What role can art therapy play within mental health?

Art therapy has become a fundamental element in many mental health settings. In today’s modern society many individuals have encountered experience(s) with a mental health issue; whether it be depression, bipolar disorder, personality disorder, anxiety, post-traumatic stress disorder, schizophrenia, obsessive-compulsive disorder, disorder eating or brain injury. These are only a few among the long list of mental health issues an individual can experience as all of these mental illnesses can branch off into other problems or overlap with each other. There have been many medical advances throughout history to help with these mental ailments, such as shock therapy/insulin shock therapy and lobotomies. Thankfully these treatments are not the common go to for a GP to prescribe you. The most common route now a days would be medication like antidepressants, antipsychotics or mood stabilisers. (depending on the individuals mental health problem) A supplementary treatment would then be put along sides this, for example counselling or therapy. Up until recently therapy has been a treatment that is mostly about talking, voicing the individual’s thoughts/feelings and how they can then learn to change their thought process and make positive changes in their life e.g. cognitive behavioural therapy. But what can be said for the individual that feels like they can not voice their thoughts and feelings? Whether they feel like they would be judge, it would be too painful to talk about or physically cannot put it into words. This is where I feel art(s) therapy can come into play. Can it be used as a therapy or aid in recovery? Can it be used to improve the client’s way of life or benefit their wellness/well-being? Or can it simply be a form of escapism for the service user? Chapter one In one case study that will be included is ‘Art therapy and Arts in health: Identifying shared values but different goals using a framework analysis. This case study was an online survey taken by 60 art therapists and 62 artists in health care. They were asked 12 questions in total but there were 5 main questions to investigate how they perceive their own occupation. The 5 main questions were; ‘What do you think art therapy/arts in health provides for program participants? Are there any limitations to what art therapy/arts in health can provide to program participants? Are there some approaches used by art therapists/artists in health care that work better than others? If yes, explain. Are there any situations when the art therapy/arts in health should not be used? How would you describe the art therapy/arts in health to someone in a casual conversation setting?’ (Van Lith/Spooner pg89). The common fundamental attributes between art therapist and artists in health care were; ‘Having the inherent belief in the healing capacity of creativity’. (Van Lith/Spooner pg 89)The art therapists and artists in health care equally determined the significant that the arts contributed to the healing process of the client, whether it be emotionally, physically, socially or spiritually. ‘Regarding the Creative process as a means for expression.’ (Van Lith/Spooner pg 89) Contributors from both sides disclosed that art aided in the client’s communication skills and gave them more ways of expressing themselves. Especially for clients that could not put thoughts and feelings into words. ‘Working towards social engagement and inclusion.’ (Van Lith/Spooner pg 89)Both professionals spare no effort to support social engagement by employing art as a form of encouraging development in communication to endorse ‘social inclusion’. They found art-based projects intercepted isolation and loneliness by introducing social interactions in a safe space. If therapy

is being done in a group setting the clients may learn about their behaviour patterns because of their interactions with others. ‘Working towards empowerment’. (Van Lith/Spooner pg 90) The professionals from both groups see art as a beneficial implement to empowerment, believing that this stimulated the recovery process in a way that is personal to the client. Obtaining a feeling of achievement through their art, the patient then could feel a sense of ownership and control in their life. ‘Working towards enhancing well-being and improvement to quality of life.’ (Van Lith/Spooner pg 90)The goal for both professionals is to apply art to enhance the clients well-being and build upon their quality of life. Which would necessitate innovate/creative experiences to encourage the clients own personal expression, allowing for relaxation and creative attentiveness. In the health profession terms can easily be ‘interchangeable’, for example ‘wellness’ or ‘well- being’.

