Art therapy (also known as arts therapy) is a creative method of expression used as a therapeutic technique. Art therapy originated in the fields of art and psychotherapy and may vary in definition.
Art therapy may focus on the creative art-making process itself, as therapy, or on the analysis of expression gained through an exchange of patient and therapist interaction. The psychoanalytic approach was one of the earliest forms of art psychotherapy. This approach employs the transference process between the therapist and the client who makes art. The therapist interprets the client's symbolic self-expression as communicated in the art and elicits interpretations from the client. Analysis of transference is no longer always a component.
Current art therapy includes a vast number of other approaches such as person-centered, cognitive, behavior, Gestalt, narrative, Adlerian, and family. The tenets of art therapy involve humanism, creativity, reconciling emotional conflicts, fostering self-awareness, and personal growth.
Video Art therapy
Definitions
Various definitions of the term "art therapy" exist.
The British Association of Art Therapists defines art therapy as "a form of psychotherapy that uses art media as its primary mode of expression and communication."
The American Art Therapy Association defines art therapy as: "an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship."
Maps Art therapy
Uses
As a mental health profession, art therapy is employed in many clinical and other settings with diverse populations. Art therapy can also be found in non-clinical settings, as well as in art studios and in creativity development workshops. Closely related in practice to marriage and family therapists and mental health counselors, U.S. art therapists are licensed under various titles, depending upon their individual qualifications and the type of licenses available in a given state. Art therapists may hold licenses as art therapists, creative arts therapists, marriage and family therapists, counselors of various types, psychologists, nurse practitioners, social workers, occupational therapists, or rehabilitation therapists. Art therapists may have received advanced degrees in art therapy or in a related field such as psychology in which case they would have to obtain post-master's or post-doctorate certification as an art therapist. Art therapists work with populations of all ages and with a wide variety of disorders and diseases. Art therapists provide services to children, adolescents, and adults, whether as individuals, couples, families, or groups.
Using their evaluative and psychotherapy skills, art therapists choose materials and interventions appropriate to their clients' needs and design sessions to achieve therapeutic goals and objectives. They use the creative process to help their clients increase insight, cope with stress, work through traumatic experiences, increase cognitive, memory and neurosensory abilities, improve interpersonal relationships and achieve greater self-fulfillment. The activities an art therapist chooses to do with clients depend on a variety of factors such as their mental state or age. Many art therapists draw upon images from resources such as ARAS (Archive for Research in Archetypal Symbolism) to incorporate historical art and symbols into their work with patients. Depending on the state, province, or country, the term "art therapist" may be reserved for those who are professionals trained in both art and therapy and hold a master or doctoral degree in art therapy or certification in art therapy obtained after a graduate degree in a related field. Other professionals, such as mental health counselors, social workers, psychologists, and play therapists combine art therapy methods with basic psychotherapeutic modalities in their treatment. Therapists may better understand a client's absorption of information after assessing elements of their artwork.
Trauma in children
In Stella A. Stephney's book Art Therapy With Students At Risk: Fostering Resilience and Growth through Self-Expression, Stephney states that art therapy can be used to help at-risk children.
General illness
People always search for some escape from illness and it has been found that art is one of the more common methods. Art and the creative process can aid many illnesses (cancer, heart disease, influenza, etc.). People can escape the emotional effects of illness through art making and many creative methods. Sometimes people cannot express the way they feel, as it can be difficult to put into words, and art can help people express their experiences. "During art therapy, people can explore past, present and future experiences using art as a form of coping". Art can be a refuge for the intense emotions associated with illness; there are no limits to the imagination in finding creative ways to express emotions.
Hospitals have started studying the influence of arts on patient care and found that participants in art programs have better vitals and fewer complications sleeping. Artistic influence doesn't need to be participation in a program, but studies have found that a landscape picture in a hospital room had reduced need for narcotic pain killers and less time in recovery at the hospital.
Cancer diagnosis
Art therapists have conducted studies to understand why some cancer patients turned to art making as a coping mechanism and a tool to creating a positive identity outside of being a cancer patient. Women in the study participated in different art programs ranging from pottery and card making to drawing and painting. The programs helped them regain an identity outside of having cancer, lessened emotional pain of their on-going fight with cancer, and also giving them hope for the future.
