Review Article - Clinical Schizophrenia & Related Psychoses ( 2022) Volume 0, Issue 0
Effect of Art Therapy on Adolescents
Shruti Mittal, Department of Amity Institute of Psychology and Allied Sciences, Amity University, Noida, Uttar Pradesh, India, Email: email@example.com
Received: 01-Mar-2022, Manuscript No. CSRP-22-58486; Editor assigned: 04-Mar-2022, Pre QC No. CSRP-22-58486 (PQ); Reviewed: 23-Mar-2022, QC No. CSRP-22-58486; Revised: 28-Mar-2022, Manuscript No. CSRP-22-58486(R); Published: 04-Apr-2022, DOI: 10.3371/CSRP.MSMM.040422
This paper provides a review of the significance of art therapy in promoting identity formation during adolescence. Art therapy is a form of experiential treatment intervention whereby the selection and use of art materials, the creativity and counseling of the art therapists, and the artwork are assumed to enhance emotional competence and resolve identity crises among adolescents. Although previous studies suggest positive outcomes of art therapy, there are insignificant breakthroughs in India due to the slow evolution process of art therapy from therapeutic state to professionalism. It is suggested that most Indians seek professional training from western countries, and in return, they face acculturation and adaptability concerns. The literature shows that adolescents with complex identity crises and diffusion benefit from art therapy techniques reinforcing self-understanding. Art therapy's responsiveness promotes flexibility in the expression and art therapist's behavior over the adolescent's needs, thereby reinstating a sense of safety and control of life. Adoption of ethnocentrism in Indian art therapy enhances alleviation of acculturation and adaptability issues.
Art therapy; Identity formation; Art-making; Self-expression; Adolescence; Emotional competence
In several regards, adolescents are prone to developmental changes that enhance the formation of identity concomitant with the social roles, values and beliefs, and goals. When an individual has a precise clarity of identity, it becomes easier to dictate individuality style, feeling of self-worth, and continuity over a significant period . Identity formation involves selfreflection, life exploration, and determination of a role in relationships and society, which dictates personal differentiation and connection to others . Evidence-based research indicates that individuals suffering from identity crisis or diffusion can alleviate these adolescent challenges by therapeutic approaches that focus on forming a healthy identity and self-realization . Studies focusing on effective identity formation can reinforce therapeutic techniques influential in helping solve identity formation problems . It is critical to note that art therapy that focuses on approaches to improve self-exploration and reflection and emotional coping skills can effectively enhance coherent identity formation through substantial integration of selfknowledge.
Art therapy during adolescence
Art therapy's significance is critical during adolescence since this is the period when adolescents express creativity and are coherently concerned with their individuality . The most common issues that bring adolescents to art therapy include identity concerns since they can engage in art-making to enhance self-exploration and coherent personality . Several scholars support the impact realized by art therapy as adolescents struggle to form their identities. Art-making integrates creativity critical to focusing on aspects that are disadvantageous to self in order to create self-awareness and acceptance while creating and recreating identity . Adolescents' emotional statuses are critically integrated into art therapy approaches to enhance their significant observation and synthesis to improve psychological integration that bores strong identity . Therefore, through art-making and effective art therapy, adolescents can gain self-insight and skills critical to developing a flexible and adaptive individuality.
The most consistent art approaches that enhance self-exploration and individual coherence include expressive, existential, and narrative processes, essential for self-understanding . First, expressive art therapy facilitates self and emotional awareness by allowing individuals to express and gain insight . Generally, the expressive approach emphasizes that art-making can have a significant therapeutic index as long as it integrates the expression of an individual's unknown aspects to enhance efficacious self-insight . The adolescents are subjected to a therapeutic space by the therapist to express themselves at a free artistic level provided valuable materials are available . Second, existential art therapy stresses the significance of experiential learning singularly on the universal understanding of the meaning of life . Therefore, adolescents showing significant challenges with identity formation, this approach effectively enhances their search for self-identity, personal goals and purpose, and meaning of life . Lastly, the narrative approach gives the adolescents a chance to tell or retell their stories to help them improve their self-exploration. This approach focuses on strategies that separate individuals from their challenging emotional status by telling stories from different perspectives, thereby expanding their mindsets towards their identity. Therefore, creativity in art-making enables individuals to discover and reframe their personality coherence by creating novel metaphoric images.
