Art therapy for children: how it leads to change

Study on the validity of the theoretical paradigm of art therapy for vulnerable children

PURPOSE

The vulnerable children refer to the special group of children with deviation in the process of children's psychological development and personality formation due to growth dilemmas.

MATERIALS AND METHODS

This may incur a series of serious social and family problems. The vulnerable children mainly cover the children suffering from children's psychological problems, such as childhood autism, autism, social anxiety and hypersensitivity, fear, depression, and PTSD arising from other factors. At present, the research results at home and abroad mainly focus on the psychological dynamic correlation investigation and solution discussion of a certain kind of difficult factor in the children's psychological development based on statistical data by the experimental methods, such as scale and model, and there is a blind spot in the humanistic orientation theory construction of psychological treatment for vulnerable children, causing the social reflection on children's psychological predicament from the humanistic perspective cannot be performed in related researches and going against searching for universal and integral theoretical paradigm for solving related problems.

RESULTS

Sophisticated technologies for the observations have emerged increasingly for enabling the psychological features of vulnerable children through developmental cognitive neuroscience experiments.

CONCLUSION

This paper introduces humanistic art therapy theory, focuses on the construction of a theoretical paradigm, and verifies its effectiveness based on the experimental results on the psychological development of vulnerable children, with an efficient performance.IMPLICATIONS FOR REHABILITATIONThis study mainly refers to children with difficulty in social inclusion and psychological development.The results showed that two kinds of art therapy can obviously improve the psychological disorders of vulnerable children.The goal was to enhance self-cognition, strengthen emotional interaction, and implement positive motivation.

The Meaning of a Group Facilitation Training to Creative Arts Therapists Working in the Public Education System

Many creative arts therapists who provide group therapy to children and adolescents in the Israeli education system do not feel they were sufficiently trained as group facilitators. Group facilitation training was provided over the course of two consecutive years by a regional support center to over 40 creative arts therapists and their clinical supervisors working in the Israel Ministry of Education. A two-stage qualitative research project examined the participants' experiences during this training. Interviews were conducted regarding the therapists' first-year experiences. A questionnaire was administered at the end of the second year. Both were analyzed according to the Consensual Qualitative Research method. The research findings pertain to the participants' perceptions of group arts therapy in the Israeli education system and included the development of unique group models, the advantages and power of group therapy at school, and the intimidating and disruptive experiences of school settings. The participants also provided their impressions of the training course: their growing confidence and skills, and the many changes required in group arts therapy at public schools to provide more professional and efficient service. The discussion centers on the value of group arts therapy in the education system and the steps needed to enhance therapists' confidence and efficiency in this field.

Art as relaxation for tic disorders: a pilot randomised control study

BACKGROUND

Despite the known benefits of art therapy, there are a limited number of studies on art therapy for tic disorders. This pilot randomised controlled study investigated effects of art as a relaxation technique for tic disorders.

METHODS

Twenty-two children aged 7-9 years were randomly allocated to art intervention (n= 11) and control (n= 11) groups. Pre- and post-test measurements included the Yale Global Tic Severity Scale (YGTSS), Heart Rate Variability (HRV), and Hassles Scale for Children (HSC).

RESULTS

Art as relaxation significantly decreased the YGTSS total score, motor tic frequency, motor tic intensity, motor tic complexity, vocal tic complexity, and total daily stressors compared to the control group. The intervention group showed significantly greater physiological relaxation, as indicated by increases in HRV parameters.

CONCLUSIONS

Art appears to be an effective relaxation technique for tic disorders. Extensive research is necessary for rigorous examination of its effectiveness.

Using interactive television-based art therapy to treat post-traumatic symptoms among survivors of abduction in Nigeria

This study was a quasi-experimental design that was aimed at understanding the impact of interactive television-based art therapy for treating post-traumatic stress disorder (PTSD) symptoms among school children who have experienced abduction. Participants took part in a 12-week art therapy delivered through interactive television. The result showed that art therapy was effective in reducing PTSD symptoms. A follow-up assessment after 6 months showed a steady decline in PTSD symptoms among participants in the treatment group when compared with their counterparts in the non-treatment group. The implications of these results have been discussed and recommendations made.

