Introduction

The students, because of the kinds of mystifications, the kind of colonial education based on hidden information, the kind of epistemological experience one gets as a colonialized person, do not always see how what they are studying relates to their lives. (Ogundipe-Leslie, 1994, p.231)

Throughout the 21st century, as art therapy has developed and evolved, increased calls for intersectionality and cultural humility have echoed throughout pedagogical discourse as more thorough and encompassing frameworks than the currently predominant model of cultural competency. Ethnocentric monoculturalism and White centrality impose inherent bias amongst practitioners, emphasising the urgency of implementing a transformative paradigm of critical ongoing self-reflection to counter the individualist, universal founding principles of art therapy. Intersectional cultural humility (ICH) (Buchanan et al., 2020) offers practitioners a process-oriented approach that counters the inherent challenges within competency models, which imply mastery and bypass individual and institutional accountability (Fisher-Borne et al., 2014; Herring et al., 2013). Despite increased demands, research surrounding ICH and art therapy is considerably lacking. Furthermore, these identified gaps are particularly visible in Australian art therapy literature and research (Kapitan, 2019; Mupotsa-Russell, 2022). The aim of this review is to present literature and evidence supporting ICH in art therapy in a bid to open the door to further research and implementation.

This study evolved from collaboration between the authors during master’s-level dissertation research. While initially the first and lead author was a student, and the second author a practising art therapist, academic and supervisor, these roles have evolved into a professional relationship. The first author identifies as a White, able-bodied, neurodivergent, middle-class, young cis woman of Irish and settler heritage. Although their personal experience of gender identity and sexual orientation is more fluid, their salient presentation engenders the associated privileges of cis-heterosexual norms. The second author is a middle-aged, able-bodied, cis-heterosexual, Indian Muslim woman of colour. These identities were brought forth by the second author introducing a singular workshop on culture, diversity and identity in the second and final year of art therapy training, which the first author observed as the only substantial example of intersectionality within the program delivered thus far. This absence of critical engagement with intersectional praxis and principles ignited a conversation between the authors that has developed into a continued collaborative exploration into the current topic.

To situate the present inquiry, an overview of art therapy and ethical practice, and of cultural competency critiques will be provided. Frameworks of intersectionality, cultural humility and the combined approach of ICH are then reviewed, followed by a review of ICH in an Australian context. Finally, implications for future research and practice are discussed with the goal of furthering ICH within Australian art therapy.

Methodology

The following databases were manually searched for papers containing the terms ‘intersectionality’ and/or ‘cultural humility’ and/or ‘art therapy’ and/or ‘Australia’: BSCO; EBSCOhost electronic journals; Gale, JSTOR, ProQuest Central, PsychoINFO, PubMed Central, Sage Online, and Wiley Online Library. The absence of literature and research on ICH in Australian art therapy warranted widening the material reviewed to include an international art therapy context and wider health and social disciplines. Even this presented a considerable dearth of comprehensive investigation into ICH. To address these gaps, secondary literature, including perspectives, opinions and viewpoints, was included to support a thorough enquiry. To centre the ethical impetus for this inquiry and to deepen the context of ICH frameworks it was necessary to include original source material. As such, and to attain a broad map of core issues relevant to the topic (such as identity, culture and power), no date restriction was employed. This additional source material was obtained by extensively searching the references provided by authors herein. Exclusion criteria were automatically applied to articles focused on art therapy and the chosen topic if the paper exclusively utilised another form of creative art therapy (dance, drama, music).

Literature review

Art therapy and ethical practice

Art therapy is an interdisciplinary field integrating visual arts and psychology, which utilises art-making to explore, contain and express clinical experiences (Fish, 2019; Junge, 2016). Core values of professional art therapists include a commitment to self-examination, self-reflection and ongoing self-questioning and engaging in personal art-making as a tool for enhancing critical reflexivity (Phillips, 2016; Van Lith & Voronin, 2016). As art therapy has evolved into a global profession, training and practice standards have become more standardised to create continuity in foundational ethical expectations. In Western countries, including Australia, professional art therapists are trained, guided and governed by educational and ethical practice standards set by respective national professional associations (Potash et al., 2012). In 2012 Potash et al. conducted a synthesised review of international art therapy training curriculum requirements, highlighting multiculturalism as a critical area of educational foci that necessitates practitioners’ awareness of their own biases and worldviews; learning skills to work with diverse social and cultural backgrounds; and proficiency in assessment, including culturally competent client appraisals and ethical decision-making. Despite broad consensus on multicultural education standards, findings revealed educators maintain authority over the depth of training and hours devoted to this area (Potash et al., 2012). The art therapy curriculum has been critiqued for upholding individualist, pluralistic and universally applicable theories derived from White, Eurocentric norms (Doby-Copeland, 2006); failing to include issues of diversity in training and theory (Awais & Yali, 2013; Talwar et al., 2004); and succinctly, not being enough (Gipson, 2015; Herring et al., 2013; Kaiser, 2017). Numerous art therapy scholars have reflected on the typical delivery of multicultural content in a single class or course as inadequate, calling for issues of culture and identity to be integrated throughout the entire course curriculum and design (Johnson et al., 2021; Selvaraj, 2021; Sochanik, 2023; Talwar, 2019). Multicultural proficiency is an expected outcome of art therapy training (Gipson, 2015; Potash et al., 2015; Ter Maat, 2011).

Talwar et al. (2004) emphasise the challenges inherent in providing multicultural education in art therapy through drawing upon Sue and Sue’s (1999) seminal unpacking of ethnocentric monoculturalism and Whiteness as two powerful and entrenched determinants of worldview that mask art therapists’ collective biases, beliefs and values. Ethnocentric monoculturalism operates outside of conscious awareness and can be seen as an invisible veil impacting the worldview of all individuals via cultural conditioning and which is imposed on all culturally diverse groups in a dominant society (Sue, 2004; Talwar et al., 2004). Art therapy has been observed to uphold an ethnocentric monocultural perspective, by failing to include issues of “culture, race, ethnicity, gender, religion, historical experiences within the dominant culture, sexual orientation, disability” (Talwar et al., 2004, p.44) as well as class, education and politics in theoretical discourse and research. Art therapy scholars have identified the dominance of hegemonic Whiteness in theoretical literature and illustrated the myriad negative impacts of unchecked White supremacy in praxis (Gipson, 2015; Hamrick & Byma, 2017; Stepney, 2019; Talwar, 2010, 2015). Critically, art therapy is a predominately White profession (Eastwood, 2021; Kaiser, 2017; Talwar et al., 2004). Moon and Faulkner (2024) draw attention to the power held by professional art therapy organisations in shaping education and ethical practice. Highlighting intentional and unconscious institutional barriers impeding social justice, they propose intersectional care ethics as frameworks for addressing and transforming the existing paradigm within the Western art therapy field. Altogether, the responsibility for art therapy as a collective field to address overt and covert oppression and discrimination inherent in professional foundations has never been more acute (Eastwood, 2021; Kaiser, 2017; Sochanik, 2023; Talwar, 2017).

