Development of a Multidisciplinary Diploma on Art Therapy in Health Education—Research into Existing Practices in Jordanian Universities: The “HEALING” Project ()
1. Introduction
Art therapy is a non-pharmacological medical complementary, an alternative stand-alone therapy, a discipline, which uses fine arts, such as painting, sculpting, writing, drama, music, to help patients on the one hand recognize, explore, and express their emotions and thoughts ( Babalis & Tsoli, 2017 ; Tsoli, 2015, 2023 ) and on the other use art to resolve the issues they are encountering ( Chiang et al., 2019 ; Hu et al., 2021 ; Papangelo et al., 2020 ). Therefore, it has a dual heritage from art and psychodynamic ways of thinking. The emphasis is on art making itself as healing ( Case & Dalley, 2014 ). The art therapy research and literature launched at the 1940’s and continues to grow. Many clinical approaches have been developed, such as psychoanalytic, humanistic, cognitive-behavioral, solution-focused and narrative, developmental and expressive and multimodal, while the clinical applications are addressed to children and adolescents (e.g., drawing, storytelling, play), adults (e.g., counselling, addictions treatment, shame reduction, domestic violence) and groups, families, and couples (e.g., medical support groups, children in grief and loss groups) ( Bowen-Salter et al., 2022 ; Malchiodi, 2012 ; Smriti et al., 2022 ).
“Development of a Multidisciplinary Diploma on Art Therapy in Health Education” (acronym HEALING) is a Capacity-Building project in the field of Higher Education, co-funded by Erasmus+ Program within the support of the European Union, whose objective is to develop and integrate the Art Therapy into Health Education ( ERASMUS+ Project, 2021 ). The project consortium consists of partner universities from Jordan, Tunisia, Greece, Italy, Portugal, Belgium and Croatia and its duration is three and a half years (2020-2023). The project aims to design and develop a professional educational program (e-learning package) of Art Therapy to enhance the capacity of students and staff from health and psychology disciplines to tailor health plans for patients (children, adults, and elderly) with a wide range of health conditions, e.g., physical and emotional abuse, mental illnesses and disorders, autism, stroke survivors, Alzheimer, dementia, terminally ill patients, traumatic experiences of refugees ( Alwledat et al., 2023 ; Chiang et al., 2019 ; Marco & Redolat, 2023 ; Park & Song, 2020 ; Partridge, 2022 ; Schouten et al., 2019 ; Schweizer et al., 2020 ). The goal of the project is to develop a multidisciplinary diploma on Art Therapy in Health Education and to establish Therapy Centers in Jordanian and Tunisian universities.
The Art therapy project is comprised of both practical and theoretical courses. The practical courses-workshops were planned to be delivered based on a face-to-face method in the Art Therapy Centers, while the theoretical courses were given on online platforms. At the beginning of this program, Art Therapy Centers’ staff was asked to raise awareness of art therapy’s role and its implications, in enabling healthcare providers to tailor individualized care plans ( University College Limburg VZW, 2019 ).
The project was planned to be implemented in four phases: design, develop, implement, evaluate and review. The first phase aimed to assess the current situation of art therapy at Jordanian and Tunisian universities. The second phase entailed both evaluating the requirements of preparing educational material related to the creative art therapy discipline and establishing specialized Art Therapy Centers in each participating university, including music therapy, drama therapy, visual art therapy and dance therapy. The third and the fourth phases were related to the implementation and evaluation of the pilot courses. In this paper, we are reporting on the initial first phase of the project, which aimed to assess the current situation of Art Therapy and the perception of students, teachers, and stakeholders at Jordanian universities regarding the utilization of art therapy in Health Education.
Preliminary in-depth analyses were crucial in the project’s preparation phase to enable partners and founders to assess the needs of each partner university. Common objectives that were in line with the project’s main goal were set in advance. The in-depth analysis of this project was comprehensive. However, based on the focus of this paper, we are reporting on the following two aspects:
· Art Therapy in Education: Curricula Status.
· Competences that are required to be developed.
Three in-depth analyses were conducted using desk research, paper, and online surveys, and interviews with appropriate stakeholders, including national enterprises, governmental bodies, and education experts and advisers. The results of this in-depth analysis were used as the foundation for developing curricula and establishing Art Therapy Centers.
