Exploring Creative Therapies for Mental Health

Creative therapies, also called arts therapies, are psychological therapies in which making something takes the place that talking takes in other therapies. The material can be a drawing, a piece of music, or a movement sequence. A trained therapist runs the session and works with what is made.

The NHS lists art therapy, dance movement therapy, drama therapy and music therapy as arts therapies, run by trained therapists, for people who find speaking about feelings hard.¹

What creative therapies are, and what they are not

An arts therapy is not an art class. The UK regulator HCPC describes an arts therapist as a psychological therapist with arts-based training who uses drama, music or art as their primary mode of communication.² The work is psychological work, done through that medium.

Painting at home, playing an instrument, or dancing to music you like can be good for you. None of that is arts therapy. The difference is a trained therapist, a treatment frame, and a second person thinking with you about what the work shows. The distinction matters when a person is choosing what to look for and what to pay for.

The four main modalities

Each modality has its own training route and its own working medium. What follows is what a session with each practitioner actually involves.

TherapyRoute carries longer pieces on art therapy and on music therapy.

What happens in a session

The NHS says a course of arts therapy usually involves weekly sessions lasting up to 2 hours.¹ The NHS says these therapies may be offered one to one or in a group, as part of a wider treatment programme.¹

Group work has a shape to it. Bateman and Fonagy describe day-hospital expressive therapy groups of 6 to 8 patients who agree a theme, work alone for half an hour, then discuss each person's work together.³ Each person is asked what they see in someone else's work before speaking about their own.

Your therapist does not mark the work for skill. The NHS describes trained therapists helping a person think about what they have created and whether it relates to their thoughts and experiences.¹ That conversation is where the therapy sits, and it is why the relationship with the therapist matters as much here as in any talking therapy.

If the medium does not suit you, say so early. Your therapist can change the task, change the material, or work out with you what is getting in the way of using it.

Why a nonverbal route can help, and where it stops

The psychiatrist van der Kolk writes that art, music and dance may be used as trauma treatments because they can get around the speechlessness that terror brings.⁴

Bateman and Fonagy describe expressive therapies as a way of placing something internal outside the mind, so it can be put into words at a distance.³ Once a feeling has been given a form outside the person, it can be looked at rather than only experienced. Bateman and Fonagy report that patients find expressive therapies produce less anxiety early in treatment than reflecting internally on themselves in relation to others.³

There is a limit, and most short guides leave it out. In the Pennebaker and Krantz study van der Kolk describes, only the students who danced and then also wrote about the trauma showed objective health and academic gains.⁴ Pennebaker and Krantz concluded that expressing the trauma alone was not sufficient, and that health appeared to require translating experiences into language.⁴ van der Kolk adds that we still do not know whether this holds in every case.

So the common claim that movement or paint by itself releases stored trauma runs ahead of the evidence. If a practitioner describes the work as making something visible so that the two of you can then think and speak about it, that matches what the sources say. If a practitioner promises release without that second half, ask how the work gets made sense of.

What the evidence supports

The trials are mostly small, and they run across very different countries and populations. The same review includes a group art therapy study from Italy and a study run in schools in displacement camps in Pakistan.⁵ Read the findings as signals, not as settled results.

• In one trial included in that review, school students aged 10 to 18 who had survived an abduction took part in art therapy or dance therapy.⁵ Both reduced PTSD symptoms, with dance therapy showing a marginally greater reduction.⁵
• In Gatta and colleagues' 2014 Italian study, nine young people aged 13 to 18 in a residential rehabilitation centre attended 18 weekly group art therapy sessions of 90 minutes.⁵ Attendance across the 18 group art therapy sessions was 44 per cent.⁵
• A systematic review of randomised trials of art therapy for anxiety in children and adolescents aged 3 to 18 required each trial to measure art therapy's added effect on anxiety symptom severity.⁶ That rule keeps studies that bundled several treatments together from inflating the result.
• Kaplan and Sadock's textbook reports a meta-analysis finding that regular singing, dance therapy, listening to music and musical games improved cognitive and behavioural functioning in people with severe dementia.⁷
• In Tol and colleagues' Indonesian school programme, described in Kaplan and Sadock's textbook, children given trauma-processing activities, cooperative play and creative-expressive elements improved and held gains at 6 months.⁸

One caution about numbers. Lemma, Target and Fonagy note that psychotherapy in general shows an average effect size of 0.8 across probably over 1,000 studies.⁹ That figure describes psychotherapy as a whole. It is not a figure for art therapy, music therapy or dance movement therapy, and anyone quoting it for one of them is stretching it.

