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Only a few studies in the arts therapies in general and in the field of visual art therapy in particular have begun to address process variables and their relationship to outcome variables. The present study thus aimed to contribute to this literature by examining the relationship between process variables and outcome variables in the school-based art therapy setting. The process-outcome relationship was examined in a school-based art therapy setting in a sample of 32 art therapists and 44 clients aged 7–13. Hypothesis 1 predicted that over the course of art therapy, client involvement and client productive behaviours would increase whereas resistance would decrease. Hypothesis 2 predicted that increases in client involvement and client productive behaviours and decreases in client resistance would be linked to decreases in behavioural problems. Both hypotheses were partially supported in that cognitive–behavioural exploration and emotional exploration differed significantly during therapy. In addition, there was a significant correlation between improvement in client involvement and cognitive–behavioural exploration and improvement in internalising problems. The present study provides initial support for the claim that the processes in art therapy with children are more complex than is typically assumed for art therapy. For example, the results showed that an increase in resistance and a decrease in insight were associated with positive outcomes. The findings indicated that in the education system, cognitive–behavioural exploration is an important variable. Models such as the cognitive–behavioural approach thus may be useful in school-based art therapy. Plain-language summary Recent studies have attested to the positive impact of art therapy on children and adolescents. However, little is known about what happens during the process of therapy and how it can lead to a positive outcome. The present study examined the relationship between process variables and outcome variables in the school-based art therapy setting. For this purpose, it focused on two process variables. The first was the art therapist's assessment of the client's degree of involvement in therapy. The second process variable was the therapist's assessment of the client's productive behaviours as well as resistance to therapy. This assessment can shed light on the ways in which the client responds to the therapist's interventions. The outcome variable was Child Behaviour Checklist that is designed to evaluate changes in children's behaviour and functioning over time or before/after therapy. Thirty-two art therapists employed by the Israel Ministry of Education and 44 clients participated in the present study. At the beginning of the school year, each art therapist selected one or two of her clients, who were in grades 1–7. Consent was obtained from both the clients and their parents. Parents and teachers filled out the outcome measure, at the beginning (September) and end of the year (June). The art therapists were asked to fill in the process measures after each treatment session (once a week). The results showed that cognitive–behavioural exploration and emotional exploration differed significantly across time. In addition, an association was found between improvement in client involvement and cognitive–behavioural exploration and improvement in internalising problems. The present study provides initial support for the claim that the processes in art therapy with children in general and within the school setting in particular are more complex than is typically assumed for art therapy.

A process-outcome study of school-based art therapy