One definition of ABR was given by Austin and Forinash (2005) as “Art forms … are essential to the research process itself and central in formulating the research question, generating data, analyzing data, and presenting the research results” (p. 459). Leavy (2009) defined ABR as “a set of methodological tools used by qualitative researchers across the disciplines during all phases of social research, including data collection, analysis, and representation” (p. ix). Later (Leavy, 2015), she highlighted the value of researching these realms with methods that make sense to tacit knowledge and included a participatory perspective. Such endeavor can preferably be explored in qualitative or arts-based studies. In line with Barone and Eisner (2012), Viega & Forinash (2016) defined ABR as an umbrella term for the use of the arts as a research method. The latter specified that ABR could be applied as a method where “the art forms are primary in the research process – and as an overall methodology – where a creative worldview forms the philosophical foundation for an inquiry” (p. 491). These authors underlined that in ABR, the arts inform and sometimes lead the research process. ABR can be one part of the research process or the main research method (Leavy, 2015; Viega & Forinash, 2016; Viega, 2016b). Viega and Forinash (2016) provided a compilation on variations in ABR in relation to music therapy. They also highlighted the favourable position of creative arts therapists in embracing an arts-based inquiry and pointed out the many ways ABR and clinical practice are intertwined and can cross-fertilize each other. According to Leavy (2015, p. 20) an artistic method can serve as an entire methodology in a study, for examples see Ledger and McCaffrey (2015).

McNiff (1998, 2011) made important introductions to arts-based inquiries. “Knowing through the arts takes place in ways that are distinctly different, yet complementary to rational cognition” (McNiff, 2008, p. 30), a statement further elaborated by (Sajnani, Marxen, & Zarate, 2017; Wiedenhofer, 2017). A theoretical understanding underpinning our perspective is given by contemporary affective neuroscience (Cozolino, 2002; LeDoux, 1996; Siegel, 2010) and relational psychodynamics (Lyons-Ruth, 1999). According to Lyons-Ruth et al. (1998). Such knowledge is distinct from that which is possible to verbalize and derives from the dynamic unconscious. ABR offers both a heuristic (Douglass & Moustakas, 1985; Moustakas, 1990, 1994), empirical and thorough artistic opportunity to engage in a dialogue with a statement, an expression, or a piece of artwork, and answers at the same level of implicit knowing in which that art-piece was done. Then depth can answer to depth (Gerge, 2016; Knill, Levine & Levine, 2004).

When studying the psychological responses to artistic experiences and expressions both an expressive and a receptive aesthetic response can be conceptualized and used. Then aesthetic responses can be performed in all kinds of artistic modalities and methods and can work together with other research methods. Sajnani et al. (2017) proposed an ethical responsibility as a way to recognize and respond on how social injustice influences lives. For such an endeavour we need tools to reach and come close to the life-worlds of others. In music therapy, critical social aesthetics (CSA) described by Sajnani et al. (2017) is where critical social theory, music aesthetics and improvisation-based music therapy are combined. Though of course self-dialogue, diary writing, poetic inquiry, and all other arts modalities and intermodal transfer can be involved in such inquiry of ABR and thus lead to an enhanced and nuanced understanding. The importance of aesthetic and relational aspects in human appraisal processes, including therapy and research, cannot be over-estimated. Nor can the intermodal transfer which refers to the fact that imagery/imaginative processes are experienced in multimodal ways and that moving between art forms might deepen and open up to enhanced implicit processing (Gerge, 2010; Knill et al.,1995).

An essential part of ABR is to allow oneself to become affected on a profound level when researching health processes. We even mean it is a necessary component when engaged in arts-based research methods and in psychotherapeutic processes utilizing altered state of consciousness (ASC), states of daydreaming where messages from the unconscious can more easily come through. As Gilroy (2012, p. 12) stated, in the art/arts therapies there might be an absence of evidence but a presence of knowledge. This is partly due to the nature of tacit knowledge (Polanyi, 1958). Polanyi affirmed that we could know more than we can tell. Even if tacit knowledge is part of everyone’s daily life, it is not easily shared, nor easily articulated. It consists of embodied memories and schemes, which are implicitly ingrained in us and which we often take for granted. Thus, methods that delve into the implicit realms of knowing are of certain interest in researching subjective experience and especially expressions of art/arts in therapy. Arts-based research is a valuable way to gain insights, not knowable by other means, and/or to enrich the understanding of data. McNiff (2011) described ABR as “especially significant” to the arts therapies, which use creative expression as a “way of knowing, communicating, and furthering personal and social development” (p. 387). According to Leavy (2015), ABR can poignantly add to consciousness-raising, emancipatory, and transdisciplinary research (p. 294). The perceptual openness potentially achieved might activate our mirror neurons (Gallese, 2009; Gallese & Ferri, 2014; Wiedenhofer, 2017). The latter highlights the embodied aesthetics including the active (expression) and the receptive (impression) side of the aesthetic experience. In using the Rx6 method we suggest a simple, easy to follow, clear structure for this.

