social and emotional needs of over 400 students in the elementary
school where the study was held. The research took on a social action objective to help
students cope with the trauma. The researcher’s naturalistic, problem-solving art therapy
intervention ultimately sought to improve students’ readiness to learn by addressing the
students’ psychosocial skills and emotional welfare.
As noted above, student artwork produced during interventions is often analyzed
for subjective meaning through the students’ explanations and the interventionist’s
interpretations. McKelvey (2003) also used art therapy directives to address objectives
related toward the students’ ability to process emotions. Data collected from the study
indicated that the art therapy intervention allowed students to recognize, identify, and
process their feelings. The art therapy intervention helped students represent their
feelings toward the September 11, 2001 attacks. Students were able to connect their
emotional perceptions of the 9-11 tragedy to their own feelings of frustration, loss, and
anger they experienced in their personal lives (McKelvey, 2003).
McKelvey’s study found indications similar to the studies discussed thus far
where art therapy incorporated in school becomes a strategic tool to alleviate students’
emotional stress causing academic problems. In another study, Abdallah (2009)
documented a qualitative case study of a 5-year-old male participant in an art therapy
program in a Canadian urban alternative school. The participant exhibited risk features

45. 33
associated with antisocial behavior and displayed a weak sense of self-esteem. He was
new to the alternative school and was being teased which resulted in his acting out or
becoming isolative. The school staff referred the participant to individual school art
therapy to allow the boy a nonthreatening environment to work on expressing his feelings
and develop resiliency to aid his self-perception. Abdallah was interested in seeing the
effects of art therapy on the participant’s behavior and self-identity. She documented the
therapist-client relationship and the relevance of a therapeutic alliance in fostering
optimal art therapy interaction. The research used a single case study to observe and
provide detailed reports of each individual on site session to gain insight on the
connection between art therapy, creativity, and the development of resiliency in students
in alternative schools. Abdallah postulated that though generalizability of single case
studies may be poor, indications from single examples have the potential to enlighten
prior generalizations within the field of study. She explained the importance of
reflexivity in exposing bias noting her attempts at dissuading her own presumptions about
her participant’s position, actions, and mood. Data were triangulated through the
collection of the participant’s verbal responses, discussions with the participant’s teachers
and parent, observations of the client and art therapy sessions, field notes, the
researcher’s interpretation of the sessions and artworks produced, peer reviews, and
discourse with her research advisor.
The participant was seen 23 times over an 8 month period. Nondirective art
therapy was offered where the participant was able to explore subject matter, themes,
ideas, symbols, and metaphors using his preference of art materials. The art therapy

46. 34
intervention allowed a safe avenue to explore and express personal feelings and conflicts.
The researcher noted that the client-therapist alliance fostered the participant’s resilient
characteristics and advancement toward personal and interpersonal growth. Abdallah’s
(2009) research indicates similar findings in the positive outcomes of art therapy use in
school. The concept of art therapy to address students’ feelings and help students
improve their self-perception was noted. Abdallah’s research also showed that student
gains are often measured in consultation with parents and teachers. Faculty perceptions
of student gains, using art therapy, were a salient theme in data analysis of the studies
discussed in this section.
In another study, school-based art therapy, though new as a globally significant
intervention with at-risk students, was implemented by Spisak (2008) who investigated
the use of nondirective art therapy with emotionally distraught Kenyan girls in a boarding
school in Kenya. Individual art therapy sessions were used hoping to alleviate emotional
distress, improve self-esteem, and change negative behavioral tendencies. Spisak
conducted a qualitative case study during one school year with 29 female participants
ranging in age from nine to 14. Some of the participants were referred by the school and
others volunteered to be participants. The study attempted to discover the usefulness of
an art therapy implementation in empowering the participants toward meaningful lives.
The study attempted to investigate the effectiveness of art therapy as an intervention in
changing the participants’ negative self-perceptions. Data were collected through
observation and description of individual art therapy sessions. The participants and the
researcher examined the artwork for themes, ideas, symbols, and subject specific content.