Child sexual abuse survivors: Differential complex multimodal treatment outcomes for pre-COVID and COVID era cohorts

BACKGROUND

Child sexual abuse (CSA) is a form of early-life trauma that affects youth worldwide. In the midst of the current COVID-19 pandemic, it is imperative to investigate the potential impact of added stress on already vulnerable populations.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of a multimodal treatment program on mental health outcomes for youth CSA survivors aged 8-17. Secondary to this, we explored the potential impact of the COVID-19 on treatment outcomes.

PARTICIPANTS AND SETTING

Participants of this study were children and youth aged 8-17 who were engaged in a complex multimodal treatment program specifically designed for youth CSA survivors.

METHODS

Participants were asked to complete self-report surveys at baseline and at the end of two subsequent treatment rounds. Surveys consisted of measures pertaining to: (1) PTSD, (2) depression, (3) anxiety, (4) quality of life, and (5) self-esteem.

RESULTS

Median scores improved for all groups at all timepoints for all five domains. For the pre-Covid participants, the largest improvements in the child program were reported in depression (36.6 %, p = 0.05); in the adolescent program anxiety showed the largest improvement (-35.7 %, p = 0.006). Improvements were generally maintained or increased at the end of round two. In almost every domain, the improvements of the pre-COVID group were greater than those of the COVID-I group.

CONCLUSIONS

A complex multimodal treatment program specifically designed for youth CSA survivors has the capacity to improve a number of relevant determinants of mental health and well-being. The COVID-19 pandemic may have retraumatized participants, resulting in treatment resistance.

Repeating patterns: Predictive processing suggests an aesthetic learning role of the basal ganglia in repetitive stereotyped behaviors

Recurrent, unvarying, and seemingly purposeless patterns of action and cognition are part of normal development, but also feature prominently in several neuropsychiatric conditions. Repetitive stereotyped behaviors (RSBs) can be viewed as exaggerated forms of learned habits and frequently correlate with alterations in motor, limbic, and associative basal ganglia circuits. However, it is still unclear how altered basal ganglia feedback signals actually relate to the phenomenological variability of RSBs. Why do behaviorally overlapping phenomena sometimes require different treatment approaches−for example, sensory shielding strategies versus exposure therapy for autism and obsessive-compulsive disorder, respectively? Certain clues may be found in recent models of basal ganglia function that extend well beyond action selection and motivational control, and have implications for sensorimotor integration, prediction, learning under uncertainty, as well as aesthetic learning. In this paper, we systematically compare three exemplary conditions with basal ganglia involvement, obsessive-compulsive disorder, Parkinson’s disease, and autism spectrum conditions, to gain a new understanding of RSBs. We integrate clinical observations and neuroanatomical and neurophysiological alterations with accounts employing the predictive processing framework. Based on this review, we suggest that basal ganglia feedback plays a central role in preconditioning cortical networks to anticipate self-generated, movement-related perception. In this way, basal ganglia feedback appears ideally situated to adjust the salience of sensory signals through precision weighting of (external) new sensory information, relative to the precision of (internal) predictions based on prior generated models. Accordingly, behavioral policies may preferentially rely on new data versus existing knowledge, in a spectrum spanning between novelty and stability. RSBs may then represent compensatory or reactive responses, respectively, at the opposite ends of this spectrum. This view places an important role of aesthetic learning on basal ganglia feedback, may account for observed changes in creativity and aesthetic experience in basal ganglia disorders, is empirically testable, and may inform creative art therapies in conditions characterized by stereotyped behaviors.

