The Arts in Psychotherapy

Published by Elsevier
Print ISSN: 0197-4556
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This article is a comprehensive analysis of qualitative music therapy research studies published in peer-reviewed music therapy and non-music therapy journals, peer-reviewed research monographs, and in edited books. The review focuses on four areas of the research report: author, publishing venue, and report information; topic and focus; methodological concerns; and, the reporting of findings. Important conclusions are that this research is meeting the stated goal of its originators by creating a clinically relevant research base. However, some methodological concerns emerged that warrant attention from researchers, primarily in the area of evaluation standards and procedures, and in the lack of sufficient transparency in data analysis. The most frequently used methods include grounded theory, naturalistic inquiry, and phenomenology. Although the results are primarily descriptive in nature, the study also contains a list of ten representative studies that demonstrate how to include sufficient methodological information within the size constraints of book chapters and journal articles.
 
This paper presents a systematic analysis of methodologies used in research published in Art Therapy: Journal of AATA between the years 1987 and 2004. The context of epistemological paradigm shifts affecting research in general and art therapy research in particular is examined. Quantitative inquiry supports hypotheses that the number of publications has continued to grow over the years and that author demographics differ from general demographic of art therapists. A qualitative analysis identified eight methods common to art therapy research: clinical case studies, self studies, survey research, interviews, art therapy tests, historiography/anthropological research, behavioral observations, and exploration of clients’ artworks. Thematic exploration of each method and integration of findings suggest indicators of methods’ maturation and shifts in how and when methods are utilized, field-specific challenges, and emergence of art therapy research norms.
 
This article is a comprehensive analysis of qualitative music therapy research studies undertaken for doctoral degrees and written in English. The review focuses on six areas: demographic information, report attributes, topic and focus, research methods and procedures, research findings, and evaluations of methodological information. Conclusions of the research include the judgment that the predominance of studies are methodologically sound although more attention can be paid to areas such as selection criteria, reflexivity, the evolution of the study, the choice of evaluation standards and procedures, illustrating data analysis, and acknowledging the presence and influence of dual relationships.
 
Recent cognitive behavioral therapy (CBT) approaches to treatment of substance use disorder (SUD) have emphasized the need for clients to explore emotional regulation and experiential avoidance. This study aimed to determine whether music therapy programs situated within a CBT framework facilitated the exploration of emotions in 24 adults with SUD attending a hospital open group CBT program. In a 7-week trial, the impact of a single music therapy session on participants’ emotional experience was assessed using a self-report questionnaire at the end of each participant's first session. Results indicated that music therapy sessions facilitate the experiencing of predominantly positive emotions, and that these were experienced to a moderate or high degree. Participants reported that music therapy was beneficial in allowing them to experience emotions without the need for substance use. It is recommended that clinicians include interventions that encourage the exploration of negative emotions so that clients can experience these in a safe environment.
 
The proposed study aims to investigate whether dissociation-defined as a disturbance or alteration of the usually integrated functions of identity, memory or conscious [American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.).Washington, DC: American Psychiatric Association.] – can be depicted within drawings of the “traumatic event” drawn by survivors of childhood sexual abuse.Twenty-seven drawings, drawn by childhood sexual abuse survivors were collected from therapists after clients signed informed consent forms. Following the completion of drawing the “traumatic event”, the Self Report version of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ; [Marmar, C. R., Weiss, D. S., & Metzler, T. J. (1997). The Peritraumatic Dissociative Experiences Questionnaire. In J. P. Wilson, & T. M. Keane (Eds.), Assessing psychological trauma and PTS.D. (pp. 412–428). New York, NY: The Guilford Press.]) was administered.Drawings were analyzed by two practitioners according to the five dissociative symptom categories [Steinberg, M. (1997). Assessing posttraumatic dissociation with the structured clinical interview For DSM-IV dissociative disorders. In J. P.Wilson, & T. M. Keane (Eds.), Assessing Psychological Trauma and PTS.D. (pp. 429–448). New York, NY: The Guilford Press.]: amnesia, depersonalization, derealization, identity confusion and identity alteration. Indicators were selected upon face validity and previous studies, including a preliminary study conducted by the author.Correlation analysis between indicators and PDEQ score was conducted. In addition analysis of variance to compare survivors who were still minors and adult survivors was conducted.Findings revealed that a significant correlation between indicators of derealization in drawings and PDEQ scores exists, in the adult group only. In addition, minors scored significantly higher on the PDEQ than adults. However, comparison between drawings of adults with drawings of minors indicated that adults scored significantly higher on the dissociative symptoms of identity confusion and identity alteration than minors.Findings may indicate that traumatic event drawings have a potential for being developed for diagnostic, therapeutic and forensic purposes. Suggestions for further research are offered.
 
Reviewing approximately 20 items of literature on art therapy with substance abusers, this article examines addict problems addressed in art therapy, characteristics of artwork by alcoholics and drug abusers, art therapists' roles and treatment styles, the special techniques, goals, and outcomes of art therapy for this population.
 