Cultural competency critiques

Cultural competency is widely recognised as the dominant model in counselling, therapy and helping professions (Buchanan et al., 2020; Fisher-Borne et al., 2014; Lekas et al., 2020), and endorsed as the cornerstone of effective and ethical art therapy practice (Doby-Copeland, 2006; Potash et al., 2015; Robb, 2014; Talwar et al., 2004; Ter Maat, 2011). This approach comprises the assumption that practitioners engage in ongoing exploration of personal awareness, acquisition of cultural knowledge and appropriate clinical skills relevant to effective practice with culturally diverse clients (Bramesfeld et al., 2019). Despite its fundamental ubiquity, a review of related literature reveals the contentious history of cultural competency within pedagogical discourse. The focus on content-oriented delivery typified in cultural competency trainings fails to address the complexities of identity and culture as dynamic and interwoven (Lekas et al., 2020). Lekas et al. (2020) assert that the risks and limitations of this approach are now well supported within literature reviewing the effectiveness of cultural competency trainings on both practitioner identity, skills and service provision.

Numerous conceptualisations of how to apply, acquire, and address cultural competency are evidenced throughout the scope of art therapy research available (George et al., 2005; Robb, 2014; Talwar et al., 2004; Ter Maat, 2011). While rigorous and generous in furthering conversations around quality care, scholars have exposed the slippery challenges of defining and measuring cultural competence (Doby-Copeland, 2006; Hewins, 2023; Kaiser, 2017; Robb, 2014). A 2014 survey of US art therapy graduates illuminated inherent challenges within the landscape of perceived cultural competence, and “the need to address unequal distribution of power” (Robb, 2014, p.26). Indeed, the past 20 years have seen a significant increase in literature across art therapy and helping disciplines that evidences the implicit challenges and explicit limitations of the assumptions held within competency frameworks that imply proficiency can be gained through self-appraisals of awareness, skills and knowledge (Awais & Yali, 2015; Fisher-Borne et al., 2014; Gipson, 2015; Talwar, 2015). This approach has been critiqued for “failure to account for the structural forces that shape individuals’ experiences and opportunities” (Fisher-Borne et al., 2014, p.165). Additionally, in its use of culture as a proxy for racial and ethnic minorities, and by ‘addressing’ identity as a singular dimension, cultural competence has been nullified for effective and ethical practice, not just with minorities, but with all individuals, given that both culture and identity are dynamic forces that intersect and change in relation to power differences (Buchanan et al., 2020; Fisher-Borne et al., 2014).

Art therapists have long been calling for this myopia within the field to be addressed. Amongst cultural competency critiques are urgent calls to increase diversity in scholarship (Awais & Yali, 2013, 2015; Moss et al., 2023; Valldejuli & Elliott, 2023), advance pedagogy and curriculum to address social justice discrepancies (Gipson, 2015; Stepney, 2019; Wood & McKoy-Lewens, 2023) and examine Whiteness and White privilege in art therapy (Doby-Copeland, 2006; Sochanik, 2023; Talwar et al., 2004). Increasingly, art therapy literature evidences the detrimental and pervasive consequences of unexamined White privilege and White fragility (DiAngelo, 2011, 2018) within the profession (Collier & Eastwood, 2022; Eastwood, 2021; Hamrick & Byma, 2017; Johnson et al., 2021; Sochanik, 2023). Menakem (2017) describes White fragility as “a way for the white body to avoid experiencing the pain and discomfort” (p.102) of inherited racialised trauma. Furthermore, as understanding of trauma increases to encompass intergenerational, historical and systemic traumas (Herring et al., 2013; Karcher, 2017; Tujague & Ryan, 2023), art therapy has been called to reckon with its undeniably historical legacy of pathologising individuals who exist outside the operative norm (Mupotsa-Russell, 2022; Zappa, 2017). Though a summary of cultural competency critiques is beyond the scope of the current inquiry, what is clear is that ideals of mastery and acquisition effectively render such models void for ethical practice (Gipson, 2015; Owen, 2013).

Intersectionality

Intersectionality asserts that within the socio-cultural-political and structural fabric of society people hold multiple positions (identities) that intersect with power and oppression at differing degrees dependent on context (Ortega & Faller, 2011). The term was first articulated by Crenshaw (1989) to challenge the limitations and consequences of single-axis frameworks that “treat race and gender as mutually exclusive categories of experience and analysis” (p.1) within anti-discrimination law and as reflected within feminist theory and anti-racist politics. Crenshaw’s formative scholarship (see also Crenshaw, 1991), centres the multidimensionality of Black women to illustrate how normative views of discrimination informed by the dominant group manifest in doctrinal structures that relegate Black women’s experiences to the margins, erase their identification and obstructs remediation. An orientation in intersectional frameworks requires an understanding of their provenance in examining the convergence of race, gender and class and as centring the lived experiences of Black women (Collins et al., 2021; Lewis, 2013). Though coined by Crenshaw as an analogy to challenge hierarchical conceptions of discrimination, intersectionality arose from the voices of women of colour whose works counter the abasement of imposed binary systems by revealing the intrinsically woven nature of identity as multifaceted, holistic and intersectional (See Collins, 1986; 1990; Ogundipe-Leslie, 1994). As both conceptual theory and analytical tool, intersectionality emerged from the body of scholarship borne of the river-meeting of critical race theory, Black feminist theory, and the lived experiences of women of colour, queer and disability scholars (Collins et al., 2021; Crenshaw, 1991; Ogundipe-Lesie, 1994; Talwar & Sajnani, 2022). Intersectionality has been widely endorsed in art therapy as an essential framework that can enhance critical consciousness through acknowledging the dynamics of power differentials and social identities (Mupotsa-Russell, 2022; Talwar, 2010, 2017; Wood & McKoy-Lewens, 2023). As art therapists, engaging intersectional analysis calls for recognition of the framework’s origins and evolution as a “contestatory prism that reveals the complex, cumulative way in which multiple forms of discrimination… combine, overlap, or intersect, especially in the experiences of marginalized groups” (Crenshaw, 2022, p.1706).

