Free Gaining rapport in art therapy with the use of a therapy dog Dissertation Example
GAINING RAPPORT IN ART THERAPY WITH THE USE OF A THERAPY DOG
Art therapy is a new field emerging in the mental health profession that seems to be increasingly becoming popular in the United States and across the world. The professionals in art therapy handle patients within the therapeutic space of hospitals, schools, rehabilitation, nursing homes, and other medical settings. Earlier research has associated art therapy with many health benefits to the clients including the elderly, adolescents, children, and pediatric patients. Patients use imagery and artistic expression in defining in and out experiences. The application of the creative, expressive model has been found suitable in art therapy to allow patients to express self-confidence, self-esteem, and their hidden potentiality.
However, client-friendly approaches are essential for getting the therapeutic space more favorable for the client and the therapist. This considers enhancing the safety and the trust of the clients for the art therapist to fully capture their emotional, physical, and psychological response for proper recommendation. The thesis considers all factors necessary and examines the use of the therapy dog in gaining rapport in art therapy. Initial research has found the therapy dogs cause a feeling of safety and trust among the patients in animal-assisted therapies. The benefits range from physical, emotional, and psychological. The thesis examines the various literature on art therapy in school areas and among adolescents. Art therapy, animal-assisted therapy, therapy dogs, and art theories are also examined. The method used involves the comparative analysis of methods already employed by researchers.
Keywords: therapy, animal-assisted therapy, rapport, clients, hospital, medical
1.1. Background information
Patients of all ages with serious chronic diseases, physical and mental problems within the medical and hospital settings use art in expressing their experiences and reducing stress. It is not only happening in the United States but across the globe. It has resulted in the domination of the art therapy in the treatment of inpatient and outpatient, schools, rehabilitation centers, programs for wellness, palliative care, assisted care and other places (Vick, 2003, pg.6). Art therapy involves using the imagery and art expression among different patients such as those who are undergoing the trauma of the body, physical illness, and other medically aggressive or invasive procedures such as radiotherapy. Today, art therapy is essential and integral part of the hospitals and medical settings and is highly being applied.
Art therapy is relatively a young area of the mental health profession, though its origin can be traced back towards the end of the 18th century when psychiatric patients were morally treated using art. In the mid-20th century, art therapy started as a profession practiced within the European countries and those speaking English (Vick, 2003, pg.8). As the art therapists who started early practice started publishing their work, the influence of art education, psychiatry, rehabilitation, and psychoanalysis was significant. Adrian Hill was a British artist who had suffered tuberculosis when he discovered the importance of art therapy as he was recovering (Vick, 2003, pg.6). He was in a sanatorium when he used to draw and paint during his recovery process noting the importance of such drawing and painting in the process of healing. In his writing, he was able to disclose how the art therapy engrosses the mind of the patient making it easy for the frequent art therapy patients to release creative energy. Hill later suggested the art therapy to other patients marking the beginning of his work as an art therapist.
Another art therapist by the name Edward Adamson followed Hill when he started offering his services in the mental hospitals of extended British stay. It opened the ways for many other art therapists like Michael Edwards and others leading to the foundation of the British Association of Art Therapists. In the United States, the early art therapists including Naumburg and Kramer had started the artwork at the same time as Hill. Naumburg in her assertion claimed that art therapy factored in psychoanalytic and that art expression makes use of symbol speech increasing therapy verbalization (Naumburg, 1953, pg. 163). Later, other art therapists emerged in the U.S leading to the formation of the American Art Therapy Foundation. Today, many countries have the professional associations of art therapy at the national levels.
1.2. Statement of the problem
Patients with mental health issues, personal and growth-related problems need to communicate the experiences they have within and outside them. However, words alone cannot depict, describe or express the actual feeling and the experience that patients across all groups undergo (Malchiodi, 2011, pg. 243). It is possible that the inner and outer experiences of these groups can be symbolically communicated through art making with the help of art therapist. In art therapy, there is need to define the expectations and the boundaries of the patients as well as providing empathy. This involves establishing and gaining rapport using an approach that welcomes and accommodates the patients with these essential aspects. Imagery and artistic expression have been found critical for building a positive rapport and creating a crucial alliance early with the patients in the therapeutic interaction.
During the art therapy, trust, authenticity, and connection with the patient are essential. It should be in consideration of the Creative Expressive model (CET) which will enhance the level of confidence among the patients as they start regaining self- intensity. Therefore, any particular art interventions preferred should be balanced, considerate and knowledgeable to facilitate the therapeutic relationship. In consideration of these aspects, it then becomes a challenge which requires finding an approach that is trustful, flexible and receptive to the patients (Chandler, 2017, pg. 183). As may appear from the historical experience of patients, most associate their predicaments such as rejection, abandonment and others forms of difficult experience to human activities. This creates a perception of human mistrust which then requires a more trusted object in the creation of the rapport in art therapy.
