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International Journal of Arts Humanities and Social Sciences Studies
Volume 5 Issue 2 February 2020ǁ
ISSN: 2582-1601
www.ijahss.com
Expressive Arts Therapy Techniques as Part of Psychological
Counseling: Perception of Medical Students in the Sultanate of
Oman
Miriam A. Simon1, Ayat Al-Ajmi2, C.K. Priyanka Raj3
1Department of Psychiatry and Behavioral Science, College of Medicine and Health Sciences
National University of Science and Technology, Sultanate of Oman
2College of Medicine and Health Sciences, National University of Science and Technology
Sultanate of Oman
3Department of Epidemiology and Public Health, College of Medicine and Health Sciences
National University of Science and Technology, Sultanate of Oman
Abstract: The college environment is considered a universally stressful period. The need for counseling
services among college students is well-documented. Expressive arts therapy is the use of creative arts in the
form of therapy. Though the efficacy of expressive arts therapy in the management of stress has been validated,
data on the perception and acceptability of expressive arts therapy in the process of psychological counseling is
limited. The aim of the present study was to explore medical students’ perception of including expressive arts
techniques as part of the psychological counseling process. Students were required to complete a questionnaire
that assessed their knowledge and acceptance of expressive arts therapy as part of the counseling process.
Results indicated that students were open to including expressive arts techniques as part of the counseling
process. They were also convinced with the effectiveness of expressive arts techniques. Incorporation of this
therapeutic approach in the modules offered at the institution’s Student Counseling Center will enhance the
outcomes of the counseling process.
Key words: Expressive Arts Therapy, College Counseling, Client preference.
I. Introduction
Expressive arts therapy is the use of creative arts in the form of therapy. McNiff (1981) observes that
expressive therapies are those that introduce action to psychotherapy and that “action within therapy and life is
rarely limited to a specific mode of expression”. While talk is still the traditional method of exchange in therapy
and counseling, practitioners of expressive therapies know that people also have different expressive styles—
one individual may be more visual, another more tactile, and so forth [1]. The common expressive arts techniques
include Art and Painting, Dance and Movement, Drama, Music, Creative Writing and Storytelling [2]. Art therapy
uses art media, images, and the creative process, and respects patient/client responses to the created products as
reflections of development, abilities, personality, interests, concerns, and conflicts [3]. Music therapy uses music
to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with
health or educational problems [4]. Drama therapy is the systematic and intentional use of drama/ theatre
processes, products, and associations to achieve the therapeutic goals of symptom relief, emotional and physical
integration, and personal growth [5]. Dance and movement therapy is based on the assumption that body and
mind are interrelated and is defined as the psychotherapeutic use of movement as a process that furthers the
emotional, cognitive, and physical integration of the individual [6]. Creative writing- Poetry therapy and
International Journal of Arts Humanities and Social Sciences Studies V 5 ● I 2 ● 1
Perception of expressive arts therapy techniques as part of psychological counseling
bibliotherapy are terms used synonymously to describe the intentional use of poetry and other forms of literature
for healing and personal growth [7].
Expressive arts therapy is predicted on the assumption that people can heal through the use of
imagination and the various forms of creative expression [8]. Expressive arts therapists usually blend a passion
for art to their established skill of counseling [9]. When therapists are able to include these various expressive
capacities in their work with clients, they can more fully enhance each person’s abilities to communicate
effectively and authentically [10]. There are sufficient findings to indicate the benefits of expressive arts
therapies. Effectiveness is indicated in physical and psychological conditions including asthma, dementia,
coping with cancer, terminal illness, depression, schizophrenia, stress, anxiety, eating disorders and behavioral
disorders [2, 11].
With the advent of brief forms of treatment, many therapists find that the expressive therapies help
individuals to quickly communicate relevant issues in ways that talk therapy cannot do. For this reason and
others, psychologists, counselors, and other health care professionals are turning to expressive modalities in
their work with individuals of all ages [2]. Expressive therapies add a unique dimension to psychotherapy and
counseling because they have several specific characteristics not always found in strictly verbal therapies,
including, but not limited to, self-expression, active participation, imagination, and mind–body connections [2].
