ARTS IN PSYCHOTHERAPY

A Theoretical Model of Emotional Processing in Visual Artmaking and Art Therapy
Weinfeld-Yehoudayan A, Czamanski-Cohen J, Cohen M and Weihs KL
Current theoretical models of emotional processing rely mainly on detecting emotional processing through verbal, conscious, and cognitive processes. However, artmaking can potentially reveal embodied and implicit processes that may otherwise remain hidden in verbal expression. This paper attempts to close the scholarly gap by introducing a novel art-based emotional processing model that integrates emotional processing and art therapy literature, incorporating emotional meaning-making, awareness, acceptance, and memory consolidation. The art-based EP model explains the processes through which art creation may benefit emotional processing. It also elucidates the ways in which art therapy can be used to enhance therapeutic outcomes.
Photovoice techniques and art therapy approaches with refugee and immigrant adolescents
Feen-Calligan H, Grasser LR, Nasser S, Sniderman D and Javanbakht A
This paper describes a program informed by art therapy and Photovoice approaches and techniques aimed at helping new immigrant and refugee teens to navigate personal and cultural identities by reflecting on their experiences as new residents in the US. Photovoice is a photography and social action method that encourages participants to photograph aspects of their daily lives, reflect on their meaning and significance and galvanize necessary changes. The program began in February 2020 at the Arab-American National Museum (AANM), but was adapted for an online format and re-framed towards a reflection on the COVID-19 pandemic. Broad questions teens explored included: What is good? What is challenging? What is sustaining during challenging times? What needs to change? and What about your culture and background are you proud of and wish to share with other US residents? Highlights of the sessions demonstrate how art therapy interventions paralleled photography-assigned themes of self, home, and community and encouraged group interaction and mutual support. A virtual museum exhibition culminated the program and reached community leaders. Self-reports from select participants highlight changes in posttraumatic stress, anxiety, and somatic symptoms over the course of programming.
Loss, adaptation and growth: The experiences of creative arts therapists during the Covid-19 pandemic
Keisari S, Feniger-Schaal R, Butler JD, Sajnani N, Golan N and Orkibi H
Since the outbreak of the COVID-19 pandemic in March 2020, mental health professionals have been called upon to cope with various challenges, including the shift to telehealth without prior training, overload in the workplace, increased risk of infection, and personal stressors relating to the pandemic. This article presents the qualitative findings of a larger international mixed-method study that explored the experiences of creative arts therapists around the globe during the first year of the pandemic (Feniger-Schaal et al., 2022). Twenty creative arts therapists were interviewed between July 2020 and March 2021. Transcriptions of the interviews were qualitatively analyzed through reflexive thematic analysis. Three main themes were identified: an experience of processing the losses caused by the pandemic, a restorative orientation that focused on adaptations the therapists made, and innovations that lead to personal and professional growth. Artistic engagement and creativity were found to be a resource when coping with losses and helped therapists adapt to the shift to tele-creative arts therapies (tele-CAT). Although this shift can lead to advances in the field of creative arts therapies, it requires further consideration, including the need for ethical guidelines, specific training, the development of digital methods that support the creative process, and dedicated supervision for therapists. The findings also point to the importance of psychological support to mitigate the burden therapists experience during stressful events.
A mixed methods exploration of a pilot photo-reflection intervention for enhancing coping and well-being during COVID-19
Burton AE and Elliott JM
Restrictions enforced during the COVID-19 pandemic are associated with negative impacts on mental health and well-being. There is a need to support individuals to cope with these challenging circumstances. An embedded design mixed methods approach was employed to explore challenges experienced during the pandemic, the effectiveness of a photo-reflection intervention for enhancing coping, wellbeing, and resilience, and how this intervention functioned to impact on these outcomes. 108 participants were randomised to one of three photo-taking conditions; challenges experienced, coping strategies, or experiences and were assessed with measures of wellbeing, coping and resilience. In addition, open-ended survey questions were used to assess perceptions of experiences and of the effects of the intervention. There were no significant differences across the groups, however subjective psychological well-being, and emotional and functional well-being improved post-intervention regardless of intervention type. There was also an increase in planning and self-distraction coping for those whom the intervention elicited reflection. Qualitative data highlighted a range of challenges experienced and examples of both adaptive and maladaptive coping approaches. Photo-reflection intervention approaches may improve well-being and enhance coping during these challenging circumstances through providing opportunity to review and reflect on life experiences.