In a study involving women facing cancer-related difficulties such as fear, pain, altered social relationships, etc., it was found that:
Engaging in different types of visual art (textiles, card making, collage, pottery, watercolor, acrylics) helped these women in 4 major ways. First, it helped them focus on positive life experiences, relieving their ongoing preoccupation with cancer. Second, it enhanced their self-worth and identity by providing them with opportunities to demonstrate continuity, challenge, and achievement. Third, it enabled them to maintain a social identity that resisted being defined by cancer. Finally, it allowed them to express their feelings in a symbolic manner, especially during chemotherapy.
Another study showed those who participated in these types of activities were discharged earlier than those who did not participate.
Studies have also shown how the emotional distress of cancer patients has been reduced when utilizing the creative process. The women made drawings of themselves throughout the treatment process while also doing yoga and meditating; these actions combined helped to alleviate some symptoms.
A review of 12 studies investigating the use of art therapy in cancer patients by Wood, Molassiotis, and Payne (2010) investigated the symptoms of emotional, social, physical, global functioning, and spiritual controls of cancer patients. They found that art therapy can improve the process of psychological readjustment to the change, loss, and uncertainty associated with surviving cancer. It was also suggested that art therapy can provide a sense of "meaning-making" because of the physical act of creating the art. When given five individual sessions of art therapy once per week, art therapy was shown to be useful for personal empowerment by helping the cancer patients understand their own boundaries in relation to the needs of other people. In turn, those who had art therapy treatment felt more connected to others and found social interaction more enjoyable than individuals who did not receive art therapy treatment. Furthermore, art therapy improved motivation levels, abilities to discuss emotional and physical health, general well-being, and increased global quality of life in cancer patients.
Disaster relief
Art therapy has been used in a variety of traumatic experiences, including disaster relief and crisis intervention. Art therapists have worked with children, adolescents and adults after natural and manmade disasters, encouraging them to make art in response to their experiences. Some suggested strategies for working with victims of disaster include: assessing for distress or post traumatic stress disorder (PTSD), normalizing feelings, modeling coping skills, promoting relaxation skills, establishing a social support network, and increasing a sense of security and stability.{rp|120ff}}
Dementia
While art therapy helps with behavioral issues it does not appear to affect worsening mental abilities. Tentative evidence supports benefits with respect to quality of life.
Autism
Art therapy has not been studied much in autism as of 2011.
Schizophrenia
A 2005 systematic review of art therapy as an add on treatment for schizophrenia found unclear effects.
Purpose
The purpose of art therapy is essentially one of healing. Art therapy can be successfully applied to clients with physical, mental or emotional problems, diseases and disorders. Any type of visual art and art medium can be employed within the therapeutic process, including painting, drawing, sculpting, photography, and digital art.
One proposed learning mechanism is through the increased excitation, and as a consequence, strengthening of neuronal connections.
A typical session
Malchiodi (2006) provides an example of what an art therapy session involves and how it is different from an art class. "In most art therapy sessions, the focus is on your inner experience--your feelings, perceptions, and imagination. While art therapy may involve learning skills or art techniques, the emphasis is generally first on developing and expressing images that come from inside the person, rather than those he or she sees in the outside world. And while some traditional art classes may ask you to paint or draw from your imagination, in art therapy, your inner world of images, feelings, thoughts, and ideas are always of primary importance to the experience.
Art therapy can take place in a variety of different settings. Art therapists may vary the goals of art therapy and the way they provide art therapy, depending upon the institution's or client's needs. After an assessment of the client's strengths and needs, art therapy may be offered in either an individual or group format, according to which is better suited to the person. Art therapist Dr. Ellen G. Horovitz wrote, "My responsibilities vary from job to job. It is wholly different when one works as a consultant or in an agency as opposed to private practice. In private practice, it becomes more complex and far reaching. If you are the primary therapist then your responsibilities can swing from the spectrum of social work to the primary care of the patient. This includes dovetailing with physicians, judges, family members, and sometimes even community members that might be important in the caretaking of the individual." Like other psychotherapists in private practice, some art therapists find it important to ensure, for the therapeutic relationship, that the sessions occur each week in the same space and at the same time.