Artmaking in Elementary School Art Therapy: Associations with Pre-Treatment Behavioral Problems and Therapy Outcomes

Engaging in artmaking is one of the key components of art therapy. Theoretical conceptualizations posit that artmaking is not only influenced by the mental state of the artmaker, but can also modify it. The quantitative longitudinal study reported here examined these assumptions in the context of school art therapy. Seventy-seven elementary school students in art therapy in Israel completed the Art Based Intervention Questionnaire (ABI) three times during the therapy year. Their parents and homeroom teachers reported on the students’ behavioral and emotional problems on the Child Behavior Checklist (CBCL for parents, and TRF version for teachers). The results indicated an inverse correlation between the students’ externalizing and mixed problems before starting treatment and these clients’ experiences of artmaking during the first month of therapy. A regression model for predicting gain scores on the TRF internalizing problem indices was significant, whereas the significant regression predictor was the students’ experience of artmaking at T1. These findings provide initial support for an association between the experience of artmaking and mental state, and an improvement in mental state, and are discussed in relation to the context of school art therapy.

The moral experiences of children with osteogenesis imperfecta

BACKGROUND

Serious ethical problems have been anecdotally identified in the care of children with osteogenesis imperfecta (OI), which may negatively impact their moral experiences, defined as their sense of fulfillment towards personal values and beliefs.

RESEARCH AIMS

To explore children's actual and desired participation in discussions, decisions, and actions in an OI hospital setting and their community using art-making to facilitate their self-expression.

RESEARCH DESIGN

A focused ethnography was conducted using the moral experiences framework with data from key informant interviews; participant observations, semi-structured interviews, and practice-based research (art-making) with 10 children with OI; and local documents.

PARTICIPANTS AND RESEARCH CONTEXT

The study was conducted at a pediatric, orthopedic hospital.

ETHICAL CONSIDERATIONS

This study was approved by McGill University Institutional Review Board.

FINDINGS/RESULTS

Children expressed desires to participate in their care, but sometimes lacked the necessary resources and encouragement from healthcare providers. Art-making facilitated children's voice and participation in health-related discussions.

CONCLUSIONS

Healthcare providers are recommended to consider the benefits of art-making and educational resources to reduce discrepancies between children's actual and desired participation in care and promote positive moral experiences.

Capturing the Nature of Teacher and Learner Agency Demonstrating Creativity: Ethical Issues and Resolutions

This article will focus on the ethical dilemmas and concerns related to eliciting the nature of agency in classrooms that emerges in learning contexts. Agency is a somewhat elusive phenomena to evidence because it involves capturing signs and indications of thinking involved in negotiating meanings, the capacity for initiating, and constructional decision-making. These processes are often made explicit through dialogic and actional exchanges between teachers and/or learners. This includes taking account of activities engaged in, either independently or collaboratively. It also requires evidence of earlier happenings or interactions between classroom participants that might influence and shape later events. There is also concern about the ways that teachers’ and learners’ demonstrable originality or creativity are recognised and communicated for scrutiny by others. Additionally, ethical approval procedures (BERA 2018) require that research protects participants’ anonymity, confidentiality, and dignity; therefore, research has to be carried out with integrity. Ensuring benefits from research are maximised and that no-one is harmed or made to feel uncomfortable requires the utmost care and balance between eliciting insightful data while maintaining the appropriate duty of care for participants. To achieve these objectives, multiple research methods were used. Audio and video recordings were transcribed and analysed to make sense of teacher and learner agency. The findings include an events map, photographic images, and dialogic episodes illustrating the nature of contrasting teacher and learner agency. The conclusion considers tensions that emerge as researchers seeking to characterize agency without compromising privacy.

