[Healing Through Art and Play for Hospitalized Children With Medical Trauma].

Children suffering from critical illness often face significant life changes during hospitalization that can impact their external and internal worlds dramatically. Moreover, invasive treatments and medical procedures may cause physical pain and severe psychological distress. Furthermore, children with long-term hospitalization are often preoccupied with feelings of isolation, anxiety, helplessness, and hopelessness. Because children often have difficulty expressing their experiences and may resort to screaming and crying, it is necessary to help them express and transform their disturbing emotions. The literature supports the efficacy of art psychotherapy (AT) in helping children cope with suffering illness and distressing medical treatment procedures. The process of creation and play in AT helps pediatric patients express emotions non-verbally and experience catharsis in gentle and safe ways. AT can promote a sense of security in these patients by building up courage, mental stability, and the readiness necessary to face upcoming medical treatments and procedures. How AT may be used to care for pediatric patients' bodies and minds during hospitalization is presented in this article using a review of the literature and clinical case presentation, with a particular focus on how AT can effectively reduce anxiety and medical trauma responses (i.e., pediatric medical traumatic stress). In addition, the participation of the family and the medical team in the AT process is important in better understanding and appreciating the physical and mental states of pediatric patients and in realizing and transforming the emotions these patients express through this process. Family and medical team members can form a support system and offer appropriate comfort and care to children during their medical treatment, creating a trauma-informed treatment environment and reducing the risk of patient medical trauma.

The Effects of Adding Art Therapy to Ongoing Antidepressant Treatment in Moderate-to-Severe Major Depressive Disorder: A Randomized Controlled Study.

This randomized controlled study aimed to investigate the effects of art psychotherapy on moderate-to-severe major depressive disorder (MDD). Forty-two MDD patients were recruited from a psychiatric outpatient clinic in Seoul, the Republic of Korea. Participants were allocated on a randomized, open-label basis to either an experimental group, wherein they were treated with art psychotherapy added to pharmacotherapy, or a control group, wherein they were treated with pharmacotherapy alone. Pre- and post-test measures of the Hamilton Depression Rating Scale, Beck Depression Inventory-II, and remission rates were measured. The results indicate that patients treated with art psychotherapy and ongoing pharmacotherapy showed slightly greater improvement when compared with pharmacotherapy alone in moderate-to-severe MDD. These results suggest that art psychotherapy could be an effective add-on strategy for the treatment of moderate-to-severe MDD. However, a rigorous test would facilitate a better understanding of art psychotherapy as an add-on strategy for MDD treatment.

Drawing on Dialogues in Arts-Based Dynamic Interpersonal Therapy (ADIT) for Complex Depression: A Complex Intervention Development Study Using the Medical Research Council (UK) Phased Guidance.

Aim: The aim of this paper is to present the development and evaluation of an art psychotherapy brief treatment method for complex depression for patients referred to mental health services. Background: Art Psychotherapy literature describes a range of processes of relational change through the use of arts focused and relationship focused interventions. Complex depression has a prevalence of 3% of the population in the West and it is recorded that in 2016 only 28% of that population were receiving psychological treatment. This study was developed to test the hypothesis of whether an accessible and acceptable approach to the treatment of complex depression could be developed in relation to existing evidence-based practice within mental health services. Method: The United Kingdom Medical Research Council phased guidance for complex intervention development was used (Phases I and II) to develop the intervention. The process included producing a literature overview, systematic description of clinical practice, including a logic model and a clinical protocol. The art psychotherapy protocol described an arts-based dynamic interpersonal therapy approach (ADIT), offered 1:1 over 24 sessions. Further to this the intervention was tested for referrer acceptability. The intervention is in the early stages of evaluation, using changes to the patient's depression and anxiety measured pre- and post-treatment with a follow-up measure at 3 months following completion of treatment. Results: Phase I of the study provided a good basis for developing a logic model and protocol. The authors found that there was good clinical consensus about the use of a structured clinical art psychotherapy method (ADIT) and the literature overview was used to support specific examples of good practice. The verification of clinical coherence was represented by a logic model and clinical protocol for delivering the intervention. The acceptability study demonstrated very high levels of acceptability for referrers reporting that (i) ADIT was acceptable for patients with complex/major depression, (ii) that they were likely to refer to ADIT in the future (iii) that the use of arts was likely to improve accessibility (iv) the use of arts was likely to improve outcomes and (v) that offering ADIT was an effective use of mental health resources. Discussion: Phase I of this intervention development study (following MRC guidance) demonstrated theoretical and practice coherence resulting in a clinical protocol and logic model. Whilst Phase II of this study showed promising results, Phase II would need to be sufficiently scaled up to a full trial to further test the intervention and protocol.

