Creative arts therapies and clients with eating disorders

Creative arts therapies and clients with eating disorders Creative Arts Therapies and Clients with Eating Disorders, edited by music therapist Annie Heiderscheit, provides a thorough look at the use of creative arts therapies in the treatment of clients with eating disorders. The editor begins by describing the complexity of these disorders that include anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified. She then points out a worldwide increase in their pervasiveness, which calls for effective, multidisciplinary, and new methods of treatment. This is where the creative arts therapies come into play. While there are only limited evidence-based studies that examine the creative arts therapies in the treatment of clients with eating disorders, countless qualitative case illustrations indicate the effectiveness of art therapy, music therapy, dance/movement therapy, poetry therapy, and drama therapy with this population. A shared aim in all creative arts therapies is the development of a symbolic language that “can provide access to unacknowledged feelings and a means of integrating them creatively in the personality, enabling therapeutic change to take place” (Dokter, 1995, p. 3). In 16 thoughtfully assembled chapters, we learn about the symbolic language of each of the five creative arts therapy modalities. We discover how they foster insight and change, uncover feelings and stories, give voice to the hidden, and allow for meaning to emerge. With international contributions from four different countries—the United States, Australia, Norway, and Latvia—the authors ultimately expand and further investigate the use of creative arts in the treatment of eating disorders. Particularly helpful are the numerous case illustrations that are sprinkled throughout each chapter, offering a sense for the practical implementation of creative arts therapy methods. After a brief outline of the global scope and incidence of eating disorders, two women in recovery share their lived experience with their eating disorders. I appreciate this chapter, as it gives us a close, “insider” look at this complex disorder and demonstrates how a client might perceive creative arts therapy. In both examples, music and art are described as catalysts that promote honest self-expression, insight, support, and, ultimately, freedom. Chapters 3 through 6 focus on various music therapy approaches with clients with eating disorders. For example, McFerran and Heiderscheit present four eclectic well-known theories—psychodynamic theory, humanistic theory, cognitive-behavioral theory, and ecological theory—in relation to music therapy. Each theory is shown to differ in terms of etiology of eating disorders, stance, method, and therapeutic outcomes. McFarren and Heiderscheit urge music therapists not to cling prescriptively to any particular approach/theory but rather to be flexible and congruent in their thinking and actions. Another example is resilience-based music therapy, specifically with adolescents in Australia. Music therapist Sarah Punch emphasizes the focus on the healthy self, personal strengths, coping, and resources with this approach. When resilience is strengthened through tools such as music, the prognosis for recovery seems to improve. Punch describes three musical means that can support the client in the moment and are “a valuable resource within the construct of resilience” (p. 94): a “coping playlist exercise,” “trigger songs,” and a “lyrical companion,” The focus of chapter 5 is on expressive and receptive music therapy with the eating disorder population. Norwegian music therapist Trondalen reviews the four types of musical experience that explore different aspects of life: improvising, recreating/performing, composing, and listening (Bruscia, 2014). Trondalen distinguishes between “alone-listening,” which may perpetuate feelings of loneliness and separation, and “self-listening,” listening to one’s own recordings in a session. She also addresses the importance of relationships in recovery, calling them “the driving force of human development and change” (p. 104). The experience of closeness with another individual can foster meaning and coherence, inspire hope, and establish a sense of belonging. Finally, we learn about the Bonnie Method of Guided Imagery in Music (BMGIM) and its applications with the eating disorder population. What is particularly striking with this method is its use of imagery in accessing and addressing underlying, unconscious emotions and issues. Mainly applied in individual sessions, adaptations exist for its use in groups. Since deep emotions are likely to emerge during BMGIM, Heiderscheit issues a caveat, highlighting the importance of medical stability and developed coping skills in the individual undergoing this approach. Chapters 7 through 9 offer us a look at art therapy with eating disordered clients. Australian art therapists Cameron and Kipnis, in their work with acute inpatient adolescents, emphasize that art therapy is a non-threatening, gentle