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Art therapy as a therapeutic tool in mental health

Abstracts

This study aimed to report the application of art therapy in daily practice, taking as object the experience developed in one of the therapeutic groups of the Center for Psychosocial Care of the Regional Executive Secretary III, that is a governmental institution of the city of Fortaleza that works in partnership with the Federal University of Ceara, using therapeutic devices in the field of mental health; besides that, promotes awareness and encouragement of other professionals and artists to have experiences of this nature. Thus, the actions taken were intended to: 1) maximize and give credit to the singular forms of the process of free creation of users, 2) improve self-esteem, 3) obtain a better emotional balance, and 4) minimize the negative effects of mental illness. The group has been appropriating of the languages of art, like painting, sculpture and the actions of production of free artistic expression, obtaining, thus, support and involvement of participants in the process, allowing changes in the fields of: affection, interpersonal and relationship.

Mental health; Art therapy; Creativity


Este trabalho objetivou relatar a aplicação da arteterapia na prática cotidiana, tomando por objeto a experiência desenvolvida em um dos grupos terapêuticos do Centro de Atenção Psicossocial da Secretaria Executiva Regional III, órgão da esfera municipal de Fortaleza que atua em parceria com a Universidade Federal do Ceará e que utiliza dispositivos terapêuticos no campo da Saúde Mental, além de promover a sensibilização e estímulo de outros profissionais dessa área e artistas para vivenciar experiências dessa natureza. Desse modo, as ações realizadas visaram à potencialização e valorização de formas singulares do processo de livre criação dos usuários, elevação da auto-estima, melhora do equilíbrio emocional e minimização dos efeitos negativos da doença mental. O grupo vem se apropriando de linguagens da arte, como a pintura, a escultura e de ações de produção de livre expressão artística, obtendo-se, assim, a adesão e o envolvimento dos sujeitos implicados no processo, propiciando mudanças nos campos afetivos, interpessoal e relacional.

Saúde mental; Terapia pela arte; Criatividade


Este estudio tuvo como objetivo informar sobre la aplicación de la terapia del arte en la práctica diaria, tomando por objeto la experiencia desarrollada en uno de los grupos terapéuticos del Centro de Atención Psicosocial de la Secretaría Ejecutiva Regional III, que es una institución municipal de la ciudad de Fortaleza, que trabaja en colaboración con la Universidad Federal de Ceará y que usa dispositivos terapéuticos en el campo de la salud mental; además, promueve la sensibilización y el estimulo de otros profesionales de esta área y de artistas para que experimente vivencias de esa naturaleza. Por lo tanto, las medidas adoptadas tienen por objeto: 1) maximizar y valorizar las formas singulares del proceso de creación libre de los usuarios, 2) la mejora de la autoestima, 3) obtener mayor equilibrio emocional, y 4) minimizar los efectos negativos de la enfermedad mental. El grupo viene apropiándose de los lenguajes del arte, como la pintura, la escultura y de acciones la producción de libre expresión artística, obteniéndose de ese modo la adhesión y participación de los sujetos involucrados en el proceso, lo que permite cambios en los ámbitos afectivo, interpersonal y relacional.

Salud mental; Terapia con arte; Criatividad


EXPERIENCE REPORT

Neusa Freire CoqueiroI; Francisco Ronaldo Ramos VieiraII; Marta Maria Costa FreitasIII

ISocial Assistant. Specialist in Epidemiology and Health Surveillance, active social assistant at CAPS/UFC. Psychosocial Care Center (CAPS / Universidade Federal do Ceará - UFC - Fortaleza (CE), Brazil

IIPlastic Artist. Graduate student of the Image and Communication Theories Specialization Course, Universidade Federal do Ceará - UFC - Fortaleza (CE), Brazil

IIISpecialist in Hospital Infection. Nurse of the General Psychosocial Care Center (CAPS), of Secretaria Executiva Regional III (III Regional Executive Department), partner of the Universidade Federal do Ceará - UFC - Fortaleza (CE), Brazil

