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Introduction
What are arts therapies?
Music therapy
Dance movement therapy
Voice movement therapy
Drama therapy
Art therapy
Regulation of arts therapies
How to find an arts therapist
Further reading
Useful organisations
References
‘Arts therapies’ refers to the use of arts – for example, music, painting, clay work, dance, voice or drama – in a therapeutic environment with a trained therapist.
This factsheet describes different types of arts therapies and the role of arts therapists in mental health. It has been written for anyone who is interested in finding out more about arts therapies.
The value of the arts for human survival tends to be underestimated in our society. Song, music, dance, drama and art have been fundamental and consistent forms of expression throughout human history, and are 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]
Arts therapies should not be confused with the arts for 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 fact that their creativity is art in its own right, rather than therapy, is one of the most important aspects that gives it value. This factsheet is about the arts as therapy.
Arts therapies are a way of using the arts – for example, music, painting, clay, dance, voice or drama – to express oneself in a therapeutic environment with a trained therapist. The therapist helps 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 skilled in whichever medium they use and have undergone intensive training as therapists. They work with 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 whilst maintaining professional boundaries and acting within the code of practice of their chosen therapy.
Arts therapies can provide a powerful means of expression and of release from trauma. They are particularly helpful for people who feel disengaged from their feelings or who 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 helping to accept them and to come to terms with events or to live with the memory of difficult experiences. Arts therapies can help people to get to know themselves better and can also enable people to get in touch with their spiritual side.
The guideline on schizophrenia published by the National Institute for Health and Clinical Excellence (NICE) quotes evidence that arts therapies are the only form of treatment found to be effective for the negative symptoms of schizophrenia, and recommends that they should be considered for everyone with this diagnosis, at all stages of the condition, including the acute stage, and to promote recovery. [2]
Music has two distinct applications as therapy:
This factsheet focuses mainly on the first of these applications.
In music therapy, 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 client and 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. Music therapy usually uses percussion or simple melodic instruments that can be played successfully without prior knowledge or the need to read music; 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 their voices, and to 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; 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 help the client to develop increased self-awareness and, particularly 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. [4] 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; a skilled therapist will use music to engage the client’s 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 to more open spoken expression, or to writing.
Music can act as a stimulus to awaken buried memories or evoke emotional responses that may otherwise be inaccessible. In this way, it can obtain results that may take weeks to achieve with talking therapies. It can be a useful route to healing for people of any age or background. It can be particularly valuable in the care of people with dementia – the part of the brain that responds to music is the most long-lasting, and a person may be able to play or sing, appreciate music and be calmed by it even 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 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. It can also be helpful to friends and family as something they can share. [5]
Dance, or dance movement, therapy uses movement and dance to help people express their feelings and to feel that their mind and body are integrated. Dance therapy has its roots in modern dance and the work of dancers such as Isadora Duncan and Martha Graham, who pioneered expressive dance that allowed spontaneous individual expression. [6] Dance therapy 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 with individuals or in groups, in a wide range of settings, including hospitals, residential care and day centres.
The therapist observes, acknowledges and supports the client’s movements, and encourages the client to develop and change their movement to facilitate emotional changes. For example, a person who is 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, 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 the client is feeling.
Dance therapy is also helpful for people who want to develop greater self-understanding and personal growth. It may be particularly effective for clients whose problems are expressed physically; for example, those concerned about body image, or whose emotional problems are expressed psychosomatically (as physical illnesses). 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. The 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 a client brings to a session reveals their personal developmental history. The way they move may also be affected by antipsychotic drugs, which often have significant effects on movement. [7] While drugs may limit the effects of therapy, dance may help clients to overcome some of these side-effects. Dance movement therapy may help people who are experiencing dissociative states – feelings of being detached and disconnected from one’s surroundings, and out of touch with everyday life , which may arise as a result of trauma, stress or substance misuse – to express their feelings physically and to be more aware of their bodies as part of themselves.
Working with movement can free the emotions. Developing a new repertoire of movements may help clients to feel happier in their bodies and more at ease with themselves.
The human voice reflects both physical and emotional elements of a person. 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). [8]
Voice movement therapy essentially uses the voice to explore the self, and uses movement and massage to help free the voice, breath and throat, all of which may be blocked or constricted, inhibiting free expression through the voice. Voice movement therapy 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 that 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 as a way to express hidden emotions. The different voices from the full range may also be used to create characters that represent different aspects of the self. In this way, voice movement therapy may incorporate music, drama and dance. The effect can be uplifting and invigorating, releasing both the voice and the spirit.
