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Arts in psychotherapy

Overview

As well as activities led by arts organizations, the arts can also be used in health as established psychological therapies. Arts therapies are delivered by trained professional therapists to support people’s psychological, emotional, cognitive, physical, communicative, or social needs. They can be delivered in individual or group settings. In these settings, the arts are often used as a bridge to strengthen and support patients and help them develop skills and strategies that can be transferred to other areas of their lives. Examples of the arts in psychotherapy could include:

  • ? Drama therapy to reduce antisocial behaviour in teenagers
  • ? Art therapy to express difficult feelings in people who have been bereaved
  • ? Music therapy to communicate without words for children with autistic spectrum disorders
  • ? Dance therapy to reconnect with the body for people coping with chronic illnesses
  • ? Poetry therapy to reduce symptoms of post-traumatic stress in military veterans
  • ? Play therapy to distract children having painful procedures
  • ? Sand tray therapy to regain control over anger

A common confusion lies around how arts therapies are different from participatory arts programmes for specific patient groups. Interventions delivered as part of music therapy, for example involving group drumming, could be very similar to community-led group drumming projects. Indeed, historically there was some overlap in the 1950s and 1960s between the British Society for Music Therapy and the charity Music in Hospitals. However, they soon moved away from one another with their key difference being that arts therapies must be delivered by trained professional therapists and have specific psychotherapeutic aims, whereas arts in healthcare settings or in everyday life are delivered normally by musicians or professional workshop leaders who do not have training as a therapist. Although there remains debate around the similarities and differences in approach between the two areas of work, the involvement of a trained therapist is still, in many countries, a defining distinction between arts therapy and other arts interventions.

History

Each individual form of arts therapy has had its own unique history, tracing back through history as discussed in Chapter 1. Although some arts therapies existed in the early twentieth century (the National Society for Musical Therapeutics in America, for example, was founded in 1903), it was in the mid-twentieth century that the arts therapies really began to emerge into their own areas of practice. Many of the early ideas within arts therapies came from psychoanalysis, drawing on theories of Sigmund

Freud and Carl Jung, among others. For example, American psychologist Margaret Naumberg, who became known as the ‘Mother of Art Therapy, drew on similar methods to psychoanalytic practices of the day, developing a dynamically oriented art therapy that used art as a symbolic communication of unconscious thoughts.(15) Dancer and choreographer Marian Chace, drew on Jung’s writings on the use of the arts to alleviate trauma to develop dance classes to help patients in Washington express their emotions, which became one of the early examples of dance therapy.(16) And psychiatrist and psychosociologist Jacob L. Moreno drew on the work of psychoanalysts such as Freud and Wilhelm Reich to develop ‘psychodrama’; a form of spontaneous dramatization and role-play that helped clients explore their own lives.(17)

However, arts therapies did not just rely on psychiatry and psychoanalysis. They also drew on more general arts engagement. For example, in Australia, the Red Cross played an important role in the development of music therapy. In 1950, the Victoria branch of the Red Cross, which had been organizing concerts, formed a Music Therapy Committee. This was followed in 1954 by a Red Cross music library, which was established in Melbourne and started sending recordings to hospitals throughout Victoria to stimulate discussion groups led by occupational therapists. By 1984, the Red Cross Music Therapy committee had employed four music therapists and was working in 14 hospitals.(18) As another example, in the UK the British artist Adrian Hill, known for his depictions of the Western Front in World War I, used his own experiences of recovering from tuberculosis while in a sanatorium to draw aspects of his ward. Finding the process therapeutic, he went on to set up further arts projects in sanatoriums. Hill disliked the use of psychiatric terms in conjunction with art. However, he began using the term ‘art therapy’ to describe his work as he felt it would appeal to those working in the medical profession.(15)

The professionalization of arts therapies quickly followed. Among other examples, in the UK, the Society for Music Therapy and Remedial Music was formed in 1950 which became the British Society for Music Therapy in 1967, with the Guildhall School of Music and Drama leading the first training courses a year later. In 1966, the American Dance Therapy Association was formed. In 1975, both the Australian Music Therapy Association and Canadian Association for Music Therapy were founded. And in 1979 the North American Drama Therapy Association (NADTA) was incorporated for both Canada and the USA.

The precise forms of arts therapies in practice today vary enormously between country and even between different schools of thought. For example, within music therapy alone, there are a broad range of different models, including guided imagery and music (known as the Bonny method), a receptive music therapy method involving active music listening; analytically oriented music therapy (known as the Priestley model), a method based largely on improvization; creative music therapy (known as the Nordoff-Robbins model), originally developed for children with learning disabilities and hearing-impairments; free improvization therapy (known as the Alvin Model) also based around improvization including through unconventional ways of making sounds; and behavioural music therapy, which focuses on using music to modify adaptive behaviours and extinguish maladaptive behaviours.(18) Furthermore, arts therapies are now used across a range of settings, including hospitals, schools, hospices, care homes, prisons, community spaces, and bespoke therapy centres, as well as clients’ own homes.

Case study

Title: MusicWorks

Aims and objectives: The Cape Flats is an expansive, low-lying area to the southeast of Cape Town. The area is known as ‘apartheid’s dumping ground’ as during the apartheid many people were forcibly removed from inner city suburbs of Cape Town to the Flats. Over the past decade, young people in the Flats have been left vulnerable by the ravages of drug and alcohol abuse, violence, and high incidences of HIV/AIDS infection. As a result, many children are exposed to trauma and suffer from the debilitating effects of rage, distrust, grief, anxiety, and depression.

The project: MusicWorks provides one-on-one and group-based music therapy delivered by qualified music therapists for young children in the Flats. Music therapy is used to give a voice to children and young people who are normally unheard and support their development. Young people create songs to tell their individual stories and play instruments to help deal with strong emotions such as anger and grief.

Research: MusicWorks has captured a plethora of case studies from their work illustrating how the music therapy programme supports children who take part. They have identified the sessions as encouraging playfulness, expression, resilience, and hope in children, as well as supporting healing, strength, and empowerment.

Further information: For more information, including case studies of the project featured in the annual reports, visit www.musicworks.org.za.

For a broader overview of the history of art therapy, Susan Hogan’s Healing Arts: The History of Art Therapy provides a rich overview.(15) For more information on art therapy practice, Judith A. Rubin’s Introduction to Art Therapy: sources and resources is comprehensive and is accompanied by a DVD of over 400 images and 250 video clips to give the reader a real insight into the field.(19) For music therapy, A comprehensive guide to music therapy provides a comprehensive exploration of the theoretical foundations of music therapy and its application with various clients in clinical practice.(18) For dramatherapy, the

Routledge International Handbook of Dramatherapy provides a thorough overview of activity around the world, alongside comparisons of different theoretical approaches and case studies of practice,(20) while Current Approaches in Drama Therapy considers much more the history and psychoanalytic aspects of different models and methods.(21) For more information on dance therapy, Sharon W. Goodill’s An Introduction to Medical Dance/ Movement Therapy gives a concise overview.(22) For more detail, Dance Movement Therapy: Theory, Research and Practice brings together chapters on a variety of topics from dance for post-traumatic stress disorder to dance for holistic birth preparation alongside considerations of social and cultural issues in practice.(23)

 
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