Therefore, in this case, there is need to have a comprehensive understanding of how best a good rapport can be gained in art therapy for the effective administration of the therapy process. An attachment relationship between the patient and therapist is important for therapy process (Wallin, 2007, pg. 100). The creativity needs to be regarded in the designed approach through creative expression as patients freely choose what to do. One such an effective approach that can be used in art therapy in building rapport to have the patients symbolically communicate through imagery and art expression involves the use of a therapy dog. Though the use of the therapy dog in treatment is a new approach that needs more research to define the efficacy involve, prior research associate it with physical benefits (Fine, 2015, pg 105). More studies that have been done before have as well identified both emotional and psychological benefits despite the little research.
The use of the therapy dog in art therapy emanates from the historical relationship between the human and the dog which happens to have built a set trust between the two. Earlier theories such as the one by Raymond Coppinger suggest having there a mutual relationship that resulted in the two benefiting from one another. It is such historical revelation that a therapy dog becomes crucial in creating the rapport during the art therapy. It is also associated with enhancing the imagination, and free creativity discovery as the patients exhibit their capabilities through creative art expression.
The study, therefore, aims at determining if the presence of a therapy dog during the interventions of the therapist in the art therapy will help build the rapport of the therapeutic relationship. The examination of the study is about the application of the art therapy in pediatric areas, in schools, adolescents and among the older adults.
1.3. Limits of the study
Many art therapists will prefer an art therapy basing on the personal experiences they have had. The art therapy they may use may not be subjected to the treatment evaluation to ascertain the effectiveness of the therapy. Even amidst the research indicating art therapy to help in the treatment process, there is the need for interventions and evaluations to make sure that the art therapy has a positive contribution to improving the mental health of the patient.
2. Literature review
2.1. School facility
Sparse research on the use of art therapy in school is underway with advocates proposing it especially to students having emotional, behavioral and learning problems. They claim it is the only way to have the equal access and personification among students. The school facility in this study is the ideal place and helps in building a quick rapport with students. Art therapy can be very effective when used in school where learning children are preoccupied with a lot of pressing issues (Malchiodi, 2011, pg. 126). They have to deal with the stress of sitting in class for long hours, cleaning their classes and the school compound, doing the assignment and attending long lessons. So the art therapy does not just help them recognize the fact that they are in school, but they make this adjustment very fast. The application of the Creative Expressive model helps students become creative and imaginative gaining self- esteem thus getting in a relaxation mood to forget about life problems (Crespo, 2003, pg. 188). This as well puts students in the right position as they just prepare for their homes after schooling.
Through creative arts, the student clients can express the fear they have and the same times express their acknowledgment of their current position as students which make them have an experience that is normal. Malchiodi (2011, pg. 228) notes that art therapy is meant to have the patients get an opportunity to use the imagery and art activities; they can express how they feel and any possible interventions to the particular problem. By creating art expression, they acknowledge what they have been going through in schools and what awaits them just to bring their experience to normalcy. For fear of being punished by the school management, students find it difficult to express their experience verbally; however, they can easily do this through drawing, building, and paintings (Gross, and Hayne, 1998, pg.165). In natural set up, for instance, children do drawing though this comes with resistance at the beginning (Gross, and Hayne, 1998, pg. 163). In the process of doing the natural activity of painting, children do express their grief, abandonment, abuse or anything they are not satisfied with even without recognizing the art therapist.
As Gross and Hayne (1998, pg. 163) say, if at all art therapy is introduced in schools, students should utilize it to express things that they find difficult to express verbally. By doing this, the teachers and parents will be relieved of the many issues that might have been bothering the children without being aware. As the therapy dog is introduced in this environment, this makes it very faster to have the school environment come to normal for children with difficulties. Students find it normal doing their drawing with the therapy dog around them. The feeling of isolation and loneliness then goes, and the creating of rapport between them and the art therapist becomes quicker than before. Like in animal-assisted therapy, a therapy dog in art therapy is important more so in creating the therapeutic relationship which makes the atmosphere favorable for therapy.
2.2. Art therapy for adolescents.The study of the art therapy with the adolescents according to Malchiodi (2011, pg.241) is a reminder of the struggles that the adolescents undergo as they try to make sense of the world around them. At the same time, they try to make impacts that are meaningful. The group usually feels much uncertain about the future; they feel unaccepted and struggle with both the internal and external changes happening on them. As pressure and stress mount the adolescents, art therapy can be the great alternative as they work closely with the art therapist. Through Creative Expressive model, they concentrate on their capability by creativity which helps them forget about the life challenges they go through. Thus, the application of the Creative Expressive model is only meant to have patients gain self- esteem, and intensity. At past during this stage, the adolescents tend to resist since that is the time they are struggling to transform into adulthood from the childhood (Malchiodi, 2011, pg. 242). The application of art therapy with adolescents makes use of the artistic expression that makes any interaction, connection and support for them valuable.