Art therapy became evident in India in 2001, and this concept has remained a nightmare to the general population . Given that India has the largest population, the evolution of art therapy is a slow process from therapeutic state to professionalism. India is in a transitional state following the emergence of art therapy. It is suggested that India has no formal art therapy training, and the Indians are forced to seek professional training from western countries since there are no university-based postgraduate training centers in India . Applying art therapy becomes difficult when trained therapists use theories and concepts practiced in those countries; acculturation and adaptability issues are overwhelming by the sojourner art therapists . Few art therapists available are spread geographically across India to offer a wide variety of approaches (no standardized approach) to the Indians [9,10]. Art therapy grounded on diverse orientations is the most significant to embrace in the community, whereas art psychotherapy is effective in clinical practices since it embraces psychodynamic orientations . Due to the significant gap in art therapy among Indians, ethical concerns by the United States have shifted to determine the competence and appropriateness of art-making processes in India . Scholars dictate the essence of adopting ethnocentrism in art therapy education in India to invalidate hegemonic orientations of theories and practices imposed in different cultural contexts . Therefore, to eliminate the colonial view of the emergence of art therapy in India, it is vital to bond art therapy with culture and never culture blind it.
Art therapy in India acts as a holistic approach significant in addressing the emotional status and other cognitive aspects concomitant with augmentation of social, physical, and developmental growth [9,10]. Art therapy engages people strategically by introducing potent artworks that provide significant perspective to their current thoughts. The Indian art therapy association emphasizes analyzing adolescents with identity crisis and diffusion to whom drawing contents speak more about their thoughts and feelings that are challenging to express [9,10]. The contents of drawings help develop a symbolic image of the visual thinking of the adolescents . Moreover, art therapy encourages adolescents to say whatever they are hesitant to express, thereby reinstating a sense of safety and control of life.
Art therapy in India became significant in 2019 to promote the mental health ecosystem, contributing to social and individual coherency . In adolescents, art therapy is used as a treatment regimen to alleviate traumatic life incidences . It is noted that when adolescents are immersed in artmaking, they verbally express their feelings effectively . Sometimes adolescents choose to live under their shadows and find it hard to trust that adults understand what it is to search for identity and individuality.
Furthermore, the adolescents fear criticism, poor understanding, and mistrust while forming their identity and developing personality coherency. However, through art therapy, the individuals can disclose and discuss their personal goals, life struggles, and understanding of the meaning of life and spiritual wellness (Briks, 2007). Adolescents have a deep-rooted belief that self-worth comes from within, and you cannot rely on others for validation.
The process of art therapy revealed incidences that were awful for the adolescents to cope and embrace self-exploration and reflection. The Indian culture is critical to shaping adolescents' perception in matters involving measures necessary to implement when dealing with an identity crisis and identity diffusion. Therefore, art therapists base their treatment strategies on experiential and tacit knowledge, which comprise principles, therapist behavior, and art therapeutic interventions of expressions to enhance decision-making concerning identity crisis and identity formation to produce significant outcomes . Suppose the elements critical to strengthening these outcomes are identified, interpretation and understanding of the outcomes become easier, thereby providing a platform to trigger empirical knowledge of art therapy. This paper aims to provide an overview of the effects of art therapy for strengthening emotional competence and resolving identity issues among adolescents, specifically in India.
Review of Literature
According to Rowe et al. , art therapy allows individuals to express themselves under psychotherapy interventions involving artmaking processes that focus on improving mental, social and emotional competence. The efficacy of art-making lies upon self-exploration and discovery, and catharsis, whose significance results in healing power using non-verbal cues of communication . Consequently, art therapy can alleviate mental health problems by comforting individuals, facilitating personality coherency.
Slayton et al.  described the phenomenon of Art Therapy (AT), reporting its impact on majorly treating mental illnesses, severe traumatic events, and alleviating social problems. When the current generations are compared with the previous ones, studies suggest that traumatic brain injuries that cause neurological impairments, substance abuse with new additives, and war effects in current generations have accelerated the severity of mental health complications . Scholars believe that art therapists are in a critical position to provide significant evidence that affirms the impact of art in enhancing individual wellness . Slayton et al. noted that when art therapy is combined with other interventions, it becomes challenging to determine the compelling profile of art therapy in realizing positive outcomes. The individuals enrolled in art therapy sessions and their therapist can identify when necessary to progressively imply change and growth during sessions . Because adolescents struggle with emotional competence and resolving identity issues as reviewed above, this will be the significant dependent variable. This literature review aims to evaluate the impact of art therapy on enhancing emotional competence and resolving identity issues among adolescents.