Voice movement therapy is useful for people who find it difficult to use their voices for speaking or singing because of physical or neurological problems or emotional blocks. For some people, speaking is difficult, especially in large groups, and they can feel that their voice is trapped. Voice movement therapy can free the voice and promote free self-expression, self-confidence and self-knowledge.
‘It is a paradox of dramatherapy that stepping out of themselves into a role they are playing enables clients to engage with damaged or buried aspects of themselves’ (Sue Jennings, Dramatherapist). [9]
Dramatherapy is a form of group therapy that 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 to 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. Drama may be used to act out a situation that has really happened, helping a client 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, or sessions 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 that the group members are addressing.
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 the 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 – partly because they are given no language with which to speak of it. To talk on a spiritual level, one has to use metaphor and stories. Trying to use scientific language can trap us into not being able to say anything.
Dramatherapy may allow the creation of a story that 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 client ever having to spell out the meaning. Drama draws on the use of metaphor, which is crucial to expression of the inexpressible. It provides a distance from an experience that cannot be spoken about.
The client is not confined to the role of player. The roles of director and lighting engineer and the creation of scenery, costume and so on may all be used in therapy. Clients may, in role reversal, become a prop or a piece of scenery themselves. They may also be the audience if they are feeling overwhelmed, allowing them to withdraw to a safe space without leaving the group.
Drama may enable people to change power relationships, which can often be the first step towards a full recovery. When someone has been in a situation where they have no power – which is often the case for people with mental health problems – being asked to take control can be frightening. Dramatherapy and psychodrama offer a safe experience of being in control and the possibility of practising such roles and learning to say no.
Dramatherapy can be used to treat clients who have been abused, 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. [10]
Art therapy is the use of painting, clay work and other 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 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 that have troubled them for many years.
Using a camera may help clients to connect with the present moment, as well as relating the things they choose to photograph with memories and emotions connected 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 expresses, 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 produced can provide important clues to what is behind their client’s 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 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 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 help 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 stabilising because of the engagement with physical materials.
The arts therapies are regulated by the Health Professionals Council (see 'Useful organisations'). Once qualified, art psychotherapists, art therapists, dramatherapists and music therapists must apply for state registration with the Health Professions Council before they can practise. Each of the therapies has its own professional organisation (see below) and code of practice.
Arts therapists are employed as part of mental health teams in some NHS trusts, and in those areas arts therapies can be provided as part of a mental health service. However, this is not very common; so although it is possible to be offered some form of arts therapy as part of a care programme, provision is patchy. Psychiatric wards sometimes offer arts therapies to in-patients, and other local providers, such as local Mind associations, may offer arts therapy groups, depending on the availability and interest of local therapists. The other possibility is to find a private therapist, who may offer individual therapy sessions or run groups, depending on the type of therapy they are offering. See ‘Useful organisations’ for further information.
Bunt, L. 1994, Music therapy, an art beyond words, London: Routledge.
Case, C. and Dalley, T. 2006, The handbook of art therapy, London: Routledge.
Casson, J. 2004, Drama, psychotherapy and psychosis – dramatherapy and psychodrama with people who hear voices, London and New York: Brunner-Routledge.
Chaiklin, S. and Wengrower, H. (eds), 2009, The Art and science of dance/movement therapy, 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.
Darnley-Smith, R. and Patey, H.M. 2003, Music therapy (creative therapies in practice), London: Sage.
Farrelly-Hansen, M. (ed), 2001, Spirituality and art therapy: living the connection, London: Jessica Kingsley Publishers.
Langley, D. 2006, An introduction to dramatherapy, Sage Publications Ltd.
McNiff, S. 2004, Art heals: how creativity cures the soul, Shambhala Publications Inc.
Moreno, Z, Bradshaw Tauvon, K, Holmes P and Holmes P (eds), 1998, The handbook of psychodrama, London: Routledge.
Newham, P. 1999, Using voice and movement in therapy: the practical application of voice movement therapy, Jessica Kingsley.
Payne, H. (ed.), 2006, Dance movement therapy: theory and practice, London: Routledge.