Creating Art Together as a Transformative Process in Parent-Child Relations: The Therapeutic Aspects of the Joint Painting Procedure.

The relationships between parents and children contain implicit aspects, which are non-conscious and non-verbal, in addition to explicit ones. Both explicit and implicit aspects are central to understanding the dyadic dynamics and are implicated in psychotherapy processes and outcomes. Visual symbolization has a unique value as a channel of expression that can capture the implicit characteristics of relationships. Creating art together goes even further because it allows the presence of implicit representations of the relations in vivo. These representations can then be transformed through the joint process of creation, which has a unique potential to unleash reflective capacities when it is experienced in a playful and safe context. This paper presents a qualitative study that is part of larger mixed-methods research with 87 mother-child dyads (with children 9 to 12 years old). Dyads were administered the Joint Painting Procedure (JPP), which includes dyadic painting by the parent and child on the same paper and is used for evaluation and treatment in the field of parent-child therapy and art therapy. The study's objectives were to uncover and better understand the unique therapeutic aspects that such method allows and its potential to impact parent-child relationships. The findings of the qualitative study indicated that the JPP enabled several dynamic processes such as pleasure and fun, bi-directionality, mutual regulation, mentalization, and mutual recognition, which together created a salient positive transformation in the relationship. Through the JPP, a new transformative aspect of relations emerges and enables new and different modes of communication and interactions in about half of the dyads and a lesser and partial positive transformation in about a third of them.

Interpersonal art psychotherapy for the treatment of aggression in people with learning disabilities in secure care: a protocol for a randomised controlled feasibility study.

BACKGROUND: Art psychotherapy has greater potential for use with adults with mild to moderate learning disabilities as it places less of a burden on verbal interaction to achieve positive therapeutic, psychological, and behavioural goals. The feasibility study objectives include testing procedures, outcomes, validated tools, recruitment and attrition rates, acceptability, and treatment fidelity for manualised interpersonal art psychotherapy. METHODS: Adult males and females with mild to moderate learning disabilities will be recruited from four NHS secure hospitals. Twenty patients will be recruited and randomly assigned to one of two treatment groups: fifteen 1-h individual sessions of manualised interpersonal art psychotherapy, or a treatment as usual waiting list control group. The Modified Overt Aggression Scale will be administered to both treatment arms. Four patients will be recruited to a single-case design component of the study exploring the acceptability of an attentional condition. DISCUSSION: This multi-site study will assist in future trial planning and inform feasibility including, procedures, treatment acceptability, therapist adherence, and estimation of samples size for a definitive RCT.

Child art psychotherapy in CAMHS: Which cases are referred and which cases drop out?

BACKGROUND: The Vasarhelyi method of child art psychotherapy (CAP) is offered at certain Child and Adolescent Mental Health Services. Children attend three introductory sessions, and then choose to continue weekly CAP or conclude the sessions. AIMS: This study aims to identify the clinical disorders and characteristics of patients referred to CAP, and to determine who engages with the therapy. METHODS: A retrospective review of the clinical records of 67 children who attended CAP in DNCC/Mater CAMHS over 13 years was performed. The data was analysed using Microsoft Excel 12.0 and SPSS version 20. RESULTS: 67 children (57 % male and 43 % female) aged 5-17 years participated in CAP with an average age of 10.6 years. Children attended an average of 14 sessions of CAP, with a range of 1-61 sessions (mean of 13.8 ± 12.9 sessions). Anxiety disorder (28 %), behaviour disorder/ODD (25 %), and ADHD (21 %) are the most common diagnoses referred. These diagnoses along with autism spectrum disorder (ASD) had the highest overall engagement, while those with depression engaged the least. Children with ADHD and with ASD attended high numbers of sessions (with a mean of 23 and 19 respectively). Those who experienced acute life events or difficulties in the home engaged well (60 and 40 % respectively). There was no significant difference found in the percentage of appointments attended by males in comparison to females. CONCLUSION: CAP is generally acceptable to children, with a high average attendance rate. It was noted that children with ADHD and with ASD engaged well with the therapy for prolonged periods, whereas children with depression did not engage so well. We suggest that CAMHS clinics should consider referring children diagnosed with ADHD and children diagnosed with ASD to CAP as an adjunct to other therapies. We suggest that individuals with depression should be referred initially to other therapeutic services as the engagement with CAP was relatively poor.