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Bildterapi – en väg till inre förändring och förbättrad hälsa
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).ORCID iD: 0000-0001-9497-2617
2018 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Avhandlingens övergripande syfte var att undersöka bildterapins möjlighet att bidra till inre förändring och förbättrad hälsa hos individen. Med inre förändring avses en strukturell och varaktig förändring som sker på ett psykologiskt djupare plan, till skillnad mot en yttre och mer tillfällig förändring. Den bildterapeutiska behandlingen bygger på en kombination av bildskapande och olika grad av reflekterande, bearbetande samtal. En triangulär relation, patient – bild – terapeut, är det som på ett avgörande sätt skiljer bildterapi från andra verbala behandlingsmetoder.

Avhandlingens design var främst kvalitativ, med undantag för delstudie I som var en review. I delstudie I granskades studier om bildterapi för tre olika patientgrupper. En kvalitetsbedömning genomfördes med två olika system för evidens. I delstudie II djupintervjuades kvinnor om upplevelser av inre förändring och om den visat sig i utvalda målade bilder. Intervjuerna analyserades med deduktiv och induktiv innehållsanalys. I delstudie III ställdes via e-post två öppna enkätfrågor till bildterapeuter om vad de uppfattade som en inre förändring hos patienten. Data analyserades med tematisk analys. I delstudie IV genomfördes en sekundäranalys av intervjuerna från delstudie II. Utifrån ett teoretiskt perspektiv undersöktes förekomst av vitalitetsaffekter och grundaffekter samt deras betydelse för inre förändring. En deduktiv innehållsanalys genomfördes.

I avhandlingen beskrivs inre förändring och förbättrad hälsa ur tre olika perspektiv; en grupp kvinnliga patienters upplevelser, en grupp bildterapeuters uppfattningar samt ur ett teoretiskt perspektiv. Resultatet visar att bildterapi kan bidra till en varaktig inre förändring som innebär identitetsförändring, förändrat beteende och förbättrad hälsa. Kvinnor som inte upplevt en inre förändring fann att bildterapin var ett stöd i vardagen. Existentiella frågor om meningen med livet var centrala både i kvinnornas och i bildterapeuternas utsagor. Resultatet visar att den terapeutiska alliansen och förmågan att utveckla en reflektiv distans till bilden är avgörande för om en individuell inre förändring är möjlig. Vidare är det viktigt med ett utforskande förhållningssätt och samtal om bildens betydelse för att en inre förändring skall kunna ske. En bildterapeutisk förändringsprocess innehåller vitalitetsaffekter och grundaffekter. Den leder till ökad insikt och medvetenhet om känslor. Den förbättrar självbilden, ökar autenticitet och autonomi, samt ger vidgade perspektiv.

Avhandlingen bidrar till ökad kunskap om inre förändring och förbättrad hälsa genom behandling med bildterapi. Genom att beskriva och visa på att inre förändringar sker, beskriva vad i terapin som upplevs och bedöms som en inre förändring och att bekräfta inre förändring utifrån bakomliggande teorier, kan avhandlingen bidra till att avmystifiera den konstnärsmyt som ofta omger bildterapin och göra den mer förklarbar. Avhandlingen kan bidra till förbättrad kommunikationen mellan bildterapeuter och vårdgivare avseende metodens möjligheter och begränsningar. Vården kan därigenom överväga att använda bildterapi både som ett komplement eller ett alternativ till annan behandling. 

Abstract [en]

The overall aim of the dissertation was to investigate the ability of art therapy to contribute to inner change and improved health in the individual. Inner change refers to a structural and lasting change that occurs on a psychologically deeper level, as opposed to an external and more temporary change. Art therapy treatment is based on a combination of image creation and a different degree of reflective, processing dialogue. Art therapy is distinguished from other verbal therapies by a triangular relationship, patient – image – art therapist.

The thesis design was primarily qualitative, except for study I, which was a review. Study I involved examination of studies of art therapy for three different patient groups. A quality assessment was carried out using two different evidence systems. In study II, interviews were carried out with women about their experiences of inner change and whether these were exhibited in selected painted images. The interviews were analysed using deductive and inductive content analysis. In study III, two open questions were sent to art therapists about what they perceived as an inner change in the patient. Data was analysed using thematic analysis. Study IV entailed a secondary analysis of the interviews from study II. Based on a theoretical perspective, the occurrence of vitality affects and basic affects and their importance for inner change were investigated. A deductive content analysis was conducted.

