ART FOR ALLEVIATING MENTAL HEALTH: HISTORY, THEORY AND APPLICATION

Research Paper Psychology

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ART FOR ALLEVIATING MENTAL HEALTH: HISTORY, THEORY AND APPLICATION Hakalya Palaparthi Ph.D Research Scholar, Department of Psychology, Andhra University.

ABSTRACT Art therapy is a mental health profession that uses the creative process of art making to improve and enhance the physical and emotional well-being of individuals of all ages. It allows expressing the inner battle of the individuals by means of painting, drawing, photography, sculpture, or a variety of other types of visual art expression which are nonthreatening. Art therapy is acquiring its prominence because it subdues all the boundaries of verbal expression and can be applied in various fields and with various age groups as well. In this paper, researcher tries to give a brief introduction including history and theories involved in art therapy, with special focus on the Indian scenario. The paper also tries to argue the clear paucity in research and literature in the particular area.

KEY WORDS: Art therapy, Intervention, Nonconventional modality, Mental health, Nonthreatening therapy approach.

INTRODUCTION: Although contemporary art therapy is a fairly new practice, art has been used since the beginning of human history as a medium for communicating thoughts and ideas. The utilization of creative expressions was one of the earliest forms of communication among humans. According to historians, art expression has dated back grounds from the indigenous cultures of Paleolithic age in the form of cave art. Cavemen used the art as a means of group interaction, conflict resolution, diagnosis and above all, for self-expression. They have had incorporated art and art expression into their daily lives (Kramer, 2000; Malchiodi, 2003). Hence it proved its ability as an interventional tool, the status of art has evolved and endured from the medium of expression and interaction to a means of healing power through time. However, employing the expressive arts or creative arts as a therapeutic tool for healing was happened to take place in the second quarter of this current century. Consistently art has won a significant amount of importance among the other therapy modalities and finally, Art therapy has been introduced as a relatively new human service profession in the realm of psychotherapy.

Today, undoubtedly Art therapy is one of the emerging non-conventional interventional modalities which has been acquiring enormous amounts of prominence in social, educational, clinical and rehabilitation settings from the past 30 years.

Art therapy is one of the various forms (dance-movement therapy, sand-play therapy, music therapy etc.) involved in expressive arts therapy. Expressive arts therapies were emerged on the notion of the innate capability of the human beings to express artistically by using no words. It is there in human nature to express his/her inner thoughts, feelings and emotions by creating and showcasing outer forms. Natalie Rogers argues that, utilizing art expressively means entering into our inner realms to discover feelings and to express them, and she also believed that it is an important means to discover and express ourselves in more deeply and meaningfully.

Art germinated as an interventional modality on account of its psychological non- threatening nature, absence of verbal requirements, and reported efficacy as an outlet for cognitive and emotional expression (Riley, 1999). Sometimes it is very difficult to verbalize the emotions in such cases where the victim is highly distressed and cannot discourse it or the victim is a child who cannot express comfortably because of the limited access to the vocabulary. This is the very point expressive therapies can help better to give voice to the feelings and emotions of such people.

As art therapy is a form of expressive therapy employing art media other than verbal language, art therapy allows children and adolescents to express thoughts, feelings and emotions without putting them into words (Gladding, 2005; Papalia, Olds, & Feldman, 2004). Art therapy can support the process of self-awareness, increase insight and encourage self- expression through the use of creativity (Brown et al., 2007; Dobkin-Dushman & Sutherland, 1997; Eisdell, 2005; Glasgow-Brown, 2006; Kennedy, 2008). According to Haley R. Forslund, art therapy combines both self-expression and creative process. It is recognizable for its therapeutic role in serving individuals by solving problems with stress, anxiety, trauma, physical illness, and interventions among other things. Art therapy's undemanding nature for the verbal expression has attracted huge amount of attention from the therapists.

HISTORY: ORIGINS OF ART THERAPY REALM History reveals that the therapeutic use of art has existed for centuries with a diversity that echoes the varieties of artistic experience and needs. Let's try to

take a close look at the journey of the art through time.

Early history to contemporary times: As we discussed earlier, though contemporary art therapy is a fairly new practice, art has been used since the origin of history of mankind as a medium for communicating thoughts and ideas (Malchiodi, 1998). The most former cave painting was discovered in the El Castillo cave in Cantabria, Spain. Archeologists allege that it was done dates back 40,000 years to the Aurignacian period. Though investigators are uncertain regarding the exact intention of the cave drawings, it has been speculated that they were probably performed as part of religious ceremonies and rituals or to reach out to interact with others in the area. Egyptians are reported to have encouraged people with mental illness to engage in artistic activity (Fleshman & Fryrear, 1981).

