Literature review of art therapy-based interventions for work-related stress

Abstract

Numerous interventions have been developed to address work-related stress but evidence of their efficacy is sparse. A growing interest in the impact of the arts on well-being is reflected in arts-based interventions being used to address work-related stress, but these remain poorly evidenced. This article reviews art therapy publications describing interventions to address work-related stress and aims to ascertain the current state of practice and research within this field. Publications were organised into two categories: art therapy interventions within mental and general healthcare; and art therapy interventions within palliative and oncology care, a category that comprised nearly one-half of all publications reviewed.     

‘It’s not all fun’: Introducing digital technology to meet the emotional and mental health needs of adults with learning disabilities

ABSTRACT

A project that began with an aspiration to introduce digital technologies into an arts therapies service turned into arts therapies taking a lead on these being introduced across all professions and services in a National Health Service (NHS) Learning Disabilities Service. This article can only give limited details of the project as a whole; rather, consideration is given to the benefits of digital technologies to adults with a learning disability, with particular focus on gesture-based technologies. Project design and methodology are described, followed by brief accounts of gesture-based technology (GBT) used across the spectrum of arts engagement and art therapy. Data from qualitative outcome measures inform discussion of the impact of and potential for gesture-based technology in arts therapies practice. In conclusion, we recommend areas for further investigation, and perhaps encourage others to overcome systemic barriers to introducing digital innovation.     

From rendering to remembering: Art therapy for people with Alzheimer's disease

Abstract

Throughout the last two decades, creative arts therapies have been increasingly used for support and therapeutic care in a variety of health care facilities. Personal growth through artistic activity is possible at every stage of life, even for those with dementia due to older age. Alzheimer's disease (AD) is a prevalent neurological condition without definitive cause and with limited effective treatments and interventions available. The brain regions and mechanisms involved in creating visual art are not irreparably compromised for those with Alzheimer's disease. Art therapy as a treatment for people with dementia can improve the quality of life through the benefits that come from using the visual arts to communicate inner experience and connect with others. Furthermore, creative activities stimulate several regions of the brain simultaneously, encouraging a healthy brain in older adults by promoting the brain's plastic processes. This article provides a review of the benefits of art therapy for people with AD based on the existing literature and encourages further research into the use of art therapy with this client group.     

Processes of change in school-based art therapy with children: A systematic qualitative study

Although theoretical processes of art therapy with children have been suggested, they have lacked a systematic research basis. This systematic qualitative study explored children’s school-based one-to-one art therapy in order to create a theory of change. Across two primary schools, 14 children were interviewed individually, as were their parents, teachers and art therapists (total N?=?40). All children had received art therapy within the previous 12 months. Children completed an art activity to aid the interview process. Interview data were analysed using grounded theory methodology. The analysis generated a preliminary model with three components. ‘Component 1—school context’ highlights the systemic nature of art therapy as well as its mystique to those not directly involved. ‘Component 2—core model’ describes art therapy as individualised and child-centred. Art-doing and making were considered central to children’s expression and developing understandings. ‘Component 3—change and no change’ describes the connection between identifying therapy aims and perceiving change. Recommendations are that art therapy be considered for children struggling to verbalise their difficulties; that therapists focus on therapeutic experiences being fun and enjoyable for the child, as well as embedded within the child’s system; and lastly that clear target problems are identified at the start of therapy.     

Using literature as a therapeutic tool with people with moderate and borderline learning disabilities in a forensic setting

In the past, it was rare for services for people with learning disabilities to focus on meeting the emotional and personal development needs of their clients, concentrating instead on interventions that aimed to improve self‐care, develop appropriate social skills and reduce challenging behaviours. However, recent work using psychotherapeutic interventions and art therapies has started to remedy this traditional shortfall. The purpose of this paper is to discuss the successful use of an art‐based therapy, using literature (often termed Biblio‐therapy and Poetry Therapy in published research) that has been hitherto generally overlooked with a client group of men with learning disabilities who have offended, on account of their lack of literacy skills and likely lack of understanding of the use of metaphor. The paper describes the background to the work, the preparation of materials, the presentation of the psychotherapeutically‐based group work and it's effectiveness in encouraging the development of emotional maturity and self‐expression within a mixed‐ability client group of young men in a high security setting.     

