Arts therapies

The arts therapies and how they are used

[Note: Arts therapies should not be confused with using the arts for fun or creativity. Creative arts may of course be very helpful, and for some people, the very fact that their creativity is art in its own right, rather than therapy, is one of the most important things that give it value; but this is not what we will discuss here.]

What are arts therapies?

Arts therapies are a way of using the arts – for example, music, painting, clay, dance, voice or drama – in a therapeutic environment with a trained therapist. They can help you to express things that are hard to put into words.

You do not need to have any special skill or previous experience of the arts in order to benefit from arts therapies, and the aim is not to produce a wonderful work of art, but to use the art form to understand yourself better with the help of the therapist.

Arts therapists are skilled in whichever medium they use, and they will help you to express yourself by creating something. They will then help you to make sense of what you have created in relation to your life experience and your state of mind.

Whatever you express is contained in the therapy room in a way that is safe; they will maintain professional boundaries, just as any therapist should, and act within the code of practice of their chosen therapy.

For me a major benefit of arts therapies is that it gives you the opportunity of using the art form in a safe space, which can be empowering and healing in itself.

Sometimes arts therapies take place in a group setting. You are likely to get to know the other people in the group more quickly, and to know a lot more about them, than is usual in ordinary social groups. You may find this helpful if you are someone who is isolated and you find it difficult to get to know people; but you may also find it off-putting if you are a very private person, or wish to work on issues you would not want to share with anyone who was not a therapist – in this case, you may find one-to-one sessions more suitable.

Who are arts therapies for?

For some people, arts therapies may provide more profound and long-lasting healing than more standard forms of treatment for mental health problems. They can provide a powerful means of expression and a release from trauma.

They are particularly helpful if you feel distanced from your feelings or if you find it too upsetting to talk about painful experiences, and would therefore find it difficult to benefit from talking therapies, such as counselling or psychotherapy. Using the art form to express yourself, you can express your feelings without words, come to terms with events, or learn to live with the memory of difficult experiences.

Arts therapies may be helpful for any kind of mental health problem. This includes conditions which are given the label ‘psychosis’.

The National Institute for Health and Clinical Excellence (NICE) recommends arts therapies in their guidelines on schizophrenia, quoting evidence that arts therapies are the only form of treatment found to be effective for the negative symptoms of schizophrenia, and recommending that they should be considered for everyone with this diagnosis, at all stages of the condition, including the acute stage, and to promote recovery.

What are the different arts therapies?

The information in the following sections focuses on the arts therapies for which there are recognised professional bodies, providing regulation of their members and codes of practice. These are:

• music therapy
• dance movement therapy      
• voice movement therapy
• dramatherapy
• art therapy.

Music, dance movement and voice movement therapy

What happens in music therapy?

In music therapy, music-making forms the basis of communication between you and the therapist. Usually, you would both take an active part in the sessions by playing, singing and listening. The relationship between you and the therapist is fundamental, as it is in talking therapies, but you communicate through music as well as words.

Music therapy usually uses percussion or simple melodic instruments that can be played without any musical 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 nice sound with little or no previous experience.

Sessions may include improvisation, when you make up your own piece of music and/or prepared pieces, which you practise and develop. You are encouraged to find out what sounds you can make with the instruments or with your voice, and to create a conversation with the therapist in sound. If you do play an instrument, you may want to bring it to therapy to play as part of your treatment. The music played may cover a wide range of styles depending on your taste, your musical experience and what you want to get out of it.

After a session of music, you may discuss together how it went, and what thoughts or feelings came up.

How music therapy can help

The therapist will aim to create positive changes in the way you feel by responding through music to the emotions that you express through your music. They will also help you to develop your self-awareness and, if you are working in a group, awareness of yourself in relation to others.

Improvising a song may encourage you to put your feelings into words when you have been unable to do this before. This may lead to writing things down, or to being able to talk more easily.

Music can 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.

Music therapy may be used to make contact with you if are very withdrawn and reluctant to have anything to do with other people. The advantage of music is that, because it is sound, it is difficult to avoid it. Even if you feel unable to respond to people, you are obliged to hear the music, if not to consciously to listen to it; and a skilled therapist will use music to keep you engaged and lead you to a response.

What happens in dance movement therapy?

