Art Therapy
Art therapy is a means for patients to reconcile emotional conflicts, foster self-awareness, and express unspoken and frequently unconscious concerns about their disease. In addition to its use in treatment, it can be used to assess individuals, couples, families, and groups. It is particularly valuable with children, who often cannot talk about their most pressing and painful concerns. The connection between art and mental health began to be recognized with the advent of mental institutions in the late 1800s and the early 1900s. Prinzhorn's book Artistry of the Mentally Ill, published in 1922, with stunning art made by institutionalized adults, helped ignite inquiries into the spontaneous graphic outpouring of disturbed patients. In addition to the interest in the artistic or diagnostic value of the patients' productions, there was the realization that the production of art was valuable in rehabilitating a patient's mental health. In the 1940s, Margaret Naumberg blended ideas about psychoanalytic interpretive ~techniques and art to develop art as a tool to help release "the unconscious by means of spontaneous art expression . . . and on the encouragement of free association. . . . The images produced . . . constitute symbolic speech" (Naumberg, 1958). A decade later, Edith Kramer began her own exploration into the use of art. She focused her approach on the artmaking process itself. In her brand of therapy, a therapist is able to bring "unconscious material closer to the surface by providing an area of symbolic experience wherein changes may be tried out, gains deepened and cemented. The art therapist must be at once artist, therapist, and teacher . . ." (Kramer, 1958). Then, in 1958, Hana Kwiatkowska translated what she knew as an artist into the field of family work and introduced specific evaluation and treatment techniques at the National Institute of Mental Health. Art therapy was formalized in the founding of the American Art Therapy Association in 1969.13 Along with the Art Therapy Credentials Board, the 4,000-member organization sets standards for the profession, strives to educate the public about the field, has a code of ethics and a system of approving educational programs and registering art therapists, and will soon certify art therapists. Registered art therapists (A.T.R.s) must have graduate degree ~training and a strong foundation in the studio arts as well as in therapy techniques and must complete a supervised internship with work experience. Currently, 2,250 art therapists are registered by the association. They practice in psychiatric centers, drug and alcohol rehabilitation programs, prisons, day care treatment programs, schools for the mentally retarded, residences for the developmentally delayed, geriatric centers, and hospices. Two journals are available: Journal of Art Therapy and Art Therapy Journal. Art therapy differs from regular art classes such as painting, sculpture, and drawing, in that the therapist is trained both in diagnosis and in helping patients with specific health problems. In their art, for instance, patients may focus on parts of their bodies that unconsciously concern them but which they have never mentioned to their physicians or nurses. Such revelation can lead to further investigation and additional diagnosis. In helping patients express their feelings about a disease--such as cancer, for instance--therapists may lead them to draw images of themselves with cancer. These images may reveal a great deal about their feelings about their cancer, its severity, and its effect on their health and well-being. ~Research accomplishments. Research on art therapy has been conducted in clinical, educational, physiological, forensic, and sociological arenas. Studies on art therapy have been conducted in many areas. • Burn recovery in adolescent and young patients (Appleton, 1990). • Eating disorders. • Emotional impairment in young children (Bowker, 1990). • Reading performance (Catchings, 1981). • Chemical addiction (Chickerneo, 1993). • As a prognostic aid in childhood cancer. ~ • As an aid in assessing ego development and psychological defensiveness in young children (Kaplan, 1986; Levick, 1983). • Childhood bereavement (Zambelli et al., 1989). • As a modifier of locus of control in behavior-disordered students. • Sexual abuse in adolescents. • Deafness, aphasia, autism, emotional disturbance, physical handicap, and brain injury in children (Silver, 1966). Research needs and opportunities. Among the areas for further research are the following: ~ • Test the effect of art therapy on anxiety levels of patients subjected to invasive medical procedures. • Determine whether art therapy enhances recovery and diminishes hospital stays for hospitalized patients. • Examine whether art enhances relaxation art in guided imagery and relaxation training. • Develop specific art interventions for children with communication problems and test the impact on their academic and social performance. • Determine whether clients' choice of art materials and quality of art affects their psychophysical state. • Assess group therapy as a tool to improve corporate working relationships. • Assess self-portraits as a prognostic indicator for clients with eating disorders. • Examine use of art therapy with juvenile offenders to assess moral development and modify impact of peer pressure. • Investigate art therapy as an avenue to pain control. • Test whether art therapy increases acceptance of physical and psychological changes in the elderly. • Assess the utility of art therapy as a coping technique with survivors of natural disasters.

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