The first in-depth survey on the “HEALING” project was to assess the current situation of art therapy and the feasibility of integrating Art Therapy Education. The survey aimed to identify the weaknesses and strengths in the curricula, verify the courses offered, if any, and determine what other courses are needed.
The second in-depth survey on teachers and students’ competences and awareness aimed to investigate the art therapy teaching methods employed by professors and assess the self-evaluated art therapy competencies of students enrolled in healthcare schools. In addition, this phase aimed to investigate the levels of art therapy-related competencies that could be provided to both target groups and the needs of the teaching staff. Moreover, the research group defined the most competitive and highly valued situation and trends in art therapy education and determined the new digital technologies to be integrated within the new curricula. This study assisted in reviewing, modernizing, and designing the new teaching materials.
The third in-depth survey on available facilities and resources aimed at verifying partners’ facilities to build on existing resources available in partner universities. The report has led to a gap analysis, and a discussion of the needs in capacity building, infrastructure, and human resources.
The results of these three in-depth surveys are presented in this paper. Specifically, it describes the needs and the most appropriate skills for an art therapist, according to the views of academic staff, students, and stakeholders, and it analyzes the practical and training content to be embedded in the courses. This phase contributed to the development of an innovative art therapy curriculum according to EU standards and responded to the target group’s needs.
The general aim of this study was to provide information related to the following aspects: 1) assessing the current situation of Art Therapy in Education; 2) identifying the required competences to be provided to teachers and students; and 3) verifying the resources and facilities of partner universities in Jordan.
2. Methodology
2.1. Purpose of the Study
This study aimed to assess the current situation of Art Therapy in Education in Jordanian Universities and investigate the state of the art on the topic. Hence, this study is guided by the following research questions:
· What is the current situation of Art Therapy in Education at Jordanian universities?
· What are the required competencies to be provided to teachers and staff?
· What are the required competencies to be provided to students?
· What are the facilities of partner universities in Jordan?
2.2. Design, Sampling, and Participants
A cross-sectional design was used in an online survey that was distributed to staff, students, teachers, and stakeholders (including national enterprises, governmental bodies, and education experts and advisers) among five Jordanian Universities to assess the situation of art therapy. The package leader (UCLL), with the collaboration of work package co-leaders (Irbid National University and University of Sousse), and representative participants from other partner universities (e.g., Isra University, University of Jordan) developed the content of the surveys and determined the target participants based on the existing literature. The inclusion criteria were the following: being an employee or a student at a Jordanian University, being at least 18 years old, and willing to participate.
Operational definitions
All the definitions are depicted on the healing project website ( University College Limburg VZW, 2019 )
· Package leader: (UCLL, University Center Leuven Limburg).
· Staff university: Deans/Chairmen of Departments/Professors.
· Students: Students from the partner universities (School of Arts/School of Medical Sciences/other related schools).
· Teachers: Teachers from the partner universities (School of Arts/School of Medical Sciences/other related schools).
· Stakeholders: People working in companies or centers relevant to Art Therapy (graduated art therapists, therapists, art therapists, hospitals, medical centers).
2.3. Measures and Data Collections
Google forms were used for the on-line survey, as the most convenient method for accessing the participants ( Vasantha Raju & Harinarayana, 2016 ). Four surveys were conducted, including a staff survey, a student survey, a teacher survey, and a stakeholder survey. All principles of research ethics were considered (e.g., respect for persons, beneficence, justice). The following paragraph provides a brief description of the surveys used.
1) Staff survey that aimed to assess the current curricula and e-learning facilities at the School of Arts/School of Medical Sciences/other related schools at the partner universities, with a target number of 10 participants.
2) Student survey that aimed to identify which competencies in Art Therapy students already possess (self-assessed) and which competencies they still lack (based on the newest trends and methodologies in art therapy), with a target number of 30 - 100 participants.
3) Teacher survey aimed to identify which competencies in Art Therapy teachers already possess (self-assessed) and which competencies they still lack (based on the newest trends and methodologies in art therapy), with a target number of 10 - 25 participants.
4) Stakeholder survey to identify the competencies in Art Therapy teachers and students already possess (self-assessed) and which competencies they still lack (based on the newest trends and methodologies in art therapy), with a target number of 5 - 10 participants.