Until now, art therapists relied on manual ratings for instruments such as the Face Stimulus Assessment, which is a series of stimulus drawings used to garner projective information from clients [FSA, Betts, 2003; Hamilton, M. K. (2008). Developing a standardized rating system for the Face Stimulus Assessment (FSA) using nine scales adapted from the Formal Elements Art Therapy Scale (FEATS). Unpublished master's thesis, Avila University, Kansas City, MO]. The current study outlines several image analysis techniques intended to complement interpretive analysis through demonstrating public domain image analysis software (PDIAS) capabilities adapted for measuring formal elements [Gantt, L., & Tabone, C. (1998). The formal elements art therapy scale. Morgantown, WV: Gargoyle Press]. An FSA drawing completed by an individual formally diagnosed with schizophrenia serves as the model. This study also extends manual [Gantt, L., & Tabone, C. (1998). The formal elements art therapy scale. Morgantown, WV: Gargoyle Press] and computer-assisted ratings [Kim, S. I., Bae, J., & Lee, Y. (2007). A computer system to rate the color-related formal elements in art therapy assessments. The Arts in Psychotherapy, 34, 3] through this model by using readily available PDIAS. Case study results indicate that PDIAS is able to analyze accurately formal elements of an FSA drawing. Research implications include improved inter-rater reliability in the adapted Prominence of Color Scale [Gantt, L., & Tabone, C. (1998). The formal elements art therapy scale. Morgantown, WV: Gargoyle Press; Hamilton, M. K. (2008). Developing a standardized rating system for the Face Stimulus Assessment (FSA) using nine scales adapted from the Formal Elements Art Therapy Scale (FEATS). Unpublished master's thesis, Avila University, Kansas City, MO] and the development of highly accurate art therapy assessment rating scales for those without extensive computer analysis backgrounds.
 
“We use our minds not to discover facts but to hide them.” Antonio Damasio“Art makes the invisible visible.” Paul KleeIn this article I propose an art therapy trauma protocol (ATTP) designed to address the non-verbal core of traumatic memory. Trauma theorists [van der Kolk, B.A. (2003). Frontiers in trauma treatment. Presented at the R. Cassidy Seminars, St. Louis, MO 2004; Steele, W. & Raider, M. (2001). Structured Sensory Intervention for Traumatized Children, Adolescents and Parents-Strategies to Alleviate Trauma. New York: The Edwin Mellen Press] have endorsed alternative treatment methods such as eye movement desensitization reprocessing (EMDR), body-based psychotherapy, and expressive arts therapy as an alternative to verbal psychotherapy. Following an overview of the role of memory and emotions in trauma and theories of art making and brain function, I describe a protocol that has had success in integrating the cognitive, emotional and physiological levels of trauma drawing on EMDR, McNamee's bilateral art and Michelle Cassou's method of painting. A one-session example serves to illustrate its use.
 
The aim of this paper is to initiate a comparative and theoretical study between the mechanisms of cognitive behavioral intervention (CBI) versus art therapy, in relation to the acute stress disorder (ASD) stage of trauma. The literature on CBI, art therapy, and ASD will be briefly reviewed. Similarities between these two theoretically disparate interventions will be outlined, pointing to the relevance of CBI and art therapy to alter maladaptive and traumatic sensory processing, affect excitatory reactions, modulate and challenge explicit traumatic memories and stimulate a subsequent cognitive process. Implications for mental health professionals intervening in the relatively flexible ASD period are discussed.
 
The observations reported are of the emotional, cognitive and affective reactions of youngsters with thalassaemia major, and are based upon direct, long-term clinical experience with more than a hundred children and adolescent patients who have been treated for this fatal illness, in the Department of Paediatrics and Child Care, Hadassah University Hospital, Jerusalem, Israel. These psychological reactions, which may be unique to this illness, appear to be significantly influenced by predisposing specific and idiosyncratic cognitive and cultural approaches and conceptualisations, and by the combined effects of early diagnosis and subsequent availability of modern medical therapeutics and technology. Maintenance of a relatively high haemoglobin level (above 9 dl) allows affected children to attend normal school settings and to lead relatively unrestricted lives during the early childhood and adolescent years. However, denial, unrealistic expectations, linked and combined with wide ranging cognitive distortions of illness, profound clinical depression and a pathological passivity and easy regression, social withdrawal and isolation, unsolicited dependency and profound psychological decompensation often appear to be common dynamic elements, at least during the adolescent years, foreshadowing imminent death. Emotional reactivity of the affected adolescent may be quite bewildering, and a case presentation together with an analysis of human figure drawings produced by youngsters with this illness has been included in an attempt to document these special neuro-psychological and active disruptive management issues. When affected children grow up and emotionally mature, thalassaemic adolescents, in our experience, tend to exhibit an uncharacteristic unprotesting and uncritically acquiescent and pathologically-based passivity and, further, exhibit unwarranted and, hence, often unrealistically-maintained high levels of optimism, unconsciously linked to much denial in what is clearly and tragically an inescapable confrontation with the prospects of a fatal illness with a prognosticated early death. Survival beyond age twenty-five is rare. Organising a more comprehensively orchestrated concerned psychological approach to both developmental and maturational needs with the establishment of a trusting, mutually-respectful therapeutic alliance with the medical team may in part help to overcome some of the inevitable difficulties which may otherwise menacingly interfere with optimal medical management. Hundreds of medical and technician staff contacts with frequent hospitalisations and the prospect of surgical intervention contribute to the equation of anxiety. Parental reactions to the inescapable prospects of an early death at adolescence or later often parallel those of the affected children. Anxiety, guilt, body-image disturbances of a profound and malignant psychological order combine with chronic inclinations and an easy readiness towards depression which are transparently evident in both children and their respective parents at times of acute crises, surgery or later medical decompensation. Therapeutic guidelines and principles of behavioural management are laid down which will assist the active clinician in better recognising and understanding some often difficult problems which are too easily avoided lest special attention be drawn to them.
 