Woven throughout the rise and fall of cultural competence are compelling arguments for introducing intersectionality into “research, scholarship, organisational policy making, and theorising that shapes art therapy practice” (Talwar, 2010, p.11). In a critical examination of the limitations of competency models, Gipson (2015) asserts intersectionality as an essential framework for raising the critical consciousness required to resist systemic oppression and transcend the existing paradigm of multiculturalism which regards dimensions of identity as isolated. Numerous authors have since expanded this vision of intersectionality in art therapy training (Hartman et al., 2023; Wood & McKoy-Lewens, 2023), theory (Gilroy et al., 2019; Wood & McKoy-Lewens, 2023) and praxis (Karcher, 2017; Kuri, 2017; Mupotsa-Russell, 2022; Talwar & Sajnani, 2022; Valldejuli & Elliott, 2023). Kuri (2017) argues that an ethical application of intersectionality in art therapy requires an ongoing practice of self-reflexivity, acknowledging social location and developing consciousness toward personal assumptions and biases that emerge from one’s location in relation to “macro social systems that create inequality” (p.120). Indeed, intersectionality demands self-reflexivity (Talwar, 2010). As a more critical form of self-awareness, intersectional reflexivity involves a deliberate exploration of multi-dimensional aspects of identity relating to systemic privilege and oppression (Karcher, 2017).

Intersectionality makes central “the naming of an un-named problem” by contextualising inquiry within a social and political framework that examines identity markers in relation to practice, training and research (Collier & Eastwood, 2022, p.24). Adopting intersectional frameworks involves continual acknowledgement of multiple social identities in relationship to power differences, as well as systemic inequalities and structural oppression (Karcher, 2017). In practice, this requires ongoing critical examination of the impacts of art therapists’ identities and social positioning, as well as the current sociopolitical state of identity politics, on therapeutic practice with clients (Karcher, 2017). Karcher (2017) urges art therapists to acknowledge and confront their own collusion with systems of oppression, warning that by failing “to recognise the -isms (sexism, racism, ableism, heterosexism, cissexism, xenophobia, sizeism, etc.)” (p.126) art therapists also risk perpetuating micro-aggressions and failing to recognise the implicit strengths and resiliency clients have cultivated to survive. This aligns with Holman and Walker’s (2020) appeal for intersectionality discourse to include ageing within pedagogical agenda. They encourage practitioners to avoid deterministic assumptions (that is, grouping individuals of similar social identities) and, instead, recognise the multiple intersections that individuals embody.

This approach necessitates art therapists’ active engagement with the social, political and material context of life (Collier & Eastwood, 2022). Despite consistent encouragement for intersectionality throughout art therapy discourse, Eastwood et al. (2023) caution that substantial work is required to embed “its key principles into mainstream art therapy discourse, literature and education” (p.3). There is a lack of comprehensive, formal research on art therapy and intersectionality. Van Den Berg (2024) employs intersectionality and minority stress theory as frameworks to challenge the pervasive impact of cis-heterosexism with LGBTQIA+ clients in art therapy. Van Den Berg (2024) demonstrates subjective and objective interventions art therapists can undertake across multiple levels of engagement (intra- and inter-personal, community, organisational, political) and asserts intersectional approaches as imperative for countering cis-heteronormative structures existent within therapeutic practice. Nevers-Ashton (2023) illustrates the transparency, willingness and humility inherent to intersectionality in a case study that implemented a relational intersectional approach employing art-making alongside an autistic Black-British adolescent client, asserting this approach as pivotal in engaging the client in art therapy. Another case analysis examines how community art therapy might support intersectional belonging amongst diverse identities within a unified Singapore (Lin & Ng, 2024). Situating their reflection within contextual questions surrounding ethno-nationalism and related doctrinal frameworks of racial hierarchy, they examine a participatory art-making process that opened a space for the community to converge, share and engage in intercultural contact. Wood and McKoy-Lewens (2023) provide an encouraging example of how an art therapy curriculum can improve practitioner understanding of intersecting identities and health inequities. They suggest intersectional approaches in art therapy are necessary “as adaptive responses to the contextual politics of our time” (p.32) yet conclude that future research is needed to address the intersectional imbalances within the profession (White, middle-class, female).

Cultural humility

Cultural humility is a process of ongoing, critical self-inquiry in relation to intersectional dynamics, power and adopting an ‘other-oriented’ approach, with particular attention to knowledge gaps and cultural differences (Buchanan et al., 2020). Tervalon and Murray-García (1998) introduced cultural humility as a clinical alternative to cultural competence, requiring practitioners’ continual engagement in “self-reflection and self-critique as lifelong learners and reflective practitioners” (p.118). While competence holds an implicit assumption of ongoing learning and reflecting, the lifelong constitute of cultural humility distinguishes this approach as a way of being, as opposed to mastery or acquisition of skills (Foronda et al., 2016; Tervalon & Murray-García, 1998). Cultural humility has no endpoint; it recognises culture as dynamic and therefore acknowledges each individual’s multiple intersecting social positions in an ever-changing convergence of identity formation (Bramesfeld et al., 2019; Tervalon & Murray-García, 1998). In a 2020 review of cultural competence trainings for providers, Lekas et al. determined that increased recognition of implicit bias and appreciation of intersectionality “signals the need to abolish the notion of cultural competence and prioritize the development of humility to begin dismantling racism to address health disparities” (p.3).

