Creative Arts Therapists Research Articles

International Interview Series

Expanding on the central theme of this issue, three music therapists give their responses to questions concerning the development of the profession in different areas of Europe. These three views of different aspects of the development of music therapy in a variety of countries place the work of the UK profession into perspective, as well as raising some important further questions for the future. Monika Nöcker-Ribaupierre is based in Germany, leading the music therapy training course in Munich, and is the current General Secretary of the European Music Therapy Confederation; also in this edition we publish a review of her most recent publication Music Therapy for Premature and Newborn Infants (Barcelona Publishers). Tracey Jones works in Dublin and heads the Music Therapy Department at Cheeverstown House. Tracey is an active member of the Irish Association of Creative Arts Therapists (IACAT), an organisation that is involved in new developments in the creative arts therapies professions in Ireland. Claire Flower is the Chair of the British Society for Music Therapy and well-known both in the UK and internationally as a clinician, presenter and author.

Using Group–Analytic Supervision Approach When Supervising Music Therapists

This paper will introduce a group–analytic music therapy supervision model, which I have developed and practised as a clinical supervisor with music therapists, music therapy students, creative art therapists and psychotherapists since 1995. The theoretical approach of the model is based on my experiences as a trainee of group–analysis at the Psychotherapy Institute of the Finnish Mental Health Association (1995–1999), the psychoanalytical group–analytic theories (Foulkes, 1964, 1984, 1990; Sharpe, 1995; Tsegos, 1993, 1995), Balint–theory (Drees & Akkanen–von Stein, 1994; Trenkel, 1994ab; Knoepfel, 1994), and the Group–Analytic Music Therapy Model (Ahonen–Eerikainen 2002). Every group–analytic music therapy supervision meeting is a creative process in which the group members learn to concentrate on their inner images, physical sensations and feelings. The goal is to expand participant's understanding about the therapeutic relationship and its various aspects and elements.

Establishing a model of communication between artists and creative arts therapists

Establishing a model of communication between artists and creative arts therapists

Developing cultural awareness for creative arts therapists

Developing cultural awareness for creative arts therapists

Appreciating diversity, commonality and the transcendent through the arts therapies

The call for papers for a journal issue on the “Multicultural Application of the Arts in Psychotherapy” resulted in such a high response on a special focus for The Arts in Psychotherapy that it prompted a decision to publish two issues on this profoundly significant topic, What we have discovered is that the use of the arts in the area of multiculturalism is a many-faceted subject. In the first special issue (Vol. 24, No. 2, 1997) Dosamantes-Beaudry began the exploration of how culture is developmentally transferred. Bradt and Coseo focused on the need for the therapist to be aware of his or her own world view as well as what it means to be a culturally sensitive creative arts therapist. Application articles from Farr, Linden and Landy addressed the use of the arts in psychotherapy with individuals whose race and culture differed from those of the therapist. Antinori and Moore discussed the use of drama in diversity awareness training. In this second special issue on multiculturalism and the arts in psychotherapy, Pallaro furthers the exploration of Dosamantes-Beaudry’s article with an in-depth discussion of “Culture, Self and Body-Self: Dance/Movement Therapy with Asian Americans.” Pallaro holds a magnifying glass up to some of the Western psychological theorists’ views of such topics as healthy human development and their focus upon separation and individuation and the spiritually reductive approaches that devalue and ignore the profound and pervasive significance of the transpersonal in the daily existence and world view of Asians from various cultures. She views dance/movement therapy as a medium that creates and supports a facilitating environment for the process of biculturalization. Dance/ movement is capable of holding both cultures allowing participants to explore their relationship to both world views without discounting either one. Lewis’ article, “Transpersonal Arts Psychotherapy: Toward an Ecumenical World View” continues Pallaro’s discussion of the religious and spiritual biases of therapists and their perceptual frames and their effect upon psychotherapy with individuals who hold divergent belief systems. The history and range of Western theories of transpersonal psychotherapy are traced and current or neo-transpersonal approaches discussed. Lewis then explores the role of the arts therapist as the modem priest and shaman who, as in early civilizations, combine art and spiritual beliefs toward the healing of the individual and the well-being of the community. Clinical cases follow, describing creative arts processes with three clients who hold differing transpersonal frames. Linden’s “A Festival of Light” describes the creation of a healing arts event in a high school that utilized an archetypal transpersonal symbolic theme to assist in the celebration of diversity and commonality among a multi-ethnic school body. In describing the creation of this celebration, Linden discusses the way in which the “transpersonal draws individuals together through manifesting a conscious intention that had the power to transform all who participated” (p. 255). The creation and perhaps invocation of the