Art therapy is often offered in schools as a form of therapy for children because of their creativity and interest in art as a means of expression. Art therapy can benefit children with a variety of issues, such as learning disabilities, speech and language disorders, behavioral disorders, and other emotional disturbances that might be hindering a child's learning . Similar to other psychologists that work in schools, art therapists should be able to diagnose the problems facing their student clients, and individualize treatment and interventions. Art therapists work closely with teachers and parents in order to implement their therapy strategies.
Art-based assessments
Art therapists and other professionals use art-based assessments to evaluate emotional, cognitive, and developmental conditions. There are also many psychological assessments that utilize artmaking to analyze various types of mental functioning (Betts, 2005). Art therapists and other professionals are educated to administer and interpret these assessments, most of which rely on simple directives and a standardized array of art materials (Malchiodi 1998, 2003; Betts, 2005). The first drawing assessment for psychological purposes was created in 1906 by German psychiatrist Fritz Mohr (Malchiodi 1998). In 1926, researcher Florence Goodenough created a drawing test to measure the intelligence in children called the Draw-A-Man Test (Malchiodi 1998). The key to interpreting the Draw-A-Man Test was that the more details a child incorporated into the drawing, the MORE intelligent they were (Malchiodi, 1998). Goodenough and other researchers realized the test had just as much to do with personality as it did intelligence (Malchiodi, 1998). Several other psychiatric art assessments were created in the 1940s, and have been used ever since (Malchiodi 1998).
Notwithstanding, many art therapists eschew diagnostic testing and indeed some writers (Hogan 1997) question the validity of therapists making interpretative assumptions. Below are some examples of art therapy assessments:
Diagnostic Drawing Series
The Diagnostic Drawing Series (DDS) is a three-picture art interview designed by Barry M. Cohen and Barbara Lesowitz in 1982. It is one of the most commonly taught art therapy assessments and, with more than 60 DDS studies to date, it is the most researched art therapy tool worldwide. Cohen and colleagues wrote the DDS Rating Guide that directs mental health professionals on how to score the DDS. The related research, based on the structure rather than the content of the drawings, offers a way for the art therapist to contribute to the diagnostic process.
The Diagnostic Drawing Series is standardized and was designed to be compatible with empirical social science methodology. Administrators also pay attention to the behaviors and behavioral changes of the test-taker. The DDS is designed to be administered to people aged 13 and over, but there are versions that are geared toward the assessment of children.
The assessment is administered at a table. The subject is given flat-sided chalk pastels and 18 X 24 inch white drawing paper.
Research on the DDS uses criteria that includes the following:
- Color: number used
- Enclosure
- Line length
- Space usage
- Integration
- Movement
- Placement on the page
The DDS has a drawing archive for reference. Cohen provided a quantifiable assessment for art therapists to use around the world. The test protocol attempts to control for the influence of medications and pharmaceutical confounding factors. The DDS is considered to be a reliable and valid assessment tool, and evidence continues to accrue to support this. In general, projective tests tend to be much more unreliable than objective tests. Training in the Diagnostic Drawing Series increases administrators' ability to apply research findings to the appropriate assessment of the subject.
Mandala Assessment Research Instrument
In this assessment, a person is asked to select a card from a deck with different mandalas (designs enclosed in a geometric shape) and then must choose a color from a set of colored cards. The person is then asked to draw the mandala from the card they choose with an oil pastel of the color of their choice. The artist is then asked to explain if there were any meanings, experiences, or related information related to the mandala they drew. This test is based on the beliefs of Joan Kellogg, who sees a recurring correlation between the images, pattern and shapes in the mandalas that people draw and the personalities of the artists. This test assesses and gives clues to a person's psychological progressions and their current psychological condition (Malchiodi 1998). The mandala originates in Buddhism; its connections with spirituality help us to see links with transpersonal art.
