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Creative therapies for adults
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Creative Therapies with Adults,David Read Johnson Mooli Lahad and Amber Gray. From Foa E B Keane T M Friedman M J Cohen J A 2009 Effective. treatments for PTSD Practice guidelines from the International Society for. Traumatic Stress Studies New York The Guilford Press. Historical Background, The creative arts therapies are the intentional use by a trained therapist of. art music dance movement drama and poetry in psychotherapy counseling. special education or rehabilitation Creative arts therapies as professions began. during the 1940s when a number of psychotherapists and artists began. collaborating in the treatment of severely disturbed clients Since many severely. disturbed patients were unable to utilize the highly verbal modality of. psychoanalysis nonverbal forms of communication seemed to hold much. promise Creative arts therapies were nurtured in a few long term psychiatric. hospitals such as St Elizabeth s in Washington D C the Menninger Clinic in. Topeka Kansas and Chestnut Lodge in Rockville Maryland and by. psychiatrists such as Jacob Moreno who had introduced action oriented. techniques into psychotherapy in the 1930s In addition creative arts therapies. were utilized as forms of relaxation activities therapy for returning World War II. veterans The music therapy association formed in 1950 During the 1960s the. general atmosphere of social consciousness the Vietnam War and the dearth of. jobs in the artistic field brought a number of artists into the health field By the. late 1960s the field of creative arts therapies was developing rapidly and. establishing university based graduate programs The dance therapy association. was formed in 1966 the art therapy association in 1969 and the drama and. poetry therapy associations in 1979 By this time the creative arts therapies had. diversified their interests well beyond psychoanalysis into behavior therapy. special education and humanistic approaches These associations are now. constituent members of the National Coalition of Arts Therapy Associations. NCATA There are approximately 15 000 trained creative arts therapists in the. United States and several thousand in other parts of the world Creative arts. therapists are trained in specialized university programs usually a 2 year. master s degree music therapists may receive training at the bachelor s or. master s degree level Several PhD programs also exist Scholarship from the. faculties of over 100 universities is regularly reported in the eight professional. journals in the field,THEORETICAL CONTEXT, Initially the creative arts therapies were justified by psychoanalytic. concepts such as projection externalization and abreaction or less convincingly. by assumptions of the value of artistic expression More recently however it has. become evident that the creative art therapies owe their effectiveness to the same. therapeutic elements contained in cognitive behavioral treatments Thus while. specific creative arts therapy treatments for trauma have not yet been sufficiently. tested many of the major components of creative arts therapy treatments have. received a great deal of empirical support, Imaginal exposure is perhaps the most important therapeutic element in. trauma treatment All forms of creative arts therapy treatment of trauma utilize. imaginal exposure in that the trauma scene is represented in the artwork. dramatic role play poetry or music Halfway between in vivo and in vitro. exposure the client not only imagines the trauma scene but represents it in. physical or constructional behavior The concretization of the traumatic imagery. may be especially helpful in overcoming the client s avoidant tendencies J L. Moreno s psychodrama demonstrated the power of such imaginal exposure in. the 1940 s and 1950 s and stimulated renewed interest among psychologists in. studying imagery Singer 2005 Utay Miller 2000 Weis et al 2003 Guided. imagery became an important element in early flooding procedures for PTSD. Keane Fairbank Caddell Zimmering 1989 and continues to be used in a. variety of methods in cognitive behavioral therapy Krakow et al 2001 as well. as the creative arts therapies Blake Bishop 1994 Orth 2004 Foa Doron Yadin. 2004 suggests that the clients should be engaged in the traumatic story whilst. retelling it in the imaginal exposure They describe three positions of clients. engagements Under engager a client that is emotionally remote from his story. Over engaged a client that is too close to his story and can t really tell the story. with out sobbing This concept of the right distance from one s own experience is. described by Landy 1986 in his dramatherapy model He suggest that the best. place for both the therapist and the client to be is in what he called esthetic. distancing where the client can experience the story but not be overwhelmed by. it The other two positions are over distancing somewhat like under engager. and under distancing like over engager Lahad 2006 suggests that the. imaginal exposure is very much connected to what he calls transcendence into. fantastic reality in fact he claims that the Imaginal Exposure is an as if space. fantastic reality because the event is not really happening By recounting the. story as if it is happening now and at the same time knowing it is not Lahad. suggest it allows all Ifs meaning wishes and aspirations to happen in the. impossible event They can see things they did not notice they can light up areas. and darkened others etc and thus change the experience itself. Studies of the activation of the limbic system and the hippocampus by traumatic. memories Liberzon et al 1999 may indicate to the potential of the arts. therapies These studies found more activity in the amygdala and less in the. medial prefrontal cortex MPC in PTSD than controls during challenging stimuli. Symptom severity was positively correlated with amygdala activity inversely. correlated with MPC activity in PTSD cases Shin et al 2004. The limbic memory is not linguistic but sensual colors light sensation sight. smell etc The art form therapies and its products are also non verbal in their. essence and thus can be helpful in retrieving the memory as it is embedded in. the reptile brain, Cognitive restructuring is another very important therapeutic factor in.
