Milieu Therapy is a form of
psychotherapy that involves the use of
therapeutic communities. Patients join
a group of around 30, for between 9
and 18 months. During their stay,
patients are encouraged to take
responsibility for themselves and the
others within the unit. Milieu therapy is
thought to be of value in treating
personality disorders and behavioural
problems. Henderson Hospital, in
London, uses this type of
psychotherapy.
In Children
Milieu therapy can also be used in
children. It has been in existence since
the late 1800s when moral treatment
and therapeutic communities[3] were
key issues in the treatment of
psychiatric problems. It has been used
as a viable treatment modality for kids
for over fifty years in residential and
inpatient settings and more recently in
the partial hospitalization and day
treatment settings. August Aichorn,
Bruno Bettelheim, Fritz Redl and David
Wineman were among the early
pioneers in using Milieu Therapy to
treat "impulse-ridden and ego-
impaired" kids in residential and school
settings as early as the 1920s. Their
work collectively has taught us that
Milieu Therapy can be a powerful
therapeutic tool when individual
dynamics and the social system can be
combined in a planned and meaningful
way to manage and change behavior
and relationships.
Milieu Therapy is a planned treatment
environment in which everyday events
and interactions are therapeutically
designed for the purpose of enhancing
social skills and building confidence.
Academics are woven into the daily
routine using an integrative and
interactive approach that incorporates
learning styles and areas of interest.
The milieu, or "life space," provides a
safe environment that is rich with
social opportunities and immediate
feedback from caring staff. The milieu
is not static but it is flexible and
features normalizing and
developmental perspectives that use
common structures intended to be
familiar to all children, such as daily
routines, consistent rules and
activities. The therapy is planned in
such a way that it is constantly
supporting, guiding and reinforcing the
child's ability to learn life tools, such as
problem solving and coping skills,
while at the same time offering a safe
place for these skills to be practiced
and integrated into the child's
repertoire of strategies. The milieu
takes into consideration the
perspective of the child as well as the
perspective of the milieu at large. A
simple example of this is a "wrap-up
group" at the end of the day, where
kids first tell what they appreciate
from that day, and what their high
point and low point are.
Metaphorically, this teaches kids that
every day has its ups and downs, yet
there is always something that can be
appreciated. They could do a self-
evaluation and get feedback (not
criticism) from the other kids. This is a
very powerful group and can give kids
an opportunity to see how others view
them in a non-threatening forum.
One of Milieu therapy's primary goals
is to teach kids "how" to "fit in" socially
and emotionally in their world without
changing "who" they are. They learn
new skills that help them to better
understand themselves and their
relationships. The milieu is not a static
environment, but is flexible and
incorporates the use of common
structures familiar to all children, such
as daily routines, predictable rules and
activities
Art therapy is a form of expressive
therapy that uses art materials, such
as paints, chalk and markers. Art
therapy combines traditional
psychotherapeutic theories and
techniques with an understanding of
the psychological aspects of the
creative process, especially the
affective properties of the different art
materials.
As a mental health profession, art
therapy is employed in many clinical
settings with diverse populations. Art
therapy can be found in non-clinical
settings as well as in art studios and in
workshops that focus on creativity
development. Closely related in
practice to marriage and family
therapists and mental health
counseling, art therapists throughout
the US are licensed as either MFTs,
LPCs, or LPCCs and hold either
registration or board certification as an
art therapist (see section on Art
Therapy Standards of Practice). Art
therapists work with children,
adolescents, and adults and provide
services to individuals, couples,
families, groups, and communities.
Using their skills in evaluation and
psychotherapy, art therapists choose
materials and interventions
appropriate to their clients’ needs and
design sessions to achieve therapeutic
goals and objectives. They use the
creative process to help their clients
increase insight and judgment, cope
better with stress, work through
traumatic experiences, increase
cognitive abilities, have better
relationships with family and friends,
and to just be able to enjoy the life-
affirming pleasures of the creative
experience. Many art therapists draw
on images from resources such as
ARAS (Archive for Research in
Archetypal Symbolism) to incorporate
historical art and symbols into their
work with patients. Depending on the
state, province, or country, the term
art therapist may be reserved for
those that are professionals trained in
both art and therapy and hold a
master's degree in art therapy or a
related field such as counseling or
marriage and family therapy with an
emphasis in art therapy. Other
professionals, such as mental health
counselors, social workers,
psychologists, and play therapists
apply art therapy methods to
treatment. Many art therapists in the
US are licensed in one of the following
fields: creative arts therapy, art
therapy, professional counseling,
mental health counseling, or marriage
and family therapy.
Art therapists have generated many
specific definitions of art therapy, but
most of them fall into one of two
general categories. The first involves a
belief in the inherent healing power of
the creative process of art making.
This view embraces the idea that the
process of making art is therapeutic;
this process is sometimes referred to
as art as therapy. Art making is seen
as an opportunity to express one's self
imaginatively, authentically, and
spontaneously, an experience that,
over time, can lead to personal
fulfillment, emotional reparation, and
recovery[1].
