Issues in Art Therapy with Children Essay

Art therapy is the therapeutic use of making art within a professional relationship, and the process involved in making art is healing and life-enhancing. In the early 1980s, the American Art Therapy Association (Levick, 1983, as cited in Newcomer, 1993) regarded art therapy as an opportunity for nonverbal expression and communication with the belief that the creative process of art is a means of reconciling emotional conflicts and of fostering self-awareness. The association later expanded their definition to read: â€Å"Art Therapy is a human service profession that utilizes art media, images, the creative art process and patient/client responses to the created products as reflections of an individual’s development, abilities, personality, interests, concerns and conflicts. Art experiences can provide an alternative to verbal forms of assessment and treatment† (American Art Therapy Association Newsletter, 1998). Kaplan (2000) reviewed the findings of other neuroscientists who noted that graphic representation is a complex activity, involving areas of the brain associated with language. For example, Restak (1994) reported that more brain neurons are devoted to vision than the other senses. Kaplan suggests that studio art can facilitate problem-solving abilities, stimulate pleasure and self-esteem, and provide opportunities for successful functioning in children and adults with cognitive impairments. Malchiodi (2003) cites studies by scientists who found that drawing involves complex interactions between many parts of the brain, and notes that science will be central to understanding how art therapy works and why it is a powerful therapeutic modality. Riley (2003) observed that offering opportunities to create art to depressed adolescents as a means of communication that can be enjoyed and controlled provides a lens for viewing their perceptions through their own images, as well as a vehicle for treatment and a way to address resistance. In addition, she finds drawingless confrontational, less familiar, and less judgmental than talk, and that adolescent depression is often masked. Teenagers may also be angry or aggressive, as opposed to the lassitude characteristic of depressed adults, and art-making can serve to relieve painful self-deprecation. Wadeson (1980) noted that drawings by patients experiencing depression showed less color, less affect, and less effort than the drawings of nondepressed individuals. In addition, they showed more empty space and more depressive affect, such as drawing about harming others. Silver & Ellison (1995) described the behavior and history of a 16-year-old who had been arrested and incarcerated for stabbing another youth with a pencil. His history included a volatile temper and it was feared that he might harm others. His father had disappeared and his mother had been killed in a gang-related incident. During his stay in the facility, he was placed on suicide watch, and then was disciplined for angry acting-out. Three weeks after his release, he committed suicide. Advantages of Art Therapy vs. Traditional Verbal Therapy for Children Many studies performed by therapist-researchers have been chosen to focus on art therapy in particular because of the expressive arts benefit of allowing children a nonverbal outlet for their feelings. However, because art therapy is a relatively new modality, there is a minimal amount of research that has been conducted to support its efficacy or usefulness. Therefore, traditionally there has been less acceptance of it as a viable treatment option. Due to this belief, it is important to point out the many advantages of conducting art therapy to treat a wide spectrum of mental illnesses, from severe disorders such as schizophrenia to mild behavioral disorders. There are many therapeutic advantages to this particular type of therapy. Pre-adolescent children often have difficulty expressing their thoughts and feelings verbally. Children’s linguistic and cognitive skills are not fully developed, which limits their verbal expression. Because art therapy involves nonverbal communication, it is useful with this age population whose developmental limitations prevent the level of participation often required in verbal therapy (Newcomer, 1993). Instead of words, the image created by the child is the symbolic representation of a feeling, event, wish, etc. This form of preverbal expression and preverbal thinking does not require translation because it is depicted in image form. For children who are not able to make the translation, art is used as a vehicle for expression rather than words (Newcomer, 1993). Another advantage of art therapy is that the image produced can serve as a catalyst for verbal expression. This image then provides the child with structure and a foundation in an attempt to explain or describe the production (Newcomer, 1993). Many children suffer from low self-esteem and low self-confidence. When a child participates in art therapy activities and can master the materials and projects, it provides an opportunity for the child to increase self-esteem and self-confidence. Many of the participants in the present study suffer from a poor self-image and low self-esteem and confidence. Children, particularly in violent neighborhoods, often feel a lack of control over the unpredictable and unstable environment in which they are living. Therefore, it is important to gain mastery of a task, which helps build a feeling of control. Art