approach that is rooted in the present moment, accesses multiple ways of knowing, and engages imaginative options. The images that spring from the artwork can invite an imaginal dialogue for the client (McNiff, 2004). Some of the creative approaches discussed in this chapter are the use of warm scented play dough, clay, sand, or crafts for clients who struggle with over-exercising. Particular attention to the body and self are given in an approach presented by art therapist Marmor. She describes how tactile, physical, and sensory experiences with materials parallel clients’ experiences with food. The reflection of symptom use through art media can provide opportunities to challenge set behaviors first via art and later in other areas of life: “The process of gaining competence over the materials and the artistic process can lead to a sense of mastery, supporting and building a client’s self-esteem” (p. 167). Marmor also addresses the link between sexual identity, shame, and eating disorders. Art therapy can help clients reconnect to their bodies and sexuality by giving them a chance to reconnect to their creativity. In a third example of art therapy with clients with eating disorders, we read about a new approach that integrates dialectical behavior therapy (DBT) skills with art therapy techniques. Susan Clark presents a variety of models of DBT-informed art therapy that include mindfulness, metaphor, and mastery. She goes on to describe art therapy activities and interventions that correspond to mindfulness, interpersonal effectiveness, emotion regulation, distress tolerance, and radical openness. Chapters 10 and 11 discuss dance/movement therapy approaches with eating-disordered clients. According to dance/movement therapist Nordstrom-Loeb, awareness and integration of embodied experiences are “fundamental components of the healing process” (p. 219). Body and movement patterns reflect unconscious processes and can be used to facilitate embodied change. Moving through three non-linear stages, clients learn to notice and tolerate, explore, and finally integrate new experiences (Klineman, 2009). Nordstrom-Loeb emphasizes the importance of pacing with regard to interventions as well as the need for therapists to be both familiar with personal movement biases and able to access a wide range of movement possibilities. In the other example, we see the application of art therapist Lusebrink’s (2010) Expressive Therapy Continuum (ETC) in a dance/movement therapy process. Latvian authors Vende, Orinska, Majore-Dusele, and Upmale present a model that correlates dance/movement therapy techniques with the different levels of ETC, which include kinesthetic, sensory, perceptual, affective, cognitive, and symbolic components. Eating-disordered clients tend to operate chiefly from the cognitive component. In order to create a balance and decrease symptoms, other levels need to be developed. Vende et al. offer a number of techniques that can promote this development. Poetry therapist and psychologist Chavis provides an overview of poetry therapy in the treatment of eating disorders in chapter 12. Through guided discussions about literary works such as poems, stories, plays, and novels and/or creative writing and journal exercises, clients gain an understanding for suppressed feelings. While reading literary works induces identification and projection, writing activities can be self-affirming and instill a sense of agency. Particularly effective in groups, poetry therapy fosters personal engagement and creative expression. Chavis includes numerous appropriate examples from literature that address a variety of topics within recovery. In chapter 13, we gain insight about drama therapy with the eating disorder population. Drama therapist Wood introduces the integrated application of Internal Family Systems (IFS) theory with drama therapy. In the IFS model, individuals are seen as having three different parts or subminds that develop over time: managers, which control one’s life; exiles, which emerge when a person has been hurt or shamed; and firefighters, which override the individual from the exile’s feelings. The firefighter part is manifested in eating-disordered clients. Drama therapy helps clients externalize internal experiences, and the dramatic distance in turn allows them to gain insight about the roles they had to play to protect themselves. The final three chapters in Creative Arts Therapies and Clients with Eating Disorders focus on collaborative practices in creative arts therapies with the eating disorder population. We learn that although alliances have been encouraged for close to 40 years, research literature is limited. Heiderscheit and Marmor describe a collaboration between art and music therapists and indicate that clients may benefit from multisensory experiences. On the downside, collaboration tends to be time consuming. Heiderscheit and Wellstone illustrate a partnership between music therapists and marriage and family therapists. Working with multifamily groups in treatment settings, the authors