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ABSTRACT
Background
Many childhoods and adolescent psychosocial problems involve dysfunctional emotion regulation. A programme has been developed called Affect regulating Arts Therapies (ArAT) to address emotion regulation problems in children and adolescents. The theoretical concepts and techniques have been described in the ArAT programme, but insight into which specific therapeutic actions contribute to the benefits in clinical practice is still lacking. This study aims to construct a measurement instrument (checklist) to test whether the main therapeutic actions are applied in line with the ArAT programme.
Method
To develop the measurement instrument, we performed desk research on existing documents and additional literature. In addition, developers were interviewed, and group meetings took place. Finally, to develop the instrument further and investigate the reliability of the measurement instrument, film clips from therapeutic sessions were used and scored by multiple raters.
Results
Typical therapeutic actions were defined from attachment, trauma, affect-regulating, mentalising, art therapeutic theories and treatments, and could be divided into the three theoretical phases of the ArAT programme: tension regulation, attention regulation, and affect regulation. A first draft item list of 83 items was based on qualitative analysis. In three phases, the draft item list was reduced to 15 items, of which twelve items met reliability criteria.
Conclusion
The therapeutic core of the ArAT programme lies in enhancing the self-regulatory abilities of children/adolescents through art therapeutic actions that target the regulation of tensions, attention, and affects. The set of 15 items is considered a starting point to further investigate the ArAT programme's treatment integrity.
Plain-language summary
Many childhoods and adolescent psychosocial problems involve a high sensitivity to emotions and strong emotional reactions to stressful situations, also known as emotion regulation problems. A program has been developed called Affect regulating Arts Therapies (ArAT) to address these problems in children and adolescents. The theory has been described in the ArAT programme, but insight into what the therapist does in this therapy is unclear.
This study aimed to create a questionnaire to check whether the main therapeutic actions are applied in line with the ArAT programme. To develop the questionnaire, we searched in existing documents and additional literature. In addition, ArAT developers were interviewed, and group meetings took place. Finally, to develop the questionnaire further and to investigate whether the questionnaire could be completed reliably by different people, film clips from therapeutic sessions were used and scored by multiple people.
Typical ArAT therapeutic actions were found in different attachment, trauma, affect-regulating, mentalising, art therapeutic theories and, treatments. They could be divided into the three theoretical phases of the ArAT programme: tension regulation, attention regulation, and affect regulation. The first item list of 83 items was based on literature and interviews. In three phases, this list was reduced to 15 items, of which twelve items could be reliably observed.
The therapeutic basis of the ArAT programme lies in improving the child's/adolescents ability to regulate their own emotions through art therapeutic actions. The set of 15 items is considered a starting point to further investigate the ArAT programme's extent to which the intervention is implemented as planned.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Funding
Notes on contributors
Liesbeth Bosgraaf
Liesbeth Bosgraaf has worked for many years as an art therapist in various sectors within mental health care in the Netherlands. She now works as a coordinator of the research curriculum, lecturer and researcher for the art therapy programme at NHLStenden University for applied science. She is also a member of the research cluster Small-n designs at NHL Stenden. Liesbeth has been conducting research since 2016, specifically looking at the working elements of art therapy in children and adolescents, within a PhD. Overall, in her work, her interest is on themes such as attachment, connection and attunement.
Marinus Spreen
Marinus Spreen is a lector Small-n designs at NHL Stenden, Academy of Social Studies and Academy of Health at NHL Stenden University of Applied Sciences, the Netherlands. His PhD at the Interuniversity Center for Social Science Theory and Methodology, University of Groningen addressed statistical inference problems in personal networks. His research focuses on experimental and naturalistic single case methodology and statistics in health and social studies.
Kim Pattiselanno
Kim Pattiselanno is a research lecturer at NHL Stenden University of Applied Sciences in the Netherlands. She obtained her PhD at the University of Groningen and Interuniversity Center for Social Science Theory and Methodology (ICS). Her research and teaching focuses on research methodology and child and adolescent youth, and she is currently a member of the research cluster Small-n designs at NHL Stenden, Academy of Social Studies and Academy of Health.
Susan van Hooren
Susan van Hooren is professor at Open University of the Netherlands, KenVaK Research centre on arts therapies and Zuyd University of applied sciences. She is head of department of Clinical psychology of the faculty of Psychology at the Open University. During her career, she combined practice based research, with teaching activities and clinical work. She has clinical experience with a broad range of psychopathological disorders (e.g. dementia, depression, ADHD, sexual disorders). Her research, supervising (PhD- & masterstudents), and teaching focus on evaluating arts therapeutic interventions and its working factors and clinical psychology, resulting in many publications in high ranking peer reviewed journals and contributions on national and international conferences.