Where is the art therapist? A systems approach to positioning the art therapist
Main Article Content
Keywords
Art therapist, systems thinking, bioecological model, palliative care, mapping, positioning
Abstract
This document provides guidelines for mapping and positioning the art therapist within various systems. It uses a research study that mapped the structure and dynamics of the palliative care unit at a public hospital as an example to illustrate the steps in the mapping process. It examined the optimal placement of art therapists within the palliative care system. The heuristic inquiry included reflections on observations embedded in the system during placement, as well as conversations and interviews with multidisciplinary team members and other art therapists. The various visual methods for mapping the system were valuable because they could be simplified to provide a more general understanding of the system. The art-based activities enabled the manual development of the maps and allowed participants to feel the three-dimensional textile map while integrating information about the system’s structure, dynamics, and functionality. The client type, stage of illness, and treatment plan or task determine the optimal placement of the art therapist. The primary contribution of the art therapist lies in the ability to work in a client-focused way and to employ a creative approach to meet the client’s changing needs. The process of mapping the system and considering key aspects, such as the stage of care, client type, and task of the art therapist, enabled me to understand my role in various systems. It facilitates advocacy for art therapy within systems, enabling art therapy to be applied more meaningfully.
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References
Atun, R. (2012). Health systems, systems thinking, and innovation. Health Policy and Planning, 27(Suppl. 4), iv4–iv8. https://doi.org/10.1093/heapol/czs088
Bollas, C. (1979). The transformational object. International Journal of Psychoanalysis, 60(10), 97–107.
Bollas, C. (1987). The shadow of the object: Psychoanalysis of the unthought known. Free Association Books.
Bradt, J., & Goodill, S. (2013). Creative arts therapies defined: Comment on “Effects of creative arts therapies on psychological symptoms and quality of life in patients with cancer”. JAMA Internal Medicine, 173(11), 969. https://doi.org/10.1001/jamainternmed.2013.6145
Braun, V., & Clarke, V. (2022). Thematic analysis: A practical guide. Sage. https://doi.org/10.53841/bpsqmip.2022.1.33.46
Bronfenbrenner, U. (1994). Ecological models of human development. Readings on the Development of Children, 2(1), 37–43. https://doi.org/10.1037/0033-295X.101.4.568
Bronfenbrenner, U., & Ceci, S. J. (1994). Nature-nurture reconceptualized in developmental perspective: A bioecological model. Psychological Review, 101(4), 568–586.
Bronfenbrenner, U., & Morris, P. A. (2006). The bioecological model of human development. In R. M. Lerner & W. Damon (Eds.), Handbook of Child Psychology: Theoretical models of human development (6th ed., pp. 793–828). John Wiley & Sons. https://doi.org/10.1002/9780470147658.chpsy0114
Burnham, J. (2013). Development in social GGRRAAACCEEESSS: Visible-invisible, voiced-unvoiced. In I. B. Krause (Ed.), Cultural reflexivity. (pp. 139-162). Karnac. https://doi.org/10.4324/9780429473463-7
Butler, C. (2017). Intersectionality and systemic therapy. Context, 151, 15–18.
Chilisa, B. (2012). Indigenous research methodologies. Sage.
Collette, N., Güell, E., Fariñas, O., & Pascual, A. (2021). Art therapy in a palliative care unit: Symptom relief and perceived helpfulness in patients and their relatives. Journal of Pain and Symptom Management, 61(1), 103–111. https://doi.org/10.1016/j.jpainsymman.2020.07.027
Davies, R. (2004). New understandings of parental grief: Literature review. Journal of Advanced Nursing, 46(5), 506–513. https://doi.org/10.1111/j.1365-2648.2004.03024.x
Deshmukh, S. R., Holmes, J., & Cardno, A. (2018). Art therapy for people with dementia. Cochrane Database of Systematic Reviews, 2018(9), 1–27. https://doi.org/10.1002/14651858.CD011073.pub2
Douglass, B. G., & Moustakas, C. (1985). Heuristic inquiry: The internal search to know. Journal of Humanistic Psychology, 25(3), 39–55. https://doi.org/10.1177/0022167885253004
Ellis, C., Adams, T. E., & Bochner, A. P. (2011). Autoethnography: An overview. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 12(1), Article 1.