Neighbourhood, Built Environment and Children's Outdoor Play Spaces in Urban Ghana: Review of Policies and Challenges

Although a great deal of research work has been done by social scientists on walkability and playability, the focus to a large extent has been on the global north. Research work on the urban built environment and children's play has not engaged Africa in general and Ghana in particular. More importantly, there is limited evidence of policies in terms of community-based practices and governmental policies and programmes for the promotion of play. The limited effort in promoting physical activities have to a large extent focused on walkability, yet evidence to date indicates that walking only constitutes a small proportion of the physical activities of children. This is against the backdrop of growing urbanization and the increasing reported incidence of sedentary lifestyles, less physical activity and obesity among children and the youth. Our main objective in this paper is to contribute to the literature on Ghana, and by extension Sub-Saharan Africa, by examining the extent to which playability features in city and national policies and strategies in urban Ghana. We conclude that while there is dearth of public policies on children's play, with the situation in communities compounded by weak city government capacity to plan, implement and enforce development control to protect open spaces for children's play and recreational purposes. The paper recommends a change in policy and practice on creating spaces in urban built-environments for children's play in urban Ghana.

Assessing the Extent to Which Art Therapy Can Be Used with Victims of Childhood Sexual Abuse: A Thematic Analysis of Published Studies

In a 2015-2016 UK survey of 35, 248 adults, 7% reported experiencing sexual abuse as children. This review considers the value of Art Therapy (AT) in recognizing individual needs and experiences and supporting victims to manage the lasting impact of abuse. Three main bodies of research were identified: the use of AT in childhood sexual abuse (CSA) investigations; the use of art therapy in the treatment of the psychological sequelae of CSA victims in childhood and adulthood; and an assessment of how art therapy compares to other therapeutic approaches for CSA victims. The review highlights that AT particularly benefits rapport building between victim and therapist/investigator, and alleviates some psychological consequences of sexual abuse - particularly anxiety, post-traumatic stress, and dissociation. By engaging the limbic system, AT may also provide a communicative form, building a narrative where verbal communication is hindered. However, the analysis brings attention to several weaknesses in the current AT research: available studies tend to have small sample sizes and few quantitative findings. This review concludes by identifying the need for research which considers the clinical implications of AT in CSA cases for the future.

The Effects of Mindfulness-Based Mandala Coloring, Made in Nature, on Chronic Widespread Musculoskeletal Pain: Randomized Trial

This study aimed to investigate the effects of mindfulness-based mandala coloring made within nature on individuals with chronic widespread musculoskeletal pain (CWP). Thirty-six participants were randomly allocated. In the experimental group, identical interventions and procedures were administered for each experiment. The control group members were untreated and remained in an urban environment. Overall, the experiment showed significant improvements in tender points (f = 8.791, p = 0.006), total stress level (f = 14.570, p = 0.001), depressive symptoms (f = 15.205, p = 0.001), anger symptoms (f = 7.263, p = 0.011) and salivary cortisol (f = 10.619, p = 0.003) in the experimental group. The results reflect that MBMC within nature is effective in reducing pain, psychological stress responses, and cortisol levels in individuals with CWP. The positive results could be a product of the experimental design rather than the treatment itself. A rigorous experimental design provides better understanding of MBMC within nature.

Online art therapy in elementary schools during COVID-19: results from a randomized cluster pilot and feasibility study and impact on mental health

BACKGROUND

Emerging literature on the current COVID-19 crisis suggests that children may experience increased anxiety and depression as a result of the pandemic. To prevent such school and mental health-related problems, there is a timely need to develop preventive strategies and interventions to address potential negative impacts of COVID-19 on children's mental health, especially in school settings. Results from previous child clinical research indicate that art-based therapies, including mindfulness-based art therapy, have shown promise to increase children's well-being and reduce psychological distress.

OBJECTIVE

The goal of the present pilot and feasibility study was to compare the impact of an emotion-based directed drawing intervention and a mandala drawing intervention, on mental health in elementary school children (N = 22), in the context of the COVID-19 pandemic. Both interventions were group-based and delivered online and remotely. A pilot study using a randomized cluster design was implemented to evaluate and compare both interventions in relation to child anxiety, depression, inattention and hyperactivity symptoms.

RESULTS

Analyses of covariance revealed a significant effect of the type of drawing intervention on levels of inattention, after controlling for baseline levels. Participants in the emotion-based directed drawing group showed lower inattention scores at post-test, when compared to participants in the mandala group. Post-hoc sensitivity analyses showed significant decreases in pre-to-post scores for levels of hyperactivity for the complete sample.