The Rx6 method is well suited for creative arts therapists, both for experienced researchers and for newcomers to the field, for psychologists, psychotherapists, and health researchers in general. The structure can be modulated and adapted to a variety of arts-based methods and approaches. The short written notes we used in our example can be exchanged with other expressions of the response art method (Chilton, Gerber, Councill, & Dreyer, 2015). The method can be used at several steps in the research process (Chilton et al., 2015; Gerge, 2016; Leavy, 2015) and be helpful when developing rich and expressive findings (Ledger & Edwards, 2011).

From an expressive arts perspective Shaun McNiff (1986, 1992, 1998, 2008, 2011, 2013) has highlighted the artistic endeavour in the aesthetic response as an essential part of ABR. The perspectives we bring to the Rx6 method are grounded in our own professional trainings (visual arts and music), however we consider that one of the major strengths of this method is that the researcher does not need formal training in the arts. It simply involves the capacity to be open and take in what is the focus of attention; that is enough.

The tradition of viewing, describing and researching artifacts produced in a therapeutic context by ABR seemed well suited and aligned with our pre-understandings as psychodynamically oriented psychotherapists, expressive arts therapists, art therapist (Anna Gerge) and music therapists, including GIM (Margareta Wärja and Inge Nygaard Pedersen). In the present study, applying the Rx6 method, we used paintings/drawings produced by research participants. These pictures were aesthetic responses/expressions of the subjects’ on-going rehabilitation processes and life-worlds after treatment for gynaecological cancer before and after participating in a randomized controlled trial with an arts-based intervention (Wärja et al., 2012).

We, (AG and MW) decided to write short aesthetic responses to the artworks done as an avenue to conceptualize, deepen, and expand the tacit understanding of this material. The procedure was carried out in the structured manner of the Rx6-method. This arts-based inquiry was one part of a larger overarching qualitative research process within a mixed methods study. In applying the Rx6-method we followed six steps:

Step 1: Relate to the drawing/painting, as if the viewer “were” the produced image (i.e. change role with the image).

Step 2: Resonate an immediate embodied felt sense. The embodied felt sense is defined in line with the description by Gendlin (1978) as a bodily sensed knowledge, which he called a “felt sense.”

Step 3: Respond from that embodied experience by writing a short text-note (aesthetic response).

Step 4: Reflect together and individually to gain a deepened understanding of the researched phenomena, discoveries, and findings.

Step 5: Results are acknowledged as expanded and deepened perspectives. Further informed ways to present and integrate these discoveries are searched for.

Step 6: React with this new knowledge. On a general level the Rx6-method, and other ABR approaches can lead to a more informed lived experience related the inquired phenomena. This can unleash new ways to encompass reality and – to react.

The steps relate, resonate, respond, and reflect represent a fine-tuning, layering process that can be implemented in relation to a research topic. In this example of responding to the research participants’ pictorial artifacts, we chose written statements. The whole procedure of each aesthetic response took about one minute. First taking in the image as a felt sense experience, responding to it by jotting down a few sentences on a post-it note, and then sticking it to the back of each painting. Certainly, in arts-based research it is possible to respond with various art expressions - images, sounds, rhythms, music and/or movements - that emerge in the felt sense of the responder. After the initial response, one can proceed by responding in one or more of the modalities or transfer to other art-forms, for example “answer” with a new drawing/painting to a done drawing/painting (Gerge, 2016) or by a performance piece.

The Rx6-method can be conceptualized as an adaptation to the heuristic research process (Moustakas, 1994; Schenstead, 2012), which includes: Initial engagement and Immersion – the researcher is involved in the world of experience; Incubation a space for awareness and trusting tacit knowledge (insights and understanding), including delving into the implicit domain, Illumination – an active knowing process to expand the understanding of the experience. This phase includes finding and feeling what is essential by staying immersed with the data until a new meaning arrives, Explication – reflective actions, and finally the Creative Synthesis – bringing together the phenomena to show the patterns and relationships. All through this process it is important that the researcher reflects on the internal frame of reference, practices in keeping one’s own personal context in mind, and tries to understand how this personal domain might influence the experience of the phenomena.

