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Complexities in understandings of theory and practice in art therapy find rich turf in the Asian context. Culturally-specific therapeutic orientations are explored in this book through the use of both discursive and vignette forms. Approaches are contextualized according to philosophic and religious traditions and social meanings originating in countries including Japan, South Korean, China, Cambodia and Thailand. In the current socio-political world juncture, and at a time when the discipline of art therapy is being redefined, these contributions to the literature provide welcome and much needed conceptual nourishment.

艺术治疗理论和实践的复杂性在亚洲范围内找到了丰饶的沃土。本书探讨了文化特定的治疗定向，通过使用话语和小插曲的形式。根据来自日本，韩国，中国，柬埔寨和泰国等国家的哲学和宗教传统和社会意义，背景化方法和干预。在当前的社会政治社会契合，当艺术治疗学科正在被重新定义的时候，这些对文献的贡献提供了受欢迎并非常必要的概念性补充。

An interest in re-defining what constitutes art therapy practice in the 2010s has drawn the attention of both art therapists and academics (McNiff, 2013; Potash et al, 2016; Talwar, 2016; Timm-Botos, 2016; van Lith & Fenner, 2011) and it is timely to recall that our discourses in art therapy are situated socio-geographically within distinctive political and structural contexts. Our conversational partners within this discipline, however, do not often represent the full diversity of those people with whom we already work or potentially might work with in the future. We are typically female – of European origin – and English speaking; at least, that is how it has seemed to those of us writing, reading and practicing in such countries as the USA, Australia and Britain – all countries recognized as centers for the development of the art therapy profession in the second half of the 20^th century. Some traditions of thought, however (traditions which originated in the last century and which have underpinned conceptualizations of art therapy practice) have now begun to wear thin in the current conjuncture.

Internationally, the force of governmental policies in such areas as health, social welfare, and humanitarian support (to name but a few) now impinge on our conversations and compel us to revisit what it is we think we know – applying the relevance of that thinking to issues which beset and challenge us as global citizens and, more specifically, as a profession. As the writers of this review (who are based in a socially complex yet relatively harmonious urban Australian context) we are nevertheless aware that our work – whether it be in hospitals, community centers, or other settings – is no longer as isolated as it previously once was from other parts of the world or from places and events where political conflicts multiply. We are also deeply mindful of the resultant proliferation (often chaotic at times) of displaced peoples and refugees currently shifting around the globe; people who require urgent solutions to their needs. Natural disasters such as earthquakes, landslides and flooding, extreme fire events, drought and hurricanes also punctuate and destroy the lives of individuals and communities on a devastating scale. Today, the scope of where art therapy will increasingly be practiced stretches far beyond countries that have, until now, dominated in the discourse.

Such sobering 21^st century realities now compel us to reconsider our discipline and practices with a globally conscious mindset – one which incorporates social, cultural and public health perspectives. Adopting an expanded frame of reference such as this is arguably a disruption to the traditional health deficit’s focus on the privations of individuals – something that has predominated in the West. The needs of communities and groups experiencing distress – as well as the health and wellbeing needs of those not overtly challenged by natural and political conflict – begin to draw our attention more and more to health promotion-oriented art therapy interventions and programs. Some traditional art therapy approaches of the past can – in the light of our broadened occupational scope – seem limited by contrast.

It is within this complex scenario that editors Debra Kalmanowitz, Jordan Potash and Siu Mei Chan produced Art Therapy in Asia (2012). This book explores the region-specific values and traditions that are integrally linked to the continuing evolution of art therapy in Asia; it also presents a series of country-specific accounts of art therapy projects, approaches, issues and developments.

The book is divided into such themes as the Asian conceptualization of health and approaches to healing, the influence of collectivism, the place of spirituality and the role of traditions. The editors have garnered contributions from authors located in a number of countries as well as from resident and visiting art therapists; their overall pursuit (the editors state) is an attempt to articulate a context for the understanding and the definition of an Asian model of art therapy. Are these various art therapy practices essentially different from Western approaches or do they simply utilize different metaphors and symbols? As a way of indicating the nuances explored within the book, we have chosen to review a small section of chapters where art therapy takes on distinctive forms as it illuminates some of the book’s key themes. Two of these chapters address issues in art therapy practice in Japan: Chapter 11 (by Rappaport, Ikemi and Miyake) examines focus-oriented art therapy and collage work while Chapter 16 (by Sezaki) explores group art therapy undertaken with psychiatric patients. In Chapter 15 (by Herbert), the way in which trauma and ritual have played an integral part within art therapy practice in Cambodia is also reviewed.

