In-session behaviours and adolescents' self-concept and loneliness: A psychodrama process-outcome study.

As adolescents spend many hours a day in school, it is crucial to examine the ways in which therapeutic practices in schools promote their well-being. This longitudinal pilot study examined the contribution of school-based psychodrama group therapy to the self-concept dimensions and perceived loneliness of 40 Israeli adolescents (aged 13-16, 60% boys) in public middle schools. From a process-outcome perspective, we also examined the understudied trajectory of adolescents' in-session behaviours (process variables) and its associations with changes in their self-concepts and loneliness (outcome variables). Psychodrama participants reported increases in global, social, and behavioural self-concepts and a decrease in loneliness compared to the control group. In-session productive behaviours increased and resistance decreased throughout the therapy, but varied process-outcome relationships were found. The study suggests that conducting further research into the process-outcome relationships in psychodrama group therapy is warranted to pinpoint specific mechanisms of change. Suggestions for future studies are provided.

Special Issue: Arts Therapies with Children and Adolescents-Editorial.

Arts therapy dates back to the mid-20th century [...].

The Meaning of a Group Facilitation Training to Creative Arts Therapists Working in the Public Education System.

Many creative arts therapists who provide group therapy to children and adolescents in the Israeli education system do not feel they were sufficiently trained as group facilitators. Group facilitation training was provided over the course of two consecutive years by a regional support center to over 40 creative arts therapists and their clinical supervisors working in the Israel Ministry of Education. A two-stage qualitative research project examined the participants' experiences during this training. Interviews were conducted regarding the therapists' first-year experiences. A questionnaire was administered at the end of the second year. Both were analyzed according to the Consensual Qualitative Research method. The research findings pertain to the participants' perceptions of group arts therapy in the Israeli education system and included the development of unique group models, the advantages and power of group therapy at school, and the intimidating and disruptive experiences of school settings. The participants also provided their impressions of the training course: their growing confidence and skills, and the many changes required in group arts therapy at public schools to provide more professional and efficient service. The discussion centers on the value of group arts therapy in the education system and the steps needed to enhance therapists' confidence and efficiency in this field.

Clinicians' Perceptions of Parent-Child Arts Therapy with Children with Autism Spectrum Disorders: The Milman Center Experience.

Different types of arts offer a wide variety of modes of nonverbal communication and expressive tools for children with Autism Spectrum Disorders (ASD). The present study was designed to characterize therapists' perspectives on the implementation of a parent-child arts therapy model for children with ASD. Semi-structured interviews were conducted with 13 arts therapists who participated in the study. The thematic analysis (qualitative analysis) approach yielded seven themes: (1) Therapeutic goals. (2) Adjusting the therapeutic intervention. (3) The advantages of parent-child arts therapy. (4) Difficulties in parent-child arts therapy. (5) The unique contribution of the participants to parent-child arts therapy. (6) The different types of arts in the therapy room. (7) The arts therapists' assessment of the progress of therapy. The discussion focuses on the four central components of parent-child arts therapy room: the child in therapy, the parent, the arts therapist, and the creative arts.

Ultra-Orthodox Parents' Perceptions of Arts Therapies for Their Children.

Studies have underscored the complexity of psychotherapy for Ultra-Orthodox Jews, and cross-cultural therapy in particular, which evokes fear of disruption of basic values. Parents' sense of responsibility for their child's religious education exacerbates these problems in child therapy. However, there is scant research on child therapy for the Ultra-Orthodox, especially in the field of arts therapies. The present study examined the perceptions of 17 Ultra-Orthodox parents whose children were receiving arts therapies (including art therapy, dance/movement therapy, music therapy, psychodrama and bibliotherapy). Semi-structured interviews were conducted with the parents and analyzed based on the principles of Consensual Qualitative Research. The study covered five domains: (1) The parents' experiences in therapy; (2) The parents' perceptions of the child's experiences in therapy; (3) Implications of environmental-social factors on the parents' perceptions and experiences of therapy; (4) Effects of intercultural aspects on therapy; (5) Perceptions of the use of the arts in therapy. The findings show that the experiences of ultra-Orthodox parents in the arts therapies of their children is complex due to the influence of the socio-cultural context, which involves dealing with stigma and tensions in their relationship with the education system. This context also shapes their perceptions of therapy, which can be characterized as purpose-oriented. The findings also highlight the parents' challenges in coping with the intercultural therapeutic relationship, and emphasizes the parents' preference for a therapist from a similar religious/cultural background and for cultural supervision of therapy. However, the results also suggest that there are benefits inherent to intercultural therapy in general and arts therapies in particular, including a sense of security, openness and acceptance of the parents and children.