Moving forth in history, Florence Goodenough (1926) considered children's drawings as measures of cognitive development, and others, like Hans Prinzhorn, became interested in the art of patients with severe and chronic mental illnesses (Vick, 2003). After this, art became an instrument for symbolism and self-expression. However, it wasn't until the 1940′s that the therapeutic use of art was defined and developed into a distinct discipline. Thompson (1989) reports that, Adrian Hill, English artist first coined the term "art therapy" in 1938, he proposed simply that the art does the therapeutic work" (p.3). While being treated in a sanatorium for tuberculosis, this artist suggested participating in art projects to his fellow patients. He discusses much of his work as an art therapist in his book “Art Versus Illness”.

Hill's work was expanded upon by the artist Edward Adamson. He worked with Hill to introduce this new therapy to long-term British patients in mental hospitals starting with the Netherne Hospital in Surrey. He was a proponent of “noninterventionist” art therapy where patients simply created art for self-expression rather than for psychological interpretation by a clinician.

Coming to United states, the two pioneers of art therapy were Margaret Naumburg and Edith Kramer. Psychologist Margaret Naumburg also called as “Mother of Art Therapy”, began referring to her work as art therapy in the midforties, Unlike Hill, Naumburg's work was based on the idea of using art for encouraging free association to release the unconscious realm of the individual.

The resulting artwork was considered symbolic speech that the therapist encouraged the patient to interpret and analyze.

While Naumburg adopted therapeutic concepts from the techniques of psychoanalytic practice to a great extent, Dr. Edith Kramer admitted a different approach by adapting concepts from personality theory by Freud to explain the art therapy process. She founded the art therapy graduate program at New York University and served as the Adjunct Professor. Another prominent figure in the history of art therapy is Ulman who founded The Bulletin of Art Therapy in 1961 (The American Journal of Art Therapy after 1970). According to Junge and Asawa, it was the fore most publication of its kind (Junge &c Asawa, 1994).

By the middle of the 20th century, many hospitals and mental health facilities started out including art therapy programs after observing how this form of therapy could promote emotional, developmental, and cognitive growth in children.

The discipline continued to grow from there becoming an important tool for assessment, communication, and treatment of children and adults alike. From past three decades, we could observe the highly accelerated growth in the field of art therapy literature, research and practice.

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Theoretical underpinnings: Art therapy has emerged on the basis of a strong theoretical support. The theoretical underpinnings of art therapy are drawn from both philosophical and psychological perspectives, the famous psychologists behind the art therapy are including Freud, Jung, Milner, Winnicot and Klein (Waller and Daley 1992). Judith Rubin (2001) listed sixteen major theories to practice art therapy and he arranged them into three theoretical approaches named psychoanalytical, humanistic, and cognitive-behavioral. The origin and early development of art therapy has a profound impact of both Freudian psychoanalytic and Jungian analytic theory and, to some extent, almost all the art therapy approaches grew from these foundations.

Psychoanalytical approaches: (Margaret Naumberg, and Edith Kramer) Margaret Naumberg (1958) was evidently Freudian in her approach and was most renowned to encourage the children in "free art expression" and “spontaneous drawings” which brought out "original images" apparently "created from their unconscious". Naumberg also argued that Art therapy recognizes that the unconscious as unwrapped in a patient's phantasies, daydreams and fears can be projected more immediately in pictures and drawings than words” (Naumburg, 1966, p.3).

Other theorist who incorporated Freudian theoretical principles more fully than Naumburg was Edith Kramer (Ulman, 1975). She emphasized the importance of sublimation and other defense mechanisms derived from Freud. Kramer postulated that through the experience of sublimation, individual tries to transform emotional material into fully formed images. She coined the phrase "art as therapy" (Ulman in Rubin, 1987, p. 281) and her assumption was that the art process itself allows the client or individual to reconstruct primary experiences and feelings, thereby extending the opportunity to re-experience, resolve and integrate conflict.

Humanistic approach: There are four different assumptions in humanistic approach named personcentered, Gestalt, Existential, and transpersonal.

Rogers proposed that, Person-centered approach to art therapy focuses on the individual's capacity to explore personal meaning and significance. The prime aspect of this approach is the belief that individuals are capable of expressing rather than repressing their maladjustments and conflicts which leads to a more positive and healthful way of life (Rogers, 1969).