projects can serve to do this. Art therapy is advantageous to traditional talk therapy in that it helps to provide a socially acceptable opportunity for expression and is relatively nonthreatening, whereas verbal therapy can carry a stigma. Many individuals, both children and adults, suffer from the stigma of being in therapy. Reducing or eliminating this negative stigma can serve to enhance the therapy (Newcomer, 1993). Art therapy provides a forum where children are able to freely express emotion when discussing their artwork without fear of violating social norms. Another benefit of art therapy is the social component that can be worked into the session if providing group art therapy. By working on group projects and sharing materials, it helps develop interpersonal relationships and fosters cooperation (Newcomer, 1993). At the Lake School’s Insight Through Art Program, all children in the groups share materials and at times engage in group projects. Another advantage of art therapy that has been noted is the decrease in energy level that occurs during the creative process (Newcomer, 1993). Individuals in art therapy are still stimulated as in talk therapy, but in a different way that provides greater relaxation. Many of the children at the Lake School are hyperactive, anxious, and overly excited. Working on an art project provides structure, containment, and limit setting that helps to calm children down. Art can also have the reverse effect on depressed, introverted children. Art and art-making can help stimulate these individuals and increase participation in therapy and decrease inhibition. A disadvantage of verbal therapy is that when working verbally, individuals can stop and filter thoughts and feelings (Wadeson, 1980). It is easier to control and tame your words then your art. This editing can slow down the therapeutic process. Harriet Wadeson lists objectification as another advantage. This term is based on the premise that art expression can form a bridge. Objectification is the notion that â€Å"feelings or ideas are at first externalized in an object (picture or sculpture). The art object allows the individual, while separating from the feelings, to recognize their existence† (Wadeson, 1980, p. 10). Hopefully, the individual can then come to own his or her feelings and integrate them into the self. When in art therapy, the individual is left with a tangible object that can be taken with him or her after the therapy has ended (Wadeson, 1980). In verbal therapy, there are no tangible products. The object(s) is symbolic of the work done in treatment and can also serve as a reminder of skills learned. The person then has a reminder of work done, which is especially beneficial for children. The picture or sculpture is not subject to distortions of memory. An additional advantage of having a tangible product is that it is easier to recall and notice emerging patterns. A therapist and the client can derive a sense of ongoing development that occurs in the therapeutic process. The art object provides documentation that is a direct statement by the patient, not filtered by the therapist (Wadeson, 1980). A final noted advantage is that art taps into primary process thinking and allows the child to process the event without the censorship or inhibitions of secondary process thinking. Literature Review of Art Therapy Research Art therapy programs, unlike traditional doctoral programs in psychology, have not emphasized empirical research. Students studying art therapy enter the field because they tend to be more interested in the clinical work rather than in conducting research. Many programs, though this began changing in the 1980s, do not offer the foundational courses in research design. Given this focus, the field of art therapy lacks the research studies that utilize quantifiable data. Therefore, much of the research regarding the efficacy of art therapy has been case studies. Many prolific writers in the field have written about the lack of art therapy research (McNiff, 1998a, Rosal, 1998; Malchiodi, 1995). â€Å"As a relatively new discipline we have yet to ‘advance’ to the stage where professional researchers separate the process of investigation from the ‘the practice of the craft† (McNiff, 1998a, p. 86). Many art therapists struggle with the more traditionally acceptable research procedures. Creative research methods seem to lend themselves better to studying this unique field because in enables the researcher a better opportunity to provide evidence regarding the process of therapeutic change. To show the changes that occur after the course of art therapy, many practitioner-researchers try to let the artistic products speak for themselves, coupled with a description of how the client moved through the process and experience of art therapy. â€Å"The practice of art therapy generates a desire to ‘show’ data on the part of both participants and therapists. The presentation of imagery is a natural extension of the therapeutic process and a primary feature of artistic activity† (McNiff, 1998b, p. 93). To date, it was difficult to find studies that investigated behavioral changes occurring after the introduction of a school-based group art-therapy program. However, there is research that addresses other changes art therapy can bring about. Rosal, McCulloch-Vislisel, and Neece (1997) conducted an art therapy pilot study in an urban high school with ninth-grade students. The program goal was to improve attitudes about school, relationships, and