Corresponding Author

ABSTRACT

This study aimed to report the application of art therapy in daily practice, taking as object the experience developed in one of the therapeutic groups of the Center for Psychosocial Care of the Regional Executive Secretary III, that is a governmental institution of the city of Fortaleza that works in partnership with the Federal University of Ceara, using therapeutic devices in the field of mental health; besides that, promotes awareness and encouragement of other professionals and artists to have experiences of this nature. Thus, the actions taken were intended to: 1) maximize and give credit to the singular forms of the process of free creation of users, 2) improve self-esteem, 3) obtain a better emotional balance, and 4) minimize the negative effects of mental illness. The group has been appropriating of the languages of art, like painting, sculpture and the actions of production of free artistic expression, obtaining, thus, support and involvement of participants in the process, allowing changes in the fields of: affection, interpersonal and relationship.

Keywords: Mental health; Art therapy; Creativity

RESUMEN

Este estudio tuvo como objetivo informar sobre la aplicación de la terapia del arte en la práctica diaria, tomando por objeto la experiencia desarrollada en uno de los grupos terapéuticos del Centro de Atención Psicosocial de la Secretaría Ejecutiva Regional III, que es una institución municipal de la ciudad de Fortaleza, que trabaja en colaboración con la Universidad Federal de Ceará y que usa dispositivos terapéuticos en el campo de la salud mental; además, promueve la sensibilización y el estimulo de otros profesionales de esta área y de artistas para que experimente vivencias de esa naturaleza. Por lo tanto, las medidas adoptadas tienen por objeto: 1) maximizar y valorizar las formas singulares del proceso de creación libre de los usuarios, 2) la mejora de la autoestima, 3) obtener mayor equilibrio emocional, y 4) minimizar los efectos negativos de la enfermedad mental. El grupo viene apropiándose de los lenguajes del arte, como la pintura, la escultura y de acciones la producción de libre expresión artística, obteniéndose de ese modo la adhesión y participación de los sujetos involucrados en el proceso, lo que permite cambios en los ámbitos afectivo, interpersonal y relacional.

Descriptores: Salud mental; Terapia con arte; Criatividad

INTRODUCTION

The present article intends to report how art-therapy is applied to the daily practice, through an experience developed with a therapeutic group from the Psychosocial Care Center (CAPS) of Secretaria Executiva Regional III (III Regional Executive Department) - a branch of Fortaleza Municipal Government - a partner of Universidade Federal do Ceará (UFC). This group uses artistic creation and cultural action processes to promote mental health.

Art therapy is a therapeutic instrument that absorbs knowledge from several different areas, resulting in a transdisciplinary practice that aims to rescue men integrally, through self-knowledge and transformation processes(1).

The Brazilian Association for Art Therapy defines it as a way of working with the artistic language as a basis for client-professional communication. Its essence is aesthetic creation and artistic elaboration on behalf of health(2).

Art therapy was established as a specific field of knowledge in the United States of America, in 1940, with Margaret Naumburg's work - she was known as the "mother" of art therapy for creating theoretical foundations for its development, as well as establishing it as an area of knowledge(3).

Art therapy was influenced by areas such as Freudian Psychoanalysis, which demonstrated interest for art, in the beginning of the 20th century, as means of unconscious manifestation through images. Sigmund Freud observed artists can materially symbolize the unconscious through their art, portraying psychism contents. With regard to this subject, it is possible to list his studies about masterpieces created by great artists, such as Leonardo da Vinci and Michelangelo(4-5).

Jungian Psychiatry starts using the artistic expression as part of the psychotherapy process in the 1920's. For Jung, images represent the individual unconscious, and sometimes, the collective unconscious symbolization(6).

In Brazil, two psychiatrists made outstanding contributions to the art therapy theoretical foundations: Osório César, in 1923, and Nise da Silveira, in 1946. Osório César worked with art at hospital do Juqueri, in São Paulo, and was mainly influenced by Psychoanalysis, while Nise da Silveira developed her work at Centro Psiquiátrico Dom Pedro II (Psychiatric Center), in Rio de Janeiro, and was largely influenced by Jungian psychiatry; both aimed to understand patients' artistic expressions(7-8).

