Loss, adaptation and growth: The experiences of creative arts therapists during the Covid-19 pandemic.

Since the outbreak of the COVID-19 pandemic in March 2020, mental health professionals have been called upon to cope with various challenges, including the shift to telehealth without prior training, overload in the workplace, increased risk of infection, and personal stressors relating to the pandemic. This article presents the qualitative findings of a larger international mixed-method study that explored the experiences of creative arts therapists around the globe during the first year of the pandemic (Feniger-Schaal et al., 2022). Twenty creative arts therapists were interviewed between July 2020 and March 2021. Transcriptions of the interviews were qualitatively analyzed through reflexive thematic analysis. Three main themes were identified: an experience of processing the losses caused by the pandemic, a restorative orientation that focused on adaptations the therapists made, and innovations that lead to personal and professional growth. Artistic engagement and creativity were found to be a resource when coping with losses and helped therapists adapt to the shift to tele-creative arts therapies (tele-CAT). Although this shift can lead to advances in the field of creative arts therapies, it requires further consideration, including the need for ethical guidelines, specific training, the development of digital methods that support the creative process, and dedicated supervision for therapists. The findings also point to the importance of psychological support to mitigate the burden therapists experience during stressful events.

The effect of medical/therapeutic clowns on the playfulness of children with intellectual disabilities.

BACKGROUND: Play is an essential component of children's development. Children with intellectual disability tend to have poor socioemotional abilities and impaired play. This study examined the effects of a medical/therapeutic clowning play intervention on the playfulness of children with intellectual disability. METHOD: Two medical clowns facilitated a play intervention in a preschool classroom setting with a total of 52 children with intellectual disability. We compared before and after two groups that received the intervention: group 1 met the medical clowns once a week for 6 months (long-intervention group) and group 2 for 3 months (short intervention group). Children's functioning was assessed using the Vineland Adaptive Behaviour Scales. Children's playfulness was scored using the Test of Playfulness observational assessment. A teachers' focus- group was used to gather additional information on the clowns' work. RESULTS: Children's playfulness increased significantly at the end of the intervention, whereas the improvement in the playfulness scores of group 1 was significantly larger than those of group 2 (t50  = -4.82, p < .001). The teachers' focus group revealed additional benefits of the medical clowns' work. CONCLUSION: The results shed light on the play and playfulness of children with intellectual disability and the possible contribution of a clowning play intervention to their development.

Relationship Aspects of Mothers and Their Adolescents with Intellectual Disability as Expressed through the Joint Painting Procedure.

The quality of the interaction between mothers and their children with an Intellectual Disability (ID) plays a crucial role in their development and in particular during adolescence. This qualitative study was designed to provide a better understanding of aspects of the relationships between mothers and their adolescents with ID through an art-based tool, the Joint Painting Procedure. The qualitative analysis of six dyads of mothers and adolescents with severe, moderate and mild ID was based on the principles of narrative and phenomenological inquiry. The findings yielded three key themes that emerged from the relational dynamics during the JPP: (1) from dependency to autonomy, (2) the joint painting as a way to foster verbal communication, and (3) playfulness and enjoyment. The JPP appeared to serve as a meaningful art-based assessment of the implicit and explicit aspects of the relationships which evolved during the interaction. The findings underscore the potential of the JPP as a non-verbal, art-based tool that allows researchers and clinicians to learn more about the dynamics of relationships between mothers and their adolescents with ID. It also enables a context where the expression of relational issues can be communicated and even transformed.

Shifting to tele-creative arts therapies during the COVID-19 pandemic: An international study on helpful and challenging factors.

The COVID-19 pandemic has led to an unprecedented shift to online treatment. For the creative arts therapies (CATs) - a healthcare profession that involves the intentional use of the visual art, drama, music, dance, and poetry within a therapeutic relationship - this shift has been highly consequential for practice. This study examined (a) how the COVID-19 pandemic has impacted clinical practice in the CATs, and (b) the features characterizing online practice in an international sample of 1206 creative arts therapists aged 22-86 (92% female). It aimed to identify changes in the use of the arts in therapy, resources that contributed to the delivery of therapy, and the role of therapists' creative self-efficacy in adapting to these changes. Respondents completed close and open-ended questions providing examples of what does and does not work in online practice. The results indicate that creative self-efficacy plays a meaningful role in buffering the impact of therapists' computer comfort on their perceived difference in online clinical practice; confidence in one's abilities positively contributed to their adaptation to online practice. The qualitative analysis yielded four main categories: the challenges of tele-CATs, continuing the therapeutic process through tele-CATs, adaptations for tele-CATs, and future directions. Overall, the results present a timely report on the inevitable transition of the CATs to online practice.

Synchrony in Old Age: Playing the Mirror Game Improves Cognitive Performance.