Tripathi et al.  reported that adolescents are overwhelmed with stress emerging from self-exploration, peer pressure, physical appearance, and self-expectations. The authors suggest that adolescents require art therapy sessions to enhance their emotional growth and self-discovery based on their drawing . When art therapy is incorporated with counseling, it significantly promotes better stress management among adolescents . While adolescents struggle with identity crisis and diffusion, the demands of the environment and advancements in technology have made life increase in complexity and stress . Individuals opt to deal with these changes in their ways, ultimately activating intensified and persistent stressinduced feelings . Scholars define art therapy as an effective projective technique among all ages that employ creativity in art-making to enhance physical and mental, and emotional wellness . Art therapy can resolve conflicts and other developmental problems through self-expression since it incorporates human development with counseling and psychotherapy . It is suggested that art therapy does not relate to art lessons or recreational activities, but it is enjoyable since the clients need no experience in artworks to participate (Pelton-Sweet and Sherry, individuals participate in treatment sessions when they are aware of the outcomes . Art therapy ensures that individuals develop self-awareness and understanding and how effective it is to participate in creative art-making.
Edwards shared Margaret Naumberg, a USA psychologist's model of art therapy. The research findings indicated that the spontaneous expression of art correlates with the free association between the patient and the therapist to release the unconscious perspective . The results suggest that art therapy is closely associated with a psychoanalytic theory that primarily states that humans possess unconscious beliefs, desires, thoughts, memories, and desires . Ultimately, the transference relation and consistent desires to analyse the patient's artwork dictate the treatment intervention since the images form a symbolic speech . The figurative definition of the patient's images is sometimes vague and requires enough time to evaluate its significance . Therefore, studies dictate that art therapists must embrace tolerance of the uncertainties to avoid poor decisions due to jumping to conclusions about the artwork's symbolic meaning . Critically, individuals may decide to use the same image to illustrate diverse feelings, thereby complicating the comprehensiveness of the intention of the image.
According to Freilich et al.  art therapy is regarded as a treatment intervention associated with the creator, creation, and the therapist to enhance awareness of the compromised emotions and allow selfexploration through artwork processes. Art therapy is considered adequate among adolescents due to its ability to connect them instantly to art . It is suggested to enhance self-acceptance even in children with disabilities because it utilizes non-verbal cues of communication . Moreover, it decreases therapeutic resistance by encouraging self-exploration and self-acceptance; thereby, therapists can confirm the increased therapeutic alliance with their clients.
Art therapy intervention requires the designation of a room well equipped with art-making materials such as paints, papers, journals, and or pictures . It is suggested that the adolescent should select the topic and materials necessary for expressing inner thoughts, and the therapist is summoned to guide the client to achieve a positive outcome . Research findings suggest that any case selected by the client is never incidental but a significant reflection of hidden thoughts that the clients find challenging to express directly . The therapist's role is to liaise with the client to identify relevant experiences, conflicts, or challenges in the artwork. It is imperative to encourage the client to reach their respective inner desires.
Adolescents' severely compromised emotional statuses are challenging to treat, especially when combined with disrupted attachment; thus, treatment interventions focus on asserting individuals on art therapy have a greater therapeutic index . It is suggested that art therapy reduces behavioural problems while building a solid relationship between clients attending art therapy sessions and the therapists . Both art psychotherapy and art-making effectively build self-esteem, a significant issue among the clients . According to Huang et al.  the development of adolescents is critical to their peer relationships and self-concept due to substantial positive influences evident in individual art therapy. The formation of identity among adolescents is supported by the psychosocial theory of development, which marks the boundary between childhood and adulthood . Huang et al. suggested that when adolescents combine their current self-concept with childhood concepts, they have the potential to escape identity crisis and diffusion and find ways to fit into peer groups and effectively interact socially . Adolescents can improve their egoresilience while attending art therapy sessions, especially when facing challenging socioeconomic statuses.
Art therapy has been demonstrated to be effective in incorporating expressive art approaches and psychological interventions through specialization . Art therapy has several advantages that can be used in several settings to promote personality coherency and individuality, provided essential art materials are availed during the artwork process . Ultimately, it is suggested that when individuals reflect and integrate their identity and coherency, they stand a chance to achieve self-acceptance, emotional competence, effective social interactions, and management of behavioral issues . Adolescents can achieve meaningful and creative life outcomes provided art therapy exposes the participants to different art materials and innovative processes . The effect of art therapy globally has been linked to empirical evidence, which suggests that adolescents benefit from it through significant interventions used to solve mental health problems.
