Clinical Treatment Critique of Using Art Therapy for Children and Adolescents

Though art therapy is not a new therapeutic modality, mental health practitioners are still uncovering its potential as a treatment. Traditionally, art therapy was simply a means of discovering the mental and emotional condition of a patient while enabling the patient to release negative thoughts and emotions through the artistic process. Yet, because the benefits of art therapy were considered to be subjective, it failed to become commonplace in clinical practice. However, the advances in empirical research have enabled clinicians to observe the therapeutic processes that take place through the course of art therapy treatment. This clinical treatment critique will evaluate the history, benefits, and limitations of art therapy. While art therapy still possesses the drawback of being highly subjective in its applications, new research reveals the benefit of art therapy as a treatment for children and adolescents who might otherwise be unresponsive to conventional forms of therapy.

Overview of Art Therapy as a Treatment

The primary challenge in assessing art therapy is obtaining a consistent definition of this modality of therapy. The common approach of defining art therapy is to describe how art therapy is conducted and the characteristics of this form of treatment. As Edwards (2004) noted, the term “art therapy” first emerged in the 1940s and referred to the therapeutic application of arts that involved the creation of images, such as drawing or painting (p. 1). However, the practice of art therapy has developed over time to incorporate different forms of art and different therapeutic objectives. The following contemporary definition and description of art therapy is provided by the British Association of Art Therapists:

Art therapy is the use of art materials for the self-expression and reflection in presence of a trained art therapist. Clients who are referred to an art therapist need not have previous experience or skill in art, the art therapist is not primarily concerned with making an aesthetic or diagnostic assessment of the client’s image. The overall aim of its practitioners is to enable a client to effect change and growth on a personal level through the use of art materials in a safe and facilitating environment (Edwards, 2004, p. 3).

By the provided definition, art therapy encompasses several media, including music, poetry, painting, drawing, and sculpture, and focuses on providing therapeutic benefit to the client rather than a diagnostic tool for the mental health practitioner.

The objective of art therapy depends on the context of the treatment. Typically, art therapy fosters a therapist-client relationship that enables the therapist and the client to mutually participate and find meaning in an artistic activity (Edwards, 2004, p. 4). The particular aim of art therapy is tailored to the needs of the client. For example, the process of art therapy might be used to explore an emotional difficulty, give form to unexpressed feelings, or enhance the self-image of the client (Edwards, 2004, p. 4). The primary goal of art therapy is to utilize the creative process to allow the tangible representation of subconscious thoughts and feelings.

Benefits of the Use of Art Therapy with Children and Adolescents

A primary appeal of introducing art therapy to young children is that artistic expression strongly correlates with the development process of young children. As Rubin (2005) noted, “It is probably not worth debating when ‘art’ begins, but it is important to remember that it is a logical development of the earliest forms of encountering the world through the senses” (p. 35). While children exhibit different development patterns, Rubin identified general development stages that most children will follow. The manipulating stage takes place between the ages of one to two years and is the first stage where a child can manipulate artistic materials, such a molding clay or pressing a crayon to a surface (Rubin, 2005, p. 36). The forming stage takes place between two to three years of age and marks the period where children are intellectually and physiologically mature enough to make deliberate manipulations of artistic materials, such as repeating motions with art tools, scribbling with a crayon, or making deliberate manipulations of clay (Rubin, 2005, p. 36). A primary limitation of utilizing art therapy among children in these stages is that they are still developing the motor and intellectual skills that are necessary to effectively represent their subconscious thoughts through art.

Because artistic development is analogous to other stages in the development process, it can be used as a treatment for children with developmental deficits. In a case study of a nine-year-old patient, Prokofiev (2011) presented the hypothesis “that the art process in art therapy supports the repair of developmental deficits (p. 38). As Prokofiev documented, the subject of his study experienced an insecure environment in infancy that contributed to severe developmental deficits, including delayed literacy and numeracy (Prokofiev, 2011, p. 38). Further, the subject displayed a detached and “flat” affect and was aggressive in his interactions with other children (Prokofiev, 2011, p. 21). Yet, after two years of art therapy participation, the researcher enabled the subject to access experiences that he missed in his early development, which resulted in significant improvement of his deficits (Prokofiev, 2011, p. 22). The case study demonstrated the benefits of using art therapy to create internal changes within the client that result in behavioral changes.

During the final stages of development, a child possesses the maturity to participate in art therapy. The naming stage takes place between the ages of 3 to 4 years when children finally can deliberately choose to make a specific object, such as a drawing that symbolizes a person or item (Rubin, 2005, p. 38). The representing stage takes place at ages 4 to 6 and is where children utilize the skills developed in the previous three stages to manipulate materials to create representations of known objects (Rubin, 2005, p. 38). Finally, the consolidating stage takes place between the ages of 6 and 9 is where children develop a repetitive style that is reflected in their artwork (Rubin, 2005, p. 40). As an examination of these beginning stages reveals, children as young as 3 can create meaningful images that possess the potential for therapeutic value.

The process of art therapy makes it ideal for clients who might not be responsive to traditional forms of therapy. As Dunn-Snow and D’Amelio (2000) note, art therapy has significant applications in school environments where an increasing number of children lack emotionally stable home environments and exhibit behavioral problems (p. 47). While young children might lack the maturity to benefit from formal counseling, art therapy can utilize artistic processes to stimulate the therapeutic process. As Dunn-Snow and D’Amelio assessed, the therapeutic process is mimicked in art therapy through three stages: the encounter stage, the destructive stage, and the reconstructive stage (Dunn-Snow and D’Amelio, 2000, p. 48). During the encounter stage, the client is encountered with “a vision, an issue, an obstacle, or a core problem (Dunn-Snow and D’Amelio, 2000, p. 48). The artwork is where the client must approach this problem and begin the process of solving the problem.