House-Tree-Person
The House-Tree-Person test (HTP) is a projective test designed to measure aspects of a person's personality. The test can also be used to assess brain damage and general mental functioning. By virtue of being a projective test, the results of the HTP are subjective and open to interpretation by the administrator of the exam. HTP was designed by John Buck and was originally based on the Goodenough scale of intellectual functioning. Buck included both qualitative and quantitative measurements of intellectual ability in the HTP (V). A 350-page manual was written by Buck to instruct the test-giver on proper grading of the HTP, which is more subjective than quantitative. In contrast with him, Zoltán Vass published a more sophisticated approach, based on system analysis (SSCA, Seven-Step Configuration Analysis).
Administering the Test: HTP is given to persons above the age of three and takes approximately 150 minutes to complete based on the person's level of mental functioning. During the first phase, the test-taker is asked to draw the house, tree, and person and the test-giver asks questions each picture. There are 60 questions originally designed by Buck but art therapists and trained test administrators can also design their own questions, or ask follow up questions. This phase is done with a crayon. During the second phase of HTP, the test-taker draws the same pictures with a pencil or pen. Again the test-giver asks similar questions about the drawings. Note: some mental health professionals only administer phase one or two and may change the writing instrument as desired. Variations of the test may ask the person to draw one person of each sex, or put all drawings on the same page.
Examples of follow up questions:
- After the House: Who lives here? Is the occupant happy? What goes on inside the house? What's it like at night? Do people visit the house? What else do the people in the house want to add to the drawing?
- After the Tree: What kind of tree is this? How old is the tree? What season is it? Has anyone tried to cut it down? What else grows nearby? Who waters this tree? Trees need sunshine to live so does it get enough sunshine?
- After the Person is drawn: who is the person? How old is the person? What do they like and dislike doing? Has anyone tried to hurt them? Who looks out for them?
Interpretation of results:
The quantitative measure of intelligence for the House-tree-person has been shown to highly correlate with the WAIS and other well-established intelligence tests.
The subjective analysis of the test takers responses and drawings aims to make inferences of personality traits and past experiences. The subjective nature of this aspect of the HTP, as with other qualitative tests, has little empirical evidence to support its reliability or validity. This test, however, is still considered an accurate measure of brain damage and used in the assessment of schizophrenic patients also suffering from brain damage.
Road drawing
In this drawing assessment and therapeutic intervention, the patient is asked to draw a road. This is a projective assessment used to create a graphic representation of the person's "road of life." The road drawing has the potential to elicit spontaneous imagery that represents the client's origins, the history of his or her life process, experiences to date, and intent for the future - even from a single drawing (Hanes, 1995, 1997, 2008). The road's reparative features or its need for "periodic upgrade" can serve as a metaphor for client's capacity for change and restoration (Hanes, 1995, 1997, 2008).
History
Although art therapy is a relatively young therapeutic discipline, its roots lie in the use of the arts in the 'moral treatment' of psychiatric patients in the late 18th century, this moral treatment, Susan Hogan argues, "arose out of utilitarian philosophy and also from a non-conformist religious tradition", and in a re-evaluation of the art of non-western art and of the art of untrained artists and of the insane.
Art therapy as a profession began in the mid-20th century, arising independently in English-speaking and European countries. The early art therapists who published accounts of their work acknowledged the influence of aesthetics, psychiatry, psychoanalysis, rehabilitation, early childhood education, and art education, to varying degrees, on their practices.
The British artist Adrian Hill coined the term art therapy in 1942. Hill, recovering from tuberculosis in a sanatorium, discovered the therapeutic benefits of drawing and painting while convalescing. He wrote that the value of art therapy lay in "completely engrossing the mind (as well as the fingers)...releasing the creative energy of the frequently inhibited patient", which enabled the patient to "build up a strong defence against his misfortunes". He suggested artistic work to his fellow patients. That began his art therapy work, which was documented in 1945 in his book, Art Versus Illness.
The artist Edward Adamson, demobilised after WW2, joined Adrian Hill to extend Hill's work to the British long stay mental hospitals. Other early proponents of art therapy in Britain include E. M. Lyddiatt, Michael Edwards, Diana Raphael-Halliday and Rita Simon. The British Association of Art Therapists was founded in 1964.