share how they use listening to music and improvisation with clients and their families, while simultaneously modeling how to connect through their collaboration. In the last example, Heiderscheit, Marmor, Saindon, and Wellstone utilize multiple illustrations to showcase both benefits and challenges of collaborative work between creative arts therapists and marriage and family therapists. Ultimately, they consider inter-professional practices as unique opportunities in which multiple disciplines bring their specialized expertise to the overall process and thus address unmet needs of clients and families. An extensive appendix offers a summary of training requirements for each creative arts therapy modality and additional resources. Creative Arts Therapies and Clients with Eating Disorders is a valuable and practical resource that offers countless applications and interventions and will thus be of interest to all practicing creative arts therapists as well as to those in training. This book could certainly be consumed in one sitting; however, I would recommend reading one chapter at a time. While it provides an international perspective, future scholarly work in this area could potentially include even more diverse contributions. Where the book shines is in its inclusiveness of numerous approaches and its attempts to unify the creative arts and call for increased collaboration among various disciplines. References Bruscia K. E . ( 2014). Defining music therapy  ( 3rd ed.). Gilsum, NH: Barcelona Publishers. Dokter D . (Ed.). 1995. Arts therapies and clients with eating disorders: Fragile board . London: Jessica Kingsley Publishers. Klineman S . ( 2009). Becoming whole again: Dance/movement therapy for those who suffer from eating disorders. In S. Chaiklin and H. Wengrower (Eds.), The art and science of dance/movement therapy: Life is dance  (pp. 125– 143). New York: Taylor and Francis Group/Routledge. Lusebrink V. B . ( 2010). Assessment and therapeutic application of the expressive therapies continuum: Implications for brain structures and functions. Art Therapy: Journal of the American Art Therapy Association , 27, 4. Google Scholar CrossRef Search ADS   McNiff S . ( 2004). Art heals: How creativity cures the soul . Boston: Shambhala Publications. © the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Music Therapy Perspectives Oxford University Press

Creative arts therapies and clients with eating disorders

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Publisher
American Music Therapy Association
Copyright
© the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
ISSN
0734-6875
eISSN
2053-7387
D.O.I.
10.1093/mtp/miw027
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Abstract

Creative Arts Therapies and Clients with Eating Disorders, edited by music therapist Annie Heiderscheit, provides a thorough look at the use of creative arts therapies in the treatment of clients with eating disorders. The editor begins by describing the complexity of these disorders that include anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified. She then points out a worldwide increase in their pervasiveness, which calls for effective, multidisciplinary, and new methods of treatment. This is where the creative arts therapies come into play. While there are only limited evidence-based studies that examine the creative arts therapies in the treatment of clients with eating disorders, countless qualitative case illustrations indicate the effectiveness of art therapy, music therapy, dance/movement therapy, poetry therapy, and drama therapy with this population. A shared aim in all creative arts therapies is the development of a symbolic language that “can provide access to unacknowledged feelings and a means of integrating them creatively in the personality, enabling therapeutic change to take place” (Dokter, 1995, p. 3). In 16 thoughtfully assembled chapters, we learn about the symbolic language of each of the five creative arts therapy modalities. We discover how they foster insight and change, uncover feelings and stories, give voice to the hidden, and allow for meaning to emerge. With international contributions from four different countries—the United States, Australia, Norway, and Latvia—the authors ultimately expand and further investigate the use of creative arts in the treatment of eating disorders. Particularly helpful are the numerous case illustrations that are sprinkled throughout each chapter, offering a sense for the practical implementation of creative arts therapy methods. After a brief outline of the global scope and incidence of eating disorders, two women in recovery share their lived experience with their eating disorders. I appreciate this chapter, as it gives us a close, “insider” look at this complex disorder and demonstrates how a client might perceive creative arts therapy. In both examples, music and art are described as catalysts that promote honest self-expression, insight, support, and, ultimately, freedom. Chapters 3 through 6 focus on various music therapy approaches with clients with