Art Therapy for Children - Research Paper Example

Art Therapy for Children What is art therapy? Art therapy started as a form of therapy in the late 1930s when children’s drawings were used for psychological assessments. Human figure drawings became more and more used in the 1940s to assess and diagnose children with neurotic and conduct disorders. To this day children’s drawings are used to an extent as part of the diagnostic assessment. The increasing usefulness of drawing as a way to help children express their emotions has led to the development of art therapy. Art therapy is the process whereby a professional relationship develops between client and therapist through the therapeutic use of art making. The process involves the making of the art, discussing it together and interpretation by the therapist of the child’s emotional state, with the client’s help. Many emotions are expressed through art that are normally difficult to express, especially for children. Art therapy has been shown to effect change in many ways. Generally the process involves the child completing a piece of art with the therapist providing the materials and encouragement. The child tells the story of the art work as the session proceeds. The therapist helps to interpret the story. The healing takes place as according to Eaton et al, “ As the story unfolds, fantasy and reality are teased apart, leading to self-discovery and cathartic release, and the child is assisted in coping with the reality of the trauma and the accompanying emotions”(2007). The fundamental principles of art therapy were clearly stated by Waller (1993/1996). She explains that making visual images helps in learning generally and this is what helps to make art therapy so effective. Art helps the child to express to the therapist many feelings that are hard for a child to express in words and so helps the communication process between child and therapist. Children can increase their confidence in an art therapy session that is made safe by the therapist. Art therapy has all these benefits and more when used in various situations both individually and in groups; in schools, institutions, private sessions, etc. There are numerous benefits to art therapy particularly with children. It is such a natural part of play for them that it is an easy way to help them to relax and be more open with their feelings. “Art made in the safe confines of the art therapy room may enable a child to explore and express feelings that cannot easily be put into words. Instead of acting out ‘difficult’ feelings the child puts these into the object” (Waller, 2008). The advantage of drawing over telling for children has been demonstrated by a study done by Gross and Hayne in 1998 and reported by Looman (2006). In one part of their experiments 40 children between the ages of 3 and 6 years were asked to describe specific times in their lives- when they were happy, sad and scared. Half of the sample had to talk about these times while the other half had to draw the experience and describe the drawing to the therapist. In this study the children who drew their experiences reported more than twice as much information as those who only talked about the experiences. The study also found that the accuracy of the reporting by the children who drew was greater than for those who talked. The uniqueness of art therapy lies in the fact that it is a marriage between art educators and therapists. Dunn-Snow and D’Amelio (2000) discuss how the art educator can use art therapeutically, especially in the school system. Children with behavioral problems are placed either in a ‘regular’ classroom or can be placed in a special classroom setting. In either case they most likely will be sent to regular art classes with art teachers who are not necessarily trained to deal with special educational needs. However the art educators can develop skills in using art more therapeutically in such situations. One of the ways they can do this is by talking therapeutically with the student about his or her art. They learn how to ask questions about the art work and encourage the child to define the subject matter and themes without imposing their own adult interpretation on the work. Art therapists learn how to focus on the feelings that are being expressed as the artwork is created. Art teachers can also become familiar with the Expressive Therapies Continuum (ETC), a framework developed by art therapist that helps to identify the psychological components in various art media. Art therapy has been found to be very useful in treating children with trauma as trauma is usually stored in images. Hanney and Kozlowska (2002) talk about the importance of trauma-specific treatment. For trauma-specific therapy the feelings related to the abuse must be expressed; it must prevent negative self-thoughts, it must provide abuse-prevention skills and it must interrupt the stigma and isolation and reassure the victim. Also important in trauma-specific therapy is that the victim must re-experience the traumatic arousal in a safe context to contradict the anxiety and allow for revision of maladaptive cognitive schema. This therefore means that the child should be present in the therapeutic process, but it was found that most family therapists did not include young children in the sessions either because of lack of training or lack of knowledge of child development. Art therapy, along with play therapy, puppet-play and storytelling were eventually developed as useful adjuncts to family therapy. Specifically, art therapy is effective since