Sutherland, M. 1997, Draw on your emotions, Brackley: Speechmark Publishing.
Association for Dance Movement Psychotherapy UK (ADMP UK)
32 Meadowfoot Lane, Torquay TQ1 2BW
email: admin@admt.org.uk
web: www.admt.org.uk
The ADMP aims to develop communication among dance movement therapists and to promote its use throughout the UK in accordance with the highest professional standards. The ADMP also works with the other art therapy professions in the UK (music, drama, art). The website provides a directory of therapists.
Association of Professional Music Therapists
24–27 White Lion Street, London N1 9PD
tel: 020 7837 6100
email: APMToffice@aol.com
web: www.apmt.org
The professional body for qualified and training music therapists in the UK.
The British Academy of Sound Therapy and Soundworks
tel: 01243 544 454
email: mail@healthsound.com
web: www.sacredsound.net
The website provides information about sound therapy, and information about the British Academy of Sound Therapy, which provides professional training for sound therapists.
British Association of Art Therapists (BAAT)
24–27 White Lion St, London N1 0PD
tel: 020 7686 4216
email: info@baat.org
web: www.baat.org
The professional organisation for art therapists in the UK.
British Association of Dramatherapists (BADth)
Waverley, Battledown Approach, Cheltenham GL52 6RE
tel: 01242 235 515
email: enquiries@badth.org.uk
web: www.badth.org.uk
The professional body for dramatherapists in the UK.
British Society for Music Therapy (BSMT)
24–27 White Lion St, London N1 0PD
tel: 020 7837 6100
email: info@bsmt.org
web: www.bsmt.org
The organisation responsible for promoting and developing music therapy in the UK. Runs a public information service on music therapy.
Health Professions Council
Park House, 184 Kennington Park Road, London SE11 4BU
tel: 020 7582 0866
email: info@hpc-uk.org
web: www.hpc-uk.org
Regulator for several health professions, including arts therapists (art psychotherapists, art therapists, drama therapists and music therapists).
International Association for Voice Movement Therapy
web: www.iavmt.org
Organisation for practitioners of voice movement therapy, which maintains its core principles and standards, and holds lists of registered practitioners including those in the UK.
Nordoff Robbins Music Therapy
2 Lissenden Gardens, London NW5 1PQ
tel: 020 7267 4496
email: admin@nordoff-robbins.org.uk
web: www.nordoff-robbins.org.uk
Nordoff Robbins is a charity that provides music therapy sessions to children and adults constrained by illness, disability, trauma or isolation.
Roundabout
Cornerstone House, 14 Willis Road Croydon, Surrey CRO 2XX
tel: 020 8665 0038
web: www.roundaboutdramatherapy.org.uk
Roundabout is a charity that conducts long- and short-term dramatherapy projects with a range of clients.
Tonalis music centre
4 Castle Farm Close, Leighterton, GL8 8UY
tel: 01666 890 460
email: info@tonalismusic.co.uk
web: www.tonalismusic.co.uk
The Tonalis music centre provides a wide range of music experiences. The website provides links to many other organisations involved in music therapy.
[1] Casson, J. 2004, Drama, psychotherapy and psychosis – dramatherapy and psychodrama with people who hear voices, London and New York: Brunner-Routledge.
[2] NICE, 2009, Core interventions in the treatment and management of schizophrenia in primary and secondary care (update). Clinical guideline 82. www.nice.org.uk/cg82.
[3] Darnley-Smith, R. and Patey, H.M. 2003, Music therapy (Creative Therapies in Practice), London: Sage.
[4] Nordoff, P. and Robbins, C. 1971, Therapy in music for handicapped children, London: Gollancz.
[5] Aldridge, D. (ed), 1999, Music therapy in palliative care, London: Jessica Kingsley Publishers.
[6] See www.admt.org.uk, accessed November 2006
[7] Mind. 2008, Making sense of antipsychotics, London: Mind.
[8] Newham, P. 1999, The healing voice: how to use the power of your voice to bring harmony into your life, Element.
[9] Jennings, S. 1992, Dramatherapy: theory and practice 2, London: Routledge.
[10] Casson, J. 2004, Drama, psychotherapy and psychosis – dramatherapy and psychodrama with people who hear voices, London and New York: Brunner-Routledge.
This factsheet was written by Katherine Darton, Mind Information Unit, and updated November 2009.