Chapter One: An Art Therapy Intervention on Identity Development through the Lens of the Adoptee: A Qualitative Arts-based Approach

Background Few studies have investigated brain responses to different art media. Investigations into brain processes during art making have highlighted important structures. Neuroimaging tools have been used to investigate activation of brain areas whilst artmaking, but not in a therapeutic setting. This review highlights recent advancements in this area and encourages researchers to be the first to apply this in the UK. Aim To understand how the principles of neuroscience are currently informing the literature to explain the effects of art media in art therapy practice. Methods Review of published peer-reviewed research between years 2000 and 2020 on neuroscience and art therapy. Results Findings were summarised into categories discussing psychological/neurobiological issues, art media, neuroimaging technology, and models posited. Forty-six studies were found; majority discussed the structure and function of the brain to explain art therapy processes. The Expressive Therapies Continuum (ETC) model theorised that media properties stimulate different levels of visual and cognitive processing. The novel Mobile Brain/Body Imaging (MoBI) neuroimaging technology may be used as a means of quantifying data. Conclusion Significant progress has been made in attempting to explain brain responses during the art therapy process. However empirical data is needed to prove theoretical models. The use of neuroimaging has started this process to lead research into evidence-based practice. Implications for practice/further research Evidencing the ground-breaking ETC model, using neuroimaging and MoBI technology is needed through close collaboration between transdisciplinary departments. Art therapists should be encouraged to use the ETC to inform art therapy assessment, planning and treatment. Plain-language summary Neuroscience is the study of the brain and its processes, and recently technology has been available to researchers to examine brain processes in detail. This systematic narrative review explores recent literature that uses the principles of neuroscience to investigate the effects of art therapy, with a specific interest in art media. A systematic narrative review is when the findings of the study rely on the use of words to summarise the data. Art media is an important part of art therapy, as it is through artistic expressions that the client communicates their inner troubles. Different art media has been shown to elicit different feelings and behavioural responses in clients. However, research showing brain responses to different art media is limited. This study highlights ways in which further research in this field can take place. Results show that significant advancements have already been made that identify important structures and functions of the brain accessed during art therapy. Important models which incorporate neuroscience principles and theorise the art therapy process are highlighted. A significant model is the Expressive Therapies Continuum. This model explains how the brain processes information when different art media is used. However empirical data is needed to substantiate the theory behind this model. The use of neuroimaging technology is one way to achieve this. Therefore, this paper encourages transdisciplinary research to further investigate the effects different art media has on the brain during the art therapy process.

Art therapy has often been applied in the treatment of traumatized adults, and good results in clinical practice have been reported. However, although art therapy experts underline these benefits, the effectiveness of art therapy in trauma treatment has not been established by systematic review. The aim of this systematic review is to identify and evaluate empirical evidence of the effectiveness of art therapy for trauma treatment. As a result of the systematic review, six controlled, comparative studies on art therapy for trauma in adult patients were found. In half of the included studies, a significant decrease in psychological trauma symptoms was found in the treatment groups, and one study reported a significant decrease in depression. Although there are limitations in the number of included studies, the number of participants, the heterogeneity of included studies, and their methodological quality, the results contribute to insight into the effectiveness of art therapy in trauma treatment and form an evidence base for the urgent need for further research on art therapy and trauma treatment.

Influence of art therapy in complex treatment on the quality of remission in patients with recurrent depressive disorder

This randomized controlled trial explored the impact of Expressive Therapies Continuum (ETC)-based art therapy interventions for older adults with dementia living in a complex care home. The trial examined the efficacy of 10 art therapy intervention sessions over 4 months, comparing results with an active control group that participated in 10 art sessions. Pre- and post-assessments, including the Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), and the Older People’s Quality of Life (OPQOL-Brief) questionnaires, were conducted. Results demonstrated that participants displayed similar visual expression elements, shared preferences for specific media types, and equivalent ETC-based intervention entry levels. In addition, participants in the experimental group showed significant increases in OPQOL-Brief scores. Finally, MMSE-Language scores demonstrated statistically significant increases in the experimental group and a decrease in the control group. The current study aligns with previous research demonstrating that art therapy can improve cognitive functioning and enhance the quality of life in older adults living with dementia. It expands on previous research by providing new insights into expressive and stylistic elements, ETC entry-level, and media preferences for engaging in artmaking. Keywords: Art therapy, dementia, older adults, Expressive Therapies Continuum, cognitive functioning, quality of life