Rappaport, Ikemi and Miyake present an historical overview of the moments that have led to an uptake of the focusing framework in psychotherapy, the development of collage therapy, Experiential Collage Work (ECW) and Rappaport’s Focusing-Oriented Art Therapy (FOAT) in Japan. Their overview of Japanese culture is brief but illuminating; as readers, we gain an understanding of the values, outlook and relevance of working with the felt sense in Japan. The authors point out that, within the Japanese language, there are many words for feelings expressed in relation to the body – an object which is viewed as a place of “deeper knowing” (p.160). We learn that, in Japanese daily life, the felt sense is privileged above that of reasoning. The authors give an example of how the Japanese expression “put your hands on your chest and look inside” (p.160) indicates that a person is trying to justify or explain their behavior. With this example – and within a Japanese cultural context – these authors suggest that the chest knows more than the mind.

As a rich metaphor for expressive body-focused work, this colloquialism offers the art therapist an access point for body-led inquiry.

In Chapter 16, Sezaki offers the reader an opportunity to explore the diversity of Japanese culture whilst working with unique and specific populations in various regions of the country – regions where cultural expressions may be unique to a place, group or situation. Within a section focusing on models of art therapy, Sezaki focuses on theme-based group art therapy with adult patients in a psychiatric ward. He presents a practical guide to theme-oriented group art therapy through the study of two cases. One of these cases studies involves linking the culturally popular character Teruteru Bozu – or Sunshine Monk Doll (p.230) – with a group of psychiatric inpatients. Here, Sezaki illustrates how structured art making can help connect members of a group, can provide laughter and fun and can also locate meaning for the art makers within their work. Sezaki’s second case study involves an outpatient group for alcohol-addicted adults. Both cases not only demonstrate the use of multi-axial art therapy goal systems but also illustrate work that is highly structured and goal-oriented within a culture that shares strikingly similar values.

The chapter highlights the issue of therapists who have been trained in other countries and includes those educated where an individualistic Western style structure of psychotherapy prevails. Sezaki highlights the role of hierarchy in Japanese social relations – where order, structure and respect for those in positions of authority have historically been powerful factors in relationships. Within this context, the art therapist is situated relationally above the patient and is primarily responsible for the requirements of order, instruction and leadership; this structure stands in contrast with the contemporary consumer- oriented recovery model which is popular in many western contexts.

Sezaki provides an example of art therapist named Iwai who, along with colleagues, attempts to equalize power-relations and to work in a more client-led way by providing a group of clients with an art directive expressly inviting high levels of participant involvement. Across much of Asia, many oppressive acts have resulted in traumatic experiences that have, in turn, become the central focus for arts therapies and recovery programs. For Western therapists working in parts of Asia, however, there are potential complications to be faced when their own values reflect a more client-led mode. This chapter helps us explore future structures for work in art therapy as new technologies allow us to connect more easily across the world and the exchange and synthesis of approaches becomes more feasible.

Carrie Herbert explores the influence of Cambodia’s history on the present experience of its people, emphasizing the way in which urban and rural peoples differ in their cultural connections. This research has important implications for those art therapists working in a country that (according to Herbert) remains affected by high levels of poverty, fear and political control. What, therefore, might be the implications for art therapy – not only in the service of trauma but also in addressing community development and issues of cultural identity?

Herbert notes a developing trend amongst young people from the cities; they have begun to look towards popular culture in South Korea and the Western world and are dismissing their own Cambodian cultural traditions. As they increasingly engage with cultural expressions of ‘otherness’, the risk increases – she says – of a phobic response to certain aspects of their own roots. How does the art therapist orient practice within this dynamic while remaining relevant to those who participate? By contrast to this, in rural settings still affected by socio-political traumas of the recent past and the effects of human trafficking, the play of children is more likely to reflect traditional themes and values. Complex circumstances such as these are highly instructive for art therapists who do well to educate themselves in the nuances of prevailing social norms and cultural connections when engaging in work in such settings.