Training, titles and registration differ by country

This is the part that decides whether the practitioner you contact is qualified, and it does not work the same way everywhere.

The European Union's directive on the recognition of professional qualifications defines a regulated profession as one where law restricts access, practice, or use of the professional title to holders of specific professional qualifications.¹⁰ That gives you a plain test to apply at home: is the title restricted by law here, or may anyone use it?

In the UK, art therapist, art psychotherapist, dramatherapist and music therapist are titles protected by law, and a professional must be registered with the HCPC to use them.² Where a country restricts a title that way, a public register exists and you can search it before booking. Where no law restricts the title, the title on its own tells you nothing, and the check falls to the training completed and the professional body the practitioner answers to.

Three questions that work in any country:

• What is your qualification in this modality, and how long was the training?
• Are you on a public register or a professional body's list, and what is your registration number?
• Is this title restricted by law here? If it is not, what standard are you held to?

Finding a creative therapist

Search the TherapyRoute directory for a practitioner in your own country, check the register or professional body they name, then ask the three questions above at first contact. Our guide on how to find the right therapist covers the rest of the process, including the first consultation.

Questions people ask

Do I need to be good at art, music or movement?

No. Nothing you make is judged as art. Your therapist is interested in what you made and what it opens up between you, not in how well it was made.

Are creative therapies used with children and adolescents?

Widely. A review of randomised controlled trials has examined art therapy for anxiety in children and adolescents.⁶ A child who struggles to put feelings into speech may find a medium easier to start with, though the same limit above applies: the making needs talking about afterwards.

What if I cannot move easily, or one medium is difficult for me?

Tell the therapist before you start. The task and the material can usually be adapted, and a practitioner will say plainly if your situation needs a different modality or a different service.

Can creative therapy be combined with talk therapy?

Yes, and it often is one part of a wider programme rather than a treatment on its own. In Bateman and Fonagy's programme, the expressive therapy session keeps to the themes of the person's group therapy.³

Who pays for it?

Funding differs by country and by funder. In some health systems arts therapies sit inside publicly funded mental health care as part of a treatment programme; elsewhere people pay privately or claim from a health insurer. Ask the service or the practitioner what applies where you live, before the first session.

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References

• [1] NHS. Borderline personality disorder: treatment. nhs.uk/mental-health/conditions/borderline-personality-disorder/treatment.
• [2] Health and Care Professions Council. Professions and protected titles. hcpc-uk.org/about-us/who-we-regulate/the-professions.
• [3] Bateman & Fonagy - Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. Expressive therapies.
• [4] van der Kolk - The Body Keeps the Score (2014). CHAPTER 14.
• [5] PubMed Central (US National Library of Medicine). Review of arts therapy studies, article PMC12460915. pmc.ncbi.nlm.nih.gov/articles/PMC12460915.
• [6] PubMed Central (US National Library of Medicine). Systematic review of art therapy trials for anxiety in children and adolescents, article PMC11260852. pmc.ncbi.nlm.nih.gov/articles/PMC11260852.
• [7] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017, vols 1+2). 31.4: Complementary, Alternative, and Integrative Approaches in Mental Health Care.
• [8] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017, vols 1+2). 54.4: Group Psychotherapy.
• [9] Lemma, Target & Fonagy - Brief Dynamic Interpersonal Therapy: A Clinician's Guide (2011). 1 Dynamic Interpersonal Therapy: New Wine in an Old Bottle?.
• [10] European Union (2005). Directive 2005/36/EC on the recognition of professional qualifications, Article 3. eur-lex.europa.eu/eli/dir/2005/36/oj/eng.