The Expressive Therapies Continuum (ETC), a neurobiologically-informed framework guiding art therapists in assessment and treatment makes it effective for trauma care. Somatic Experiencing (SE), like the ETC, tracks sensations, images, behaviors, affect, and meaning, denoted by the acronym SIBAM, to direct trauma-informed care. By emphasizing observations of artistic processes, not merely art products, both frameworks help art therapists identify critical behavioral and artistic indicators that can help them make informed decisions about interventions. This paper explores the integrative use of the ETC model and the SIBAM framework in two clinical cases, where positive therapeutic outcomes were achieved. It aims to reaffirm ETC’s possible neurobiological applications and the importance of observing artistic processes in both assessment and treatment interventions.

The theoretical concept of the Expressive Therapies Continuum (ETC), proposed by Kagin and Lusebrink in 1978, incorporates several US art therapy pioneers' approaches to art therapy. The ETC consists of three stepwise levels—Kinaesthetic/Sensory, Perceptual/Affective and Cognitive/Symbolic—interconnected by the creative level. Each level of the ETC encompasses two polarities, whereby the emphasis on one polarity decreases the involvement of the other polarity. The therapeutic aspects of the ETC are based on the following art therapy approaches: art as therapy, gestalt art therapy, phenomenological art therapy, psychodynamic art therapy, and cognitive art therapy. The stepwise three-tiered structure of the ETC incorporates concepts from cognitive psychology and art education, namely perception and imagery, visual information processing, stages of graphic development, and different expressive styles. Based on Fuster's (2003) theory about areas of the brain involved in processing perceptual information, Lusebrink has hypothesised that the three levels of the ETC reflect three different areas of the brain in processing visual information. The article elaborates on the practical applications of the ETC concept in therapy and the use of art media on its different levels. The goal of the article is to expand the range of art-based strategies and to further understanding of art expressions in therapy.

Background Burnout among healthcare professionals (HCPs) is a growing concern with wide-reaching implications. Manualised, evidence-based art therapy interventions offer a promising approach to staff support and have shown effectiveness in recent clinical trials. However, little is known about art therapists’ experiences of delivering these structured models. Understanding these experiences is essential to inform future implementation and sustainability. Aims To explore art therapists’ lived experiences of delivering a manualised group art therapy intervention for HCPs at risk of burnout, and to identify factors influencing implementation. Methods A qualitative study using Reflexive Thematic Analysis and Template Analysis was conducted. A focus group with four therapists who delivered the intervention was transcribed and analysed to explore personal, professional, and systemic influences on delivery Results Three interconnected domains were identified: (1) Art therapy groups as emotionally resonant, relational spaces that disrupted workplace hierarchies; (2) Therapist perspectives on balancing fidelity to the manual with flexible, relational practice; and (3) Organisational influences on delivery, including resource constraints and emotional labour. Therapists valued supportive relationships, the manual’s containing function, and contextual knowledge. Embedded expertise enhanced delivery, while systemic barriers challenged sustainability. Conclusions Delivering a manualised art therapy intervention in a medical setting was both meaningful and demanding. The structured framework supported emotional safety and creative expression, but long-term sustainability depends on organisational investment and integration into existing systems. Implications Findings emphasise the need for dedicated art therapy roles, appropriate infrastructure, and further research into scalable implementation and long-term impact. Plain-language summary This study explored how art therapists experienced delivering a manualised group art therapy programme for healthcare professionals at high risk of burnout. Four art therapists who facilitated the sessions as part of a randomised controlled trial took part in a focus group to share their reflections. Transcripts of the discussion were carefully examined using thematic analysis to explore common themes and differences. Therapists described how working within a structured manual helped them feel organised and grounded in delivering the intervention. The manual provided a clear framework that was highly valued for keeping art-making central to the sessions, preserving the integrity of the model, and fostering authentic expression and connection. Therapists also highlighted the importance of remaining flexible and responsive to the needs of each group. Being open about the manual and the research context helped build trust and engagement with participants. Delivering the intervention was experienced as both professionally enriching and personally meaningful. However, therapists also identified challenges, including organisational pressures, unpredictable physical spaces, and the emotional demands of the work. Access to supervision, team support, and strong working relationships with clinical colleagues were seen as critical to sustaining therapist wellbeing and programme delivery. The study highlights that group art therapy was experienced as creating restorative spaces for healthcare professionals within hospital environments. To sustain programmes like this, healthcare organisations need to invest in supporting art therapists through dedicated roles, protected time, appropriate spaces, regular supervision, and opportunities for reflection and creativity. Future work should explore how to adapt and extend this kind of programme across different hospitals and staff groups while keeping its core relational and creative focus alive.