Creative Arts Therapy in the "Remote Therapeutic Response" Format in the Education System.

Many creative arts therapists work in the education system on a regular basis. As a result of the pandemic, all have had to treat students in a "remote therapeutic response" format. The aim of the present study was to map creative arts therapists' perceptions of the "remote therapeutic response" in the education system. Semi-structured interviews were conducted with 15 creative arts therapists who participated in the study. The consensual qualitative research approach yielded seven domains: (1) the emotional experiences of transitioning to a remote therapeutic response; (2) the implementation of the remote therapeutic response; (3) benefits of remote creative arts therapy; (4) challenges in remote creative arts therapy; (5) remote contact with parents; (6) working in the educational system; (7) insights and recommendations. Although the findings show that creative arts therapists believe that remote creative arts therapy will never be a fully satisfactory replacement for most clients, remote work, despite its many difficulties and challenges, has also opened the door to new possibilities in the world of creative arts therapy in the education system.

Occupational, speech and emotional therapy with students attending booster classes.

The current study reviews the work being carried out in the Naomi Therapeutic Center in Kiryat Yam, Israel. The staff in this Center decided to provide a holistic response (which includes occupational therapy, speech therapy and art therapy) to 50 elementary school special education students in five booster classes. The goal of the study was to enable these students to improve their self-image, demonstrate fewer classroom adaptive behavioral problems and bring them to function better in class by the end of the school year. Findings demonstrate that in the study group, students' self-image scores were significantly higher at the end of the intervention program than they were prior to the intervention (p = 0.040). In addition, the study group demonstrated a significant difference in adaptive behavior scores before and after the intervention, indicating fewer adaptive classroom behavior problems towards the end of the intervention (p = 0.034). Finally, findings indicate that there was a significant improvement in students' functioning on all of the occupational therapy categories.

Non-Haredi Arts Therapists' Perceptions of Therapy With Ultra-Orthodox Children.

Studies have underscored the complexity of the encounter between ultra-Orthodox (Haredi) society and psychotherapy, as well as the challenges involved in developing a therapeutic relationship in cross-cultural therapy. However, there is scant research on therapy for ultra-Orthodox children, especially when it comes to arts therapies that take place in a cross-cultural setting. The current study examined the perceptions of 17 arts therapists (including visual art therapists, dance/movement therapists, psychodramatists, music therapists and bibliotherapists) who are not ultra-Orthodox, and who currently work or have previously worked with ultra-Orthodox children. Semi-structured interviews were conducted with the therapists and analyzed using the principles of Consensual Qualitative Research. The study covered four domains: (1) perceptions of the significance and objectives of arts therapy with ultra-Orthodox children; (2) the influence of the cultural difference between therapist and client on the emotional experience and the therapeutic relationship; (3) the use of arts in therapy; (4) systemic aspects. The findings indicate significant perceptual and value-based disparities between therapists and clients, which pose difficulties and challenges to all participating parties and require therapists to be highly sensitive. Aside from the difficulties, the findings suggest that this cultural difference may also have certain advantages for clients as well as therapists. The findings likewise attest to the multifaceted process of change that is taking place within Haredi society in its attitude toward psychotherapy in general and arts therapy in particular.

Relationships Between the Therapeutic Alliance and Reactions to Artistic Experience With Art Materials in an Art Therapy Simulation.

