Policy #28: Ethical Principles and Procedures in Research

28.1 The Need for Research in Art Therapy

Research in art therapy is premised on a fundamental commitment to advancing knowledge and understanding of the usefulness, efficacy, and legitimacy of art therapy in therapeutic practice and to raise the profile of the profession of art therapy in general.

Research in art therapy satisfies at least three basic needs:

• The basic desire for new knowledge and understanding in the field of art therapy
• Individual subjects may benefit from being involved with art therapy: either the discovery of information concerning their own welfare or the satisfaction of contributing to society through research.
• As well, research benefits particular groups and society as a whole. The benefits of art therapy can be both researched and published to inform segments of the helping communities that are not aware of them; increased acceptance of art therapy and art therapists into more arenas of care will increase the public’s access to this service; art therapy will be seen to have value as a profession in its own right.

28.2 The Need for Ethical Procedures in Dealing with Humans in Art Therapy Research:

An ethic of research involving human subjects should include two essential components: (1) the selection and achievement of morally acceptable ends and (2) the morally acceptable means to those ends.

The first component is directed at defining acceptable ends in terms of the benefits of art therapy research for subjects, for associated groups, and for the advancement of knowledge. The second component is directed at ethically appropriate means of conducting research. For example, even in the most promising of research initiatives the use of another human must be solely as a means toward legitimate ends.

There must be respect for human dignity. It is unacceptable to treat persons solely as means (mere objects or things), because doing so fails to respect their intrinsic human dignity and thus impoverishes all of humanity. Second, the welfare and integrity of the individual must remain paramount in art therapy research.

28.3 Overarching Ethical Principles in Art Therapy Research

28.3.1 Respect for Human Dignity:

The cardinal principle of modern research ethics, as discussed above, is respect for human dignity. This principle aspires to protect the multiple and interdependent

interests of the person—from bodily to psychological to cultural integrity. This principle forms the basis of the ethical obligations in research that are listed below.

In certain situations, conflicts may arise from application of these principles in isolation from one other. Art therapy researchers must carefully weigh all the principles and circumstances involved to reach a reasoned and defensible conclusion.

28.3.2 Respect for Free and Informed Consent:

Individuals must have the capacity and right to make free and informed decisions. In practical terms within the ethics review process, the principle of respect for persons translates into the dialogue, process, rights, duties, and requirements for free and informed consent by the research subject.

28.3.3 Respect for Vulnerable Persons:

Respect for human dignity entails high ethical obligations toward vulnerable persons—to those whose diminished competence and/or decision making capacity make them vulnerable. Children, institutionalized persons or others who are vulnerable are entitled, on grounds of human dignity, caring and fairness, to special protection against abuse, exploitation or discrimination. Ethical obligations to vulnerable individuals in art therapy research may translate into special procedures to protect their interests.

28.3.4 Respect for Privacy and Confidentiality:

Respect for human dignity also implies the principles of respect for privacy and confidentiality. Standards of privacy and confidentiality protect access to, control, and dissemination of personal information. In doing so, such standards help to protect mental or psychological integrity. They are thus consonant with values underlying respect for privacy, confidentiality and anonymity.

28.3.5 Respect for Justice and Inclusiveness:

Justice connotes fairness and equity. Procedural justice requires that the ethics review process has fair methods, standards, and procedures for reviewing research protocols, and that the process be effectively independent. Justice also concerns the distribution of benefits and burdens of research. No segment of the population should be unfairly burdened with the potentially harmful aspects of research for the advancement of knowledge. However, there should be neither neglect nor discrimination of or against individuals and groups who may benefit from advances in research.

