Expressive Art Therapy: A Case Study

Introduction

This paper discusses how Expressive Art therapy can make up the deficiencies of traditional/ current mental health services, in terms of the inability to remove clients’ self-stigmatization, fulfilling clients’ spiritual need, creating hope during recovery and allowing clients to communicate non-verbally, for psychiatric clients during recovery. In the first section, definition of expressive art therapy is discussed. The second section strengthens the position of this paper, and the third section provided evidences and rationale to show how art therapy could benefit clients differently. In the last section, how art therapy can be further discussed is proposed.

Content

What is Expressive Art therapy?

There are many different kind of expressive art therapy applied in mental health setting. According to Malchiodi (2005), expressive art therapy includes the use of “art/ music, dance/movement, drama, poetry/creative writing, play, and sand-tray within the context of psychotherapy, counselling, rehabilitation, or health care” (p. 2). Art therapists support clients through using different media or materials to express and reflect on their different intrinsic dynamic (Knill, Barba, & Fuchs, 1995) that could not be easily articulated by words.

Moreover, the reflective process on the intrinsic dynamic “reconciling emotion conflicts, fostering self-awareness, developing social skills, managing behaviour, solving problems, reducing anxiety, aiding reality orientation, and increasing self-esteem” (Malchiodi 2005, p. 2); however different type of art therapy, e.g. drama therapy, music therapy, poetry therapy, sand-play therapy make uses of unique advantages of diverse media, and focus on different kind of intrinsic dynamics.
Problem of mainstream rehabilitation services
It had been reported that many current mental health services are unable to recognize and effectively remove client’s internalized stigmatization and taking care of one’s spiritual needs. In traditional therapy, clients also lose hope easily for feeling helpless to reach the “health standard.” Moreover, some clients also experience difficulty in expressing subconscious idea verbally, while value of non-verbal way of expressing ideas and thoughts has not yet been valued.
Advantages of Using Expressive Art Therapy in Mental Health Setting
Removing Internal Labeling.

Stigmatization is one of the barriers that trigger other psychological issue that obstruct clients from recovery, and therefore treatments that could untangle/ remove the internal traumatic and discriminative effect causes by social and biomedical labeling (Murphy, 2007, Estroff, 1989) is recommended. Removing internal stigma and discrimination is also a matter of “human right” that protect the client’s accessing equal rights on career, education and social services etc. (Jacabson & Greenley, 2001). In long term, celebrating the human right can “advocate for the reduction and ultimately the elimination of involuntary commitment and other forced treatment” (Jacabson & Greenley, 2001, p.