Fish, B. (2012). Response art: The art of the art therapists. Journal of the American Art Therapy Association, 29(3), 138–143. https://doi.org/10.1080/07421656.2012.701594
Glinzak, L., Yazdian, S., Kwok, I., & Youngwerth, J. (2023). Integrating art therapy into palliative care: Man’s identity exploration in tattoo preservation. Journal of Pain and Symptom Management, 65(3), e241–e244. https://doi.org/10.1016/j.jpainsymman.2022.10.005
Harter, S. L. (2007). Visual art making for therapist growth and self-care. Journal of Constructivist Psychology, 20(2), 167–182. https://doi.org/10.1080/10720530601074721
Health Professions Council of South Africa. (2023). Regulations relating to the qualifications for registration of arts therapists and registration of persons qualified outside the republic. HPCSA. Retrieved 23 August 2023 from https://www.hpcsa.co.za/?contentId=0&menuSubId=49 &actionName=Professional%20Boards.
Hendricks, M., Steenveld, C., Thompson, V., Andrade, A., Kahl, G., Farlam, P., Balagadde-Kambugu, J., Hendricks, S., Rackstraw, A., Pedersen, L., Burger, D., Meiring, M., Davidson, A., & van Eyssen, A. (2019). Building a psychosocial and spiritual care service for children with cancer and their families. South African Journal of Oncology, 3, Article 52. https://doi.org/10.4102/sajo.v3i0.52
Hummelbrunner, R. (2011). Systems thinking and evaluation. Evaluation, 17(4), 395–403. https://doi.org/10.1177/1356389011421935
Jansen van Rensburg, M.S. (2025). A heuristic inquiry to explore the location of the art therapist in different tasks of the palliative care system. University of Johannesburg (Unpublished master’s).
Javadi, D., Feldhaus, I., Mancuso, A., & Ghaffar, A. (2017). Applying systems thinking to task shifting for mental health using lay providers: A review of the evidence. Global Mental Health, 4, e14. https://doi.org/10.1017/gmh.2017.15
Koopman, W. J., Watling, C. J., & LaDonna, K. A. (2020). Autoethnography as a strategy for engaging in reflexivity. Global Qualitative Nursing Research, 7, 2333393620970508. https://doi.org/10.1177/2333393620970508
Lister, S., Pushkar, D., & Connolly, K. (2008). Current bereavement theory: Implications for art therapy practice. The Arts in Psychotherapy, 35(4), 245–250. https://doi.org/10.1016/j.aip.2008.06.006
Lo, P. (2011). A heuristic and art-based inquiry: The experience of combining mindfulness practice and art making. Australian and New Zealand Journal of Art Therapy, 6(1), 51–67.
Madeline, C. (2017). Bronfenbrenner’s bioecological model of development. Learning Theories, May 15. Retrieved 26 September 2024 from https://learning-theories.com/bronfenbrenners-bioecological-model-bronfenbrenner.html#google_vignette
Mäkelä, M., Dash, D. P., Nimkulrat, N., & Nsenga, F. (2011). On reflecting and making in artistic research. Journal of Research Practice, 7, 1–12.
Malchiodi, C. A. (1999). Medical art therapy with adults. Jessica Kingsley Publishers.
McCaffrey, T., & Edwards, J. (2015). Meeting art with art: Arts-based methods enhance researcher reflexivity in research with mental health service users. Journal of Music Therapy, 52(4), 515–532. https://doi.org/10.1093/jmt/thv016
Meadows, D. H., & Wright, D. (2008). Thinking in systems: A primer. Chelsea Green Publishing.
Midgley, G., & Rajagopalan, R. (2020). Critical systems thinking, systemic intervention, and beyond. In G. S. Metcalf, K. Kijima, & H. Deguchi (Eds.), Handbook of systems sciences (pp. 1–51). Springer. https://doi.org/10.1007/978-981-13-0370-8_7-1
Moustakas, C. E. (2015). Heuristic inquiry. In K. J. Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook of humanistic psychology: Theory, research, and practice (pp. 309–322). SAGE.
Nash, G. (2020). Response art in art therapy practice and research with a focus on reflect piece imagery. International Journal of Art Therapy, 25, 1745–4832. https://doi.org/10.1080/17454832.2019.1697307
Park, S., & Song, H. (2020). The art therapy experiences of patients and their family members in hospice palliative care. Korean Journal of Hospice and Palliative Care, 23(4), 183–197. https://doi.org/10.14475/kjhpc.2020.23.4.183
Pask, S., Pinto, C., Bristowe, K., van Vliet, L., Nicholson, C., Evans, C. J., George, R., Bailey, K., Davies, J. M., Guo, P., Daveson, B. A., Higginson, I. J., & Murtagh, F. E. (2018). A framework for complexity in palliative care: A qualitative study with patients, family carers and professionals. Palliative Medicine, 32(6), 1078–1090. https://doi.org/10.1177/0269216318757622
Poon, Y. Y. (2017). The art materials in the therapeutic relationship: An art-based heuristic inquiry. Concordia University (master’s).