Depending on the practitioner and the setting, expressive therapies may be used as a primary form of
therapy, requiring the therapist to have a deeper understanding of how various modalities can be applied in
response to a wide range of disorders. Often, expressive therapies are integrated within a psychotherapy or
counseling framework. For example, Gladding and Newsome (2003) highlight the integration of visual art
activities into counseling treatment plans with adults and emphasize that a quick client drawing or collage can
move a client forward when talk therapy is resisted or ineffective [12]. Also, many expressive therapy techniques
have been used to complement a wide range of psychotherapy and counseling theories, including
psychoanalytic, object relations, cognitive-behavioral, humanistic, transpersonal, and others [13]. Creativity in
therapy has the potential to impact clients in memorable ways that traditional interventions do not [2]. Research
has also indicated that counselling and therapy using expressive arts supports the processing of emotions,
finding balance and building resilience [14]. The application of expressive arts therapy has been described as a
significant support for positive change within counselling [15].
The college environment is considered a universally stressful period where students face many
challenges [16, 17]. The need for and the effectiveness of psychological counseling services for young adults in this
life stage have also been well documented. Studies show that some students express reluctance about traditional
psychotherapeutic methods. But, a creative-arts therapy module may offer a compelling alternative with similar
benefits [18]. Attending to preferences has the potential to open up therapeutically valuable areas of conversation
and dialogue between client and therapist [19]. Addressing and accommodating client preferences in
psychotherapy have been consistently associated with improved treatment outcomes [20]. It was also concluded in
another study, that although presently underutilized, arts interventions may be a viable form of anxiety-reduction
among college students [21].
International Journal of Arts Humanities and Social Sciences Studies V 5 ● I 2 ● 2
Perception of expressive arts therapy techniques as part of psychological counseling
Data on the perception and acceptability of expressive arts therapy in the process of psychological
counseling, especially among college students is non-existent. Acceptability of expressive arts techniques will
enable the delivery of more effective counseling modules, encourage counselor’s skill development and change
the face of the counseling process. The College of Medicine and Health Sciences, National University of
Science and Technology at Sohar, Sultanate of Oman has a Student Counseling Center to cater to the emotional
challenges faced by medical students. The proposed study aims to explore students’ perception of including
expressive arts techniques as part of the psychological counseling process. The study also aims to determine the
specific expressive arts techniques preferred by students to be incorporated into the counseling process. Insights
from the study will be incorporated into the service delivery modules of the counseling center.
II. Materials and Methods
The present study was conducted among the Year 4 and Year 5 medical students at the College of
Medicine and Health Sciences (erstwhile Oman Medical College), National University of Science and
Technology, Sohar, Sultanate of Oman. The study was approved by the institutional Research and Ethics
Committee. Participants were required to complete a consent form. These students had completed a course in
Behavioral Science during which they were exposed to the various counseling and psychotherapy approaches,
including expressive arts therapy. 111 students consented to be part of this study. Nearly 90% of participants
were female as the college caters predominantly to female students. The mean age of participants was 22.02
years (SD=1.41).
After obtaining consent from the participants, a brief re-orientation module was presented to students
on expressive arts therapy. Students were then required to complete a structured questionnaire, with 10 items
(Appendix1) that was composed to assess the following domains: Openness to receive professional
psychological services, Knowledge of Expressive Arts Therapy, Openness to Expressive Arts Therapy,
Perceptions about the effectiveness of Expressive Arts Therapy and Intentions to use Expressive Arts Therapy.
The average time taken to complete the questionnaire was between 8 to 10 minutes. Participants had to choose
one of the following options for each item on the questionnaire- disagree (1), somewhat disagree (2), undecided
(3), somewhat agree (4) and agree (5). Data collected was analyzed.
III. Results and Discussion
46% of participants reported that they would prefer to meet a psychologist if they were experiencing
anxiety, stress and other emotional difficulties. 26% of students disagreed and 28% were undecided. This is
consistent with a previous study among medical students that concluded that students in the College of Medicine
and Health Sciences experienced moderate levels of personal privacy and stigma with regard to help seeking for
psychological difficulties, but believed in the effectiveness of counseling and psychotherapy [22].
International Journal of Arts Humanities and Social Sciences Studies V 5 ● I 2 ● 3
Perception of expressive arts therapy techniques as part of psychological counseling
39% of students were convinced of the effectiveness of Expressive Arts Therapy as part of the
psychotherapeutic process. They felt the effectiveness of Expressive Arts Therapy would be higher when
compared to traditional Psychoanalysis (35%) or Cognitive Behavior Therapy (26%). A majority of students
(75%) felt that employing Expressive Arts Therapy techniques in the counseling process would effectively help
individuals with emotional difficulties.
Psychoanalysis CBT EAT
35%
26%
39%
Participants felt that incorporating Creative Writing (39%), Story-telling (27%) and Painting and Art (21%) in
the counseling process would be most effective. The efficacy of writing therapy has been proven effective in
both health and clinical populations. It is perceived as one of the easier and non-threatening methods to express
one’s emotional difficulties [23].
39%
8% 16% 21% 13%
27%
A majority of students (58%) agreed that they would consider Expressive Arts Therapy if they had to attend
counseling sessions. If in a situation where they attended psychological counseling sessions, participants
reported that their personal preference would be to use Painting and Art (77%), Story-telling (74%) and Creative
writing (63%) as part of personal counseling. 54% of students also reported that they would feel comfortable if
expressive arts therapy techniques were employed during group counseling or group therapy sessions.
International Journal of Arts Humanities and Social Sciences Studies V 5 ● I 2 ● 4
Figure1: Perception of the Effectiveness of
Expressive Arts Therapy
Figure 2: Perception of the Effectiveness of
Art Therapy Techniques
Perception of expressive arts therapy techniques as part of psychological counseling
Writing
Drama
Dance and Movement
Painting and Art
Music
Story telling
63%
37% 42%
77%
59%
74%
4. Conclusions and Implications
Openness to receive professional psychological services for emotional difficulties was seen among the students
at the College of Medicine and Health Sciences. Students were also open to Expressive Arts Therapy as a
therapeutic approach and were convinced of its effectiveness. A majority of students agreed that they would
consider using Expressive Arts Therapy techniques in the counseling process. Preference was for specific
expressive arts techniques- Painting and Art, Story-telling and Creative Writing.
To improve the effectiveness of the counseling process and to enhance service delivery, it is vital to
take into consideration the preference of clients when planning counseling modules. Incorporation of various
expressive arts techniques by trained therapists in the psychological counseling modules offered at the Student
Counseling Center at the College of Medicine and Health Sciences is to be considered. This study not only
brings out the importance to be given to client preferences in psychological counseling, but also highlights the
need for therapists and counselors to be specialized in multiple therapeutic techniques preferred by clients.
IV. Appendix 1
Kindly read each item carefully and answer appropriately.
1. Would you go to a counselor/psychologist if you were experiencing anxiety, stress or any other
psychological/emotional difficulties?
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
1 2 3 4 5
2. If you were to attend counseling sessions, which of the following approaches would you prefer the
counselor to use? Rate your choice (1st, 2nd and 3rd)
International Journal of Arts Humanities and Social Sciences Studies V 5 ● I 2 ● 5
Figure 3: Personal preference in using
Expressive Arts Therapy Techniques
Perception of expressive arts therapy techniques as part of psychological counseling
Psychoanalysis Cognitive
Behavior
Therapy
Expressive Arts
Therapy
Any
other
(mention
)
3.Which of the following techniques do you think are involved in expressive arts therapy? (Please tick)
Writing
Drama
Dance
Movement
Painting and Art
Music
Story telling
4.Do you think that using these expressive arts techniques will help individuals with emotional difficulties?
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
1 2 3 4 5
5.In what way do you think using art, drama, dance and music will help individuals with emotional difficulties?
__________________________________________________________________________________________
__________________________________________________________________
6.If you had to attend counseling sessions would you consider expressive arts therapy?
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
1 2 3 4 5
7. In addition to talking to the counselor, which of the following techniques would you like to be incorporate
into counseling sessions?
a. Writing
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
0 1 2 3 4
b. Drama
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
0 1 2 3 4
c. Dance and Movement
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
0 1 2 3 4
d. Painting and Art
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
0 1 2 3 4
International Journal of Arts Humanities and Social Sciences Studies V 5 ● I 2 ● 6
Perception of expressive arts therapy techniques as part of psychological counseling
e. Music
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
0 1 2 3 4
f. Story telling
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
0 1 2 3 4
8. If you had to attend group therapy/counseling, would you feel comfortable if expressive arts therapy
techniques were employed?
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
0 1 2 3 4
9. Do you think expressive arts therapy is an effective approach?
Disagree Somewhat Disagree Undecide
d
Somewhat Agree Agre
e
0 1 2 3 4
10. Comments (if any)
__________________________________________________________________________________________
__________________________________________________________________
Thank you for your cooperation.