The use of art therapy in complex treatment on the quality of remission in patients with melancholy in major depressive disorder

Background: The first 1000 days (conception to 2 years postnatal) are crucial for parent and infant health. Visual art-based interventions are used to promote positive parental mental health, but currently, there are no comprehensive insights into how these interventions can support new parents during this critical perinatal period. Aims: To synthesise research on visual art-based interventions designed to promote parents’ mental well-being during the first 1000 days to understand if and how these interventions made a difference and to identify any barriers or facilitators to parents’ engagement. Method: A keyword search of five databases (CINAHL, Embase, Medline, PsychInfo and Scopus), searches via Google Scholar and backward and forward chaining were undertaken. Quality appraisal was conducted using design appropriate tools, and a narrative thematic approach was used. Results: 4417 hits were identified, and 10 studies met eligibility criteria and were included. Interventions were classified as art therapy (n = 8) or creative arts (n = 2), and overall, a lack of robust evidence was highlighted. Six themes were constructed that describe the psychosocial impacts and experiences of the interventions and relational and contextual factors that influenced parents’ engagement. While both types of interventions had benefits, art therapy had the most profound impacts. Challenges regarding sustainability of impacts and facilitator skills were noted for creative arts, rather than art therapy interventions. Conclusion: While art therapy interventions promote positive parental mental health and well-being, high-quality evidence is needed. Implications for future research: More robust evaluation designs to identify mechanisms of effectiveness in art therapy interventions are needed.

« On ne dit jamais qu’un jumeau est mort… »

La médiation argile : une thérapie innovante dans le traitement du traumatisme et du post-traumatisme

The demand to cover extensive instructional material in art therapy supervision can affect the self-efficacy of a supervisee and supervisor. Co-creating and art-making in art therapy supervision can enhance the effectiveness, growth and depth of the supervisory relationship. We propose a novel art-based model of supervision rooted in the Expressive Therapies Continuum, which we have been using and teaching for the past several years. The supervisory approach involves mastering the Expressive Therapy Continuum model, creating artwork with the supervisee, exploring artistic preferences and aversions, and strengthening supervisory alliances. The Expressive Therapies Continuum supervision process begins with the development of a collaborative plan in which the supervisor and supervisee jointly establish goals to support professional growth. It continues with mastery of the Expressive Therapies Continuum model, including gaining an in-depth understanding of the media dimension variables and their likely impact on the therapeutic process. Finally, the model uses Expressive Therapist Self-Inquiry to support an examination of artistic preferences and aversions and their possible influences on the art therapy process and the development of professional identity. This article presents multiple practical examples of the Expressive Therapies Continuum supervisory model, including a case vignette that illustrates its application. • We propose an art-based supervision model using the Expressive Therapy Continuum • The model includes co-creating art, exploring preferences/biases, and building alliances • It emphasizes mastering the Expressive Therapy Continuum and its application • Media choices are examined for their therapeutic effects on clients • Self-inquiry helps explore how artistic preferences shape identity and practice

This Viewpoint essay serves three purposes: (1) revealing the life experiences of Vija Lusebrink that shaped what would become the pantheoretical art therapy assessment and treatment model known as the Expressive Therapies Continuum; (2) clarifying the broad and deep scope of this model; and (3) encouraging the art therapy audience to recognize this model as a complex marriage of information processing and agents of change. The Expressive Therapies Continuum (ETC) lends itself to outcome-informed treatment in art therapy as a systems-oriented means of gauging client responses to multidimensional interventive inputs and modifying the therapist’s approach accordingly. It is important for art therapists to share a unified understanding of the ETC that is consistent with the ideas of its co-creators.