In Table 1 below, we bring an overview of the thematic structure of Rx6 also related to the phases of heuristic research described above.

The following is a detailed step-by-step description of the Rx6-method using the example of written notes as responses to art created by research participants. The short condensed texts were easily administrated and handled, yet holding the aesthetic experience and immersion of a given moment (bare consciousness). Words are descriptive and can hold multiple meanings, and symbolic contents, especially in metaphors (Barone & Eisner, 2012; Lakoff & Johnson, 1980/2003, 1999).

The focus of our inquiry was to understand developmental processes of women being treated for gynaecological cancer as revealed in their artwork. An approach, called KMR, Brief-Music Journeys (Korta musikresor) (Wärja, 2010) based in the tradition of Guided Imagery and Music (GIM), was chosen for the intervention. It involves listening to pre-selected short pieces of music of varying dynamic intensity (Wärja & Bonde, 2014), which lasted between 3 to 5 minutes, followed by an art-making experience, and a reflective phase around the music experience. Here the method was meant to evoke images and life-themes connected to cancer (Wärja, 2012a, 2012b, 2015). Wärja (principal investigator of the intervention study) collected pictures and texts, where the participants’ responses to their body images were gathered at three times: baseline, post-test, and follow-up after 7 months. At follow-up only paintings from the participants in the individual treatment arm were gathered. The information provided each time was, “Paint a picture quite freely and spontaneously about the experience of your body today, after illness and after cancer treatments. How do you see your body? How does it feel? How do you experience your body? After the painting was completed a similar instruction was given for writing a free and spontaneous text.

Short response statements were individually jotted down on Post-it® note (7,5 cm x 7,5 cm) by the first two authors. The statements were placed on the back of each painting. In the first step all pictorial artifacts from baseline were analysed through ABR (n = 57) to be followed by artifacts collected at post-test (n = 45), and concluded with the analysis of images from follow-up (n = 15). At follow-up only pictures from the individual treatment arm was collected. During the next step, we placed the paintings from baseline and post-test next to each other. This opened to a viewing and taking in a new combined picture, where the two pictures were “speaking to each other”. We noted changes and differences and gave room for a response. As researchers we were well aware of the therapeutic intervention that had taken place between measurements. This was most likely the case for the research participants, however at the time of data collection previous pictures were not shown. In particular, we focused on what we perceived as the change process that had taken place between the images, which was hypothesized to be an effect of the intervention. We then proceeded by adding the paintings from follow-up, thus having three images lined up (n = 15). The responding process continued until all sequences of pictorial artifacts had been worked through. In our case we worked through in total 117 pictorial artifacts. The brief written statements, used as response art, can be described as essences of immediate, spontaneous, and embodied words. The ABR process involved dialoguing with the image and inviting the possibility of surprise and emotional resonance.

When the cycle of steps and processes of aesthetic responses were followed through, a corroboration of ABR had been completed. This arts-based inquiry had a particular focus on the developmental progress between pre- and post-test images. As a final piece we thus, as a corroboration, let the multiple pieces of artistic data (the raw data) come together in a compelling whole. MW and AG composed a spontaneous free text as a condensation of what we had just experienced. This was done both to make a closure and to potentially increase the validity of the inquiry.

We found the Rx6 method helpful in carving out categories to be used in further analyses around body image connected to gynaecological cancer. (Results leading to React). We consider, in line with Viega (2016b), that art as a primary method in research can add to a deepened understanding. The emotional difficulties and existential exposure of women with a history of gynaecological cancer became explicit when encountering their artwork with an ABR stance. ABR energized us in the research process. It seemed evident, that even if the medical cancer treatments were completed, the psychosocial, sexual, and existential health of the research participants could still be improved (Juraskova et al., 2003, Steele & Fitch, 2008).

The pictorial artifacts produced by the research participants opened to a more profound understanding of the affective quality of their felt sense experience (Gendlin, 1964, 1978), such as being vulnerable, angry, and afraid. This new pre-understanding could be brought into further reflections and could sharpen the qualitative analyses to be conducted. Albeit the art was not used as an adjunctive method in research but could also have been conducted in this way.

To conclude we will highlight some general advances of the ABR-approach: