Art therapy is based on the premise that art can heal. A form of psychotherapy - treatment by psychological rather than medical means - it offers a non-threatening way for people with disabilities to express themselves, improve their social skills, solve problems and discharge aggression. Its overall goal is to engage groups or individuals in creative processes that will improve their physical, psychological and emotional well-being.
Art therapists practice in many different settings, among them hospitals, psychiatric and rehabilitation centers, senior communities and schools. Their training includes studies in human development, psychological and behavioral disorders, counselling theories and therapeutic techniques. They are also required to have a deep understanding of a range of artistic media so that they can guide their clients through a variety of creative processes.
Ideally, therapy takes place in a quiet room with access to an orderly arrangement of art materials, illustrated books, paper of all sizes, work tables, easels, as well as wall space for hanging works. Every material has special qualities and significance with which art therapists are well acquainted. For example, modelling clay comes in a rich variety of colors and is simple to handle. It is associated with childhood memories and represents playfulness and joy. Charcoal, producing black dust and staining everything it comes into contact with, is suitable for expressing emotions, such as anger or shame. (Orbach, N., Galkin, L. 2016.)
In some instances, clients may participate in a pre-planned activity. On other occasions, the therapist may ask them to select their own project as well as the materials they want to work with. These choices are not considered to be incidental, but rather a reflection of major issues in their lives that they are unable to express directly. The aim is, while working on a project under the therapist’s direction, that they will open up and explore their feelings and emotions. (This short article does not include a discussion of the different approaches, or combinations of approaches that art therapists employ.)
Much of the literature written on the subject of art therapy falls into two categories: proposed art therapy interventions for a specific group of people; and reports of interventions that have already taken place. Referred to here is just one example from each category, creating an opportunity to describe just a few out of the many types of interventions offered in art therapy sessions.
In order to propose an art therapy plan to assist people with Down Syndrome (DS) Mu-Chien Tsai, a graduate student at the University of Indiana, USA., started out by exploring literature on this subject. However, finding there was little information, she broadened her search to include texts that dealt with art therapy for the developmental impaired. This was because the challenges faced by both groups are similar, including intellectual, linguistic and social malfunctioning, as well as behavioral and emotional difficulties.
Mu-Chien Tsai then evolved a three-stage plan suitable for groups of people with DS (Tsai, M-C. 2005), its aim being to facilitate progress in the areas of social development and interpersonal skills.
“Favorite Things” was one of a number of proposed activities with the Stage One objective of improving social skills. Participants would be given illustrated magazines and asked to cut out pictures of their favorite food and drink, and paste them onto paper. (By using ready-made imagery, no- one would have to worry about the quality of their artistic skills). They would then be asked to explain to the rest of the group why they chose these particular items, and how they felt when they ate or drunk them. The aim of this intervention was to give people an opportunity to react with one another and establish relationships, thus increasing their interest in attending future sessions.
The proposed Second Stage had the goal of enhancing self-esteem and personal expression. One suggested group intervention was a doll-making project. An unadorned doll, fabrics, glue, beads, strings and other decorative items would be handed out, with the request that each person turn their doll into a self-image. When this task was completed, each in turn would tell the other participants about five of the doll’s characteristics that applied to themselves; the rationale being that the doll would act as an intermediary allowing people to connect with one another but at a safe distance. Another potential benefit on completion of this task would be to raise self-esteem –each person’s belief in themselves. The aim of the proposed Third Stage was to expand sensory and perceptual exploration and develop personal awareness. In one relevant intervention, deemed suitable for clients with low to mid-cognitive functioning, participants would be asked to make a rough drawing using only one art material out of a wide selection. Then, to repeat this activity four more times, each time using a different material, some of them resistive - i.e. hard, like pencil, others fluid - like paint. At the conclusion of each stage, the participants would be asked to talk about how they felt when they drew, why they chose a certain color, and what their associations were with that color.