Theoretically posited within a multicultural orientation (Owen et al., 2011) alongside cultural comfort (expanding practitioner capacity to experience discomfort) and cultural opportunities (including missed opportunities), cultural humility represents the intra- and interpersonal spirit of this approach maintained through practitioners’ respect, lack of superiority and attunement (Hook et al., 2013; Owen, 2013). Throughout the past decade cultural humility has asserted its place within psychotherapy literature, infiltrating practical and theoretical recommendations (Jackson, 2023; Moss et al., 2023; Tujague & Ryan, 2023) and evidencing promising empirical support toward integrating this approach across therapeutic, social and health-related fields (Fisher-Borne et al., 2014; Hook et al., 2013; Hook & Davis, 2019; Owen, 2013; Owen et al., 2016;). Foronda et al. (2016) identified five attributes of cultural humility as self-awareness, openness, lack of ego, supportive interactions and self-reflection and critique. Practitioners’ adoption of this approach requires personal accountability in addressing the individual and institutional barriers impacting clients and marginalised communities (Bramesfeld et al., 2019; Fisher-Borne et al., 2014).

Calls for adopting cultural humility have begun to infiltrate art therapy literature (Jackson, 2016, 2020; Kapitan, 2023), alongside practical case examples (Chen & Gussak, 2022; Hetherington & Luna, 2023). However, to the knowledge of these authors, only some studies have so far examined this approach. Har-Gil (2010) conducted a heuristic arts-based inquiry into the development of cultural humility as a student art therapist, propounding that art-making allowed insights to emerge that reinforced the impracticalities of cultural competence and allowed tacit and intuitive ways of knowing to emerge. Jackson (2016) followed this process with a qualitative heuristic inquiry facilitated through an Afrocentric perspective with 26 Black art therapists and similar related professionals using collective visual journalling to investigate self-worthy, identity and cultural humility. Both Har-Gil (2010) and Jackson (2016) assert that art-making as a tool of inquiry enhances the congenial dynamic between cultural humility and creative processes, encouraging the emergence of tacit ways of knowing previously inaccessible through verbal means. Jackson (2016) suggests that privileging a non-Western lens when exploring cultural humility can enhance collective and self-reflection and foster an alternate ideology within art therapy that recognises power differentials and elicits new ways of knowing and interrelated understanding. Jackson continues to expand the practical and conceptual ways cultural humility can be integrated into art therapy (Bodlovic & Jackson, 2018; Jackson, 2020, 2023). These seminal works outline considerable practical examples that can be implemented across pedagogy and practice (Bodlovic & Jackson, 2018) and employed by art therapists engaging in ongoing learning (Jackson, 2020). Additionally, both Barton and Van Den Berg (2023) and Stepney (2023) offer art directives that foster cultural humility for art therapy practitioners. A novel qualitative study (Keselman & Awais, 2018) of medical art therapists used descriptive semi-structured interviews with a visual elicitation to explore cultural humility. Of the six participants, only half referred to systemic barriers impacting patients and only two discussed responsibilities outside of therapy to address these social inequalities, concluding the need for intersectional frameworks alongside cultural humility (Keselman & Awais, 2018). Kapitan (2023) posits art therapy as an intercultural contact zone in which tensions stemming from power differentials can be examined and resolved through cultural humility, stating, “When the client… is the central force of change, cultural humility invites me to reorient and change as well” (p.64).

A similar viewpoint on cultural humility co-authored by an art therapist and client (Hetherington & Luna, 2023) encourages cultivation of a power-from-within stance for addressing micro-aggressions experienced by marginalised communities, suggesting cultural humility in practice is an embodied process that contributes to an anti-oppressive therapeutic alliance. Moon and Sandage (2019) present a relevant critique of cultural humility highlighting the pressures on practitioners of colour to assimilate to White ways of practising psychotherapy. Implicit in the nuances articulated within is that cultural humility “requires highly differentiated and diversity-sensitive communal and organisational contexts to support” practitioners adopting this approach (Moon & Sandage, 2019, p.82). Despite these critical considerations, cultural humility represents a promising approach that, if integrated appropriately, has the power inherent to confront these issues alongside the wider critical obstacles implicit in the privilege of practising art therapy (Moss et al., 2023; Mupotsa-Russell, 2022).

Intersectional cultural humility

ICH draws together the aforementioned concepts into an approach grounded in a commitment to a lifelong learning process encompassing openness, self-awareness, self-reflection and self-inquiry that acknowledges and persistently critiques the dynamic interactions of identity, power and culture (on shaping subjective experiences) (Buchanan et al., 2020). Ortega and Faller (2011) first advocated this integrated approach to improve practice in child welfare work stating that together these concepts bring diversity to the forefront of formulation and practice while drawing attention to power differentials, past and present experiences including micro-aggressions, and potential resources or gaps. Buchanan et al. (2020) posit ICH as fundamental to intersectional critical inquiry and praxis in psychology. Comparing the assumptions of this integrated approach to cultural competency models they demonstrate the distinctive strengths of ICH over a number of comparison domains, including attention to power, practitioner privilege and conceptualising culture (see Buchanan et al., 2020). Aside from these two papers, a gap in the research surrounding ICH is very visible. However, much of the aforementioned literature synthesising intersectionality and cultural humility above draws together considerable recommendations for integrating these approaches.

A review of the literature reflects that numerous authors have called for cultural humility within an intersectional framework (Grzanka, 2020; Hartman et al., 2023; Overstreet et al., 2020), and for intersectionality as a theoretical and practical constitute of cultural humility (Bramesfeld et al., 2019; Fisher-Borne et al., 2014; Foronda et al., 2016; Hook et al., 2017; Owen et al., 2016). Within art therapy, the convergence of these two approaches has been explored in supervision (Chen & Gussak, 2022), promoted as a pedagogical approach (Hartman et al., 2023) and in individual (Stepney, 2023) and group reflective art-making (Chen et al., 2022). Recently, the Canadian Journal of Art Therapy , the Journal of the American Art Therapy Association and the International Journal of Art Therapy collaborated in the publication of three special issues highlighting, respectively, anti-colonialism and re-indigenisation, cultural humility; and intersectionality (Eastwood et al., 2023). This collaborative effort to instigate a transformative paradigm of relevant, responsive and anti-oppressive practices in art therapy emphasises the critical impetus of this current moment in time (Eastwood, 2023; Jackson, 2023; Moss et al., 2023). Therefore, the combined approach of intersectional cultural humility presents a natural integration of these approaches which serves to mitigate the theoretical or practical barriers involved in either approach alone (Buchanan et al., 2020).

