A pluralistic approach encompasses a number of dimensions that guide my relational systemic practice (Sibbett, 2019).

Firstly, a pluralistic way of being is a way of regarding and valuing others, celebrating diversity and promoting rights, such as choice and agency. Pluralistic art psychotherapy features an ‘I-Thou’ stance (Buber) relating to the person and their art, characterised by reverence, which I also extend to our other companion life-forms on Earth.

Secondly, a pluralistic professional attitude honours all other bona fide evidence-based theories and orientations of helping; and features an openness to signposting to these, based on client needs and preferences. This respects diverse therapies, including talking therapies, creative therapies, and nature-based modalities, as well as wider health and social care. Multidisciplinary practice, therapeutic teamwork, and interprofessional learning are also all valued. Openness to referring to evidence-based trauma specific support is consistent with contemporary trauma informed care principles.

Thirdly, underpinned by the above two, pluralistic practice is a holistic, biopsychosocial, inclusive, and collaborative approach to clients and their creativity. It is a coherent approach where pluralism is practised across orientations, clients, and perspectives.

Pluralism across orientations

Pluralism across orientations features an openness to the diverse ways that clients can be affected and prefer to be helped. Pluralistic art psychotherapy draws on diverse theoretical orientations within one’s scope of practice, consistent with our professional body’s (BAAT) integrative approach, informed by person centred, psychodynamic, and other diverse theories. Here, there is an embracing of the diverse verbal and non-verbal creative media and methods, guided by client needs. Pluralism values multi-sensory knowing through making and symbolising, as well as speaking. It aligns with the HCPC’s standards which stipulate that ‘while art therapy has a number of frames of reference’, art psychotherapists ‘must adopt a coherent approach’. Pluralistic art psychotherapy notes the diverse ways that creative practice can help, and also can harm, thus managing psychological and/or physical ‘arts-based risk’ and injury.

Pluralistic art psychotherapy is also consistent with trauma-informed care principles in that the relationship to clients and their art aims to ensure safety and ‘see through a trauma lens’. This is guided by trauma awareness, a biopsychosocial approach, and the management of retraumatisation and vicarious traumatisation. Practice is adapted according to clients’ needs, informed by diverse integrative and trauma sensitive frameworks. Pluralistic practice can be tailored across the spectrum of ways clients have been affected and how they use art and experiential processing, guided, for instance, by the ‘expressive therapies continuum‘. This continuum maps diverse developmentally relevant ways of creative processing through sensory/kinaesthetic, perceptual/affective and cognitive/symbolic levels. In this way, pluralistic art psychotherapy aims to adapt to best fit a client’s trauma history, current functioning, and needs, guided by developmentally sensitive and neurobiologically informed trauma models.

Pluralism across clients

Pluralism across clients refers to a prizing of the diversity of clients and their art, abiding within ethical commitments. Building on Rogerian core conditions, communicated in relation to the client and their art, the art psychotherapist acts as an informed ‘bricoleur’ adapting and tailoring practice. This is guided by client aims, choice, resources, and cultural beliefs and practises, including their cultural and individual symbolic language and meanings. The creative expression in art psychotherapy can offer a ‘pluralistic microcosm’ in which the client can engage in a dynamic process in which symbolic and metaphorical expression opens up multiple meanings and possibilities.

The approach to clients and their art is guided by cultural awareness and sensitivity to the various complex types and effects of trauma, intersectionality, and many ways of healing, consistent with trauma informed care principles.

Pluralism across perspectives

Pluralism across perspectives features a collaborative ‘triangular’ partnership between client, therapist, and art, all actively interacting. The art acts as a space-within-a-space, offering a ‘trialogue’ where topics can be approached directly and indirectly. Conscious and unconscious dynamics can operate, with multiple layers of processing. Conscious, voiced, unvoiced, and unconscious goals and issues can be processed across the transference/countertransference triadic matrix. A topic that can feel too difficult to approach directly may be approached through the art and therapeutic relationship. In the triadic space, clients can consciously focus on something, whilst the art process and later artwork reviews may reveal that something else was being processed more unconsciously. Pluralistic art psychotherapy engages in verbal/non-verbal/symbolic metatherapeutic communication, enabling clients to indicate their views and preferences, allowing adaptation of therapy. Where possible, systematic feedback is integrated into practice, co-creating the alliance. Ruptures and repairs across the triadic space are worked on. Within training, supervision and beyond, the HCPC requires art psychotherapists to engage in self practice, to develop insight through personal art therapy and to maintain ‘fitness to practise’ through ‘engagement in their own arts-based process’.

Across the triadic space, pluralistic art psychotherapists work to maximise collaboration, mutuality, hope, empowerment, choice, control, trustworthiness, transparency, and wider supportive partnerships, consistent with trauma informed care principles.

I believe that a core aspect of pluralistic art psychotherapy is communicating to the other person that they and their creative potential matter; as do their unique experiences, needs, preferences, creations, future aims, and power of choice. Building on these values, the approach is one of benign, caring, creative collaboration and empowerment. Pluralistic art psychotherapy encompasses verbal, multi-sensory, symbolic, non-verbal, and unconscious projective processes; featuring a collaborative and bespoke co-creative matrix and ‘trialogue’, offering creative opportunities for constructive change.

• International Journal of Art Therapy, formerly Inscape
• The Arts in Psychotherapy
• Art Therapy Online (ATOL)
• Art Therapy Journal of the American Art Therapy Association