Basic concepts for qualitative research

This pilot study aimed to evaluate the feasibility of an assessor-blind, randomised controlled trial of psychodynamic art therapy for the treatment of patients with schizophrenia, and to generate preliminary data on the efficacy of this intervention during acute psychotic episodes. Fifty-eight inpatients with DSM-diagnoses of schizophrenia were randomised to either 12 twice-weekly sessions of psychodynamic group art therapy plus treatment as usual or to standard treatment alone. Primary outcome criteria were positive and negative psychotic and depressive symptoms as well as global assessment of functioning. Secondary outcomes were mentalising function, estimated with the Reading the mind in the eyes test and the Levels of emotional awareness scale, self-efficacy, locus of control, quality of life and satisfaction with care. Assessments were made at baseline, at post-treatment and at 12 weeks' follow-up. At 12 weeks, 55% of patients randomised to art therapy, and 66% of patients receiving treatment as usual were examined. In the per-protocol sample, art therapy was associated with a significantly greater mean reduction of positive symptoms and improved psychosocial functioning at post-treatment and follow-up, and with a greater mean reduction of negative symptoms at follow-up compared to standard treatment. The significant reduction of positive symptoms at post-treatment was maintained in an attempted intention-to-treat analysis. There were no group differences regarding depressive symptoms. Of secondary outcome parameters, patients in the art therapy group showed a significant improvement in levels of emotional awareness, and particularly in their ability to reflect about others' emotional mental states. This is one of the first randomised controlled trials on psychodynamic group art therapy for patients with acute psychotic episodes receiving hospital treatment. Results prove the feasibility of trials on art therapy during acute psychotic episodes and justify further research to substantiate preliminary positive results regarding symptom reduction and the recovery of mentalising function.

/pdf/a-pilot-rct-of-psychodynamic-group-art-therapy-for-patients-2uoqqcwu0n.pdf

A Pilot RCT of Psychodynamic Group Art Therapy for Patients in Acute Psychotic Episodes: Feasibility, Impact on Symptoms and Mentalising Capacity

This article describes the results of the first phase of a research project to develop, implement, evaluate, and improve arts therapies interventions for young offenders in secure care. By means of a naturalistic/constructivistic research methodology in combination with grounded therapy methodology, practice-based evidence has been generated. Core problems of young offenders that are connected to delinquency have been described and arts therapies interventions have been developed that can be used to change these core problems. Core problems are problems with self-image, with expressing and discharging emotions, the inability to resolve interpersonal problems and finally, negative cognitions. In co-creation with practitioners, interventions have been developed for drama therapy, music therapy, art therapy and dance-movement therapy. A treatment theory has been developed that explains the working of arts therapies by means of the first author's theory of analogy. This theory explains arts therapies by means of the equality between forms of expression in art and the core self consciousness as described by Damasio and the vitality affects within the core self as described by Stern.

Arts therapies for young offenders in secure care: A practice-based research

This article evaluates a pilot mentalization-based treatment programme for borderline personality disorder (BPD), which had an art therapy group as one of its three components. Evaluation involved a range of standardised measures and showed the programme had positive results with increases in distress tolerance, lowered service use and at least two participants no longer meeting criteria for the BPD diagnosis. The question was asked about what art therapy might contribute to mentalization in this context. A qualitative research strategy was undertaken to explore one of the author's experience of art therapy as one of the programme's service users. Repeated rounds of audio-recorded interviews resulted in eight themes which describe what helped and what should be avoided in art therapy treatment of BPD. The service user view was that art therapy was an essential ingredient in helping to develop greater mentalization. The study suggests that in anchoring mental content in an externalised form, art t...

How can art therapy contribute to mentalization in borderline personality disorder

Arguably life threatening and chronic illness is not just an attack on the body, it is an attack on a person s sense of self-identity, shattering the means by which a person experiences the world, and by which they also are experienced, contributing to a person s sense of powerlessness and distress. People living with a life threatening or chronic illness, often describe the impact of their diagnosis, treatment and illness as having changed their sense of self-identity beyond all recognition. Seven participants, purposefully selected from those attending a weekly day-hospice session in Wiltshire, took part in the study. This qualitative, practice-based research project challenges the power dynamics in art therapy and attempts to equalise the relationship between researcher and participant through the development of a collaborative intersubjective relationship, within which the participants are recognised as experts on their lived experience, and in a series of negotiations , co-design their own portraits directing how they wish to be portrayed. Through this process the participants become patient/researchers (PRs) and the artist/therapist/researcher (ATR), by creating the portraits, also becomes a reflexive participant . This project utilises an in-depth multiple case-study design and multiple creative data generation methods as well as a phenomenological approach to data analysis. This project reverses the terms of engagement within art therapy and uses the art therapist s artistic practice or third hand to create portraits for patients. (This is based upon the assumption that most art therapy theories terms of engagement include patients producing art within the therapeutic encounter, however some psychodynamic and psychoanalytic art therapists may use client art generation selectively or not at all). This raises important questions around who makes the artwork in art therapy interventions . The use of portraiture as a third hand intervention enables the art therapist to develop a sense of positive focussed attention and mirroring and attunement through the art object, enabling the addition of coherence through aesthetic resonance and the holding of dualities through metaphor and symbolism. The results of this study demonstrate the power of portraiture as an intersubjective way of knowing, being and relating, enabling the revisioning of identities disrupted by illness, characterised by increases in participants creative capacity to adapt to illness and feelings of home-like-being-in-the-world, developing a stronger, more coherent lived experience of self-identity, effecting closure to difficult life experiences, and improving their overall quality of life.

Enabling self-identity revisioning through portraiture, for people living with life threatening and chronic illnesses: paint me this way!

Forty-six seriously delinquent, incarcerated boys received individual and group therapy for 32 months. The study examined how art therapy addressed the boys' psychological needs via analysis of the boys' self-selected art productions. In descending order of frequency, the eight most frequent need themes were identity issues; need for security and tranquility; need for freedom, adventure, and fun; need for ideal parental relationships; need for affiliation and affection; erotic and sexual needs; expression of depression, childhood trauma, and other psychological problems; and religious or spiritual needs. The boys' perceptions of what was most helpful about art therapy in descending order were stress relief and relaxation, reduction of boredom, pride and self-confidence, positive recognition, working through frustration, enjoyment and fun, improvement of ability to concentrate, and the way they were treated. Three brief case histories and a description of the art therapy procedures are given. Possible implications for cognitive restructuring are discussed.

Roy W. Persons

Papers

Art Therapy With Serious Juvenile Offenders: A Phenomenological Analysis