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What do you see?: studies on time-limited psychodynamic art psychotherapy
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main purpose of this thesis is to explore experiences of two different psychological interventions based on art psychotherapy in women with a psychological or physical illness. The two interventions are art psychotherapy and art therapy. The difference between these two interventions is that the art therapist works with the transference in art psychotherapy but not in art therapy. The thesis consists of two studies of art psychotherapy: An art psychotherapy intervention is evaluated in Study 1 (papers III and V) which examines a group of patients diagnosed with depression and Study 2 (paper II) which examines experiences in a group of six patients diagnosed with vulva vestibulitis. An art therapy intervention is evaluated in the third study (papers I and IV); where experiences in patients diagnosed with breast cancer are examined.

In Study 1, forty-three (n=43) depressed women were randomly assigned to either an intervention group or a control group (verbal psychotherapy). The aim was to examine the outcome of time limited psychodynamic art therapy compared to time-limited psychodynamic verbal therapy for patients with depressive symptoms. Interviews were performed before, immediately after, and three months after the termination of psychotherapy, and self-rating scales which focus on stress reactions, depression and symptoms as well as an observer rating scale on depression were used. The interviews and the art sessions were video-recorded, and the verbal psychotherapy was tape-recorded. The results showed that the art and verbal psychotherapies were comparable. The conclusion was that short-term psychodynamic art psychotherapy could be a valuable treatment for depressed women. In an in-depth content analysis, the method of scribbling was further investigated and exemplified with the therapies of two participants. In this study, the patients’ pictures and verbal expressions of progress, along with considerations of how to interpret the pictures were in focus. When leaving therapy the two patients took advantage of the paper, made complete forms, symbolised in words what they have expressed in pictures; in pace with psychotherapy the themes alter towards separation, individuation, and attempt to relate in a new way. The conclusion was that limelimited psychodynamic art therapy suggests giving a safer place for the self as the cohesion is firmer with better boundaries.

Study 2 is a pilot study, which involved six young patients newly diagnosed with vulva vestibulitis. The aim of the study was to investigate pain at vestibulum, mental health, and self-image after fifteen sessions of art psychotherapy. Five of the patients were judged to have less pain three months after termination of therapy. The conclusion was that art psychotherapy with its openness seemed to affect young women in their experiences of vulva vestibulitis in a positive direction.

Study 3 examined the potential benefit of art therapy for women with primary breast cancer. The sample comprised forty-one (n=41) patients who were randomly assigned either to an art therapy group or to a control group. The art therapy was going on during five weeks radiation treatment, one session per week. The aim was to investigate the outcome of art therapy, to quantify and compare the participant coping s, self-image, and the symptoms with the participant in the control group. Interviews were performed before, immediately after, and six month after inclusion. A set of self-rating scales was used: Coping Resources Inventory, the Structural Analysis of Social Behavior, and Symptom Check List – 90. The result showed that the patients in the art therapy group rated their coping s and especially their social s, higher than the control group, and that the average patients in the art therapy group improved in depressive symptoms and symptoms of anxiety, and that the general psychiatric symptoms improved as well. A linear regression analysis showed a tendency that the coping s increased in the art therapy group and decreased in the control group or even stagnated in the social domain. A second report on self-image, symptoms, treatment, and social variables showed that art therapy was related to lower ratings of depression, anxiety, and general symptoms after treatment; chemotherapeutic treatment predicted lower depressive symptoms and general symptoms in contrast to axilliary surgery and hormonal treatment. The results showed that art therapy could be valuable complementary therapy in routine oncology practise. The conclusion is that art therapy can have a positive long-term effect on the crisis following the primary breast cancer and its consequences.

Conclusion: The results show that time-limited psychodynamic art psychotherapy is valuable for depressed women; that it is a valuable complement for women with vulva vestibulitis; and that art therapy is a valuable complement in the care and cure of women with primary breast cancer.

