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Arts therapies
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What are arts therapies?
Music therapy
Dance movement therapy
Voice movement therapy
Drama therapy
Art therapy
Further reading
Useful contacts
What are arts therapies?
Arts therapies are a way of using the arts – for example, music, painting, clay, dance, voice, or drama – to express yourself in a therapeutic environment with a trained therapist. Arts therapists help their clients to express themselves and to make sense of what they have created in the context of their life experience and their state of mind.
Arts therapists are people who are skilled in the medium they use, and who have also undergone intensive training as therapists. They work with the clients to use their creativity in a psychotherapeutic way, containing what is expressed in the therapy room in a way that is safe for all concerned, maintaining professional boundaries, and acting within the Code of Practice of their chosen therapy.
Arts therapies should not be confused with the arts as recreation, entertainment or creativity. This is not to deny the enormous value and importance of the arts in recovery: for some people engaged in such projects, the very fact that their creativity is art in its own right, and not therapy, is one of the most important aspects that gives it value. However, this factsheet is about the arts as therapy.
Arts therapies can be a very powerful means of expression and of release from trauma. They are especially helpful for people who feel disengaged from their feelings or unable to articulate them, or find it too difficult to address painful experiences in words, and would therefore have difficulty engaging with talking therapies such as cognitive behaviour therapy.
The arts can enable people to express emotions, not with the aim of getting rid of them, but to help accept them and enable them to come to terms with events or live with the memory of difficult experiences. They can help people to get to know themselves better. Arts therapies can also be very important in enabling people to get in touch with the spiritual part of themselves.
The value of the arts for human survival tends to be underestimated in our society. Song, music, dance, drama, and art have been the most fundamental and consistent forms of expression throughout human history, and very important to the survival of civilisations. They are essential for societies to thrive. In psychiatric settings, they may provide more profound and long-lasting healing than more standard forms of treatment. [1]
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Music therapy
There are two distinct applications of music as therapy:
- as a means of communication and self-expression within a therapeutic relationship
- for its inherent restorative or healing qualities, for example in a hospice setting. In this case, the client is usually listening rather than playing an instrument. [2]
This factsheet focuses mainly on the first of these applications.
In music therapy, the music-making forms the basis of communication between the client and the therapist. Usually, both client and therapist take an active part in the sessions by playing, singing, and listening. The relationship between the client and the therapist is fundamental, as it is in talking therapies, but the medium of communication is music rather than words.
Clients do not need to have any special skill or experience of playing a musical instrument. Percussion or simple melody instruments that can be played successfully without prior knowledge or the need to read music are usually used, for example, drums, cymbals, wood blocks, maracas, bells, xylophones, chime bars, and simple harps with which it is possible to make a beautiful sound with little or no previous experience.
Sessions may be one-to-one or in groups. They may include both free improvisation and prepared pieces which can be practised and refined. Clients are encouraged to explore the possibilities of the instruments available, and of their voices, and create a dialogue with the therapist in sound. People who do play an instrument may welcome the opportunity to bring it to therapy to play as part of their treatment.
The music played may cover a wide range of styles depending on the taste, musical experience, and needs of the client. Much of the music is improvised, and the therapist aims to create positive changes in emotional wellbeing by responding through music to the emotions expressed by the client’s music. They also aim to help the client to develop an increased sense of self-awareness, and, especially in group situations, awareness of themselves in relation to others.
Music therapy may be used to make contact with people who are very withdrawn and reluctant to engage with others. For example, it has been used extremely effectively to engage with severely autistic children, using techniques such as those developed by the late Paul Nordoff, a pioneer of music therapy. [3] The advantage of music is that, being audible, it is difficult to escape. The client is obliged to hear it, if not to consciously listen, and a skilled therapist will use music to engage their interest and lead them to a response.
The creation of improvised songs may encourage people to put their feelings into words when they have been unable to do this previously. This may lead them to more open spoken expression, or to writing.
Music can act as a stimulus to awaken buried memories, or evoke emotional responses which may otherwise be inaccessible. In this way, it may obtain results which might take weeks of more usual talking psychotherapy. It can be a useful route to healing for people of any age or background. It can be very valuable in the care of people with dementia. The part of the brain which responds to music is the most long-lasting, and a person may continue to be able to play or sing, to appreciate music and be calmed by it, after most other faculties have gone.