Students’ artistic experience before and during graduate training

This qualitative study investigated creative arts therapies students’ relationship with the arts during a pre-training phase beginning student phase, and advanced student phase. Thematic analysis was used to identify themes and patterns within the data. Major findings suggest that during the pre-training phase, art therapy students, followed by dance movement therapy students, had more extensive learning and practical experience in their art form than drama therapy students. Also during this phase, art therapy students use their art form for self-care more often than did dance movement therapy students, and there were no indications of drama being used for self-care by drama therapy students. During training, most students refrained from personal art making outside of training due to lack of time and money; students’ conception of their art form changed from aesthetic product to expressive process; and in-training exposure to different modalities as well as professional socialization in practicum cultivated students’ individual and collective professional identity. Policy and practice implications are suggested and recommendations for further research are offered.     

A case example of art therapy in relation to Dialectical Behaviour Therapy

Abstract

Theoretical and practical aspects of Dialectical Behaviour Therapy (DBT) as developed by Marsha Linehan are related to the development of a pragmatic art therapy approach to working with severe distress and disturbance, including ‘borderline personality disorder’, through a case example. The dialectical approach of DBT to acceptance and change, emotional regulation and the development of ‘wise mind’ are found to resonate with art-making processes, both inside and outside the formal art therapeutic space, and the art therapist's interventions become central to a team approach. Innovative art therapy interventions (for example the structured use of ‘homework’) and theory (for example ‘the Learning Circle’) contribute to a therapeutic journey from dangerous and extreme patterns of self harm and in patient admissions to a stabilised and community-based level of support. The approach challenges the helpfulness of a formal psychodynamic psychotherapeutic model of art therapy in all circumstances. It opens up the possibilities of developing art therapy not only as an integrated aspect of a DBT-based approach, but also of developing art-making and therapeutic relationships in terms of a psychosocial education model. Psychotherapy understandings underpin, contain and amplify pragmatic, arts-based interventions which are shown to catalyse profound psychological change.     

Indigenous music therapy theory building through grounded theory research: The developing indigenous theory framework

There are diverse understandings within music therapy about what constitutes theory. Also, there is debate about whether research methodology, developed outside of the field of music therapy, is able to support the development of music therapy theory that is indigenous to the profession. In this paper, a framework, called the developing indigenous theory (DIT) framework, which allows for the development of indigenous theory through the use of grounded theory research methodology, is presented. A new definition of indigenous music therapy theory is provided. Here, indigenous music therapy theory refers to knowledge emergent from music therapy relationships which are able to be plausibly generalised across settings and time, allowing for the development of theory that is idiosyncratic to the field of music therapy. The difference between “precursors to theory” and actual “theory” are examined, and the outcomes of numerous studies are considered through the use of the framework. The distinction between complete and modified grounded theory studies is discussed. It is suggested that the DIT framework may hold relevance for the development of theory in other human relationship-based arts therapies.     

The rise and fall of the autochthonous self: from Italian Renaissance art and Shakespeare to Heidegger, Lacan, and intersubjectivism