The poet, through the exploration of his own inner space and time, becomes a specialist in those inner experiences called dreams, images, visions, reverie, memory, and hallucination. This is why the poet has always had affinity for both the child and the madman—both victims of the denial and repression of self fostered by family, school, and society. (Berger, 1973, p. 175)
 
This study examines the effectiveness of a cinematherapy intervention at enhancing the perceived self-esteem of 16 youth with a serious emotional disturbance. Participants completed the Rosenberg Self-Esteem Scale (RSE) at pre-, post-, and 1-week follow-up within a 6-week coping skills group in which a brief cinematherapy intervention is introduced to a treatment and delayed treatment group. A control group was used, which only received the coping skills training. Results of a split-plot analysis of variance (ANOVA) with one between-groups factor and one repeated-measures factor revealed no significant differences within or between groups, however, meaningful differences between the three groups were found. Implications for counselors and therapists are discussed.
 
Asperger's syndrome is a neurodevelopmental disorder characterized by impairments in social interaction, restricted, repetitive and stereotyped patterns of behavior, interests, and activities. Adolescents with Asperger's syndrome have developed a compromised self-regulatory system, which leads to difficulty in many areas of functioning. Some of these areas include social, behavioral, emotional, and an increase in anxiety. Art therapy is an important activity based intervention that allows those with Asperger's syndrome to receive and learn information in a non-conventional, nonverbal, comprehensive, and expressive language. Over a 7-month period of creating art, Emma became increasingly more communicative and comfortable in areas of functioning, especially social interactions. The incorporation of visual creativity allowed her to express herself and be heard on a new level of communication. Through her artwork she was able to move from having difficulty in functioning to learning, growing, challenging herself, and making post-secondary education plans.
 
The construct of emotion regulation (ER) has received considerable emphasis in developmental psychology, with growing interest in the possible association of dysfunctional ER with various forms of child and adolescent psychopathology. However, the empirical study of emotions often entails their abstraction from the immediate context – particularly, from interpersonal and social variables having a pivotal role in the origin and modulation of emotive processes. In this study we used a school-based drama intervention with special class, immigrant adolescents with behavioral difficulties as a real-life context for the study of forms of emotional expression (EE) and strategies of ER using qualitative methods of analysis. Our findings suggest some impairment in EE and ER in this study sample. In addition, we observed difficulties accessing a range of emotions appropriate to a variety of circumstances, anger being the predominantly expressed negative emotion. Hypotheses drawing on issues of immigration and marginalization were raised to explain this finding. In general, the drama process seemed to help emotional expression and awareness and to foster a transformation of emotive processes in the sense of a “collective ER.” The importance of teacher awareness of students’ dominant emotional state and its potential impact on learning was emphasized.
 
This descriptive paper explores the effect of music as a stimulus in creative storywriting in an ongoing inpatient group psychotherapy with young adolescents. While short segments of music were played, each group member was instructed to compose a story of his choice. As the musical selections changed, the stories were rotated among group members to allow each to write part of every story. Clinical examples are cited to illustrate the utility of the technique as a projective diagnostic tool and as an aid in promoting positive interaction and group cohesion. In addition, directions for further research regarding the potential utility of the technique are discussed.
 
The aim of this study was to assess the therapeutic efficacy of analytical psychodrama groups for psychiatric adolescents.Six patients with various psychiatric diseases (mean age 16.67 years, SD ± 1.21) were assessed before, during and after psychotherapy (12 sessions, one a week) by administering the Symptom Check List-90 (SCL 90 R) to identify any changes in their symptoms. Their clinical pictures are described, with observations on their treatment. The findings were compared with those of a clinical control group.The results demonstrated the efficacy of the treatment in terms of symptom reduction, with statistically significant differences by comparison with the control group.
 
The aim of this study was to determine the effectiveness of psychodrama on the attachment styles of young adults and to assess the qualitative gains of psychodrama participants. The subjects of the study were 21 master's level students. Data were gathered by using the Experiences in Close Relationships-Revised (ECR-R) form and a personal information form. The study used the mixed method. The quantitative aspect of the study involved the use of pretest–posttest experimental and control group design with random assignment, while the qualitative aspect utilized the methods of case study, observation and interview. A 12-session psychodrama program extending over 3 months was implemented with the experimental subjects, while the control subjects underwent a placebo study. The quantitative findings showed that participating in the group psychodrama program was effective on the anxious attachment style of young adults. However, no meaningful difference existed between the experimental and control groups regarding the anxiety dimension. The qualitative findings, on the other hand, suggested that psychodrama participants improved themselves in understanding the self; developing insight; having awareness of attachment styles; natural and forthcoming in their relationships; having self-confidence; developing listening, empathy and coping skills; and seeing life from a more hopeful perspective.
 