Australian art therapy and intersectional cultural humility

There is a particularly significant gap in the literature relating to intersectional cultural humility within Australian art therapy. However, it is clear both intersectionality and cultural approaches are beginning to infiltrate the Australian landscape (Bogle et al., 2021; Gilroy et al., 2019; Jewell & Camden-Pratt, 2023; Mupotsa-Russell, 2022; Tujague & Ryan, 2023). Intersectionality is promoted by Gilroy et al. (2019) introducing a recent Australian art therapy publication that ends with an epilogue from Kapitan (2019) calling for decolonising practice, and posing directly to Australian art therapists the question: “What myriad ways are you taking action on the knowledge that all oppression is interconnected?” (p.424).

Bogle et al. (2021) explored cultural humility with nine therapists in a study that employed narrative inquiry with a visual art elicitation representing their personal journeys towards decolonised practice. This process revealed five major approaches contributing to the development of cultural humility, emphasising the need for practitioners to engage in (deeply challenging) personal critical reflection that acknowledges social identities and addresses the impacts of privilege (Bogle et al., 2021). Similarly, cultural humility is considerably advocated by Tujague and Ryan (2023) as a framework for culturally safe, trauma-informed practice. Another study, by Jewell and Camden-Pratt (2023), exemplifies cultural humility and provides a relevant example of how creating art alongside peer art therapists can dismantle power locations inherent to traditional art therapy spaces and promote co-learning in a safe space.

Three critical contributions stand out amongst recent literature as rich, illustrative examples of the role and value of intersectionality in Australian art therapy (Mupotsa- Russell, 2022; Parthasarathy, 2024; Selvaraj, 2021). Parthasarathy (2024) narrates their personal intersectionality as experienced and employed within community art therapy and cultural art practices designed to tackle mental health stigma in a South Asian demographic. In a skilful use of metaphorical weaving, Parthasarathy offers a series of warps and wefts to convey the complex and multidimensional relationship between their intersecting voices and experiences as art therapist, woman of colour and grieving daughter, for example. Self-reflexivity is woven throughout her reflection, spanning emergent practitioner to community arts entrepreneur, providing a deeply creative example of the interconnection between intersectional identities in practice (Parthasarathy, 2024). Mupotsa-Russell (2022) presents a vivid and compelling example of intersectionality in art therapy practice grounded in a decolonial, anti-racist, feminist and explicitly anti-oppressive framework. Drawing upon her own positionalities as an African therapist, Mupotsa-Russell (2022) unequivocally unmasks an Australian landscape where Whiteness operates as the dominant norm and exemplifies the responsibilities of art therapists to name and challenge systemic definitions of individuals as ‘complex’ and ‘diverse’.

This same conclusion is echoed in Selvaraj’s (2021) autoethnographic enquiry into pedagogical institutions and spaces in art therapy centred in queer, decolonial critique examining their lived experiences of exclusion as a queer South Asian therapist. In this radical offering, Selvaraj utilises arts-based methodology to reflect on institutional training that highlights the “overtly violent nature of racism” and fails to interrogate the embedded and “covert nature of White supremacy” (p.72). Selvaraj highlights the glaring incongruence between advocated theories that disrupt the operant White cis-heteropatriarchy, and the bodies of power and privilege that disseminate and appropriate knowledge through White positionality. Each of these contributions elucidate the weighted burden imposed upon students, educators and practitioners whose positionalities are effectively othered amongst pedagogical art therapy discourse and practice (Mupotsa-Russell, 2022; Parthasarathy, 2024; Selvaraj, 2021).

Ethical practice in Australia requires the implicit acknowledgement of the ongoing impacts of colonisation, racism and trauma within Australia (Herring et al., 2013; Moss et al., 2023; Tujague & Ryan, 2023). An ICH approach can support art therapists working in First Nations contexts to develop treatment in collaboration with Indigenous individuals that is conceptualised within an Indigenous worldview. The value of fostering Indigenous knowledge equality throughout pedagogy, research and practice can be seen in recent work synergising Indigenous models of health with Western interventions. Moss et al. (2023) offer a decolonised model of creative arts therapy in pedagogy and practice that emphasises the non-linear approach with focus areas such as deconstruction/reconstruction, community and land, story sharing, and the nonverbal. The importance of incorporating Indigenous concepts of holistic healing and spirit into mainstream models and service delivery is essential within the Aboriginal context (Moss & Lea, 2019).

A relevant example of incorporating such concepts into art therapy is provided by Vlasić Manaia (2017) in a case study utilising kaupapa Māori arts therapy in conjunction with Western art therapy methods. Despite profoundly different historical and cultural contexts, Australia and Aotearoa New Zealand are tied by a shared story of colonisation by the British Empire resulting in ongoing detrimental outcomes for both Māori and Aboriginal and Torres Strait Islander peoples (Durie, 2012). Vlasi Manaia (2017) explicates that practical adaptations to therapeutic approaches and art-making must be founded upon the spiritual, familial, cultural and historical experiences of Māori individuals. It has been suggested that incorporating a bicultural approach and integrating art therapy alongside Indigenous values, tools and protocols may be applicable to other Indigenous groups (Durie, 2012; Sones et al., 2010; Vlasić Manaia, 2017). Art therapy is well positioned to support the adoption of bicultural therapeutic approaches combining Indigenous worldviews, protocols and tools with Western therapy. Moss and Lea (2019) emphasise the existing synergies between art therapy and Aboriginal culture, including “relationship, connection, silences” and even “creativity itself” (p.57).

Furthermore, the ethical standards of practice and professional responsibilities of Australian and Aotearoa art therapists outline several pertinent considerations that bear relevance to the current inquiry. Namely, practitioners’ commitment to ongoing individual education on aspects of diversity and intersectionality; awareness of own prejudices and biases; and maintenance of personal creative and reflective practices (ANZACATA – Ethics and Standards, 2024). Considered alongside the substantial gaps in the literature surrounding ICH and art therapy in Australia, further research is required to gain a foundational understanding of how practitioners can begin to engage in this process and journey (Kapitan, 2019).