This article addresses the unresolved question of the existence of a private core autochthonous self, as it has been described by Winnicott, Modell, and others. The postmodern version of the self has eliminated this concept entirely, relegating the self to a changing and unstable display, or regarding it as totally chaotic, or even an illusion. The question is raised whether by returning to the origins of this notion of a private self and then tracing its apparent dissolution it might be possible to discover some evidence that it still exists. The methodology used is that of obtaining knowledge directly through the arts and the claim is made that because empirical science has clamored to be the only source of knowledge, we have lost what could be obtained by direct intuitive seeing and experiencing the works of creative geniuses. To explore the rise of the autochthonous self this article provides an examination of the shift from Gothic art to Italian Renaissance art, a time which engendered the origin of "man" with his or her elusive private individual self that then became expressed in changing works of art. As this spread north, Shakespeare appeared and similarly invented and illustrated in his characters the private individual self, a concept not appreciated or recognized before the renaissance. But as science arose and Western civilization began to decline, a corresponding disillusionment with "man" took place. The self began to be viewed as solely a social construction with no core except perhaps a genetic endowment. This was accompanied by a reduction in the concept of the human as a valuable and precious living being and was replaced by regarding the human as an object of control and exploitation. After the Second World War a movement in contemporary United States psychoanalysis gradually replaced the ideas of Freud and his emphasis on the "I" in the psychoanalytic process, with forms of relational therapy, assuming that the self was ab initio intersubjectively formed and could be altered fundamentally by focus on intersubjective processes. The author contends that this attitude makes it less likely for the psychoanalyst to focus on the regressive transferences from which derivatives of the private self arise and to grasp the phenomenological whole of the patient.     

Introduction: commentaries and author's response to "The rise and fall of the autochthonous self: from Italian Renaissance Art and Shakespeare to Hediegger, Lacan, and Intersubjectivism" by Richard D. Chessick

This article addresses the unresolved question of the existence of a private core autochthonous self, as it has been described by Winnicott, Modell, and others. The postmodern version of the self has eliminated this concept entirely, relegating the self to a changing and unstable display, or regarding it as totally chaotic, or even an illusion. The question is raised whether by returning to the origins of this notion of a private self and then tracing its apparent dissolution it might be possible to discover some evidence that it still exists. The methodology used is that of obtaining knowledge directly through the arts and the claim is made that because empirical science has clamored to be the only source of knowledge, we have lost what could be obtained by direct intuitive seeing and experiencing the works of creative geniuses. To explore the rise of the autochthonous self this article provides an examination of the shift from Gothic art to Italian Renaissance art, a time which engendered the origin of "man" with his or her elusive private individual self that then became expressed in changing works of art. As this spread north, Shakespeare appeared and similarly invented and illustrated in his characters the private individual self, a concept not appreciated or recognized before the Renaissance. But as science arose and Western civilization began to decline, a corresponding disillusionment with "man" took place. The self began to be viewed as solely a social construction with no core except perhaps a genetic endowment. This was accompanied by a reduction in the concept of the human as a valuable and precious living being and was replaced by regarding the human as an object of control and exploitation. After the Second World War a movement in contemporary United States psychoanalysis gradually replaced the ideas of Freud and his emphasis on the "I" in the psychoanalytic process, with forms of relational therapy, assuming that the self was ab initio intersubjectively formed and could be altered fundamentally by focus on intersubjective processes. The author contends that this attitude makes it less likely for the psychoanalyst to focus on the regressive transferences from which derivatives of the private self arise and to grasp the phenomenological whole of the patient (p. 625).     

Development of an art-therapy intervention for patients with personality disorders: an intervention mapping study

Art therapy for people diagnosed with personality disorders (PD) cluster B/C seems valuable to explore dysfunctional patterns in managing emotions. Current art therapy interventions are based on practical beliefs or commonsense approaches, without a sound basis in research results. To increase the effectiveness of art therapy for this target group, a planned, systematic and theory-based approach is needed. The principles of Intervention Mapping were applied to guide the development, implementation, and planned evaluation of the art therapy intervention. Empirical findings, theoretical models, and clinical practice experience were combined to construct a programme tailored to the needs of the target group. A structured 10-session art therapy intervention programme for patients was developed, aimed at: experiencing a (more) stable and positive sense of self, being able to express and regulate emotions, understanding emotions, thoughts and behaviours, using improved social and problem solving skills. Implementation took place and evaluation of the intervention is being carried out. The systematically developed art therapy intervention seems to be promising for PD patients in learning to deal with their problems. The results of the evaluation study may contribute to the knowledge about the use of art therapy for PD problems.     