Although phototherapy has been around in one form or another since the advent of the camera it has only recently, with the wider use and lower prices of computers and digital editing equipment, taken on more universal interest within the art therapy community as a viable new modality for art therapists who have not, in the past, had the resources available to implement a more traditional film-based phototherapy component in their practice. This paper demonstrates the integration of digital media into the training of phototherapists within graduate-level art therapy training programs. While the examples and illustrations given here are of graduate students enrolled in masters-level art therapy training programs, these exercises may be modified for use with various client populations. This paper addresses the need of those creative art therapists who are currently in practice and have not had the advantage of benefiting from the advances in digital technology that currently enrolled students have had.
 
The article describes the body of knowledge of arts therapies in forensic psychiatry based on recent practice, theory and research. The first part gives an overview of observational details, interventions, effects and rationales of drama therapy, music therapy, art therapy and dance-movement therapy in general and more specifically in the Netherlands. It shows that arts therapies can help to decrease recidivism. In the second part the results are presented of a qualitative naturalistic inquiry with 31 experienced arts therapists working in 12 institutions in the Netherlands and Germany. The arts therapists have been involved by means of semi-structured questionnaires, interviews and focus groups. Their implicit knowledge about indications, goals, interventions, effects and rationales have been compared and integrated into consensus-based treatment methods. The research reflects the Dutch tradition where all arts therapies are developed and researched within the same methodological formats. The results of one of the problem areas that have been researched, destructive aggression, are presented. Finally a comparison has been made between all arts therapies for the treatment of destructive aggression.
 
The objectives of this study were twofold: to better understand urban children and adolescents’ views of aggression and empathy and how those views may change when exposed to a Playback Theatre intervention; and to measure students’ understanding of the criminal justice/court system through the impact of instructive material on their comprehension levels. In an urban middle school, fifth and eighth grade students were randomly assigned (within age and gender) to experience a Playback Theatre intervention (N = 24) or to a video intervention control group (N = 23). All of the students received instruction on the basics of the criminal justice system. Also, students in both groups received pre- and post-intervention testing, including a comprehension test of the criminal justice/court system, an aggression questionnaire and an empathy scale. Students in both groups showed a significant increase in comprehension levels of the criminal justice/court system between assessments. Also, students’ ratings of tolerance for aggression were significantly reduced after exposure to Playback Theatre, however, students’ empathy scores were not significantly affected. The intervention of Playback Theatre yielded qualitative responses from students indicating that better perspective taking might be the mechanism underlying the effects of the Playback Theatre experience.Highlights► Playback Theatre explored as intervention to build empathy, reduce aggression w/kids. ► Allowing children to express experience via story may increase perspective taking. ► Strengths of Playback Theatre as a form of drama therapy and research intervention. ► Empathy scores remained unchanged (ns), aggression scores changed (p < .05). ► Knowledge of criminal justice increased significantly from pre to post test (p < .001).
 
Aggression is one of the major reasons for inpatient hospitalization in child psychiatry. The problem of aggression faced by inpatient child psychiatry needs solutions that are practical in nature and offer an ease of implementation. In this study a psychotherapeutic relaxation group, a combination of creative arts therapy and progressive muscle relaxation, was implemented in the school setting of inpatient child psychiatry at Elmhurst Hospital Center, Queens, New York to explore the relationship between the group and aggression. The control group N = 23 received treatment as usual, and the experimental group N = 25 in addition to treatment as usual received up to 13.5 h of relaxation training. Both groups were rated daily during school hours by the Modified Overt Aggression Scale (MOAS). The experimental group demonstrated significantly lower aggression scores as measured by the MOAS. Analysis utilized a two-tailed t-test and univariate analysis of covariance (ANCOVA) with length of stay as a co-variate and both tests produced almost identical and significant results on total aggression scores. Along with other management techniques, a relaxation prevention program may help children manage aggressive impulses and prevent crisis situations due to aggression.
 
This paper presents a model for improving the effectiveness of individual art therapy with children who behave aggressively. It addresses two major challenges. First, these children often present the therapist with several dilemmas, such as how to respond when faced with symbolic or direct expressions of aggression, and how to establish a treatment relationship when clients arouse strong emotions in the therapist. Second, when working in educational settings, art therapists often question whether they should strive to integrate themselves into the school and, if so, what should be their role with teachers and parents?The model presented here emerged from a phenomenological study that included a survey of a large sample of Israeli art therapists and in-depth follow-up interviews with two sub-samples of therapists, who treated aggressive children and whose cases showed the most and least improvement. The study, which focused on the relation between treatment outcomes and therapists’ practices, perceptions, and experiences, yielded a conceptual model for effective treatment. The model highlights the dual principal of conveying acceptance and directing toward change, which is applied on three levels: the child, teachers and parents, and the therapist. The paper presents the model and suggestions for its implementation.
 