CONCLUSION

Overall, results from this pilot and feasibility study showed that both an emotion-based directed drawing intervention and a mandala drawing intervention may be beneficial to improve mental health in elementary school children, in the context of the current COVID-19 pandemic. From a feasibility standpoint, results indicate that the implementation of both interventions online and remotely, through a videoconference platform, is feasible and adequate in school-based settings. Further work incorporating larger sample sizes, longitudinal data and ensuring sufficient statistical power is warranted to evaluate the long-term impact of both interventions on children's mental health.

Art Therapy With Jewish Ultra-Orthodox Children: Unique Characteristics, Benefits, and Conflicts

The paper presents the potential benefits and conflicts of the encounter between Jewish ultra-orthodox (UO) children – belonging to a closed and segregated group – and art therapy – with its cultural, Western, secular, and professional characteristics. The paper describes the complex interface between the therapeutic use of art as a form of free expression and religious commandments and restrictions. The dialogue between art, therapy, and cultural religious boundaries is described through a case study of an 8-year-old UO boy and a secular female art therapist. Issues such as self-expression, gender roles, and identity exploration are discussed, emphasizing the unique characteristics, benefits, and conflicts of such an encounter.

Art Therapy for Psychosocial Problems in Children and Adolescents: A Systematic Narrative Review on Art Therapeutic Means and Forms of Expression, Therapist Behavior, and Supposed Mechanisms of Change

Background: Art therapy (AT) is frequently offered to children and adolescents with psychosocial problems. AT is an experiential form of treatment in which the use of art materials, the process of creation in the presence and guidance of an art therapist, and the resulting artwork are assumed to contribute to the reduction of psychosocial problems. Although previous research reports positive effects, there is a lack of knowledge on which (combination of) art therapeutic components contribute to the reduction of psychosocial problems in children and adolescents. Method: A systematic narrative review was conducted to give an overview of AT interventions for children and adolescents with psychosocial problems. Fourteen databases and four electronic journals up to January 2020 were systematically searched. The applied means and forms of expression, therapist behavior, supposed mechanisms of change, and effects were extracted and coded. Results: Thirty-seven studies out of 1,299 studies met the inclusion criteria. This concerned 16 randomized controlled trials, eight controlled trials, and 13 single-group pre-post design studies. AT interventions for children and adolescents are characterized by a variety of materials/techniques, forms of structure such as giving topics or assignments, and the use of language. Three forms of therapist behavior were seen: non-directive, directive, and eclectic. All three forms of therapist behavior, in combination with a variety of means and forms of expression, showed significant effects on psychosocial problems. Conclusions: The results showed that the use of means and forms of expression and therapist behavior is applied flexibly. This suggests the responsiveness of AT, in which means and forms of expression and therapist behavior are applied to respond to the client's needs and circumstances, thereby giving positive results for psychosocial outcomes. For future studies, presenting detailed information on the potential beneficial effects of used therapeutic perspectives, means, art techniques, and therapist behavior is recommended to get a better insight into (un)successful art therapeutic elements.

Art in debrief: a small-scale three-step narrative inquiry into the use of art to facilitate emotional debriefing for undergraduate nurses

Background

The context of the research was in a setting where undergraduate nursing students spend 50% of their programme in clinical practice and 50% in a higher education institute. Research participants were undertaking the adult branch of nursing education.

Aims

• To explore emotional debriefing in relation to nursing practice.• To highlight the emotional concerns of the research participants regarding clinical placement.• To gain an insight into the use of art/creativity in emotional debriefing.

Methods

Narrative inquiry was used to gain an insight into, and a deeper understanding of, how undergraduate nurses feel about their clinical placement experiences. The research was carried out in three stages: the art intervention, a diary account of the art intervention, and a follow-up face-to-face discussion between each participant and the researcher.

Results

The findings suggest the intervention helped the participants to articulate and process their emotions. All participants acknowledged the importance of the three-step approach, with follow-up to the art intervention.

