A 4-year-old girl who suffers emotional trauma stops talking anywhere outside of the house. What are the parents to do?
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This girl’s parents decide to try music therapy and bring her to Dorit Amir, who heads Bar-Ilan University’s music therapy department. Within two years of the therapy, the girl began talking again.
Positive outcomes like that can be expected in the majority of people treated with music therapy, says Amir, who puts the success rate at 70 percent.
Dorit Amir is one of an estimated 6,000 creative art therapists working in Israel, 85 percent of whom are women. These therapists use a variety of disciplines - drama, dance, drawing, sculpting, and reading and writing stories, as well as music - to treat patients of all ages. But these fields are not regulated or officially recognized, so people can call themselves therapists with little or no training. At the same time, even the best of the therapists, some of whom have master’s degrees in their fields, have little job security.
The pay typically comes to an estimated NIS 6,000 to NIS 7,000 a month, but therapists usually have to work in several institutions, such as hospitals or schools, to make that much.
“The situation is intolerable: The Education Ministry employs therapists at special education schools at identical pay to that of the teachers, but mainly in part-time jobs,” says drama therapist Edna Leshem, who heads the Israeli Association of Creative and Expressive Therapies. “A therapist needs to work in several schools to earn a wage that is low in any case. Another thing that bothers us is that the state is about to transfer the mental health field from our responsibility to that of the HMOs. When this reform occurs, we don’t know if we’ll be able to fit in at all.”
Creative arts therapy gained traction in the 1940s, with the urgent need to treat millions of people suffering from shell shock or post-traumatic stress disorder during World War II. But it wasn’t until 1980 that the first training program in Israel for creative arts therapists was launched, by Haifa University's education department. Several other institutions have since followed suit.
Tamar Hazut, a visual arts therapist specializing in trauma victims and bereavement, founded the therapy training program at Haifa University. She says that unlike in the United States and Britain, the profession is not fully recognized as therapy, even though many art therapists practice here.
"As a result, 40 years after treatment through the arts for people suffering emotional disability or having experienced deep trauma began establishing itself in Israel, therapists still lack any official status, meaning the profession isn't organized," says Hazut. "The field isn't eligible for dedicated budgets, for defined staffing positions and, no less important, there isn't a pay scale or therapist ranking to improve employment conditions."
The Knesset came close to recognizing creative arts therapy as a profession twice in the past few years, but each time adjourned before a final decision could be made. At the end of 2012 legislation for recognizing creative arts therapy passed its first reading but never made it into law because the issue got swept aside by the national election in early 2013.
The Health Ministry did recognize arts therapy as a profession in 1988, but this was paradoxically undermined by the Basic Law on Freedom of Occupation passed in 1994.
"This law, as important as it should be in an enlightened country, created a problematic loophole," says Hazut. "It essentially says that as long as the profession isn't enshrined in law, anyone can call themselves a therapist in this field. So a situation came about in which, according to the law, the clear line separating professionals from charlatans was erased, and this harms all of us."
Several creative arts therapists petitioned the High Court of Justice after the basic law was passed. The court ordered the state to initiate legislation that would legally define the profession, but a decade has gone by and the law still hasn't been passed.
"We aren't giving up," says Hazut. "Our goal is to gain recognition from the state exactly like that given to social workers and psychologists."
The lack of official state recognition makes it hard for creative arts therapists to work in the public sector, where most of the jobs are.
“Health maintenance organization representatives told the labor committee discussing the matter that they want their clients to receive arts therapy from us, but that the HMOs can’t do this without proper legislation,” she says. “At the same time there is no career ladder because professional rankings can’t be set based on criteria such as work experience or the level of professional training.”
Hazut says legislation could also set the licensing and testing requirements and number of internship hours necessary to determine who should be certified as a therapist.
“The legislation is also supposed to bring order into the wide open market,” she says. “Today any college can open a program for training arts therapists, even without certification from the Council for Higher Education, and anyone passing a quick course can declare himself a therapist.”
Creative arts therapists run up against a fair amount of skepticism from the traditional medical establishment.
"Therapy through arts isn't a treatment technique that's considered one of the building blocks of psychiatric or psychological treatment," says a former chief executive of a mental health hospital. "This technique can be complementary at best. It can be used only if the classic mental health disciplines have been exhausted."
The former hospital official’s attitude toward creative arts therapy indicates that the perceived amateurism of some therapists - a problem that can arguably be ameliorated by strict licensing requirements - sometimes gives all the others a bad name.
The main problem, he says, is the amateurism exhibited by therapists "who repeatedly present patients with the same picture or dance, and it doesn't help at all.”
“The relevant treatment disciplines rank in the following order: psychiatry, psychology, followed by social workers with the relevant training,” he says. “And only afterward is there sometimes room to use the arts."