Children are commonly encountered who are reluctant or unable to directly discuss their emotional or behavioral problems with a therapist. Numerous techniques have been employed in the attempt to learn more about the attitudes, traits, and characteristics that are part of these children's personalities, but about which they, themselves, may be unaware. These techniques include the use of drawings, storytelling, puppets and doll play. Described and illustrated is a technique (the Draw a Story game) adapted from D. W. Winnicott's Squiggle game, R. Gardner's storytelling techniques, and commonly accepted use of children's drawings that has proved helpful in the evaluation and treatment of children with emotional problems.
 
World AIDS Day 2000—view of the clinic setting and placement of the mural.  
Living With AIDS I.  
Valentine I.  
This paper describes the process and impact of community progressive mural-making in an HIV/AIDS outpatient clinic. The words and drawings in these murals were the spontaneous expressions of the patients, their families, and the staff at the clinic. Six murals were created over a period of seven months and were housed in the lobby of the clinic. The project revealed unique insights into the inner experiences of the individual patients, and into the culture of the HIV/AIDS clinic community. This paper highlights the parallels between group dynamics, the group art therapy process, and the development of a community culture through the creation a symbolic therapeutic group in a progressive mural.
 
Since Sifneos in 1973 introduced the term, “alexithymia” to describe the apparent incapacity of some of his patients to discern and verbally express their emotions, without finding a physical cause for it, this phenomenon has become the object of various studies and publications. In the pursuit of effective treatment methods, art therapy has been indicated as being among the possibly effective forms of treatment. But in the literature on art therapy alexithymia up to now has scarcely received the attention the authors believe it deserves. This paper focuses on the concept of alexithymia, especially in psychotrauma, and the usefulness of art therapy. A concise review of literature on the concept of alexithymia is included and an illustration of the use of art therapy by a detailed description of treatment of a case of alexithymia in a patient, Rita, with severe self-pathology, who had grown up in a traumatizing environment. The patient was able to recognize and name emotional reactions after the treatment with art therapy, and thus, art therapy seems to be a promising form of treatment for traumatized patients suffering from alexithymia, even in cases of severe self-pathology.
 
This article explores the use of play and metaphor in clinical supervision. The intention is not to attempt to cover the whole area of play, or the use of metaphor in clinical supervision, but rather to highlight particular aspects of their respective roles in the service of learning about therapeutic work. The relevance of the arts – especially the visual arts – in relation to this is also discussed. A number of brief clinical vignettes are included by way of illustration. All names, and some identifying details, have been changed to preserve confidentiality.
 
This article takes its starting point from certain results from our randomized study on art therapy with women with breast cancer. Previous results from this study showed significant benefits on coping, quality of life, and symptoms for women who participated in an art therapy intervention. Analyses of interviews and diaries showed that especially women from the intervention group had distanced themselves from traditionally gendered understandings about cultural limits and boundaries. The aim of this study was to gain further knowledge about how women with breast cancer who participated in the art therapy intervention gave meaning to the gendered limits and boundaries in their daily lives, and to trace their trajectories, in therapy, towards helpful management of restraining boundaries. When analyzing the women's verbal reflections on the therapy sessions, we discerned five subject positions, defining them as follows: being someone who reacts to violation attempts; actively connecting body and self; actively locating oneself and moving forward; being in a position to see important connections throughout life; and being able to acknowledge and harbour conflicting emotions. The results of the study suggest that art therapy served as a tool that helped the women to get access to subject positions that enabled them to protect and strengthen their boundaries. This involved challenging dominating discourses and reacting against perceived boundary violations. Art therapy offered a personal, physical, and pictorial “safe space” with opportunities to deal with complex existential experiences and issues, and also make important connections throughout life. Looking back and summarizing important experiences acted as a way to prepare oneself for the future and moving forward.
 
Creative arts therapists, as professionals, have progressed from their nascent position in developing training programs and defining skills and competencies for qualified art, dance/movement and music therapists in particular. It appears, however, that we Mill may he in a nascent position in defining our role with relationship to other mental health professionals in the work setting.Cashell, an an therapist and Miner, a dance/movement therapist, present a provocative survey and discussion of this issue, identify some problems and suggest we have much to do to clarify our role as members of the mental health profession with specific skills that are valuable and valued.We invite our readers to contribute their thoughts about this issue, either in the form of letters to the Editor or as articles on the subject.
 
The music therapy analyzing partitura (MAP) is a method that was recently proposed to visually describe and analyze music therapy sessions. The main objective of this study was to examine the method and to see if it was in fact clear and usable to music therapists (MTs). Twenty-six experienced and inexperienced MTs were exposed to a MAP and to a written verbal description of the same session. Under a time limitation, they answered informative questions regarding the session and, in addition, indicated the potential of each of the descriptions to raise and analyze research questions. It was found that MTs could easily understand the MAP code. When using the MAP, they correctly answered significantly more questions in comparison with the verbal condition. MTs indicated that the MAP had better analyzing potential than the verbal description. Suggestions for future development of the MAP, as well as its possible implications to arts therapists at large, are discussed.
 