creating art is pleasurable which acts a contradiction to the trauma and so it helps to facilitate desensitization and allows speedier processing of the traumatic memories. The second advantage of art therapy is that it “acts as a “transition space” where the intolerable feelings can be externalized in a concrete form that can be manipulated, returned to and reworked” (Hanney and Kozlowska 2002). They recommend using art therapy with children from approximately fours years old. They developed the “illustrated storybook tool” while working in a child psychiatric hospital with children from 3- 14 years old with a wide array of traumatic experiences and emotional consequences. The family storybook is eventually made up of sheets of paper that the members of the family were given, along with paints, colored pens or pencils. The family, including the major child in the therapy, contributes to the book. The story was always begun at a period of low anxiety to give the child safety. Each page represents an event in the story. The therapist facilitates by asking questions about the drawings. However, illustrated books can be used not only with non-traumatized children, but with children with behavioral disorders, or children who have been through a chronic medical experience or a family break up. Trying to get the child to relate incidences of trauma can cause hyper-arousal in the child where he becomes very anxious, hyperactive and inattentive. This hyper-arousal can cause emotional shut down in the child and therefore regular intervention strategies used by the therapist are ineffective. The child is unresponsive to verbal and cognitive interventions. Art has therefore been found to be an effective way to get to the child in such incidences. Kozlowska and Hanney ( 2001 ) explain how art therapy is useful when they state that “it involves ‘doing’, provides a non-verbal medium, the creation of an ‘image’, a concrete visual expression depicting memories and experiences stored at both conscious (declarative) and unconscious (implicit) levels, for exposure to conscious reflection and cortical processing”. They go on to describe many reasons why art is such a useful therapy strategy with children who have suffered trauma. Art is pleasurable and gives hope to the children. It is also described as a safe tool for the children and because they are able to freely express their feelings it makes them less anxious and so more able to interact with the therapist. Art is a starting point for traumatized children to put their feelings and experiences into a narrative. A specific type of trauma that art therapy has been extensively used with is disasters; including wars, hurricanes, earthquakes, loss through death. When a child experiences a disaster it can have long term effects such as nightmares, acting out, or they may become withdrawn and depressed. Due to the rising incidences of natural disasters that children are exposed to and the increasing use of art therapy to help these children, Orr (2007) undertook an analysis of the literature in order to proved therapist with information on art therapy that could be useful to them. She analyzed newspaper articles, television footage, research articles, newsletter articles, and online articles to compile information on what art therapists are doing with children after a disaster. Following the disasters art therapist went to these places to work with the children. As Orr reported from her analysis, “Children used the art in a variety of ways. Some used it to repeat images of the event, while others resisted memories of actual events and used the art to sooth and reduce stress” (2007). One specific example of successful use of art therapy after a disaster was the efforts of a large team of health workers in the aftermath of Hurricane Katrina in Louisiana, USA. Looman (2006) describes the use of art therapy with children of all ages displaced from their homes. Another case scenario in which art therapy has been explored and used is in post-separation families. In order to fully involve the children in family therapy, Shafer (2008) developed specific arts-based family therapy resources. In particular she developed a programs she calls ‘Famlart’. She also believes in the benefits of art therapy for children as a way to help them express feelings that would normally be difficult to verbalize. She describes how it helps in family therapy with children from families that are separated The children can reflect on their experiences of the parents’ separation; they can show through their drawings how they perceive the family alliances, and the stresses; it gives them a way to participate in family sessions and it helps in the communication between parent and child. Her Famlart resources include individual and/or family drawings, collage, picture cards, paper, pencils, felt markers, water colors, crayons, play-dough, glue stick, childrens scissors, Famlart cards/forms, and play materials (dolls, doll house, finger and hand puppets and games tike Snakes and Ladders and Chinese Checkers. These are all used very flexibly with the families depending on the session. Shafer describes her success with a family that has been through migration and separation of the parents, and how it is useful in dealing with children of different ages in the one family. She describes some of the ways that art therapy was helpful. The art therapy was used to gather information about the problems and how the family was coping; it helped the family to reflect on their feelings and their interactions with each