life; decrease the number of failing grades; and keep students from dropping out of school. Results of this study indicated that the art therapy, in conjunction with the English curriculum, had a positive effect on the subjects. The investigators found that the participants stayed in school, failed a very small number of courses, and improved their attitude about school, family, and self. Another study, conducted by Jasenke Roje (1995), utilized art therapy with latency age children who were victims of the 1994 Los Angeles earthquake. Roje found art therapy to be an effective and successful treatment modality in the recovery of earthquake trauma. â€Å"It enabled children to express internal processes which they had no verbal awareness of and it facilitated working through the defenses in order to identify underlying conflicts which hindered recovery† (Roje, 1995, p. 243). Rosal (1993) investigated the use of art therapy to modify the locus of control and adaptive classroom behavior of children with behavior disorders. Subjects were fourth, fifth, and sixth grade students living in a poor urban area in a large city. Most of the children came from unstable families. All subjects were identified as having behavioral difficulties at school and poor peer relationships. Results of this study were not statistically significant, however, Rosal noted change in the subjects. One of the measures Rosal utilized was The Children’s Nowicki-Strickland Internal-External Locus of Control (CNS-D3) measure. She found that although there were no statistically significant results, both experimental groups made greater moves toward the norm of the CNS-IE than the control groups. A second measure used in this study was the Conners Teacher Rating Scale (TRS). Results indicated that the two art therapy treatment conditions showed significant differences in changes of diagnosis on the TRS. Both art therapy treatment conditions were more effective than the control group in helping the behavior disordered students improve. Seventy-five percent of the subjects in one of the treatment conditions showed an improved diagnosis on the TRS and 67% showed improved diagnosis in the other treatment condition. The third and final measure that Rosal used in this study was a personal construct drawing interview (PCDI) that was developed specifically for this study to measure changes in self-perception. The students in both art therapy treatment conditions showed an increase in positive attitudes, whereas no major change was noted in the control group. In conclusion, Rosal’s study suggests that art therapy may be an effective modality in helping children with behavior disorders increase levels of control. Pleasant-Metcalf and Rosal (1997) utilized a single-case study research design in a school setting to study the effectiveness of individual art therapy with a 12-year-old girl whose academic performance declined following the divorce of her parents. Evidence in this pilot study suggests that school-based art therapy was effective in helping increase academic performance. This study adds to the growing body of literature supporting the notion that art therapy is an important school-based service and can positively impact academic performance. Avidar (1995) explored through two case studies how art therapy can address treatment needs of children who experience pervasive trauma. The subjects in Avidar’s study, much like the ones in the current study, reside in a violent inner-city housing project in a major metropolitan city. Avidar found that art therapy proves to address the psychological needs of individuals who experience chronic trauma. â€Å"[Art therapy] provides distance, expression, mastery, control, and above all, safety and trust† (Avidar, 1995, p. 16). Omizo and Omizo (1989) used art activities with minority children aged 8 to 11 to help improve self-esteem. It is well documented that poor self-esteem, feelings of incompetence, worthlessness, hopelessness, powerlessness, and feelings of inadequacy contribute to delinquency, substance abuse, unemployment, unrealized potential, poor achievement, and involvement with crime (Roundtree, 1979 and Shaplen, 1982, as cited in Omizo & Omizo, 1989). As in Omizo and Omizo’s study, the children in the current study face the aforementioned feelings and problems. Children in the Omizo study were assigned to an experimental group or a control group and were pre- and post-tested using The Culture-Free Self-Esteem Inventory for Children (SEI) to measure self-esteem. Results on the post-test indicated a significant difference between the experimental and control group. The minority children who participated in group counseling that utilized art activities had significantly higher social peer-related and academics/school-related self-esteem. Application of Art Therapy in Counseling Children Historically, therapy has been provided in private offices, hospitals, and community clinics. Traditionally, schools have been viewed narrowly as places to educate. Now that we have entered the 21st century, an expanded notion of the function of the school needs to be considered. Schools are not just the place where students learn academic material; schools also shape students’ psychological well-being, especially in poor urban neighborhoods where there are few resources available to families. Schools are the primary institutions where children gather, and as such, they provide an excellent setting in which to deliver effective services to children