This study examines the Animal Kinetic Family Drawing (AKFD) as a diagnostic tool to assess how parental divorce affects the self-concept of latency children. A Kinetic Family Drawing (KFD) and an AKFD were administered to latency children from intact and divorced families. A previously validated self-concept scoring system was applied to the interpretation of both KFD and AKFD tasks. Self-concept scores of the divorced and intact family groups were compared for both the KFD and AKFD. Additionally, scores for each task were compared within each study group. Two hypotheses were tested. One states that children of divorced parents will show a lower self-concept score on both the KFD and AKFD than children of intact parents. The other hypothesis states that within the divorce group children will achieve higher self-concept scores on the AKFD than the KFD and there will be no significant difference in the scores of the two tasks in the intact group. This hypothesis is based on the assumption that the AKFD is less threatening and more revealing of unconscious material than the KFD. There were no significant differences in the self-concept scores between the divorce and intact group of children with either task. Nor were there any significant differences between the KFD and AKFD within either group.
 
In an era of evidence-based practice (EBP), it is becoming increasingly important to distinguish the quality of research studies and synthesize results so they can be applied to clinical practice. Thus, in an attempt to categorize research and amalgamate results, scholars have developed various hierarchical levels of evidence to differentiate research implications. However, these levels of evidence have not yet been applied to the psychiatric music therapy literature base. The purpose of this paper was to discuss and identify the levels of evidence and apply well-established levels of evidence to the psychiatric music therapy literature base. Results indicated a lack of randomized controlled trials and overall low level of evidence. Further, regardless of taxonomy applied, most studies met criteria for the lowest level of evidence. This finding is congruent with the levels of evidence of other well-established psychosocial treatments for psychiatric consumers. Limitations, generalizations, and implications for research and clinical practice are provided.
 
In today's healthcare environment, there is an urgent need to address job burnout because of its negative impact on medical personnel and consequently, service delivery to patients (Gray-Toft & Anderson, 1981). The purpose of this study was to investigate the effects of music-imagery on self-reported burnout, sense of coherence and job satisfaction in nursing personnel, and to examine the self-reported perceptions of nursing personnel with regards to the music-imagery experiences. Sixty-five medical personnel who had direct patient contact participated in a two-arm randomized controlled mixed-methods trial. Results revealed that there were no statistically significant differences in change scores between the control and experimental groups for self-reported burnout, sense of coherence, and job satisfaction. Qualitative results on the subjects’ self-report of the interventions indicated that the music-imagery experience helped them to relax, rejuvenate, and re-focus, enabling them to complete their shifts with renewed energy. Various reasons for the differences between the qualitative and quantitative results were discussed, as well as implications for future research.
 
This clinical case study describes a 3-year-old girl diagnosed with childhood apraxia of speech and her progress in weekly music therapy. The child was seen for a total of 24 sessions over a period of 9 months. The music therapy treatment involved a mixture of behavioral, improvisational, and creative approaches in what has been termed a data-based music therapy approach. A variety of musical interventions, visual, and interactive aids were used, as well as an engaging, playful dialogue between child and the clinician. The child's communicative methods at the beginning of her treatment process were almost exclusively non-verbal. By the final session, she was pronouncing a number of syllables, combination sounds, and words. The treatment program is described as it unfolded in three phases, and significant events from each individual session are described in detail.
 
Working with and through art in the context of mental health has become popular and quite well known amongst social workers, community workers, nurses, artists and teachers. Many seek art therapy skills, and a greater understanding of the use of art in healing. In parts of the world where there is no professional art therapy training and no established art therapy profession, some may go on to call themselves art therapists. Despite this, art therapy is a recognized profession, with a master's level or post graduate level training and a written code of ethics. This article looks at the ethical considerations we as art therapists face in training non-art therapists. To explore this subject in greater depth we draw upon training we have delivered for social workers in Hong Kong.
 
In a recent survey of art therapists affiliated with the American Art Therapy Association (American Art Therapy Association, I. (2007). Newsletter, XL. American Art Therapy Association, INC., pp. 23), bereavement/grief was listed as one of the top 10 specialties of practicing art therapists. Despite the apparent popularity of this kind of work, publications suggest that stage-based approaches to grief still seem to be the norm (Finn, C. A. (2003). Helping students cope with loss: incorporating art into group counselling. The Journal for Specialists in Group Work, 28, 155–165; Hiltunen, S. M. S. (2003). Bereavement, lamenting and the prism of consciousness: Some practical considerations. The Arts in Psychotherapy, 30, 217–228) regardless of the recent theoretical and empirical advances in bereavement. Instead of seeing the natural process of grief as something that must be experienced in stages, the more recent theories (Neimeyer, R. A. (1998). Lessons of loss: A guide to coping. NY: McGraw-Hill; Stroebe, M. S., & Schut, H. (1999). The dual process of model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197–224) focus on finding meaning in the aftermath of loss and describe the process in a more complex way. These approaches fit well with the art therapist's orientation towards externalizing, facilitating insight and understanding in the client. The article describes these newer approaches to bereavement and provides clinical and theoretical implications for art therapists working in grief/bereavement.
 
