The 20th Congress of RSCANP,

Băile Felix, 18-21.09.2019

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The 42st National Conference of Child and Adolescent Neurology and Psychiatry and Allied Professions with international participation


THE USE OF ART THERAPY IN THE EMOTIONAL DISORDERS OF THE CHILD

Autor: Emilia Chirilă Daniela Laura Campean Elena Mureșanu Flaviu Câmpean
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The art therapy process involves the application of certain artistical means by the artist,  in order to facilitate the non-verbal deliverance of emotions. In this respect, a number of 50 children and teenagers (an eterogeneous group in matters of sex, age and social background) have profited by the benefits of Art therapy at CSM Copii şi Adolescenţi Cluj-Napoca (The Centre for Child and Adolescent Mental Health Cluj-Napoca). A more accurate clinical diagnosis has thus been established, as therapeutic interventions were undertaken in the multidirectional ways of psychopharmacology, psychotherapy, art therapy and social assistance.

 

The therapy improved the following aspects: • The interpersonal relationships • The non-verbal communication • The personal skills • The Catharsis.

 

Consequently, art therapy, alongside some other interventions (particular medication, classical psychotherapy, social assistance), contributes to the amelioration (and sometimes even to the disappearance) of the symptomatology and engenders several positive results regarding the self-portrayal of children and teenagers.

Introduction

The approach of the emotional disorders in childhood and adolescence through a multidirectional therapy involves a long experience and a thorough circumstance of the neurobiological aspects, of the neuroclinical pictures, of the means of verbal and nonverbal communication, as well as of the family and social group of the child.

In respect of mood disorders, especially regarding the risk of suicide, the researches in the field of the neuromediators are well known – serotonin, noradrenalin, dopamine, the hypothalamic-pituitary axis. In the case of the serotonin, a hypoactivity can be inferred, while in the case of the hypothalamic-pituitary axis, it’s a hyperactivity that can be concluded upon. The recent neuroimaging researches are also important.

From the anamnestic perspective, the following aspects are very important:

  • the relevant family background (mental disorders, substance abuse, disharmonies of personality – concerning the genitors).
  • the clinical picture, often identified indirectly through observation and nonverbal communication, suggests: mood disorders, instability, irritability, impulsivity, aggressiveness, concentration disorders, stereotypes and oddities, anxiety of separation, tics.

The anamnesis offers valuable information regarding family life, academic performance and the identity disorders that undermine the self esteem and generate distress.

 

Motivation of the choice of the theme

Art therapy represents a valuable method in the diagnosis of the emotional disorders of the child. Through the graphic gesture, the child expresses various issues related to his feelings, like the search of his identity, the generated anxieties, the family and professional environment, the situations of neglect and abuse. Accordingly, the following reactions can be identified: aggressiveness, frustration, tendency to dominate, lower self-esteem, brotherhood rivalry, lack of hope, sadness, compensation mechanisms and self defense, other significant psychotraumatic aspects, solutions for traumatic situations.

 

Consequently, the art therapy method proves itself useful in the achievement of a therapy through:

 

  • stress relief of the child and his family
  • repeated positive conditionings
  • the possibility of a nonverbal manifestation of the traumatic situations by the annihilation of the sense of shame and criticism from others.
  • interpersonal relationships and communication with other members of the group.
  • the development of attitudes and motivations
  • the increase of self esteem and the finding of appropriate mechanisms in order to solve the traumatic situations.
  • the adequacy of behavior at the requests of the group and understanding the needs of others.

 

Material and method

The study included 50 children and teenagers aged 5 to 18 years of both sexes, different social backgrounds in terms of housing, culture and education.

The results pointed out the functional problems of micro-clustered families, as well as the issues concerning the adaptability to the collectivities frequented by the respective children and young patients. The diagnoses were established by the collaboration of a multidisciplinary team which assessed each child, led by the specialist physician. The basic diagnosis was: emotional disorders with onset in childhood; the complementary diagnoses were, as it follows:

  1. language disorders, in 7 children, a rate of 18 %
  2. tics, in 3 children, a rate of 6%
  3. anxiety disorders in 8 children, a rate of 16%
  4. elimination disorders in 6 children, a rate of 12%
  5. ADHD in 13 children, a rate of 26%
  6. mild mental retardation in 11 children, a rate of 22%

The patients were examined and subjected to therapy both individually and in groups of four, according to the following guidelines:

  • the child’s behavior
  • the ability to interact with the therapist and with the other patients
  • the coordination, the fine and coarse motricity
  • the ability to comprehend the therapist’s demands
  • the precision of the graphic gesture
  • the mimic and the pantomime
  • the spatial structuring
  • the emotional intelligence
  • the visual thinking
  • the discovery of special artistic abilities and the professional orientation

The art therapeutic process is based on the artist’s creativity which, alongside that of the patient, merges into a creative flux adapted to the latter’s necessities. Throughout the process, the art therapist (and artist as well) makes use of specific means that belong to artistic education, in order to form psychomotor skills and with the final purpose of facilitating nonverbal expression. Thus, the artistic crafts are being reinvented as therapeutic methods.