The chapter itself provides four vignettes – one presenting work with a child, one looking at an art therapist who’s working with clients with trauma backgrounds, another focusing on an adult experiencing the loss of both husband and child under the rule of Pol Pot and a final exploration of a community-based program for elders. While the chapter may be slim on contextual detail, the vignettes highlight strength-based approaches where a focus on cultural symbols for resilience and transformation (such as the Aspara dancer) has proven beneficial for participants.

As McNiff suggests in his foreword to the book, these themes raise more questions than answers and provide the opportunity for more research in the future. Herbert’s contribution provides an impetus for continued discussion as well as an invitation to the reader to approach art therapy practice in Cambodia with an understanding informed by prevailing tensions around cultural identity and the enduring effects of trauma and fear. We wonder if this might be extended to potential collaborations between traditional and contemporary arts and medicine/healing practitioners – as well as to projects incorporating Eastern and Western elements relating to trauma and recovery within Cambodia.

The sharpening divisions between the disciplines of medicine, health and art in the West have less relevance in many Asian contexts where art-making and well-being have long been connected with self-cultivation and transcendence. According to Sun Hyun Kim in her discussion on an integrated approach to art therapy in Korea, both art-making and healing are understood to be creative acts. She argues the case that the drawing together of both art therapy and Eastern medicine forms a coherent alliance (or fit) as clinicians in Korea use art therapy as a way of enhancing medical treatment. The Eastern emphasis on harmony and balance – both within the self and in relationships – is well served through creative practices that embrace a ‘we-ness’ more than ‘I-ness’, Sun Hyun Kim says. Kalmanowitz, Potash and Chan have dedicated several chapters to addressing the qualities of balance and harmony in Asian culture and in art. By identifying the health benefits of both art and art therapy, they project forwards to a future practice which will be as much oriented towards prevention and holistic care as it is towards deficit-oriented approaches.

The editors acknowledge the ambitiousness of their task in representing the current state of art therapy in Asia. They have been at pains to highlight regional differences as well as – where evident – patterns in values and practices. They have also worked carefully to avoid the trap of presenting a picture that inadvertently supports the simplistic binaries of practice in either East or West. They have set the book against a fluid backdrop of struggle that the profession must undertake in order to formulate its identity in Asia. This is a struggle that includes finding a balance between two worlds: the old and the new – the traditional and the modern. This, the authors say, can lead to complex and even contradictory formations of identity – helping to frame a middle ground between East and West. They also explore the notion of an emerging model of art therapy specifically suited to Asia which is simultaneously relevant beyond Asia and may yet lead to a reconceptualization of the artistic discipline. The authors acknowledge the limitations of the text – one of which involves constraints on the number of countries and cultures represented. Narratives from the Islamic worlds of Malaysia and Indonesia or Pakistan (for example) would enrich, challenge and enhance the reader’s knowledge and experience and would increase discourse.

The timing of this literary contribution and its discourse of this artistic discipline is highly apposite. Embracing the differences articulated and illustrated in this text is highly recommended in a time where such wisdom in its many forms is needed more than ever.

Patricia Fenner, PhD, is Senior Lecturer and Art Therapy Program Coordinator at La Trobe University, Australia. Her research fields include art making and mental health recovery; art therapy in the Asia Pacific.

Ange Morgan (MAT) is Associate Lecturer at La Trobe University, Australia. She is a practicing art therapist in adult mental health and homelessness.

References

McNiff, S. (2013). Developing arts and health – within creative-arts therapy or separately? Journal of Applied Arts and Health, 4(3), 345–353.

Potash, J. S., Mann, S. M., Martinez, J. C., Roach, A. B., & Wallace, N. M. (2016). Spectrum of art therapy practice: Systematic literature review of art therapy 1983–2014, Art Therapy: Journal of the American Art Therapy Association, 33(3), 119–127.

Talwar, S. (2016). Is there a need to redefine art therapy? Art Therapy: Journal of the American Art Therapy Association, 33(3), 116–118.

Timm-Botos, J. (2016). Beyond counseling and psychotherapy: There is a field. I’ll meet you there. Art therapy: Journal of the American Art Therapy Association, 33(3), 160–162.

Van Lith, T., & Fenner, P. (2011). The practice continuum: Conceptualizing a person-centered approach to art therapy. Australian and New Zealand Journal of Arts Therapy, 6(1), 17–22.