47. 35
The creative art interventions were an invitation to freely explore art media, subject
matter, or simply as an opportunity for creative expression. The researcher noted that the
art therapy intervention offered participants the opportunity in a school environment to
play and interact creatively while finding resources to express their emotional conflicts
(Spisak, 2008).
Art therapy research in academic environments noted above ties each researcher’s
study together through art therapy as an intervention modality to dissuade problems
causing emotional and academic strife. The research methodologies, targeted
populations, participant ages, and cultural settings of each study were different; however,
the core theme of improving students’ emotional well-being through the creative act of
art expression was pervasive. The various studies provided similar findings that
indicated optimism in the use of school-based art therapy in assisting at-risk students’
behavior and emotional change. School art therapy was helpful in improving students’
self-perception and resiliency. Art therapy was delivered in both directive and
nondirective forms to stimulate the art making process. The studies showed data were
collected both qualitatively and quantitatively and data were supported through students,
teachers, parents, and interventionists’ feedback.
Therapeutic Relationships
Often in therapy and instructional settings two or more people engage in
discourse that may lead to continued dialogue. According to Bush (1997), the
intention of dialogue may be to establish a working relationship to meet an
objective or achieve a goal. Functional interaction relies on the alliance or bond

48. 36
mutually established by those involved in regular dialogue. Whether in a
therapeutic or educational setting, the significance of feeling connected or
experiencing a sense of belonging will more than likely impact treatment or
academic outcomes (Moriya, 2000).
Chronic at-risk students are likely to view educational settings as a source
of disturbance since failure, negative treatment, and discipline issues are common
re-lived experiences troubled students may find difficult to endure. Life
circumstances for many disadvantaged students are often more harsh and
intolerable than the stress experienced in academic settings. Interventionists must
be catalysts of change in establishing academic approaches and educational
philosophies that respond to students’ psychological and emotional needs. Much
like a therapeutic alliance in the context of psychotherapy that enhances self-
revelation and goal setting, the psycho-educational alliance that is positive,
encouraging, respectful, unconditional, and caring fosters improved self-concept
and a chance at success. Therapeutic relations with at-risk students, if positive
and ambitious, may be the needed stimulus that fosters students’ interaction in
school-based art therapy (Abdallah, 2009). Disadvantaged students require
affection, bonding, respect, and encouragement to promote self-esteem and
dissuade antisocial behavior. Satisfactory engagement strategies that encourage
harmony and well-being may decrease the likelihood of defiance and self-
defeating behavior. Aiding at-risk students in public school settings requires
interaction that rejects dissociation, disaffection, and apathy and embraces

49. 37
feelings of belonging, empathy, while promoting students’ self-esteem (Stepney,
2001).
Ethical Considerations of Art Therapy in School Environments
Art therapists, similar to other mental health therapists, strive to provide a
safe and inviting environment that protects the welfare of the client. A major
objective in therapy is to promote the well-being of the individual. Establishing
trust through confidentiality is a treatment concern that requires a full
examination of ethical considerations (American Art Therapy Association, 2011).
Unlike clinical or private practice therapy environments, where the client enters
and exits a facility geared toward therapeutic intervention, public schools are
social environments that require more planning and ethical considerations to
protect the safety and privacy of the participant.
To avoid negative implications, Moriya (2006) outlined several points of
interest concerning the integration of art therapy in schools. She presented ideas
on the practice and theory of including art therapy successfully, safely, tactfully,
and in an ethically sound manner in the delicate environments of school systems.
Major ethical issues in school art therapy exist including the privacy of the art
therapy site, confidentiality and the sharing of information, recording and
presenting art therapy sessions, the public display of art therapy productions, and
loyalty concerns to the participant and the school organization.
The American Art Therapy Association (2003) explained the importance
of advancing the well-being of clients by ensuring the rights and safety of those