At the age of adolescence, chronic loss, abuse, and neglect, abandonment, domestic violence and grief for various reasons are the order of the day. As they express their inner and outer experiences through art activities and imagery, they also think of their position as the youths and what awaits them. They then gain some sense of normalcy. However, as Malciodi (2011, pg.242) puts it, the approach taken should be trustful and flexible since this group already has lost trust in adults due to the perception that their suffering emanates from the actions of the adults. Collage material such as magazine photo can be used to make it easy for the adolescents to introduce themselves. The material should be such that it does not instill fear among the patients.
A therapy dog, in this case, will make the environment around look normal for the patients as they develop some sense of trust. This will also deal with an earlier relaxation mood of the patients as a result of the creative expression that turns them away from problems and allows the gain confidence of their current situation. Art therapists who have worked with the dog before during the treatment have recorded positive response. The feeling of the mutual relationship between the dog and human that has existed will bring new hope to the patients. As a result, the trust will increase leading to greater rapport achieved in the art therapy session.
2.3. Art therapy
The American Art Therapy Association defines the term art therapy in a long elaborated sentence. According to the association, art therapy is a human profession which involves mental health that explores the feeling of the clients or patients. It brings their emotional conflicts together, increase their awareness, control their behavior and what they are addicted to, facilitate them with social skills, improve their self- esteem and help them reduce anxiety by the help of an art therapist. From how the association defines art therapy, then we can say that this is a program that is meant to achieve the goals of restoring back the normal functioning of the affected patient and give him or her some sense of acceptance and belonging. In art therapy, the visual art plays a huge role which involves drama, poetry, painting, drawing, dance, gaming, and building among other forms (Madden, C, & Bloom, T 2004, pg. 137). Other processes involved in art therapy include the process of creativity, as well as the techniques and the theories that are involved in counseling, psychology, and human development.
Therefore, for the art therapist in the art therapy, his or her first work is to try as much as possible to create the appealing therapeutic setting that will be able to develop the emotional alliance with the patient. As Malchiodi (2011, pg. 241) tries to explain, that this process of building up that alliance with the patient should be a trustworthy, receptive to the patient and very flexible. The features of the therapeutic approach just aim at allowing the patients to be able to express themselves freely. Also, their pace of adjustment must be factored in.
The Creative Expressive model is fundamental when introduced in the art therapy since it can increase the self- esteem and confidence of the patients. The art therapy, therefore, promotes creativity (‘Art therapy practice: Innovative approaches to diverse populations’ 2001, pg. 126). As patients given an opportunity to express themselves through artwork, they expose their creativity and imaginations. Creative expression is a quick way for the art therapist to tell the ability of the patients. Once they gain self- esteem, patients tend to relax and forget about their lives’ problems as they become more creative and imaginative. Thus, they stay away from their problems, so in the real sense, the Creative Expressive model helps patients run away from their problems. The application of the art therapy among the pediatric patients, in schools, adolescents and among the elderly groups is a great opportunity for these patients to express what their feelings and emotions are (Gross and Hayne, 1998, pg. 163). For the case of the children and students in schools, the drawings, paintings, buildings, and gaming was just an opportunity to express the frustrations of classwork, homework, long reading hours and overworking. The adolescents were able to express the severe abuse and neglect and abandonment which then mixed with the fact they are just changing created some normalcy among them. The pediatric patients and the elderly people as well use the art expressions to show the situation they are in and use this to compare before, present and future which helps to reach normalcy.
2.4. Animal-assisted therapy
According to the Delta Society, the definition of the animal-assisted therapy is given as an intervention that is directed at achieving some goals in the treatment process by involving an animal that meets some well-defined criteria (Chandler, 2017, pg. 4). The animals involved in such therapies must have been trained and registered as well as working with professionals who are well trained. In this area of study, the first ever professional in mental health that made a document on the therapeutic relationship existing between human and animals was Boris Levinson. This came after one of the patients he was attending to started talking after exposure to his dog. Since then, several studies have been done to get the clear definition of what role does the animals especially a dog plays in the therapeutic process. As a therapeutic intervention, a therapy dog has continuously been used by the art therapist in the treatment of their patients.
