Leaving a Bright Spot: Practicing Therapeutic Arts with Underserved International Populations

Interns making art with children in Ghana

Interns lead a painting session in Ghana.

Stemming from her own experiences delivering art therapy workshops around the world, Ikuko Acosta, director of NYU Steinhardt’s Graduate Art Therapy program, and clinical associate professor, wanted to offer her students the invaluable experience of practicing art therapy internationally.

More than a decade ago, Acosta established a global internship program at Steinhardt to provide “the opportunity for students to develop racial and cultural self-awareness, work with diverse communities, hone critical thinking skills, and explore the role of art therapy in another culture.” Says alumna Krystal Atwood of her decision to enroll in the internship in Buenos Aires, “I wanted to learn everything I could to provide the most nuanced and culturally fluent art therapy services possible to a range of client populations.”

Coordinated in collaboration with several of NYU’s global sites, Acosta’s interns have practiced therapeutic arts in a wide array of foreign settings, including Florence, which welcomes its third cohort in July 2019. Some of this year’s group will serve a geriatric population that has worked with two different intern cohorts. Acosta recalled that this population was especially receptive to engagement in creative activities, noting “their facial expressions became cheerful, moods were boosted, and their social interactions improved.” In Accra, Ghana, students have worked at a rehabilitation center for young men with mental, cognitive and physical disabilities. A grouping, Acosta said, that contrasts with “facilities in the US where patients are usually separated based on the nature of their disabilities.” The men are also provided with “job training and various types of skills to survive in society” explained Acosta. During the three weeks that the men worked with interns, she emphasized that “they are not treated in a clinical sense, yet a very positive change can be seen in their self-esteem due to their increased ability to express themselves freely without being judged. Their general attitudes became more positive.”

Returning to NYU’s global sites offers faculty the opportunity to observe the long-term impacts of programs. In Ghana, when the van entered the driveway to the rehabilitation center one year later, Acosta and her students were greeted by shouts of “art therapy!” “And,” she added, “the young men went right back into making art as if they had done so yesterday.” When returning to the geriatric facility in Florence two years later, the demeanor of the residents immediately became “uplifted,” and they “even remembered the names of some interns from prior years,” providing “evidence,” that the “experiences were etched in their memories.” Acosta says that “while what we do may be little, at a basic human level, the experience leaves a bright and memorable spot in their minds.”

“There is an amazing resilience that each location reveals. The internship leads to a questioning of one’s values in a way that can’t be gained inside a classroom.”

Professor Ikuko Acosta

Indeed, Acosta notes that “the program is not geared toward addressing mental illness directly” and that “it would be unrealistic to treat a patient in three weeks.” Furthermore, she explained that “applying a western concept of art therapy to non-western societies can create tension with local attitudes around mental illness. And therapeutic techniques that are not adapted to the culture situate the therapist as a colonialist.” But while mental illness is viewed in various ways around the world, she emphasized that “the symptoms and behavioral manifestations of mental and psychological disturbances are very similar.  What differs are cultural attitudes and treatment.” Yet she has observed that art therapy brings together commonalities in international settings. “Art is universal and so too is human suffering.”

Regardless of location, Acosta says, art therapy students work to build a “human connection.” In every country in which the course has been held, Acosta has seen “students establish relationships despite not speaking the local language. They learn to become highly receptive and attuned to the subtleties of body language and other non-verbal cues.” She added that her students “thoroughly enjoy getting to know each client’s personality beyond his/her disability through creative communication.” Inevitably, explained Acosta, “basic human bonds are formed during experiences that are not bound by a singular form of expression. Connecting in this way is a universal phenomenon.”

Other skills that students quickly acquire, said Acosta, are “flexibility and adaptability, because their clinical training does not translate directly in foreign locations.” She went on to say that “outside of the US, concepts of boundaries between patient and client are much different, particularly those that are physical – it is common and natural for patients to openly and physically express affection to their therapists in many cultural contexts. Another example is corporal punishment, which seems to be an acceptable form of discipline in some countries.” Therapists in the US, Acosta explained, are trained to report signs of “abuse,” so it can be “difficult to set aside feelings of confusion about roles and responsibilities during the internship.”

Reflecting on her experiences in Buenos Aires, Atwood explained that she “felt humbled by the grace and dignity with which Dr. Acosta acknowledged our interpersonal struggles while maintaining hope for all of the involved parties and, ultimately, guiding the student interns toward providing life-changing art therapy services to the clients.” The level of care delivered by the interns is possible, says Acosta, because they “very quickly, learn to take a humanistic perspective and adapt to local mores.” “Interns observe, learn, and respect the host country and are not there to negate or impose their cultural norms,” she explained, and added that “after we leave, they resume their own lives, yet are instilled with memories of the brief but undeniable human connections that we all shared.”

A boy paints a cardboard puppet in Florence.

Creating stick puppets in Florence.

“Students also learn to adapt their planning process for clinical sessions,” said Acosta, as “they develop activities appropriate to the population […] and seek out locally available art materials.” During an early iteration of the program in India, coordinated by Cross-Cultural Solutions, a New York-based non-profit that provides volunteer service to communities around the world, Acosta said her students “found beautiful textiles with which they made dolls with women at a shelter for victims of domestic violence. They also collected many found objects from the streets, which they incorporated into a piece of artwork.” In Florence, a capital of the art world, “students find low cost materials at art stores and unusual items from junk shops.” Acosta elaborated that “these experiences too contribute to students’ creative growth and help them to become more flexible and less confined in their practice of art therapy.”

“Through exposure to how others survive amidst adversity,” Acosta noted, “with very limited resources and significant hardship, students gain a sense of humbleness.” For Atwood, her work with refugees and asylum seekers in Buenos Aires provided a glimpse into individuals’ experiences – many had fled war and violence, and struggled to live with uncertainty in the confines of refugee centers. During the internship, explained Krystal, she saw increases in “self-efficacy and a reduction of isolation as they connected with other refugees and asylum seekers in art therapy groups.”

“There is an amazing resilience that each location reveals,” said Acosta. “The internship leads to a questioning of one’s values in a way that can’t be gained inside a classroom. And that is essential as a therapist because personal value systems can’t be brought into clinical sessions.”