trauma treatment Psychologists in the 1950 s demonstrated the effectiveness of. role playing in attitude change Hovland Janis Kelley 1953 so much so that. role playing has been integrated into most forms of education and many types of. psychological intervention McMullin 1986 Role playing and its relative. covert modeling have not surprisingly become standard elements in many forms. of trauma treatment e g Foa Rothbaum 1998 Playing out scenes switching. roles and replaying more health promoting options can be a very effective. means of changing or challenging a person s view of a situation Role playing is. a way to learn new behaviors and words for old ways of doing things the. repeated practice of a behavior reduces anxiety and makes it more likely that a. new behavior will be used Foa Rothbaum 1998 p 217, Cognitive interventions including identification of distorted cognitions. cognitive reprocessing and reframing are essential components of the creative. arts therapies The aim is to impact the client s narrative of their traumatic. experience often termed restorying the use of journaling writing and. storytelling are common narrative techniques used in the creative arts therapies. Lahad 2000 Rose 1999 Producing the trauma narrative is a component of. many cognitive behavioral forms of intervention Cohen Mannarino. Deblinger 2006 Rynearson 2001, Stress anxiety management skills are also important elements of effective. trauma treatment especially relaxation techniques These techniques were. integrated into behavioral treatment for anxiety disorders in the 1960 s and have. been utilized in trauma treatments particularly as Stress Inoculation Training. Meichenbaum 1974 Techniques such as progressive muscle relaxation. Bernstein Borkovec 1973 and deep breathing are standard elements in most. forms of creative arts therapy for trauma Dayton 1997 Levy 1995 Riley 1997. Resilience enhancement techniques are more recently receiving greater. attention Bonanno 2005 Here the creative arts therapies can presumably make. an important contribution since most studies of resilience point to the. importance of creativity humor flexibility and activity all of which are. incorporated into creative arts therapy methods Lahad 1999 2000 Raynor 2002. Creative activity is increasingly being recommended for traumatized clients. Bloom 1997 Creative arts therapies may improve PTSD clients self esteem. hope and prosocial behavior and reduce feelings of shame and guilt through. the association of traumatic material to adaptive and aesthetic modes of. expression, Effective therapeutic interventions at the social level include testimony. public education and de stigmatization which can often be enhanced through. creative forms For example theatre troupes of trauma victims exhibitions of. victim s artworks and public readings of victim poetry serve to educate the. public about trauma de stigmatize the condition of PTSD and offer an avenue. for re integration into society for the victims themselves Jones 1997 Losi. Reisner Salvatici 2003 Mapp Koch 2004 Meyer Weitz Sliep 2005 Park. Fuller 2000 Sithamparanathan 2003, In summary the effectiveness of the creative arts therapies will most. likely be shown to be due to their use of the empirically supported therapeutic. factors of imaginal exposure cognitive narrative restructuring stress. management skills and resilience enhancement methods. Unique Contribution of the Creative Arts Therapies. The potential advantage of utilizing a creative arts therapy procedure is. most likely based on the nonverbal behavioral aspects of the artistic modalities. First the symbolic media of the arts may provide more complete access to. implicit as opposed to explicit memory systems as well as visual kinesthetic. schemas Johnson 1987 van der Kolk 1994 It seems possible that certain. aspects of traumatic experience and associated distorted schemas are stored in. these non lexical forms By providing a wider range of stimuli visual sonic. tactile and kinesthetic the creative arts therapies may increase the vividness of. imaginal exposure By providing concretized forms of representation visual. written enacted the creative arts therapies may help decrease avoidance Both. of these effects should lead to greater habituation of the client s fear response. The behavioral nature of the creative arts therapies may also support or enhance. cognitive restructuring strategies All of these potential effects appear to be. especially helpful with clients with dissociative tendencies Altman 2000 Kluft. 