The second definition of art therapy is
based on the idea that art is a means
of symbolic communication. This
approach, often referred to as art
psychotherapy, emphasizes the
products—drawings, paintings, and
other art expressions—as helpful in
communicating issues, emotions, and
conflicts. The art image becomes
significant in enhancing verbal
exchange between the person and the
therapist and in achieving insight;
resolving conflicts; solving problems;
and formulating new perceptions that
in turn lead to positive changes,
growth, and healing. In reality, art as
therapy and art psychotherapy are
used together in varying degrees. In
other words, art therapists feel that
both the idea that art making can be a
healing process and that art products
communicate information relevant to
therapy are important.
Purpose of Art Therapy
The purpose of art therapy is much the
same as in any other
psychotherapeutic modality: to
improve or maintain mental health and
emotional well-being. But whereas
some of the other expressive therapies
utilize the performing arts for
expressive purposes, art therapy
generally utilizes drawing, painting,
sculpture, photography, and other
forms of visual art expression. For that
reason art therapists are trained to
recognize the nonverbal symbols and
metaphors that are communicated
within the creative process, symbols
and metaphors which might be difficult
to express in words or in other
modalities. By helping their clients to
discover what underlying thoughts and
feelings are being communicated in
the artwork and what it means to
them, it is hoped that clients will not
only gain insight and judgment, but
perhaps develop a better
understanding of themselves and the
way they relate to the people around
them. According to Malchiodi[1] "Art
making is seen as an opportunity to
express oneself imaginatively,
authentically, and spontaneously, an
experience that, over time, can lead to
personal fulfillment, emotional
reparation, and transformation. The
creative process can be a "health-
enhancing and growth-producing
experience."
What Does a Typical Art Therapy
Session Look Like?
Marachi (2006) provides an example of
what an art therapy session involves
and how it is different from an art
class. "In most art therapy sessions,
the focus is on your inner experience—
your feelings, perceptions, and
imagination. While art therapy may
involve learning skills or art
techniques, the emphasis is generally
first on developing and expressing
images that come from inside the
person, rather than those he or she
sees in the outside world. And while
some traditional art classes may ask
you to paint or draw from your
imagination, in art therapy, your inner
world of images, feelings, thoughts,
and ideas are always of primary
importance to the experience.
Therapy comes from the Greek word
therapeia, which means 'to be
attentive to.' This meaning
underscores the art therapy process in
two ways. In most cases, a skilled
professional attends to the individual
who is making the art. This person’s
guidance is key to the therapeutic
process. This supportive relationship is
necessary to guide the art-making
experience and to help the individual
find meaning through it along the way.
The other important aspect is the
attendance of the individual to his or
her own personal process of making
art and to giving the art product
personal meaning—i.e., finding a story,
description, or meaning for the art.
Very few therapies depend as much on
the active participation of the
individual (p. 24)." In art therapy, the
art therapist facilitates the person's
exploration of both materials and
narratives about art products created
during a session.
Art-Based Assessments
Art therapists and other professionals
use art-based assessments to evaluate
emotional, cognitive, and
developmental conditions. There are
also many psychological assessments
that utilize artmaking to analyze
various types of mental functioning
(Betts, 2005). Art therapists and other
professionals are educated to
administer and interpret these
assessments, most of which rely on
simple directives and a standardized
array of art materials (Malchiodi 1998,
2003; Betts, 2005). The first drawing
assessment for psychological purposes
was created in 1906 by German
psychiatrist Fritz Mohr (Malchiodi
1998). In 1926, researcher Florence
Goodenough created a drawing test to
measure the intelligence in children
called the Draw–A–Man Test (Malchiodi
1998). The key to interpreting the
Draw-A-Man Test was that the more
details a child incorporated into the
drawing, the MORE intelligent they
were (Malchiodi, 1998). Goodenough
and other researchers realized the test
had just as much to do with
personality as it did intelligence
(Malchiodi, 1998). Several other
psychiatric art assessments were
created in the 1940s, and have been
used ever since (Malchiodi 1998).
Notwithstanding, many art therapists
eschew diagnostic testing and indeed
some writers (Hogan 1997) question
the validity of therapists making
interpretative assumptions. Below are
some examples of art therapy
assessments:
The Diagnostic Drawing Series
(DDS)
The Diagnostic Drawing Series is an art
therapy assessment that is correlated
with the diagnosis of major psychiatric
disorders (Mills, 2003). The DDS is a
three drawing series that is used by
mental health professionals around the
world (Diagnostic Drawing Series
website, 2009). In the first part,
subjects are asked to draw any picture
using colored chalk pastels on an 18 x
24 inch piece of paper. Then they are
asked to draw a tree in the second
part. In the last part of the art
interview, subjects are asked to show
how they are feeling using lines,
shapes, and colors. Research
regarding the pictures is generally
based on the presence and absence of
many elements, such as use of color,
blending, and placement of the images
on the paper (Cohen, Hammer, &
Singer, 1988)...