‘Well-being’ is ‘the state of being comfortable, healthy, or happy.’ (https://www.mentalhealth.org.uk/blog/what-wellbeing-how-can-we-measure-it-and-how-can-we- supportpeople-improve-it) Which the artist in health care will focus on the overall happiness of the client or how it can be improved. The sessions are more so for a creative outlet. The artist in health care is aware of the clients tells or signs of interest, engagement, enjoyment or discomfort. An artwork that is completed is a reward in the artist in health cares eyes as they have taught the client a number of skills and they are then able to appreciate their own artistic qualities, as well as others. The outcome of the sessions is to promote the clients health and well-being through being motivated to socially interact through art. Overall artists in health care provide a service that can be used alongside medical treatment as it can be seen as a distraction or a form of escapism for the client. Whereas ‘wellness’ is the ‘state of being healthy in body and mind, especially as a result of deliberate effort.’ (https://www.dictionary.com/browse/wellness) that the art therapists perceptive would come from a multidimensional framework/approach. In sessions with an art therapist, clients are encouraged to explore the materials that can be used, the use of symbolic imagery to externalize what is internalised within the client. Bringing it into the real world, to possibly give the client a different perceptive of there thoughts and feelings. To start to comprehend possible underlying problems that they can then process and work through. The main qualities among the two types of professionals are similar. Which I feel in any care giving profess it is of paramount importance that the clients thoughts and feelings are put into consideration. Whether that is finding other ways to aid the development and ways in which the client can communicate and express themselves. One major difference between the two professions is an art therapist is required to have formal training, be nationally registered with the art therapy credential board and follow ethical and professional guidelines for their practice. Whereas an artist in health care can access this profession through varied routes. For the example, many may have different levels of training in the arts, some have formal health care training and there is the option of work placement training. There is the option of masters or doctorates in the arts but it is not a requirement to have if the person is looking to go into the profession of an artist in health care. When working in mental health I agree there should be a level of education to have the wealth of knowledge needed to comprehend of all the different approaches, concepts, theorist, techniques and correct terminology. A number of professionals may have the education to follow guidelines, protocols and frame work that is used in order to carry out treatment but are these the only elements to being a ‘good’ practitioner? I would disagree on the grounds that you cannot get be educated in the ability to listen and communicate effectively, be empathic, have compassion and being non-judgemental. These are some of the humanistic qualities that most humans have but not all are attuned to them as well as others. Without these qualities an art therapist is just going

through the motions. This can be a hindrance to the client not receiving compatible treatment that is right for them as every client is unique and will respond differently to approaches. ‘Art therapy is not specific in it’s practices, making it customizable to the ever-changing life of a patient. (Robert A. Bitonte pg 18) However, there is also the factor of ‘the professional knows best’ (David Pfeiffer) mentality when the art therapist is involved. The practitioner may have the mentality that a certain approach may work for the set amount of sessions with the client but not ask themselves the question of what might work better for the individual. ‘Art therapy is likewise defined by many art as healing groups as a strictly diagnostic field, a field in which practitioners are only interested in interpretation rather than in the artistic process and its relationship to health and well-being.’ (Malchiodi pg 154) There could be a number of factors that could hinder the developmental process of the client, such as their mental health issues, for example, depression. The therapist may not take into consideration depression can lower the motivation of a client. Their energy levels to be able to participate are lessened on certain days as depression can fluctuate. (as can any other mental health problem). Their energy is maybe focused in the wrong place by trying to ‘fix’ the client’s problems in a way which the client does not find enjoyable or beneficial. Yes, I agree that there should be some sort of framework in place but it should not be set in stone. Referring back to what (Bitonte, pg 18) said that it is imperative that the practice is flexible to be able to adjust easily to the clients’ needs. There is the question of is there a discussion between the art therapist and the client? Is the art therapist taking into consideration what the client wants from their sessions spent together? The answer could be yes or no depending on the art therapists’ ideas of what framework is used and how they execute this in their own work with the client. For some clients the idea of discussing expectations can be daunting (never the less it is important). In turn this can make them anxious, less willing to be open to the experience and not be fully engaged in the process. There must be a consistency in the attendance of the session to be able to build a repour with the therapist, for the therapist to get to grips with what the clients ins and outs are so they can begin to build a sense of trust within a safe space. ‘Although it may be difficult to quantify the effectiveness of art therapy, studies have repeatedly shown that art therapy is beneficial to patients within a broad spectrum of conditions.’ (Bitonte) However, often at the end of the program the therapist makes their own conclusion on whether the client has made any progress. Which is based on the assumptions of what they witness when they are with the client for a short space of time. For there to be any way forward in the right direction concerning ‘customizable’ treatment, clients giving honest feedback is a paramount. When it comes to feedback it should be optional to be anonymous as some clients might be apprehensive to speak up if they feel that the sessions have not been beneficial. Using an an example from (Bitontes pg 18-19) article there was a section about children and adolescents with Epilepsy that they had come to realise that using group art therapy sessions could be a helpful tool in aiding in social interactions as it can give the participants the chance to meet others with the same condition(s). Being able to relate to others can help an individual not feel so lonely in their illness.

