Art Therapy for Psychosocial Problems in Children and Adolescents: A Systematic Narrative Review on Art Therapeutic Means and Forms of Expression, Therapist Behavior, and Supposed Mechanisms of Change

Abstract

Background: Art therapy (AT) is frequently offered to children and adolescents with psychosocial problems. AT is an experiential form of treatment in which the use of art materials, the process of creation in the presence and guidance of an art therapist, and the resulting artwork are assumed to contribute to the reduction of psychosocial problems. Although previous research reports positive effects, there is a lack of knowledge on which (combination of) art therapeutic components contribute to the reduction of psychosocial problems in children and adolescents. Method: A systematic narrative review was conducted to give an overview of AT interventions for children and adolescents with psychosocial problems. Fourteen databases and four electronic journals up to January 2020 were systematically searched. The applied means and forms of expression, therapist behavior, supposed mechanisms of change, and effects were extracted and coded. Results: Thirty-seven studies out of 1,299 studies met the inclusion criteria. This concerned 16 randomized controlled trials, eight controlled trials, and 13 single-group pre–post design studies. AT interventions for children and adolescents are characterized by a variety of materials/techniques, forms of structure such as giving topics or assignments, and the use of language. Three forms of therapist behavior were seen: non-directive, directive, and eclectic. All three forms of therapist behavior, in combination with a variety of means and forms of expression, showed significant effects on psychosocial problems. Conclusions: The results showed that the use of means and forms of expression and therapist behavior is applied flexibly. This suggests the responsiveness of AT, in which means and forms of expression and therapist behavior are applied to respond to the client's needs and circumstances, thereby giving positive results for psychosocial outcomes. For future studies, presenting detailed information on the potential beneficial effects of used therapeutic perspectives, means, art techniques, and therapist behavior is recommended to get a better insight into (un)successful art therapeutic elements.

From Therapeutic Factors to Mechanisms of Change in the Creative Arts Therapies: A Scoping Review

“…Art therapy takes place in the safety of the studio environment (Van Lith, 2015 ; Abbing et al, 2018 ; Nolan, 2019 ; Bosgraaf et al, 2020 ) and functions in the context of a strong therapeutic alliance (Bosgraaf et al, 2020 ; Keidar et al, 2020 ). Art therapists work in the here and now (Haeyen et al, 2015 ) to facilitate the expression and clarification of thoughts and feelings visually (Deboys et al, 2017 ; Abbing et al, 2018 ; Czamanski-Cohen et al, 2019 ).…”

“…Art therapy, like all CATs, modulates one's sense of time and space; art therapy promotes relaxation and a flow state (Abbing et al, 2018 ). Individuals and groups benefit from the opportunity to learn and practice artistic skills and forms of visual self-expression (Van Lith, 2015 ; Bosgraaf et al, 2020 ). The art-making process helps individuals and groups symbolize and externalize experiences that are not easily verbalized and concretize internal conflicts to facilitate perspective-taking and reflection (Deboys et al, 2017 ; Gabel and Robb, 2017 ; Abbing et al, 2018 ; Czamanski-Cohen et al, 2019 ; Bosgraaf et al, 2020 ).…”

“…Individuals and groups benefit from the opportunity to learn and practice artistic skills and forms of visual self-expression (Van Lith, 2015 ; Bosgraaf et al, 2020 ). The art-making process helps individuals and groups symbolize and externalize experiences that are not easily verbalized and concretize internal conflicts to facilitate perspective-taking and reflection (Deboys et al, 2017 ; Gabel and Robb, 2017 ; Abbing et al, 2018 ; Czamanski-Cohen et al, 2019 ; Bosgraaf et al, 2020 ). This non-verbal expression enables emotional elicitation and processing (Haeyen et al, 2015 ; Gabel and Robb, 2017 ).…”

“…The tactile quality of art (Abbing et al, 2018 ) and the choice of appropriate and specific art materials (Haeyen et al, 2015 ; Bosgraaf et al, 2020 ) contribute to reducing anxiety and enhancing self-concept. Researchers observe transference during art-making and the artistic product (Hilbuch et al, 2016 ) as well as the specific potency of art-making in promoting perspective taking and self-awareness.…”

“…Researchers observe transference during art-making and the artistic product (Hilbuch et al, 2016 ) as well as the specific potency of art-making in promoting perspective taking and self-awareness. Visual self-expression and the creation of a visual narrative were demonstrated to enhance self-concept, self-esteem and promote emotion regulation (Bosgraaf et al, 2020 ).…”