Music is also used in palliative care (treatment that alleviates symptoms or eases pain/anxiety, but is not a cure – usually for people with a terminal illness). When someone is too weak to be able to participate in more active arts, they are still able to hear, and may be able to sing. Music may continue to reach them in a coma, and therapy may continue until death, and be very helpful to friends and family too as something they can all share. [4]
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Dance movement therapy
Dance, or dance movement, therapy is the use of movement and dance to help a person to express their feelings and to help them to feel that their mind and body are integrated. Dance therapy has its roots in modern dance and the work of people such as Isadora Duncan and Martha Graham, who pioneered expressive dance which allowed spontaneous, individual expression. [5]
It is based on the idea that the way people hold themselves and move expresses the way they feel about themselves. By expressing their moods and feelings through movement, they can become more aware of parts of themselves that are not expressed verbally, and become more in touch with themselves.
Dance therapy may be used both with individuals and in groups, in a wide range of settings, including hospitals, residential care, and day care centres.
The therapist will observe and acknowledge and support the clients’ movements and encourage their development and change to facilitate the emotional changes that will accompany the new movement patterns. For example, a person who is very subdued, and generally carries themselves stooped and small, may be encouraged to reach up and out and become more erect and confident in their stance, and so they feel more self-confident.
Through moving with the client and copying their movement patterns, the therapist directly shares their experience and can develop an instant empathy and awareness of how they are feeling.
It is also helpful for people who want to use the therapy for developing greater self-understanding and personal growth. It may be particularly effective for people whose problems are expressed physically, for example, those with concern about body image, or whose emotional problems are expressed psychosomatically. It may also help people who struggle with issues around bodily contact and trust.
People with a history of early trauma or with psychotic illness may manifest this in the way they hold themselves and the way they move. Dance movement therapy can connect people with their memories in order to work through the associated past experiences. Movement becomes the method of remembering and expressing.
The repertoire of movement that clients bring to the session reveals their personal developmental histories. How they move may also be affected by antipsychotic drugs which often have significant effects on movement; [6] while drugs may therefore limit the effects of therapy, at the same time dance therapy may help clients to overcome some of these side effects. People experiencing dissociation states may be helped by dance movement therapy to express their feelings physically and to be more aware of their bodies as part of themselves.
Working with movement can free the emotions, and developing a new repertoire of movements may help clients to feel happier in their bodies and more at ease with themselves.
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Voice movement therapy
The human voice reflects both physical and emotional elements. Voice movement therapy works with the emotional aspects of using the voice: "singing not as a means of entertaining a judgmental ear, but as a means of giving form and shape to the deepest parts of our souls". (Paul Newham). [7]
Voice movement therapy essentially uses the voice to explore the self, and uses movement and massage to help free the voice, the breath, and the throat, all of which may create blocks which inhibit free expression though the voice. It combines knowledge of acoustics and the anatomy and physiology of the voice with movement, enactment and imagery.
Words are often not the most important part of the expression, although they may be used. Expression can be through wordless singing, shouts and cries and other utterances which vocalise emotion without words.
Alternatively, the therapist may encourage the client to write and create songs that use the broadest possible range of the voice, so that they are encouraged to express hidden emotions. The different voices from the full range produced may also be used to create characters which represent different aspects of the self. Voice movement therapy may in this way incorporate music, drama, and dance. The effect can be both spiritually uplifting and physically invigorating, releasing both the voice and the spirit.
Voice movement therapy is useful for people who find it difficult to use their voices, either for speaking or for singing, either because of physical or neurological problems, or because of emotional blocks. For some people speaking is very difficult, especially in large groups, and their voices can feel trapped. Voice movement therapy can free the voice and increase free self-expression and self-confidence and self-knowledge.
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Drama therapy
"It is a paradox of drama therapy that stepping out of themselves into a role they are playing enables clients to engage with damaged or buried aspects of themselves." (Sue Jennings, Drama therapist) [8]
Drama therapy is a form of group therapy which uses all aspects of theatre and drama. It uses improvised scenarios or prepared scripts to help people to come to terms with their experiences and emotions, to gain insight into their responses to them and learn new ways of dealing with them. It promotes creativity and imagination, and develops insight and personal growth.
