What is art therapy and how can it be implemented into arts education to help the mental health of secondary school students?

Learning Area Visual Arts & Design (Additional) 2, Semester 2 - November 2020

INTRODUCTION

In July of 1890, Oscar Wilde published his gothic and philosophical novel, A Picture of Dorian Gray. Within this novel came Wilde’s infamous proclamation, “all art is quite useless”. Despite Wilde, a creative writer, publishing this statement in a fictional novel, itself a form of art, this is something he believed widely to be true (Wilde, 1890). However, much research in the medical field has suggested art and creativity is actually quite beneficial for our mental and physical wellbeing.

Whether you choose to create it yourself or observe and enjoy it, art is a relaxing and inspiring activity for many people. But the benefits of artistic expression can go much further than only relaxation and inspiration. In this paper, I will explore the benefits of art as a therapeutic practice and use literature to support my proposition that therapeutic creative arts approaches and strategies can be used in a secondary school setting to help adolescents with their mental health. This will be done through the method of critical autoethnography (Ellis, Adams & Bochner, 2011), which is the process of analysing my own personal experiences in order to understand cultural experiences.

As someone who endured my secondary school experience with my own myriad of mental health conditions, my main motivation for becoming  a Visual Arts educator is to help young people. I want to provide adolescents with the resources I was not privileged enough to have access to, and create a space where they feel comfortable and safe to work through whatever conflicts they may have. I believe that art has the potential to provide this.

I am increasingly interested in the relationship between people and the things they make. For example, a chef and their dishes, an architect and their buildings, and a fashion designer and their garments. But most prominently, I am intrigued by the relationship between an artist and their artwork. Why do people choose to make what they do, and how have their lives and experiences impacted their work? The artists and creators I feel most drawn to are those who are vulnerable within their art and who have used art to reflect on themselves and their lives. I have commonly found that these artists who I feel a particular connection to have experienced their own mental health struggles. This revelation led me to question what the link is between creative arts and mental health, and why so many of us often turn to art to help.

MENTAL HEALTH CONCERNS

Diverse mental health issues are increasing and causing concern worldwide. In the past decade, there has been a 13% rise in reported mental health cases, with the average length of the disability lasting between one and five years (WHO, 2020). In 2018, there were over 3,000 deaths by intentional self-harm or suicide in Australia. 

Hankin (2006) explains how depression and other mental health concerns often begin in adolescents. A recent study by Headspace (2020) reported that close to 70% of Australian school-aged participants rated their mental health as being either poor or fair, while two-thirds of participants reported experiencing high or very-high psychological distress over the past 12 month. 83.2% of participants were stressed, and 75.8% felt anxious. More than half of the participants reported lack of energy or motivation, feelings of hopelessness and worthlessness, trouble sleeping and panic, while over one third of participants reported having thoughts of self-harm or suicide. Intentional self-harm or suicide is the leading cause of death in people between the ages of 15 and 44, and in 2018, suicide accounted for over one third of deaths among people aged between 15 and 24, with three quarters of those being between the ages of 15 and 17 (ABS, 2018). McNamara (2013) explores the risks that could potentially lead to suicide in this age bracket with the key concerns being disengagement with school and school or examination associated stress. For the 25,000 participants between the ages of 15 and 19 involved in the Mission Australia 2019 Youth Survey, the top three concerns for their wellbeing were coping with stress (44.7%), school or study problems (34.3%) and mental health (33.2%). The NAB Independent Schools Survey (NAB Group Economics, 2019) confirms this, with their results indicating the biggest impact to student wellbeing to be related to schoolwork, followed by mental health and future job prospects.

For students, anxiety has a significant impact on their learning and academic achievement (Gaudry & Spielberger, 1971), as well as social, physical and emotional performance. Mental health can affect energy levels, concentration, and optimism. Anxiety can cause extreme discomfort, especially within a learning environment, hindering their ability to learn. Anxiety also affects memory and the ability to hold onto information, as well as interfering with thought processes (Melbourne Child Psychology, 2020). 

