Creative arts therapies in psychiatry : A clinical application of the Bonny method of guided imagery and music and creative arts groups

University dissertation from Stockholm : Karolinska Institutet, Department of Clinical Neuroscience

Abstract: The Creative Arts Therapies (CATs) are characterized by imagery in altered states of consciousness, artistic expression (art, music, dance, drama) and metaphoric expression (as in poetry). The CATs implemented in this thesis consist of The Bonny Method of Guided Imagery and Music (BMGIM), and the Spektrum Creative arts group program. Spektrum is a four-week treatment program, where group applications of BMGIM and Art therapy are combined with psychodynamic verbal group and occupational therapy. BMGIM and Spektrum both have all the characteristic components of CATs. In addition to the tools of verbal therapy, CATs techniques also evoke implicit (non-verbal) memories and analogic symbols (sensory images with multiple, parallel meanings). CATs are proposed to provide ana-logic symbolization for integrating bodily, and affective memories stored outside of verbal recall. They also spontaneously mobilize inner resources that facilitate a therapeutic reexperience of traumatic memories. The aim of the study was to investigate general and subgroup treatment effects with particular focus on gender and trauma, suggested in the literature. Since control groups were difficult to obtain, outcome differences between subgroups were cues to indications for treatment. Effects were measured according to statistical significance, effect size and change from pathological to non-pathological status. Outcome measures were the Symptom Checklist-90 (SCL-90), Inventory of Interpersonal Problems (IIP), and the Sence of Coherence (SOC) scale. The Dissociative Experiences Scale (DES-II) was translated and validated for the purpose of using it as a possible prognostic factor. The Relationship Style Questionnaire (RSQ), was included as a validating measure of the DES. A Trauma Quality Questionnaire (TQQ) was developed, exploring different qualities of trauma. Three populations were studied: 1) general psychiatric patients with a range of diagnoses 2) psychotherapy clients and 3) 650 subjects from a normal population. Results : Viability of the Spektrum program was demonstrated by statistically significant changes in the Spektrum sample of 43 patients with a wide range of diagnoses. In the BMGIM study, clinical significance was demonstrated through the change of 6 of 10 patients from pathological (dysfunctional) to non-pathological (functional) status according to the SCL-90 criteria, with large effect sizes. The functional subgroup was improved in measures that are considered hard to change through psychotherapy. Gender differences in IIP and SOC subscales were found following BMGIM treatment. The men were at a disadvantage not only in outcome, but also in greater pre-treatment impairment. Possible ways of improving the fit between BMGIM and gender are discussed. In the Spektrum sample, a history of trauma was a positive prognostic factor, as a traumatized sub-group had better outcomes, although with a large variation in the treatment results. As DSM diagnoses were not indicative of outcome, a dimensional concept of trauma related disorder was explored. Patients with separative trauma were found to have the best outcomes. A neuropsychological theory of traumatic imagery in BMGIM is presented. The DES was validated and found to have adequate psychometric properties to be used as a prognostic factor. Other dimensions to be explored include attachment, creativity and autobio-graphical memory. Finally, ways of developing CATs for trauma-focused psychotherapy are discussed.

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