An autistic teenager learns to communicate with other people by playing the drums as part of a group. A family in therapy makes a drawing together, allowing the therapist to observe their interactions and the finished picture. Members of a breast cancer support group use dance and movement to express their feelings about being ill. A group of abuse survivors write a poem together and then read it aloud.
Each of these is an example of creative arts therapy at work. Creative arts therapies--sometimes also called expressive therapies--use media like dance, drama, music, poetry and visual arts to help clients express themselves.
"In verbal therapy, the medium is words--therapists listen to people talk in order to make assessments and formulate interventions," says Anne Fisher, PhD, a psychologist and registered dance therapist in Washington, D.C. "In dance therapy, movement is the medium for assessment and intervention."
Now, some psychologists who are also creative arts therapists say they'd like to teach more of their colleagues to integrate expressive techniques into their practices.
To facilitate this collaboration, psychologist and registered dance therapist Ilene Serlin, PhD, and others recently formed a new section within APA Div. 32(Humanistic) focused on arts therapies. The goal, Serlin says, is to introduce expressive therapies to more psychologists and provide a resource for master's-level arts therapists who want to earn a doctorate in psychology.
"I see this as part of a whole-person approach to therapy," says Serlin, who practices in San Francisco. "I think a collaborative approach to health care is essential, and creative arts therapy is part of that. We need to step outside our niches."
Of course, each of the creative arts therapies is a discipline in its own right. Creative arts therapies in the United States first emerged in the 1940s and 1950s, often in the context of working with patients who could not express themselves verbally. For example, Marian Chace, one of the original pioneers of dance therapy, began by working with patients at Washington, D.C.'s St. Elizabeths Hospital, where many of the patients were considered too disturbed to benefit from verbal therapy. And Arleen Hynes, a librarian at the same hospital, established a pioneering training course in bibliotherapy (of which poetry therapy is part) there in the 1970s.
For many years, arts therapies were a mainstay in such hospitals--and in some, they still are, particularly as part of therapeutic recreation. Greg Siples, a music therapist and the chief of rehabilitation therapy services at Patton State Hospital, a forensic mental health hospital in California, says that Patton State employs more than 60 creative arts therapists for its 1,400 judicially committed patients.
But others say the pendulum has swung away from expressive therapies as inpatient treatment.
"Expressive artistic activities have a useful role in psychiatric rehabilitation as leisure and occupational skills," says William Spaulding, PhD, a professor at the University of Nebraska and consulting psychologist in psychiatric rehabilitation programs. "Although specific interventions have not been evaluated in controlled clinical trials, it is clear that having such skills is an important factor in recovery."
There are few controlled clinical arts therapy trials because it's difficult for therapists to standardize the treatment, says Daniel J. Wiener, PhD, a psychologist and drama therapist at Central Connecticut State University. However, he says, a lot of research is available in case study form.
In fact, arts therapy journals are filled with articles detailing the therapies' use in different situations. A case in point is the National Association for Poetry Therapy's 18-year-old Journal of Poetry Therapy, founded and edited by Nicholas Mazza, PhD, a poetry therapist, marriage and family therapist and professor of social work at Florida State University.
"I receive submissions from an amazing variety of settings," he says. "I've had articles from people working with the homeless, in psychiatric hospitals, in family practice, everywhere."
And in fact, some empirical research does point to expressive therapies' efficacy beyond the inpatient psychiatric population. For example, James Pennebaker, PhD, a University of Texas at Austin psychologist, has published studies that demonstrate that expressive writing about emotions and feelings can help boost immune function in patients with HIV/AIDS and other illnesses (see the June 2002 Monitor).
Spurred on by such positive findings, creative arts therapies have long since spread outside the psychiatric hospital setting. Arts therapists work in medical hospitals, community mental health centers, senior centers, schools, private practice and many other settings. Each type of creative art therapy has its own association--from the nearly 5,000-member American Art Therapy Association to the 600-member National Association for Drama Therapy. These associations regulate professional training and licensing, registry or certification standards (most require a master's degree), journals and meetings.
Arts therapies can also effectively augment verbal therapy, says Wiener, who is also a marriage and family counselor. "A lot of things make more of an impact when they're presented nonverbally," he explains.
Arts in psychology
Most creative arts therapists have extensive backgrounds in the arts that they use, as well as in therapy, says art therapist Debra Linesch, PhD, chair of the marital and family therapy department at Loyola Marymount University in Los Angeles, which offers specialized training in art therapy. "Most of the students who come to us have a substantive background as artists," she says, "so they're embedding their training in that background."
Likewise, psychologists who are also licensed or registered arts therapists generally have a background in the arts: Fisher was a ballet dancer for years, and then completed a psychology degree in college. One day, she says, she was in a checkout line at the grocery store, when she saw a magazine with a headline that said "Dance Therapy." Within a year, she'd been accepted into a dance therapy program.
Mazza has a remarkably similar story: After receiving an undergraduate degree in English in 1972, he read a magazine article about the then-relatively new field of poetry therapy. Soon, he was back in school on his way to a career as a psychologist.
Given that most psychologists don't have this extensive background in the arts, Linesch says, it's important to distinguish between an arts therapist and a psychologist who uses some art in his or her practice.
"To be committed to the arts is different than being a social worker or psychologist who uses some art," she says.
But nonexpert psychologists can still integrate expressive therapies into their practices after garnering some training, says Serlin. For example, she teaches a daylong continuing-education workshop through Alliant University called "Expressive Therapies: Integrating Mind/Body Therapies into Practice." In the class, she presents some of the research and theory behind expressive therapies and then discusses case examples. The students then work in small groups to practice the new skills.
The new section of Div. 32 plans to develop training toolkits for psychologists, Serlin says, and to sponsor panel discussions on expressive therapies at APA meetings.
Wiener agrees that training is important for psychologists who want to learn to use expressive therapies: "If a person wants to try it, they'd need to start out by learning some fairly simple techniques, watch others leading group exercises, and then try leading the exercises themselves. You can't just learn off the page--you learn from trying to do it."
For more information about the new psychotherapy and the arts section of Div. 32, e-mail Serlin.
Wiener, D.J. (1999). Beyond talk therapy: Using movement and expressive techniques in clinical practice. Washington, DC: American Psychological Association.
Wiener, D.J., & Oxford, L.K. (2003). Action therapy with families and groups: Using creative arts improvisation in clinical practice. Washington, DC: American Psychological Association.
Mazza, N. (2003). Poetry therapy: Theory and practice. New York: Brunner Routledge.