The plastic artist particularly skilled in nonverbal expression has, by virtue of understanding the directions of formal expressivity that fine arts embrace in their evolving dynamic, a unique and fundamentally essential function regarding: the laying out of a space for therapy (both individual and group therapy), the assurance of an appropriate environment for therapeutic interventions through the use of open spaces in order to vent the psychic tensions, the framing of a more involved and continuous psychomotor activity (for example pottery, in our case) which plays an important part in psychomotor alleviation – a fundamental phenomenon in relaxation techniques, the adjustment of plain elements in the context by transforming them into art and handicraft objects, all of them with the final purpose of highlighting various inner tensions and to insure the alleviating catharsis of the rehabilitation of self esteem and, implicitly, of the socio-affective dimension. We need to emphasize here the contribution of the art therapist, by way of the psychomotor training aforementioned, to the measurement through visualization of trauma, abuse and their causes and to the relief and disinhibition in the posttraumatic situations. Through the use of nonverbal language to identify the practical self-knowing aptitudes, art therapy facilitates school and professional orientation, the development of several personality features, like manual skills, perceptive abilities, and space orientation.

Sean McNiff, speaking about the direct involvement of the artist in the experimental process and about his relationship with education and creative art therapy, states that the latter is an “extension of his practice…implies the transfer and the counter-transfer and other subtle nuances in perpetual fluctuation, which rise out of the experimental process…The sciences acknowledge the role of observation in research. It may be concluded then that the personal participation of the artist to the experimental research is mandatory and conditioned by the artistic practice.” Moreover, in the context of art therapy, neither the artist, nor the patient asks himself “Am I good enough”, the judgments of value being therefore excluded in favor of spontaneous expression. The approach is an adjustable one – all artists who practice art therapy rely on their own artistic activity and present a recurrent common feature: they are always in accordance with the “essential pragmatism”.

To exemplify, we present several clinical cases.

 

1. M.A. sex  M, 6 years Dg. Selective mutism

At the beginning of the art therapy sessions the patient didn’t interact with any of the members of the team. The communication started by way of modeling. Various figurines were crafted, by means of which the therapist could interact with the patient, for example by staging a battlefield. Thus, the child is verbally stimulated in order to describe what happens in the imaginary bi or tridimensional world. Being motivated in this manner by the wish to make the world come true, he manifests considerable progresses both verbally and non-verbally.  

1..M.A. sex  M, 6 years Dg. Selective mutism

Relevant Results:
  • The discovery of one’s skills through art production and the consciousness of one’s emotions and feelings pave the way for an effective communication, especially a non-verbal one. Moreover, the joy of creating and the success related to it, properly appreciated by the parents and by all people in the child’s vicinity, have, in this case, mitigated the conflictive environment of the brotherhood rivalry. Consequently, once the self image and the self esteem having been improved, the emotional disorders due to the social environment can be surpassed. We also mention in this respect that our patient is currently working individually with the speech therapist while taking part on the other hand in group therapies, alongside other two or three patients. Due to the favorable results, the patient is attending a normal kindergarten, after having begun to communicate verbally. Our objectives in improving his behavior were thus achieved with the aid of art therapy.

 

2. FPC, sex M, 5 years   

Diagnosis:

  1. Emotional disorders that started in childhood
  2. A conflictive family environment

The child is assisted in his development concerning his self conception, the environment and its functioning.

2. FPC, sex M, 5 years

The art therapy exercises are initiated on the small wheel, where the warm up and the focusing labor is stimulated by the concentric colors (similar to mandalas). The next stage consists in interpreting the colorful stains and in the spatialization through the simultaneous stimulation of the tactile and of the sight.

In art therapy, the development of problem solving strategies and the decision making with an eye to formal diversification are encouraged; new skills, unknown up until then, are always discovered, rendering a positive structuring of the self image.