Art therapy is a "predominantly non-verbal process that uses plastic arts and dramatization to understand human beings with their complexities and dynamicity. (...) it aims to accept patients' several aspects, such as affective, cultural, motor, social, among other aspects also important for mental health"(9).

Within such innovative perspective, Fortaleza's CAPS - through the Art and Health Project, part of the city mental health initiative - have been developing work involving art in mental healthcare, intending to enable and stimulate therapeutic group processes at the CAPS by using varied artistic expressions; work is developed by artists, art therapists, art educators, and mental health professionals graduated in art therapy.

At CAPS/ UFC these experiences began in 2007, initially with two groups. Eight months later, eight groups were participating, utilizing several different artistic languages.

Art is now present at the many CAPS of Fortaleza, trough the Art and Health Project, and art therapy groups are being created. The project is assisted and systematically supervised by the Instituto Aquilae (Aquilae Institute), which specializes in graduating art therapy professionals.

NARRATION OF AN EXPERIENCE: GROUP FRIENDS OF ART

In February 2008, an art therapy group named Friends of Art was created. The name was chosen by the participants, and embodies the affective bonds developed through art creation. Initially, the group was comprised of 15 members, both men and women, aged between 20 and 54. Currently it has 13 participants.

The therapeutic contract agreed upon was supposed to last for eight months, but was extended from September 2008 to February 2009. The calendar alteration was due to the results reached, which empirically presented a satisfactory psychic stability level among the participants, as well as the need for individual preparation (each participant at their own time) for therapeutic discharge, once they demonstrated an especial affection for such therapy model.

Although there were no rigid criteria to participate in the therapeutic group, people who were interested in art were prioritized. Another priority factor concerns serious mental disorder diagnoses, such as schizophrenia, bipolar affective disorder, and some cases of depression. Participation was granted to those who presented the minimal essential conditions to attend sessions.

It is worth highlighting that prioritizing people who were interested in or liked art was not a selection criterion, but a process facilitator. It does not mean emphasizing technique or the aesthetic aspects of art, on the contrary: the project intentions met the creative processes and free expression principles. Therefore, art is understood as an instrument of subjective enrichment, valorization of expression, and discovery of individual potentials.

Experience has demonstrated that to be willing to do it and admiring art creation are essential to be part of a group: in some cases, it does not matter how much a person is stimulated to do it, they do not demonstrate interest in participating. Hence, the user wish is respected, so that a new approach can be used in a different occasion.

The group used to meet once a week on Fridays, from 8:30 to 11am, and its facilitators included an artist graduated in plastic arts, a social assistant graduated in art-therapy, and a nurse who works with educational music, based on health area themes.

It was considered a semi-opened group due to the relative rotation of participants, and those who were absent for a period, returning later on. According to families' reports, these absences had reasons such as a diseased family member, accumulation of housework, and in less frequent cases, new episodes related to the participant's mental condition. It is relevant to highlight the "especial affection" users demonstrated to have for the group - which could justify the return to the sessions.

Activities were performed at an especially dedicated space: an adapted CAPS room, known at the time as the Studio, where all the material used in the meetings was kept, such as inks, canvasses, paper, crayons, clay, brushes, fabric, and recyclable material, among others. Pieces created by the participants in each session were exposed while getting dried, which brought a colorful visual aspect to the facilities.

The first meetings were basically dedicated to introductions and discussions about the group's expectations, as well as activities distributed along the initial sessions so as to integrate the participants and, at the same time, break resistances. From the first sessions, audio equipment, chairs, tables, and mats had been arranged in a circle so as to symbolize a closed gestalt situation(10).

During sessions, two distinctive techniques were used, depending on the participants' behavior at that moment, that is: if most of them presented a certain level of restlessness, a relaxation technique with instrumental music would be used, intending to reduce tension levels and anguish, allowing emotions to flow more intensely, transforming the session into a moment of deep contact with one's feelings(11-12).