50. 38
being serviced in art therapy interventions. The orientation and scope of
educational environments often welcomes the sharing of academic, instructional,
or student performance information through staff meetings, professional
development scenarios, and collaborative or collegial interaction. Discussing
school-related student reports is common in traditional academic settings;
however, discussing art therapy related issues that may include treatment
objectives, progress notes, art therapy productions, or details of the art therapy
sessions with educational staff have the potential to breach confidentiality with
the participant (Moriya, 2006). Discussing a client’s therapeutic treatment in
school environments may require a conscientious balance that does not jeopardize
a participant’s rights to confidentiality yet allows selective school staff
information on a need-to-know basis. Art therapists must first consider the safety
of their clients and inform only intended audiences in an ethically considerate
manner.
Most ethical concerns may be managed accordingly through planning and
predictability of the art therapy treatment and the art therapy intervention site
(Moon, 2000). Informed consent from the underage participant and the
participant’s parents to participate in art therapy intervention provides an
opportunity to discuss the retrieval and appropriate disclosure of treatment
occurrences, records, and art therapy productions. By explaining the premise of
the art therapy intervention and confidentiality measures, the necessary discourse
when warranted with intentional staff about unique circumstances of conducting

51. 39
art therapy in school settings, a majority of ethical dilemmas may be resolved
before occurring. Selectively informing teachers and parents of treatment
outcomes may maintain positive alliances that foster trust, relationship, and the
advantageous consequences for the participant (Moriya, 2006). Most traditional
psychotherapy upholds the highest order of ethical standards that protect the
client’s safety and privacy through confidentiality. The orientation and dynamics
of therapy addresses an individual’s issues and can reveal personal problems. The
nature of therapy has the tendency to disclose difficult situations and traumatic
issues that are more suitable when addressed in a confidential environment.
Students should be aware of their involvement as participants in school-based art
therapy and school art therapists must keep their participants and or students
informed of their status or involvement in art therapy (Moriya, 2006).
Summary of Literature Review
This literature review contained several themes supported with empirical
evidence of the process and objectives of art therapy as a potentially viable
educational tool supplementing the delivery of instruction in aiding at-risk
students decrease their risk of social and academic calamity. Breakdown and
failure are common experiences that at-risk students endure in multiple facets of
their lives and may be thwarted and dissipated through the application of creative
art therapy based interventions in school settings.
Art therapy finds its roots in the developmental stages of human psychology and
fundamentally is an intervention that helps a troubled person come to terms with trauma

52. 40
in an expressive and creative way. Art therapy, whether conducted in academic or open
studio environments, rests in the premise that successful art therapy technique relies on
the positive aspects of the relationship between therapist or teacher and student and the
effects of the established alliance. Ethically sound implementation of creative art therapy
helps to insure a safe and confidential environment. The promotion of participants’ well-
being fosters trust to examine academic and social concerns.

53. 41
Section 3: Methodology
Research Method
The objective of the study was to examine the implementation and premise of the
use of art therapy with at-risk students in public school settings. The study used a
qualitative grounded theory approach to generate concepts about the theoretical
orientation, operation, and objectives of school art therapy programs in the United States.
Art therapy usage in schools was conceptualized through the explanations of participants
who facilitated and administered school-based art therapy. Themes emerged from
connections between categorical data found in participants’ responses (Kelle, 2005). The
development of concepts from connected categories formed a probable function or a
model of school art therapy. According to Merriam (2002), the nature of qualitative
research rests in deriving meaning from the interactions of individuals. The participants’
thoughts, experiences, and knowledge of the objectives, premise, and procedures used in
school art therapy were recorded. A grounded theory approach allowed for a delimitation
of the research design that selectively inquired about participants’ explanations (Glaser,
2005). The specific context and conditions of the art therapy programs became important
factors affecting the understanding of a theoretical model.
The qualitative grounded theory approach relied on the discussions that occurred
in the semistructured interviews between the researcher and participants. This grounded
theory design rested in the analysis of information derived from participant feedback.
Concepts, themes, and ideas regarding the operation and premise of school art therapy

54. 42
arose from substantive coding that occurred from the line-by-line, methodical analysis of
interview transcripts. The study attempted to clarify the school-based intervention
strategy of art therapy by researching the perceptions and concerns of the operators. The
grounded theory approach became a systematic study of the facilitators’ experiences that
generated concepts of how art therapy worked in schools. Answers to the question of
“what’s going on?” in school art therapy emerged through the examination of coded
information that was highly specific to the context, population, and interactions of the
individual school art therapy programs.
The study could have taken a phenomenological approach that examined the
phenomenon of change of at-risk students’ behavior when participating in school art
therapy. Though the phenomenon of change in at-risk students involved in school art
therapy would have provided insight about specific art therapy interventions, a
phenomenological approach would not have provided detailed perceptions of multiple art
therapy approaches from facilitators embedded in their own context-specific school art
therapy programs. Studying the emergence of school art therapy operations from the
responses of various facilitators of school art therapy offered a model or concept of
school art therapy. A case study examining individual student participants’ experiences
in school art therapy programs might have provided valuable insight into the efficacy of
art therapy interventions and might have offered a view of how that case’s art therapy
strategy operated but would have fallen short in conceptualizing a grounded theoretical
orientation from the various implementations of public school art therapy.