Psychology Notes HQ. (2019). What is Bronfenbrenner’s ecological systems theory? Retrieved 26 September 2024 from https://www.psychologynoteshq.com/bronfenbrenner-ecological-theory/
Reiter, M. D. (2018). Introduction to systems thinking. In M. D. Reiter (Ed.), Systems theories for psychotherapists (pp. 1-19). Routledge. https://doi.org/10.4324/9780429444029-1
Robson, I. (2021). Improving sensemaking in social work: A worked example with Deleuze and art. Qualitative Social Work, 20(5), 1204–1222. https://doi.org/10.1177/1473325020968916
Rochford, J. S. (2017). Art therapy at the John and Mable Ringling Museum of Art: A feminist systems thinking approach to art therapy and museum collaboration. Journal of Art for Life, 9 (Systems Thinking Special Issue). Retrieved 23 August 2023 from https://journals.flvc.org/jafl/article/view/90781
Sanhueza, M. I., & Fossa, P. (2023). Affectivity and learning at the end of life: Expressive art therapy in palliative patients. In P. Fossa & C. Cortés-Rivera (Eds.), Affectivity and learning: Bridging the gap between neurosciences, cultural and cognitive psychology (pp. 665–684). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-31709-5_34
Stevenson, S. (2020). Psychodynamic intersectionality and positionality. Group Analysis, 53(4), 498–514. https://doi.org/10.1177/0533316420953660
Sultan, N. (2018). Heuristic inquiry: Researching human experience holistically. Sage. https://doi.org/10.4135/9781071802632
Sultan, N. (2020). Heuristic inquiry: Bridging humanistic research and counseling practice. The Journal of Humanistic Counseling, 59(3), 158–172. https://doi.org/10.1002/johc.12142
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin.
Williams, B., & Hummelbrunner, R. (2010). Systems concepts in action: A practitioner’s toolkit. Stanford University Press. https://doi.org/10.1515/9780804776554
Winnicott, D. W. (1953). Transitional objects and transitional phenomena. International Journal of Psychoanalysis, 34, 89–97.
Winnicott, D. W. (1971). Playing and reality. Tavistock Publications.
Wood, M. J., Jacobson, B., & Cridford, H. (2019). The international handbook of art therapy in palliative and bereavement care. Routledge. https://doi.org/10.4324/9781315110530
World Health Organization. (2023). Palliative care. WHO. https://www.who.int/europe/news-room/fact-sheets/item/palliative-care
Bollas, C. (1979). The transformational object. International Journal of Psychoanalysis, 60(10), 97–107.
Bollas, C. (1987). The shadow of the object: Psychoanalysis of the unthought known. Free Association Books.
Bradt, J., & Goodill, S. (2013). Creative arts therapies defined: Comment on “Effects of creative arts therapies on psychological symptoms and quality of life in patients with cancer”. JAMA Internal Medicine, 173(11), 969. https://doi.org/10.1001/jamainternmed.2013.6145
Braun, V., & Clarke, V. (2022). Thematic analysis: A practical guide. Sage. https://doi.org/10.53841/bpsqmip.2022.1.33.46
Bronfenbrenner, U. (1994). Ecological models of human development. Readings on the Development of Children, 2(1), 37–43. https://doi.org/10.1037/0033-295X.101.4.568
Bronfenbrenner, U., & Ceci, S. J. (1994). Nature-nurture reconceptualized in developmental perspective: A bioecological model. Psychological Review, 101(4), 568–586.
Bronfenbrenner, U., & Morris, P. A. (2006). The bioecological model of human development. In R. M. Lerner & W. Damon (Eds.), Handbook of Child Psychology: Theoretical models of human development (6th ed., pp. 793–828). John Wiley & Sons. https://doi.org/10.1002/9780470147658.chpsy0114
Burnham, J. (2013). Development in social GGRRAAACCEEESSS: Visible-invisible, voiced-unvoiced. In I. B. Krause (Ed.), Cultural reflexivity. (pp. 139-162). Karnac. https://doi.org/10.4324/9780429473463-7
Butler, C. (2017). Intersectionality and systemic therapy. Context, 151, 15–18.
Chilisa, B. (2012). Indigenous research methodologies. Sage.