There is a clear urgency to address these issues at a preventative level and to provide and improve strategies for those already affected. While the Australian Government has implemented initiatives such as Beyond Blue, Headspace and Kids Help Line, it is vital to address and make changes to the current education system to support these students. I propose using art within the school environment to provide students with an outlet to express these concerns.

HOW CAN ART HELP?

Art has always been a method of communication and expression. We have been creating since prehistoric time, when our ancestors left the first marks on cave walls over 40,000 years ago. Children naturally learn to use art as language; beginning with scribbles and lines, the ability to express their feelings and needs through art is developed before verbal language is learned (Shemps, 2008). 

Whether creating or viewing it, art has the ability to help explore emotions, develop awareness of the self, cope with stress and improve social skills (Cherry, 2020). Engaging within creative activities has the potential to reduce stress, depression and ease other mental health conditions. The recent challenges of a global pandemic have seen many turn to the arts as a creative outlet for expression and managing their fears and uncertainty. Not only is the actual act of creating often considered relaxing and meditative, it provides an evidence-based solution for externalising inner feelings. 

Recent advances in biological, cognitive and neurological science have found new evidence that supports the link between art and mental health. Studies have found that creating art reduces cortisol levels in the brain, which reduces stress and induces a positive mental state (Kaimal, Ray & Muniz, 2016) (Beerse, Van Lith, Pickett & Stanwood, 2019). Robert Mendick (2011) reported a study conducted by Professor Semir Zeki, who holds the chair in neuroaesthetics at University College London. The study was to determine “what happens in the brain when you look at beautiful paintings.” A group of participants underwent brain scans while being shown a series of 30 paintings by major artists, including Guido Reni, Claude Monet, Paul Cezanne and Hieronymus Bosch. When participants viewed the artworks that they considered the most beautiful, there was as much as 10% increase in blood flow to part of the brain, which is equivalent to gazing at a loved one. Zeki concluded that “whether it is a landscape, a still life, an abstract or a portrait, there is strong activity in that part of the brain related to pleasure.” This conclusion was reiterated in a later study (Nielsen, Fich, Roessler & Mullins, 2017) that found that art displayed in hospital settings contributed to promoting an experience of enhanced safety and satisfaction among patients, additionally contributing to positive health outcomes.

The arts help develop neural systems that produce a range of benefits, including fine motor skills to creativity and improved emotional balance (Phillips, 2015). When we make art, we are making a series of decisions and solving problems, which supports cognitive development. The brain is a predictive machine, as it is always consciously and unconsciously trying to imagine what is going to happen as well as prepare ourselves for it. Art provides a means for us to navigate those problems that might arise. Therefore, the act of imagining is an act of survival (Gharib, 2020). 

ART THERAPY AND ART AS THERAPY

Art therapy was conceived from the idea that the creative process of art making in itself is healing and provides a form of nonverbal communication of our thoughts and feelings. It is the marriage of two disciplines: psychotherapy and the creative arts. Like other forms of psychotherapy, it is used to encourage personal growth, increase self-understanding, and assist in easing negative emotions. Although the method of using art as a means of healing is as ancient as the prehistoric drawings on cave walls, the profession itself is an “infant” in the family of mental health disciplines (Rubin, 1980). Margaret Naumberg and Edith Kramer developed this concept during the Freudian era of Id psychology and the discovery of the conscious, preconscious and unconscious. Using a metaphor of an iceberg, Freud suggested that the mind was made up of three levels. The conscious consists of our immediate thoughts, like our inner monologue or perceptions. Preconscious holds our stored knowledge and memories that can be made conscious through a cue, such as being asked a question or reminded. The unconscious is inaccessible to our consciousness and we cannot become aware of them. This is the primary source of human behaviour, and like the iceberg, the most important part of the mind is the part you cannot see. Our feelings, motivations and decisions are powerfully influenced by our past experiences and unconsciousness (Codrington, 2018). Building on this theory, Naumberg and Kramer, among others, considered how art could be used as a tool to understand these levels of consciousness. 

