ART-Psychotherapy
Framework of the AMSS Study
The diagram below illustrates the fields that, when bridged together, are the framework of the AMSS study. This diagram also explains how the context of the AMSS study is defined and locates the fields of study of which it consists. These fields are unified sensory stimulation, color therapy, sand therapy, and play therapy. The dementia population can not express themselves cogently, but through the use of multi-sensory stimulation and by means of art work they can express themselves behaviorally. “In terms of Freudian psychology, this artwork mirrors the primary process mode of thinking [unconscious functioning] to which these patients have regressed” (Wald, 1986, p 78). The following section introduces the AMSS study from a clinical art-psychotherapy approach-addressing and stimulating certain vulnerable populations- and elaborates how patients primarily proceed in their thinking and expression.
Figure 1: Framework of the AMSS study
Clinical Art Therapy for Vulnerable Populations
Recent research has evidenced the positive contribution of clinical art therapy in the treatment of vulnerable populations. Saunders (2000) and Ball (2002) found evidence of positive change in children and young people working with clinical art therapy. According to Elmar (2003), clinical art therapy contributes positively in therapeutic contexts in old adult patients but no controlled studies exist. However, Jones (2002) carried out a randomized control trial of clinical art therapy in England in adult mental health patients and found an inverse relationship between increasing self-esteem and declining of negative symptoms.
Statistical evidence of positive clinical art therapy effects resulting from systematic quantitative research comes from studies in Edinburgh, England. A research study conducted as clinical art therapy in a General Practitioner (GP) practice (Dunkeld-Turnbull, 2000) found positive outcomes for patients on a number of measures. In services to older people, Waller et al. (1998) found that people with dementia do respond to clinical art therapy as evidenced by decreased levels on objective measures of depression, when compared with a control group.
These clinical art therapists/practitioners initiated the emotional therapeutic exploration of clinical art therapy for vulnerable populations from children to the ill elderly. Clinical art therapy offers dementia patients the opportunity to make decisions in a particular area, and by altering the materials used it offers the feeling of being able to be in control of something, creating a stabilizing effect (Harlan, 1993). Clinical art therapy contributes to the reduction of social isolation and withdrawal as well as to an increase in feelings of identity and social self-confidence. However, there is a lack of evidence as to the effectiveness of behavioral improvements, such as the positive influence of calming inner agitation, as based on descriptions of cases by Dunker and Kahn-Denis (Elmar, 2003).
Interdisciplinary Clinical Art Therapy in Sensory Stimulation
We already have evidence of the effectiveness of clinical art therapy on the emotional well-being of the dementia population. However, few research studies in the field of art therapy have focused on behavioral benefits with evidence of emotional well-being at the same time. Kramer’s dissertation (1994) through the search link, www.proquest.com, found that dementia patients’ wandering can be alleviated through the use of art materials geared to visual and tactile stimulation. This appears to be the only research article that establishes the use of specific sensory stimulation focusing on behavioral improvement in the dementia population. Nevertheless, a connection between “multi-sensory stimulation” and behavioral improvement for dementia patients seemed possible through the practice of Snoezelen.
