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Findings from research involving service users

Analysis of data from research involving caregivers and children highlights the important role of the image in dyadic art therapy.

Art and art making can open alternative channels of communication between the child and carer, enabling the child to communicate aspects of their experience through doing rather than explaining.

The images were used to help the child develop expressive and creative skills, and they also had a key role to play in recording and processing important events and the feelings associated with them.

Having caregivers present in the sessions was also seen as important, many of the valued outcomes highlighted by the research were achieved by having the caregiver present in sessions.

Caregivers gained insights at first-hand. Conversations and interactions could be initiated in sessions which the dyad would then continue afterwards in everyday life.

As well as having these benefits, the joined-up dyadic approach was also seen as potentially creating a challenging dynamic, particularly if the three key participants had conflicting agendas.

Research with the therapists has suggested that therapists have an awareness of this issue but it is helpful to understand more about it from the service user’s perspective.

Findings from research involving therapists

Interviews with dyadic art therapists highlight some of the changes they have seen in their work.

These include:

  • Establishing therapeutic alliances and building trusting relationships with service users.

  • Building up a picture of the child’s internal and external world which can be shared with caregivers during the therapy.

  • Building a picture of the caregivers and their strengths.

  • Caregivers gaining new insights and understanding.

  • Children’s emotional (and maybe even physical) growth.

  • Reduction in child’s confusion and sense of blame.

  • Child becomes more relaxed.

  • Child’s emotional regulation and articulation increased.

  • Child’s ability to tolerate potentially stressful situations increased.

  • Caregiver and child gain greater understanding of each other.

  • Changes occur within the primary attachment relationship(s).

Thoughts about evaluation

There is currently no agreed or formal evaluation tool for Dyadic Art Therapy.

However, interviews with dyadic art therapists indicate that it might be the helpful and illuminating to evaluate the following outcomes:

  • The quality of the attachment relationship between the primary caregiver and the child.

  • Stability of placement.

  • Caregiver sensitivity.

  • Caregiver stress levels.

  • Child’s ability to make links with current behaviours and past events.

  • Child’s ability to manage relationships.

  • Reflective functioning.

  • School attendance.

  • Attachment behaviours.

  • Emotional literacy.

  • Regulation and arousal and stress levels (including trauma symptoms).

  • Cognitive gains.

If goal based outcome measures are used, the outcomes might relate to progress in meeting individually established goals.


Some forms of evaluation may involve adherence testing.

View a draft adherence tool.