Kostyunina et al.  reported that school anxiety plays a significant role in humiliating adolescents' emotional competence due to excessive pressure and uncertainty. It is suggested that school-age is critical to enhancing the adolescents' capability to form their identity and personality coherency since anxiety bores insecurities, impulsive behaviors, and doubtful personalities . In a nutshell, when adolescents experience anxiety disorders, it hinders intellectual development, which generates creativity, curiosity, and self-exploration . Art therapy creates a protected space that allows the adolescents to develop a sense of protection while expressing their inner feelings, facilitating emotional competence and propensity to resolve identity crises . Scholars suggest that once an individual has gained balance and stability, they have an opportunity to create a space for interacting with contradictions.
Research conducted by Alders and Levine-Madori et al.  suggests that art therapy improves cognitive functioning by enhancing emotional status, effective communication strategies, social interaction, ability to solve cultural issues, and person-centered interactions. It is also suggested that activities involving creativity and catharsis with integrated art therapy are critical to improving the quality and individual wellness, such as increased visual and mobility performance . When a person self-initiates artmaking and combines it with art therapy, the overall cognitive performance improves because of a significant advancement of individual perception of cognition ability. Visnola et al.  suggested that art therapy serves as a preventive measure among stressed and anxious employees by providing a means to have a sound understanding of the stressful situation and manage their anxieties. It was reported that when individuals learn to manage and cope with stress adequately through creativity, their quality of life improves drastically . Researches indicate that art therapy is effective for both genders, and therapists are encouraged to employ flexible thinking to develop significant perspectives on their clients.
Many case studies in the literature focus on art therapy enhancing emotional competence and resolving identity issues among adolescents . Studies by Lyshak-Stelzer et al.  indicate that adolescents face challenges identifying safety and dangerous life situations because of identity crises and diffusion. Art therapy orients such individuals using non-verbal strategies, which form a basis for verbalizing their underlying issues in a supportive social context . Therefore, using imaginary representations in art-making enhances constructive use of displacement effective in reducing traumatic events among adolescents.
Gussak et al.  discussed the significance of art therapy in prisons, noting that individuals can express complex issues more straightforwardly. The author reported that art therapy allows individuals to bypass awful defense mechanisms, especially pervasive dishonesty . It is suggested that the clients are taught to express effectively in compliance with the societal requirements . Moreover, art therapy is significant among populations with low levels of education, poor psychological functioning, and other issues that compromise cognitive development and verbal communication.
A brief report by Hessler et al.  suggests that when adolescents are exposed to dysfunctional styles to nurture their emotions; they become emotionally driven to risky behaviours. Critically, adolescents with inadequate skills effective against emotional experiences show an increased propensity to participate in risky behaviors to mask their feelings' negative impact or fake self-expression . Based on the stress vulnerability approaches, when a person lacks a strategic way of handling emotions, the probability of using substances emerges effective to solve their negative traumas . Empirical studies show that a lack of strategic skills can bore multiple deficits in emotion-related competencies, which form the foundation for problematic adolescent situations . Research findings suggest that enhancing emotional competence by art therapy serves to halt adolescent risky developmental behaviors . In several regards, scholars indicate that poor emotional awareness and competency is associated with substance use disorders, several sexual partners, and difficulties in adjusting behavioral concerns.
Several studies support art therapy in that it is diversified to comply with different populations undergoing specific traumas to decrease the severity of symptoms . The scholars noted that art therapy was the effective treatment intervention that could connect emotional-psychological functioning and sensations through symbolic representations . Consequently, art-making enhances the development of self-insight to improve the quality of life, making healthy decisions, and sense of security.
Scholars have provided evidence-based information to support the significance of altered books to realize the effects of art therapy . Art therapists recommend using altered books to promote creativity through containment protocols that allow artistic free self-expression . Incorporating books into art therapy intentionally enhance significant growth and developmental changes that correlate with individuality . Altered books are believed to provide self-reflection and stimulation critical due to enhanced visual art-making.
