نظارت از راه دور: پژوهش، یافته ها و ملاحظات برای هنر درمانی

Art therapy internships are arguably one of the most important aspects in the training of future professionals in the field. Many counselors and educators have written about the need for greater links between universities and fieldwork placements (Howey, 1996, Imig and Switzer, 1996, Ishler et al., 1996, Khamis, 2000, Perraton, 2000 and Rahman et al., 2006). Most of the current research on providing distance supervision has been written in education and general counseling journals and usually are examining international uses of supervision (Rahman et al., 2006; Roland et al., 2006). In both education and counseling fields, as in art therapy, the use of the Internet to provide supervision has the similar issues of confidentiality of the clients or students, the ability to observe and provide feedback, and the need to see the student or beginning professional conducting sessions, and the sharing of the session/class products for assessment and review (Burrak, 2008 and Simpson, 2006; Szeftel et al., 2008). In the art therapy field, there have been presentations at national conferences on techniques for distance supervision, but there has yet to be a written research study on the topic. Therefore, this paper will investigate what has been researched and written about in the general counseling and education fields in order to provide a framework of understanding to work within.

Upon graduating from an American Art Therapy approved program in 1991, my plan was to return to my home state of South Carolina, start an art therapy in the public schools program, and work on attaining my Art Therapy credentials. However, when I arrived in my home state I ran into a few hurdles. The most critical hurdle was that I was not able to find a registered art therapist within my area. The closest registered art therapist who could provide me with supervision was 3 h away and mostly worked in a medical setting with adults. I found that upon graduation, I did not have easy access to supervision and in particular did not have access to a supervisor who had actually worked with the clientele I was interested, or in the setting in which my population existed. I solved my problem by getting a job as an art therapist in a hospital and putting off my work in the school system for several years. Since the early 1990s when I was starting out, art therapy has grown substantially, making the task of finding a qualified art therapy supervisor a little easier; however, gaining access to appropriate and quality supervision is still an issue in the following cases. First, each year art therapy programs around the United States graduate a number of international students who may wish to return to their home countries upon graduation where art therapists are in short supply. These students may need continued support, supervision, and coaching when returning to their home countries. Second, the increased breadth of the possibilities for art therapy placements, populations, or procedures also has created sub-specialties in art therapy. There are art therapists who are well known for their use of phototherapy, work with veterans, trauma, crisis intervention and many other areas. Access to supervision with a person who has specialized knowledge of a particular population, media or placement may be needed and would provide more appropriate supervision. Third, Feinber (1993, p. 109) made the point that “the quality of clinical supervision varies tremendously in the field of art therapy, yet it is difficult to overstate the importance of good supervision in the development of skilled art therapists.” Good supervision is dependent on the quality of the skills of the supervisor, and should not be dependent upon simple proximity to the supervisee. And finally, as members of a helping profession, it is our obligation to make sure that we provide access to our services, including supervision, in a safe and ethical manner, but also in a manner that includes all persons and reduces unintentional barriers. We need to find solutions to address the barriers to quality supervision that exist today. As a person who specializes in the use of technology in art therapy, it seemed logical to me that current advances in online meeting capabilities would make it possible for art therapy supervision to occur at a distance in a simple, barrier-free way. However, as a person who looks at using technology in a confidential manner in a creative field, I was unsure about how this would work and what issues were involved. As a result, I started to research the literature on what has already been accomplished in art therapy and related fields so that I could develop a protocol of best practices for developing an initial trial distance supervision with some of my art education students, to be followed later by a trial with recently graduated art therapists. This paper will investigate what has been researched and written about in the general counseling and education fields in order to provide a framework for understanding potential distance supervision issues and benefits for the field of art therapy. Technological applications are rapidly evolving as a near-normative vehicle for a variety of medical and psychological interventions. These applications are gaining acceptance through more widespread usage, rules, regulations, and reimbursement mechanisms. We are beginning to acknowledge and incorporate telehealth and distance applications into policy and procedure. As an example, changes in reimbursement codes, e.g., CPT code 0074T, by the American Medical Association (Kraus, Zack, & Stricker, 2004) in the U.S. now allow for billing of certain online consultations. Ethical and professional issues when using the Internet in counseling are addressed by regulatory bodies such NBCC (2009) and ACA (2005) and the ATCB (2009), which shows the viability of distance communications where confidentiality is necessary and people are working across traditional borders. Also the Center for Credentialing and Education, the newest credentialing arm of the NBCC, has established a Distanced Credentialed Counselor certification (CCE, 2009). This credential was developed to ensure standardization of online and distance counseling practices as well as to assure the public that counselors who use distance technologies adhere to a specialized set of ethical and practice codes. As solutions to the issues surrounding the transmission of information via the Internet (whether in counseling or as a part of supervision) is refined, the potential and need for distance supervision of internships and practica will grow in importance. Art therapy internships are arguably one of the most important aspects in the training of future professionals in the field. Many counselors and educators have written about the need for greater links between supervisors and fieldwork placements (Howey, 1996, Imig and Switzer, 1996, Ishler et al., 1996, Khamis, 2000, Perraton, 2000 and Rahman et al., 2006). During art therapy fieldwork, students and new professionals begin to combine the theory and content knowledge that they have learned in their art therapy classes with hands-on practice working with clients. Students need feedback on counseling techniques and interventions, processing of sessions and artwork, and evaluation of assessment techniques and results. Research has shown that supervision has the strongest instructional impact when it occurs early and often during the fieldwork experience (Zahorik, 1988). However, supervisors are often limited in the timing and frequency of in-person supervision because of distance and scheduling issues, which reduces the impact of that supervision (Casey, 1994) as well as the above-mentioned list of potential barriers. Most of the current research on providing distance supervision has been written in education and general counseling journals (Rahim et al., 2006; Roland, Jones, & Birmingham, 2006). In both the education and counseling fields, the use of the Internet to provide supervision imposes similar problems of confidentiality of the clients or students, the ability to observe and provide feedback, the need to see the student or beginning professional conducting sessions, and the sharing of the session/class products for assessment and review (Burrak, 2008, Simpson, 2006 and Szeftel et al., 2008). In the art therapy field, there have been presentations at national conferences on techniques for distance supervision, but there has yet to be a written research study on the topic.

As the above literature review suggests, many unanswered questions regarding distance supervision remain; however, the review does provide supervisors and supervisees with a basis of knowledge. The literature related to process variables in distance supervision is sparse, but the findings of studies evaluating the outcomes of distance supervision have been mostly positive. The literature on distance supervision for art therapy is essentially non-existent at this point and definitely needs to be addressed to keep this field on par with related counseling and education fields. From the literature reviewed a listing of best practices was developed (see Fig. 1). Full-size image (139 K) Fig. 1. Best practices in distance supervision. Figure options The results in the reviewed literature provide preliminary evidence that distance supervision can be an effective form of supervision in counseling and education fields if all the ethical and technical issues are rigorously addressed. Research has also offered preliminary support to the notion that distance supervision may be useful for increasing services to populations that underutilize clinical services, such as disabled or rural individuals. In the literature reviewed, each study indicated that participants thought distance supervision was a needed alternative to traditional supervision. Participants also indicated that they found distance supervision to be helpful and beneficial for the student, the supervisor, and the client. Distance supervision is beneficial where other options are limited, and the drawbacks it faces are currently being addressed through advances in technology and governing policy. Distance supervision is likely to continue to become more prevalent as online education grows and art therapy spreads throughout the world. Research on this practice within the fields of education, art therapy, and other counseling fields is strongly needed to help guide its future ethical and quality development.