It was widely believed that artworks in some way or another reflect the psychic experience of the artist. Some of the most well-known artists were plagued with their own mental health conditions, and even in the current day we hear too often about performers in the creative arts industries who have struggled with their mental health. Most notably is Vincent Van Gogh, who infamously cut off his own ear and later took his own life. In a letter to his sister (1889), he wrote “I am unable to describe exactly what is the matter with me. Now and then there are horrible fits of anxiety, apparently without cause, or otherwise a feeling of emptiness and fatigue in the head”.  Edvard Munch’s The Scream (1893) captures his anxiety and internal torment, which fuelled his art. In these artworks, much like the art produced within an art therapy environment, there is a continuity between the outer physical environment and the inner psychological environment of the person.

Art therapy, or art in therapy, is a psychotherapy procedure undertaken with a licensed art therapist, who takes on the role as a facilitator rather than an authority figure. No prior artistic skill or experience is expected or required. Art therapists meet people where they are in order to create “an oasis of creative experimentation” (Councill, 2015) within a treatment environment, focusing on defining problems and creating realistic goals. The essence of art therapy lies not within the final product, but in the act of creating something and making personal marks on something. We view and interpret art and the world in terms of our own biases and experiences (Takacs, 2003), therefore, the therapist's role is not to interpret the artwork made, but to work with the client to discover what they were thinking during the process of creating and what the artwork means to them personally. These artworks are considered both visual products of the client’s knowledge, as well as the process of embodied knowledge production. This process develops “whole brain” learning by promoting use of critical thinking (Bush, 1997).

Art as therapy is a similar approach that utilises the process of art making and connecting with the arts as a means of healing, but without a licensed art therapist. Engagement in the arts, both creating and viewing it, has therapeutic value. Art as therapy is most commonly found in music. We often turn to music and select pieces that will enhance or alter our current moods. We find listening to sad and minor music comforting when we are down, as it reminds us that we are not the only person experiencing these feelings. On the other hand, we may choose to listen to upbeat, positive music in order to lift our spirits. Many may find the act of playing an instrument and creating that music themselves the source of their comfort. The visual arts can do this too. 

Art as therapy is the foundation and prime motivation in my own artistic practice. Since a very young age, I have used the arts, both visual art and music, to explore and express my own feelings. In times of distress or discomfort, I have focused on the meditative act of drawing to calm myself down. I have explored issues of conflict as subjects within my artworks as a way of understanding them and providing closure. After being diagnosed with Asperger’s Syndrome at the end of 2018, I spent the following year exploring what this meant and coming to terms with my identity through the art I created. Consequently, at the start of 2020 I made a series of three artworks that embodied my thoughts and feelings about how I saw myself as someone on the ASD spectrum. Additionally, during a period of lockdown later in 2020, I created an artwork exploring my feelings surrounding COVID-19 and the consequential feelings of isolation and loneliness. Throughout both of these projects, I was able to externalise and objectify these inner thoughts in a neutral form that I was then able to distance myself from. Furthermore, the actual act of putting pencil to paper was not only meditative and calming, but created a headspace where I was easily able to process those negative thoughts and feelings.

HOW CAN THESE IDEAS BE IMPLEMENTED IN A SCHOOL SETTING?

As suggested previously, there is an urgent need to provide resources and ways for students to express themselves in order to ease and prevent mental health conditions from worsening in adolescents. Students want and need a place to discuss their emotions and experiences (Berman, 2001), and using ideas from art therapy within art education can provide that opportunity for them. Ideally, schools would have the funding to allow educational creative arts therapists to work within a school environment alongside wellbeing directors, school counsellors and art teachers. That way, both art in therapy and art as therapy approaches could be implemented in school settings. 

Some art therapy programs currently exist within Australian schools (Niemi, 2018), however these art therapists primarily work outside of the traditional classroom setting with individuals or small groups with special needs. I believe that these programs have the potential to help all students, and larger group programs should be implemented into an art education setting. 