This thesis describes inner change and improved health from three different perspectives: a group of female patients, a group of art therapists and a theoretical perspective. The results show that art therapy can contribute to a lasting inner change that involves identity change, changed behavior and improved health. Women who did not experience an inner change found that art therapy provided support in everyday life. Existential questions about the meaning of life were central to both the women's and the art therapists’ statements. The results show that therapeutic alliance, attachment and the ability to develop a reflective distance to the image is crucial to whether an individual inner change is possible. Furthermore, an exploratory approach and reflective dialogue about the importance of the image is important for an internal change to occur. An art therapeutic process of change contains vitality affects and basic affects. It leads to increased insight and awareness of feelings. It improves self-esteem, increases authenticity and autonomy, and provides widening perspectives.

The thesis contributes to increased knowledge of inner change and improved health through treatment with art therapy. By showing that inner change occurs, describing what, is experienced and perceived as inner change, and by confirming inner change by theories, the thesis may demystify the myth of artistry that often surrounds art therapy and make it clearer. The thesis may contribute to improved communication between art therapists and caregivers with regard to the method’s possibilities and limitations. Caregivers can therefore consider using art therapy as a complement or as an alternative to other treatments. 

Place, publisher, year, edition, pages
Halmstad: Halmstad University Press, 2018. , p. 75
Series
Halmstad University Dissertations ; 39
Keywords [en]
Art Therapy, Expressive Therapies Continuum (ETC), Inner Change, Vitality Affects, Basic Affects, Intersubjectivity, Qualitative Research
Keywords [sv]
Bildterapi (Art Therapy), Expressive Therapies Continuum (ETC), inre förändring, vitalitetsaffekter, grundaffekter, intersubjektivitet, kvalitativ forskning
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-35679Libris ID: 22152405ISBN: 978-91-87045-80-6 (print)ISBN: 978-91-87045-81-3 (electronic)OAI: oai:DiVA.org:hh-35679DiVA, id: diva2:1162015
Public defence
2018-01-26, Bertlingsalen, hus J (Visionen), Kristian IV:s väg 3, Halmstad, 13:30 (Swedish)
Opponent
Supervisors
Available from: 2017-12-04 Created: 2017-12-01 Last updated: 2018-02-28Bibliographically approved
List of papers
1. Is there evidence for the use of art therapy in treatment of psychosomatic disorders, eating disorders and crisis?: A comparative study of two different systems for evaluation
Open this publication in new window or tab >>Is there evidence for the use of art therapy in treatment of psychosomatic disorders, eating disorders and crisis?: A comparative study of two different systems for evaluation
2012 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 53, no 1, p. 47-53Article in journal (Refereed) Published
Abstract [en]

As with any type of treatment the requirement for evidence based practice (EBP) has also affected art therapy (AT) when used as an intervention. This review evaluates the available evidence for using AT for psychosomatic disorders, eating disorders and crisis. The search in Cochrane, Best Practice, AMED, CINAHL, PION, PsycINFO and PubMed from 1987 until now resulted in a huge number of articles but only 32 articles met our criteria for evaluations. The articles were assessed with two evaluation systems, the GRADE system used by the Swedish Council on Health Technology Assessment (SBU) and the US Preventive Services Task Force (USPSTF/Task Force). When comparing the results we found that the GRADE evaluation system rejected the quality in 84% of the 32 studies and the USPSTF/Task Force 41% of these studies. An evidence base for AT was found only according to the criteria of USPSTF/Task Force. Hence, the evidence concept is not explicit, which means that effective treatments run a risk of not being implemented in health care. We suggest a broader view of what constitutes evidence in order to make it possible to include different types of research designs and methods. © 2011 The Authors. Scandinavian Journal of Psychology © 2011 The Scandinavian Psychological Associations.

Place, publisher, year, edition, pages
Chichester: Wiley-Blackwell Publishing Inc., 2012
Keywords
Art therapy (images), psychosomatic disorders, eating disorder, crisis.
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hh:diva-35587 (URN)10.1111/j.1467-9450.2011.00923.x (DOI)000298949400007 ()22023072 (PubMedID)2-s2.0-84855780025 (Scopus ID)
Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2017-12-01Bibliographically approved
2. Women’s experiences of change through art therapy
Open this publication in new window or tab >>Women’s experiences of change through art therapy
2017 (English)In: Arts and Health, ISSN 1753-3015, E-ISSN 1753-3023, Vol. 9, no 3, p. 199-212Article in journal (Refereed) Published
Abstract [en]

Background: Art therapy is based on the conception that image making in a therapeutic context may facilitate processes of change.

Methods: A semi-structured interview with focus on the image was conducted with 17 women in order to explore change, after which a qualitative content analysis was performed.

Results: The women experienced internal change as a sudden, unexpected turning point or as a more gradual process, although some reported no internal change whatsoever. Five themes reflecting the women’s experiences of what was important for internal change emerged: Trust in the therapist, Belief in the method, Creative impulse, Meaning of the image and The art therapy process.