The identity of the creative arts therapist: Guided by ethics

The identity of the creative arts therapist: Guided by ethics

Shame dynamics among creative arts therapists

Shame dynamics among creative arts therapists

Hope, meaning and the creative arts therapies in the treatment of AIDS

The general proposal of this paper is that the creative arts therapies have a significant role to play in the treatment of AIDS patients. Not only do they offer an existential form of therapy that accepts patients as they are and affords them an oppo~unity to define themselves as they wish to be, they are primarily concerned with aesthetic issues of form and existential notions of potential rather than concepts of pathology. That the persons are infected with a virus recalcitrant to medical initiatives is a given and is inarguable. What the persons will become and how a personal future is defined, a future admittedly restricted and often tragically curtailed, are matters for joint therapeutic endeavor between therapists and patients and are not accessible to a normative medical science ( Aldridge, 199 1 a). The end stage of our therapeutic endeavor is that the patients will die. This raises important questions about the nature and goals of therapy, with important implications for establishing the criteria for measuring or assessing the efficacy of our therapeutic endeavors. Many of the considerations we need to make, particularly with the dying, are not amenable to operational de~nition and thereby elusive to measurement (Feifel, 1990). However, they are amenable to artistic expression in that they can be written as poetry, acted as drama, moved as dance, drawn, sculpted and painted as art, told as stories and played as music. Creative arts therapies (music therapy, art therapy, dance therapy, drama therapy and poetry therapy) have been developed for use in predominantly psychotherapy settings. Some creative arts therapists have developed the work with the dying in hospice settings (Dessloch, Maiworm, Florin, & Schulze, 1992; Frampton, 1989) and Lee ( 199 1) has developed the use of music therapy both with cancer patients in the hospice setting and with AIDS patients. The following sets out some considerations that we may wish to incorporate into our treatment and research initiatives. As the treatment of AIDS patients occurs predominantly in a medical setting, it is necessary to present some of the medical understandings of the problem in the first part of this paper. Those medical understandings, however, are partial. Medicine is a restricted set of practices from the repertoire of our possible healing strategies. What we also need are understandings gained from existential psychology and the creative arts themselves. Such understandings will be attempted in the latter part of this paper.

Commonalities among the creative arts therapies as a basis for research collaboration

Poetry therapy is similar to the other creative arts therapies not only in its use of creative processes and products, but also in its intrinsic positiveness, gentle indirectness, and breadth of appeal and application. These commonalities suggest that collaborative research efforts among poetry therapists and other creative arts therapists can lead to new understandings of the processes and effects of creative arts therapies.

Creativity and change: The two-tiered creative arts therapy approach to co-dependency treatment