Mala Betensky (1973) Joseph Zinker (1977), and Violet Oaklander (1978) were considered to be the persons who laid the foundation stones for Gestalt approach of art therapy. Zinker promoted the multimodal use of creative expression; Mala Betensky combined phenomenological approaches with Gestalt principles, and Oaklander developed a Gestalt approach to work with children and families through art, play, and other sensory modalities.

Art therapist Bruce Moon (1995) proposed a theory for the application of existential principles to art therapy, based on art expression as a personal search for meaning and creativity as an important component of health. Existential approach emphasizes liberating the individual from fears and anxieties and helping the person to live life to the fullest.

Transpersonal approach based on the notion that the Art expression is a way to explore beyond the self. Florence Cane (1951) developed the “scribble technique” to combine art activities with meditative awareness. Garai (1976), explored how art expression led to self-transcendence, Joan Kellogg (1978) noted the value of artistic expression in accessing transpersonal prospects of the self through mandalas.

Cognitive-behavioral approach: Camic (1999) was considered to be the first person to use cognitive-behavioral therapy along with arts therapies to formulate an interventional program for pain management. In this approach, the client is offered the opportunity to collaborate with the therapist in designing creative activities to support and enhance behavioral change. cognitive-behavioral art therapy is action oriented. This therapy brings out the behavioral changes and enhances the psychological well being by demanding the active participation and the total devotion of the individual in the hands-on strategies through drawing, collage, or other art making excersises.

Steele and Raider (2001) employed drawing and cognitive reframing techniques to help children recall and process traumatic events, Malchiodi (2001) uses specific drawing tasks and questions to assist children in crisis to depict their experiences, with the goal of reframing emotions and negative thoughts and reducing the symptoms of posttraumatic stress.

APPLICABLE FIELDS: Educational domain: Ample amount of research has done so far in the field of education to explore the effectiveness of art therapy for children in educational settings. Research findings have established strong grounds for the modality to help a wide variety of problems in children such as ADHD, learning difficulties, eating disorders, stress, depression, and anxiety. Utilizing the art material for painting, drawing, and sculpting are a great hands-on treatment for a racing mind by helping the

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child gain focus on the art process, fight with inattention, distractibility, impulsivity and hyperactivity (Henley, D. 1998; Kingsley, J. 2002; Safran, D. 2002). Art making has been said to be able to alleviate aggressive feelings replacing or sublimating these urges through art (Kramer, 2000; Levy, 1995). It is also effective in improving a broad range of social and emotional difficulties for students identified by schools as needing additional support (Cortina, M. 2014).

Depressive symptoms can be gradually alleviated by the individual and group art therapy techniques (Silver, R. 2005).

Clinical and health care domain: Art therapy is also employed as an adjunct (or complementary) therapy to traditional medicine for the treatment of biological based diseases and conditions.

Potential benefits have been demonstrated by art therapy in relation to symptoms associated with HIV/AIDS (Rao, D., et al. 2009). Promising results have been shown by art therapy among cancer patients who have been going through chemotherapy by reducing stress, depression and fatigue (Bar-Sela, G., et al. 2007; Garland, S. N., et al. 2007). This therapy modality is highly effective with geriatric conditions like Alzheimer's, and dementia by alleviating positive mood parameters such as happiness, peacefulness, satisfaction and calmness (Kamar, O. 1997; Mimica, N., & Kalinić, D. 2011; Wilkstrom, B. M., et al. 1993). Art therapy has proved its fruitfulness in serving many other clinical conditions which can be listed as diabetes, epilepsy, Parkinson's, asthma etc, (Stuckey, H., & Tisdell, E. 2010; Anschel, D. J., et al. 2005 ; Elkis-Abuhoff, D. L., et al. 2008 ; Beebe, A., et al. 2010).

Psychological and mental health domain: A growing body of research suggests that art therapy helps to improve productive behavior, resulting in enhanced self control (Franklin, 2000), counselor-client relationship lead clients to understand the inner self and to express internal conflicts, ultimately culminating in improved emotional health and hence art has evolved into a treatment technique for emotional disturbance (Natale , 1996). Art therapy found to fit with the problems of personality disorders such as Lack of self-control and structuring skills (Suzanne Haeyen, Susan van Hooren & Giel Hutschemaekers 2015; Linehan, 1996). AT effectively provokes mental states connected with 'child modes' and improves the `healthy adult mode' known from Schema Focused Therapy (Van den Broek, Keulen-de Vos, & Bernstein, 2011).