1992 Mills 1995 Like other victims of childhood trauma DID dissociative. identity disorder patients are often uniquely responsive to nonverbal. approaches Art therapy occupational therapy sand tray therapy movement. therapy other play therapy derivatives and recreational therapy are reported as. helpful toward achieving treatment goals including integration ISSD 1997 p. Second the claim that creative arts therapies are especially helpful to. traumatized inexpressive persons has been supported by the concept of. alexithymia about which much has been written in the trauma field Krystal. 1988 The inability to put feelings into words appears to be relatively common in. patients with posttraumatic stress disorder Krystal Giller Cicchetti 1986. Presumably clients who are unable to find words to express their experience. may find the nonverbal behavioral forms of the creative arts a more welcoming. means of expression Lev Wiesel 1998 There is ample evidence that this is a. reason why creative arts therapies have been especially useful with children See. Chapter X Creative Arts Therapies with Children,TECHNIQUES.
Given the numerous formats and models in the creative arts therapies it is. a difficult task to describe them in a comprehensive manner Nevertheless we. can outline some general principles Generally a typical session whether with an. individual family or group begins with discussion about how clients are doing. and what problems or concerns they have been facing Then instead of exploring. these issues in continued verbal discussion the therapist guides the client s into. the use of a particular art medium such as painting movement role playing or. listening to or creating poetry or music as a means of working on the presenting. problem Often the therapist leads the client in warm up or relaxation exercises. in order to help prepare for the work and or focus on the issue i e stress. management For example in art therapy the client may be asked to draw or. scribble randomly on a sheet of paper in dance movement therapy the client. may be guided through slow breathing exercises stretching or even running. around the room in music therapy a client listens to music sings a familiar. song or makes random noises on an instrument or in poetry therapy the client. might write spontaneously for 5 minutes or listen to a poem These activities. typically open up and relax the client and indicate to the therapist the client s. mood or level of anxiety regarding the presenting issue. The creative arts therapist attempts to understand the client s behavior in. terms of the particular art medium for example the art therapist attends to the. expressive qualities of different colors lines forms patterns and arrangements. the dance movement therapist assesses the meaning of different movement. patterns and qualities rhythms energy flow articulation of body parts and use. of space the poetry therapist attends to word choice images or metaphors. selected and the music therapist attends to the rhythm harmony pitch timbre. and meter of the client s musical productions Cultural and social contexts are. always taken into account in these observations Each discipline has developed. assessment procedures that give the therapist information about different clients. with different diagnoses, The main part of the session is spent participating in the arts medium. Sometimes the therapist participates with the client or group at other times he. or she acts as a facilitator of the client s expressive activity In psychodrama the. director rarely participates In treatment models specifically designed for. psychological trauma the traumatic memories are worked on directly i e. imaginal exposure for example when a man is having trouble with memories of. physical abuse by his father the drama therapist takes on the role of his father. and they role play the scene At other times the client draws sings or. improvises and issues linked to the trauma are addressed by the therapist as. they emerge For example the art therapist may ask the client to draw a picture. of her home before the abuse began or a picture of her feelings of anger or her. perception of her own body The music therapist may help the client to produce. an improvised song concerning the impact of the rape on her life The client in. poetry therapy may write and then read a poem written as a letter to a buddy. who died in Vietnam In each of these activities in addition