References
[1] McNiff, S. The arts and psychotherapy. Springfield, IL: Thomas, 1981
[2] Dunphy, K., Mullane, S and Jacobsen,M. The effectiveness of expressive arts therapies: A review of
literature. Melbourne: PACFA, 2013
[3] American Art Therapy Association. About art therapy. Available at www.arttherapy.org, 2004
[4] American Music Therapy Association. Definition of music therapy. Available at
www.musictherapy.org, 2004
[5] National Drama Therapy Association. General questions about drama therapy. Available at
www.nadt.org/, 2004
[6 ] National Coalition of Creative Arts Therapies Associations. Dance/ movement therapy. Available at
www.nccata.org/dance.html, 2004
[7 ] National Coalition of Creative Arts Therapies Associations. Poetry therapy. Available at
www.nccata.org/poetry.html, 2004
[8] Expressive Arts. (n.d.). Retrieved from https://www.emergehealing.com/mindfulness
[9 ] Bettsi, Jason, Beirne, D., Olive, Schreibman, R., Hana. N, . . . Sena. (n.d.). What is Art Therapy? | What
Does an Art Therapist Do? Retrieved from http://www.arttherapyblog.com/what-is-art-
therapy/#.XKMUA5gzaUk
[10] Malchiodi, C A. Expressive Therapies. New York: Guilford, 2003
[11] Smitheman-Brown, V., & Church, R. P. Mandala drawing: Facilitating creative growth in children with
ADD or ADHD. Art Therapy: Journal of the American Art Therapy Association, 1996, 13(4), 252-262.
[12] Gladding, S. T., & Newsome, D. W. Art in counseling. In C. A. Malchiodi (Ed.), Handbook of art
therapy (pp. 243–253). New York: Guilford Press, 2003
[13] Malchiodi, C. A. The art therapy sourcebook. New York: McGraw-Hill/ Contemporary Books, 1998
[14] Pearson, M., & Wilson, H. Using Expressive counselling Tools to Enhance Emotional Literacy,
Emotional Wellbeing and Resilience: Improving Therapeutic Outcomes with Expressive Therapies.
Counselling, Psychotherapy, and Health, 2008, 4(1), 1-19, Regular Peer Reviewed Submission.
[15] Pearson, Mark & O 'brien, Patrick. Changing views of theory and practice in counselling: Multiple
intelligences, eclecticism and the therapeutic alliance. Psychotherapy & Counselling Journal of
Australia, 2012
International Journal of Arts Humanities and Social Sciences Studies V 5 ● I 2 ● 7
Perception of expressive arts therapy techniques as part of psychological counseling
[16 ] Baysden, M. International and United States citizen student adaptation to college, opinions about
mental illness, and attitudes toward seeking professional help. Dissertation Abstracts International
Section A: Humanities and Social Sciences, 2002, 64(2-A), 393
[17] Rice, K., & Van Arsdale, A. Perfectionism, perceived stress, drinking to cope and alcohol-related
problems among college students. Journal of Counseling Psychology, 2010, 57(4), 439-450
[18] Randal W. Boldt & Sherin Paul Building a Creative-Arts Therapy Group at a University Counseling
Center, Journal of College Student Psychotherapy,2010, 25:1, 39-
52, DOI: 10.1080/87568225.2011.532472
[19] Client preferences: building bridges between therapy and everyday life
John McLeod, University of Abertay, Scotland Psychotherapy and Counselling Journal of Australia
Third edition, 2015, 3(1)
[20] M. Cooper, J.C. Norcross. A brief, multidimensional measure of clients’ therapy preferences: The
Cooper-Norcross Inventory of Preferences (C-NIP) International Journal of Clinical and Health
Psychology, 2016, 16, 87-98
[21] E. Aaron, Ragan & Rinehart, Kimberly & Ceballos, Natalie. Arts-based interventions to reduce anxiety
levels among college students. Arts & Health. 2011, 3. 27-38. 10.1080/17533015.2010.481290.
[22] A. Simon, Miriam, Elizabeth, Smitha , Mafiana, Ngozichukwu, Al Ghailani, Amal. Addressing
Psychological Challenges: Attitude of Medical Students in Oman. IAFOR Journal of Psychology & the
Behavioral Sciences. 2018, 4. 61-70. 10.22492/ijpbs.4.2.05.
[23] Mugerwa, S., & Holden, J. D. Writing therapy: a new tool for general practice?. The British journal of
general practice : the journal of the Royal College of General Practitioners, 2012, 62(605), 661–663.
doi:10.3399/bjgp12X659457
International Journal of Arts Humanities and Social Sciences Studies V 5 ● I 2 ● 8