Place, publisher, year, edition, pages
Umeå: Psykiatri , 2008.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1188
Keyword [en]
Art psychotherapy, scribble, depression, anxiety, GSI, breast cancer, vulva vestibulitis, SASB, SCL-90, CRI, content analysis, phenomenology
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-1684ISBN: 978-91-7264-570-7 (print)OAI: oai:DiVA.org:umu-1684DiVA: diva2:141824
Public defence
2008-05-22, sal B, Tandläkarhuset, NUS, UMEÅ, 13:00 (English)
Opponent
Available from: 2008-05-29 Created: 2008-05-29 Last updated: 2011-04-08Bibliographically approved
List of papers
1. Art therapy improves coping resources: a randomized, controlled study among women with breast cancer.
Open this publication in new window or tab >>Art therapy improves coping resources: a randomized, controlled study among women with breast cancer.
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2006 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 4, no 1, 57-64 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Women with breast cancer suffer from considerable stress related to the diagnosis, surgery, and medical treatment. It is important to develop strategies to strengthen coping resources among these women. Research in art therapy has shown outcomes such as an increase in self-esteem and cohesion, significant improvement in global health, and a decrease in anxiety and depression. The aim of the present article was to describe the effects of an art therapy intervention program on coping resources in women with primary breast cancer. METHOD: In this article, we report some of the results from a study including 41 women, aged 37-69 years old, with nonmetastatic primary breast cancer, referred to the Department of Oncology at Umeå University Hospital in Sweden for postoperative radiotherapy. The women represented various socioeconomic backgrounds. They were randomized to a study group (n = 20) with individual art therapy for 1 h/week during postoperative radiotherapy or to a control group (n = 21). The article focuses on changes in coping resources, as measured by the Coping Resources Inventory (CRI) before and 2 and 6 months after the start of radiotherapy. The study protocol was approved by the Umeå University Ethical Committee at the Medical Faculty (archive number 99-386). RESULTS: There was an overall increase in coping resources among women with breast cancer after taking part in the art therapy intervention. Significant differences were seen between the study and control groups in the social domain on the second and third occasions. Significant differences were also observed in the total score on the second occasion. SIGNIFICANCE OF RESULTS: This study shows that individual art therapy provided by a trained art therapist in a clinical setting can give beneficial support to women with primary breast cancer undergoing radiotherapy, as it can improve their coping resources.

Keyword
Art therapy, breast cancer, coping, gender, support
Identifiers
urn:nbn:se:umu:diva-20858 (URN)10.1017/S147895150606007X (DOI)16889324 (PubMedID)
Available from: 2009-03-27 Created: 2009-03-27 Last updated: 2011-08-25
2. Förändringar av vestibulitsmärtor, psykiskt mående och välbefinnande samt upplevelser av själv och andra: en systematisk pilotstudie av sex unga kvinnor med vulva vestibulit som genomgått tidsbegränsad bildpsykoterapi
Open this publication in new window or tab >>Förändringar av vestibulitsmärtor, psykiskt mående och välbefinnande samt upplevelser av själv och andra: en systematisk pilotstudie av sex unga kvinnor med vulva vestibulit som genomgått tidsbegränsad bildpsykoterapi
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2007 (Swedish)In: Matrix, ISSN 0109-646x, Vol. 24, no 1, 49-72 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
København, Danmark: Matrix. (Hillerød), 2007
Keyword
psykiatri, klinisk psykologi, behandling, bildterapi, kvinnor psykosomatiska sjykdomar, psykoterapi
National Category
Psychology
Identifiers
urn:nbn:se:umu:diva-3283 (URN)
Available from: 2008-05-29 Created: 2008-05-29 Last updated: 2012-11-12Bibliographically approved
3. The outcome of short-term psychodynamic art therapy compared to short-term psychodynamic verbal therapy for depressed women
Open this publication in new window or tab >>The outcome of short-term psychodynamic art therapy compared to short-term psychodynamic verbal therapy for depressed women
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2007 (English)In: Psychanalytic Psychotherapy, ISSN 0266-8734, Vol. 21, no 3, 250-264 p.Article in journal (Refereed) Published
Abstract [en]

The primary aim of this randomized controlled clinical trial was to compare the outcome from two types of short-term psychodynamic psychotherapy. The participants were thirty-nine women with depression. Half of the participants (n = 18) received art psychotherapy and the other half received verbal psychotherapy (n = 21). Data was collected before and after psychotherapy, and at a 3-month follow-up using self-rating scales and interviewer-based ratings. Results showed that art and verbal psychotherapies were comparable, and at follow-up, the average participant in both groups had few depressive symptoms and stress-related symptoms. The conclusion was that short-term psychodynamic art therapy could be a valuable treatment for depressed women.