other and work on changing those; any conflicts in the stories were cleared up through the art therapy sessions in a less stressful way. Another effort to demonstrate the effectiveness of art therapy with children was a study done by Mallay (2002). Art therapy was used as a psychotherapeutic method with children with Posttraumatic stress disorder. The author adds further advantages to the use of art therapy with children with PTSD when she states that “exercises are goal-oriented, require no artistic skill, and help to process feelings and concepts without having to ‘say’ all the words. Art Therapy is ideal when sensory, verbal or cognitive abilities are affected because it does not rely on verbal output.” Art therapy has also been found to help in diagnosing PTSD thus speeding up processing and coming to resolution. The author describes her work with a young boy who had suffered a sudden and very traumatic experience when a car crashed into a restaurant where he was sitting and pinned him to the table. He suffered head trauma among his injuries. Mallay was concerned about the emotional and psychological trauma that would undoubtedly accompany such an experience. She reported successful results after fifteen sessions of art therapy. There was greater expression of emotions, less sleep difficulties, decrease in the auditory and visual hallucinations that had accompanied the accident. Through his drawings he had gone through the three stages of recovery from PTSD; stabilization by connecting with and forming a safe bond with the therapist; part two discussing the event mostly through his drawings and part three exploration and managing the after effects (Mallay, 2002). Sexual abuse is properly the most appropriate situation for the use of art therapy. The shame, embarrassment, fear and anxiety that could accompany this experience by a child could make it almost impossible for the child to talk about it. Art therapy has all the qualities to help a child through this. It particularly helps the child to deal with ambivalent feelings towards the abuser. One of the most difficult stages in counseling a child through a sexual abuse experience is usually the first interview. It is difficult for the child to trust an adult that is most likely a stranger and so will not be eager to talk to this therapist about such a difficult and embarrassing experience. Drawings can be an asset to the interview process. Through drawing the therapist can understand the child’s level of coping, and get an idea of how the child is reacting emotionally to the abuse. The child will also provide specific information about the abuse through drawings that he may not be able to verbalize. However the interview phase is not the only phase where art therapy is invaluable in helping children who have been sexually abused. Cohen-Liebman (1999) is a CIS (child interview specialist) and has been using art therapy with child sexual abuse for many years. She describes her model that she has developed that incorporates art therapy into the phases of counseling sexually abused children, including detection, identification, assessment and management. Using art therapy has been found to have benefits to both the child and the therapist. Establishing rapport is a benefit to both. The therapist can gain many insights into the developmental stage of the child and use those insights to prepare a strategy for communicating and working with the child. A specific use of art therapy is in the anatomy identification that the child may be asked to do. It is easier for the child to indicate the body parts that have been abused through drawings than through pointing to their own bodies. The author has also found that art has helped children to remember additional information about the abuse. The art of abused children has revealed recurring characteristics that art therapists now use to help them to analyze and therefore better support the child. Clements (1996) explains some of these characteristics as sexual connotations in the art, the refusal to draw the lower part of the body often accompanied by distorted pictures of the body parts, the use of the color red and similar colors, and the use of the heart shape in various ways. Another common feature is “encapsulation” where the child encloses something in the picture and makes it separate from everything else in the picture. Clements (1996) describes one of the advantages of art therapy with victims of sexual abuse is that the drawings can be brought out at a later time and discussed when the child feels more comfortable to discuss the abuse. But she mentions that the child should be in control of the image, i.e. the colors, the content, material, size and esthetics, as children who have been through abuse need control and choice as part of their healing. Medical art therapy is a special arm of art therapy used particularly with children in serious medical crises. Children who have to undergo diagnostic and therapeutic medical interventions also undergo severe psychological and emotional trauma. According to Favara-Scacco et al (2001)”Medical AT addresses psychotherapeutically childrens natural capacity to use art for self-expression, conflict resolution, and emotional reparation. By respecting the ego functional defenses, medical AT allows childrens psycho-emotional growth to continue”. In September the authors piloted a study of using art therapy with hospitalized children and the parents. This project included medical play and structured and free drawing for children who were scheduled for medical