Conclusions: Art therapy may contribute to change in the sense of moving from an inadequate to a healthier state. Even when art therapy does not lead to internal change it may be supportive and provide short-term help in everyday life.

© 2016 Informa UK Limited, trading as Taylor & Francis Group

Place, publisher, year, edition, pages
Abingdon: Routledge, 2017
Keywords
Art therapy, Expressive Therapies Continuum [ETC], change, turning point
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:hh:diva-32081 (URN)10.1080/17533015.2016.1225780 (DOI)000411793900001 ()2-s2.0-84988568908 (Scopus ID)
Note

Funding: FoU, Skaraborgs Sjukhus, Skövde, Sweden [vGSKAS-459281] & Skaraborg Institute for Research and Development, Skövde, Sweden [09/1032]

Available from: 2016-09-26 Created: 2016-09-26 Last updated: 2017-12-01Bibliographically approved
3. What art therapists consider to be patients´ inner change and how it may appear during art therapy
Open this publication in new window or tab >>What art therapists consider to be patients´ inner change and how it may appear during art therapy
2017 (English)In: The arts in psychotherapy, ISSN 0197-4556, E-ISSN 1873-5878, Vol. 56, p. 45-52Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore what art therapists consider to be patients’ inner change and how it may appear during art therapy. Thirty-eight trained art therapists with experience of using art therapy as a treatment were included in the study. They were asked to describe how they perceived their patients’ inner change and a situation during art therapy when they observed such a change. An inductive thematic analysis resulted in five themes; Therapeutic alliance, describing trust of the therapist and belief in the method, Creating, which concerns the work in the therapeutic process, while Affect consciousness, Self-awareness, and Ego-strength are part of the therapy outcome. The situations in which an inner change can be observed have been presented by means of quotations and discussed in relation to different theories and art therapy research. The participating art therapists formed a heterogeneous group, resulting in an unexpected consistency about what they considered to be an inner change in the patient. The study may be seen as a contribution to further discussion about the benefits of a more common language to describe patients’ inner change in art therapy. © 2017 The Authors. Published by Elsevier Ltd.

Place, publisher, year, edition, pages
Kidlington: Pergamon Press, 2017
Keywords
Art Therapists, Art Therapy, Inner change, Qualitative research
National Category
Art History Nursing
Identifiers
urn:nbn:se:hh:diva-34671 (URN)10.1016/j.aip.2017.07.005 (DOI)000418626100006 ()2-s2.0-85027506645 (Scopus ID)
Note

Funding: FOU, Skaraborgs Hospital, Skövde, Sweden [VGSKAS-663501]; Skaraborgs Institute for Research and Development, Skövde, Sweden [09/1032]

Available from: 2017-07-31 Created: 2017-07-31 Last updated: 2018-02-02Bibliographically approved
4. Expressions of vitality affects and basic affects during art therapy and their meaning for inner change
Open this publication in new window or tab >>Expressions of vitality affects and basic affects during art therapy and their meaning for inner change
2018 (English)In: International Journal of Art Therapy, ISSN 1745-4832Article in journal (Refereed) Epub ahead of print
Abstract [en]

The aim of this study was to describe the occurrence of vitality affects and basic affects and to shed light on their importance in terms of patients’ inner change through art therapy. In an earlier study, where 17 women were interviewed about inner change through art therapy, a secondary deductive content analysis of images and statements was performed exploring the presence of vitality affects and basic affects. Nine of the 17 interviews contained clear descriptions of vitality affects and basic affects in the intersubjective communication between the patient and the therapist; these affects were also mirrored in the patients’ painted images. Three cases are used to illustrate the result and how affects are related to inner change. These three cases differ from each other in that they describe vitality affects either; arising from the art therapist’s empathetic verbal or non-verbal response, from a particular experience in nature, or from the interpreted symbolic language of the image. The common denominator identified as uniting the three cases was the intersubjective communication with the therapist. This study indicates that image making in art therapy gives rise to vitality affects and basic affects that contribute to inner change. It also indicates the importance of having trust in both the method and the art therapist. © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

Place, publisher, year, edition, pages
Abingdon: Routledge, 2018
Keywords
Art therapy, vitality affects, basic affects, intersubjectivity, deductive content analysis
National Category
Other Medical Sciences Psychiatry
Identifiers
urn:nbn:se:hh:diva-35589 (URN)10.1080/17454832.2018.1480639 (DOI)2-s2.0-85049599402 (Scopus ID)
Note

As manuscript in thesis. Funding: This work was supported by FOU, Skaraborgs Hospital, Skövde [VGSKAS-663501], and Skaraborgs Institute for Research and Development, Skövde [09/1032].

Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2018-07-16

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