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Study Inquiry
This grounded theory study targeted participants’ actions, perceptions, and
knowledge about conducting art therapy in public school environments. This qualitative
study described the circumstances and operation of school art therapy from the interview
responses of facilitators who administer school art therapy. The inquiry for this grounded
theory study attempted to clarify the context-specific operation of art therapy in public
schools. I was interested in how school art therapy programs functioned. What were the
premise and theoretical orientations of art therapy in schools? What were the standard
operational procedures of school-based art therapy? What kinds of art therapy methods
were incorporated, and what was the logic and objective of art therapy systems in school
environments? What were the challenges, obstacles, benefits, and achievements found in
the transactions of school art therapy with at-risk students? The objective of this
qualitative research was to ground operative systems of art therapy in schools to offer a
potential model of school art therapy. Increasing insight on the function of art therapy in
schools may offer indications of optimal school art therapy procedures and perhaps
indications of areas of school art therapy requiring further study.
Context for the Study
The context for the study included 16 art therapists operating art therapy in K-12
public schools in the United States. Weaving together the art therapists’ views, positions,
delivery, and understanding of their particular school art therapy service offered meaning
in the development of a school-integrated art therapy program. The study may help my
former school district establish an art therapy program, as well as help school districts

56. 44
across the United States develop art therapy interventions. Facilitators who administer
and coordinate their school art therapy programs and who agreed to participate became
the main data sources as interview participants.
Role of the Researcher
My primary role as the researcher was to develop an interview guide and conduct
interviews with the participants to record their perceptions and knowledge of operating
school-based art therapy programs. My other primary role was to sort, categorize, and
find emerging themes related to the use of art therapy in public schools. My role as the
researcher also involved the dissemination of findings and indications about school art
therapy to my former school district, where I had been employed as an art educator for
the past 8 years, and to the participants of this study.
Visual art has been a part of my life for as long as I can remember. Art education
and art therapy were natural paths for me to follow. I have been a licensed art educator
and a registered art therapist practicing and learning my craft for the past two decades in
schools, hospitals, mental health organizations, and private practice. My personal bias
rests in my belief that art is beneficial to at-risk students. I have observed the positive
effects making art has on at-risk students’ self-esteem and emotional state, which seem to
lead to improved academic performance. I am interested in research that involves the
development of school-based art therapy to meet the needs of at-risk students. For the
scholar, conducting research is much like creating a work of art is for the artist. I have
found that significant qualitative research, much like important art steeped in subject
matter, evokes a personal response not only from the researcher, but also from the viewer

57. 45
or reader. The construction of new ideas and directions and the stimulation of more
insightful responses result from works that hold validity, can be interpreted individually,
and have the potential to influence social and environmental changes.
Participants
Participants were identified through criterion sampling (Creswell, 2007). The
criteria for participation included employment as a facilitator or art therapist operating
school art therapy in the United States. The participants were adults who coordinated and
operated school art therapy programs. Each of the participants was privately invited and
offered the opportunity to participate in the study. Sixteen school art therapy facilitators
participated. Three of the participants came from the same school district. Each of the
remaining participants came from a different school district. The volunteer participants
offered an opportunity to investigate individual perspectives (Pinnegar & Daynes, 2006).
Protection of Participants
Ethical considerations related to the privacy of study participants were a priority
(Creswell, 2007). By representing participants anonymously and avoiding specific
identifying factors, I prevented the unwanted disclosure of participant identities. Each
participant was informed about the nature and process of the study.
The interviews occurred through use of the U.S. Postal Service, phone, and
e-mail. I conducted the interviews in the privacy and security of my home office. Data
that remained as part of the viewable study were de-identified. Participants were
designated alphabetically to protect their identities. All raw data were kept locked in my
home office.