On the other hand, if individuals presented low energy levels, body expression techniques would be used, namely body expression through collective games, and body movements with music, aiming to improve the emotional potentials in a ludic manner. During these moments, activities intending to improve expression abilities with regard to both body and mind were performed, not only in group, but also in an individualized way, guiding individuals towards self-discovery(11-13).

Therefore, activities began with relaxation or body expression exercises. Further on, participants would talk about how they feel, which was an opportunity to reflect over their emotions. As of this moment, according to the narrations depth and extent, facilitators would propose an appropriate technique, considering the situation at that moment, and using artistic expression. Thereby, emerging difficulties were worked with the group.

Several expression modalities with inherent therapeutic and specific properties are used in art therapy. It is the art therapist's responsibility to create an information repertoire regarding each modality, adjusting it to the user's needs(14).

The group Friends of Art has executed several proposals up to the present time, including works such as paintings on canvas, fabric painting techniques, monotype (ink printing technique), clay sculpture, painting and collage on tiles, and plaster painting techniques. Objects were also created from recyclable material, PET bottles, construction pipes, and cardboard.

By the end of the creative process, participants were stimulated to observe their work, and reflect about its meanings, considering the whole process, from the first moment of the artistic representation. The recyclable material is used in art therapy as a type of expression that rescues edification, structure, organization, and matter elaboration, stimulating individuals to construct in a personal way, simultaneously creating a social-environmental consciousness. Hence, the group was stimulated either individual or collectively to create and artistically express themselves, with an emphasis to the creative process, and how participants were led to reflect, searching for meanings (either inferred or given meanings) for their creation.

FINAL CONSIDERATIONS

Art therapy has been more and more accepted in the health area, mainly, the mental health field. Work developed with users of the General CAPS of Secretaria Executiva Regional III/ UFC offers an essential tool to ease mental disorders negative effects. Its main concern is to promote well-being for individuals going through mental suffering, favoring changes to the affective, interpersonal, and relationship areas, and improving emotional balance at the end of each session.

It is possible to observe that art therapy has been enabling users to experience their difficulties, conflicts, fears, and anguish in a less painful way. It is an effective way to positively deal with the mental disorder variables, as well as with personal and family conflicts. Negative factors related to the affective or emotional aspects are minimized. Such factors naturally emerge with the disorder, namely: anguish, stress, fear, aggression, social isolation, apathy, among others.

Considering the recent experiences using art as a therapeutic instrument for mental health at the previously mentioned CAPS SER III/ UFC, it was possible to empirically verify that art therapy, however way artistic languages are applied, has become an important tool to help people with mental disorders, generating visible results in a relatively short period of time.

The group Friends of Art can be understood as a space that is constantly building and rebuilding integration, socialization, experimentation and creation freedom with its participants, and has an essential objective: to ease mental suffering, enabling the right to find a connection with life, even if out of the normally accepted social standard(15).

The therapeutic experience interpretation and reflections enable people to embrace their own contents, getting to know themselves, and becoming active subjects in the therapeutic process.

It seems to be reasonable to think that the experience with the above mentioned CAPS art therapy group was a beneficial one, due to the results it presented. Therefore, it is necessary to broaden the Art and Health Project so as to create new therapeutic groups that see art as an important instrument to provide well-being to people suffering with mental disorders, as well as to promote health in general.

Upon this context, and based on the presented reflections, other mental health area professionals and artists in general are expected to have been sensitized and stimulated to experience such rewarding experiences.

REFERENCES

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  • 13. Kunz Elenor. Didática da Educação Física. Ijuí: Unijuí, 2002.
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  • 15. Munari Denise. Arte, arteiros e artistas: uma reflexão acerca da arte. In: Valladares, ACA (Org). Arteterapia no novo paradigma de atenção em saúde mental. São Paulo: Vetor, 2004.
  • Art therapy as a therapeutic tool in mental health

    La terapia del arte como herramienta terapéutica en salud mental
  • Publication Dates

    • Publication in this collection
      13 Jan 2011
    • Date of issue
      2010

    History

    • Received
      16 Feb 2009
    • Accepted
      05 Apr 2010
    Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
    E-mail: actapaulista@unifesp.br