The techniques used include improvisation, role play, mime, enactment, movement, rhythm, speech and vocalisation, as well as other aspects of theatre. The drama may be used to act out a situation that has really happened, and to try to understand and work through the emotions aroused, or it may improvise a new situation which brings insight into a client’s feelings, or the way they interact with others.
Existing scripts, including published plays, may be used or adapted for particular situations, or to represent a particular experience, and sometimes the session may be entirely improvised. The same story or script may be used over several sessions to explore ideas and feelings and develop understanding over time, or it may be used for one session only, depending on the problems being addressed by the group and the individuals within it.
The enacting of a story may enable people to address difficult issues and experiences, such as psychotic experiences, indirectly. For example, hearing voices may be an expression of some kind of spiritual crisis. Doctors trained exclusively in the medical model cannot begin to address this, and are often dismissive of it. This is partly because they are given no language with which to speak of it. To talk on a spiritual level you have to use metaphor and stories. If you try to use scientific language, you can be trapped into not being able to say anything.
Drama therapy may allow the creation of a story which can be enacted to express such material indirectly. As with myths and fairy tales, the story can have a powerful and therapeutic effect without the meaning ever needing to be spelt out. Drama draws on the use of metaphor which is crucial to enable the expression of the inexpressible. It provides a distance from the experience which cannot be spoken about.
The client is not confined to the role of player. Theatre also allows for the roles of director, lights, the creation of scenery, costume, and so on, and all these may be used in the therapy. Clients may, in role reversal, become a prop or a piece of scenery themselves. They may also be audience, allowing them to withdraw to a safe space if they are feeling overwhelmed, without needing to leave the group.
Drama may enable people to change power relationships which can often be the first step to recovery in the full sense. When you have been in a situation where you have no power, which is often the case for people with mental health problems, being asked to take control can be frightening. Drama therapy and psychodrama offer a safe experience of being in control, the possibility of practising such roles and learning to say ‘no’.
Drama therapy can be used very successfully to treat clients such as victims of abuse, so that they learn to live with their past, put it behind them and continue with their lives, without the need for medication or other further therapy. [9]
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Art therapy
Art therapy is the use of painting, clay work and other similar creative art as a form of non-verbal expression in a therapeutic setting. Other art forms such as music, poetry or a story may be used as a trigger for a creative work.
Media may also include found objects, collage and photography. The use of objects such as stones or pieces of driftwood or bark may help clients who have become disengaged from reality, or feel disconnected from the natural world, to reconnect with nature in a way that is healing to the spirit. Found objects may also represent life experiences and can trigger the expression of associated feelings in the art created.
In some situations, colour is over-stimulating. Clay work may be used as a stabilising medium. Clay can be used to represent feelings that can be changed and transformed. This can change the way people deal with emotions, enabling them to leave behind things which have troubled them for many years.
Using a camera may help to connect people with the present moment, as well as relating the things they choose to photograph with memories and emotions connecting with their past.
"Contemplative photographs serve as images that collect and return soul to the world. The camera preserves the imagery of instants and reveals the vast expression taking place in the most ordinary environments." (Shaun McNiff, President of the American Art Therapy Association)
The art created may be discussed afterwards, to explore the feelings it expressed or, as in the therapeutic use of stories, this may not be needed. Indeed it may be counterproductive, the art itself being all the expression that is needed.
Thomas Merton, contemplative monk and author, observed that art allows us to find ourselves and lose ourselves at the same time. Part of its value as therapy is that, like music and dance therapies, it is a means of expression without words. It can get directly to the heart of emotions, and provide an emotional outlet that feels safe because it is contained in the artistic creation. It can also reach beyond cultural limitations.
For the therapist, the art someone produces can provide important clues to what is behind their clients’ distress, and their progress and recovery may be mapped or documented by their artistic creations.
For the client, art therapy means that they are taking a very active part in the therapy – they have to engage with it for anything to happen. In addition to providing a means of contacting and resolving deep emotions, it may open up to them creative resources that they were unaware they possessed and promote an increased sense of self, self-awareness and feelings of achievement.
The artistic creations themselves, and perhaps their inclusion in an exhibition, may provide a satisfying way of concluding the therapy. Framing and hanging a picture may be part of the therapeutic process, and the way that the therapist interacts with the client. A frame may, for example, represent a boundary, a way of containing emotions and making them safe. On the other hand, it may represent a way of giving more space and allowing expression to expand beyond its original limits.