Animals have been found best human companions helping in reducing stress and anxiety (Barker, and Dawson, 1998, pg. 800). The therapy dog is among the best animal to use in the animal-assisted therapy. Its suits in this case because of the bond it has had with the human making it unique in the therapeutic space. Dogs have majorly received training to carry out various functions involving supporting those people who are in need and helping improve the qualities of life of people who may require some special needs (Fine, 2015, pg.3). Naturally, dogs are sensitive in such a way that they can detect any possible change in behaviors of human beings which makes them suitable for this special task in art therapy. Their role in the therapeutic process remains consistent and easier, and normally has a positive experience with the humans. With a dog around, the patient gain calmness concentrates on his artistic expression as he or she tackles the present problem. This as well will allow a smooth transition even as the patient stays away from treatment. When a therapy dog is presented in the therapeutic process, normalcy among the clients or patients tends to be gained fast which in turn influences the quick relationship between the patient and the dog. The created favorable environment does not just make it comfortable for the patient but to the art therapist making the process of the art therapy easier and smooth. So the general goal of Animal Assisted Therapy is to have the life quality of the patient improved (Caprilli, and Messeri, 2006, pg. 379).
2.5. Therapy dogs
A therapy dog in the art therapy has a non-judgmental companion role. It normally offers support to the patient in needs and helps increase the life quality of the patients. According to the American Kennel Club, therapy dogs are defined as the dogs that accompany the owners to the various medical settings such as hospitals, nursing homes, and even schools to offer the volunteer services. Therefore, therapy dogs in this case closely work with the art therapist to make sure that the lives of the patients who need art therapy sessions have improved (Chandler, 2017, pg. 7).
There quite some benefits that are associated with the therapy dogs to a patient during the art therapy. Depending on the medical setting the therapy dog is serving, it makes it easier for the art therapist to accomplish the mission by creating the rapport of the therapeutic environment. Its benefits range from physical, emotional, social and mental. For the psychiatric patients having health problems, the dogs help to reduce the level of anxiety and feeling of isolation among the patients (Barker, Pandurangi, and Best, 2003, pg. 38)). They as well offer the needed comfort allowing the lessening of depression at the same time adding up the level of socialization by encouraging a patient to communicate. In schools, children or students doing literacy learning, therapy dogs are very supportive since they can create an enabling atmosphere that has no stress. Students doing the imagery and art expressions in art therapy will increase the confidence which allows better focus thus literacy improvement. In the hospital setting within the pediatric section, patients under treatment for chronic diseases and undergoing art therapy, therapy dogs will be essential in the provision of the physical health support. The patients with health problems in cardiovascular, the situation will experience improvement at the same time help to lower the level of blood pressure for patients with hypertension (Allen, Blascovich, Tomaka, and Kelsey,1991, pg. 582). The availability of the therapy dog to a great extent diminishes the physical pain of a patient.
In most cases, the emotional health problem is caused by the patient undergoing stress. Numerous studies have been able to link the therapy dogs and the interaction with patients undergoing emotional challenge to the reduction of stress in the patients. Various articles have established that a patient who plays with the therapy dog has the capacity of increasing the oxytocin, a hormone responsible for stress reduction at the same time cortisol hormone that increases stress will not survive. For instance, in the school environment, as the hormones change within the students, those with difficulties find it easier to draw, paint or even continue gaming which at the end improves literacy learning in school. Patients within the pediatric areas as well get relieved off the pain as they pay attention to art expression that brings normalcy to them fostering faster healing (Chandler, 2017, pg. 9). The same is experienced among the struggling adolescents and the older adults who might be undergoing a lot of stress. Stress as well leads to the hypertension patients increase the level of sugar in the body resulting in increased pressure. Therapy dogs by reducing stress will be able to manage blood level in the body.
2.6. Theories of art therapy
While attending to his patients, Freud, a mental health professional realized that most of the patients could communicate through using visual imagery (Rubin, J.A., 1999, pg. 158). During the production of the fantasy such as dreams, the patients could hardly describe the dreams verbally using words. He described some of what the patients could account for, saying they could only experience images but find it difficult to translate the images into words. They accepted that they could draw the dreams but could not say it with words (Naumburg, 1953, pg. 163). Researchers have been able to capture the words of Freud’s experience with his patients and integrate them into the art therapy.
The use of the psychodynamic approach to the art therapy gives the patients the opportunity to describe the art created verbally. This approach incorporates various techniques including the use of symbolism, relations of objects, sublimation and spontaneous expression among other methods (Rubin, J.A., 1999, pg. 159). The importance of the usage of sublimation as a defense mechanism and other mechanisms has been identified by the mental professionals working with the adolescents, elderly, pediatric patients and others. Art expression in therapy, therefore, helps to enhance the understanding of the psychoanalytic. Carl Jang as well had another approach of psychodynamic to the analytic theory where he looked forward to the ideas that involved the use of imagery in therapy. Today, many researchers have subscribed to the ideas of Carl Jung of using images in art therapy. According to the ideas of Jung, a patient during the art therapy can enter the unconscious relationship with the images.