How health-focused choirs adapted to the virtual world during the COVID-19 pandemic - An international survey
Tamplin J and Thompson Z
The COVID-19 pandemic significantly impacted the operation of choirs around the world due to the high-risk nature of group singing for disease transmission. These risks are even greater for people living with health conditions. This paper presents the results of an international, cross-sectional survey that asked health-focused choir facilitators if and how they adapted their choir to due to COVID-19 restrictions and the high-risk of transmission during group singing. Participants were recruited through searches of choir and music therapy networks, social media, and snowballing sampling methods. The anonymous online survey consisted of 17 multiple choice and 7 short answer questions. Data was analysed using descriptive statistics and thematic analysis. Sixty-five surveys were commenced (50 completed). Many respondents (63 %) took their choirs online, and neurological conditions were the most common populations served. Format and methods of online choirs are described, as are benefits and challenges of online choirs. Several respondents indicated they would continue online post-COVID-19 restrictions. Online choirs were seen as feasible and beneficial, despite challenges. Recommendations regarding facilitator skills, technology set up, accessibility and session structure for online facilitation of health-focused choirs are provided.
Outcomes and experiences of an online Balance-Space music therapy intervention for cancer patients: A mixed methods study
Rabinowitch TC, Dassa A, Sadot AS and Trincher A
Coping with cancer requires both physical and emotional fortitude, and various intervention programs attempt to address these needs. Since the outbreak of the COVID-19 pandemic, many interventions have transitioned from live to online settings. Balance-Space is a music therapy intervention, which includes listening to original composed music, followed by an open discussion. Participants with a cancer diagnosis were randomized to either an online group music listening intervention or an online group meditation intervention. Both activities were followed by a group discussion led by two music therapists. A mixed methods study was employed and included both quantitative measurements of distress, anxiety, and pain and a qualitative analysis of the group discussion in the music intervention group. We found a significant reduction in participants' perceived pain levels following the music intervention when compared to the meditation intervention. This result was supported by qualitative content analysis, which revealed how music evoked physical reactions and affected the participants' experience of pain. There were no significant differences in participants' perceived distress levels and perceived anxiety levels between the two groups. These preliminary results are encouraging and support the need for further exploration of online music therapy interventions as a non-pharmacological treatment for cancer patients.
Pivotal care practices: Care ethics in inclusive arts-based research with people labelled/with intellectual disability during the COVID-19 pandemic
Kuri E and Schormans AF
In this article, we aim to illustrate how inclusive research can be situated as a form of care work. We do this through addressing tensions and possibilities arising in an ongoing arts-based community-research project - . We discuss the design of the project along with critical, philosophical, and ethical foundations that drive decision-making and shifts in methodology in response to COVID-19 pandemic restrictions. We argue that understanding inclusive research as care work is vital, particularly in pandemic times where complex socio-political contexts threaten the social survival of individuals and communities that have traditionally been excluded from knowledge creation projects. Our efforts to counter epistemic violence through practices of care are critically considered alongside tensions emerging in connection with physical contact restrictions combined with technology barriers experienced by many of our group members.
Commentary: Troubling care
Estrella K
Music to decrease anxiety in college students during the COVID-19 pandemic
Hernandez-Ruiz E
The COVID-19 pandemic impacted the world in a multiplicity of ways. For college students, considered emerging adults in a time of transition between adolescence and adulthood, the stressors were multiplied by severe disruptions in education, social activities, family distress, and job losses. Significant impact on mental health in college students has been reported during this period. We investigated the effect of a previously researched music experience on the anxiety levels of 36 performing arts college students. Results showed a high level of anxiety pre-intervention, but a significant decrease and normative levels at posttest. Although a small sample size warrants caution in generalization, these results show the feasibility of theoretically sound, brief music experiences to address significant distress in vulnerable populations.
