Art therapy 
Emily Davison & Holly Matusas
Lakeview College of Nursing 

Art therapy: When words are not enough 
	The initial assessment of the children’s psychiatric unit at St. Mary’s Hospital in Decatur revealed a therapeutic environment. The unit was well lit. The walls in the halls are painted with a colorful mural. The front doors of the children’s unit had a large whimsical tree painted on it with a squirrel near its base giving the unit an outdoorsy feeling. In addition, in front of each of the children’s rooms there were chalkboards, which the children were allowed to decorate. The availability for the children to express their selves and use their imagination did not stop there. The dining room, which also serves as an activity room was filled with art supplies. The walls even displayed some of the children’s artwork. While the unit is full of art work there could be more done with it. Art is a form of expression and the staff should explore the meanings behind the children’s artwork, they can do this through what is known as art therapy.  
Art therapy allows patients to focus on their strengths, interests, and their concerns in a healthy way (Keltner). In addition, it can help the patients as well as the staff to identify their needs, wishes, and hopes. Art therapy is simple enough that the young children on the unit can participate in it. The goal behind it allows them to express their selves through art in a healthy way and be able to connect their emotions to the art. This is accomplished by asking the children questions about their artwork. Sample questions would be why they chose a particular color or how it makes them feel. 
Art therapy can be tailored to help with certain diagnoses or personality problems. Here are some examples from the American Art Therapy Association that can be used to help address self-esteem issues: (1) have the child draw a picture that portrays what they like about their self and ask them to share about it; (2) have the child write down two words that they wish to hear more often or would like others to say about them and decorate them; (3) have the child draw a picture of something that he/she is good at and ask them to explain how that makes them feel. There are plenty of other art therapy options besides drawing. 
For this milieu presentation, since it is for children, keeping it simple would be most beneficial. The presentation is going to be carried out in the following manner. To start with, an understanding of what they know about art therapy would be the first step and this is going to be achieved through a set of questions. After a rough understanding of how much they understand is gathered, the children will be given paper and colored pencils to draw with. Once each child is done with their drawing they will be asked to discuss what they have drawn. In addition, they will be asked about their feelings associated with the drawings, praised, and encouraged for a job well done. Once everyone is done sharing, they will be asked the same set of questions to see what they learned from their session of art therapy. 
Getting the presentation started took a little bit of time because there was a situation with one of the other patients.  The presentation started with  handing out blank pieces of paper, colored pencils, and markers.  It continued by asking the adolescents four questions. The first question asked was, "have any of you ever heard of the word self-esteem and can you tell us what you think it means?" The adolescents described self-esteem being how a person feels about themselves.  One of the patients also stated that a person's self-esteem can determine if he/she is mad, happy, or sad.  Another one of the patients stated that self-esteem is also determined by what people think and say about a certain individual. This question was selected because according to the American Art Association art therapy has been proven helpful in increase  one’s self esteem. Poor self esteem is linked to many different psychiatric disorders particularly depression ( Swearingen). This question also was selected because it helped us to see what kind of insight they had on their current state. The next question asked was, "do you enjoy coloring and why?” The response to this question was better than we could hope for, they did not respond with the superficial answer because it fun. Instead, the patients stated they liked coloring because it is a way to relax and express their feelings. The third question asked was, "do you ever have trouble talking about your feelings?"  All of the patients stated they have troubles expressing their feelings in a healthy manner. This question was chosen because for some it is easier for them to express their feelings through art instead of verbalizing their feelings (White, Bull, and Beavis). The final question asked was, "does color affect your mood?"  One of the patients stated she hated the color yellow because it is too bright and too happy.  Her favorite color was black and purple. Two other patients stated they loved the rainbow, and the boys stated they liked colors like blue and green.
The presentation continued with explaining to the children to draw something they are good at or like about themselves. A few of the girls in the group had trouble coming up with anything to draw. They struggled with coming up anything positive about their selves. Despite the fact that the girls struggled with what to draw was emotionally sad it was a good sign because it allowed them and us to see where improvement needs to be made (Keltner). All the children were given an adequate amount of time because as previously mentioned the task was challenging for some. In addition, giving plenty of time helped the patients not to feel rushed. Furthermore, allowing ample time gave them the opportunity to perfect their picture and express all the feelings they wanted to express, after all the purpose of this exercise is was to help them see that art can be a way of coping and helping them feel better about their selves. 
After ten to fifteen minutes of drawing and coloring the patients showed and talked about their pictures and what it meant to them.  One of the patients drew her smile because people have told her she has a beautiful smile.  She did not use much color, she used green as the tongue and when asked why she stated her friend told her to, showing the patient cares about what others think. The next picture shown was by a boy who drew a football with flames behind it.  When asked why he drew a football with flames he said he is good at football and football makes him happy.  When questioned more in depth he got defensive because he is no longer allowed to play football at his high school due to getting into trouble.  The next picture described was drawn by a girl and her drawing was a girl with lots of makeup on.  She did not use any bright colors, she used grays and blacks.  When asked why she drew a girl with a lot of makeup on she said it was because she loves wearing makeup and doing other peoples makeup.  When she was asked why she loves wearing makeup she stated it is because it hides the real her.  There was a moment of silence because it took the other individuals in the room off guard.  The next picture shown and described was done by a young boy and he drew a truck with flames.  He drew a truck with flames because it makes him happy and when he turns sixteen he hopes to have one just like the one he drew.  The next boy would not talk about or show his drawing at first.  He was asked to show his picture multiple times and it took him a while but he finally at the end of the presentation came over and sat it in front of Holly.  His picture was a hunting scene.  He started opening up and talking about loving to fish and hunt.
The teaching approach taken when creating and giving the presentation was for it to be age appropriate so all the adolescent and children patients could participate.  The presentation also needed to be interesting to keep the attention and focus of the younger patients.  Children love to color and draw and it was simple enough so everyone could participate.  The questions presented needed to be simple and clear so the patients would understand what was being asked.  An adequate amount of time was needed so the patients did not feel rushed and had enough time to create what they wanted to express. The reason art therapy was chosen was because children do not always open up when just speaking about feelings, with the ability to draw a picture that expresses their feelings it makes it easier for them to then talk about their feelings.
The insight gained was that children are able to open up more when asked to draw a picture and talk about it rather than just sitting in a circle going around and talking about their feelings. Unlike traditional therapy where one person at a time is allowed to talk, we encouraged the children to talk among each other. Many of the children where helpful and supportive to the other children. They complimented each other on their drawings and were not rude when they were sharing why they drew what they did. When the one boy did not want to show his drawing to the other children they gently tried to coax him to show it them. These children just want to be listened to and some of their drawings really showed happiness while others showed a deep secret or insecurity. There was a lot of use of therapeutic communication; praising and encouraging the children for their art work, opening up ,and sharing their stories. When one of the young boys was having troubles and getting upset because he could not draw the flames the way he wanted, Holly went over and sat down with him and offered him help and reassurance. When the young girl talked about being insecure with her appearance, therapeutic communication was used to gain more depth and information about why she feels insecure.
In conclusion, the activity was a success. The children seemed to gain an understanding of how the use of different colors affects their moods but that is minor compared to the other knowledge, skills and insight they gained. Performing this activity forced them to dig deep within their selves and explore their feelings. Art therapy is about “self-discovery, empowerment, relaxation, personal fulfillment, and expression of self-worth (Guzman)”.   If the unit at Sarah Bush would take the time to add some form of art therapy to the children’s daily schedule the effects could be tremendous. They have all the resources right there and as this paper demonstrates it not a time consuming task. In addition, the children enjoy it. 

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