2.6.2. Object relation theory
With a therapy dog near a patient whether in school settings, hospital, or palliative care will just help the patient find the safety and comfort in case they are confronted with any pain or fear (Chandler, 2017, pg. 7). The object relation theory enables the patient split negative affection and to make a difference between him or herself with the others with the help of the therapist (Armstrong, & Howatson, 2015, pg. 218). This will allow the patient put the needs and the wants he has first to satisfy them before turning to the other person. The presence of the dog within the therapeutic space signifies the “other” that the patient will only bother for safety and offer comfort. As the patient examines the dog, he or she feels that what she or he has been admiring is right where he or she is. The patient, however, accepts the idea that they are separated and distinct from the therapy dog which then makes him or her focus on his artistic expression. Researchers who have researched this topic have expressed the willingness among the patients in art therapy the moment they hear of a therapy dog involvement in the therapy. This object is a representation of tranquility, comfort, and safety as compared to the prior experience the patients have had with the human interaction.
Regarding the nature of my study, ascertaining the claim in my thesis topic could not be achieved by getting information from the primary sources that require data from patients. However, I could achieve my goals by examining various methods already documented in the various studies of similar nature. Though most of the literature I encountered relating to animal-assisted therapy was limited to certain group of patients. The patients were either children in the pediatric areas of the hospital settings, the adolescents within the clinical settings, the elderly in the nursing homes or the students with different challenges in schools. With the clear goals in my mind, the method, I intended to use should reflect which approach most utilized the Creative Expressive model and rapport building with the therapy dog during the art therapy session. Therefore my chosen method will involve a comparative analysis of the two approaches employed by Alison Silver in her study on the building rapport in art therapy with pediatric children. This will involve a sharp and detailed comparative analysis of the phenomenological approach and the quantitative analysis she employed in her study of the pediatric children. The only difference will be the scope of the study where my study will cover the analysis of these methods as possibly may be applied for children in schools, the older adults, pediatric patients and the adolescents.
In her application of the phenomenological approach, A. Silver aimed at covering all the related attributes by involving her blind group participants through their artworks. She referred to her participant group of children as blind since they could not notice the presence of the therapy dog until they were introduced to it during the art therapy session. Her approach to this method could best suit especially when involving various categories of participants like the older adults, adolescents, students, and children. Some of the participants in these groups, for instance, the older adults have never had a pet dog. Thus prior realization of its presence will scare them off. She, however, could mention the presence of the therapy dog before the study to see the response from her patients.
However, regarding the application of the creative expression model, Silver’s use of the phenomenological method failed when organizing the patients into two groups, i.e., groups. Art therapy recognizes the principle of creative expression where the patients use arts to show their creativity in various art activities including drawing, painting, and building among others. They use the imaginations or the prior knowledge they had to express the strengths and abilities they technical have. Creative expression is most advocated for when the patients are freely allowed to reflect themselves and have self- reflection. Unlike what the principle of creative expression therapies express, Silver had to give envelopes to the participants that dictated the group where patients could be attending their sessions. From the reaction, the majority of those children in the hospital who participated wished to be included in group B where a therapy dog was introduced. This clearly could tell that majority of the pediatric patients in the study preferred being near therapy dogs. Therefore, unlike the approach by Silver, in consideration of various categories of clients, elderly, adolescents and children, they will be allowed to choose which group to belong. In cases where all the participants choose to work in the group with the therapy dog, then the sessions will be broken into two to satisfy the creative expression urge of all patients.
Alternatively, all patients will be in one group, given an opportunity to choose their materials including the colors and have the first session with them without the therapy dog. Then there will be a second session that will involve the introduction of the therapy dog. At the end of each of the sessions, all the artwork of the patients shall be subjected to comparison. The examination should include the fact in the colors used by the patients, the themes they state, and how they format their images. The results of these aspects are important in determining the difference in the two sessions carried out as well as what the patients communicate through the artistic expression. Silver had the right focus when using the phenomenological method which allowed her not to pay much attention to the sessions of the artwork that were being done by her participants. Instead, she paid very close attention to the phenomena that were happening between her patients in the therapeutic space and to the availability of the therapy dog. Through observing the movements of the patients, verbal communication and how the patients contacted the therapy dog tells a lot about their feeling and attitude with the presence of the therapy dog. This as well needs to an extent to examine the Creative Expressive model and how creative the patients become as a result of the therapy dog presence. And in fact, with keen observation of these phenomenological events during the art therapy is an easy way to tell the rapport building.