eating disorders. For example, McFerran and Heiderscheit present four eclectic well-known theories—psychodynamic theory, humanistic theory, cognitive-behavioral theory, and ecological theory—in relation to music therapy. Each theory is shown to differ in terms of etiology of eating disorders, stance, method, and therapeutic outcomes. McFarren and Heiderscheit urge music therapists not to cling prescriptively to any particular approach/theory but rather to be flexible and congruent in their thinking and actions. Another example is resilience-based music therapy, specifically with adolescents in Australia. Music therapist Sarah Punch emphasizes the focus on the healthy self, personal strengths, coping, and resources with this approach. When resilience is strengthened through tools such as music, the prognosis for recovery seems to improve. Punch describes three musical means that can support the client in the moment and are “a valuable resource within the construct of resilience” (p. 94): a “coping playlist exercise,” “trigger songs,” and a “lyrical companion,” The focus of chapter 5 is on expressive and receptive music therapy with the eating disorder population. Norwegian music therapist Trondalen reviews the four types of musical experience that explore different aspects of life: improvising, recreating/performing, composing, and listening (Bruscia, 2014). Trondalen distinguishes between “alone-listening,” which may perpetuate feelings of loneliness and separation, and “self-listening,” listening to one’s own recordings in a session. She also addresses the importance of relationships in recovery, calling them “the driving force of human development and change” (p. 104). The experience of closeness with another individual can foster meaning and coherence, inspire hope, and establish a sense of belonging. Finally, we learn about the Bonnie Method of Guided Imagery in Music (BMGIM) and its applications with the eating disorder population. What is particularly striking with this method is its use of imagery in accessing and addressing underlying, unconscious emotions and issues. Mainly applied in individual sessions, adaptations exist for its use in groups. Since deep emotions are likely to emerge during BMGIM, Heiderscheit issues a caveat, highlighting the importance of medical stability and developed coping skills in the individual undergoing this approach. Chapters 7 through 9 offer us a look at art therapy with eating disordered clients. Australian art therapists Cameron and Kipnis, in their work with acute inpatient adolescents, emphasize that art therapy is a non-threatening, gentle approach that is rooted in the present moment, accesses multiple ways of knowing, and engages imaginative options. The images that spring from the artwork can invite an imaginal dialogue for the client (McNiff, 2004). Some of the creative approaches discussed in this chapter are the use of warm scented play dough, clay, sand, or crafts for clients who struggle with over-exercising. Particular attention to the body and self are given in an approach presented by art therapist Marmor. She describes how tactile, physical, and sensory experiences with materials parallel clients’ experiences with food. The reflection of symptom use through art media can provide opportunities to challenge set behaviors first via art and later in other areas of life: “The process of gaining competence over the materials and the artistic process can lead to a sense of mastery, supporting and building a client’s self-esteem” (p. 167). Marmor also addresses the link between sexual identity, shame, and eating disorders. Art therapy can help clients reconnect to their bodies and sexuality by giving them a chance to reconnect to their creativity. In a third example of art therapy with clients with eating disorders, we read about a new approach that integrates dialectical behavior therapy (DBT) skills with art therapy techniques. Susan Clark presents a variety of models of DBT-informed art therapy that include mindfulness, metaphor, and mastery. She goes on to describe art therapy activities and interventions that correspond to mindfulness, interpersonal effectiveness, emotion regulation, distress tolerance, and radical openness. Chapters 10 and 11 discuss dance/movement therapy approaches with eating-disordered clients. According to dance/movement therapist Nordstrom-Loeb, awareness and integration of embodied experiences are “fundamental components of the healing process” (p. 219). Body and movement patterns reflect unconscious processes and can be used to facilitate embodied change. Moving through three non-linear stages, clients learn to notice and tolerate, explore, and finally integrate new experiences (Klineman, 2009). Nordstrom-Loeb emphasizes the importance of pacing with regard to interventions as well as the need for therapists to be both familiar with personal movement biases and able to access a wide range of movement possibilities. In the other example, we see the application of art therapist Lusebrink’s (2010) Expressive Therapy Continuum (ETC) in