U.S. art therapy pioneers Margaret Naumburg and Edith Kramer began practicing at around the same time as Hill. Naumburg, an educator, asserted that "art therapy is psychoanalytically oriented" and that free art expression "becomes a form of symbolic speech which...leads to an increase in verbalization in the course of therapy." Edith Kramer, an artist, pointed out the importance of the creative process, psychological defenses, and artistic quality, writing that "sublimation is attained when forms are created that successfully contain...anger, anxiety, or pain." Other early proponents of art therapy in the United States include Elinor Ulman, Robert "Bob" Ault, and Judith Rubin. The American Art Therapy Association was founded in 1969.
National professional associations of art therapy exist in many countries, including Brazil, Canada, Finland, Israel, Japan, the Netherlands, Romania, South Korea, and Sweden. International networking contributes to the establishment of standards for education and practice.
Diverse perspectives exist on history of art therapy, which complement those that focus on the institutionalization of art therapy as a profession in Britain and the United States.
Outsider art
The relation between the fields of art therapy and outsider art has been widely debated. The term 'art brut' was first coined by French artist Jean Dubuffet to describe art created outside the boundaries of official culture. Dubuffet used the term 'art brut' to focus on artistic practice by insane-asylum patients. The English translation "outsider art" was first used by art critic Roger Cardinal in 1972.
Both terms have been criticized because of their social and personal impact on both patients and artists. Art therapy professionals have been accused of not putting enough emphasis on the artistic value and meaning of the artist's works, considering them only from a medical perspective. This led to the misconception of the whole outsider art practice, while addressing therapeutical issues within the field of aesthetical discussion. Outsider Art, on the contrary, has been negatively judged because of the labeling of the artists' work, i.e. the equation artist = genius = insane. Moreover, the business-related issues on the term outsider art carry some misunderstandings. While the outsider artist is part of a specific art system, which can add a positive value to both the artist's work as well as his personal development, it can also imprison him within the boundaries of the system itself.
Standards of practice in the United States
Board certification and registration
In the United States, art therapists may become Registered (ATR) or Board Certified (ATR-BC) (Source: http://www.atcb.org/Public/AboutTheCredentials). The ATCB Code of Professional Practice is divided into five main categories; General Ethical Principles, Independent Practitioner, Eligibility for Credentials, Standards of Conduct, and Disciplinary Procedures (ATCB 2005). Becoming a registered art therapist (ATR) with the ATCB requires that one complete a graduate-level program in art therapy from an accredited university, as well as practicum and internships, and additional clinical experience post-graduation with supervision from a professional clinician (Source: www.atcb.org/home/code). To become board-certified (ATR-BC) with the ATCB, a registered art therapist must pass a statistically vetted, nationally recognized examination, the Art Therapy Credentials Board Examination (ATCBE) (Source: www.atcb.org).
Licensure
In some states, art therapists can be licensed as an art therapist, creative art therapist (LCAT; NY State only), or professional or mental health counselor (many states). For more information on how to become licensed, US art therapist should contact the state licensure board in the state in the US in which they wish to practice. Art therapy students who are preparing for practice in the field should consult with their academic advisers about what courses are necessary to meet board certification and/or licensure requirements. Licensure is generally needed to obtain reimbursement for services as an independent practitioner and in some states, is required by law in order to practice independently. Depending on where an art therapist practices geographically, certification is not always necessary in becoming a professional art therapist. Source: http://www.atcb.org/Examinations/StateApplicants
Education standards
The entry level educational preparation for professional art therapists is a master's degree in art therapy, or a master's degree in related counseling or psychology fields, with an art therapy focus. According to The American Art Therapy Association (AATA), master's program students must have taken courses in a variety of studio art disciplines as a means of signifying artistic proficiency as a prerequisite to the master's degree. Additionally, students are required to take at least 48 credit hours at the graduate level in particular art therapy, counseling, and psychology related topics, as well as successfully partaking in practica and internships. In countries other than the US, art therapists should contact governmental or regulatory boards that oversee the practice of mental health or health care professions to identify any specific coursework or education that is needed. Because art therapy is still considered a developing field, most countries do not regulate its practice and application.