In the psychodynamic theory, Carl Jung examined the analytic aspect from the ideas of the importance of including the imagery in the therapy process (McFadden, 2012, pg. 683). This presentation requires that a researcher need not rely so much on the theory or the discipline itself but the physical thing, and that is the image in this case (Rubin, J.A., 1999, pg. 160). Silver must have drawn her approach from what Jung presents in her use of the phenomenological method in her research. From the observation that the researcher makes using this method, I can say it is the best method to apply in my study. At-large range, the method fully allows patients’ interact with the therapy dog as the researcher observes art therapy. The researcher as well can establish the ability to build rapport using the therapy dog’s presence during art therapy. Unlike the researcher, I intend to allow creative expression with the patients in my study.
In comparison with the phenomenological method, the researcher uses quantitative analysis which involves the ratings of the blood pressure of the patients. The method is applied before the art therapy sessions and after the sessions. The use of the quantitative method by the researcher is quite contextual and aims at determining the effects the art therapy has to the patients and how the therapy dog impacts these ratings of the blood pressure. The method can be well applicable when carrying the art therapy with the older adults who are prone to chronic illnesses like hypertension and type 2 diabetes that often results in increased blood pressure. Adolescents too are at the risk of being affected by the blood pressure as they undergo hard changes when becoming adults. Children and students in schools also face challenges including reading problems that likely may lead to the blood pressure change.
However, in the application of the quantitative method, various limitations resulted in the inefficiency of the method as the researcher could not account for some variables. The researcher, therefore, could not fully utilize the quantitative method. However, a combination of the two method yields more facts that the researcher might not have been discovered earlier. The quantitative method would lead to a more elaborate rapport built with the introduction of the therapy dog. It also explains the extent art therapy improves the performance of students who initially had challenges in reading and writing.
Whichever, the method of study to be chosen in the art therapy session, it should allow free engagement of the patient and focus on the creative expression of the patient. In this sense, the therapy dog’s presence equips the patient with feelings safety and subsequent trust in the art therapy. The Creative Expressive therapy is more accomplished if the patient is allowed to lead the therapeutic space and choose what they want to do. Free space needs to be given by the method employed as the patients enjoy the autonomy in the therapeutic process. With absolute autonomy, creativity, imagination, and focus become the pillar of the whole healing process. When the therapy dog is either brought within the therapeutic space, the meaning of creativity becomes a reality with the patients. Malchiodi (2011, pg. 243) identifies adolescents as the most resistance group among the art therapy patients to work with and often their resistance associated with hardships they have been through. By allowing the patients themselves to take the leading role in the art therapeutic process, the art therapist learns much regarding their ability to create, their inability and the needs they have. In many occasions, the inability, the strength and the needs of the patients are the basis of the return to normalcy for the patients. Once the therapy dog introduces the safety and trusted environment, it becomes smoother and less strenuous for the art therapist to learn of the weaknesses of the patients, strengths and where the need for improvement is required. The phenomenological and quantitative methods employed should possess the power to achieve these results.
3.1. Time Period
Since the start of my study is marked by the review of the various literature in the related fields of my thesis topic. The literature review will involve the texts books, electronic journals, and articles in the fields of animal-related therapies. I intend to go through more than 40 printed books, 10 electronic journals and 20 articles on this topic. My first quick review will allow me to select the most substantial sources that I will narrow down to seven to aid me in concluding. Therefore, the time required should be enough to allow me to get the right sources. The quick review of the preferably related field sources will take me at least three months. The three months’ time will be enough to get my final sources of the seven books. I will again require at least three months going through the final sources thereby preparing my thesis. Approximately, this study intends to take six months.
The sources I would like to review involve those with the information in the field of animal-assisted therapy specifically, on art therapy. They should exclusively and intensively cover the concept of therapy right from the time it originated through many processes to become a modern mental health profession. They should as well cover the already carried out research on the application of art therapy in schools for children and other students with various physical, emotional and behavioral challenges. Others should provide this information within the hospital setting for pediatric disease, nursing and palliative care for older adults and research for adolescents. All the sources need to portray animal intervention as a catalyst to the good relationship between the patient and art therapist. The most preferred animal is the therapy dog in that case. The reason for reviewing different sources is to have a common conclusion on how the presence of the therapy dog in the art therapy builds the rapport to enhance quick normalcy regain to patients. The observation will be made in line with the creative expression by the patients and the subsequent recovery after that. Finally, a report will be drawn based on the sources review of the results of different researchers and the conclusion they came up with about thesis topic.