Dance, or dance movement, therapy is based on the idea that the way people hold themselves and move expresses the way they feel about themselves. It uses dance and movement to help you express those feelings spontaneously and to feel that your mind and body are integrated. It may help you to become more aware of emotions that you find it hard to talk about and more at ease with your body.

Dance therapy may be used with individuals or in groups, in a wide range of settings, including hospitals, residential care and day centres. You will probably want to wear loose, comfortable clothes, and may dance in light, flat shoes, or bare feet.

How dance movement therapy can help

The therapist observes, acknowledges and supports your movements, and encourages you to develop and change your movement to change the way you feel. For example, if you are subdued and generally carry yourself stooped and small, you may be encouraged to reach up and out and stand more upright, so you feel more self-confident. Through moving with you and copying your movement patterns, the therapist can directly share some of your experience and can develop an instant empathy and awareness of how you are feeling.

Dance therapy is also helpful if you want to develop greater self-understanding and personal growth. It may be particularly effective if your problems are expressed physically; for example, if you are concerned about body image, or if your emotional problems come out as physical illnesses. It may also help you if you struggle with issues around bodily contact and trust.

If you have a history of early trauma or psychotic experiences this may affect the way you hold yourself and move. Movement in therapy becomes a method of remembering, and expressing and resolving issues.

If you have feelings of being detached and disconnected from your surroundings, and out of touch with everyday life, dance movement therapy may help you to express your feelings physically and to be more aware of your body as part of yourself.

The way you move may also be affected by medication, especially if you are taking antipsychotic drugs, which often have significant effects on movement, making you stiff, giving you muscle spasms, or slowing you down (see Antipsychotics). Dance may help you to overcome some of these side-effects.

What happens in voice movement therapy?

The human voice reflects how you are both physically and emotionally. Voice movement therapy works with the emotional aspects of using the voice. In voice movement therapy you use your voice to explore your self, and your therapist may also use movement and massage to help free your voice, breath and throat, all of which may be blocked or constricted, and make it hard for you to express yourself freely.

Words are often not the most important part of the expression, although they may be used. You may express yourself through wordless singing, shouts and cries and other utterances that vocalise emotion without words.

Alternatively, your therapist may encourage you to write and create songs that use the broadest possible range of your voice as a way to express hidden emotions. You may use different voices to create characters that represent different aspects of yourself. In this way, voice movement therapy may incorporate music, drama and dance.

How voice movement therapy can help

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 self-expression, self-confidence and self-knowledge. 

Voice movement therapy combines knowledge of acoustics and the anatomy and physiology of the voice with movement, acting out, and imagery. The way you breathe is an important part of this, and you may find you learn a new way of breathing and controlling your breath. Its effects on breathing may be especially helpful if you have panic attacks.

Dramatherapy

What happens in dramatherapy?

... [In] dramatherapy 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).

Dramatherapy is a form of therapy that uses all aspects of theatre and drama. It is usually used in groups, but may also be offered on a one-to-one basis.

Existing scripts may be used or adapted for particular situations, or sessions may be entirely improvised (made up by the client/s and the therapist). Drama may be used to act out a situation that has really happened, helping you to understand and work through the emotions aroused, or you may improvise a new situation which brings insight into your feelings and relationships.

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 you or the group are addressing.

The techniques used include improvisation, role play, mime, acting out, movement, rhythm, speech and using your voice in other ways, as well as other aspects of theatre. However, you don’t need to be an actor in dramatherapy; you may also be the director or producer, do the lighting, or help with creating scenery, costume or props (depending on how elaborate your sessions are and what equipment you have). All of these roles may be used in therapy. You may become a prop or a piece of scenery yourself. You may also be the audience: if you are feeling overwhelmed, this allows you to withdraw to a safe space without leaving the group.

How dramatherapy can help

Dramatherapy may enable you to explore difficult issues, such as psychotic experiences. You might create a story that can be acted out to express that kind of experience indirectly. The story or characters can express your feelings and represent people and events through imagery or symbols and have a powerful therapeutic effect without you ever having to spell out the meaning. You may be able to understand yourself better as a result of this, without needing to analyse and explain it all afterwards. In this way, drama allows you to express things you find it too difficult to talk about. It provides a safe distance from the experience.

Drama may enable you to change power relationships, which can often be the first step towards recovery. 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. Dramatherapy can let you practise being in control, saying what you want, and saying ‘no’.