28.3.6 Balancing the Harms and Benefits of Research:

Art therapy research ethics require a favourable harms-benefits balance—that is, that the foreseeable harms should not outweigh anticipated benefits. Harms-benefits analysis thus affects the welfare and rights of research subjects, the informed assumption of harms and benefits, and the ethical justifications for competing research paths. Because research involves advancing the frontiers of knowledge, its undertaking often involves uncertainty about the precise kind of benefits or harms that attend proposed research. These realities, as well as the principle of respect for human dignity, impose ethical obligations on the prerequisites, scientific validity, design, and conduct of research.

28.3.7 Minimizing Harm:

When conducting art therapy research there is a duty to avoid, prevent, or minimize harms to others. Research subjects must not be subjected to unnecessary risks of harm, and their participation in research must be essential to achieving scientific and societal important aims that cannot be realized without the participation of human subjects.

28.3.8 Maximizing Benefit:

There is a duty to benefit others and, in research ethics, a duty to maximize net benefits. Art therapy research tends to produce benefits for subjects themselves, for other individuals or society as a whole, as well as for the advancement of knowledge.

28.4 A Subject-Centered Perspective

Art therapy research subjects contribute enormously to the progress and promise of art therapy as a process and a profession and therefore a resource for advancing the human condition. There may be opportunities in art therapy research where subjects can be participants in the development of a research project, and collaboration between them and the researcher in such circumstances is vital and requires nurturing. Such collaboration entails an active involvement by research subjects, and ensures both that their interests are central to the project or study, and that they will not be treated simply as objects. Nevertheless, some research will require a more formal separation between subject and researcher because of the nature of the research design.

A subject-centered approach should, however, also recognize that researchers and research subjects might not always see the harms and benefits of an art therapy research project in the same way. Indeed, individual subjects within the same study may respond very differently to the information provided in the process of free and informed consent. Hence, researchers must strive to understand the views of the potential or actual research subjects.

Art therapy researchers should take into account that potential subjects who are asked to participate in research by, for example, their therapist, their doctor, their caregiver, teacher, or supervisor may be overly influenced by such factors as trust in the researcher or the hope for other goals—more than by assessment of the pros and cons of participation in the research. A research subject may hope for specific benefits from art therapy due to these influences. This places extra demands on the researcher for accuracy, candor, objectivity, and sensitivity in informing potential subjects about proposed research.

Art therapy researchers should also be aware that some research might be legitimately opposed to the immediate interests of the research subjects. The Research Ethics Board should take this into consideration when evaluating a research proposal.

28.5 Academic Freedoms and Responsibilities

Researchers enjoy, and should continue to enjoy, important freedoms and privileges. To secure the maximum benefits from research, society needs to ensure that researchers have certain freedoms. It is for this reason that researchers and their academic institutions uphold the principles of academic freedom and the independence of the higher education research community. These freedoms include freedom of inquiry and the right to disseminate the results thereof, freedom to challenge conventional thought, freedom from institutional censorship, and the privilege of conducting research on human subjects with public trust and support.

However, researchers and institutions also recognize that with freedom comes responsibility, including the responsibility to ensure that art therapy research involving human subjects meets high scientific and ethical standards. The researcher’s commitment to the advancement of knowledge also implies duties of honest and thoughtful inquiry, rigorous analysis, and accountability for the use of professional standards. Thus, review of research proposals, the findings, and their interpretation by an Ethics Review Committee contribute to accountability, both to colleagues and to society.

Review of the ethics of research helps ensure a more general accountability to society. Accountability, moreover, requires that the whole process should always be open to critical assessment and debate.

28.6 Ethics and Law

The law affects and regulates the standards and conduct of art therapy research involving human subjects in a variety of ways, such as privacy, confidentiality, intellectual property, competence, and in many other areas. Human rights legislation prohibits discrimination on a variety of grounds. In addition, most documents on research ethics prohibit discrimination and recognize equal treatment as fundamental. This legal context for research involving human subjects is constantly evolving, and varies from jurisdiction to jurisdiction. Researchers and institutions should have recourse to expertise to identify legal issues in the ethics review process.