Gestalt Approach

I feel the Gestalt theory is very relevant to the art therapy practice as art therapy is an outlet in which the clients internalized thoughts and feeling can externalised by giving ‘shape, form or figure’ to them. (as ‘shape, form or figure (as in Gestalt theory = theory of shape or form)’ pg 15 ) This approach promotes the idea of individuality as it ‘aims for the development and maintenance of such a harmonious state and not for a ’cure’. Cure refers implicitly to a state of ‘’normality’’ which is the opposite of the Gestalt approach. In Gestalt the right to be different is highly valued, as is the uniqueness of each person’ (pg17) The word ‘therapy’ can be highly stigmatised and the person receiving treatment can be harmfully labelled by others that could become a deterrent for simply looking help. When in reality art therapy can be used as a way of exploring self-expression to discover possible underlying problems the client may have. This in turn can help them recognised contributing factors that may be a catalyst to their problem(s). By doing this they can then start to work on coping mechanisms or possibly resolving some of their issues. When the individual is undergoing gestalt therapy, they ‘responsible for his own choices and avoidances. The individual works at the rate and level that suits him, according to what emerges in the present moment.’ (Gestalt pg22) which in comparison to the other case study I mentioned above involving the art therapists that have a rigid framework, Gestalts idea of letting the individual choose what they want out of their session gives them a sense of control that they may not have outside of the sessions. However, to some professionals this could be seen as too loose of a structure to be able to have a plan in place with a certain outcome but having an expectation for the client from the beginning can add unnecessary stress or pressure on the client. Perhaps using this approach within a framework could be a good combination if used correctly. As ‘experimentation can employ any of a whole variety of media’ from physical movement, sculpture, textiles, paint, dialogues/literature to encourage exploration of the self. Again, I feel the Gestalt approach can be employed by art therapy in practice as a theme within it is ‘to make explicit that which is implicit, to bring out in the open that which is hidden. When the client can externalize what is going on inside, he can see a clear picture of how he “works” here-and-now, and what goes on at the “contact boundary” between himself and his environment.’(pg27) Once a client is able to externalize their thoughts and feelings they can then begin to look at each individual point that has been brought to light and with the new perspective be able to understand themselves more; why do they feel this way? Do certain people or environmental factors influence their morals, self-esteem/self-worth, ideas about the world around them? Do everyday life responsibilities impact on their mental wellbeing? Does externalizing all of their issues/problems give the client some sort of relief and help put their life in perspective, letting them almost have an outsider looking in feeling to perhaps let them reflect and react logically and not irrationally. Everyone’s experience of the world around them are different to another. It will depend on their environment, their own morals, what influences them (consciously or subconsciously) with the people they surround themselves with, the material they listen, read and watch. Other factors could be if the individual has a mental health problem in which could distort their reality making them perceive something differently than a person with no mental health problems. Some may argue that how you feel/perceive things is a state of mind and that you are in control of how you perceive the world around you. That the individual is able to control how it makes them feel. This may be the case for some however, this is easier said than done for people with

mental or physical health issues. ‘What you see depends on how you look, and how you look influences what you see.’(pg32 Gestalt) Yes, with the right treatment people are able to rewire how they think/react with the likes of CBT (Cognitive Behaviour Therapy). This type of therapy is not a cure but a way of learning about yourself, coping mechanisms and strategies to help with how a person can manage their issues in a ‘healthier’ way. In some cases, repeatedly going over painful or traumatic life events can sometimes have a negative impact on the client. The same as ruminating on negative, damaging or self-destructive thoughts or ideas. ‘In fact, continually going over a painful moment often serves to reinforce the bad memory; continually talking about a difficult period of mourning is not enough to overcome it … Reopening the wounds of childhood and making them bleed means they will never get a chance to heal: once the wound is properly cleaned (but not before!) there is a necessary convalescence while the scab forms and must not be scratched off.’. (pg36) In the absence of art therapy, there are other types of creative therapies. ‘Monodrama allows

exploration, recognition and integration of the opposing “polarities” in relationships, without

getting arbitrarily “stuck in the middle”: a false, artificial and arid middle way. I can in fact feel

violently aggressive towards someone, and love him or her passionately, at the same time. Each

of these feelings deserves to be clarified as much as possible and not just “neutralized” by a

composite attitude of relative love, nor reduced to the “bland greyishness” which results from

the arbitrary algebraic sum of two violent and opposing feelings. In fact, strong and opposing

emotions are in reality more additive than canceling’. (pg29) Having many feelings can be

conflicting but giving them validation and transparency is a healthy way of dealing with them.

Not giving acknowledgement and acceptance to certain emotions like anger, love, fear, hatred,

jealousy can become a pressure cooker and in turn be let out in a way that could be harmful to

themselves or others.

References Art therapy and Arts in health: Identifying shared values but different goals using a framework

analysis. Theresa Van Lith & Heather Spooner https://doi.org/10.1080/07421656.2018.1483161

‘Art therapy: An underutilized, yet effective tool’ by Robert A, Bitonte and Marisa De Santo ‘Art as Healing, Art in Healthcare, and Arts Medicine: New Names for Art Therapy?’ By Cathy A. Malchiodi (https://www.tandfonline.com/doi/pdf/10.1080/07421656.1989.10759316?casa_token=aA2mX IgQLGMAAAAA:ZJS_lHKkNMdGKaf5XsbN0rK_tsjW8cgl61GfllqnKmJSifoiGAVfo_7EL1YhgYbpLE7cv 5bUZpI) Ginger, Serge. Gestalt Therapy: The Art of Contact, Taylor & Francis Group, 2007