"Migrated onto the Screen": The impact of the COVID-19 pandemic on the clinical practice of drama therapy
Atsmon A, Katz T and Pendzik S
This article analyzes the impact of the COVID-19 pandemic on the clinical practice of Drama Therapy, considering how a forced shift to the online setting impacted drama therapy's concepts and practice. Anchored in a qualitative analysis of 20 interviews with well-established drama therapy practitioners from 19 different countries, we put forward the notion of four positions of reaction to the online setting: . Our discussion of the four positions aims to reflect a composite exploration of practitioners' experiences during various phases of their online work. Importantly, we insist that movement between positions is fluid and dynamic. Building on a prior research examining the use of digital resources before March 2020, our analysis utilizes the metaphor of forced migration to consider the range of experiences and challenges that emerged when online work was no longer a choice amidst the spread of the coronavirus. We hypothesize that practitioners who were able to channel the discipline's creative ethos and recognize that online drama therapy presents a qualitatively different phenomenon (vis-a-vis in-person practice) were best able to experience the fluency position. We speculate that "online drama therapy" may be different from "practicing drama therapy online," wondering whether it will develop into a new brand of drama therapy, as more and more practitioners and clients "migrate onto the screen".
Shifting to tele-creative arts therapies during the COVID-19 pandemic: An international study on helpful and challenging factors
Feniger-Schaal R, Orkibi H, Keisari S, Sajnani NL and Butler JD
The COVID-19 pandemic has led to an unprecedented shift to online treatment. For the creative arts therapies (CATs) - a healthcare profession that involves the intentional use of the visual art, drama, music, dance, and poetry within a therapeutic relationship - this shift has been highly consequential for practice. This study examined (a) how the COVID-19 pandemic has impacted clinical practice in the CATs, and (b) the features characterizing online practice in an international sample of 1206 creative arts therapists aged 22-86 (92% female). It aimed to identify changes in the use of the arts in therapy, resources that contributed to the delivery of therapy, and the role of therapists' creative self-efficacy in adapting to these changes. Respondents completed close and open-ended questions providing examples of what does and does not work in online practice. The results indicate that creative self-efficacy plays a meaningful role in buffering the impact of therapists' computer comfort on their perceived difference in online clinical practice; confidence in one's abilities positively contributed to their adaptation to online practice. The qualitative analysis yielded four main categories: the challenges of tele-CATs, continuing the therapeutic process through tele-CATs, adaptations for tele-CATs, and future directions. Overall, the results present a timely report on the inevitable transition of the CATs to online practice.
Art therapists' fear of COVID-19, subjective well-being, and mindfulness
Jue J and Ha JH
The COVID-19 pandemic has hit face-to-face service fields, including art therapy. The present study examined changes in Korean art therapists' subjective well-being between the pre- and during pandemic periods. We also investigated whether the fear of COVID-19 affected art therapists' subjective well-being and verified the mediating effect of mindfulness on the relationship between COVID-19 fear and subjective well-being. We used the existing data of 203 Korean art therapists' subjective well-being, and recruited 132 new participants. The participants were Korean art therapists and art therapy students who completed a subjective well-being questionnaire, a Fear of COVID-19 scale, and a mindfulness questionnaire. The results indicated lower levels of subjective well-being during the COVID-19 period than pre-pandemic. Furthermore, we confirmed that the fear of COVID-19 lowered subjective well-being, with mindfulness mediating the relationship. This study discusses core components of mindfulness, decentering, and embodiment as attributes shared with art therapy. Our results highlight the importance of dispositional mindfulness to foster subjective well-being during the pandemic.
