Art Therapy in Mental Health Promotion ^†

Abstract

The description of this clinical nursing intervention reaffirms the therapeutic potential of art therapy in the promotion of mental health in a psychiatric setting. Ten patients participated. An intervention plan was developed based on the nursing process methodology, using the nursing ontology approved by the Portuguese Order of Nurses. The nursing diagnoses related to the intervention group were identified. The aims and the planning of the art therapy sessions were delineated, and, in addition, the assessment strategies. We concluded that art therapy promoted the relationship between the nurse and the therapeutic group, with positive results in self-concept and mood balance.

1. Introduction

Art therapy is considered a transdisciplinary art that uses artistic activity to promote health and quality of life, involving different areas: plastic, sound, literacy, drama, and the body, based on different expressive techniques such as drawing [1], painting, modelling, music, poetry [2], and drama and dance [3], with the unblocking function of the internal contents [4], thus presenting itself with a potential therapeutic promoter of mental health.

In the 20th century, Jung understood that artistic language was associated with psychotherapy. He considered artistic creativity a natural and structuring psychic function, whose healing ability was to give form and transform unconscious contents into symbolic images [3]. His patients would freely draw or paint their dreams, feelings, and conflicts, examining the images created as a symbolization of the individual and collective unconscious, as he admitted that this allowed the reorganization of the inner chaos [3], providing the patient with contact with his/her real psychic core, which was often unconscious.

Therefore, art therapy is assumed to promote the relationship between nurses and patients, minimize pathological symptoms, and promote health. It can be used in groups or individually, at school, in hospitals, and with different age groups and different health issues, with implications at the level of mood, interpersonal skills, stress reduction, and discrimination of reality [5,6,7].

Although art therapy has been gaining attention in the mental health area, we believe it is important to promote literacy on its therapeutic purpose to contribute to its more regular and systematic use in nurses’ clinical practice. Thus, we describe an experience of art therapy clinical intervention in a psychiatric inpatient institution.

2. Material and Methods

A descriptive study, a report of an experience of clinical art therapy intervention in a psychiatric setting, was carried out during the month of April 2022. The study involved ten patients who were motivated to participate in the activities, who signed informed consent forms and who did not meet the following exclusion criteria: confusion/disorientation, delirium or hallucination, aggressive behavior, sleepiness, or social phobias.

An intervention plan was developed based on the nursing process methodology, using the nursing ontology approved by the Portuguese Order of Nurses in 2021. The nursing diagnoses related to the intervention group were identified and the objectives, the planning of the art therapy sessions, and the assessment strategies were outlined.

3. Results

The following nursing diagnoses emerged: compromised self-concept, depressive mood, the potential for improving knowledge about strategies promoting mood balance, and the potential for improving awareness of the relationship between positive thinking and mood balance.

The art therapy clinical intervention involved various types of artistic expression, related to the theme ‘spring’, considering the time of year the study took place. The users drew, painted, cut, and pasted, with positive results regarding concentration, decision-making capacity, and creativity, allowing the stimulation of visual, motor, and cognitive functions. Through the colors and the expression of the stroke (soft/strong/shivering, among others), the painting and drawing allowed the users to organize, objectify, express feelings and their vision of the world/life, expand their imagination and control their movement. The users were calmer after these activities.

Cutting and pasting allowed for the improvement of concentration, memory, imagination, construction, and recreation, promoting the reformulation of mental processes.

As regards to music therapy and given the type and rhythm of music selected, this had more perceptible results in users with a depressive mood, with positive effects for insomnia, in the verbalization of more positive thoughts, and for users trending to social isolation as well.

4. Discussion

The nurses’ intervention enhanced the level of self-concept and mood, as well as users’ knowledge about strategies promoting mood balance and awareness of the relationship between positive thinking and mood balance. Furthermore, it promoted fine motor skills, social interaction, and respect for social rules.

The findings [7,8,9] revealed that art therapy promotes social interaction and the remission of the symptoms that cause psychic suffering, which allows users to express emotions and feelings, improve their perception of their health condition, reduce their restlessness, and facilitate self-reflection and the acquisition of autonomy regarding their mental condition. Radzińska and collaborators [10] and Santos and collaborators [11] also point out that art therapy improves mood, stimulates practical and cognitive skills, and mitigates behavioral changes [10,11]. The stimulation of perceptual functions and the reorganization of internal contents are also mentioned by Lopes [12].

In this clinical experience, it was evident that artistic expression allowed for working in the affective-emotional sphere, enabling participants to experience their difficulties, conflicts, fears, and anxieties, promoting the knowledge of self and others. For example, in drawing, the gesture of drawing symbolically records the feelings of its creator; calm gestures in soft strokes, insecure gestures in intermittent or flickering strokes, aggressive gestures in strong strokes, among others, according to the emotions that emerge while drawing [4]. In turn, cutting and pasting may symbolize repair, and construction through the cohesion of different materials may imply reorganization and may symbolize fragmented aspects of self.

In relation to music therapy, other studies corroborate these results by stating that music therapy may help patients with depression to integrate into a group, reduce anxiety symptoms, and improve self-esteem [13]. On the other hand, the advantages of using music therapy are also described regarding insomnia, substance addiction, anxiety, and aggressive and antisocial behavior [14].

Thus, the art therapist uses resources such as imagination, symbolism, and metaphors, which facilitate communication, the reorganization of internal contents, meaningful emotional expression, and the deepening of internal knowledge, with individuals being able to release the ability to think and be creative [4], minimizing harmful affective and emotional factors that naturally arise with mental disorders, such as anguish, stress, fear, aggressiveness, social isolation, and apathy, among others [15].

Although this clinical experience portrays a scene from a specific context related to specific participants and cannot be generalized, it contributes to reinforcing the importance of art therapy in preventing the worsening of patients’ conditions and enhancing their mental health. This may reinforce the advantages of more regular use of this type of intervention, which may contribute to the further development of research on its therapeutic potential.

5. Conclusions

Art therapy allowed for interaction between the therapeutic group and the nursing professionals and promoted the expression of feelings and emotions through reflection on the artwork produced, which led to self-knowledge and better perception of others, improved self-concept and mood, and the development of cognitive and emotional resources which are potentially more effective in the resolution of daily conflicts, therefore promoting mental health in each of the subjects of the intervention.