Collette, N., Güell, E., Fariñas, O., & Pascual, A. (2021). Art therapy in a palliative care unit: Symptom relief and perceived helpfulness in patients and their relatives. Journal of Pain and Symptom Management, 61(1), 103–111. https://doi.org/10.1016/j.jpainsymman.2020.07.027
Davies, R. (2004). New understandings of parental grief: Literature review. Journal of Advanced Nursing, 46(5), 506–513. https://doi.org/10.1111/j.1365-2648.2004.03024.x
Deshmukh, S. R., Holmes, J., & Cardno, A. (2018). Art therapy for people with dementia. Cochrane Database of Systematic Reviews, 2018(9), 1–27. https://doi.org/10.1002/14651858.CD011073.pub2
Douglass, B. G., & Moustakas, C. (1985). Heuristic inquiry: The internal search to know. Journal of Humanistic Psychology, 25(3), 39–55. https://doi.org/10.1177/0022167885253004
Ellis, C., Adams, T. E., & Bochner, A. P. (2011). Autoethnography: An overview. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 12(1), Article 1.
Fish, B. (2012). Response art: The art of the art therapists. Journal of the American Art Therapy Association, 29(3), 138–143. https://doi.org/10.1080/07421656.2012.701594
Glinzak, L., Yazdian, S., Kwok, I., & Youngwerth, J. (2023). Integrating art therapy into palliative care: Man’s identity exploration in tattoo preservation. Journal of Pain and Symptom Management, 65(3), e241–e244. https://doi.org/10.1016/j.jpainsymman.2022.10.005
Harter, S. L. (2007). Visual art making for therapist growth and self-care. Journal of Constructivist Psychology, 20(2), 167–182. https://doi.org/10.1080/10720530601074721
Health Professions Council of South Africa. (2023). Regulations relating to the qualifications for registration of arts therapists and registration of persons qualified outside the republic. HPCSA. Retrieved 23 August 2023 from https://www.hpcsa.co.za/?contentId=0&menuSubId=49 &actionName=Professional%20Boards.
Hendricks, M., Steenveld, C., Thompson, V., Andrade, A., Kahl, G., Farlam, P., Balagadde-Kambugu, J., Hendricks, S., Rackstraw, A., Pedersen, L., Burger, D., Meiring, M., Davidson, A., & van Eyssen, A. (2019). Building a psychosocial and spiritual care service for children with cancer and their families. South African Journal of Oncology, 3, Article 52. https://doi.org/10.4102/sajo.v3i0.52
Hummelbrunner, R. (2011). Systems thinking and evaluation. Evaluation, 17(4), 395–403. https://doi.org/10.1177/1356389011421935
Jansen van Rensburg, M.S. (2025). A heuristic inquiry to explore the location of the art therapist in different tasks of the palliative care system. University of Johannesburg (Unpublished master’s).
Javadi, D., Feldhaus, I., Mancuso, A., & Ghaffar, A. (2017). Applying systems thinking to task shifting for mental health using lay providers: A review of the evidence. Global Mental Health, 4, e14. https://doi.org/10.1017/gmh.2017.15
Koopman, W. J., Watling, C. J., & LaDonna, K. A. (2020). Autoethnography as a strategy for engaging in reflexivity. Global Qualitative Nursing Research, 7, 2333393620970508. https://doi.org/10.1177/2333393620970508
Lister, S., Pushkar, D., & Connolly, K. (2008). Current bereavement theory: Implications for art therapy practice. The Arts in Psychotherapy, 35(4), 245–250. https://doi.org/10.1016/j.aip.2008.06.006
Lo, P. (2011). A heuristic and art-based inquiry: The experience of combining mindfulness practice and art making. Australian and New Zealand Journal of Art Therapy, 6(1), 51–67.
Madeline, C. (2017). Bronfenbrenner’s bioecological model of development. Learning Theories, May 15. Retrieved 26 September 2024 from https://learning-theories.com/bronfenbrenners-bioecological-model-bronfenbrenner.html#google_vignette
Mäkelä, M., Dash, D. P., Nimkulrat, N., & Nsenga, F. (2011). On reflecting and making in artistic research. Journal of Research Practice, 7, 1–12.
Malchiodi, C. A. (1999). Medical art therapy with adults. Jessica Kingsley Publishers.
McCaffrey, T., & Edwards, J. (2015). Meeting art with art: Arts-based methods enhance researcher reflexivity in research with mental health service users. Journal of Music Therapy, 52(4), 515–532. https://doi.org/10.1093/jmt/thv016
Meadows, D. H., & Wright, D. (2008). Thinking in systems: A primer. Chelsea Green Publishing.