4. The main body of the text
4.1. Art therapy and its effectiveness to patients
From the onset of my thesis, evidence has been provided based on the research of significance of art therapy to patients. The patients entitled to the art therapy include among them the adolescents, older adults, school going children, students and the pediatric patients within the hospital and clinical settings. Most of these patients undergo mental, emotional, physical, and behavioral challenges that exposure to the therapeutic space would help the patient regain the normalcy in these areas.
The adolescents, for instance, undergo various changes ranging from physical, emotional, psychosocial, mental and even behavioral changes that come along with different feelings (Malchiodi, 2011, pg. 243). This group of adolescents experiences severe abuse; abandonment, violence, and denial from the people whole they feel need to offer them support. They face frustration, destruction and often think of giving up on life. The worst happens when they give up on the trust they have in the adults, and other humans whole they feel they are the source of their predicaments. The contact between the adolescents and the art therapist forms the first step for this potential group healing of the challenges they face. The art therapist aims at discovering the challenges, get their strengths and help them meet the needs they require. Through, art therapy, the adolescents reflect on their challenges at their stage and think of what they are expected of as youths which then help them gain normalcy (Malchiodi, 2011, pg. 245). By drawing, painting, gaming and other art expressions, adolescents tend to communicate the challenges and the needs. Through self-autonomy, they can practice their creative expression which then helps the art therapist discovers the areas of strengths of the adolescent. Due to the early experiences of the adolescents, the art therapist can utilize the intervention approaches to see the therapeutic process a success. A therapy dog is introduced during the art therapy for its flexibility, receptivity and the care it provides which just creates a therapeutic environment of safety and trust. Once the adolescents have gained a feeling of safety and trust, the creative expression will be increased which will quickly build a rapport with the art therapist. In this kind of therapeutic space, success of the art therapy is accomplished.
The art therapy can also be introduced within the schools’ setting with advocates claiming that is one best way of addressing the many challenges learners go through. The school assessments procedures that are based on art therapy get to understand students who might have troubles. Art therapist can capture the emotional and cognitive attention of the students and provide the feedback which they can refer to school management for the treatment program (Kahn, 1999, pg. 291). Students and children in schools who may find it difficult to communicate through words find an opportunity of doing so in art therapy by artistic expression and imagery. Naturally, expressing through art has been perceived as that which has no threat to the patients especially to children and the students in schools. Just as the art therapy itself to a patient provides creative skills, visual-spatial and interpersonal skills, a quick problem solving is arrived at faster.
The older adults are the vulnerable groups prone to chronic illnesses such as dementia, hypertension, Alzheimer’s disease, and diabetes. This group undergoes emotional and physical challenges and usually exposed to the opioid painkillers which often their excessive usage results in side effects (Malchiodi, 2011, pg. 283). An alternative treatment such as art therapy can be very accommodative to the elderly and can do much regarding stress reduction, pressure reduction and pain reduction among other associated benefits. In most cases, at this older age, the patients would not like to show that they are undergoing pain with the fear that they are perceived as overburdening to the family. Just like children with pediatric, the elderly can be tricked to reveal what they go through by art expression. Most of them may find drawing and painting as childhood activities and find them enjoyable and increase interaction viewing their problems differently (McNiff, S., 2008, pg. 32). When a creative expression model is employed in the art therapy, the elders will likely explore their creativity. They tend to forget the troubles they go through and get into relaxation mood thus gaining self- esteem. As Chandler (2017, pg. 9) discusses, the presence of a therapy dog in the therapeutic space of the elderly people ignites the creativity. Ultimately, the heart rates will lower while increasing creativity. With the older adults, it is a responsibility to own a pet, and it feels a sense of self- worth and purpose which promotes health.
Thus, the increasing popularity of the field of art therapy in the various hospital, schools, and other medical settings is an implication of its effectiveness. As evidenced in much literature, patients through art therapy get an opportunity to express their inner and out experiences that words could not express. Through imagery and art expression, patients show their cognitive and emotional challenges and their needs. The creative, expressive model has been found to give patients an opportunity to express their creativity through artwork. The art therapist gets an opportunity to recommend for any further action and helps the patients heal.
4.2. The therapy dog in creating rapport in art therapy
Researchers in the mental health have done a lot of research on the topic of the animal-assisted therapies. These studies have existed since the time of Sigmund Freud and Boris Levinson during the practice on their patient who could behave differently as a result of being exposed to a therapy dog. Various documents have been written from the 20th century since this topic started being considered a profession within the mental health (Rubin, 1999, pg.5). Luckily enough, with the so many of these research, positive results have been recorded regarding the benefits being seen physically, emotionally and socially. Though, the physical benefits are the most documented right from the time when Levinson’s patient could be heard talking as a result of dog introduction to many other researchers in this field like A. Silver who have found the same connection. However, this does not mean that emotional and social benefits have not been written nor documented. Many researchers have found this and documented these benefits of the presence of an animal in the therapeutic space.