Discussion

Reviewing the literature corroborates that ICH offers a valuable critical alternative to competence frameworks in art therapy practice and pedagogy (Buchanan et al., 2020). Reoccurring themes in the literature included White centrality and White supremacy (Doby-Copeland, 2006; Kaiser, 2017; Talwar et al., 2004); White fragility, discomfort and resistance toward critical self-reflection on culture, identity and worldview (Hook et al., 2017; Jackson, 2020; Moss et al., 2023); and the pertinence of practitioners’ reflexivity (Talwar, 2010; Van Den Berg, 2024). Considerable scholarship has been devoted to making visible the pervasive and present forces of White supremacy, racism and ethnocentric monoculturalism in art therapy (Doby-Copeland, 2006; Hamrick & Byma, 2017; Hartman et al., 2023; Kaiser, 2017; Moon & Faulkner, 2024; Talwar et al., 2004). Racialised trauma impacts all bodies, and intersectional inquiry evokes recognition of the different ways this trauma manifests dependent on individual identity markers and context (Menakem, 2017; Sochanik, 2023). Furthermore, the intersectional imbalances within art therapy (Gilroy et al., 2019; Talwar, 2010; Wood & McKoy-Lewens, 2023) and the position of privilege inherent in professional education and accreditation (Moss et al., 2023; Mupotsa-Russell, 2022) necessitate practitioners’ ongoing, active engagement in dismantling systems of oppression and “interrogating messages of dominance” (Gipson, 2015, p.145) found within masked identities on both intra- and interpersonal levels. For White practitioners, this necessitates ongoing interrogation of the veiled power and privileges entrenched within Whiteness, as well as active engagement to challenge the structures that sustain power through systemic oppression (Eastwood, 2021; Hamrick & Byma, 2017; Hewins, 2023; Karcher, 2017; Sochanik, 2023). White art therapists’ investigations into their own racialised identities provide illustrative examples for practitioners initiating their own formative inquiry (Collier & Eastwood, 2022; Eastwood, 2021; Hewins, 2023; Karcher, 2017; Sochanik, 2023). These authors echo art therapists of colour in explicating the urgency of adopting transformative frameworks that imbue practitioners with critical consciousness and self-reflexivity necessary for ethical practice (Doby-Copeland, 2006; Gipson, 2015; Mupotsa- Russell, 2022; Selvaraj, 2021; Ter Maat, 2011).

Art therapists of colour have articulated their own experiences, throughout training and within the field, of being silenced and devalued, and excluded from professional spaces and discourse (Awais & Yali, 2013; Gipson, 2015; Johnson et al., 2021; Mupotsa-Russell, 2022; Selvaraj, 2022). Each of these authors speaks to the detrimental, exhaustive and often violent repercussions of being a person of colour educated and operating in White-dominated spaces where racism and White supremacy are unacknowledged and, consequently, perpetuating an environment where micro-aggressions are rampant. In sharing these experiences, the ethical imperative for a professional reckoning with the blatant incongruence between espoused values and actual practice becomes clear. If students, educators and colleagues whose identity markers position them outside of the operative norm are not experiencing safety in professional spaces, how can art therapy truly be an ethical practice? These issues are not isolated to international contexts, but also vividly illuminated within the Australian landscape (Mupotsa-Russell, 2022; Parthasarathy, 2024; Selvaraj, 2021). These perspectives advance Australian art therapy in unpacking the present systemic framing of individuals as ‘complex’ and ‘diverse’, unveiling the lived realities of navigating therapeutic practice within structural spaces and theoretical frameworks that shield privilege-bodied individuals from unpacking their complicity within such systems of power (Mupotsa-Russell, 2022; Parthasarathy, 2024; Selvaraj, 2021).

This aligns with the authors’ own art therapy training, which presented training for clinical encounters with individuals who exist outside of hegemonic groups as ‘non-traditional’ – overtly upholding a pathologising system without imbuing essential context. The singular lens through which identity and culture are framed within pedagogy derives from the dominance of Western-Eurocentric paradigms in shaping art therapy, and indeed psychology (Doby-Copeland, 2006; Talwar et al., 2004). Through this lens, practitioners are indirectly led to absorb the dangerous myth of a ‘single story’ – the belief that one visible characteristic of an individual contains the whole (see Adiche, 2009). This perspective becomes amplified when theory involving or written by First Nations, Indigenous and other ‘culturally diverse’ authors is proffered only when deemed corresponding to a topic, or as recommended further reading (as opposed to required learning). The importance of fostering knowledge equality and diversifying pedagogy relied upon in training programs is evidenced from this review. This necessitates educators incorporating diverse sources of current and historical knowledge throughout an entire training program and continual engagement to ensure a balance within core content between dominant and marginalised voices. Without a thorough interrogation of our frames of reference, art therapists may unknowingly rely upon culturally ingrained singular narratives rather than recognising culture and identity are dynamic and must be engaged with as such. At present, White and other privileged positionalities have not yet been explored within Australian art therapy. While there is limited scope in this paper to address the multidimensionality of identity, these authors have identified an urgent need for further intersectional inquiry, praxis and research which centres marginalised lived experience.

Support for both approaches respectively as frameworks for addressing the current impetus for calls to action is evident. Intersectionality, if applied throughout mainstream art therapy practice and pedagogy, offers to equip practitioners with a critical lens to analyse issues of identity, culture and power, and counters the reductive paradigms of historical binaries upon which art therapy was founded (Kuri, 2017; Moon & Faulkner, 2024; Talwar, 2010). Cultural humility, as “the soil that can nourish” (Jackson, 2023, p.59), provides an orientation that grounds intersectional inquiry in a lifelong commitment to ongoing learning and persistent practice of accountability, self-awareness, self-reflection and self-critique (Foronda et al., 2016; Jackson, 2023). Both frameworks together provide an ethical foundation that can promote art therapists’ ongoing learning and development of a responsive, process-oriented approach that aligns critical inquiry and praxis (Overstreet et al., 2020).

This practice involves the self and embraces continual engagement in a lifelong journey of learning with curiosity and persistently critiquing intersections of identity in relation to power dynamics and social context (Buchanan et al., 2020; Collier & Eastwood, 2022). However, ICH is not developed in isolation but through relationship. Implementing this approach within practice aligns with existing relational approaches central to effective art therapy. It is in the intra- and inter- relational domains where the seeds of this ongoing learning journey take root. While practitioners may be comfortable engaging relational approaches, this approach reorients our understanding that every therapeutic relationship is an intercultural encounter. This means that regardless of shared or divergent identities, we acknowledge that those we support hold distinct worldviews and implement necessary reflection and action to distinguish where our own ethnocentrism may be impeding our ability to honour others as the experts of their own lives (Stepney, 2023). As opposed to the content-oriented expectations of competency frameworks, ICH points to a process of being with questions and embracing learning as an ongoing journey. When we are comfortable being without answers, perhaps our questioning can become a supportive vehicle of continued transformation, guided by curiosity and humility (Moon & Faulkner, 2024). Yet the literature also highlights that for privileged individuals, interrogating identity, culture and power can often be uncomfortable, evoking shame, guilt or fear, which in turn evoke behavioural responses such as defensiveness or White fragility (Gipson, 2015; Sochanik, 2023). Central to such explorations must be recognition that these feelings are not actual threats to safety and, crucially, are not comparable with the realities of oppressed individuals and groups (Bodlovic & Jackson, 2018; Mupotsa-Russell, 2022; Selvaraj, 2021).

The literature reviewed herein demonstrates a lack of sufficient evidence to support the idea that Australian art therapy is currently culturally safe – for educators, practitioners and clients alike. For example, the considerable discrepancies in health, morbidity and mortality between Indigenous and non-Indigenous populations (Durie, 2012; Moss & Lea, 2019) suggest that ethnocentric monoculturalism is upheld in Australia as a veiled mechanism that shields practitioners from recognising the connection between historical traumas and present-day outcomes. These disparities in care, access and experience stem in part from a lack of representation within the field of minoritised groups and individuals, as well as the detrimental reverberations of problematic characterisations originating from the dominant medical model. Although no research has been undertaken in this area so far, it is likely that the majority of practitioners in Australia are operating from the dominant cultural perspective (Western, White). A reorientation towards ICH would require practitioners to develop critical consciousness, encompassing expanding cultural awareness through education and experience, as well as the practice of self-reflexivity. Fundamentally, it is not possible to develop ICH in a monoculture (Kapitan, 2023). Cultural awareness evolves through ongoing interrogation of personal identity and culture, while maintaining a curiosity towards the cultures and identities of others and demonstrating willingness to adapt oneself accordingly. While education and intercultural contact may enhance cultural self-awareness, exposure to differences is not enough to counter bias or foster ICH. Self-reflexivity is a continual process of examination that strives to disrupt inaccurate judgements and bias arising from social locations, privileges and power. The practice of self-reflexivity enhances cultural awareness by promoting the ability to take action towards change, an essential first step towards fostering critical consciousness. As an approach rooted in historical oppression and ongoing marginalisation, the practice of ICH must extend beyond intra- and interpersonal domains to engage with “structural forces within the social, political and historical contexts which shape lived experience” (Kapitan, 2023, p.62).

A promising theme that emerged from this inquiry is the power of art-making to enhance and encourage development of critical consciousness and self-reflexivity as a practice that promotes the emergence of tacit discoveries (Har Gil, 2010; Jackson, 2020). Art therapists’ familiarity with responsive art-making positions practitioners with an experiential entry-point to deepen awareness of ICH (Stepney, 2023). Reflective art making as a tool to facilitate self-reflection and critical inquiry has been posited to generate agency and “make the invisible visible” (Karcher, 2017). Though some studies in art therapy have examined cultural humility and/or intersectionality using arts-based inquiry, the majority of these studies appear to be heuristic (Har-Gil, 2010) qualitative heuristic (Jackson, 2016) or purely qualitative methodology (Keselman & Awais, 2018). Other scholars have employed intersectionality as a tool of critical analysis within arts-based research, such as auto-ethnography (Selvaraj, 2021), and reflective case studies (Lin & Ng, 2024; Nevers-Ashton, 2023). Stepney (2023) offers a reflexive, intersectional inquiry enacted through a symbolic self-portraiture art directive that provides practitioners with an experiential understanding of cultural self-awareness enacted through critical inquiry and analysis, demonstrating cultural humility as the foundational pillar of developing a multicultural orientation (Stepney, 2023). While interventions designed to foster cultural humility for art therapy practitioners are growing (Barton & Van Den Berg, 2023; Jackson, 2020; Stepney, 2023), there is a significant lack of research to suggest these approaches have been effectively incorporated into mainstream art therapy.

Chen et al. (2022) demonstrate a relevant example of reflective art-making to develop a social justice stance in art therapy. They suggest art-making and group reflection can create spaces for difficult conversations, asserting the process of cultural humility as a lifelong, transformative journey. Similarly, Lin and Ng (2024) posit that mindful art-making in community could serve as a catalytic vehicle to engender a shared sense of belonging by supporting the “communication, visualisation, and negotiation of what it means to belong among diverse intersecting identities” (p.10). Aside from Jackson’s (2020) seminal examples of reflective art-making activities to explore and enhance cultural humility, there is a considerable lack of literature supporting a case for reflective art-making and ICH. Furthermore, a critical absence of mixed-methodological research into the current themes of this inquiry was identified. What is clear is that reflective art-making can “further promote art therapists’ examinations of prejudicial and discriminatory beliefs and practices within social and power contexts” (Chen & Gussak, 2022, p.103).

Implications for research and practice

A consensus shared amongst the body of literature presented in this review is the need to abolish cultural competency entirely and address the root causes of health discrepancies by reestablishing art therapy frameworks firmly rooted in social justice, anti-oppressive theories and praxis. ICH is well positioned to be integrated within Australian art therapy as a promising framework that can support practitioners ongoing learning and development. As a critical alternative to cultural competency, this approach presents an opportunity for a professional reckoning with entrenched perspectives that uphold explicitly discriminatory theories, practices and outcomes. The findings of this study highlight the urgent need to implement ICH as a core therapeutic approach across pedagogy, practice and research in art therapy. Integrating ICH into the professional landscape will require a foundational reorientation encompassing collective and individual responsibility, accountability, commitment and action.

To initiate an ethical practical reorientation towards ICH, art therapists’ personal engagement with the body of literature reviewed is absolutely recommended. The calibre of scholarship dedicated to these topics contains a wealth of clear tangible recommendations for practitioners, educators and organisational bodies. It is essential that educators and leaders in Australian art therapy engage with and commit to ICH themselves while integrating ICH into art therapy training and ongoing professional learning. Individual and collective commitment across the entire profession to move beyond words and into action is fundamental for the task at hand. Introducing ICH as a foundational framework of practice from the onset of art therapy training and integrating continuous inquiry into identity, culture and power throughout the entire program curriculum would allow more space for practitioners to engage with the “complexities of compoundedness” (Crenshaw, 1989, p.166), encouraging practical orientation towards ongoing learning and active engagement to address injustice. This approach affirms anti-oppression as a foundational practical framework that can imbue privileged practitioners and students with more capability to recognise their own responsibility to mitigate harm and ensure safety and genuine inclusion within pedagogical and professional spaces for all bodies.

Parallel to the above is the need for educators to integrate holistic, culturally diverse scholarship, which exists aplenty and provides critical alternative narratives that counter dominant, operant norms. Cultivating a balance of representation within core pedagogical material is a matter of priority. The reviewed literature affirms the need for a full-curriculum investigation to ensure that pedagogical values, content, discourse and spaces are not consciously or unwittingly upholding systemic structures that sustain privilege and oppression (Moon & Faulkner, 2024; Selvaraj, 2021). Diversifying literature, methodologies and concepts utilised within art therapy training programs is imperative for ethical learning, and an important step towards fostering Indigenous knowledge equality in the field. A literature review focused on Indigenous knowledge and methodologies and art therapy in Australia and Aotearoa respectively is required to further this goal. Johnson et al. (2021), in their qualitative study of American art therapy graduates of colour, emphasise that the single course on cultural competency offered in the second year, alongside lack of culturally diverse representation within the curriculum, threatens the sustainability of the profession. They suggest these results may be transferable to other graduate programs (Johnson et al., 2021). Selvaraj (2021) elucidates the same problems in Australian art therapy, revealing the “absence of meaningful self-reflexive discourse” (p.73) within institutional spaces, and the painful consequent outcomes on queer and BIPOC students. The experiences Selvaraj (2021) unveils within their autoethnographic inquiry into art therapy institutions and spaces in Australia are mirrored by reflections from other Australian authors. Parthasarathy (2024) writes of graduating bringing “relief” (p.4) from the challenges and exhaustion of marginalisation within a pedagogical context; Mupotsa-Russell (2022) describes the weight and routinised exhaustion imposed on marginalised individuals by the “nonperformative” reforms promised by multiculturalism and “diversity” (p.192). Therefore, it is imperative that Australian art therapy pedagogical, professional and institutional spaces commit to the critical inquiry necessary to dismantle current paradigms that uphold systemic oppression.

This review highlights important practical implications for art therapists relating to personal reflection and ongoing learning, supervision and adaptations to practice. Adoption of ICH as a therapeutic framework guides art therapy practice as a way of being that includes openness to being wrong, being accountable and learning from and alongside others. Art therapists’ familiarity with response art as a reflective practice provides a foundational practice that can be utilised to deepen reflexivity and enhance cultural awareness. Myriad examples of art-making interventions reviewed herein can be explored in the development and practice of ICH (Barton & Van Den Berg, 2023; Bodlovic & Jackson, 2018; Chen et al., 2022; Hartman et al., 2023; Jackson, 2020; Stepney, 2023). Many of these authors draw attention to the reciprocal benefits of engaging in collective reflection post art-making to generate discourse and strengthen the practice of ICH (Chen et al., 2022; Hartman et al., 2023; Jackson, 2020). Art therapists could engage with or establish collective learning environments committed to ICH, such as peer supervision, focused reflection groups or dedicated social-action groups that encompass reflection and action. In practice, art therapists working from an ICH framework recognise the clients as the experts of their own lives and formulate treatment from their worldview. This requires an openness to learning from those they are working with, as well as independent learning and making relevant practical adaptations. While each context will differ, the literature highlights examples of such adaptations, including longer or shorter session times, the inclusion and involvement of community or family members in treatment, sharing food and time together and, inclusion of spirituality and faith-based practices such as prayer, ritual or elemental connection (earth, fire, water) (Mupotsa-Russell, 2022; Vlasić Manaia, 2017). Art therapists may also benefit from engaging in personal supervision with individuals whose salient intersectional identities vary from their own. Chen and Gussak (2022) emphasise the value of reciprocal relationships that provide “space for positionalities, emotionally charged experiences and potential intersections” (p.104). These authors echo that value, as learned through the process of this review. The creation of a mutually safe dynamic was supported by centring intersectional inquiry, which in turn allowed for vulnerability and promoted willingness to address discomfort and speak to resistance. The practice of ICH as an ongoing learning journey is to be confronted, challenged and invigorated into response. It is these authors’ experience that this response can be guided into meaningful responsibility through dialogue, collaboration and learning with/alongside individuals and communities whose positionalities and cultural perspectives diverge from their own. The literature asserts the likelihood of encountering resistance, which also supports the necessity of reflective learning contexts that promote ICH.

An additional priority is the development and widespread integration of professional learning on ICH for existing art therapists in the field. It is essential that practitioners have access to professional training that initiates this framework, as well as ongoing learning encounters that support its development. Learning contexts in which ICH can be fostered extend beyond traditional institutional spaces. For example, Indigenous led training and workshops may be deemed informal yet contain important learning encounters relevant to ethical practice. Practitioners’ engagement with such spaces would benefit from the encouragement and support of art therapy organisations.

Finally, the dearth of research on this topic underscores the need for further scholarship to address the issues identified and to fill significant gaps in the field. The findings from this literature review point to the following recommendations for future research in Australian art therapy:

• The current standing of ICH

• Curriculum across training programs

• Whiteness (also White supremacy, White privilege)

• Anti-racist pedagogy informed by Indigenous perspectives and frameworks

• Barriers to individual, collective and organisational transformation

• Pedagogical, professional and practical inquiry that centres and includes individuals and communities whose experiences are traditionally marginalised

• Reflective arts-based inquiry as a method for enhancing ICH

Conclusion

This review of ICH and Australian art therapy emphasises the critical need for applying this fundamental reorientation to practice as well as further research to both enhance understanding and support pedagogical and practical application. This approach is a lifelong pathway oriented towards relationship, learning and being with multiple truths. Although the task at hand is large, art therapy is uniquely positioned to lead professional inquiry into individual and collective ways to engage with the work required to embrace this transformative paradigm. Establishing ICH as a constituent approach within Australian art therapy offers the field, practitioners, students and educators alike an opportunity to move forward by being accountable for the past and engaging honestly, openly and critically with the present.