Tele-psychodrama therapy during the COVID-19 pandemic: Participants' experiences
Biancalani G, Franco C, Guglielmin MS, Moretto L, Orkibi H, Keisari S and Testoni I
Italy was severely hit by the COVID-19 pandemic. In early March 2020, a series of legislative decrees have been issued, establishing the restrictions that all Italian citizens are required to respect, according to which it is strictly forbidden to leave the house if not for reasons of necessity, health, or work. This qualitative study investigated which aspects clients find helpful or hindering in shifting to group tele-psychodrama due to the COVID-19 pandemic, after participation in an in-person psychodrama group. Participants were 15 adults who were members of a pre-existing in-person psychodrama group that shifted to a tele-psychodrama group format facilitated by two psychodrama therapists. The Client Change Interview was used at the end of the tele-psychodrama as a post-treatment assessment. All the interviews were transcribed and then underwent a thematic analysis. The analysis yielded six shared themes: the role of tele-psychodrama sessions during COVID-19 pandemic; perceived effectiveness of tele-psychodrama; main advantages of tele-psychodrama; limitations encountered during the online intervention; the termination of tele-psychodrama; and the relationship with the therapist. The findings provide preliminary evidence for the clinical practice of tele-psychodrama and lays the groundwork for further studies that can contribute to the use of electronic platforms in psychodrama interventions.
Covid-19 and absence of music therapy: Impact on mother-child dyad during invasive procedures in pediatric oncology
Giordano F, Rutigliano C, De Leonardis F, Rana R, Neri D, Brienza N and Santoro N
During COVID-19 pandemic, Italian pediatric oncology departments were obliged to adopt restrictive measures to minimize the risk of in-hospital infections in frail patients and staff members. Access to the wards was significantly reduced and music therapy (MT) activities were suspended. The aim of this study was to compare the level of anxiety and sedation in pediatric patients undergoing invasive procedure before (T1), during(T2) and after(T3) the pandemic, with and without the presence of MT. From January to September 2020, all children aged 2-15 with oncological and hematological diseases undergoing to invasive procedure were enrolled. During T1 and T3 children received preoperative preparation with MT by a certified music-therapist. In T2 they received music or video by clinical staff. Preoperative anxiety scores were measured with the m- YPAS scale. Interviews with mothers were performed. The average consumption of drugs used was analyzed. Significant differences in preoperative anxiety levels between scores in T1, T2 (p.value = 0,0000014) and in T2, T3 (p.value = 0,0000031) were observed. No difference between T1-T3 (p.value = 0,96). Higher dosage of midazolam in T2 (1,14 mg 0,189) compared to T1 (0, 71 mg 0,399) and T2 (1,14 mg 0,189) were observed. Mothers also recorded higher scores on anxiety and stress without music therapy.
Art in the time of corona: A thematic analysis
Lakh E, Shamri-Zeevi L and Kalmanowitz D
This study looks at 102 images made by women in the month of April 2020 at the time of COVID-19 and during the first lockdown in Israel. Submissions were anonymous and participants were asked to write a few words of description alongside their images. The data collected was analyzed by thematic analysis approach. Four major themes were revealed: Art making for self-regulation, artmaking as embodying and containing mental states and emotional expression, art as enabling creativity, imagination, experimentation and play and art making as related to time. The art making in this study pointed to the mental processes of the contributors as well as to the role that art played.
I know what I like, and I like what I know: Patient preferences and expectations when choosing an arts therapies group
Millard E, Cardona J, Fernandes J, Priebe S and Carr C
Patient preferences deserve consideration as they play a role in engagement with psychosocial interventions. This study sought to understand more about preferences and expectations of the arts therapies, in order to support informed decision-making. Semi-structured interviews were conducted with 17 participants in a trial of group music therapy, art therapy and dance-movement therapy. Audio recordings were transcribed. Data relating to the process of choosing their preferred arts therapies groups, expectations and experiences of the groups were analysed using framework analysis. Three overarching themes were found relating to the experience of choosing an arts therapies group and subsequently attending it: past experiences of the art forms, social interactions in the groups and expectations of helpfulness. Familiarity and perceived capability were important factors for the therapy experiences. Although each participant had a unique decision-making process, the themes offer understanding of common considerations when making a choice about engagement with the arts therapies. Clinicians should guide discussions around past experiences of the art forms, group dynamics and therapy aims during shared decision making for the arts therapies.