This paper explores the narratives of three women who had lived with severe chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) for many years, and who engaged in art-making as a leisure activity rather than for psychotherapy. Three distinct narratives about the role of art-making in CFS/ME were inferred. One participant represented art as a way of filling time rather than having further psychological significance. In her narrative, art provided satisfaction but also functioned as a witness to time and opportunity that had been lost to an unchanging illness. The second participant narrated both illness and art-making as intertwined journeys towards a more able and useful self. Her narrative had features of the quest described in previous typologies. The third participant also provided a quest narrative, but her struggle focused inwards on understanding her feelings about her illness and its effects on her life. The analytic focus on narrative revealed the distinctive constructions of illness and art-making that are usually submerged when qualitative analysis focuses on themes common to groups of participants. These narratives of art-making in CFS/ME have relevance to understanding the multi-faceted therapeutic benefits of art.
 
This article describes a brief service-learning assignment in which graduate art therapy students at an urban university in the United States worked with children residing in a homeless shelter. The term service-learning refers to the integration of community service into a college course to help students achieve specific learning objectives. In this case, service-learning was intended to supplement an art therapy internship course through an opportunity for students to increase knowledge about homelessness. Students’ learning was assessed using the criteria of two art therapy education standards: Cultural and Social Diversity, and Human Growth and Development (American Association of Art Therapy [AATA], 2007). In addition to achievement noted in these areas, the service-learning assignment unexpectedly seemed to foster achievement in a third education standard: Studio Art. This article demonstrates how even a short-term service-learning assignment can enhance art therapy education and benefit the community, when it is thoughtfully integrated into the curriculum and connected to education standards.
 
Three lines of research support the concept that trauma is primarily a nonverbal problem: (a) evolutionary survival responses; (b) brain imagery studies of human responses to trauma cues; and (c) the relation of alexithymia to posttraumatic dissociation. Based on these research findings the authors offer a neurobiological view of psychological trauma that points the way to use art therapy as a primary means of treating posttraumatic symptoms.
 
In making decisions, a human being considers all of the factors concerning the situation in a comprehensive and intuitive manner by using all of his or her experience and knowledge. Due to the inherent nature of human decision making, the reasoning process from confronting the problem to finding a solution is too complicated to be explicitly represented. In this paper, we implement an expert system for the diagnosis process of art psychotherapists. We model the complicated mechanism of this process as several procedural stages and feedbacks. We devise a suitable method of maintaining consistency among numerous decisions derived from the system. We also provide the system with a learning facility to improve its intelligence. Finally, we demonstrate the usefulness and suitability of the proposed system through a case study.
 
The purpose of this investigation was to explore some of the main issues springing from the computerized assessment of art-based instruments (CAABI). The results indicated that there were opposing viewpoints, limitations, and solutions regarding the limitations. Many art therapists believe that this technology will supplant their own expertise in assessment ( [38] and [48]). However, due to the prototypical and delineating nature of these programs, CAABI are incapable of replacing human assessment, particularly clinical intakes (Lichtenberger, 2006). Despite opposition and limitation, the author concluded that there is a need for increased research in CAABI based on the advantages it offers, such as ease-of-use, early detection, less scoring time, reduction of subjective human error, improved statistical measures, and resiliency in the face of healthcare reform ( [48], [49], [52] and [53]). Overall, a hybridization of both subjective and objective methodologies will likely further art therapy assessment, but collaboration between clinicians and program developers is necessary for this to occur ( [45], [51] and [63]).
 
This joint-authored article explores the ways in which music can speak directly to the traumatic, and how music therapy offers a unique means of coming to an understanding of the traumatised patient. We take a musical and psychoanalytical theoretical stance. Drawing on case material from work with a young boy and an adult attending a psychiatric outpatient department, we show how a form of musical listening and thinking about what is emerging in the clinical room can help us to understand something about the patient, about the treatment of those traumatised, and also about the art of music itself. Our aim is to place the music and the therapeutic relationship as the central focus in the work.
 
Ongoing studies have revealed the positive effects of art therapy with prison inmates. The most recent publication presented the effectiveness of art therapy with male and female prisoners [Author. (in press). The effects of art therapy on male and female inmates: Advancing the research base. The Arts in Psychotherapy]; specifically, the results demonstrated significant, positive change with both the male and female prison population in mood and locus of control. However, one interesting trend that seemed to emerge as the study progressed was an apparent difference in the effectiveness and response to the art therapy between the male and female inmate populations. Along with qualitative evaluation, additional statistical calculations were applied to determine if the numbers indicated any significant difference between the men and women in changes of depression and locus of control for those that received art therapy services. The results indicated a trend towards significance in a greater improvement in mood and internal locus of control in female inmates than the male inmates did. This article concludes with a brief discussion on possible reasons for these differences, and with a reevaluation of past theoretical concepts of the advantages of art therapy with prison inmates, contending that not all of these advantages apply to the female inmate population.
 