a dance/movement therapy process. Latvian authors Vende, Orinska, Majore-Dusele, and Upmale present a model that correlates dance/movement therapy techniques with the different levels of ETC, which include kinesthetic, sensory, perceptual, affective, cognitive, and symbolic components. Eating-disordered clients tend to operate chiefly from the cognitive component. In order to create a balance and decrease symptoms, other levels need to be developed. Vende et al. offer a number of techniques that can promote this development. Poetry therapist and psychologist Chavis provides an overview of poetry therapy in the treatment of eating disorders in chapter 12. Through guided discussions about literary works such as poems, stories, plays, and novels and/or creative writing and journal exercises, clients gain an understanding for suppressed feelings. While reading literary works induces identification and projection, writing activities can be self-affirming and instill a sense of agency. Particularly effective in groups, poetry therapy fosters personal engagement and creative expression. Chavis includes numerous appropriate examples from literature that address a variety of topics within recovery. In chapter 13, we gain insight about drama therapy with the eating disorder population. Drama therapist Wood introduces the integrated application of Internal Family Systems (IFS) theory with drama therapy. In the IFS model, individuals are seen as having three different parts or subminds that develop over time: managers, which control one’s life; exiles, which emerge when a person has been hurt or shamed; and firefighters, which override the individual from the exile’s feelings. The firefighter part is manifested in eating-disordered clients. Drama therapy helps clients externalize internal experiences, and the dramatic distance in turn allows them to gain insight about the roles they had to play to protect themselves. The final three chapters in Creative Arts Therapies and Clients with Eating Disorders focus on collaborative practices in creative arts therapies with the eating disorder population. We learn that although alliances have been encouraged for close to 40 years, research literature is limited. Heiderscheit and Marmor describe a collaboration between art and music therapists and indicate that clients may benefit from multisensory experiences. On the downside, collaboration tends to be time consuming. Heiderscheit and Wellstone illustrate a partnership between music therapists and marriage and family therapists. Working with multifamily groups in treatment settings, the authors share how they use listening to music and improvisation with clients and their families, while simultaneously modeling how to connect through their collaboration. In the last example, Heiderscheit, Marmor, Saindon, and Wellstone utilize multiple illustrations to showcase both benefits and challenges of collaborative work between creative arts therapists and marriage and family therapists. Ultimately, they consider inter-professional practices as unique opportunities in which multiple disciplines bring their specialized expertise to the overall process and thus address unmet needs of clients and families. An extensive appendix offers a summary of training requirements for each creative arts therapy modality and additional resources. Creative Arts Therapies and Clients with Eating Disorders is a valuable and practical resource that offers countless applications and interventions and will thus be of interest to all practicing creative arts therapists as well as to those in training. This book could certainly be consumed in one sitting; however, I would recommend reading one chapter at a time. While it provides an international perspective, future scholarly work in this area could potentially include even more diverse contributions. Where the book shines is in its inclusiveness of numerous approaches and its attempts to unify the creative arts and call for increased collaboration among various disciplines. References Bruscia K. E . ( 2014). Defining music therapy  ( 3rd ed.). Gilsum, NH: Barcelona Publishers. Dokter D . (Ed.). 1995. Arts therapies and clients with eating disorders: Fragile board . London: Jessica Kingsley Publishers. Klineman S . ( 2009). Becoming whole again: Dance/movement therapy for those who suffer from eating disorders. In S. Chaiklin and H. Wengrower (Eds.), The art and science of dance/movement therapy: Life is dance  (pp. 125– 143). New York: Taylor and Francis Group/Routledge. Lusebrink V. B . ( 2010). Assessment and therapeutic application of the expressive therapies continuum: Implications for brain structures and functions. Art Therapy: Journal of the American Art Therapy Association , 27, 4. Google Scholar CrossRef Search ADS   McNiff S . ( 2004). Art heals: How creativity cures the soul . Boston: Shambhala Publications. © the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Journal

Music Therapy PerspectivesOxford University Press

Published: Nov 11, 2016

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