Towards sustainable implementation of music in daily care of people with dementia and their spouses
Dassa A, Rosenbach M and Gilboa A
Primary caregivers (PCs) of people with dementia deal with stressful daily living, especially spouses whose care recipient is at home. Several programs have been developed to aid caregiving by providing musical strategies, yet successful sustainable implementation of music in the daily lives of the couples awaits further research and development. To promote this, in this pilot study we proposed a music therapy program that included 12 weekly sessions with the couple in their home environment. In addition, there were bi-weekly phone counseling sessions with the PC, to reflect on the joint sessions and to help implement music in daily life. Findings based on the description, analysis, and interpretation of two cases showed that the proposed program provided a strong foundation upon which the treatment could succeed; it relied on natural forces such as the use of songs, which can empower each of the spouses individually, as well as together as a couple; and it included elements of ongoing support that enabled preservation of the accomplishments that were achieved during the sessions. Future research is required to examine whether this program is appropriate for couples in other housing contexts, and in different stages of dementia.
Receptive music therapy to reduce stress and improve wellbeing in Italian clinical staff involved in COVID-19 pandemic: A preliminary study
Giordano F, Scarlata E, Baroni M, Gentile E, Puntillo F, Brienza N and Gesualdo L
The influence of music therapy (MT) as a support intervention to reduce stress and improve wellbeing in Clinical Staff (CS) working with COVID-19 patients was evaluated. Participants were enrolled as a result of spontaneous agreement (n = 34) and were given remote receptive MT intervention over a 5-week period. Their levels of tiredness, sadness, fear and worry were measured with MTC-Q1 before and after MT intervention. An immediate significant variation in the CS emotional status was observed. The results seem to confirm that in an emergency situation, it is possible to put in place a remote MT support intervention for CS exposed to highly stressful situations.
Aesthetic presence: The role of the arts in the education of creative arts therapists in the classroom and online
Sajnani N, Mayor C and Tillberg-Webb H
Literature about the integral role of the arts in learning is widely available, but much less has been written about how the arts and aesthetics support education in the creative arts therapies, particularly in the online learning environment. This article introduces the concept of aesthetic presence within the Community of Inquiry pedagogical model in line with values espoused within a Universal Design for Learning framework. The authors contextualize this concept with examples of how attention to the use of aesthetic and multimedia strategies in the classroom and in the online learning environment may foster openness and connection, encourage flexibility, humor, critical thinking, and animate and facilitate conversations about emergent and emotionally difficult themes while increasing accessibility for different kinds of learners.
Development and Pilot Randomized Control Trial of a Drama Program to Enhance Well-being Among Older Adults
Moore RC, Straus E, Dev SI, Parish SM, Sueko S and Eyler LT
Develop a novel theatre-based program and test its feasibility, tolerability, and preliminary efficacy for improving empathy/compassion and well-being among older adults.
The Bodymind Model: A platform for studying the mechanisms of change induced by art therapy
Czamanski-Cohen J and Weihs KL
This paper introduces the Bodymind model of Art Therapy and delineates the processes through which it has salutary effects on individuals coping with a variety of health related challenges. The goal of this model is to articulate how activation, reorganization, growth and reintegration of the self can emerge from bodymind processes activated by art therapy. It provides a framework for the conduct of research that will test the key theoretical mechanisms through which art therapy benefits clients. We expect this model to be a spring board for discussion, debate and development of the profession of art therapy. Furthermore, we hope readers can use this model to conduct sound mechanistic studies. This paper can inform social scientists and medical professionals on the manner in which art making can contribute to health.
Poetry therapy, men and masculinities
Furman R and Dill L
Therapists have long utilized poetry with various at risk male populations. Yet, in spite of its use, therapists have also been aware of the dilemmas associated with using poetry in a population whose behavior and identity may at times run counter to the core tenants of poetry therapy. However, the literature of poetry therapy does not fully explore what therapists need to know about men and masculinities in order to work with them. This article helps prepare therapists using poetry to become more sensitive to gender issues and utilize this understanding in their practice with men. It explores some of the key concepts from gender and masculinities studies and provides examples for how these concepts can be used in practice.