Delphi study

A two-round Delphi process was used to seek consensus on the core therapeutic principles, practices, and competences required for the delivery of dyadic art psychotherapy.

The members of the Delphi panel were

• Lucille Proulx

• Teresa Boronska

• Caroline Case

• Penelope Hall

• Lesley Hanney

• Anthea Hendry

• Hilary Hosea

• Jay Vaughan

The principles and competences used in this manual come directly from the Delphi.

Principles from Delphi

• The therapeutic work includes discussions of attachment and emotion regulation.

• The therapeutic work aims to develop the carer’s capacity for reflective functioning.

• The therapeutic work addresses how the carer’s own internal working models are enacted in the relationship with the child.

• The therapeutic work seeks to enhance the carer’s sensitivity to the child’s emotional and behavioural signals.

• The therapeutic work promotes carer-child relationships characterised by both connectedness and autonomy.

• Great flexibility is employed in the planning of the treatment programme, respecting diversity of family history, culture and individual experience.

• Therapeutic work creates links with the present and past, in a historical, developmental and social context.

• Within the safe, boundaried space of art therapy, the child is encouraged to expand their ability to recognise his/her own feelings in the context of being together with the carer.

• Focusing on moments of attunement, when warmth and playfulness emerge, is at the heart of the work.

• Therapeutic work aims to enhance the carer’s capacity for openness, working with experiences as they occur within the session.

Practices from the Delphi

• The therapist is alert to the carer’s own affect and helps the carer to recognise, contain and eventually understand this.

• The therapist does not become the child’s therapist or the carer’s therapist. The art therapist is the relationship’s therapist.

• The therapist observes attachment related behaviour.

• Through observations, the therapist determines the functional emotional level of the child.

• The therapist receives supervision.

Competences from the Delphi

• Understanding developmental trauma and the impact this has on every aspect of the child’s development.

• Understanding trauma in the context of therapy, PTSD symptoms, and sensitivity to the child’s ability to tolerate traumatic memories being exposed.

• An understanding of child development.

• Knowledge about the nervous system and how this is impacted by trauma and stress. How to help it calm as well as how to assess whether a child is being activated into a stress response (fight, flight or freeze) or whether they are able to manage higher level reflective functioning.

• Ability to make a broad assessment of an adult’s and a child’s attachment style. In particular to recognise unresolved trauma in an adult.

• Ability to recognise contra-indictors to Dyadic Art Therapy.

• Knowledge of parenting strategies particularly those for working with children with disturbed attachment behaviours (it is not enough to understand disturbed behaviours, a carer also has to respond to them, so this inevitably will be part of the work with the carer).

• Understanding the difference between therapy with a birth parent and their child, and therapy with a fostered or adopted child.

• Awareness of alternative theoretical frames and an openness to many ways of working.

• Understanding of psychotherapeutic ideas of how the self is built up and strengthened including infant-parent psychotherapy, Winnicott and Daniel Stern.

• Ability to develop an understanding of the child for the carer and for the child, so that the child’s feelings can be seen and acknowledged, and so the child can begin to regulate his/her own feelings and the carer can help to soothe and contain them. (This was originally given as a competence – but also describes a practice).

More information about the Delphi process from a paper describing the study.