All surveys were developed in the English language (source language). However, since the mother tongue language in Jordan is Arabic, the surveys were translated to Arabic (target languages) based on existing outlines ( Al-Amer et al., 2015 ; Al-Amer et al., 2016 ).
3. Results
3.1. Sociodemographic Characteristics of the Sample
This survey took place between March 2020 and August 2020. The total study sample consisted of eighty-two (82) academic staff; one thousand and thirty (1030) students; one hundred and ninety (190) teachers; and sixty-seven (67) stakeholders. Regarding the Jordanian Universities, on which this research is focused, the total number of the sample that participated in the three surveys was sixty-four (64) academic staff, eight hundred and fifteen (815) students, one hundred and twenty-four (124) teachers and fifty-one (51) stakeholders. The ratio of staff in terms of female to male who participated in this study was 38 females: 24 males for the academic staff, 536 females: 279 males for the students, 8 females: 43 males for the teachers and 30 females: 21 males for the stakeholders (Table 1).
At this point we present the most important results of the research.
3.2. The Current Situation of Art Therapy
The aim of the first survey of the study was to assess the current curricula and e-learning facilities at the School of Arts and/or School of Medical Sciences at the Jordanian Universities, according to the responses of the academic staff.
1) The current curricula in art therapy education
Most participants reported that currently, no art therapy related courses are offered at the Jordanian Universities, and they confirmed that there is a need for Art Therapy courses at their university.
2) Experiences and facilities for e-learning-infrastructure issue
The survey examined the extent to which e-learning is already applied in the participating universities/departments. E-learning is a type of learning that could be taken by studying at home using computers and courses provided on the internet. Most universities indicated that e-learning is already used in their departments, mostly in the form of teaching and learning through online platforms. Online face-to-face meetings through online meetings software is the
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Table 1. Sociodemographic characteristics of the sample from Jordanian Universities.
second most used form of e-learning. The use of apps and gamification as a form of e-learning is not common.
3.3. Art Therapy Education Competences
The second of the three in-depth surveys aimed at identifying which competencies in Art Therapy teachers and students already possess (self-assessed) and which competencies they still lack (compared to the newest trends and methodologies in Art Therapy). The results of this survey form the basis for the development of new methodologies in Art Therapy. Since different target groups were involved, this survey was split up into 3 main parts per target group, namely students, teachers or academic staff, and stakeholders.
A total of 1287 participants completed the second survey: students (n = 815), teachers (n = 124), and stakeholders (n = 51). Questions about e-learning were answered by the students and teachers, but not the stakeholders.
1) E-LEARNING
a) Experience with e-learning
This section on e-learning provides insight into the current experience with e-learning of each target group, to give an idea of which applications the participants were already familiar with. In addition, the students’ personal experience was surveyed to obtain an overview of the most frequently encountered advantages and disadvantages of e-learning. The majority of teachers (92.5%) and the majority of students (69.5%) have experienced e-learning. The most common form of e-learning was online platforms for both teachers (53.5%) and students (63.4%). Table 2 summarizes the frequencies of use of the other forms of e-learning.
b) Benefits of e-learning
Teachers (47.4%) and students (53.9%) agree that the benefit of e-learning was learning on the student’s own time and location. Students also think that e-learning platforms offer more possibilities than traditional classrooms (20.5%), followed by choosing what they think was relevant (12.7%) and learning at their own pace (12.9%). On the contrary, teachers stated that e-learning offered more possibilities (21.1%), followed by learning at their own pace (17.5%), learning what was necessary (8.8%), and no need for logistic organization (5.3%).
c) Downsides of e-learning
The most reported downside of e-learning among the students was that
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Table 2. Summary of the e-learning forms used at the Jordanian universities.
e-learning can cause poor posture and eyesight (28%). Further, students reported that e-learning requires self-discipline (26.6%), can make the student dependent on technology (24.5%), and results in less “real-life social contact” (20.8%). For teachers, the most reported downside of e-learning is the less “real-life social contact” (66.9%), followed by the need for self-discipline on the student end (19.8%), being dependent on technology (9.9%), and causal of poor posture and eyesight (3.3%).