Post-master's
In order to apply for the ATR (registered art therapist) certification with the Art Therapy Credentials Board (ATCB), candidates are required to complete a minimum of 1,000 hours of direct client contact post-graduation from a master's program that is AATA-approved or a minimum of 1,500 hours from a master's program that is not AATA-approved (Source: www.atcb.org/pdf/ATR_Application.pdf). After obtaining an ATR, individuals have the opportunity to apply for Board Certification from the Art Therapy Credentials Board by passing a nationally vetted examination, the ATCBE. Practitioners are encouraged to contact their state's licensing board or the office of their state attorney general to investigate licensure, which is different from certification.
General ethical principles
One topic covered in this section describes the responsibility art therapist have to their patients (ATCB 2005). According to the ATCB, art therapists must strive to advance the wellness of their clients, respect the rights of the client, and make sure they are providing a useful service (2005). They cannot discriminate against patient whatsoever, and may never desert or neglect patients receiving therapy. Art therapist must fully explain to their patients what their expectations of the patients will be at the outset of the professional relationship between the two. Art therapists should continue therapy with a patient only if the client is benefiting from the therapy. It's against the principles established by the ATCB for art therapist to have patients only for financial reasons.
Another topic of this section discusses the competency and integrity art therapists must possess (ATCB 2005). The ATCB states art therapists must be professionally proficient and must have integrity (2005). Art therapists must keep updated on new developments in art therapy.
They are only supposed to treat cases in which they are qualified as established by their training, education, and experience (ATCB 2005). They are not allowed to treat patients currently seeing another therapist without the other therapist's permission (ATCB 2005). Art therapists must also observe patient confidentiality (ATCB 2005).
Other topics covered in this section further discuss responsibilities of art therapists. These responsibilities include, "responsibility to students and supervisees, responsibility to research participants, responsibility to the profession" (ATCB 2005). This section also establishes the rules by which art therapists must follow when making financial arrangements and when they choose to advertise their service (ATCB 2005).
Eligibility for credentials
This section of the ATCB Code of Professional Practice outlines the process by which art therapy students receive their credentials. It discusses the standards for eligibility and describes the application process. It also states that the ATCB certificates are the property of the ATCB and that any art therapist who fails to maintain the credential and still claims to have ATCB credentials is subject to sanctions. It also discusses the procedure to follow when accused of criminal or ethical wrongdoing. For more information about the ATCB Code of Professional Practice, please visit www.atcb.org/home/ATCBcode.
Standards of conduct
This section of the ATCB Code of Professional Practice addresses in detail confidentiality, use of clients' artwork, professional relationships, and grounds for discipline.
Art therapists are not permitted to disclose information about the clients' therapy sessions. This includes "all verbal and/or artistic expression occurring within a client-therapist relationship" (ATCB 2005). Art therapist are only allowed to release confidential information if they have explicit written consent by the patient or if the therapist has reason to believe the patient needs immediate help to address a severe danger to the patient's life. Also, therapists are not allowed to publish or display any of the patient's work without the expressed written consent of the patient.
The standards of a professional relationship between art therapists and clients are covered in this section. Within a professional relationship, art therapists are banned from engaging in exploitative relationships with current and former patients, students, interns, trainees, supervisors, or co-workers. The ATCB defines an exploitative relationship as anything involving sexual intimacy, romance, or borrowing or loaning money. Within professional relationships, therapists are to do what they feel is best in the client's interest, shall not advance a professional relationship for their own benefit, and shall not steer their patients in the wrong direction.
The breaking of any of the standards established in this section is grounds for discipline.
Disciplinary procedures
The content contained in this section of the ATCB Code of Professional Practice specifically discusses in legal and technical detail the entire disciplinary procedures for wrongdoings in art therapy (2005). Main topics covered in this section cover: "submission of allegations, procedures of the Disciplinary Hearing Committees, sanctions, release of information, waivers, reconsideration of eligibility and reinstatement of credentials, deadlines, bias, prejudice, and impartiality".
While the ATCB oversees disciplinary procedures for art therapists, if an art therapist is licensed, the state board through which the art therapist is licensed carries out disciplinary action for violations or unethical practice.
See also
- Bibliotherapy
- Comic book therapy
- Expressive therapy
- List of psychotherapies
- List of therapies
References
External links
- Media related to Art therapy at Wikimedia Commons
Source of the article : Wikipedia
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