Activating Expression, Connection, and Transformation to Enhance Meaning and Renew Existence

Public recognition of the benefits of the creative arts therapies and the arts in health for the aging population is on the rise as is evidenced through an increase in the efforts of national entities in the United States and abroad to improve quality of life and to enhance wellness (Lambert et al., 2017). We now know that “constant care of people who are facing the physical, mental, and emotional challenges of coping with major illness or impending death often leads to significant stress, exhaustion, and depression” (p. 29), pointing to a need to serve the caregiving population. A special section in this issue draws attention to the unique ways in which art therapy helps to address and alleviate the medical problems and mental health challenges related to aging, demonstrating how the later stages of the human life cycle are valued and honored.

Overall, a common theme manifests across all of the articles in this issue: that of humanistic and humanizing approaches to art therapy services. The first two articles, although not directly related to the theme of the special section, illustrate innovative approaches to art therapy practice and research. Jonathan Lee Haag’s “Recontextualizing the Draw A Story Assessment: Expanding the Expressive Function in Art Therapy” describes a client’s valuable process of cocreating a video-recorded visual narrative in response to the death of a loved one that can be viewed, therapeutically expanded, and further responded to post-session. In their article “Using Clay Sculpting to Prime Readiness to Change: An Experimental Analog Study,” authors Kristy Leone, Steven Robbins, and Michael Morrow investigate an overlooked process variable in therapy that may be enhanced via the medium of clay sculpting.

The Imperatives of Older Adult Care

The four articles that follow in this special section are from three different countries (Canada, Iran, and the United States), representing geographic diversity and reflecting, through their commonalities, the universality of the aging process and the shared experiences and challenges involved today. As described by Elena Guseva, not only is the world population of older adults increasing, but aging-related diseases also are on the rise. This demographic places an unprecedented burden on care systems, with economic and human resource implications. Furthermore, with dim prospects for curing Alzheimer’s and dementia and the limited effectiveness of pharmacologic treatments, alternate routes to treatment evidently are needed (Chancellor, Duncan, & Chatterjee, 2014).

This scenario presents societies the world over with a clear imperative to increase access to services that can help. Fortunately, along with increased awareness, research that demonstrates the benefits of the arts in health for older adults, and the creative arts therapies in particular, also appears to be on the rise. We are seeing today increased evidence and public recognition of how art therapy helps to address a range of challenges related to aging, which in turn is addressing behavioral and rehabilitative health needs at a critical time. The benefits of arts participation are evidenced in such programs as the Alzheimer’s Poetry Project, TimeSlips^TM, and Meet Me at MoMA (Bienvenu & Hanna, 2017), and the partnership between IONA Senior Services and the Phillips Collection in Washington, DC. Families are relieved that such programs help reduce social isolation and stigma for their loved ones as well as improve their sense of purpose, independence, and other benefits that support their quality of life.

In this issue Canadian art therapist Elena Guseva imparts her work on “Bridging Art Therapy and Neuroscience: Emotional Expression and Communication in an Individual With Late-Stage Alzheimer’s”; Iranian authors Ehteram Sadat Ilali, Farzaneh Mokhtary, Nouraddin Mousavinasab, and Abdul Hakim Tirgari present their research in a report entitled “The Impact of Art-Based Life Review on Depression Symptoms Among Older Adults”; Canadian art therapist Martine Guay describes “The Impact of Group Art Therapy on the Quality of Life for Acquired Brain Injury Survivors”; and U.S. art therapist Sarah Anacleto presents her informed perspective on “Aspirational Ethics: Considerations for Art Therapy Practice in a Health-Care Setting for Adults With Dementia.” As a collection of current research and writing for this special section, I was struck by the ways in which the older adult populations described share similar challenges related to their mental health and well-being, despite geographic diversity or medical needs. In particular I noted that in each of these articles participants were helped through three main avenues: by activating creative expression, enhancing social connection, and experiencing transformation. Taken together, art therapists and readers are given guidance for how to enhance meaning in life, provide a sense of renewed purpose, and validate an older adult’s sense of self and very essence of existence.

Activating Expression

The articles challenge us, first, as practitioners and researchers: How can we best serve the aging population through art therapy? We are challenged on a personal level, too: How can we age well? What does it even mean to age well? I have found these questions are best answered, for me, through the conceptual model of the Expressive Therapies Continuum (ETC; Hinz, 2009; Kagin & Lusebrink, 1978) that applies to both art therapy practice and for living well (Hinz, 2018). Readers might be familiar with the ETC’s four levels of engagement with artistic media that are based on four modes of human expression. The first three levels reflect the systems of human information processing, consisting of the kinesthetic/sensory, perceptual/affective, and cognitive/symbolic levels. The fourth is the creative level and represents a synthesis of the other three. Benefits of activating creative expression are amply reflected throughout this issue. For example, Guseva applied a visually enhanced art therapy intervention for her client with advanced Alzheimer’s disease that enhanced emotional expression and improved communication skills and psychological well-being. The act of engaging our expressive function benefits us as individuals; however, expression also can be further enhanced within a community context, as we are social beings who thrive on connection with others.

Activating Connection

A second avenue of benefit is art therapy (and the arts in general) as a means to enhance the self through collective engagement. When we as individuals activate connection with others, we can fortify the meaning of our lives and experience a renewed sense of existence. An excellent example that emphasizes the importance of social networks, particularly later in life, is that of Ilali and colleagues’ work with older Iranian adults. Their group therapy participants were found to have decreased levels of depression after drawing based on life review. The authors attributed this longer term effect to the sharing of memories and emotions, which reduced older adults’ feelings of loneliness and enhanced their social connectedness. Similarly, Guay found that group art therapy for adults 51 to 93 years old with acquired brain injury increased communication and socialization and improved their emotional state toward enhanced quality of life. Activating expression and connection support well-being and enhance our quality of life.

Activating Transformation

As a third avenue, we may be changed through arts-based transformative experiences. Kapitan (2007) encouraged art therapists to “transform suffering into wisdom” as one means of more effectively combating trauma, loneliness, and despair (p. 155). We see in this issue that Ilali et al.’s group therapy life review drawing approach led to improved ego integrity and alleviated depression and despair for older Iranian adults. Leone, Robbins, and Morrow remind us, as well, that the process involved in clay work is inherently transformative. When creating form out of formlessness, we create meaning, which can lead to positive change. Conversely, Anacleto’s thoughtful and sensitive application of the art therapist’s ethical principles to a health-care setting for adults with dementia reflects the many ways in which this population has transformed her and informed her approach to helping them through art therapy. Her work serves as a vital reminder of the bidirectional nature of therapy, and how clients and their art therapists change each other.

Throughout this issue, readers will be reminded of the fragility of life, its brevity, and consequently the importance of extending kindness and understanding to all persons. Yet again we are shown myriad ways in which the creative process enhances compassion and the very essence of what it means to be human, at any stage of life.