The emergence of dance/movement therapy in Estonia

In 1991 the Baltic nation of Estonia peacefully achieved independence from the Soviet Union. The arts played a significant role throughout this historic process and they continue to be an important in contemporary Estonian society. Out of these roots, there is growing academic and professional focus on the uses of creativity to facilitate health, well-being and other therapeutic goals. This paper is based on the author's experiences as a U.S. Fulbright Scholar teaching at Tallinn University's Department of Applied Creativity in 2011. It examines recent academic and professional developments in the field of dance/movement therapy and other creative arts therapies in Estonia. It also analyzes the academic, cultural, and economic factors that will likely have significant influence on the future of Estonian dance/movement therapy and creative art therapies.     

Holding and creating: A grounded theory of art therapy with 0–5-year-olds

Abstract

This research utilised grounded theory methodology to explore the current clinical experiences of art therapists who work with young children, formulating an art therapy frame that currently does not exist. Following a series of focus groups with art therapists who have worked extensively with 0–5-year-olds, additional written and creative responses were collected and further clarified the emergent theoretical frame. This theoretical frame posits art therapy as a modality that offers both creativity and structure, a dialectic integration that responds to identified issues at the early stages of life while combating pressures to over-standardise treatment.     

Music and healing in cancer care: A survey of supportive care providers

This paper explores the role of music activity and music therapy in health care drawing on a survey of UK cancer care providers offering music interventions and music therapy. The survey examined the extent and type of music provision and explored providers’ views about the role and contribution of music and music therapy in healing. As well as music, the survey organisations offered a range of supportive therapies including complementary and alternative therapies (CAM) and creative therapies such as art therapy. The results provide insight into the way in which music and creative therapies are viewed by those responsible for care provision in this sector. The data point towards some of the challenges facing music therapists in the changing world of cancer care. These include responding to changes arising from developments in treatment and the organisation of care as well as increased collaboration with a diverse range of supportive care practitioners. These include providers of music and arts for health activity as well as complementary and alternative therapy practitioners who are increasingly involved in cancer care provision. We discuss the implications of these changes for the development of music therapy in cancer care.     

Art therapy for people diagnosed with schizophrenia: Therapists’ views about what changes,how and for whom

Abstract

National guidance recommends that clinicians consider the offer of arts therapies including art therapy to people diagnosed with schizophrenia. However, because schizophrenia is a heterogeneous condition and this recommendation is based on population-level evidence, it may be difficult to meaningfully apply locally. Whilst art therapy is inextricably linked with ‘psychosis’ and receives clinical support, those charged with implementing guidance, developing and delivering services need to know more about art therapy, specifically what changes, how and for whom. We used grounded theory methods to address these questions from the perspective of art therapists. The data demonstrate richness and diversity in practice and therapists’ abiding belief in its inherent value; art therapy is ‘good’ for those who engage. We present therapists’ understandings of schizophrenia, conceptualise therapy as occurring in the complex interaction of use of art materials, space, therapist and participant and propose mechanisms of action, understood as both unique and universal and potential ‘outcomes’. Whilst therapists’ dedication to their practice is apparent and the potential benefits of its non-medical system status cannot be ignored it seems that integration of art therapy within the spectrum of care necessary to effectively support people diagnosed with schizophrenia will require clear articulation of theory and practice.     