An inclusive program that utilised arts-based therapeutic interventions at school would allow all students to participate, not just those recognised as having special needs or for those whose parents could afford additional therapy. The research has shown how art can be used to affect the brain and promote positive outcomes. Art education has the potential to affect everything in a student’s life, from overall academic achievement to their social and emotional development. As Jensen (2001) explains, “the systems [art] nourishes, which include our integrated sensory, attentional, cognitive, emotional, and motor capacities, are, in fact, the driving forces behind all other learning.” Not only would a program like this improve learning in all subject areas, it would also allow students to learn more about themselves.

There is an important relationship between adolescent mental and emotional health and their self-expression. This research is fixed in the fields of social cognition and differential psychology, and focuses on creativity being a subdomain of the self and identity (Linesch, 1988) (Barbot & Heuser, 2017). Therefore, it is important for secondary school educators to provide students with a space they can utilise and foster creativity in order to impact their identity formation. Art education can provide an outlet to do this, however student perceptions have been a source of barriers in doing so.

The arts are often seen as ‘soft subjects’ (Scholes & Nagel, 2012), perpetrated by the idea that they are female-dominated. In 2019, 1,100 males completed VCE Studio Arts, compared to the 3,400 females (VCAA) (not including gender X). As adolescents in secondary school are at such a critical point in their identity formation, they are often concerned with the perception of themselves from others. A contributing factor to the ratio of males to females in these subjects may be the fear of being bullied from their peers. Bullying is the second largest threat to student wellbeing, which poses a significant risk for students who do not conform to gender norms (Hannigan, Grima-Farrell & Wardman, 2019). Art in/as therapy practices can provide a space where all students, especially males, feel safe enough to explore, deconstruct and examine what their identity means to them in counter-hegemonic ways, while nurturing a sense of wellbeing in an environment that is supportive, non-judgemental and compassionate. Art with a therapeutic focus, rather than a focus on art being for the talented, promotes inclusivity and assures students that their ways of expression and creativity are correct and valued.

In order to develop strong inclusivity and a deep awareness of diverse perspectives relating to ethnic, class and gender sensitivities, as well as fostering student voice through “authentic student participation” (Hannigan et al, 2019), this program would have to sit outside of the marginalised and limited space and time that art education is commonly given in secondary schools. Additionally, to avoid issues surrounding assessment, this program would be initiated through either lunch-time or after school hours. Assessment is problematic in Visual Arts curriculums, as it prevents students from being experimental with the creative process, and focuses on the final product. Teachers need to be aware of ambiguity and avoid encouraging students to create something they have in mind, but rather focus on how the artwork is created. Assessing artworks can be highly subjective as each individual’s interpretation or analysis is drastically impacted by their own experiences and biases (Takacs, 2003). Instead of focusing on art for an assessment, there needs to be a strong focus on art for the individual and art for art’s sake.

The effectiveness of this practice within schools will be determined by levels of student participation and feedback. As this program will take place outside of regular class hours, student participation will be voluntary. There is clear evidence of the effect art has on the brain, however individual success depends on the students’ willingness to partake in such practices. Through recording numbers and regularity of attendance, as well as observing students’ mood throughout the program, teachers and schools will be able to determine it’s necessity and usefulness.

Students need to see the purpose of school within their own life. An emotional curriculum that incorporates positive psychology lets students incorporate their own experiences, conflicts and anxieties within their education, therefore allowing them to understand the importance of what they are being taught and how it directly applies to them. This helps students break away from feelings of hopelessness, and exchanges those feelings into ones of purposefulness.

CONCLUSION

The statistics of young people who are at risk of developing, or who have already developed mental health conditions is alarming, and secondary school educators have a responsibility to address those issues. This paper has highlighted the research on how art affects the brain physically to promote healthier mind sets. Art therapy and art as therapy are both practices that have used arts-based interventions and strategies to help people overcome their issues pertaining to their mental health conditions. I have proposed a way for art educators to use these practices and strategies to help adolescents during this critical period in their lives.

Additionally, this paper has led me to see the benefits in undergoing a creative arts therapy degree as professional development for being an art educator. An art educator’s primary job is to share knowledge, build a warm environment and mentor students, while an art therapist provides resources and insight into an individual's wellbeing. Having both of these skills would allow me to be fully dedicated to helping and nurturing individuals through art.