The destructive and reconstructive stages work together to produce a “breakthrough” for the client. The destructive stage is where creative insights eventually compel the client to deconstruct his or her rational justifications for a belief or way of thinking (Dunn-Snow and D’Amelio, 200, p. 49). Once an approach is challenged, the client can utilize materials to develop a new form. Thus, the reconstruction process involves the act of replacing the deconstructed elements from the previous stage with new forms that reflect the transformed insights of the client (Dunn-Snow and D’Amelio, 200, p. 49). The benefit of art therapy is that it enables a trained teacher or counseling professional to initiate the therapeutic process on a symbolic level that is more accessible to younger clients.

Empirical research validates the use of art therapy to treat specific mental health issues and illnesses. For example, schizophrenic patients, who typically struggle with traditional forms of therapy, have been demonstrated to respond positively to traditional forms of art therapy, such as drawing and painting, when it is used as a supplemental treatment program for schizophrenia (Mandic, 2003, p. 1068). While painting and drawing are common approaches to art therapy, less traditional approaches receive less support from the literature in terms of their efficacy. However, a study on poetry therapy determined that poetry therapy could successfully treat patients with depression by assisting the patient in obtaining a better understanding of his or her emotional state (Parsa & Harati, 2013, p. 149). The ability of art therapy to provide a physical or verbal form for abstract emotions and ideas

Limitations of Art Therapy Use with Children and Adolescents

The primary criticism of art therapy is presented from a theoretical standpoint. As Edwards asserted, though the benefits of art therapy in enabling patients to access the subconscious is challenged by the role of psychoanalysis in shaping the modality (2004, p. 44). While psychoanalysis was initially used to aid the development of art therapy, it is considered to be inappropriate because it is focused on arcane concepts, such as “object,” “ego,” “id,” “libido,” and “complex,” which encourage preoccupation with sexual symbols (Edwards, 2004, p. 44). The lack of an original theoretical framework upon which to base art therapy causes patients from diverse backgrounds to be underserved by the practice. As Edwards notes, feminist art therapy has highlighted how the psychoanalytical framework influences art therapy to adopt misogynistic descriptions of female clients (Edwards, 2004, p. 44). Further, the focus on concepts such as “mad” or “deviant” can cause practitioners to stigmatize clients from different social or cultural backgrounds (Edwards, 2004, p. 44). To improve the approach that practitioners take to working with clients, art therapy must be developed through a framework that positively appraises differences in gender, race, and sexual orientation.

Moreover, while empirical research documents the benefits of art therapy, studies also highlight potential detriments of the therapy. For example, Nelson (2010) assessed that many teenagers were offended by the “inauthentic” intrusions into their personal mental and emotional states of mind (p. 66). As this feedback demonstrates, art therapy has the potential to be manipulative in practice and provide discomfort for the client when applied inappropriately. The potential practice of art therapy by unqualified professionals exacerbates this problem. As Rubin cautioned, “Art is a powerful tool – one that, like the surgeon’s, must be used with care and skill if it to penetrate safely beneath the surface” (Rubin, 2005, p. 387). Because art therapy seems to be simple, parents and teachers might attempt to utilize art therapy at home or in the classroom setting without appropriate training. Yet, when working with vulnerable individuals, all individuals utilizing art therapy must be competently trained in both the clinical and artistic applications of this modality of treatment.

Conclusion

The concept of art therapy has expanded significantly since its inception in the 1940s. Today, art therapy includes a wide range of media, including sculpture, painting, drawing, and music, and is applied to treat a wide range of mental health issues. As empirical research confirms, art therapy is effective when used with children and adolescents because the process correlates with the development process. As young as 3 years of age, children can construct meaningful symbols that represent their internal experiences. However, the primary limitation of art therapy is that it has yet to utilize a framework that enables it to be applied to culturally and socially diverse groups. Additionally, the detriments of inappropriate applications of art therapy require the development of uniform and rigorous standards for practitioners. However, as empirical research continues to validate the benefits of art therapy, it can be expected that this modality will be applied more frequently in the clinical setting.

References

Dunn-Snow, P., & D'Amelio, G. (2000). How art teachers can enhance artmaking as a therapeutic experience: Art therapy and art education. Art Education, 53(3), 46-53.

Edwards, D. (2004). Art therapy. London: SAGE Publications.

Parsa, N. A., & Harati, S. (2013). Art therapy (poetry therapy) can reduce the effects of depression. International Journal of Academic Research, 5(4), 149-152. doi:10.7813/2075-4124.2013/5-4/B.22

Prokofiev, F. (2011). “I’ve been longing and longing for more and more of this”: Researching art therapy in the treatment of children with developmental deficits. In A. Gilroy (Ed.), Art therapy research in practice (pp. 19-38). Oxford: Peter Lang AG.

Mandić Gajić, G. (2013). Group art therapy as adjunct therapy for the treatment of schizophrenic patients in day hospital. Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal of Serbia & Montenegro, 70(11), 1065-1069. doi:10.2298/VSP1311065M

Nelson, C. (2010). Meeting the needs of urban Students: Creative arts therapy in Jersey City Public Schools. Art Therapy: Journal of The American Art Therapy Association, 27(2), 62-68.

Rubin, J.A. (2005). Child art therapy. Hoboken, NJ: Wiley.