The purpose of this research was to explore the interaction and influence of cultural, epistemological, and philosophical structures on the development of educational missions, curricular components, and pedagogical methods of doctoral education for art therapists. A modified qualitative case study research design was used to collect data from three primary sources – the literature, interviews, and existing doctoral curricula. The analysis of data resulted in the identification of seven emergent themes that provided constructs for the development of doctoral-level art therapy education. The seven emergent themes that were identified were learning culture, epistemologies, rationale and competencies, interdisciplinarity, research, self- and other knowledge, and pedagogy. A recommendation for the development of a curriculum for a doctoral program in art therapy based upon these seven themes is proposed.
 
Using nodal sessions in the case of a profoundly traumatized woman as an illustrative foundation, this paper explores the mutative actions of psychoanalytically informed art therapy interventions. The efficacy of these interventions, which range from subtle to active, is supported by current research in the fields of neurobiology, infant development, cognitive science, and psychoanalysis. Focus is given to the continuum of dissociation as a survival response to overwhelming trauma, the relationship of dissociative processes to implicit memory, the mirror neuron system, and embodied simulation, as well as ways that the therapist's sensitivity to the impact of trauma and dissociation on the survivor can be harnessed to promote the healing process.
 
At this time in history, the medical world is beginning to accept holistic approaches to aid in the psychosocial treatment of its patients. This is particularly true for cancer patients. Art therapy is one such psychosocial intervention that provides many possibilities for healing for such patients. This case study examines the art therapy experience of one such patient, a 52-year-old male in medical isolation after having received stem cell transplantation (SCT) to treat myelofibrosis, a life-threatening illness. The patient was a Vietnam Veteran and had a history of alcohol abuse. This study examines how the patient’s history impacted his state of mind during hospitalization and isolation and how this was reflected in his artwork. Art therapy provided a means of examining this patient’s past traumas so that he could then move into examining and living in the present moment. It also provides an example of how art therapy moves beyond the means of art making as healing to the world of metaphor and mental imagery as healing agents in a therapeutic process.
 
The Learned Helplessness model of depression is described and its applicability to persons with mental retardation, especially those in institutions, is discussed. The usefulness of Habilitative Arts Therapy as a treatment to alleviate Learned Helplessness among this population is described and illustrated. Case studies are presented. Suggestions for future study are made.
 
There are many benefits to justify the use of art therapy assessment techniques and rating instruments. However, methodological, theoretical and philosophical problems abound. These problems are explored, in relation to art therapy assessments and their corresponding rating tools. Information about the various types of rating scales is provided, including a comparison of the Diagnostic Drawing Series (DDS) rating system and that of the Person Picking an Apple From a Tree (PPAT) assessment, i.e., the Formal Elements Art Therapy Scale (FEATS). The most effective approach to assessment in the field of art therapy appears to incorporate objective measures such as standardized evaluation procedures (formal assessments; behavioral checklists; portfolio evaluation), and subjective approaches such as the client's interpretation of his or her artwork.
 
The purpose of this research was to explore placement and count of standardized sand tray figures based on a sample of adults (n = 5) completing the Erica Method in an effort to address the need for higher accuracy in sand tray assessment ( [8], [17] and [45]). This study demonstrated image analysis capabilities and limitations in assessing both 3-dimensional object count and placement, which are important clinical sand tray assessment components ( [6], [10] and [17]). Public domain image analysis software (PDIAS, Mattson, 2009) objectively determined total sand tray figure count and total sand tray figure area used. Human raters (n = 4) assessed the same criteria. Human-PDIAS inter-rater reliability was higher than human inter-rater reliability. As a result, computerized rating may hold potential for more efficient rating based on this study.
 
Self-portraiture can be a means of self-reflection and accepting the self. Art therapists can be informed of the benefits and drawbacks of recreating the self by examining the art of artists who experienced melancholy and depression. Vignettes of artists whose self-portraits were healing, as well as of artists who became stuck in feelings of despair, are described. Self-portraiture is an introspective tool that can be beneficial with many client populations. Examples from the literature in art therapy regarding the use of self-portraits in therapy augment the importance of this genre and describe some of the clinical applications of self-portraiture.
 
The following paper is based on a review of 31 communications consisting of refereed journal articles, news articles, television interviews, and books. Each communication focused on working with children using art after a disaster. Each communication was analyzed in six key areas: design of communication, theoretical basis of art therapy conducted, environment surrounding art therapy practice, the art therapist, the client, and the artwork. The following patterns emerged: only two communications met the criteria for research studies; the communications described art therapy in short-term crisis situations and longer-term therapeutic settings; it takes strong, resourceful, compassionate, and resilient people to work as art therapists in this setting; art interventions ranged from free choice activities to very structured craft activities; no prevalent theory about working with children emerged. It is concluded that semi-structured art interventions work well with this population, but more reliable research and planning is needed on working with children after a disaster.
 
Top-cited authors
Sabine C. Koch
  • Alanus University Alfter, RIArT / SRH University Heidelberg
Michael J. Silverman
  • University of Minnesota Twin Cities
Jane Edwards
  • University of New England (Australia)
Dafna Regev
  • University of Haifa
Thomas Fuchs
  • Universität Heidelberg