Dramatherapy can be used to treat people who have been abused, so that they learn to put their past behind them and continue with their lives without the need for medication or other further therapy.

Art therapy

What happens in art therapy?

Art therapy uses 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. The materials you use may also include found objects, collage and photography. If you have become disengaged from reality, or feel disconnected from the natural world, using objects such as stones or pieces of driftwood or bark may help you to reconnect with nature in a way that helps you to feel closer to your surroundings. Found objects may also remind you of experiences you have had, and help you express associated feelings in the art you create with them.

In some situations (for example, a manic episode), colour is over-stimulating, and clay work may be used to help you feel more grounded. Clay can be used to represent feelings that can be changed and transformed. This can change the way you deal with emotions, enabling you to leave behind things that have troubled you for many years.

Using clay to sculpt ‘my family’ was really revealing - I thought I knew what the problems were and whose fault it was, but my perspective changed. It helped me start understanding my family dynamics better and move on from being stuck in them.

Using a camera may help you to connect with the present moment, as well as relating the things you choose to photograph with memories and emotions connected with your past.

You may discuss the art you have created with the therapist, or in the group, to explore the feelings it expresses, but this may not be necessary, and in some situations it may make you feel worse – the art itself may be all the expression you need, because talking may be too distressing.

How art therapy can help

Art allows us to find ourselves and lose ourselves at the same time.Thomas Merton, contemplative monk.

Part of art’s value as therapy is that, like music and dance, 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 boundaries.

For the therapist, the art produced can provide important clues to what is behind your distress, and your progress and recovery may be mapped or documented by your artistic creations.

The artistic creations themselves may provide a satisfying way of concluding therapy, and they may be put in an exhibition. Framing and hanging a picture may be part of the therapeutic process. A frame may, for example, represent a boundary which contains emotions and makes them safe. On the other hand, you might let your picture spill over it so that it represents a form of breakthrough.

An exhibition may help you to accept your 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 help you return to mainstream society if your life has become dominated and limited by your mental health problems.

Art therapy can have profound effects in enabling you to get in touch with and express your feelings, while at the same time being stabilising, because you are handling physical materials.

Regulation of therapists and how to find one

How are arts therapies regulated?

Each of the therapies discussed here has its own professional organisation. Therapists need to belong to the appropriate professional body and adhere to its code of practice in order to be accepted in employment as a therapist. If you are seeing someone privately, it is important to check this with them before you start therapy.

Some of the arts therapies are regulated by the Health and Care Professionals Council (HCPC). Once qualified, art psychotherapists, art therapists, dramatherapists and music therapists must apply for state registration with the HCPC before they can practise. Voice and dance movement therapies are not regulated by the HCPC.

How can I find an arts therapist?

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. Private therapy can be expensive; groups may be more affordable because they share the cost. See ‘Useful contacts’ for further information.

Useful contacts

Association for Dance Movement Psychotherapy UK (ADMP UK) web: www.admt.org.uk
Provides a directory of therapists

The British Academy of Sound Therapy
tel: 01243 544 454
web: www.healthysound.com
Information about sound therapy

British Association of Art Therapists (BAAT)
tel: 020 7686 4216
web: www.baat.org
Provides a directory of therapists

British Association of Dramatherapists (BADth)
tel: 01242 235 515
web: www.badth.org.uk
Has a list of drama therapists

British Association for Music Therapy (BAMT)
tel: 020 7837 6100
web: www.bamt.org
Information on music therapy in the UK

Health and Care Professions Council
web: hpc-uk.org
Keeps a register of health and care professionals, including "arts therapists".

International Association for Voice Movement Therapy
web: www.iavmt.org
Lists registered practitioners, including those in the UK

Nordoff Robbins Music Therapy
tel: 020 7267 4496
web: www.nordoff-robbins.org.uk
Provides music therapy sessions to children and adults with a range of conditions

Roundabout
tel: 020 8665 0038
web: www.roundaboutdramatherapy.org.uk
Charity that conducts long- and short-term dramatherapy projects with a range of clients

Sesame Institute
tel: 020 7633 9690
web: www.sesame-institute.org
Drama and movement for play and growth

Tonalis music centre
tel: 01666 890 460
web: www.tonalismusic.co.uk
Provides a wide range of music experiences and links to many other organisations involved in music therapy

Published 2012
To be revised 2014
See our guidance on reproducing our information