Co-dependency, the companion “disease” to addiction, has been referred to as the 20th century condition (Cermak, 1986, p. 9). Popularized in books and periodicals, endlessly discussed on television and radio talk shows, painfully described by participants in the anonymous fellowships of Alcoholics Anonymous (AA), Al-Anon, Adult Children of Alcoholics (ACOA), Overeaters Anonymous (OA). codependency has dcmonstratcd its staying power. After extcnsivc rcscarch and clinical experience in this area, the writer wishes to state that codependency is a bona fide. recognizable clinical entity that appears to respond positively to therapeutic intervention. Researchers in the field arc concluding that the co-dependent stance may be based on an incomplete identity formation and compromised ego structure (Bradshaw. 1988. 1990; Smith, 1988; Subby, 1987). In other words, if “who one really is” is not clear, then “who one is in the world” will show any number of distortions as well. It has also been reported that verbal, insightoriented psychotherapy alone may not fully reach the preverbal layers of co-dependency (Bradshaw, 1990; Whitfield. 1987). Similarly, repeated cathartic selfdisclosure at l2-step meetings, although therapeutic, may not necessarily ensure that actual consolidation of self and ego integration, leading to deep structural change, is taking place in the co-dependent either (Smith. 1988; Wegscheider-Cruse & Cruse, 1990). Treatment opportunities that are specially designed to respond with accuracy to the needs of this population appear necessary. It is this writer’s belief that the dance therapist or other creative arts therapist, working alone or in a co-leadership capacity with an allied trained professional, offers the best, most complete, and therefore most hopeful therapy to this large patient group. The following describes a two-tiered creative arts therapy model of treatment for co-dependency, developed and implemented by the writer on the Inpatient Impaired Professionals Unit at the Institute of Living, t lartford, Connecticut.

Introduction to the special issue on creative arts therapies in the treatment of substance abuse

“Drugs appear to give an enormous impetus to the creative intuition.” Alan Watts (1962) “No one can look upon God’s face, and live.” Hemik Ibsen, in Peer Gynt The treatment of substance abuse with the creative arts therapies is confronted with a paradox: the creative arts and mind-altering substances are not entirely antagonistic forces; in fact they share close ties. Both have been hailed as methods of opening the ‘ ‘doors of perception, ’ ’ as Afdous Huxley (1954) proclaimed. Festivals and celebrations, such as Mardi Gras, are characterized both by intoxication and the arts, as are many central figures of mythology, religion, and literature, such as Dionysus, Bacchus, or Alice in Wonderland. Creative artists have often used stimulants to help access inner images, as well as sedatives to numb the intensity of their psychic visions. Shamans, who are often cited as models for creative arts therapists, generally use psychoactive substances to enhance their healing powers (Harner, 1980). So how can it be said that creativity is an antidote to substance abuse, when the two seem to occur so often together? When so many creative artists become addicts, like James Joyce, or Eugene O’Neill, or Alvin Ailey? One might argue that the healing power of both the creative arts and psychoactive substances is derived from the same source! For example, Carl Jung took this stance when he told Bill W. that a person’s use of intoxicants (“spirits”) may be motivated by a spiritual quest, that is, a search for God that also underlies the arts (Jung, 1974). The questions are, Do creative expression and addiction support each other? or Can creativity become a replacement for addiction, as a kind of homeopathic alternative? Aldous Huxley defended the use of drugs to help people “get in touch” with their inner unconscious images, which societal dictates often suppress. Likewise, the creative arts therapies allow for the expression of essential aspects of self by circumventing the rigid censorship of the superego. However, in conditions characterized not by an overly rigid superego, but a weak one, perhaps a different approach is needed, A large body of evidence indicates that a primarily extemally-focused, suppressive, and supportive approach to substance abuse, such as found in Alcoholics Anonymous (AA), has been the most successful. This approach advocates a focus on the disease, not on the self; on the present, not on the past; on the search for contact with a Higher Power, not resources within the self. It emphasizes naming feelings, not examining them. In general the intent is to distract the addict from the self and direct him or her toward other people and the battle with the disease. Introspection leads to self-preoccupation, which leads to relapse. How can the creative arts therapies, which stimulate an inner-directed state, fit in with this approach? Substance abuse programs also advocate avoidance of emotional arousal, as arousal leads to bodily tension that leads to relapse when addicts try to numb themselves. The emotional arousal offered by the creative arts therapies, stimulating clients’ bodies, sights, and imaginations, is well-known, and has been identified as the key element in the treatment of other diagnoses, particularly depression and dementia. We all know of the “high” accompanying a truly creative achievement, followed by the “down.” One study of drama therapy noted increased acting out and substance abuse following an intense and successful

Introduction to the special issue on the creative arts therapies with adolescents