In art therapy, art-making plays an important role in the therapeutic relationship. To better understand the triangular relationship between the art therapist, the client and the artwork, this study investigated the association between the therapeutic alliance and reactions to artistic experiences with art materials in an art therapy simulation. The simulation consisted of a series of 6-8 sessions in which art therapy students were divided into teams composed of a permanent observer (art therapist) and creator (client). The client's role was to self-explore through art- making, and the art therapist's role was to accompany the client. Thirty-four students, all women, who played the art therapist role, and 37 students (one male) who played the client participated in the study. Of these participants, there were 24 pairs where both participants filled out all the questionnaires. A short version of the Working Alliance Inventory (WAI) was completed by the clients and the art therapists on the second session (T1) and on the penultimate session (T2). The clients also completed the Art-Based Intervention Questionnaire (ABI) at T2. Significant positive correlations were found between indices of the WAI for the art therapist and the client and the clients' reactions to the artistic experience with art materials on the ABI. The evaluation of the emotional bond between the art therapist and the client at the start of the simulation significantly predicted the client's reactions to the artistic experience with art materials at the end of the simulation and explained 45.4% of the variance for this variable. These findings highlight factors related to the development and influence of the therapeutic alliance, as well as the role of the artistic experience in art therapy and lay the groundwork for further research.

Pictorial Phenomena Depicting the Family Climate of Deaf/Hard of Hearing Children and Their Hearing Families.

This mixed method study (Explanatory Design - the Participant Selection Model) investigated the use of joint drawing (the Family Squiggle) as a family climate assessment tool for hearing families who have a deaf/hard of hearing (D/HH) child. The goal was to evaluate the possibilities of applying a quantitative approach to characterize the pictorial phenomena produced by hearing families who have a D/HH child and then apply qualitative research approaches to better understand the meaning of these phenomena. Twenty-eight hearing families (parents and child) whose child was diagnosed as D/HH and used hearing devices (hearing aids and implant) were recruited along with 16 families with a hearing child of a similar age enrolled in a mainstream school. The sessions involved a joint drawing followed by a family interview. In the quantitative stage, pictorial phenomena for which there was a significant association between the phenomena and the group of families were defined. These were: (1) the number of dominant images, (2) images occupying less than a quarter of the page, (3) images with accentuated outlines, (4) moderate colorfulness with four to five colors in each drawing, (5) minimal representation of the face, (6) concrete rather than creative titles, (7) muting of conflictual themes, and (8) images reminiscent of hearing devices (hearing aids and implant). In the qualitative phase, interviews were conducted with the hearing families with a D/HH child to better understand the meaning of these pictorial phenomena. The findings suggest that each of these phenomena represent the preoccupation of the family with D/HH, capture a certain aspect of family dynamics, and together provide a broader and deeper picture of the family climate and the interactions between the children's family and hearing. This assessment tool may thus be utilized when verbal tools cannot be easily applied.

The quality of the relationship between typically developing children and their siblings with and without intellectual disability: Insights from children's drawings.

The current study examined the relationships of typically developing (TD) children with siblings with and without intellectual disabilities (ID), as expressed in TD children's drawings and questionnaires answered by TD children and their mothers. It also examined group differences in the sibling relationships, as well as the associations between having a sibling with or without ID and sibling relationships, and TD children's social-emotional adjustment. Participants were mothers and their TD children (8-13 years). Some had ID siblings ID (N=28); others had TD siblings (N=31). Sibling relationships were examined via mothers' and target children's completion of questionnaires, and objective visual indicators (location, size, distance) and observed content-based indicators (support, investment, presence of parents) of children's drawings were assessed following the art-based phenomenological analytic approach. Mothers reported on children's social-emotional adjustment. Findings indicated differences in sibling relationships, including higher levels of positive relationships for children with ID siblings. Children's drawings also showed positive relationship aspects for these children. Sibling relationship qualities were significantly associated with children's adjustment. Children's drawings may be a useful data gathering tool to deepen our understanding of unique aspects of sibling relationships.

Perceptions of Art Therapy in Adolescent Clients Treated Within the School System.

Research in School-Based Art Therapy has been widely discussed in recent years, and the number of studies that examine staff perceptions and the special characteristics of art therapy within the education system has risen considerably. The current study explored the critical issue of adolescent clients' perceptions of art therapy in school, from their point of view as clients. The methodology and data analysis were conducted according to the principles of Consensual Qualitative Research (CQR). The sample was composed of 12 adolescent clients, aged 14-18 (M = 16), who took part in in-depth semi-structured interviews. The findings were organized into five domains that emerged from the interviews: referrals and initial engagement with therapy, the setting within school, the nature of art therapy at school, the relationship with the art therapist, and the impact of art therapy on these clients. The analysis revealed that although some participants initially agreed to art therapy because it got them out of class and let them have fun instead, they realized after a period of time of art therapy that they were engaged in a personal and emotional process focusing on them which allowed them to express their feelings without the fear of judgment. Participants at times used the word "mother" to describe their relationship with the art therapist, and stated that the presence of the art therapist at school made them feel safer and helped them deal with day-to-day problems. School-based art therapy was seen as having specific advantages according to the participants. Having a therapeutic hour during a stressful school day was considered to give these students an opportunity to relax, and the art therapy room was perceived as a shelter. In addition, when the therapist was perceived as a supportive figure, the whole school experience tended to be perceived as supportive or enabling greater acceptance.