to the client s. manifest thoughts that arise about the subject it is believed that the presence of. the rhythms melodies colors and actions of the arts media enhances the. possibility that new aspects of the situation will emerge These sensory prompts. may allow a more vivid recalling of the trauma scene The therapist may leave it. up to the client to make observations about how he or she is feeling and what the. artwork means At other times the therapist may facilitate the client s. exploration and questions about the poem artwork or song Usually the. therapist will attempt to direct the client toward more healthy views of his. traumatic experience i e cognitive restructuring by encouraging them to. represent in the art medium a more hopeful or accurate perspective or the. articulation of a more integrated narrative i e re storying The concretization of. the client s issues in the art form tends to serve as a distancing tool allowing the. client to reflect on his or her own behavior in real life situations In time some. therapists point out possible underlying meanings or clarify vague undeveloped. meanings or themes evident in the client s artwork In institutions the course of. therapy is determined by the client s length of stay In outpatient situations or in. private practice creative arts therapy may be brief such as 6 8 weeks when a. particular problem can be focused on readily or it can be a long term. commitment of 6 months to several years While many creative arts therapists are. familiar with several arts media each therapist generally specializes in one or. two In most cases the selection of the particular medium is based on the client s. preference However in institutions where creative arts therapists work in teams. more sophisticated assessments have been developed that help the team select. the best modality for the client For example in working with people with PTSD. such as Vietnam veterans or sexually abused women art is often used to help. elicit the visual aspect of the repressed images Drama and poetry are often used. in the later stages of therapy when the client has become aware of the traumas. and wishes to rejoin the world through testimonial or public education formats. Johnson 1987,METHOD OF COLLECTING DATA, The material gathered for this chapter was derived from an extensive. review of existing literature on the creative arts therapies including PILOTS and. PsycLIT databases as well as reports from two previous International Society. for Traumatic Stress Studies ISTSS Task Forces on Curriculum. LITERATURE REVIEW, The creative arts therapies have been used both to target specific PTSD. symptoms and to address other associated conditions and functional problems. Carey 2006 Thomas 2005 Exposure based components address re. experiencing and avoidance symptoms and relaxation and distraction based. components target hyperarousal symptoms Group interaction components aim. to improve interpersonal relationships communication skills and work. functioning Creativity performance based components aim to increase resilience. and reduce shame caused by victimization The multifaceted aspects of creative. arts therapy treatment lend themselves to broadly defined treatment goals Thus. Cruz and Essen 1994 note that many adult survivors of childhood trauma can. benefit from the inclusion of arts therapies into their overall psychotherapy. treatment program, The creative arts therapies have been utilized with all types of trauma. though there are no data to indicate whether their efficacy varies according to. type of traumatic event single versus repeated traumatization or age of. traumatization Cohen Cox 1995 Dayton 1997 Kellerman Hudgins 2000. Kluft 1992 Spring 1993 Winn 1994 Clinical experience suggests that the. creative arts therapies have been helpful for clients with acute trauma in. accessing memories of their trauma or abuse Steele 2003 These therapies have. been increasingly applied in cross cultural interventions with survivors of war. and torture and in post man made disasters Baker 2005 Barnes Peters 2002. Hardi Erdos 1998 Lahad 1999 2000 van der Velden Koops 2005 The. creative arts therapies have also aided clients with chronic posttraumatic stress. disorder PTSD address conditions of demoralization and hopelessness Dintino. Johnson 1996 Feldman Johnson Ollayos 1994 LeLieuvre 1998. There is a dearth of experimental research on the creative arts therapies.

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