Place, publisher, year, edition, pages
Routledge, Taylor & Francis Group, 2007
Keyword
counselling social work, psychoanalytic psychotherapy, psychological disorders adult, psychotherapy
Identifiers
urn:nbn:se:umu:diva-16194 (URN)10.1080/02668730701535610 (DOI)
Available from: 2007-11-14 Created: 2007-11-14 Last updated: 2016-05-09Bibliographically approved
4. Individual brief art therapy can be helpful for women with breast cancer: A randomized controlled clinical study
Open this publication in new window or tab >>Individual brief art therapy can be helpful for women with breast cancer: A randomized controlled clinical study
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2009 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 7, no 1, 87-95 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Recent research shows that almost every second woman with breast cancer is depressed or has anxiety; the risk for younger women is even higher. Moreover, research shows that women are at risk for developing depression, also a threat for women with breast cancer. The aim of this randomized controlled clinical trial was to study the outcome of five sessions of art therapy given at a 5-week period of postoperative radiotherapy.

Methods: The participants were between 37 and 69 years old; six participants in each group were below 50 years of age. Half of the participants (n = 20) received art therapy and the other half (n = 21) were assigned to a control group. At the first measurement, at least 17% (n = 7) of the participants medicated with antidepressants. Data were collected before and after art therapy and at a 4-month follow-up using self-rating scales that measure self-image (the Structural Analysis of Social Behaviour) and psychiatric symptoms (the Symptom Check List–90).

Results: At follow-up, significant lower ratings of depression, anxiety, and somatic symptoms and less general symptoms were reported for the art therapy group compared to the control group. The regression analysis showed that art therapy relates to lower ratings of depression, anxiety, and general symptoms; chemotherapeutic treatment predicts lower depressive symptoms; in contrast to axilliary surgery and hormonal treatment as well as being a parent predicts higher ratings of anxiety and general symptoms.

Significance of results: The conclusion suggests that art therapy has a long-term effect on the crisis following the breast cancer and its consequences.

Place, publisher, year, edition, pages
Cambridge University Press, 2009
Keyword
Art therapy, Breast cancer, Symptom Check List-90 (SCL-90), Structural analyses of Social Behaviour (SASB), Oncology
National Category
Medical and Health Sciences Psychology
Research subject
medicinsk beteendevetenskap
Identifiers
urn:nbn:se:umu:diva-18605 (URN)10.1017/S147895150900011X (DOI)
Available from: 2009-02-18 Created: 2009-02-18 Last updated: 2012-08-14Bibliographically approved
5. The entangled butterfly and the blue cactus: two case studies on time-limited psychodynamic art psychotherapy
Open this publication in new window or tab >>The entangled butterfly and the blue cactus: two case studies on time-limited psychodynamic art psychotherapy
(English)Manuscript (Other academic)
Abstract [en]

The aim of these two case studies is an in-depth analysis of the practice of scribbling in time- limited psychodynamic art psychotherapy. Our hypothesis is that the answers to "What do you see?" change as therapy proceeds, due to changes in emotions and cognitions expressed in scribbles and amplifications. The treatment is one hour per week for ten weeks, exempli- fied by two women with depression selected for differences in age, demographics and art expression. Analysis of the pictures and words is in two steps. The pictures were first tran- scribed into words using a phenomenological approach and then analysed according to con- tent analysis. Correspondingly, the words of the sessions were first transcribed verbatim and then analysed according to content analysis. The results show that the even if the two women have the same diagnosis at inclusion according to DSM IV, the symptoms of depression are expressed differently both in how they are manifested and in latent messages in the content analysis. The two women’s therapies can be divided into three phases each marked by turning points in the pictures – hence the pictures rather than the words set the theme for the phase. On leaving therapy the patients are able to use their drawings, their amplifications are in a complete form, they symbolise in words what they have expressed in pictures.

The study’s conclusion is that the practice of scribbling seems to give a better capacity to regulate affects and, hence, a better regulation of the self. The women used not only their intellects but also their bodies in making latent communications manifest; their self-esteem improved as therapy proceeded, and they regained a sensitivity of "me – not me", i.e. better boundaries. The clinical implications are that the time-limited model of art psychotherapy is well suited to process emotions connected with depression, and that the patient’s problem should determine the length of the time limit.

 

Keyword
Time-limited psychodynamic art psychotherapy, Scribble, Case study, Depression.
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-3286 (URN)
Available from: 2008-05-29 Created: 2008-05-29 Last updated: 2012-11-14Bibliographically approved

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