Arts with offenders: A literature synthesis

This article applies systematic review and meta-synthesis techniques to research studies (qualitative and quantitative) with the aim of addressing the research question: do the arts have any role to play in therapeutic goals for offenders?While arts and arts therapies are used in various offender contexts research has been variable in purpose, style and rigor. This is the first systematic attempt to compile a literature synthesis concerning the role of arts with offender populations.A systematic review and literature synthesis of both qualitative and quantitative studies was conducted, with a focus on systematic research addressing questions either of efficacy/effectiveness, or of the nature and experience of arts practice with offenders.Notwithstanding methodological shortcomings, arts and arts therapies were invariably found to be associated with improvements in arousal levels, emotional literacy, and quality of life.While both qualitative and quantitative reports tend to focus on the same broad issues identified in this literature synthesis, they communicate these findings using very different languages. The authors recommend a mixed methods approach in future research, to facilitate an understanding of the effects of arts with offenders through different lenses and measure their long term effects on offender behaviour.     

The Use of Art Therapy in Alleviating Mental Health Symptoms in Refugees: A Literature Review

There are over thirty million refugees globally with severe experiences of trauma. Art therapy intervention allows for nonverbal expression and could alleviate mental health symptomatology among refugees. The present review’s aim was to integrate and summarize the previous research which examined the effects of visual arts on alleviating psychological conditions of refugees. However, due to the paucity of studies which solely used visual arts, we included studies that used visual arts alongside other modalities as part of an expressive arts therapy intervention. The present review synthesizes studies that examined the effect of art therapy on mental health issues of refugees from January 2000 to March 2021. Seven studies (child and adolescent sample, N = 5 and adult sample, N = 2) with a total of 298 refugee participants (n = 298) met our inclusion criteria. The participants were from the Middle East and North Africa (MENA), Southeast Asia, and Europe. We found three commonly reported mental health disorders, namely Post Traumatic Stress Disorder (PTSD), anxiety, and Major Depression Disorder. The research highlights how art therapy interventions could be a great starting point to alleviate symptomatology among refugees. Four additional benefits of art therapy which were commonly reported across the seven studies emerged from this review: working with traumatic experience/loss, rebuilding social connection and trust, nonverbal communication and self-expression of loss and trauma, and retelling stories. Art therapy interventions could be used as a starting point in the healing process of traumatized refugees to encourage verbal articulation of their feelings and reduce mental health symptoms. Despite these promising findings, due to a dearth of robust methodologies, further research is required to assess the long-term effectiveness of art therapy.     

Art therapy in the postmodern world: Findings from a comparative study across the UK, Russia and Latvia

This is a comparative study of the development of art therapy in the UK, Russia and Latvia. The study is triggered by the belief that important learning can take place from fostering shared understanding and respecting differences across practices within a postmodern world that bears the danger of fragmentation and the loss of professional identity. Following a discussion of key postmodern ideas within art and arts therapies and historical references to the development of art therapy in the three countries studied, this paper provides an opportunity for empirically-based comparisons of practice. In particular, a questionnaire, originally developed by Karkou (1998), was disseminated to all practicing art therapists in the UK, Russian and Latvian specialists using art and art therapy methods, Russian graduates and Latvian students of the first training program in art therapy ( [Nazarova, 2008] and [Martinsone, 2009]). Collected information relating to work environments, client groups and therapeutic trends were statistically analyzed in order to identify differences across countries. Mutual interactions and ‘cultural borrowing’ were also found and discussed primarily with regard to therapeutic trends. Despite methodological limitations, the study opens the way for future collaborations on the basis of informed understanding of art therapy practices across countries.     

Art as subjective solution: a Lacanian theory of art therapy

Lacanian psychoanalysis is not frequently mentioned in discussions of art therapy. Yet its premises offer intriguing possibilities for art therapists. Lacan was engaged with art and artists and often turns to artworks in his essays and seminars, not only as illustration for psychoanalytical concepts but also as sources of new knowledge for psychoanalysis. Lacanian psychoanalysis also highlights the inherent link between creativity and solutions individuals find for their suffering, as do theories of art therapy. This article proceeds upon the recognition that the fields of art therapy and Freudian-Lacanian psychoanalysis, especially in its consideration of creativity and the arts, have much to offer one another. Combining theories of expressive therapies and Lacanian psychoanalysis, this article works towards a systematic articulation of a Lacanian theory of art therapy.