However, legal and ethical approaches to issues may lead to different conclusions. The law tends to compel obedience to behavioral norms. Ethics aim to promote high standards of behaviour through an awareness of values, which may develop with practice and which may have to accommodate choice and liability to err.

28.7 Putting Principles into Practice in Art Therapy Research at CiiAT

For meaningful and effective application, the foregoing ethical principles must operate neither in the abstract, nor in isolation from one another. They should be applied in the context of art therapy research and art therapy ethical norms and practices. Good ethical reasoning requires thought, insight and sensitivity to context, which in turn help to refine the roles and application of norms that govern relationships. Thus, because principles are designed to guide ethical reflection and conduct, they admit flexibility and exceptions. To preserve the values, purpose and protection that they attempt to advance, the onus for demonstrating a reasonable exception to a principle should fall on those claiming the exception.

Art therapy researchers should be aware that there are a variety of philosophical approaches to ethical problems, and that debate between various schools of thought both informs ethical decisions and ensures an evolving context for ethical approaches. CiiAT advocates a feminist analysis, which is centered on context, relationships of power, and allocations of privilege that perpetuate disadvantage and inequality. For example, art therapists engaged in research must be aware of their influential position with respect to research participants and must make every effort to avoid dual relationships that could impair professional judgment or increase the risk of exploitation. The feminist approach may therefore help to correct the systemic exclusion of some groups from research.

Effective guiding principles for conducting art therapy research depend on procedures and policies for their implementation. Indeed, modern research ethics are premised on a dynamic relation between ethical principles and procedures. This relationship in CiiAT is implemented through a Research Ethics Committee that reviews all prospective student and faculty research projects and implements procedural norms.

28.8 Procedures for Art Therapy Research at CiiAT

All prospective researchers must request an ethical review of their proposed project. No research that includes human subjects must commence in the absence of ethical approval.

The procedure for submitting an application for approval to the Research Ethics Committee is as following:

The application must thoroughly outline the research project, including addressing the following ethical considerations:

1. Rationale and statement of value of the research for the contribution that this research will make and the way in which the methodology addresses this;
2. A clear description of the research design, which outlines the composition and size of the sample, with recognition of the drawbacks and benefits.

Consent must be gained for the use of tape recordings, videos, or other material data provided; details of the way that the anonymity of the data will be assured must be provided. Forms/checklists will be provided to prospective researchers that will assist them in the preparation of the application and particularly in the matters of consent and anonymity.

28.8.1 The application will comprise of:

1. A completed application form
2. A full proposal including any methodologies, questionnaires, interview schedules, or other materials to be used in the collection of data
3. The self assessment checklist for researchers
4. A checklist that is a summary of information to be given to the participants of the research
5. Research Ethics review checklist
6. Letter of invitation to subjects to participate in research
7. Copy of the proposed participant information sheets
8. Participant Consent Forms (e.g., for active participants, client subjects, online subjects, telephone subjects, etc.)

28.8.2 The Research Ethics Committee:

The Research Ethics Committee will be composed of CiiAT faculty and clinical supervisors. Members of the committee will have conducted research themselves and/or have done a thesis.

28.8.3 The Procedure, including time frames:

1. The researcher will submit the application to the thesis team.
2. The thesis team will notify the researcher within one month of the date of receipt of the application package in writing of their decision.
3. The decisions can be as follows:
   1. yes, with no changes;
   2. no – the research is not acceptable;
   3. the research is acceptable with changes and/or additional information.
4. If required, the revised application package should be re-submitted within one month
5. The thesis team will inform the applicant within one month of the date of receipt of the re-submission in writing. If there is still a problem with the research proposal, a meeting will be offered to the applicant, including the thesis team, the applicant, and a faculty advisor if applicable, to determine if a further submission is required.
6. The research must be carried out in accordance with the procedures as approved.
7. The completed research will be submitted to appropriate faculty, and the Ethics Committee within the agreed upon time.