Conclusions

This research project has highlighted the potential value of a creative approach to emotional debriefing. A wider inclusion of the arts could be explored. Facilitation of emotional debriefing may help build resilience in undergraduate nurses. There is growing recognition for the need to foster resilience in undergraduate nursing student programmes.

[Humanization: A Conceptual and Attitudinal Problem]

The exercise of medicine has changed since its beginnings up to the present day. Technological advances and changes in the management of the health service caused a distance between the patient and the doctor. On the other hand, professionals prefer to not have their own patients, but rather to strictly adhere to the diagnosis or treatment (specialists) without involving or committing themselves. A fragmentation of the attention that does not benefit the patient can thus be observed. The humanization in medical attention is characterized by a group of practices that are orientated at achieving better attention and greater care. The humanization process of the endeavor contributes so that this is welcomed by the other party, to improve the relationship, the patientś safety and to prevent medical errors.

Child Art Psychotherapy in CAMHS in Ireland-a parent satisfaction study

OBJECTIVES

We aimed to evaluate parent satisfaction with the Vasarhelyi method of Child Art Psychotherapy offered at two Child and Adolescent Mental Health teams by postal survey using the Client Satisfaction Questionnaire, and by performing a qualitative interview.

METHODS

Parents of 29 children who attended Child Art Psychotherapy over the previous 4 years were invited to participate-they were sent the Client Satisfaction Questionnaire and invited to attend for an interview about Child Art Psychotherapy. The postal survey was followed up by a telephone call to complete missing surveys. The Client Satisfaction Questionnaire has a 4-point Likert scale with a minimum score of 8 and maximum score (highest satisfaction) of 32.

RESULTS

Fourteen Client Satisfaction questionnaires were returned indicating a response rate of 48%. The mean age of the children who attended CAP was 10.84 years. The mean CSQ-8 score was 25.6 (95% CI 22.0-29.3) with a range of 8 to 32. Eighty-five percent of parents indicated that they were satisfied on all questions regarding the service of CAP their child received. One of 29 parents attended for interview and 4 themes were identified in the interview: (1) the importance of the child's opinion, (2) behavioural change occurred during and after CAP, (3) the parent would recommend CAP to others, and (4) parental expectations of therapy and level of engagement.

CONCLUSION

Parents are satisfied with the Vasarhelyi method of Child Art Psychotherapy.

Effectiveness of art therapy with pediatric populations affected by medical health conditions: a systematic review

Background: Visual art therapy has been widely used with children with medical health conditions within various settings. However, less is known about its effectiveness. The scope of this systematic review is to shed light on what benefit art therapy may have for ill health adjustment in youth populations. Methods: Electronic databases (Psychinfo, Medline, CINAHL, ERIC, Scopus, Embase and Child and Adolescent Studies) were searched (1806-2017). Systematic methods for study selection and data extraction were used. Results: Twelve studies (N = 404 participants, 318 in the control group; aged between 2 and 19 years old, with various medical conditions) were included. Ten studies reported significant improvements concerning at least one outcome with an overall inconclusive trend toward effectiveness. Conclusions: Visual art therapy interventions were found weak in evidence quality. However, future evidence-based research designs could show the effectiveness of these interventions in health care settings.

Learning to Work with Trauma Survivors: Lessons from Tbilisi, Georgia

Survivors of armed conflict may experience traumatic stress, psychological symptoms, distress, or other behavioral health issues related to the disaster of war. This article outlines the historical background of the Russian-Georgian war, details the implementation of social work in the developing country of Georgia, and describes the training and application of social work knowledge and values using macro and micro examples of interventions that provide Masters of social work students and social workers with tools to address the needs of refugees affected by disaster. Following the macro- and microexamples, pedagogy and implications for social workers and social work students working with victims of trauma with few available resources are discussed.