Therefore, to bring into perspective the role of the therapy dog in rapport building within the therapeutic environment, it is prudent that I briefly discuss some of the benefits already documented. The significant number of studies associate increase in life expectancy that has been found to be impacted by the pets like dogs (Chandler, 2017, pg. 62). By talking to a dog, a person is likely to reduce the rate of the heartbeat as well the blood pressure which has been the factors behind the reduction in physiological arousal. Apart from the reduction of the blood pressure and the heart, the therapy dogs to a great extent reduce stress and relieve pain in patients with chronic illnesses. Patients with mental problems often feel depressed, feel isolated, difficult in communication, are anxious, and experience discomfort and sometimes can hardly socialize. A therapy dog has however been found to correct these situations that a patient undergoes which then increase the chances of a patient in the art therapy gaining normalcy (Glenk, 2017, pg. 4). The big role of the therapy dogs in stress reduction has been found most significant in the healing process. Thus, conclusively, in all the therapeutic space, in schools, hospitals, rehabilitation, nursing home and clinical setting, therapy dogs have been found having various effects that have often resulted in the positive response of the patient.
Therefore, with the many benefits, the therapy dogs have to the patients, the dogs play an essential role in the whole therapeutic process. Initially, the art therapy is made to use the imagery and the art express to have the patients express their experiences which then aids the healing process of the patients. The art therapist takes full charge of the whole treatment process and helps in the interpretation of the art expressions presented by the patients. The art therapist takes the patients through the whole therapy processes including welcoming the patients, preparing the environment and making it possible that the patient freely shares the information through artwork. Depending on the age, gender and the nature of the patients and the problem they are undergoing, the art therapist has to do everything to get the cognitive and emotional response of the patient. Though, this becomes a challenge since most patients might have had the bad experience with the human being. Malchiodi (2011, pg. 241) associated to some of the difficulties experienced by the adolescents as having been caused by the adults. Thus, to adolescents and children who might have suffered due to domestic violence might lack trust in adult presence near them. Thus, the position of the art therapist is again threatened. An approach needs to come in to intervene and make it easy that the art therapist works with the patient well.
For the need to have the art therapy smoothly achieve its purpose, a therapy dog plays the important role once introduced within the space. In the case of Feud, whenever he accompanied his dog, Jo-Fi in the therapy sessions, his patients could experience a feeling of calmness (Rubin, 1999, pg. 159). This could make him come up with many conclusions on how his dog handled the tension within the therapy room. Once calmness had been gained, the dog could lie near the patient. The same discovery was made in the therapy session of Levinson and his patient who could talk about his interaction with the dog. The two pioneer discoveries and others on the role the therapy dogs play in the therapeutic space explain how the situation becomes with the therapy dogs in the therapy session room. On seeing the therapy dogs, a feeling of calmness comes to the patients. Based on the protective role of the dog, the patients feel safe, and a sense of trust comes to them. The patients feel what they have been looking for has finally come, though they are different and has no control over it, the patients choose to continue doing their artwork. In the process, the creative expression is enhanced and the patients more likely to respond to the art therapist for the possible conclusion. This is the very important role of the therapy dog in creating rapport in art therapy to facilitate the process of treatment.
In conclusion, therefore, it is acceptable that the field of art therapy is popularly increasing with the mental health profession. Professionals in this area find the artistic expression and use of imagery as a way to get the patients share their experiences that helps them attain normalcy. Art therapy has been found to work in various settings including schools, nursing homes, and hospitals. Various patients including pediatric, the older adults, adolescents, children, and students have been found legible for this kind of therapy. However, to make it more effective, a therapy dog is introduced into the therapeutic space to enhance the rapport of the environment. It allows the art therapist to quickly build the rapport with the patients and get the best out of the process. The feeling of trust and safety is felt among the patients who then cognitively and emotionally response through drawings, painting, building, gaming among other art activities. The creative, expressive model has as well found resourceful in the art therapy and equally important in getting the patients practice they could do best. The creative expression has been as well seen enhanced by the therapy dogs which make patients more creative and imaginative thus enhancing the whole process.
However, from the review of the literature, many researchers avoided dealing with the question of fact of the art therapy in the treatment and how the dog’s effects were evaluated. This challenges most of the conclusions researchers have drawn on the effectiveness of the art therapy to the patients. Less has also explained what the therapy dog does in the therapeutic process. Therefore, the future researcher needs to bring out the evaluative healing effects of the art therapy and document what the therapy dog exactly does in the process to give out such results concluded. Despite this limitation that has been pointed out from the various studies, substantial evidence documented link the therapy dogs to rapport building in art therapy.
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