Midgley, G., & Rajagopalan, R. (2020). Critical systems thinking, systemic intervention, and beyond. In G. S. Metcalf, K. Kijima, & H. Deguchi (Eds.), Handbook of systems sciences (pp. 1–51). Springer. https://doi.org/10.1007/978-981-13-0370-8_7-1
Moustakas, C. E. (2015). Heuristic inquiry. In K. J. Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook of humanistic psychology: Theory, research, and practice (pp. 309–322). SAGE.
Nash, G. (2020). Response art in art therapy practice and research with a focus on reflect piece imagery. International Journal of Art Therapy, 25, 1745–4832. https://doi.org/10.1080/17454832.2019.1697307
Park, S., & Song, H. (2020). The art therapy experiences of patients and their family members in hospice palliative care. Korean Journal of Hospice and Palliative Care, 23(4), 183–197. https://doi.org/10.14475/kjhpc.2020.23.4.183
Pask, S., Pinto, C., Bristowe, K., van Vliet, L., Nicholson, C., Evans, C. J., George, R., Bailey, K., Davies, J. M., Guo, P., Daveson, B. A., Higginson, I. J., & Murtagh, F. E. (2018). A framework for complexity in palliative care: A qualitative study with patients, family carers and professionals. Palliative Medicine, 32(6), 1078–1090. https://doi.org/10.1177/0269216318757622
Poon, Y. Y. (2017). The art materials in the therapeutic relationship: An art-based heuristic inquiry. Concordia University (master’s).
Psychology Notes HQ. (2019). What is Bronfenbrenner’s ecological systems theory? Retrieved 26 September 2024 from https://www.psychologynoteshq.com/bronfenbrenner-ecological-theory/
Reiter, M. D. (2018). Introduction to systems thinking. In M. D. Reiter (Ed.), Systems theories for psychotherapists (pp. 1-19). Routledge. https://doi.org/10.4324/9780429444029-1
Robson, I. (2021). Improving sensemaking in social work: A worked example with Deleuze and art. Qualitative Social Work, 20(5), 1204–1222. https://doi.org/10.1177/1473325020968916
Rochford, J. S. (2017). Art therapy at the John and Mable Ringling Museum of Art: A feminist systems thinking approach to art therapy and museum collaboration. Journal of Art for Life, 9 (Systems Thinking Special Issue). Retrieved 23 August 2023 from https://journals.flvc.org/jafl/article/view/90781
Sanhueza, M. I., & Fossa, P. (2023). Affectivity and learning at the end of life: Expressive art therapy in palliative patients. In P. Fossa & C. Cortés-Rivera (Eds.), Affectivity and learning: Bridging the gap between neurosciences, cultural and cognitive psychology (pp. 665–684). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-31709-5_34
Stevenson, S. (2020). Psychodynamic intersectionality and positionality. Group Analysis, 53(4), 498–514. https://doi.org/10.1177/0533316420953660
Sultan, N. (2018). Heuristic inquiry: Researching human experience holistically. Sage. https://doi.org/10.4135/9781071802632
Sultan, N. (2020). Heuristic inquiry: Bridging humanistic research and counseling practice. The Journal of Humanistic Counseling, 59(3), 158–172. https://doi.org/10.1002/johc.12142
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin.
Williams, B., & Hummelbrunner, R. (2010). Systems concepts in action: A practitioner’s toolkit. Stanford University Press. https://doi.org/10.1515/9780804776554
Winnicott, D. W. (1953). Transitional objects and transitional phenomena. International Journal of Psychoanalysis, 34, 89–97.
Winnicott, D. W. (1971). Playing and reality. Tavistock Publications.
Wood, M. J., Jacobson, B., & Cridford, H. (2019). The international handbook of art therapy in palliative and bereavement care. Routledge. https://doi.org/10.4324/9781315110530
World Health Organization. (2023). Palliative care. WHO. https://www.who.int/europe/news-room/fact-sheets/item/palliative-care
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Feb 3, 2026
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Where is the art therapist? A systems approach to positioning the art therapist. (2026). South African Journal of Arts Therapies, 3(2), 62-91. https://doi.org/10.36615/me3kdr95
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Author Biography
Madri Jansen van Rensburg, University of Johannesburg
Dr Madri Jansen van Rensburg is a research and consulting psychologist who does research, evaluation, and organisational development work throughout Africa. She integrates health, social and business sciences and is passionate about systems thinking, inclusion, participation, and visual and creative methods. She is an Art Therapist in training associated with the palliative care team at the Rahima Moosa Mother and Child Hospital.
How to Cite
Where is the art therapist? A systems approach to positioning the art therapist. (2026). South African Journal of Arts Therapies, 3(2), 62-91. https://doi.org/10.36615/me3kdr95