Sensory Stimulation
Snoezelen is a specially designed environment where well-being is influenced by controllable multi-sensorial stimuli (Mertens, 2003/2005). Snoezelen is designed to be a wonderful environment for the senses, filled with sights, sounds, textures, and aromas and is used to stimulate, calm, relax, or energize the patient (www.nursinghomesmagazines.com, 2005). There is evidence of behavioral benefits to patients with dementia in terms of rest and relaxation, improved sleep patterns, less agitation and reduced use of medication for pain through Snoezelen environmental stimuli (Wiles et al., 2004). According to the Brian Center Health and Rehabilitation team, their application of Snoezelen to dementia patients successfully evidenced and illustrated how dementia patients’ agitated behaviors, blood pressure rates, and pulse rates were positively affected (Sphon et al., 2003-ongoing). They reported effectiveness in improved swallowing and decreased agitation, and reduced patient’s yelling through cases studies utilizing the Snozelen therapy model (Sphon et al., 2003). One such example can be seen in the figure below, provided by www.nursinghomesmagazine.com, which shows how ten residents relaxed with Snoezelen therapy by means of before and after-intervention pulse-rate measurements:
Figure 2: Before and After-Snoezelen Intervention Pulse-Rate Measurements
Development of AMSS
Theoretically, the combination of the Snoezelen model and art therapy should lead to a balance between art therapists’ emotional well-being objectives and occupational therapists’ physical objectives. However, the application of Snoezelen to the dementia population was limited to use by occupational therapists for the sole purpose of physical rehabilitation with the aim of maintaining and restoring function and independence. However, the art therapist focuses on emotional expression and the facilitation of creative processes (Abraham, 2005, p. 90). The art therapist is seen as an “ego organizer,” a facilitator encouraging the patients, praising all their efforts, and reminding them of their tasks. The art therapist can examine the conscious and the unconscious structure of the personality interpreted through artwork to assess the level of patient functioning and the effects of dementia on the patients’ behavior (Kramer, 2005, p. 27).
In spite of the positive outlook for behavioral outcome in dementia patients through Snoezelen treatment, Perrin’s research (1997) found out that a multi-sensory environment could be over-stimulating for the dementia population. She concluded that multi-stimulus activities in the Snoezelen room, involving constant or rapid change, may not be comfortable for people with severe dementia. Her study group appeared to gain more satisfaction from single-focus, repetitive activities.
To address Perrin’s criticism, the Brian Center Health and Rehabilitation team offered a mobile unit, a cart that took outside of the Snoezelen room a subset of the Snoezelen experience, activities and objects like holding a small bubble tube, a fiber-optic light spray, a projector, music equipment, aromatherapy materials, and a variety of tactile toys. In the evaluation of this technique, the major benefit for dementia patients has been that they were smiling and laughing more and were more relaxed through the use of the portable Snoezelen cart (Sphon et al., 2003). However, no systematic research or quantification of such benefits exists yet, and further research needs to be conducted beyond anecdotal evidence.
Framework of the AMSS Study
The diagram below illustrates the fields that, when bridged together, are the framework of the AMSS study. This diagram also explains how the context of the AMSS study is defined and locates the fields of study of which it consists. These fields are unified sensory stimulation, color therapy, sand therapy, and play therapy. The dementia population can not express themselves cogently, but through the use of multi-sensory stimulation and by means of art work they can express themselves behaviorally. “In terms of Freudian psychology, this artwork mirrors the primary process mode of thinking [unconscious functioning] to which these patients have regressed” (Wald, 1986, p 78). The following section introduces the AMSS study from a clinical art-psychotherapy approach-addressing and stimulating certain vulnerable populations- and elaborates how patients primarily proceed in their thinking and expression.
Figure 1: Framework of the AMSS study
Clinical Art Therapy for Vulnerable Populations
Recent research has evidenced the positive contribution of clinical art therapy in the treatment of vulnerable populations. Saunders (2000) and Ball (2002) found evidence of positive change in children and young people working with clinical art therapy. According to Elmar (2003), clinical art therapy contributes positively in therapeutic contexts in old adult patients but no controlled studies exist. However, Jones (2002) carried out a randomized control trial of clinical art therapy in England in adult mental health patients and found an inverse relationship between increasing self-esteem and declining of negative symptoms.
Statistical evidence of positive clinical art therapy effects resulting from systematic quantitative research comes from studies in Edinburgh, England. A research study conducted as clinical art therapy in a General Practitioner (GP) practice (Dunkeld-Turnbull, 2000) found positive outcomes for patients on a number of measures. In services to older people, Waller et al. (1998) found that people with dementia do respond to clinical art therapy as evidenced by decreased levels on objective measures of depression, when compared with a control group.
