Book review

Arts therapies in international practice: Informed by neuroscience and research, edited by Caroline Miller and Mariana Torkington, with a foreword by Noah Hass-Cohen

Routledge, 2022
eBook ISBN: 9781003082897

Reviewed by Johanna Davies

This new multi-authored book is a rich and welcome addition to the practice of creative arts therapies, and includes descriptions of dance, drama and movement, music, and visual arts therapies that have been informed by neuroscience and research. The authors of each chapter come from, and/or are living and working in a diverse array of countries such as Malaysia, United Kingdom, Aotearoa New Zealand, USA, Singapore, Australia, and South Africa.

The foreword of the book is written by Noah Hass-Cohen, who has made an extensive contribution to this field. Hass-Cohen reminds us that the arts in psychotherapy provide “unique advantages for recovery and resilience” (p.xvii) and outlines how the contributing authors to this book have furthered the fields of the creative arts therapies while utilising and integrating neuroscience-based aspects of practice. Hass-Cohen describes the theoretical frame for an art therapy relational neuroscience (ATR-N) approach (Hass-Cohen & Clyde Findlay, 2015) as a mechanism for unifying psychotherapeutic agents of change using memory reconsolidation processes.

Part one: Setting the scene

Part one of Arts Therapies in International Practice sets the scene of the book, with a moving and heartfelt compilation of personal reactions from the authors who wrote this book while experiencing some of the following challenges: deaths of family members, natural disasters, broken limbs, moving house, and the impact of living in a time of the (ongoing) global Covid-19 pandemic, with the associated illnesses and lockdowns that impacted them as they wrote their contributions. The scene-setting themes then move into the now-familiar impact of working during Covid-19 and the many necessary ‘pivots,’ and adaptations that have been made to deliver therapy to clients and participants during this time, as well as the broader impacts to the environment, communities and more.

The introduction and chapter one are written by Caroline Miller, who begins by describing how neuroscience continues to uncover new connections with and between the arts therapies, serving to confirm already-existing practices as well as suggest new ones. This is followed by a summary of each chapter, and a reflection on the pressing need for arts therapists to be able to report outcomes of therapy and change in a comprehensive way.

In ‘Arts therapies: Recent advances’, Miller introduces the ways in which the use of creativity within the arts therapies may enhance neurological and behavioural changes, then outlines how neuroscience adds to established practices by briefly explaining how the brain works, how traumatic events impact the brain, and by describing the brain’s plasticity over the human lifespan. Miller illustrates how the engagement of both body and mind via play, storytelling, communication, drama, and sensory involvement contributes to client engagement, and more successful therapy outcomes. 

Part two: Arts therapies in practice

Chapters two to eleven compromise contributions from several authors who describe research projects and case studies of arts therapies practices that have been informed by neuroscience. Chapters two, three and four focus on drama-based practices; chapters five to seven focus on the use of visual arts expression; chapters eight and nine concentrate on music-related practices; and chapters ten and eleven involve dance and movement. These are briefly outlined below. 

Chapters two to four

The chapters begin with a case study by Sarah Mann, about a young, adopted child, who had experienced loss and trauma at an early and pre-verbal age. Mann demonstrates how she worked using drama therapy, metaphor, and neuroscience with the child and his adoptive mother, in a framework that worked with explicit memory and implicit memory via engagement with dramatic play, to help understand the child’s inner world, his worries and preoccupations, and to assess his capacity to use available resources.

This is followed by a study made by Pamela Dunne and Renda Dionne Madrigal using Narradrama as a Three Act Play (NTAP) which integrates dramatherapy, narrative and the creative arts. In this case study, Dunne and Madrigal work with a mixed gendered, predominantly American Indian and Alaskan Native group of participants, supporting them to develop scripts that explore personal issues through the “creation of preferred roles, alternative stories, and preferred outcomes” (p.47). Principles and research from interpersonal neurobiology also inform the practices shown here, with the processes and outcomes described in some detail by the authors.