Adolescence. The teen years, ages 1319, right? Not exactly. Isn’t it a normal period of psychological development? Normal? Perhaps it is really a psychopathological condition yet to be listed in DSM-III-R? On the other hand, my great uncle always said he was an adolescent. Maybe it is just a state of mind. This Special Issue will address the relationship between the creative arts therapies and adolescents. Many unique observations and techniques are offered that will contribute much to the field. Nevertheless, there is something special about this particular population that holds importance to creative arts therapists. I began my adolescence performing skits with my brothers for my parents and their guests. Now I am a drama therapist, and I perform skits with my patients for the staff and families at my hospital. What I began then, I have never stopped. For many creative arts therapists, adolescence was the time we discovered our art form. After all, art as a conscious process requires the development of the capacity for abstraction, a capacity that emerges fully during adolescence. From the playful musings of the child, in adolescence we begin to discern talent, and mere expression turns into disciplined form. We make these discoveries because someone we loved gave our artistic expression value, just as now we affirm our patients by giving value to their artistic creations. Adolescence has been characterized as the stage of life where play is transformed into work. Creative arts therapists, whose work is play, can legitimately be accused of living in this transformative space. Not set in our ways, still skeptical of authority, not quite yet accepted, our near rebellious energy and spontaneity have kept many an institution alive with spirit, stirred by a rhythmic, creative pulse. Yes, there is a special tie between the creative arts therapies and adolescence, and yet this population can be among the most challenging to us. Their emotionality and defensiveness, fragility and stubbornness demand a special clinical acumen. Their rejection of childish ways often is expressed by a rejection of our modalities. Finally, their need to create private inner space beyond the reach of parents is expressed by a refusal to share their thoughts with us. “A penny for your thoughts, ’ ’ my mother would say when she wanted me to tell her what she already had surmised. After age 15, I simply retorted, “Humpf.” I thought they were worth at least a dollar. The Special Issue begins with a Perspective by Rente Emunah entitled, “Expression and Expansion in Adolescence: The Significance of Creative Arts Therapy. ” Emunah presents the four concepts of explosion, expression, containment, and expansion to link adolescent feelings and behavior to the processes of the creative arts therapies. She asserts that the balance and interplay between expression and containment in creative arts activities help adolescents achieve a sense of mastery over their emotions. Emunah describes both the extreme challenge and potential for creativity inherent in the adolescent’s struggle for maturity, and identifies some of the techniques she has found useful in overcoming their resistance and establishing a therapeutic alliance. She also reminds us that many of our own primary values and perspectives on life were forged during our adolescence, particularly our love of our art form. She notes that this is one “population” we have all been! C. Jane Estelle, in “Contrasting Creativity and Alienation in Adolescent Experience,” gives us an understanding of two underlying processes that con-

On being a female creative arts therapist

Une femme therapeute utilisant la danse comme support therapeutique relate les problemes de discrimination sexuelle qu'elle vit dans son travail, dans des structures hierarchiquement dominees par des hommes

Training the creative arts therapist: Identity with integration

The most difficult issue facing educators of creative arts therapists in the 1980s and 1990s is how to continue to prosper in the present social and economic ambiance. Diminished financial resources available to support a mental health system in the United States have produced forces that demand that creative arts therapists collectively make a case for their efficacy and cost effectiveness. Accepting this premise leads to the conclusion that the graduates of creative arts therapy programs must be prepared to face that challenge. Therefore, a comprehensive ongoing program evaluation is required to continually measure progress in preparing students for this challenge. In assessing the academic and clinical qualifications required of the professiona therapist, three major goals in education emerge: (a) the graduate must be a competent team member and be able to maintain a professional and competent identity as a therapist; (b) the graduate must be taught the most updated concepts in the mental health disciplines, and trained and experienced with an increasingly widening population; and (c) the graduate must be trained to be at least a competent consumer of research and to be at least capable of participating with a research team. As educators, the authors have looked at these goals for graduates and continue to reevaluate whether we are meeting the goals. in this article we summarize the means of addressing these competencies. This represents only one view of the problems of growth and development of our profession in this period. As with any program in any discipline, the context in which it is placed, in our case a university Mental Health Sciences Department and Hospital, affects perspective and to a degree defines limitations .