procedures especially lumbar punctures and bone marrow aspirations. The results were very positive. Art therapy provided strong support for these children. It was also seen how important it was to provide this kind of emotional support for the children as part of their preparation for facing serious medical procedures. The parents also benefitted tremendously from this form of therapy. The art therapist helped the parent to become more self-aware and to provide the parent with ways they can support the child. The therapist and parent both acted as models to the children to face the procedure with less emotional stress. ADHD is a spectrum disorder in which the specific features include inattention, impulsiveness, difficulties with organization and structure and mood lability. Treating children with ADHD has always been fraught with controversy over the use of behavioral versus chemical therapies. Henley (1998) developed a program of expressive therapies specifically for children with ADHD. The program included free play and socialization, group discussion and an expressive art activity. Henley explains that children with ADHD often suffer rejection by peers and so they withdraw into their own world where the computer becomes their main focus. Their socialization skills thus atrophy. The expressive therapies helped to bring the child back out and to develop skills to express themselves. Eaton et al (2007) reviewed the literature that reported on the use of art therapy in order to get a full picture of the success of art therapy with children. The use of art therapy was found to be universal and used for a wide range of psychosocial issues, particularly associated with traumatic events. Many of the therapists reported that this form of therapy was most successful with the youngest clients. This review confirmed many of the conclusions that have been drawn about the usefulness of art therapy and the particular reasons why it is so useful. The most common reason is that the child is better able to express emotions and memories that he has no words for through drawing. The therapists report how beneficial this is to building a communication with the client. Art therapy seems to form the safe therapeutic bond between client and therapist more easily than other therapy strategies with children. What was notable to the reviewers also was the unstructured and unconstrained way in which art therapy was conducted. This flexibility seemed to be advantageous to the therapy sessions. Precautions One of the precautions in using art therapy with children is in interpreting the art. Cockle (1994) discusses several issues when interpreting children’s art in therapy. It is important to be clear about what feelings the child is expressing in the art. The child’s individuality must be taken into account and generalizations are to be avoided. This means the therapist must know some things about the child’s culture and background. Cockle advises that the therapist should encourage the child to explain the art and to tell the story of the picture. Looman (2006) emphasizes the importance of “applying a developmental lens” when using drawing as a tool for assessment. The approach used to apply art therapy with children should take into account the child’s age and developmental levels in cognition, social and emotional development. References Clements, K. (1996) The use of art therapy with abused children. Clinical Child Psychology and Psychiatry. 1 (2): 181-198 Cockle, S. (1994) Healing through art: the self-portrait technique. International Journal of Play Therapy. 3 (1) 37-55 Cohen-Liebman, M. (1999). Draw and tell: drawings within the context of child sexual abuse investigations. The Arts of Psychotherapy. 26, 3. 185-194 Dunn-Snow, P. & D’Amelio, G. (2000). How art teachers can enhance art making as a therapeutic experience: Art therapy and art education. Art Education. 53 (3): 46-53 Eaton, L. G., Doherty, K.L., &Widrick, R.M. (2007). A review of research and methods used to establish art therapy as an effective treatment method for traumatized children. The Arts in Psychotherapy 34, 256–262 Favara-Scacco, C., Giuseppina Smirne, G., Schiliro, G. & Di Cataldo, A. Art therapy as support for children with Leukemia during painful procedures. Medical and Pediatric Oncology 36: 474-480 Hanney, L. & Kozlowska, K. (2002). Healing traumatized children: creating illustrated story books in family therapy. Family Process 42, (1): 37-65 Henley, D. (1998). Art therapy in a socialization program for children with ADHD. American Journal of Art Therapy. 37 (1): 2-12 Kozlowska, K. & Hanney, L. (2001). An Art Therapy Group for Children Traumatized by Parental Violence and Separation. Clinical Child Psychology and Psychiatry 6 (1): 49–78 Looman, W.S. (2006) A developmental approach to understanding drawings and narratives from children displaced by Hurricane Katrina. Journal of Pediatric Health Care. 20 (3): 158-166 Mallay, J.N. (2002). Art Therapy, an effective outreach intervention with traumatized children with suspected acquired brain injury. The Arts in Psychotherapy. 29. 159-172 Orr, P. (2007). Art therapy with children after a disaster. The Arts in Psychotherapy. 34, 350-361 Shafer, M. (2008). Talking pictures in family therapy. Australia and New Zealand Journal of family Therapy. 29 (3) 2008 pp. 156-168 Waller, D. (1993/1996) Group interactive art therapy: Its use in training and treatment. London: Routledge. Waller, D. (2006). Art Therapy for Children: How It Leads to Change. Clinical Child Psychology and Psychiatry 11(2): 271–282. Read More