2) ART THERAPY SUBJECT MATTER
a) Topics or subjects that currently are part of art therapy courses, as well as topics that should be present in an art therapy program
In Jordan, students indicated that mainly Art history, Artistic abilities, Psychology, Therapeutic methodology and Expression of emotions are lacking in their curriculum. Practical skills seemed to be the topic that was most present. Students also indicated that there was a need for psychology, developing communication skills, and critical thinking. Lastly, 55% of students indicated that Art history is unnecessary.
39% of the Teachers stated that therapy using diverse art forms was essential, while 49% believed it was required. Moreover, developing communication skills were reported as essential by 34% or required by 50% of the teachers. Ethics were viewed as essential by 34% or required by 45% of the teachers. Lastly, Art history, psychopathology, critical thinking, and artistic abilities were seen as unnecessary and/ or hardly necessary.
b) Specifically proposed subjects, inspired by preliminary research and existing art therapy programs with European partners involved in this project
The majority of Jordanian students believed that medical knowledge and skills should either be mandatory (43%) or optional (43%). Similar responses can be found for practical skills and insights, where 39.5% of students indicated it should be mandatory, and 47% believed it should be optional. Jordanian students attached immense importance to psychology, psychiatry, and therapy, with 41% of students indicating it should be mandatory, and 49% optional.
Subjects about Art Therapy, Psychology, and Art should be part of an Art Therapy Curriculum according to the students of the sample, but there is a clear preference for these courses being optional rather than mandatory.
Most of the academic staff in the participating universities believed that all the proposed courses should be part of an Art Therapy Program, either mandatory or optional. The responses for Artistic skills show a preference for this course to be optional rather than mandatory.
Jordanian stakeholders mainly hold the view that medical knowledge and skills and Practical skills and insights should be mandatory (70%) rather than optional in an Art Therapy Program, while Psychology and art and Psychology, psychiatry, and therapy should be mandatory or optional. Subjects that were seen as optional rather than mandatory in art therapy were Artistic skills.
Figure 1 and Figure 2 summarize the personal skills that should be present in
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Figure 1. Personal skills important for future art therapists according to Jordanian students.
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Figure 2. Personal skills important for future art therapists according to Jordanian teachers.
art therapists, as reported by students (Figure 1) and teachers (Figure 2). Students reported that all personal skills were necessary for an art therapy program, with at least 90% of the students indicating that each skill was “important” or “very important”. Self-knowledge and creativity seemed to be the skills students attached the most importance to, as these scored the highest for “very important” (59% and 58% respectively). The majority of teachers (60%) reported that communication skills are “very important” for art therapists.
3.4. Available Resources and Facilities
The final survey in this study was a survey verifying facilities and resources available in Jordanian partner universities. The main goal of this survey was to assess these resources in order to build on existing resources available in partner universities. Moreover, the results of this survey would be considered for the configuration of the laboratory equipment. The sample chosen to conduct the third survey was those who have good knowledge about the facilities and resources available at each partner university, i.e., academic staff (Deans/Chairmen, professors, etc.).
1) E-LEARNING
a) Facilities
The survey investigated the most important IT infrastructure (particularly, PCs, servers, IT rooms, network and connectivity, and e-learning software) that facilitates e-learning services for students, teachers, and participants. On the one hand, the answers to this survey showed that all Jordan Universities have modern e-learning software, such as e-learning interface for blended learning, Moodle, and Microsoft Teams. On the other hand, all Jordanian partner universities have the other IT facilities mentioned above.
b) Obstacles
The survey revealed the following three types of obstacles:
· Technical obstacles related to IT infrastructure: Respondents in all universities were mainly considering technical obstacles when discussing obstacles related to e-learning. The quality of the network and connectivity were a recurring issue, as well as outdated or low-performance equipment.
· Obstacles related to limitations in IT infrastructure: Respondents mentioned some limitations in IT infrastructure, such as a limited number of PCs, and a lack of video conference equipment and studios for recording.
· Obstacles related to personal skills and situation: Respondents were also concerned about the technological skills of the students. Also, they pointed a lack of commitment from students to e-learning. Thus, a lot of self-discipline on the part of the student is required. This should be considered as an important challenge for e-learning in the education process.