On the road to educating the creative arts therapist

In the process of gathering my notes for this article I travelled back mentally over two decades. It became obvious that this road back called forth a revivification of an intense and gratifying trip that was also attended with some episodic, jarring bumps. The task facing me was to sort out that which was personally significant from that which was professionally significant. Certainly, there is often a fine line of difference between them. The format of this presentation allows for a personal examination of an issue. The focus here will be a personal view on the state of the arts vis-a-vis the education of creative arts therapists over the past 22 years. This panorama, albeit unavoidably subjective, is based on frontline, trenchant involvement in graduate education of art, music, and dance therapists. For those readers who, in 1967, were not yet members of our league, I shall recapitulate history briefly. In that year, Hahnemann Medical College and Hospital, now Hahnemann University, initiated a graduate training program in art therapy leading to a Master’s of Science degree on completion of one-year didactic and supervised clinical internship and of a thesis project that met the standards of the graduate school. This was the first program to accept and graduate students in this field. A graduate program in art therapy had been established at The University of Louisville some years before, but was not activated until after 1969 and the establishment of the American Art Therapy Association. Other graduate programs soon followed and their number has grown impressively to include seventeen approved graduate training programs. I had the extraordinary opportunity, privilege, and burden of being the coordinator and then Director of the Hahnemann program. When, in 1976, I was awarded a National Institute of Mental Health (NIMH) grant to establish the first program to train art, dance, and music therapy students under an umbrella degree, Master’s Creative Arts in Therapy (MCAT), my vista was considerably expanded. Required to guide three progam directors through a maze of divergent philosophies and requirements toward university and national organization approval, I became exquisitely cognizant of the educational systems in the creative arts in therapy. As I recently searched my files for notes and data I uncovered a paper I had prepared in response to an invitation to participate in a closing panel at the American Art Therapy Association (AATA) Conference in 1978. The topic was “Quality in Training” (Levick, 1978). In rereading this paper I was struck by the fact that some of the questions I raised then are still being posed today, that my answers have not changed over time, that some of my concerns then exist in the present. Travelling back, I begin this cerebration with the closing statement of that paper. In recounting the prophecy of one of our professors in the Department of Psychiatry who said that art therapists would “become the X-ray of psychiatry,” I

Arts therapy and healing

In this issue, three related papers are presented, each written by an experienced practitioner in music, dance, or art therapy. As a drama therapist, I have been asked to comment, adding my own thoughts on the topic of shamanism and its relationship to the arts therapies. At the heart of these papers is the issue of professional identity: as arts therapists, who are we, and what theoretical model(s) do we follow? Following close are questions pertaining to goals, techniques, and training. That is, what do we try to accomplish in our sessions; what kind of help do we give and toward what end? What kind of training will enable us to perform our work sensitively, intelligently, and effectively? Beyond this is the still-larger question of healing; i.e., what is it, after all, that helps people feel better, more in charge of their lives? These are the issues that underlie these contributions. This series of papers began with Joseph J. Moreno’s cont~bution-“The Music Therapist: Creative Arts Therapist and Contemporary Shaman.” Responding to his paper are Claire Schmais and Shaun McNiff, each adding ideas from dance and art therapy, respectively, as well as from her and his own theoretical perspective. To chart a path through this terrain, let us briefly review the positions taken by each. Moreno’s premise, boldly stated, is that the “modem” music therapist functions in many essential ways like the shaman of old. The roots of music therapy are in a 30,000 year-old tradition of shamanic practices that link music, art, dance, drama, and holistic healing rites. Decrying the overspecialization and “single focus” that marks both Western medicine and arts therapy training, Moreno makes a plea for a holistic, integrated approach, one similar to that used by the shaman who integrates dimming, chanting, dance, and drama in community healing rituals. In this multi-arts process, Moreno sees the music therapist as central, “the binding force,” as he or she works to synthesize these diverse modalities. In direct and indirect ways, Moreno comments on the implications of this approach for training and practice. In order to work in an integrated way, students should be given at least an introductory course in other arts modalities. Additionally, Moreno stresses the importance of in-depth training in ethnomusicology, training that is necessary to work effectively with diverse cultures. Indirectly, via the examples he cites, he makes a case for in-depth training in both group and verbal psychotherapy. For example, he speaks of enabling patients to focus on “unconscious feelings rather than on the superficial realities of ordinary daily life” (p. 277). Similarly, in talking about guided imagery and music he makes a distinction between shamanic practices and music therapy practices. The music therapist, he says, may not find it necessary to enter the trance as the shaman does, but may invite the patient to do so. The material that emerges from such a session can be talked about later in group therapy. Here Moreno seems to stress the necessity of in-depth training in both group and verbal psychotherapy for he says that it “is still necessary to help patients to verbally process their experiences and gain insight into their feelings” (p. 277). Apparently he assumes that