Psychologists suggest that adolescents' issues provide a solid foundation to understanding several psychological problems evident among adults . It is estimated that 15%-22% of adolescents suffer from identity crisis and diffusion . Several methods are used in art therapy sessions, but research findings indicate that painting is the most effective technique to use while expressing inner feelings and emotions freely . According to Bazargan, painting techniques among individuals with traumatic mental events experience a sense of security of awful memories since painting allows them to symbolically express those events and their impacts. Furthermore, the art-making process provides individuals with opportunities to feel safe and express challenging emotions in order to move forward while pinpointing strategies effective in integrating previously unspeakable life events . Conclusively, art therapy can aid in alleviating an adolescent's internalizing and externalizing behavioral problems.
Studies have evidenced that the relationship between spoken word and symbolic images is prone to translation to reinforce the significance of art therapy; it provides a means to a significant route to speak about the interior states of an individual by self-reflectivity and communicating freely . It is suggested that art therapy contributes to individual empowerment through creativity and policies critical to social conventions. Artworks are significant depending on what an individual represents, interprets, and utilizes to relay specific information and knowledge that is valuable ethnographically . The process of art-making provides valuable insight into an individual's psychological functionality . Art therapy is used to develop symbolicinteractionist ideas, and it enhances the intensive exploration of selfhood's fluidity that is critical to forming the art of subjectivity . Art-making engages all five human senses; hence, it is vital to develop an informed perspective of the artwork regardless of the assumptions made on the visual image . Moreover, art therapy has no standard verbal or visual language for communication . Art therapy focuses on common issues known to everyone to personal and psychological concerns to enhance compatibility to identity crisis and diffusion evident among adolescents.
This review sought to examine how art therapy interventions effectively enhanced emotional competence and resolved identity issues among Indian adolescents. The primary emphasis was on art therapy's applied means and expressiveness, clinical features, and suggestions to substantiate artmaking processes . The most significant results showed that various art materials and approaches effectively treat identity crises among adolescents . No specific art material or method stood out to resolve adolescents' issues . The interventions applied during or after art therapy sessions do not relate specifically to therapists' behaviours resulting in difficulties identifying which combination of art materials and approaches and structural forms effectively treat mental health challenges faced by the adolescents . Therefore, various art materials, techniques, and topics used in art therapy suggest that this intervention is responsive more often at individual level cases during treatments . This finding attunes the concept of art therapists in identifying the client's possibilities and needs.
Furthermore, it is suggested that adolescents with emotional competence and identity issues benefit from all domains of art therapists' behavior and art-making processes. Verbal communication is enhanced despite the significant focus on therapeutic artwork because sometimes teens want to talk about their imagery paradoxically provided they are not pressed to speak . Therefore, symbolic visual expression and verbal discussion complement each other to enhance therapeutic communication critical to addressing individual concerns and issues . The sensitivity and perceptiveness of the adolescents can be improved through significant interaction with their visual imagery. It is suggested that observation and dialogue of the artwork can promote awareness and connection to the issues among adolescents . The strategic interventions of art therapy contribute to new directions and the propensity to develop an informed perspective for adolescents. Based on the literature, creative expression and artwork facilitate therapeutic transformations and self-reflection of the impact realized.
Clinical art therapy practice that has integrated art psychotherapy specifically for adolescents is advocated because it applies to all developmental stages for a broad spectrum of mental health complications. Moreover, it creates a positive association to therapy by embracing personal expression, which studies suggest most adolescents find enjoyable and less threatening than verbal communication. Art-making provides adolescents with a safe and transitional space that can help eliminate obstacles that hinder an effective therapeutic relationship with oppositional, distrustful, and non-verbal adolescents. Consequently, art therapy bridges nuances of cultural diversity and enables adolescents with disabilities to improve their expressiveness. Artistic expressions are significant in permitting the externalization of conflicted emotions, inner conflicts, and anxiety by functioning to restore order in internal issues and paving the way for safer ways to contain all emotions. Therefore, the art-making process can restore the identity, contributing to personality coherency and individuality through inner healing activation processes. Art therapy reduces overwhelming therapeutic resistance by promoting autonomy, whereby an adolescent is encouraged to build identity actively. Symbolic visual expression protects the adolescents' ego strength since the content of imagery is analyzed at the level of symbolic metaphor, which objectifies the inner experiences and addresses issues fairly.
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Citation: Mittal, Shruti, and Mamata Mahapatra. "Effect of Art Therapy on Adolescents.� Clin Schizophr Relat Psychoses 16S (2022). Doi:10.3371/CSRP.MSMM.0329222
Copyright: � 2022 Mittal S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.