An article written in the Journal of American Art Therapy Association (Sunderland, J., Waldman, G., Collins, C., 2010) describes an intervention that took place under the auspices of Art Therapy Connection (ATC). This is a non-profit organization operating since 2002 in Chicago with the purpose of meeting the mental health needs of children in the city’s inner schools.
Since its inception, ATC has partnered with 10 schools to serve over 2,300 students living in the city’s disadvantaged neighborhoods. Some of these young people may experience threats to their well-being, and suffer from neglect or abuse. Their fears, or lack of self-worth, are expressed in school by poor grades, truancy, uncooperative behavior, aggression or violence.
ATC’s interventions for this group have two main objectives: to encourage positive social interaction - caring for oneself and others; and to foster respect and form positive relationships with other students, staff and parents.
The “Hand Mural” was an example given of one group activity that encouraged positive social interaction. Participants were asked to trace the outline of their hand onto a piece of paper, then cut the form out and decorate it with images that represented things about themselves that they were willing to share with the group. All the decorated hands were then glued onto a large sheet of paper to make a mural, whose title was decided by the group. Next, the therapist initiated a discussion in which everyone shared his or her thoughts and ideas on this project. By this means, they made friends in a relaxed and positive way. The researchers noted other positive results: that all the participants derived pleasure in working in a creative way with other people; and, that this interaction gave them a sense of belonging to a group, something they may not have experienced before.
The second objective of this intervention was to encourage anger management and responsible behavior. In one relevant activity, the participants were asked to create a form in plaster or clay that expressed some emotion or feeling, but not to tell anyone in the group what it was. When the sculptures were completed, members of the group went from one sculpture to the next trying to identify the feeling expressed, and then wrote down their thoughts. The group discussion that followed examined how feelings and emotions can be expressed in acceptable ways; and what it means to feel empathy – the capacity to relate to how other people are feeling.
In recent years, art therapists and educational psychologists have begun to research the effectiveness of digital technology as a therapeutic art form. They realized that this medium would be a useful tool, in particular, for people on the autism spectrum, or with development disabilities characterized by tactile and olfactory sensitivity, who disliked getting paint or mess on their hands. (Grandin, T., Panek, R. (2013.)
In this connection, a study by Darewych, O. H., Carlton, N. R., & Farrugie, K.W. (2015) investigated the ways that adults with developmental disabilities experienced digital technology as an art-making tool, and, also, which creative applications suited them best.
Eight volunteers with a dual diagnosis of developmental disabilities and psychiatric issues volunteered to take part in this project. All of them attended the Salvation Army’s Paperella Innovative Community Art Program in Ontario, Canada; and, were familiar from home with computers or hand touch devices.
These people attended five one-hour individual art therapy sessions where they were offered a variety of assignments using digital means, including scribbling, free drawing, or representations of their ‘favorite day’. It was found that although they all tried out different types of touch screens, most of them preferred working on Windows 8 touchscreen laptop, because of its upright easel-like table positioning and printing features.
At the end of the project, the researchers got positive feedback. All the participants had enjoyed trying out this ‘new’ medium. Without exception, they cited the ease with which they could access applications to produce colors, patterns, rhythmic and repetitive images. Microsoft’s Fresh Paint was their preferred choice, due to the simplicity of its design, variety of textures and paints, as well as the drop-down art box that permitted full use of the screen. The sand drawing option was also a favorite, with some people applying large digital stickers to sand-like textural imagery. The researchers also concluded that as a result of this project the cognitive and visual skills of the participants had improved, and that it had instilled a new sense of empowerment in the participants -–a belief in their own abilities.
Stressed in several articles referred to in this brief review is the importance of developing a good and trusting relationship between client and therapist. Cited, as an example, (Sunderland, J., Waldman, G., Collins, C., 2010) was the case of a very angry 14 year old who got into trouble at school every day. During their sessions together, his art therapist leant about his home life, and the fact that his mother was in prison for life. Gradually, with therapeutic intervention, the boy calmed down, and came to a point when he longer needed help. Nevertheless, each day when he arrived at school he would check in with the art therapist. In his own words, she had become “My mother at school”.