These clinical art therapists/practitioners initiated the emotional therapeutic exploration of clinical art therapy for vulnerable populations from children to the ill elderly. Clinical art therapy offers dementia patients the opportunity to make decisions in a particular area, and by altering the materials used it offers the feeling of being able to be in control of something, creating a stabilizing effect (Harlan, 1993). Clinical art therapy contributes to the reduction of social isolation and withdrawal as well as to an increase in feelings of identity and social self-confidence. However, there is a lack of evidence as to the effectiveness of behavioral improvements, such as the positive influence of calming inner agitation, as based on descriptions of cases by Dunker and Kahn-Denis (Elmar, 2003).
Interdisciplinary Clinical Art Therapy in Sensory Stimulation
We already have evidence of the effectiveness of clinical art therapy on the emotional well-being of the dementia population. However, few research studies in the field of art therapy have focused on behavioral benefits with evidence of emotional well-being at the same time. Kramer’s dissertation (1994) through the search link, www.proquest.com, found that dementia patients’ wandering can be alleviated through the use of art materials geared to visual and tactile stimulation. This appears to be the only research article that establishes the use of specific sensory stimulation focusing on behavioral improvement in the dementia population. Nevertheless, a connection between “multi-sensory stimulation” and behavioral improvement for dementia patients seemed possible through the practice of Snoezelen.
Sensory Stimulation
Snoezelen is a specially designed environment where well-being is influenced by controllable multi-sensorial stimuli (Mertens, 2003/2005). Snoezelen is designed to be a wonderful environment for the senses, filled with sights, sounds, textures, and aromas and is used to stimulate, calm, relax, or energize the patient (www.nursinghomesmagazines.com, 2005). There is evidence of behavioral benefits to patients with dementia in terms of rest and relaxation, improved sleep patterns, less agitation and reduced use of medication for pain through Snoezelen environmental stimuli (Wiles et al., 2004). According to the Brian Center Health and Rehabilitation team, their application of Snoezelen to dementia patients successfully evidenced and illustrated how dementia patients’ agitated behaviors, blood pressure rates, and pulse rates were positively affected (Sphon et al., 2003-ongoing). They reported effectiveness in improved swallowing and decreased agitation, and reduced patient’s yelling through cases studies utilizing the Snozelen therapy model (Sphon et al., 2003). One such example can be seen in the figure below, provided by www.nursinghomesmagazine.com, which shows how ten residents relaxed with Snoezelen therapy by means of before and after-intervention pulse-rate measurements:
Figure 2: Before and After-Snoezelen Intervention Pulse-Rate Measurements
Development of AMSS
Theoretically, the combination of the Snoezelen model and art therapy should lead to a balance between art therapists’ emotional well-being objectives and occupational therapists’ physical objectives. However, the application of Snoezelen to the dementia population was limited to use by occupational therapists for the sole purpose of physical rehabilitation with the aim of maintaining and restoring function and independence. However, the art therapist focuses on emotional expression and the facilitation of creative processes (Abraham, 2005, p. 90). The art therapist is seen as an “ego organizer,” a facilitator encouraging the patients, praising all their efforts, and reminding them of their tasks. The art therapist can examine the conscious and the unconscious structure of the personality interpreted through artwork to assess the level of patient functioning and the effects of dementia on the patients’ behavior (Kramer, 2005, p. 27).
In spite of the positive outlook for behavioral outcome in dementia patients through Snoezelen treatment, Perrin’s research (1997) found out that a multi-sensory environment could be over-stimulating for the dementia population. She concluded that multi-stimulus activities in the Snoezelen room, involving constant or rapid change, may not be comfortable for people with severe dementia. Her study group appeared to gain more satisfaction from single-focus, repetitive activities.
To address Perrin’s criticism, the Brian Center Health and Rehabilitation team offered a mobile unit, a cart that took outside of the Snoezelen room a subset of the Snoezelen experience, activities and objects like holding a small bubble tube, a fiber-optic light spray, a projector, music equipment, aromatherapy materials, and a variety of tactile toys. In the evaluation of this technique, the major benefit for dementia patients has been that they were smiling and laughing more and were more relaxed through the use of the portable Snoezelen cart (Sphon et al., 2003). However, no systematic research or quantification of such benefits exists yet, and further research needs to be conducted beyond anecdotal evidence.