in need. Individuals and families may not be able to obtain services if they are required to go to an office-based treatment setting. School-based services can provide a solution to the problem of children not being independently mobile and having to rely on a family member, guardian, or some other adult to take them to therapy. Schools are â€Å"where the children are. We have to take the service to them, rather than expect them to come to us† (McNiff, 1997). This is especially the case when working with disadvantaged, at-risk children. There are a multitude of factors that may lead to a lack of participation in treatment. It is often not a lack of desire or motivation for treatment, but rather a confounding situation. Disadvantaged families usually do not have a reliable source of transportation. Therefore, it makes it very difficult to make a scheduled session that possibly is miles away, outside of their community. Another problem with children receiving services outside of the school is that they have to rely on an adult to get them there. Parents in poor urban settings are often disenfranchised by the system and may lack the motivation to get their child to treatment. In addition, there may be crises that arise and other children whose parents or guardians are caring for that make it difficult to get to scheduled appointments. However, with school-based interventions, if the child attends class, he or she is able to receive treatment without relying on an adult to provide transportation. The school is therefore a more effective place to reach children more consistently. The earlier the intervention, the more likely it is that one can eradicate and reshape unhealthy behaviors among children. The longer the behavior continues, the more difficult it is to extinguish. By meeting the needs of children in a school setting, there is a greater chance of targeting and changing negative behaviors at an early stage. There are numerous advantages to school-based treatments when compared to more traditional settings. There is a push for briefer treatments in which the patient takes a more active role in the therapeutic process. In addition, there is no longer the belief that one type of treatment is appropriate for all presenting problems. Art therapy in the public schools is an alternative approach to a variety of problems, one that is both active and brief. The therapy takes place when school is in session; therefore, the school calendar dictates treatment to only be a certain length of time. Another advantage is that the therapist, by being in the school, is part of the school system and climate and has an opportunity to â€Å"gauge the general social climate that is impinging on the child† (Nicol, 1979, p. 83). The therapist can witness the child interacting with peers and teachers and identify problematic social relationships and social skills that are causing difficulties for the child. Providing treatment in a familiar environment is linked to clients remaining in treatment. The school is a very familiar environment for children, thus increasing the chances that the child will remain in treatment. A final advantage of the school-based setting is the collaboration that can occur amongst professionals (Nicol, 1979). Teachers do not receive the necessary training on how to handle children with behavioral problems. The school-based therapist can serve as a resource for the teachers and school staff, providing consultations and in-school workshops. Given the central role that schools play in the lives of children, we need to expand upon this by not only educating children on subjects of reading, writing, and arithmetic, but also help to foster positive self-esteem and emotional and cognitive growth. In addition, schools also should help children build interpersonal relationship skills and help students to develop positive behaviors. By broadening the definition and role the school plays beyond academic success, children will have a greater chance of success and a larger set of skills necessary to make it in the outside world. Most of the literature on art therapy in schools represents work that is taking place in specialized settings, not urban public schools. â€Å"The severity of problems that children bring into school settings is rising dramatically. Violence, sexual abuse, suicide, substance abuse, poverty, and the decay of family and community structures are just some of the numerous issues affecting children today† (Essex, Frostig, & Hertz, 1996, p. 182). Children bring these problems into the classroom and schools are left with the responsibility to handle these grave situations. When a child is in distress, it interferes with the child’s ability to learn. In 1990, a decision by the Supreme Court of New Jersey emphasized the critical need for public school support of these issues. There have been several other legislative initiatives that focus on the benefits of creative art therapies to help individuals who do not respond to more traditional therapies. â€Å"The Senate and House Report (No. 96-712, May 18, 1980) on the Mental Health Systems Act of 1980 gave special attention to the creative arts therapies in the treatment of persons who required mental health services but who did not respond to traditional therapeutic modalities† (Bush, 1997b, p. 10). Janet Bush (1997a) introduced the first comprehensive art therapy program in a public school in Dade County, Florida during the 1979-1980 school year which still exists today. Other art