OBJECTIVES: Studies have shown that synchronized motion between people positively affects a range of emotional and social functions. The mirror-game is a synchrony-based paradigm, common to theater, performance arts, and therapy, which includes dyadic synchronized motion, playfulness, and spontaneity. The goal of the current study is to examine the effects of the mirror-game on subjective and cognitive indices in late life. METHODS: Thirty-four older adults (aged 71-98) participated in a within-group study design. Participants conducted two sessions of 9-minute movement activities: the mirror-game and the control condition - a physical exercise class. Several measures were taken before and after experimental sessions to assess socio-emotional and attentional functions. RESULTS: The mirror-game enhanced performance on the attention sub-scale and led to faster detections of spoken words in noise. Further, it enhanced perceived partner responsiveness and led to an increase in positive reported experience. CONCLUSIONS: Our preliminary findings suggest that the mirror-game, rather than the exercise class, may have an immediate impact on mood and some attentional functions. CLINICAL IMPLICATIONS: The mirror-game is a novel intervention, with potential benefits of social-emotional and cognitive functioning, which can be easily implemented into the daily routine care of older adults. Future studies should explore the effect of the mirror-game on additional cognitive and socio-emotional aspects.

Using Drama Therapy to Enhance Maternal Insightfulness and Reduce Children's Behavior Problems.

Maternal insightfulness or the capacity to see things from the child's point of view, is considered to be a crucial construct for therapeutic change. In the present study, we aimed to implement the knowledge gleaned from the studies on attachment theory and maternal insightfulness into clinical practice to create an intervention program for mothers of children-at-risk due to inadequate parental care. We used drama therapy to "practice" maternal insightfulness in more "experiential" ways, because the use of creative expressive means may be accessible and effective for the target population of the study and help improve maternal care. We used a manualized 10-week drama therapy-group intervention, focusing on the core concepts of maternal insightfulness: insightfulness, separateness, complexity, and acceptance. We used various dramatic means to explore and experience these components of maternal insightfulness. Forty mothers of children-at-risk took part in eight groups of parental insightfulness drama therapy (PIDT). To evaluate the efficacy of the intervention, we used the Insightfulness Assessment (IA) interview, which produces 10 scales and a final classification of PI and non-PI. The Child Behavior Check List (CBCL) was used to evaluate a change in children's behavior problems. The assessment took place at three time points: before the intervention (T1), right after the end of the intervention (T2), and 6 months following the intervention (T3). Results at T2 showed a significant improvement compared to T1 in some of the maternal insightfulness scales, but not in the maternal insightfulness categorical classification. At T3, there was a significant change in the classification of the mothers, from non-insightful to positively insightful. At T3, there was also a significant decline in the children's externalized and general behavioral problems. The results of this study contribute to an evidence-based practice of using drama therapy in the treatment of mothers and children at risk.

Integrative systematic review of psychodrama psychotherapy research: Trends and methodological implications.

BACKGROUND: Psychodrama is an experiential psychotherapy in which guided role-play is used to gain insights and work on personal and interpersonal problems and possible solutions. Despite the wealth of literature describing clinical work, psychodrama intervention research is relatively scarce compared to other psychotherapies and psychological interventions. OBJECTIVE: For this reason we implemented the integrative approach to systematic review that authorizes the combination of publications with diverse methodologies and all types of participants, interventions, comparisons, and outcomes. Our aim was to produce a comprehensive summary of psychodrama intervention research in the last decade that critically evaluates methodological issues to inform future studies. METHODS: We searched four major electronic databases (PsycINFO, PubMEd, Scopus by Elsevier, and Web of Science) for peer-reviewed articles on psychodrama interventions published in English between 1 January 2007 and 31 December 2017. The quality of qualitative and mixed methods studies was assessed on the basis of pre-established guidelines, and the risk of bias was assessed for all quantitative randomized control studies, consistent with the PRISMA protocol. FINDINGS: The database search and a hand search resulted in 31 psychodrama intervention publications. Overall, these studies examined the effects of psychodrama on more than 20 different outcomes and most studies had adult clients. The next largest group was adolescents, whereas only two studies involved children. Thus psychodrama intervention research in the last decade suggests there are promising results in all methodologies, and highlights the need to enhance methodological as well as reporting quality and to theorize and examine modality-specific mechanisms that lead to therapeutic change. Recommendations to improve methodology, transparency, and specificity in reporting future psychodrama and other psychotherapy research are discussed.

The Body Speaks: Using the Mirror Game to Link Attachment and Non-verbal Behavior.