Padala Olga, Krupa Adrianna, Putowski Maciej, Konopelko Michal, Piasek Ewa. The efficacy of art therapy in psychiatric patients. Journal of Education, Health and Sport. 2019;9(8):377-383. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3376782 http://ojs.ukw.edu.pl/index.php/johs/article/view/7324 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.08.2019. Revised: 15.08.2019. Accepted: 23.08.2019. The efficacy of art therapy in psychiatric patients Padala Olga, olga.padala@gmail.com ORCID:0000-0003-1469-0877 1st Department of Psychiatry, Psychotherapy and Early Intervention Medical University of Lublin, Gluska Street 1, 20-439 Lublin, Poland Krupa Adrianna, adriannakrp@gmail.com ORCID:0000-0003-0866-3952 Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4 Street, 20-090 Lublin, Poland Putowski Maciej, putowski.maciek@gmail.com ORCID:0000-0002-7575-2456 Department of Experimental Hematooncology, Medical University of Lublin, Chodźki 1 Street, 20-093 Lublin, Poland Konopelko Michal, mm.konopelko@gmail.com ORCID:0000-0003-4103-7400 Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin, Jaczewskiego 8, 20 954, Lublin, Poland Piasek Ewa, ewa.piasekk@gmail.com, ORCID:0000-0003-3344-4022 I Clinic of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego 8, 20 954, Lublin, Poland Abstract: Introduction: Art therapy is a form of psychotherapy that uses art media as its primary mode of expression and communication and enables individuals to use art to creatively express themselves. Art therapy is used to improve cognitive and sensorimotor functions, foster self-esteem and self-awareness, cultivate emotional resilience, promote insight, enhance social skills, reduce and resolve conflicts and distress. Purpose: The purpose of the review is to present the different uses of art therapy in psychiatric patients. State of knowledge: National Institute for Health and Clinical Excellence identifies that arts therapies, including art therapy or art psychotherapy, dance movement therapy, body psychotherapy, drama therapy and music therapy, are considered to improve negative symptoms of psychosis. Improved social skills are likely to be associated with increases in prosocial behaviours. Art therapy interventions are effective in reducing trauma symptom severity and anxiety in traumatized adults. Art and music therapy programs were effective in reducing the degree of depression. Summary: Art therapy is a part of therapy in many psychiatric diseases, including depressive disorders, post-traumatic stress disorder and psychotic disorders. Although the effectiveness of art therapy has been confirmed by some studies, this topic should still be investigated so that art therapy can become more effective and available for bigger group of patients. Key words: art therapy, PTSD, depression, psychotic disorder, schizophrenia

Burn injuries are profoundly traumatic and painful events with diverse physical and psychosocial consequences. Improving psychosocial functioning in hospitalized burn survivors involves minimizing distress and pain and fostering emotion regulation. Art therapy could uniquely address the non-verbal aspects of distressing experiences, facilitating healthy emotional expression. Therefore, this study included developing and implementing a four-session semi-structured art therapy intervention comprising expressive and receptive sessions as part of a mixed-methods doctoral dissertation research with hospitalized adult burn patients. This study used a small N study design to assess art therapy's impact on distress, positive and negative affect, pain, overall perception of improvement, and self-expression and regulation. Twelve patients completed the study and served as their control when assessed before and after art therapy. Quantitative assessments were conducted using standardized self-report measures for distress, positive and negative affect, and pain before and after each session, assessment of self-expression and regulation in art therapy, and patients' overall perception after completing all art therapy sessions. Qualitative data were collected from session feedback, artworks, notes, and exit interviews, which were thematically analyzed and then integrated with quantitative findings. Quantitative results showed significant improvements in the outcomes across the four sessions; however, changes did not reach statistical significance within-sessions. Thematic analysis of qualitative data indicated that art therapy encouraged physical engagement and prompted symptom management through relaxation, distraction, and emotional expression, with art serving as tangible reminders. The third aim of the research addressed understanding providers' experiences of working in an inpatient burn center and their perspectives on art therapy. The thematic findings of the semistructured interviews with ten health-care providers from varied disciplines indicated that they perceived burn care as a "multifaceted problem" which was also a rewarding experience for the providers. They perceived art therapy as a necessary "emotional outlet" for burn patients. Future implications for art therapy research/practice goals relating to complex patient presentations, specific multidisciplinary team challenges, and the critical care environment emerged. This is the first study to systematically investigate the impact of art therapy intervention with adult burn patients using a mixed-methods approach. Overall, findings indicated that art therapy positively enhanced psychosocial functioning in hospitalized burn patients. Positive perceptions of patients and providers reinforced how art therapy could contribute to inpatient care and inform clinical practice as part of the multidisciplinary team within burn centers. More research is needed to address patients and providers' identified psychosocial, functional, and interprofessional needs.