Results:

The discovery of one’s skills through art production and the consciousness of one’s emotions and feelings pave the way for an effective communication, especially a non-verbal one. Moreover, the joy of creating and the success related to it, properly appreciated by the parents and by all people in the child’s vicinity, have, in this case, mitigated the conflictive environment Consequently, once the self image and the self esteem having been improved, the emotional disorders due to the family environment can be surpassed.

 

3. B.G.  sex M, 8 years – comes from an orphanage

Diagnosis:

  1. Medium transient depression
  2. Mild Mental retardation
  3. Specific disorder of articulated speech
  4. Low adaptability

 

3. B.G.  sex M, 8 years – comes from an orphanage

We began the therapeutic stimulation with simple activities, tasks way below the skill and intelligence level of the chronological age, to insure the primary objective of disinhibition. Throughout the process, the patient started to develop his first simplistic and impersonal works, to explore new artistic spheres and to stimulate himself in his creativity, stating his courage to explore. (He may have been poorly stimulated during childhood or put to take care of his brothers as the eldest child, maybe even affectively abused once in awhile).   

Results:

The overcoming of the emotional blockings, the disinhibition and the forming of the communication and interaction abilities. The optimization of self-knowing and self-acceptance capabilities through the gradual increase of the difficulty levels and, implicitly, a growing satisfaction following his successes. The development of cognitive skills (memory, attention, language, thinking) accomplished by virtue of analogy between the real objects and the artistic products. The disappearance of the frustrations and of all the negative feelings due to the parent’s disinterest (particularly the mother’s, who doesn’t visit her children, not even at holidays) was achieved through the gain of authority over the environment and through the improvement of the pre-existent skills. The restructuring of the self image and the positive self esteem led to the development of social competences. The anxiety to please has vanished, while the patient is now proud of his accomplishments, since he now signs his works so that everyone knows they are his own and, moreover, he wishes to bring his brothers to CSM, where he feels safe.

 

4. A.D., sex F, 6 years  

Diagnosis:

  1. Anxious disorders
  2. ADHD
  3. Specific disorder of articulated speech

 

4. AD, sex F, 6 YEARS

Drawing and painting are universally known as means of communication with a direct implication into the development of the sensorial consciousness of the environment between 4 and 7 years; the patient interacts with the environment increasingly more, while using the self-referent gestures increasingly less, as the images above prove it. The child is thus stimulated to work by playing, by creating a potential space in the frame of an appropriate environment which inspires safety and self-assurance in respect of emotional expression.  

Results:

The gain of authority over the environment leads to the decrease of anxiety facilitates the expression of satisfaction regarding success through the involvement in the creative interactive process. The stimulation by the environment increases the self esteem, which alongside the acquired self-confidence throughout the accurate perception of one’s skills, builds up a steady social adaptation. The potential space represents an intermediate zone, between reality and fantasy, between subjectivity and objectivity, and also a medium for perpetually using the object – the object being defined as the product of artistic activity (for example even a piece of paper with drawn on it), as a transitional object that satisfies through fantasy and, at the same time, reflects a self-detachment. In the cases of ADHD patients like this one, the method aims to stimulate the focusing on a particular activity.

 

5.K R, sex M, 7 years

Diagnosis:

  1. Reactive disorders of childhood attachment
  2. Specific disorder of articulated speech
  3. Environment deficiencies
  4. Low adaptability

 

5.K R, sex M, 7 years

The patient executed several paintings of different dimensions and using various techniques: modeling on the potter’s wheel, collage on colored paper, exercises of acquaintance with forms and colors in the play room (associated with the technique of role playing).

Results:

The overcome of emotional blockage, the disappearance of frustrations, the stimulation of creativity and of tonic affective atmosphere, the inculcation of a peaceful state of mind and of self acceptance, the reduction of tension and of anxiety, the capacity to overcome psychic obstacles (like “I can’t do this or that”, I’m not able to..”), the giving up of postponing.

 

6. M. P., sex F, 14 years

Diagnosis:

  1. Learning disorders
  2. Liminar intellect
  3. School adaptation disorders

 

6. M. P., sex F, 14 years

The “strong points” of the patients were identified. In this case we are dealing with a particular inclination to visual and plastic expression, that enabled us to further develop- the execution skills and the visual language. We also aimed an eventual professional orientation of the patient towards areas that exploit such skills (decorative arts, craftsmanship etc). By way of art therapy, the patient consequently formed a perspective of his own emotions, thoughts and feelings.