2) MATERIALS
a) Instruments
All representatives of universities were provided with a list of instruments for Art Therapy Education, and then were asked if these instruments were already presented in their university. The answers were as follows: the University of Jordan already disposed of one or more pianos, drum sets, rain sticks, and djembes. Irbid National University, Isra University only disposed of at least one piano per institution. Hashemite University and Jordan University of Science and Technology didn’t have any of the mentioned instruments at their disposal.
b) Facilities
Each Jordanian university was asked if they had any of the following Art Therapy Education facilities on their campuses: a soundproof room, a recording studio, a professional camera, costumes, or props. The University of Jordan also disposed of all facilities, except a professional camera. For the Jordan University of Science and Technology, the camera was the only equipment at their disposal. Hashemite University and Irbid National University did not have any of the facilities mentioned in their institution.
c) Art Therapy Facilities
Finally, when partners were asked about medical laboratories or facilities for students to access on campus, the answers were as shown in Table 3.
It is important to mention at this point that all partners are convinced of the importance of medical experiments and interventions to analyze the effect of Art therapy methods on patients.
4. Discussion, Conclusion, Suggestions
Art therapy is a pristine area in Jordanian Universities ( Alwledat et al., 2023 ); hence, this discipline could gain momentum through tertiary educational institutions. Also, scholars are invited to conduct a wide range of studies with different methodologies to achieve good levels of reliability and validity in the application of this discipline among collectivist communities.
Based on the findings of this study, it is evident that there is a need to establish art therapy courses at health and psychology schools. A potential explanation of these results is that art therapy was proven to be effective as a complementary therapy to a wide range of mental and physical diseases ( Iguina & Kashan, 2022 ; Shafir et al., 2020 ; Shukla et al., 2022 ). Also, it is important to note
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Table 3. The medical facilities in each partner university.
that currently, Alwledat et al. (2023) reported that using creative art therapy is important in the rehabilitation process for chronic diseases, such as depression, anxiety, and stress in patients with stroke.
It is important to note that the courses in art therapy could be delivered in a hybrid form of educational method ( Sajnani et al., 2020 ). Thus, it was important to assess the infrastructure levels in terms of online education, and it was proven that the online platforms are well used by the students and the teachers as well ( Ismaili, 2021 ; Yaseen et al., 2021 ). For example, Jordanian universities have started taking measures related to distance courses since 2015 and the Accreditation and Quality Assurance Commission for Higher Education Institutions has established the regulations and accreditation guidelines for distance and hybrid learning ( Maali & Al-Attar, 2020 ). Thus, it is evident that e-learning platforms are well established to start creative art therapy teaching courses using e-learning platforms and facilitate establishing the intended courses in the next phases of this project. However, we should note that there are technical and personal factors that could impede using online platforms in education, such as but not limited to the quality of the network, the levels of support received from the IT technicians, and the levels of student’s knowledge related to using online platforms for learning ( Elumalai et al., 2021 ; Ismaili, 2021 ).
In addition to that, the first phase of this project investigated the personal skills that should be possessed by an art therapist; most of the respondents reported knowledge, creative thinking, and communication skills. These results are in line with other studies that reported therapists should acquire important features such as but not limited to knowledge, observational skills, self-awareness, and creativity ( Case & Dalley, 2014 ; Iguina & Kashan, 2022 ; Koutouvela & Tsoli, 2022 ); these attributes would enable an art therapist to collaborate with other health disciplines and critically analyze a social situation ( Pate et al., 2022 ). Additionally, students who participated in this study reported that art therapy classes and courses are important because they felt that self-expression is not considered in their education.
Finally, we believe that the practice should be promoted in both communities and hospitals. Art therapy guidelines should also be established based on the accumulated evidence. Further studies should be conducted on the mechanisms of art therapy, such as at the cellular, molecular, and neurological levels.
Author Contributions
HEALING Project team designed the whole study, analyzed the data, and wrote the manuscript. UCLL searched for selected studies. UJ participated in the interpretation of data. All authors read and approved the final manuscript.
Funding
This study was financially supported by the HEALING Project “Developing a Multidisciplinary Diploma on Art Therapy in Health Education” which has been co-funded with support from the European Commission. ERASMUS+ PROGRAMME Project Number: 610134-EPP-1-2019-1-JO-EPPKA2-CBHE-JP.
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