Patients learn to reduce their tension, to structure chaotic behaviour and to rethink behaviour before acting on it. This results in strengthened control, improved self-structuring skills and more positive behaviour (Eren et al., 2014; Haeyen, 2005, 2007; Zigmund, 1986). Along with these benefits, art can be the key component to address the psychological, emotional and behavioral problems of emotionally troubled children (Tibbets & Stone, 1990), students with somatic symptoms (Philippopoulos & Lucas, 1983) and behaviorally disordered students (Rosal, 1993).

Rehabilitation domin: Rehabilitation setting is the other field where art therapy can be applied successfully. It could be a good helping measure for individuals with mild and moderate levels of mental retardation, sexually abused women (Brooke, 1995; Waller, 1992), and juvenile offenders (Hartz & Thicke, 2005). Researchers have identified the benefits of art with those who have chronic mental health problems (Schofield 2009). Art serves as an aid to rehabilitate sense of self, self-esteem and social skills through group participation and self-exploration (Smith 2007). Art therapy is used in prison settings for rehabilitative process through various domains such as educational, therapeutic, prison quality of life management and societal or community involvement (Johnson 2008).

Status of Art therapy in India: Counseling, psychotherapy, cognitive behavioral therapy and rational emotive therapy (sometimes combination of two of these or more) are the most commonly used interventional modalities by the psychologists and therapists to treat psychological problems in India. When we try to investigate the status of art therapy practice and research in India, unfortunately it is still in the embryonic stage.

Only a very few therapists are employing art therapy to address the psychological problems as a combination with other conventional therapies. Despite of its elevated success echoes from plenty of efficacy studies in western countries, India is still in the process of laying foundation stones for art therapy. Coming to the research aspect in the very field in Indian context, we can find very few evidences of research on the other forms of expressive arts therapy likewise drama therapy and dance movement therapy as complementary therapies. Though it is well established in the western countries, surprisingly in India,we could hardly come across the schools, hospitals, clinics and rehabilitation centers practicing art therapy as alternative interventional technique. Let's examine the possible road blocks for the modality to be developed adequately in our country.

Possible barriers for development of art therapy in India: Ÿ

Though there are few private organizations and individual persons who are devoted to art therapy but the number is very less and almost negligible when compared to the requirement.

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Lack of awareness is another major cause which stands a clear barrier for the development of the therapy in India. The clear paucity in the research and practice in art therapy is evident of the lack of awareness regarding the nonconventional therapies. As it was originated and developed in the west-

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ern countries, it will take few more years to proliferate in adequate level in our country.

Another important factor that hindering the public exposure of the importance of art therapy is the substantial scarcity in the number of well trained and certified art therapists.

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The people in general have the misconception that nonconventional therapies are expensive compared to conventional therapy modalities.

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Most of the common Indians perceives art is only for entertainment and for passing the free time or as an profession but could hardly accepts it's therapeutic nature especially when it has to deal with serious mental health issues.

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Recommendations: A clear demand for employing the non verbal interventions like art therapy is growing in our country progressively. A country like India with large population has to shatter the cultural boundaries and welcome the new therapeutic approaches from the other countries to serve and to alleviate the psychological well being of our people. Keeping the demands probing by the Indian population in mind, researcher tried to propose some recommendations to introduce and develop the art therapy in Indian scenario in order to fulfill the psychological needs of the country to a large extent. Ÿ

Establishing the specialized research centers for non conventional therapies can be of good impact.

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The government and non government funding agencies should play an important role in encouraging the researchers and therapists to carry out the research in this area.

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Scarcity in the number of well trained and certified art therapists demands the need of establishing the art therapy associations in our country as well like AATA (American art Therapy Association) and BAAT (British Association of Art Therapy) with authorized credential system to provide training programs to produce the certified art therapists and to up lift the research.

Conducting awareness programs and short term work-shops is important to take the modality to every nook of the country.

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Therapists should give equal importance to the alternative interventional techniques besides traditional therapies in helping the clients.

Ÿ

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Conclusion: All the therapy models that are using in the process of counseling demand the verbal interaction between the client and the therapist, but on the other hand, unlike to these traditional talk therapies, art therapy involves visual symbols and images which are the most accessible and natural form of communication to the human experience. Art therapy is one of the various forms of expressive arts therapy and never focuses on the aesthetic values of the art work given by the individual but only on the process of art making. So, one need not to be a great artist to gain from art therapy. Misconceptions should be removed from the mindset of the general Indian population by making them aware of the therapy process as art therapy can be carried out with chalk, crayons and water colors and oil pastels which are very cheap in cost and are easily available. This economical nature is one of the strongest factors that make the modality even more fascinating. Hence Art therapy is highly recommendable in our country as complementary and alternative interventional method; there is a greater need and scope for research and practice in near future in this field and a clear demand for the certified art therapists.

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