484).
One of the causes of social labeling is hospitalization (Llyd, Wong & Petchkosky, 2007). Bledsoe (2001) talked about how hospitalization creates isolations between herself and family, and could even establish labeling by the family, which appears to be the greatest support for her. The hospitalized setting also fills with the atmosphere of “hopeless, distraught, sad, and wandering faces without names, lives or futures” (Bledsoe, 2001, 16), which Bledsoe started believing that she was “faceless, scary, “crazy””, and got “scared and fearful…couldn’t figure our who [she] was or what [she] was becoming” (Bledsoe, 2001, p. 25).
Art at this moment creates a space for clients to recognize their value. According to Llyd, Wong & Petchkosky (2007), some of the clients’ art about their own successful recovered experience, become something useful and significant to the society that the clients are bringing positive energy to the society, in a “non-threatening way for both the artist and the community” (p. 212).
Taking Care of One’s Spiritual Need. Spiritual is believed to be basic need of human (Carson, 2008). According to Oldnall (1996), spirituality does not necessary associated with religion, but “a sense of meaning to life or with a sense of an inner spirit” (p. 139), which could “consist of either a religious…or a secular dimension (atheistic and humanistic views) or a combination of the two (agnosticism)” (p. 139). However, although many researches and practitioners also agree that there are necessary needs to consider one’s spirituality when providing mental health services, one’s spirituality is often fail to be noticed in many health services (Baldacchino, 2015; Brémault-Phillips, Olson, Brett-MacLean, Oneschuk, Sinclair, Magnus, Weis, Abbasi, Parmar, Puchalski, 2015).
More researches have described how psychiatric client benefit from art therapy through being considered their spiritual needs. Lloyd, Wong & Petchkovsky (2007) reported that, the art creation gives the clients “spiritual fulfillment… [provides] meaning and purpose as well as a way to relate to a higher power” (p. 210) during the recovery. Also, Archibald, Dewar, Reid and Stevens (2012) mentioned how art therapy carries therapeutic values in Indigenous culture, which people see “traditional arts, culture, spirituality and healing were, and are, interconnected” (p. 7) and how art plays a role to support Indigenous people to “restore mental, physical, emotional, and spiritual health” (p. 13).
Healing as a Self-discovery Process. Healing in medical model means to meet the “normal” health standard, which practitioners intend to deal with and remove symptoms (Jacabson & Greenley, 2001). The aim of removing symptoms is problematic, because client might perceive recovery (achieving “normal” health standard) is an unachievable task (Jacabson & Greenley, 2001). As how Jacabson & Greenley (2001) emphasizes, “recovery is not synonymous with cure… [and] not necessarily a return to “normal health and functioning” (p. 483). Estroff (1989) mentioned that, psychiatric client “become” (p. 189) the illness, which “results in a transformation of self as known inwardly” (p. 189), and this is described as “loss of self and defeat of person” (p. 194).
However, in art therapy, therapist tried to “[discover] a new identity apart from the illness and gaining a sense of “control” over the symptoms of the illness” (Llyd, Wong & Petchkosky, 2007, p, 208). This discovery is a process of “[constant] learning”, “hopeful learning”, “unique experience”, which clients focus on different details that they re-own the power to “[allow] the internal processes to adapt subconsciously”, and “be aware of their internal processes and chose to use art as a reflective process” (Llyd, Wong & Petchkosky, 2007, p, 210). In other words, the discovery of new identity, or new self- understanding change the self identity of seeing themselves as the problem, but a person who own power to control over and manage the mental health issue.
Creating Sense of “Hope” in Recovery. Hope is an important component in mental health recovery, which the sustainability of hope is the key of recovery (Murphy, 2007; Jacabson & Greenley, 2001). However, many clients in recovery stage experiences sense of hopeless during the treatment (Torrey & Wyzik, 2000) and the sense of hopelessness can even lead to suicidal tendency (Cohen, Test & Brown, 1990; Beck, Brown, Berchick, Stewart & Steer, 1990), however the hopelessness is hard to be tackled positively. In art therapy, hope can be created through life meaning making and communicate non-verbally (Johnson & Sullivan-Marx, 2006), through removing self-stigmatization, developing/ fulfilling one’s spiritual need and seeing recovery as the client “managing the illness” rather than “getting back to the normal health standard.”
Surfaces Unconscious Ideas. According to Llyd, Wong & Petchkosky (2007), art is a preferred way for expression, for “art provided…a way consciously to access an “imaginary” world that was personally very real” (p. 209) and “bring [the issue] into the world as a physical manifestation of their observing [the issue]” (p. 210). In traditional therapy, client might experience difficulty expressing themselves verbally on subconscious ideas. However, art therapy acknowledges this difficulty and creates a space for client to express non-verbally. Art therapy believes that art could help express subconscious idea and art is a way to communicate subconscious mind. Llyd, Wong & Petchkosky (2007) reported an example that a client with mood disorder reflected her feeling of how art replaces her suicidal attempt and fear, which the change can be attributed to how art triggers “self-generated strategy” of client. The “self-generated strategy” is also a way of upholding client’s strengths of being creative to manage emotions and lead to survival.
Further discussion
Ontario, BC has implemented an Art-based Mental Health Treatment program for Children and Youth (Children’s Mental Health Ontario, 2005), and given out a few implemental questions, regarding their direction of art-based mental health, which worth us considering. The document suggests further research on the duration, goals, and assessment tools for the therapy sessions. These questions are realistically provides guidance of what could be further discussed on this topic.
Also, as Art therapy is a psycho-analytics-based and art-based therapy, which can be hard to quantified, however reporting effective to many service users. Therefore, another theme that could be further discussed is that, how can we build or explore a research data based that do not reply on science-based research. This discussion can be very large and causes much insecurity for its criticism on “science” and the scientific way of understanding “truth” and “treatment.” However, this discussion is vital, because the effectiveness of Art therapy tells us that, quantified assessment appears to be too narrow and risky to measure a quality of service, while “quality” can be understood in diverse way (Dahlberg, Moss & Pence, 2007).