therapy programs have been started in the United States, but they are not as extensive as Dade County and have developed differently. Initially, the goal of the pilot program in Dade County was to provide art therapy for students with physical, emotional, educational, and psychological problems â€Å"to ameliorate a variety of unacceptable behaviors and to help the students learn by improving students’ insights, attitudes, and skills† (Bush, 1997a, p. 9). Eventually, the program narrowed its focus to only include students with emotional problems. While obtaining her graduate degree in art therapy, Bush recognized how students’ problems were directly and indirectly affecting their educational goals. By introducing art therapy in the school, she hoped to assist the children in problem resolution by providing tools to foster self-expression and emotional and cognitive growth. In 1999, the Bade County school district employed 20 Mi-time art therapists to work in 28 public schools. (Minato, 1999, p. 59). As the art therapy program grew and developed, other professionals (psychologists, social workers, family therapists, and teachers) joined the treatment team. At first, the program combined art education along with art therapy. This was due to the fact that the original funding for the program came from the art education department. In 1995, the program shifted away from art education and started focusing entirely on clinical art therapy objectives with severely emotionally disturbed children (Bush, 1997a). The activities the school art therapists provided were very comprehensive. They included: consultation, assessment, intervention, professional training and development, research, program planning, and evaluation (Bush, 1997b). Although the Dade County school-based art therapy program has been a success, its success has been measured by observation and experiences of the therapists. This program, along with most school-based art therapy programs, lacks the documentation to support empirical research. The Dade County program has continued to prosper since its commencement in 1979, but empirical research supporting it is minimal (Bush, 1997b). Art therapy in schools, however, has not taken root. It is time for controlled research and documentation on the application of art therapy in schools. Relevant outcome criteria on the effectiveness of art therapy in treating students and the effects of participation on a school’s team should be reported. (Bush, 1997a, p. 13) The Dade County art therapy program is a model program, which can serve to inspire future development of similar school-based art therapy programs. Art therapy in a school-based setting can provide at-risk children with an outlet to work through obstacles that are hindering their educational, emotional, and social growth. Conclusion Behavioral science research has focused on the psychological, emotional, behavioral, and cognitive problems that children exposed to chronic stress and violence face. Research in this area has become increasingly prolific as the rates of violence and risk of exposure increases. This is especially true in large urban cities where the prevalence rate of urban youth exposed to violence and chronic stress is rapidly increasing. There are many factors in the lives of impoverished African-American children that lead to chronic stress. Rutter (1978) identified six significant familial stressors that increased the probability of behavioral disorders among children. They are: (a) the father having an unskilled/semiskilled job, (b) overcrowding in the home or a large family size, (c) the mother suffering from depression or a neurotic disorder, (d) the child having ever been â€Å"in care,† (e) the father having been convicted of any offense against the law, and (f) marital discord (Rutter, 1978). Other researchers examined multiple stressors on school-aged children’s psychological functioning: parental conflict, maternal depression, overcrowding, and family income. Shaw and Emery found that â€Å"cumulative family stressors predicted clinically-elevated child behavior problems and below-average ratings of children’s IQ and perceived social competence† (1988, p. 204). The research suggests there is a significant relationship between exposure to chronic stress, crime, and violence and behavioral, psychological, and academic problems. It is necessary to then take the next step and focus on ways in which to ameliorate these negative effects. Traditionally, psychological services of art therapy have been provided in hospitals, community mental health centers, and private offices. There are, however, numerous factors that impede the ability of at-risk children from getting these needed services that are often provided outside their community. School-based interventions in art therapy can provide one solution to this problem. School-based therapeutic interventions have been effective in helping children to deal with the emotional repercussions of living with multiple stressors. By addressing common problems in a novel way, school-based art therapy therapy opens the doors to many children who otherwise would not receive the needed therapeutic help. The children are in their schools everyday, so why not bring the service to them. Outcome literature supports the notion that school-based intervention programs in art therapy can yield to positive outcomes in the lives of children. References Art therapy: Definition of profession. 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