Effectiveness of Art Therapy With Adult Clients in 2018-What Progress Has Been Made?

In the year 2000, an important art therapy literature review addressed an essential question-does art therapy work? It discussed 17 articles dealing with the issue of the effectiveness of art therapy. Two decades later, this research field has extended its scope and is flourishing. Several current reviews of research work have described the broad range of methods implemented today, which includes qualitative and quantitative studies; other reviews have focused on art therapy with specific populations, or by age group. The aim of this systematic literature review is to contribute to the ongoing discussion in the field by exploring the latest studies dealing with the effectiveness of art therapy with a broad scope of adult clients. We conducted a comprehensive search in four databases and review of every quantitative article that has addressed outcome measures in the art therapy field from 2000 to 2017. This paper presents the latest 27 studies in the field that examine the effectiveness of art therapy with adult clients and divides them into seven clinical categories: cancer patients, clients coping with a variety of medical conditions, mental health clients, clients coping with trauma, prison inmates, the elderly, and clients who have not been diagnosed with specific issues but face ongoing daily challenges. It underscores the potential effects of art therapy on these seven clinical populations, and recommends the necessary expansions for future research in the field, to enable art therapy research to take further strides forward.

The Efficiency of Art-Based Interventions in Parental Training.

In recent years, the field of art therapy has gained momentum, but art therapists still tend to work verbally during sessions with parents. The therapeutic approach presented here is anchored in the notion that the encounter between the art world and treatment creates a unique relationship between therapist, parents and the artwork. Eighty-seven parents of five to eight year olds filled in two quantitative questionnaires before and after a ten-month therapeutic intervention during which their child was treated through art therapy. Two other questionnaires were completed by the children and by the 14 art therapists. Three groups were tested: (1) Parental training with art-based interventions (intervention group). (2) Verbal parental training. (3) No Parental training. The parents in the first and second groups met the art therapist for parental training once every 3 to 4 weeks. In the intervention group the art intervention was based on a uniform protocol of exercises with various materials. It was hypothesized that a combination of art-based interventions during parental training (parents whose child was receiving art therapy) would contribute more to parent-child relationship, affect the parents' self-perceptions of parental functioning, and improve the child's daily functioning than verbal parental training or no parental training, both in terms of the parents' and the child's perception. Analysis of the children's questionnaire indicated significantly higher scores in the intervention group than in the control groups for perceived cognitive abilities, perceived acceptance by peers and by the mother. Analysis of the parents' questionnaires indicated there was no difference in parental perceptions of their child, level of satisfaction, or efficiency between the intervention and the control groups. The art therapists reported improvement in the intervention group on almost every measure. When parents take part in a therapeutic experience that enables them to create and play with art materials, they may accept and appreciate their inner 'child' more easily. This may help them accept the fact that their own children are dependent on them, while at the same time acknowledging their need for autonomy, which can heighten children's perception of their own acceptance by peers and acceptance by their parents.

The Principles of Art Therapy in Virtual Reality.

In recent years, the field of virtual reality (VR) has shown tremendous advancements and is utilized in entertainment, scientific research, social networks, artistic creation, as well as numerous approaches to employ VR for psychotherapy. While the use of VR in psychotherapy has been widely discussed, little attention has been given to the potential of this new medium for art therapy. Artistic expression in VR is a novel medium which offers unique possibilities, extending beyond classical expressive art mediums. Creation in VR includes options such as three-dimensional painting, an immersive creative experience, dynamic scaling, and embodied expression. In this perspective paper, we present the potentials and challenges of VR for art therapy and outline basic principles for its implementation. We focus on the novel qualities offered by this creative medium (the virtual environment, virtual materials, and unreal characteristics) and on the core aspects of VR (such as presence, immersivity, point of view, and perspective) for the practice of art therapy.