The Mandala Assessment
Research Instrument (MARI)
In this assessment, a person is asked
to select a card from a deck with
different mandalas; designs enclosed
in a geometric shape, and then must
choose a color from a set of colored
cards (Malchiodi 1998). The person is
then asked to draw the mandala from
the card they choose with an oil pastel
of the color of their choice (Malchiodi
1998). The artist is then asked to
explain if there were any meanings,
experiences, or related information
related to the mandala they drew
(Malchiodi 1998). This test is based on
the beliefs of Joan Kellogg, who sees a
recurring correlation between the
images, pattern and shapes in the
mandalas that people draw and the
personalities of the artists (Malchiodi
1998). This test assesses and gives
clues to a person's psychological
progressions and their current
psychological condition (Malchiodi
1998). The mandala originates in
Buddhism; its connections with
spirituality help us to see links with
transpersonal art.
House–Tree–Person (HTP)
In this assessment, the patient is
asked to draw three separate images;
a house, a tree, and a person
(Malchiodi 1998). After the patient has
finished the drawings, the therapist
asks questions like, "How old is the
person in your drawing? What is he or
she doing? What is the house made of?
What is the weather in this picture?"
(Malchiodi 1998). This assessment can
be done achromatically (one color,
such as lead pencil) or chromatically
(with various colored markers or
pencils). This is a projective
assessment and the house, the tree,
and person in the drawing represent
different aspects of the artist and the
way the artist feels about him or
herself (Malchiodi 1998).
Road Drawing
In this drawing assessment and
therapeutic intervention, the patient is
asked to draw a road. This is a
projective assessment used to create a
graphic representation of the person's
"road of life." The road drawing has the
potential to elicit spontaneous imagery
that represents the client's origins, the
history of his or her process,
experiences to date, and intent for the
future - even from a single drawing
(Hanes, 1995, 1997, 2008). The road's
reparative features or its need for
"periodic upgrade" can serve as a
metaphor for the client's capacity for
change and restoration (Hanes, 1995,
1997, 2008).
Music therapy is both an allied health
profession and a field of scientific
research which studies correlations
between the process of clinical therapy
and biomusicology, musical acoustics,
music theory, psychoacoustics and
comparative musicology. It is an
interpersonal process in which a
trained music therapist uses music and
all of its facets—physical, emotional,
mental, social, aesthetic, and spiritual
—to help clients to improve or
maintain their health. Music therapists
primarily help clients improve their
observable level of functioning and neuroscience model of music
self-reported quality of life in various perception and production, and the
domains (e.g., cognitive functioning, influence of music on functional
motor skills, emotional and affective changes in nonmusical brain and
development, behavior and social behavior functions."[7] In other words,
skills) by using music experiences NMT studies how the brain is without
(e.g., singing, songwriting, listening to music, how the brain is with music,
and discussing music, moving to measures the differences, and uses
music) to achieve measurable these differences to cause changes in
treatment goals and objectives. the brain through music that will
Referrals to music therapy services eventually effect the client non-
may be made by a treating physician musically. As internationally known
or an interdisciplinary team consisting professor and researcher Dr. Thaut
of clinicians such as physicians, said, "The brain that engages in music
psychologists, physical therapists, and is changed by engaging in music."[8]
occupational therapists.
Music therapists are found in nearly
every area of the helping professions.
Some commonly found practices
include developmental work
(communication, motor skills, etc.)
with individuals with special needs,
songwriting and listening in
reminiscence/orientation work with the
elderly, processing and relaxation
work, and rhythmic entrainment for
physical rehabilitation in stroke
victims.
The Turco-Persian psychologist and
music theorist al-Farabi (872–950),
known as "Alpharabius" in Europe,
dealt with music therapy in his treatise
Meanings of the Intellect, where he
discussed the therapeutic effects of
music on the soul.[1] Robert Burton
wrote in the 17th century in his classic
work, The Anatomy of Melancholy, that
music and dance were critical in
treating mental illness, especially
melancholia.[2][3][4]
It is considered one of the expressive
therapies.
Forms
There are a few different philosophies
of thought regarding the foundations
of music therapy. One is based on
education and two are based on music
therapy itself, both of which will only
be briefly covered here. In addition,
there are philosophies based on
psychology, and one based on
neuroscience.
Different approaches from education
are Orff-Schulwerk (Orff), Dalcroze
Eurhythmics, and Kodaly. The two
philosophies that developed directly
out of music therapy are Nordoff-
Robbins and the Bonny Method of
Guided Imagery and Music.[5]
Music therapists work many times with
individuals who have behavioral-
emotional disorders. To meet the
needs of this population, music
therapists have taken current
psychological theories and used them
as a basis for different types of music
therapy. Different models include
behavioral therapy, cognitive
behavioral therapy, and
psychodynamic therapy.[6]
The therapy model based on
neuroscience is called "neurological
music therapy" (NMT). A definition of
NMT is "NMT is based on a