The Mirror Game (MG) is a common exercise in dance/movement therapy and drama therapy. It is used to promote participants' ability to enter and remain in a state of togetherness. In spite of the wide use of the MG by practitioners, it is only recently that scientists begun to use the MG in research, examining its correlates, validity, and reliability. This study joins this effort by reporting on the identification of scale items to describe the non-verbal behavior expressed during the MG and its correlation to measures of attachment. Thus, we explored the application of the MG as a tool for assessing the embodiment of attachment in adulthood. Forty-eight participants (22 females, mean age = 33.2) played the MG with the same gender-matched expert players. All MG were videotaped. In addition, participants were evaluated on two central measurements of attachment in adulthood: The Adult Attachment Interview (AAI) and the Experience in Close Relationship questionnaire (ECR). To analyze the data, we developed the "MG scale" that coded the non-verbal behavior during the movement interaction, using 19 parameters. The sub-scales were reduced using factor analysis into two dimensions referred to as "together" and "free." The free factor was significantly correlated to both measurements of attachment: Participants classified as having secure attachment on the AAI, received higher scores on the MG free factor than participants classified as insecure [t(46) = 7.858, p = 0.000]. Participants, who were high on the avoidance dimension on the ECR, were low on the MG free factor [r(48) = -0.285, p = 0.007]. This is the first study to examine the MG as it is used by practitioners and its correlation to highly standardized measures. This exploratory study may be considered as part of the first steps of exploring the MG as a standardized assessment tool. The advantages of the MG as a simple, non-verbal movement interaction demonstrate some of the strengths of dance/movement and drama therapy practice.

Attachment quality of children with ID and its link to maternal sensitivity and structuring.

BACKGROUND: Attachment theory produced a fertile field of research and clinical application. Although the topic of attachment of children with intellectual disability (ID) has received increasing research attention over the past 15 years, the empirical evidence is still limited. AIMS: We applied theoretical and empirical knowledge of parenting typically developing children to examine the mother-child relationship in the ID population. The aim was to examine maternal sensitivity and structuring and its association with children's attachment classification and their disability. METHODS: Forty preschool children (mean age 47.25, range 26-75 months) with non-specific ID and their mothers participated in the study. The mean developmental age was 25.92 months (SD = 10.89), The DQ mean score was 55.45 (SD = 17.28). We assessed children's quality of attachment using the SSP and maternal interactive behavior using the Emotional Availability Scales. OUTCOMES: Forty percent of children showed secure attachment, and 32.5% showed disorganized attachment. Attachment classifications correlated significantly with maternal sensitivity and maternal structuring but not with the child's cognitive disability. CONCLUSIONS: The results point to the importance of maternal interactive behavior for children with ID. Clinical implication may consider interventions aiming to enhance maternal sensitivity and structuring to improve children's quality of attachment.

Would you like to play together? Adults' attachment and the mirror game.

Why is it easy for some people to play together and difficult for others? In this interdisciplinary pilot study, we looked at dyadic interaction in motion as a paradigm to explore the expression of attachment in adulthood. We used a device that gives simple, quantitative and automated indicators for the quality of interaction while playing the mirror game. Forty-seven participants played the mirror game with the same gender-matched expert players. In addition, participants were interviewed on the Adult Attachment Interview to assess their quality of attachment. Using high resolution kinematic measures, we found that secure attachment was correlated with high complexity of the game and low synchrony compared to insecure attachment. The findings suggest that security of attachment is related to a more exploratory and less rigid game than insecure-dismissing attachment. These preliminary findings imply that high resolution analysis of simple movement interaction could carry information about attachment behavior.

Individuality and togetherness in joint improvised motion.

Actors, dancers and musicians that improvise together report special moments of togetherness: high performance and synchrony, seemingly without a leader and a follower. Togetherness seems to conflict with individuality- the idiosyncratic character of each person's performance. To understand the relation of individuality and togetherness, we employed the mirror game paradigm in which two players are asked to mirror each other and create interesting synchronized motion, with and without a designated leader. The mirror game enables quantitative characterization of moments of togetherness in which complex motion is generated with high synchrony. We find that each person as a leader does basic strokes of motion with a characteristic signature, in terms of the shape of their velocity profile between two stopping events. In moments of togetherness both players change their signature to a universal stroke shape. This universal velocity profile resembles a half-period of a sine wave, and is therefore symmetric and maximally smooth. Thus, instead of converging to an intermediate motion signature, or having one player dominate, players seem to shift their basic motion signatures to a shape that is altogether different from their individually preferred shapes; the resulting motion may be easier to predict and to agree on. The players then build complex motion by using such smooth elementary strokes.

Resolution of the diagnosis and maternal sensitivity among mothers of children with Intellectual Disability.

We examined mothers' resolution of their children's diagnosis of Intellectual Disability (ID) and its link to maternal sensitivity, and we hypnotized that mothers' who are "resolved" will show more sensitivity during their interactions with their children than "unresolved" mothers. We assessed maternal resolution using the Reaction to Diagnosis Interview and maternal sensitivity in three different play episodes using the Emotional Availability Scales. Our sample included 40 children between the ages of 2.5 and 5.5 with clinical diagnoses of non-syndromic ID and their mothers. Supporting our hypothesis we found that mothers who were resolved regarding the diagnosis of their children showed more maternal sensitivity to their children in two of the three play episodes. Another important finding was that resolution and sensitivity were associated even when we controlled for the child's responsiveness to and involvement with the mother, suggesting that the link between resolution and sensitivity cannot be accounted by the impact of the child's behavior on the mother.