Exploring Expressions: Therapists’ Use of the Creative Arts in Therapy
8.14 The Scope of Creative Art(s) in Therapy
Through their experience with the art form and its use in therapy, the therapists had developed a theoretical framework which gave the rationale about why they used this approach, but also guided their interactions with the individual in ther- apy. The arts have the inherent ability to tap into the subconscious because of which more authentic and organic forms of expressions emerged. These lead to deeper insight which promoted problem resolution.
The understanding of the therapy influenced the nature of the therapeutic relationship with clients. The therapeutic relationship was influenced by the the- oretical orientation of the therapist, and the experience they gained as practition- ers in the field. Therapists used either a facilitative approach or a more directive approach. In the former, the client was given the baton to guide the session, and the therapist played the role of the shaping and guiding the session to move it towards achieving the goals. In the directive approach, the therapist adopted the role of expert.
In order to achieve therapeutic goals, the therapists assessed the need of the client. Standardized tools as well as self-designed forms of assessment were used.
Therapists trained in clinical psychology adopted and adapted standardized tools in the therapy process. However, most others relied on the art form they used as the basis for assessment. The tool helped the client in responding and expressing himself or herself, which was then observed and analysed by the therapist, within the framework provided by theory they followed.
Based on the assessment of the individual(s), the goals were formulated by the therapist and the client. These goals were both explicit and implicit (Dryden and Reeves 2008). The goals were inclined towards the client’s needs, and included the therapists’ interpretation of the client’s needs and the context the clients belonged to, such as the organization which referred them.
Based on the goals set, the means to achieve the goals were designed. The intervention strategies included techniques of various kinds: preparation, theme based, relaxation and reflecting techniques. Specific to the use of arts in therapy was the use of metaphor as a technique to glue the session together and gain deeper meaning from the symbolic responses that emerged within the session.
Once the expected outcome was achieved and autonomy was gained, the thera- peutic relationship was terminated. The duration for this outcome to occur could be fixed by the therapists’ from their experience and understanding of the process and/or it could depend on the individual’s needs. However, most therapists talked of a maturity period where they felt that a particular number of sessions were required for changes to be seen.
Since the therapeutic process involved expression using various symbols, meth- ods to document the same varied from verbal therapy. In case of art work such as painting or sculptures, the therapists either stored them or took pictures of the work done. Observation notes that were reflective of the nuances of the art form were kept; some instances were when dance therapists observed and documented the movements and facial expressions of the clients; when music therapists had audio CDs or videos of the work done. The documentation helped the therapist and client gain an insight into the process as it could be reviewed at any time, alongside, it fulfilled certain criteria established by the organization the therapists worked with (if any) as well as provided material for research in the field.
While the above stated therapeutic processes were used in the session, the manner in which they were operationalized in therapy flowed in a step wise fash- ion. Before the session began, clients approached the therapists either through an organization which was in touch with the therapist or through information they had received via websites owned by the therapists, or through ‘word of mouth’.
Before the client and the therapist interacted, the therapist prepared himself or her- self for the therapeutic encounter. Preparation involved the self, the space, and the session. The therapists used themselves as the ‘instrument for change’ (Bor and Palmer 2001) and felt the need to bring in a particular mindset and energy into the session so that they could act as the catalysts for change. In CAT, therapists used resources such as art materials, music, physical space for movement and the like, the space and materials used had to be given equal attention. Depending on the
activities and the needs of the clients, the space and the materials were prepared so that the therapeutic encounter was further enhanced. The therapists had to enter the session with an ‘intention’, thus, mentally orienting oneself to the session and having an idea of the outcome of the session helped in structuring and providing a therapeutic experience for the client(s).
The therapeutic encounter took place in three parts—warm up, theme build- ing and closure. Warm up involved the initial interactions between the therapist and the client, which could involve small talk, to build rapport, in assessment, and problem clarification. During theme building in the middle phase of the session, intensive activities directly addressing the client’s issues were used. Closure was the final phase of the session where the therapist and the client reflected on the session and prepared to refocus on their normal lives. Rituals were used to bring the client(s) down to a more regular state of being as expressing through art forms could result in an altered state of mind (Atkins and Williams 2007).
The study indicated that there were similarities and differences in practice among therapists in each modality. Further research can explore each modality in detail so that deeper insight can be gained into the therapist and the therapeutic process. The study looked only at self-identified therapists using CAT; there are therapists in the field who use arts in their therapeutic work but do not carry the CAT label. Exploring the practices of the therapists specific to use of arts modali- ties, examining their pool of knowledge as well as the coexistence of other thera- pies could be explored.
This study has explored the therapists’ perspective; the experience of the cli- ent in CAT could give an idea of the effects the arts have on an individual seek- ing therapy. A perception of other health professionals is an important domain in this field, as it lies parallel to other healthcare professionals who have greater acceptance in mainstream therapy. The process of therapy when using the art form stands in contrast to verbal therapy—importance given to materials used, symbolic expression are some of the features that are unique to this practice. Exploring the effects that these special features can have in therapy can help highlight the areas and issues in which CAT could be beneficial.
The arts are inherent to a person’s being. Thinking in terms of images, move- ment, and enjoyment of music or telling stories are a part of every culture. They are not unique to a person but are more ancient and universal than verbal language.
While words are given to a person, images, sounds and movements are more natu- ral. They provide more clarity and give a more authentic expression of the person within.
Engaging in the arts taps into the more aesthetic elements of being, along with the deeper mind of the individual. It nurtures the innate creativity every individual possesses, and can result in deeper insight (Rogers 2010). The act of engaging in creating something of personal relevance can be therapeutic. Creativity as a tool for healing is a concept that therapists using CAT have brought into the therapeutic setting which can be developed and adopted as counselling is a creative endeavour by nature (Gladding 2011).
Using CAT was seen as an alternate therapy—one that was tried when all else failed. The creative arts complement the existing practices in therapy and provide a new dimension for therapists and clients to work. To promote individuals who are interested in working in this area as well as professionals who are already practising CAT, training centres, research in the field, registration bodies, ethical guidelines and other forms of organizing the profession must be encouraged. This will help build the profession, validate and standardize their practices as well as allow greater accessibility to those individuals who require these services.
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