The efficacy of art therapy on hope and resilience in youth within a secure care centre

Figures & data

Table 1. Art-based interventions over 12 weeks.

Name of art directive	Directive Description	Objective
I Am Poem	Poem includes 12 prompts that invite the client to reflect on what they need, feel, understand, believe, hope etc.	To support client in developing an awareness and understanding of sense of self.
Tree of Strength (Denborough’s (2008)	Client traces their outstretched hand on the paper. Fingers are extended to create branches with leaves attached. In each leaf client is encouraged to write one thing that helps them get through difficult times.	To assist client in connecting to their strengths and abilities.
This Is Me Collage	Using images and words cut out from newspaper and magazines client creates a collage that describes the things that are important to them and gives them pleasure.	Introduce client to therapist while validating their lived experience.
Coping Strategies Poster	Client folds a large piece of paper into nine squares. Each square is used to illustrate a coping strategy introduced and practiced in session including: counting backwards from 50, square breathing, grounding using five senses, listening to music, drawing your emotion, 15 jumping jacks etc.	The visual image is a reminder for clients to use their skills, to develop mastery over their emotions.
Positive Self-Talk Shield	Client is provided with an image of a pre-cut shield, markers and paint. Client writes their negative self talk on the shield and then is encouraged to attach a card over their statement that incorporates positive self talk.	To increase self-confidence, reduce stress and increase positive sense of self.
Self-Soothe Pillow	Using a sewing machine and hand sewing skills client creates a pillow that can be used to self soothe and create a sense. of comfort.	To support client in developing a sense of mastery and transitional skills.
Coping Ahead Box	Decorate a reclaimed shoe box that will be used to contain activities to help distract client. Box includes: deck of cards, journal for writing or drawing, stress ball, photos of beautiful images or favourite people, small bottle of scented lotion, tea bag, hard candy, a piece of soft, silky fabric.	Support client in managing intense emotions while increasing their ability to cope in the moment and develop a sense of competency.
Self Portrait Mask (Liebmann, 1986)	Using a cardboard mask and paint, marker, and collage piece the client explores how others see you on the outside of the mask and how you really feel on the inside of the mask	Mask making helps to increase awareness of self, develop mastery and improve communication
Road Map to the Future	Using a large sheet of paper, markers, paint, and cut-outs of road signs the client creates a road map to their future.	Future orientation in the form of a road map provides the opportunity to see their future from a survivor vs victim visual their safe place.
Transitional Bus (Darewych, 2020)	Client is given a Styrofoam bus, paint markers and collage pieces. Client uses papier-mache to cover the bus The bus is used as a metaphor for transition to the community. Clients consider being the driver of their bus, reflecting on where their bus will stop what parts of town they will avoid, who they will allow onto their bus, who they will ask to leave their bus. Client also considers what they stand for in regards to advertising on the side of their bus including	The transitional bus provides the client with the opportunity to reflect on their values and the direction they would like their life to go in Placing the client in the driver’s seat gives them a sense of empowerment and control.

Figure 1. The Children’s Hope Scale.

Table 2. Descriptive statistics at pre and post art therapy (N = 13).

		Pre	Post
Outcome	Range	M (SD)	M (SD)
Total Hope	6-36	19.85 (6.78)	22.62 (8.64)
Agency	3-18	9.23 (3.44)	12.85 (4.39)
Pathways	3-18	10.62 (3.57)	12.62 (4.07)
Total Resilience	25-175	114.08 (25.95)	132.92 (29.98)
Competence	17-119	78.27 (19.15)	90.23 (19.69)
Acceptance	7-56	35.81 (7.28)	37.46 (9.20)

Figure 2. The Resilience Scale.

Table 3. Interrater agreement on coding of BDP categories.

	Raters			Average	Kappa Agreement
BDP image categories	Raters 1 & 2	Rates 2 & 3	Raters 3 & 1
Axis of the Paper
Pre	0.16	0.09	0.53*	0.26	Fair
Post	0.63**	0.84**	0.47*	0.64	Substantial
Directionality
Pre	0.53	0.03	0.22	0.26	Fair
Post	0.74**	0.37	0.41*	0.50	Moderate
Placement of Self in the Picture
Pre	0.81**	0.81**	1.00**	0.87	Almost Perfect
Post	1.00**	1.00**	1.00**	1.00	Perfect
Bridge Connection
Pre	0.71**	0.68**	0.68**	0.69	Substantial
Post	0.60**	0.77**	0.77**	0.71	Substantial
Bridge Type
Pre	1.00**	1.00**	1.00**	1.00	Perfect
Post	0.87**	0.87**	1.00**	0.91	Almost Perfect
Matter Drawn under Bridge
Pre	0.86**	0.86**	1.00**	0.91	Almost Perfect
Post	1.00**	0.74**	0.74**	0.82	Almost Perfect

Table 4. Percentage of participants under each BDP rating category.

BDP image categories	Pre	Post	Cochran’s Q p-value
Axis of the Paper			.368
Horizontal axis	69%	85%
Vertical axis	0%	0%
Undefined	31%	15%
Directionality			.695
Direction from left to right	54%	23%
Direction from right to left	0%	15%
Upward direction	46%	62%
Downward direction	0%	0%
Undefined/no movement/centralized	0%	0%
Placement of Self in the Picture			.717
No self	69%	61%
Depicts self in picture	31%	39%
Bridge Connection			.115
Bridge floating, not attached to land	62%	77%
Bridge attached to land mass	31%	8%
Bridge omitted	8%	15%
Bridge Type			.368
Non-arch type bridge	31%	39%
Bottom arch type bridge	62%	46%
Bridge omitted	8%	15%
Matter Drawn under Bridge			.368
None	62%	62%
Water	15%	31%
Land	23%	8%

Figure 3. Pre- and post- bridge drawing with path.

Figure 4. Participants’ responses on the Client Satisfaction Survey.

Table 5. Participants’ written responses on the Client Satisfaction Survey.

Question and responses	% of participants	Examples of written feedback
What is the most helpful or useful aspect of art therapy?
The opportunity to express emotions, feelings, or thoughts	39%	“I found that it was a good thing to have a place [where] you don’t have to talk to [communicate] you can do it through the art work”
The opportunity to understand themselves	31%	“I got to understand my thoughts, feelings, etc. It helped me realize my emotions.”
Artistic activity	23%	“Making a drum”
A way to manage emotions/stress	15%	“It helped me manage my emotions and learn how to express myself.”
Positive relationship with art therapist	8%	“I believe having a true genuine connection/relationship with the therapist is 100% the most helpful and useful aspect […]”
What could be improved?
Nothing	31%	“The program is great! Nothing needs to be improved!”
Having longer sessions	15%	“Long sessions/more sessions”
Having music in the sessions	8%	“Maybe some more up [beat] music”
Having fewer restrictions	8%	“I think that not having so many “loose ends” or strict rules because it prohibits all the good work that could and can be done”