Results:

The development of emotional intelligence, the stimulation of all sensorial channels, the development of an easy free-floating expression, the outlining of the patient’s personality in accordance to the aesthetic values and the incorporation of the concept “beautiful” in everyday life, the development of visual perception and representation, the facilitation of interpersonal communication, sociability and social adaptation, the efficient solving of conflicts, the staging of comic affective states, the inculcation of a peaceful, self-acceptance atmosphere, the decrease of tension and anxiety, the capacity to overcome psychic obstacles (like “I can’t do this or that”, I’m not able to..”), the giving up of postponing.

 

7. M.M., sex F, 13 years

Diagnosis:

  1. Complex chronic tics
  2. Social phobia
  3. Clonic and tonic balbism
  4. Constitutional anxiety
  5. Low adaptability
  6. The stimulation of the sensorial channels by way of color and modelling

 

7. M.M., sex F, 13 years

Results:

The development of easy free-floating expression, the triggering of the complex processes of assimilation and affective fixation of the aesthetic values, the staging of comic affective states, the inculcation of a peaceful, self-acceptance atmosphere, the decrease of tension and anxiety, the capacity to overcome psychic obstacles (like “I can’t do this or that”, I’m not able to..”), the giving up of postponing.

 

General Results

Many therapists consider art therapy, form an analytical point of view, a projection of thoughts and feelings, the artistic product being itself the projection as well. They also emphasize the importance of the conversation and debate on the artistic product, during or after its accomplishment.

In the cases of low self esteem patients, the fundamental characters that insure a successful therapy (both individually and group therapy) are, as it follows: the stimulation of hope, the universality, the exchange of information, the altruism, the regular restatement of the acquired knowledge, the development of socializing techniques, the mimetic behavior, the interpersonal learning, the group’s cohesion, the feedback learning process within the group.

The groups can be sustained by the gradual development of their members’ skills and resources.

In the sphere of the educational creative art therapy, the therapeutic process favors the building up of three axis of communications:

  1. therapist-patient
  2. patient-artifact
  3. therapist-artifact

The creative process and the interaction increases self esteem, courage, taking of risks; the experimental aspect favors the learning of new skills, enriching the patient’s life according with the therapeutic purposes. New ideas, conceptions and ways of expression emerge.

In conclusion, when the patient’s engagement is voluntary, the creative art therapy proves very efficient in developing the adaptation abilities by which a thorough authority over the environment and, implicitly, a general feeling of ableness is gained. Thus, the individual becomes more prone to voluntarily facing his existential problems and to assume a social role appropriate for him in the interaction with the environment and with the others. Finally, it’s worth noting and revising some of the manifold advantages of creative art therapy, particularly in connection with the craft of ceramics and its associated techniques from sculpture painting or graphic arts used by us:  enactment of empathy,  development of interpersonal and intrapersonal problem and conflict solving strategies, overcome of emotional blockages, optimization of self knowledge capabilities and of cognitive ones (memory, attention, language, thinking etc),  tension and anxiety release, removal of frustrations and of negative states of mind, the improvement of pre-existent skills (in painting, collage, modeling etc), development of social competence.

 

Bibliography

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  2. MENTAL HEALTH, PSICHIATRY AND THE ARTS- a teaching hanbook- Reacliffe Publishing, Oxford- New Zork, Victoria Tishler.
  3. EINON Dorothy, Creative Child- Recognize and Stimulate your Child’s Natural Telent, Barron’s, 2010
  4. KAPLAN & SADOK, Manual de buzunar de psihiatrie clinică, Editura medicală 2001,  p. 175  – 221
  5. KAPLAN & SADOK Study Guide and Self-Examination Reviev in Pschiatry  Wolter Kluver –Lippicott Wiliams /Wilkis , p 310-317, 364-367
  6. MALCHIODI, Cathy A, Handbook of Art Therapy, The Guilford Press, New York and London, 2003, p. 157
  7. MALCHIODI, Cathy A, Understanding Childrens Drawings, The Guildford Press, New York, 1998
  8. McNIFF, Shaun, Trust the process: an artist’s guide to letting go. Creative ability. Psyhological aspects. Self-actualization (Psychology). Artist-Psychology, Shambbala Publication, Boston, 1998, p. 78
  9. DENNIS OUGRIN, TOBIAS ZUNDEL, AUDREY V.Ng, Self-Harm in Young People- A Therapeutic Assessement Manual, Hodder Arnold, an Hachette UK Company , 2010  p 49-59

 

Correspondence to:
Mental Health Center 57 Gheorghe Bilascu street, Cluj-Napoca