Exploring responses to transformative group therapy for orphaned children in the context of mass orphaning in Botswana

In the context of AIDS, the Botswana Government has adopted a group therapy program to help large numbers of orphaned children cope with bereavement. This study explores the effectiveness of the therapy and examines how it interacts with cultural attitudes and practices concerning death. Ten orphaned children were involved in five rounds of data collection during a therapeutic retreat; eight social workers completed questionnaires concerning the effectiveness of the therapy. Most children were able to come to terms with their loss, face problems in their home and school environments, and envision ways of solving problems. All the children described benefits of group formation and the support it would provide when they returned to their home situations.

"Scratching" beneath the surface: an integrative psychosocial approach to pediatric pruritus and pain

Pruritus is prevalent in children with atopic dermatitis and associated with effects on mood, quality of life, sleep, scholastic performance, social and family functioning. In this study a 7-year-old African American female with severe atopic dermatitis, itching and pain refractory to multiple systemic and topical medications was referred for treatment. At baseline, the patient scratched to the point of bleeding, despite maximal doses of anti-histamines, antidepressant and topical therapies. The patient became progressively shy, anxious, and her scholastic performance suffered. A literature review prompted the implementation of a multi-modal program of family cognitive behavioral therapy, imagery, aromatherapy, drawing, and biofeedback. The results were that decreased itch, scratching, pain, and anxiety were seen within the first month. Fewer lesions and episodes of bleeding were observed with almost complete skin clearance by the fourth month. The article concludes that a short-term, integrative program including psychological, complementary and alternative medicine (CAM), and medical therapies may represent a novel, efficacious approach for children suffering from severe atopic dermatitis.

[Art therapy and the promotion of child development in a hospitalization context]

This study aimed to evaluate and compare the development of hospitalized children before and after art therapy interventions. Qualitative case studies were undertaken in this descriptive-exploratory research, based on the developmental evaluation of the children. The study participants were five children between seven and ten years old, in the Hospital of Tropical Illnesses (HDT) in the city of Goiânia, state of Goiás, Brazil, in 2006. Results showed that art therapy interventions efficiently promoted children's development. Art therapy is a resource for positively channeling the variables of hospitalized children's development and for neutralizing affective factors that naturally appear, as well as for exposing the child's healthier potentials, which sometimes receive little stimulus in the context of hospitalization.

Group Art Therapy with Sexually Abused Girls

The psychological impact of child sexual abuse has been widely researched. The purpose of this study was to evaluate a group art therapy intervention designed by the authors aimed at reducing depression, anxiety, sexual trauma and low self-esteem among 25 sexually abused girls aged 8–11 years. The programme was based on existential-humanistic, Gestalt, client-centred and abuse-focused principles. The Solomon four-group design was used to investigate the efficacy of the intervention, and the Trauma Symptom Checklist for Children and Human Figure Drawing were used as measures for assessing symptom change. The results indicated that the experimental groups improved significantly compared to the control groups with regard to anxiety and depression. The study adds to the literature on therapeutic approaches that can be applied to sexually abused children and on the use of group art therapy as an intervention technique.

An unusual clinical phenomenon: a case of bedtime ritual with apparent sexual overtones

A 6-year-old boy attended a psychology clinic with a history of separation anxiety, delayed bedtime and problematic daytime behaviour. In addition, his mother described that at bedtime he would rock over a particular soft toy (teddy bear) on the floor of his bedroom with the bear straddled between his legs in what appeared to be a sexualized ritual. Clinical history taking and a psychological assessment led to a diagnosis of Separation Anxiety and sleep related Rhythmic Movement Disorder (RMD). Systematic desensitization, token-reward systems and play therapy were used to reduce separation anxiety. Alternative bedtime rocking routines without sexual overtones were developed and resulted in reduced time for sleep initiation, increased total sleep time and improved daytime behaviour. This case study demonstrates a case of severe RMD used as a self-soothing and anxiety-reduction strategy which was initially misinterpreted as a sexualized activity. Caution should be exercised in misinterpreting similar case presentations. Correct diagnosis was increased in this case with a psychologist with expertise in sleep and therefore presents a potentially unmet clinical need for sleep psychologists.