Vanitha Chandrasegaram describes the work that she did with a group of drama students from diverse cultural backgrounds, in an international school in Malaysia. The dramatherapy project extended the work that these students did in their drama classes by providing alternative, interactive mechanisms for the group to strengthen social connections, build self-confidence and capacity. The author draws on the use of mirroring, the polyvagal theory and neuroplasticity to demonstrate how neuroscience can inform the group experience.

Chapters five to seven

Agnes Desombiaux-Sigley begins this section with the use of a case study of a long-term client living with depression, loss, trauma, and grief. The author uses trauma-informed practices of somatic awareness and countertransference, the polyvagal theory, attachment theory, theories of loss and grief, and an understanding of the phenomenology of perception within her integrative arts therapies approach.

Kim Hau Pang describes several art-therapy-informed initiatives in his work in the context of palliative and bereavement care, while working within an interdisciplinary team in Singapore. This includes the use of a structured open studio, as well as an adaptation of the Australian Men’s Shed model as a mechanism for encouraging more men in the hospice to engage in creative activities. Pang describes how these creative spaces and engagements offer people who are experiencing bereavement, grief and loss and the associated impacts of these stressors, an opportunity to be socially engaged, improve cognitive functioning, and experience a sense of safety and familiarity.

Editor and author Mariana Torkington explores the role of imagination while working with a 13-year-old girl in Aotearoa New Zealand over an 18-month period. The child was experiencing issues with trauma and attachment, was separated from her family of origin, and living with a foster carer. Torkington describes in some detail the process of using the Outcomes Rating Scale (ORS) to assess the client and gain some insight into her self-perception, as well as how the CREATE approach (Hass-Cohen & Clyde Findlay, 2015) informed and guided her work.

Chapters eight and nine

Alison Talmage describes her ongoing research into therapeutic singing, based on her work with the CeleBRation Choir for adults with acquired neurogenic communication difficulties (conditions caused by changes in the brain or nervous system), participants’ partners and family members, and choir volunteers. This choir has an emphasis on “presence, camaraderie, enjoyment, effort, and improvement” (p.139), and the author is involved in a quality-of-life research study with this group.

Daphne Rickson applies a mixed-methods approach to her case study, to investigate the impact of music therapy in supporting the interpersonal communication and social-skills development of children with autism. Rickson uses the example of one case vignette demonstrating how music therapy is perceived to facilitate change, as well as how and why the change occurred. This in turn opens the possibility of more research using a qualitative synthesis approach. 

Chapters ten and eleven

Sian Palmer offers a group of attendees at the African Women in Dialogue conference in Johannesburg an opportunity to explore the conference theme through dance and expressive movement. The aim was to offer a space that could facilitate relationship building, allow for personal and collective stories to be told, and to debrief and process the conference content. The social interaction that dance facilitates is described from a neuroscience perspective as something that builds relationship and integration, as an embodied presence can encourage attunement and resonance.

Verity Danbold reflects on the current, urgent, global state of mental health provision and the systems that respond to it, and describes how dance movement therapy (DMT) is an effective intervention. Danbold posits that neuroscience (targeting the brain, the nervous system, and breath with three interventions using mirroring, the felt sense and grounding) can work effectively with this health emergency, while acknowledging what has been known to humans since prehistoric times: that movement and dance are useful tools for growth and recovery. Danbold writes in some detail about working with cultural integrity and addressing inequality, including that of mental health provision.

Part three: Reflections and review

In this final section, chapters twelve and thirteen reflect on the contributions made by the authors of this edited book, as well as how neuroscience contributes to and confirms the validity of the creative approaches of the arts therapies. The book concludes by looking ahead to future innovations and understandings of arts therapy practice (with its capacity to work with all the holistic facets of treatment: the physical, emotional, mental, spiritual, cultural, and social), with a future intention of deepening understanding of under-reported areas of practice.

This is a timely and accessible addition to the literature of the arts therapies. While some chapters are more detailed than others in describing and defining what is happening through the lens of neuroscience during creative clinical sessions, each chapter offers straightforward examples of how neuroscience and creative practices align in these spaces. These “intersecting points of learning and practice” (p.199) can assist arts therapists to explain more clearly how and why the arts benefit our clients, our communities and ourselves.