An exhibition may be a way of helping a person to accept their emotions because they are presented in a way that is acceptable to the rest of the world. This may be an important step in recovery and return to mainstream society for people whose lives have become dominated and limited by their mental health problems.
Art therapy can have profound effects in enabling people to get in touch with and express their feelings, while at the same time being very stabilising because of its engagement with physical materials.
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Further reading
Payne, H. (ed.), 1992, Dance movement therapy: theory and practice, London: Routledge.
Cook, K. Ledger, S. and Scott, N. 2003, Dancing for Living: Women's experiences of 5 rhythms dance and the effects on their emotional wellbeing, London: The Mental Health Foundation.
Casson, J. 2004, Drama, psychotherapy and psychosis – dramatherapy and psychodrama with people who hear voices, London and New York: Brunner-Routledge.
Jennings, S. 1992, Dramatherapy: theory and practice 2, London: Routledge.
Sutherland, M. 1997, Draw on your emotions, Brackley: Speechmark Publishing.
Case, C. and Dalley, T. 1992, The handbook of art therapy, London: Routledge.
Newham, P. 1999, The healing voice: how to use the power of your voice to bring harmony into your life, Element.
Darnley-Smith, R. and Patey, H.M. 2003, Music therapy (Creative Therapies in Practice), London: Sage.
Bunt, L. 1994, Music therapy, an art beyond words, London: Routledge.
Holmes, P. and Kemp, M. (eds), 1991, Psychodrama: inspiration and technique, London: Routledge.
Farrelly-Hansen, M. (ed), 2001, Spirituality and Art Therapy: living the connection, London: Jessica Kingsley Publishers.
Useful contacts
Websites
The Association for Dance Movement Therapy UK (ADMTUK)
web: www.admt.org.uk
Creative Voicework
www.creativevoicework.com
International Association for Voice Movement Therapy
www.iavmt.org
Music Therapy
http://homepage.eircom.net/~musictherapy/welcome.html
Tonalis
www.tonalismusic.co.uk
Voice movement therapy
www.voicework.com
Other organisations
The British Association of Art Therapists (BAAT)
tel: 020 7686 4216
web: www.baat.org
The professional organisation for art therapists in the UK.
The British Association of Dramatherapists (BADth)
tel: 020 7731 0160
web: www.badth.org.uk
The professional body for dramatherapists in the UK.
British Society for Music Therapy (BSMT)
tel: 020 8441 6226
web: www.bsmt.org
The organisation responsible for promoting and developing music therapy in the UK. They run a public information service on music therapy.
The Courage to Sing
tel: 01297 35966
web: www.thecouragetosing.co.uk
An organisation helping to develop singing, voice, music, creativity,
self-confidence, personal power, talent, imagination, health and wellbeing
Nordoff Robbins Music Therapy
tel: 020 7267 4496
www.nordoff-robbins.org.uk
Provides music therapy sessions to children and adults in need across the UK.
Roundabout
tel: 020 8665 0038
web: www.roundaboutdramatherapy.org.uk
Conducts long-term and short-term drama therapy projects with a range of clients.
This factsheet was written by Katherine Darton, Mind Information Unit, November 2006.
[1] Casson, J. 2004, Drama, psychotherapy and psychosis – dramatherapy and psychodrama with people who hear voices, London and New York: Brunner-Routledge.
[2] Darnley-Smith, R. and Patey, H.M. 2003, Music therapy (Creative Therapies in Practice), London: Sage.
[3] Nordoff, P. and Robbins, C. 1971, Therapy in music for handicapped children, London: Gollancz.
[4] Aldridge, D. (ed), 1999, Music therapy in palliative care, London: Jessica Kingsley Publishers.
[5] See www.admt.org.uk
[6] Darton, K. 2005, Making sense of antipsychotics, London: Mind.
[7] Newham, P. 1999, The healing voice: how to use the power of your voice to bring harmony into your life, Element.
[8] Jennings, S. 1992, Dramatherapy: theory and practice 2, London: Routledge.
[9] Casson, J. 2004, Drama, psychotherapy and psychosis – dramatherapy and psychodrama with people who hear voices, London & New York: Brunner-Routledge.
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