58. 46
E-mails were kept safe through password protection. A major priority of the
research was to protect the participants’ welfare. Participants were informed that they
could stop their participation in the study or retract statements at any time for any reason
without any negative consequences or pressure to participate (Rubin & Rubin, 2005). I
attempted to promote a trusting bond that allowed informants to explain their
understanding, perceptions, and knowledge of operating school art therapy programs.
Data Collection
A qualitative method of inquiry was used to develop an understanding of how
school art therapy operates and the premise of school art therapy with at-risk students
experiencing academic problems and social maladjustment. In a grounded theory
analysis, I sought to explain the operative systems of school art therapy through the
accounts of those who operate school art therapy programs. I used semistructured
interviews with the facilitators of school art therapy programs to conceptualize the
operation and orientation of public school-integrated art therapy (Hatch, 2007).
The literature review, which included studies that examined art therapy in
schools, was useful in the formulation of interview questions (Bush, 1997; Stepney,
2001). My inquiry concerned the actual function and logistics as well as the logic and
objectives of art therapy use in school. The literature review offered insight into the
methods and study formats of research on school art interventions but afforded little
understanding of the motives, operative choices, and theoretical orientation of school art
therapy. Thus, the interviews were designed to gain insight on the purpose, function, and
assertion of school art therapy from the perspective, experiences, and knowledge of the

59. 47
adults in educational systems conducting art therapy interventions. The 11-question, self-
designed interview guide (Appendix A) is a combined collection of convergent and
divergent questions that probed the informants’ perspectives on school art therapy (Mills,
2003).
Upon completion and return of the signed consent forms, correspondence with the
participants occurred via telephone or e-mail, depending on the respondents’ preference
of interview method. Eight participants responded by phone. Eight participants replied
through e-mail. The developed interview guide was used to collect data from each
participant. School art therapists who chose to use e-mail correspondence replied to the
interview guide questions in written form, which they forwarded through electronic mail.
The e-mail responses of each participant were downloaded to a JPEG file, and a hard
copy of the written e-mail responses was produced to secure the information and prevent
any loss of data. The e-mail form of reply offered the participants ease in responding.
Each participant’s reply was dated and assigned a code.
Phone interviews were established based on the participants’ availability and their
choice of time of day to respond, which they sometimes indicated on their signed consent
forms or through e-mail. The phone interviews occurred in the security of my home
office, except for two phone conversations, which occurred in the privacy of my vehicle.
A hand held digital recorder was used for all recordings. The recordings were burned to
a compact disc, assigned a code, dated, and downloaded to a JPEG file. The phone was
placed on speaker mode to allow the recording of the interview. The structure of the
phone interview was maintained by following the interview guide.

60. 48
In the phone interviews and e-mails, each of the school art therapists answered all
of the questions. It was not known how much time the participants took to write the
e-mail responses; however, as noted, the phone interviews lasted between 30 and 45
minutes and were responsive interviews that stimulated interactive conversations (Rubin
& Rubin, 2005). Data were collected between January 3, 2012 and April 11, 2012.
Data Analysis
The grounded theory method of qualitative research helped me to analyze data
sequentially to form a theory of how school art therapy operated. The data describing the
objectives, premise, and operation of school art therapy were coded, interpreted, and
analyzed. Based on the work of Glaser (2005) and Charmaz (2006), I first coded specific
evidence that arose from individual participant interviews. The simultaneous collection
and analysis of data occurred as a way of focusing ideas and concepts into groups of
information that addressed the research intention (Hart, 2009). Important and relevant
information derived from the interview were identified and coded. Codes essentially
similar in substance were grouped into categories. An analysis of the categorical
explanations of the orientation and function of art therapy in schools directed the
development of a theory conceptualizing a model of school art therapy. A theory of art
therapy use in schools emerged from the systematic analysis of participant interview
responses. A general principle was offered to explain more clearly the phenomenon of
art therapy practice and rationale in public schools.
Concepts, ideas, and themes that arose from selective categories were established
after data were explored and compartmentalized into individual components that