The music therapist: Creative arts therapist and contemporary shaman

The music therapist: Creative arts therapist and contemporary shaman

Introduction to the special issue on assessment in the creative arts therapies

The creative arts therapies have not been exempt from the pressures brought upon the health care system by greater attention to accountability, cost effectiveness, shorter length of stays, and quality assurance. Rapid and specific assessments in each area of intervention are increasingly required for the determination of reimbursement and quality control. However, more than external pressures from the health care industry motivates the development of sophisticated assessment methods in the creative arts therapies; these efforts are also a natural outgrowth of our increased maturity as a profession. As Bruscia describes in his excellent Perspective, “Standards for Clinical Assessment in the Arts Therapies,” an organized process of assessment is critical to our ability to contribute to health care. Assessment addresses four basic needs: (a) to describe patients’ behavior more exactly, (b) to determine their diagnosis more accurately, (c) to suggest treatment methods with greater specificity, and (d) to extend our empirical and theoretical knowledge. Of the three major components of health care: assessment, treatment, and evaluation, assessment may be the most chahenging, for it is here that a profession must have concretized its knowledge base, and be able to apply it usefully before there is much data, without the luxury of time, and with great sacrifices to comprehensiveness. It is here that we are most directly tested: can a creative arts therapy assessment produce reliable and valid data that can describe or predict relevant behaviors? What information can we provide to the entire treatment team that they would not otherwise acquire? Or are assessments in the arts therapies needed only to help arts therapists design a treatment program within their own modality? Even more problematically, how are the various art forms related to each other, and does each provide unique information about the client? If not, are they all needed? Only with accurate assessment procedures will these questions be answered. And they are important questions. The nine articles in this special issue address these questions in some detail. Five describe assessment procedures within a particular modality (art, drama, movement, music, and poetry), and three describe interdisciplina~ efforts. Examples of both research and clinical orientations, and individual and group formats, are represented. Bruscia’s Perspective provides a clear overview of the basic issues in assessment, explaining how each assessment procedure should “(a) have clearly defined objectives, (b) be conducted by a qualified therapist, (c) offer unique clinical advantages, (d) employ effective methods of data collection, (e) produce reliable data, (f) lead to valid conclusions, and (g) adhere to ethical standards.” These criteria are both stringent and necessary, and increasingly creative arts therapists are taking up the challenge in producing sophisticated assessments. Cohen, Hammer, and Singer, in their article, “The Diagnostic Drawing Series: A Systematic Approach to Art Therapy Evaluation and Research,” have taken this challenge seriously. They ask if diagnostic decisions by art therapists, which may be used by others to determine treatment, reimbursement, or disposition, are based

Stimulating creativity in the mentally retarded through music experiences

As interest in the area of creativity increases, music therapists and other creative arts therapists have begun to iook at the potential for creative behavior in individuals, such as the mentally retarded, who have not traditionally been considered for such involvement. This article will attempt to delineate a theoretical foundation for stimulation of creativity in the mentally retarded and will make suggestions for the development of appropriate music strategies and activities with this population.

Educating the Creative Arts Therapist: A Profile of the Profession

(1987). Educating the Creative Arts Therapist: A Profile of the Profession. Art Therapy: Vol. 4, No. 2, pp. 84-85.