Abstract
The effectiveness of the arts-based psychotherapy methods may rely on offering tools for preverbal implicit processing, especially in work with traumatized clients. This can enhance clients’ self-soothing capacities, activate flow experiences in line with positive psychology, and change inner working models through memory reconsolidation. The arts-based psychotherapies offer expanded Windows of Tolerance through dual awareness, and concretizes the psychotherapist’s care in the therapeutic relationship, in line with psychodynamic psychotherapy. These methods activate the innate human ability to express and experience creativity, including beauty and awe. The arts in therapy offer a creative space of play where a new reality may be constructed and shared. The interventions are proposed to offer more than plain cognitive restructuring and behaviour activation (although they may lead to additional changes in these parameters). The clinical usefulness of the arts-based methods is reflected in relation to traumatized clients’ opinions of what has helped them. The potentially effective mechanisms in the arts-based psychotherapies ought to be further investigated in clinical work and research processes, thus, promoting the methods’ abilities to enhance clients’ well-being and change capability.
 List of abbreviations: ASC altered state of consciousness; AT art therapy; BMGIM Bonny Method of Guided Imagery and Music; CBT cognitive behavioural therapy; DMN default mode network; EMDR Eye Movement Desensitization and Reprocessing; AMT active music therapy; MT music therapy; PDT psychodynamic psychotherapy; PTSD posttraumatic stress disorder; RCT randomised controlled trial; RMT receptive music therapy; GrpMI Group Music and Imagery; WoT window of tolerance
Highlights
In this scholarly paper the authors, who are experienced clinicians and researchers, focus on the mechanisms of change in the arts-based and altered state of consciousness based psychotherapy methods
It is not possible to specify if the efficacy of the arts-based psychotherapy methods is grounded on offering the client the opportunity to: (a) reclaim their selfsoothing capacity (Krystal, 1988, Gerge, 2018a, 2018b); (b) activate flow experiences in line with positive psychology (Seligman & Csikszentmihalyi, 2000, Wilkinson & Chilton, 2013), or; (c) change inner working models (Bowlby, 1969) through memory reconsolidation, including reworking earlier hardships
It would seem that the artsbased interventions offer more than plain cognitive restructuring and behavior activation
Summary
There is confusion concerning which methods should be considered. Part of the evidence for MT is based on studies of music used in medicine, not MT (Gold, Heldal, & Dahle et al, 2005; Bradt et al 2016), and supportive therapy might not have been distinguished from psychotherapy. According to Malchiodi (2006) art making consists of creation, observation, reflection, and meaning making Such experiences lead to change and insight through the arts-based psychotherapies offering an imaginative sphere for containing the implicit. We propose that experiencing arts, for example in RMT or active music therapy, where the client is relationally held and relaxed when listening to or playing music, can have the same change-creating potential as AT Both inner images and created pictures supposedly represent processes in the implicit realm (Belkofer & Nolan, 2016; Gerge, 2017,, 2018a,, b; Hass-Cohen & Findlay, 2015), and correspond in multifaceted ways with affects and arousal levels of the body
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