61. 49
contained specific revealing elements. Recurring themes and ideas that repeated were
identified, isolated, and pieced together to derive an understanding of how art therapy
worked in schools. Verbatim transcripts of the interviews were analyzed to determine the
content and meaning of participants’ responses.
The participants’ methods of administering art therapy became key data.
Selective coding was derived from substantive coding or open coding of the operation,
premise, and objectives of art therapy in schools. The proposition of axial coding was
employed in the study to connect categories of concepts illuminating the specific process
and context of each participant’s experience and knowledge of school art therapy.
Memos that I wrote and rewrote as I analyzed the emergence of themes helped to
formulate theories of school art therapy. I sorted data and employed memoing as well as
written summaries of each participant’s interview to connect and reconnect open codes,
and I categorized themes to analyze the evolution of emerging theories of probable
school art therapy models (Charmaz, 2006).
ResearchValidity
Quantitative research builds validity and significance based on the steadiness and
constancy of findings with the intention of generalizability to the greater population
(Creswell, 2003). Qualitative research is based on examining a naturally occurring
phenomenon in a true or actual setting (Patton, 2001). Naturalistic interpretation
unfolded as a result of interactions with the participants during the course of phone
interviews and e-mail correspondence. Rather than focusing on causality, prediction, or
generalizability common to the quantitative paradigm, the qualitative analysis in the

62. 50
study sought to establish validity through increased insight, illumination, and
enlightenment from respondents’ perspectives. The credibility and trustworthiness of this
qualitative study rested in the provision of authentic and accurate accounts of the data
collection and participants’ replies. Research validity increased through the context,
events, and actions derived from participant perspectives and confirmations.
The data collection was prompt and accurate in the recording and transcription of
participants’ responses. A candid description that identified evidence and assertions
established a more credible report. The genuineness of this qualitative research rested in
the accurate collection and synthesis of participant responses.
The dependability of the research relied heavily on essential quality
characteristics such as neutrality, confirmability, and consistency. I attempted to achieve
a reliable, qualitative research study that used member checks. Each participant was sent
his or her transcribed interview responses along with a synthesis of the transcription to
validate the responses (Appendix C). The examination of data from each of the
facilitators’ responses about his or her individual program offered a triangulation of
specific information that constructed a greater understanding of school art therapy. The
different origins of information provided a strengthening of evidence that conceptualized
school art therapy. Recorded interviews, the consequent memoing, and interview
summarizations were continually reviewed to ensure accurate analysis.
The construct of validity was contingent upon the operation and purposes of the
specific form of methodological inquiry (Winter, 2000). The explanatory and
interpretive nature of the study’s qualitative methodology gave the participants an

63. 51
opportunity to establish their perceptions. Validity occurred through categorizing coded
information, memoing ideas, forming preconceptions of theories, and extensive written
summarizations. The verification of findings was established through comparing codes,
categories, and evolving concepts until a logical theory and model of school art therapy
arose.

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Section 4: Results
The purpose of the study was to examine the operation, premise, and objectives of
school art therapy programs across the United States to form a better understanding of the
function and models of school art therapy aiding at-risk students’ academic and social
improvement. Section 4 focused on the analysis and interpretation of data collected to
offer insight on the study’s research questions. The aim of the study was to understand,
from the perspective of school art therapists, how school art therapy operates (Research
Question 1), the premise of school art therapy (Research Question 2), and the objectives
of school art therapy (Research Question 3). In Section 4, I critically examined the
collective cross-analysis of the school art therapists’ responses for content to identify the
differing and similar themes that emerged about the operation, premise, and objectives of
school art therapy.
Assurance of Data Integrity
The data collection began with the description and understanding of the data
analysis process (Creswell, 2007). This grounded theory study first investigated the
responses of the participants to the interview guide. The recorded phone interviews were
immediately transcribed to produce accurate transcriptions of the participant responses.
E-mail responses were printed into hard copy form. The printed e-mail responses and
phone interview transcriptions of the school art therapists’ statements were coded and
critically analyzed to decipher and correlate responses to the research questions. Key
statements and word choices were selectively coded from the substantive coding of the
participants’ perceptions of the process, orientation, and purpose of school art therapy.