Accessible Arts / arts + disability NSW

Creative therapies can be seen to allow the individual to explore and express conscious and unconscious feelings, working towards resolution of interpersonal and intrapersonal conflict through the process of self-exploration, self-discovery, self-determination and self-help (Atkinson & Wells, 2000).

Literature Review

Creative arts can be used as a means to express emotions, feelings, desires and thoughts, thus it is no surprise that artistic works can be analysed by professionals to gain insight into an individual’s mind (Schaverian, 1991). A dance for example, can be understood as an expression of emotion through movement (Pearson, 1996). For people with disabilities, creative arts and performance can serve as ways to portray intrinsic processes without direct announcement (Warren, 1994). Warren (1994) gives another example: “for the person with cerebral palsy, dance/movement can offer an opportunity to gain control over muscle spasms creatively; for the person who is withdrawn, it may allow them the opportunity to make a creative statement about themselves” (p. 87).

Creative arts in group settings are a means for human interaction and provide opportunities to verbally, physically and emotionally communicate with others (Reynolds, 2003).

Group settings allow practice of the creative process whereby imaginative thought becomes action, and whereby social behaviour and other social skills such as teamwork, decision making, leadership, turn taking and compassion can be learnt (Pearson, 1996).  The group setting also provides freedom for individuals with disabilities to express themselves amongst others without judgement, as they “are working on their particular form of expression they are getting in touch with those same archetypal energies which are the root of all art, whatever the level” (Pearson, 1996, p. 36).

The use of imagination and the physical movements involved in creative and performing arts can have very significant effects on individuals with impairments.  As individuals explore their capabilities and learn what their bodies can do, they can grow an awareness of their body’s structure and develop their own self-image. The testing and use of their bodies and minds is “linked to cognitive development, particularly in the areas of assimilation and recall of new information” (Warren, 1984, p. 87).

James (1996) describes creative arts, drama and movement as “an integrative multi-sensory approach, which actively stimulates the imagination for self-exploration, and can promote extraordinary growth, development, healing and change” (p. 215). By engaging in creative arts individuals can experiment with their abilities to both initiate and respond thus greatly strengthening their sense of self in the process. Barnes (2003) described creative arts as “potentially educative, transformative, expressive, emotionally exploratory, participative and involving” (p. 7).

During the early 1900’s creative arts became popularly used and recognised to decrease the negative effects of industrialization and social segregation of people with chronic illnesses or disabilities (Barker Schwartz, 2003). Johnson (1920, as cited in Barker Schwartz, 2003) stated one of the values of creative arts for these people was to “provide a stimulus to mental activity and muscular exercise at the same time, and afford an opportunity for creation and self-expression” (p. 6).

A group context for receiving art experiences also provides much needed stimulation and socialization for individuals with disabilities who are isolated from peers (Canner Hume and Hitti, 1988). This is confirmed in more recent studies focusing on the benefits of group activities. One such study was that of Lynch and Chosa (1996) that examined the relationship between participation in group-oriented community-based expressive art programs for individuals with disabilities and perceptions of psychosocial function change. Community arts participation was found to increase self-esteem, communication abilities and socialisation skills.

A study by Reynolds and Prior (2003) exploring the meanings and functions of art for a group of women living with disabling chronic illnesses revealed that art filled occupational voids, distracted thoughts away from illness, promoted the experience of flow and spontaneity, enabled the expression of emotions, maintained a positive identity, and extended social networks.

The need for creative arts services is on the increase. They have become a context in which people can get together, enjoy and freely express themselves and think about issues of common concern (Vasey, 1992). This disability culture would offer people a key to “the basic process of identifying as a disabled person” (Vasey, 1992, p. 11), because culture and identity are closely linked concepts.

Method

The present study employed qualitative methods of research. Participant observation of creative arts programs in session took place as well as semi-structured interviewing with creative arts program co-ordinators. Qualitative data was produced by these research methods for five creative arts services for adults with disabilities. Participant observations, lasting between 60-90 minutes looked at the following aspects of creative activity sessions:

• Facilitators
• Environment
• Materials
• Participants

The researchers transcribed notes of their observations while on the field, a method described by Esterberg (2002) and took photographs of the environment and activities they observed. The semi-structured interviews that took place with program co-ordinators lasted approximately 20 minutes and were concerned with the following:

• Creative philosophies of the co-ordinator
• Promotion of creativity within the service
• Facilitator aspects relevant to participants’ experience of creativity
• How participants’ creativity was inspired during sessions
• The ratio of staff to participants
• Continuation of participants’ creativity beyond the service setting
• Participant benefits of the service
• Barriers to the creative process for the participant
• The aim of creative sessions e.g. product driven
• Degree to which staff had been trained in creative arts disciplines

The five interviews with program co-ordinators were audio recorded by agreement and transcribed for the purpose of data analysis.

Settings

To maintain confidentiality the participating services in this study have not been named. The services represented a range of creative arts programs including drama, dance, movement, and fine art.  The participants of the services were adults with disabilities whom attended these sessions in day and evening programs. Placement in these programs was subject to eligibility, available places, and funding. Facilitators of creative programs varied in their experience and training. Some facilitators had more than 20 years experience in disability and creative art service provision. Others were highly skilled artists or trained in creative arts and inexperienced in direct care prior to assuming their role in the disability service.

Participants

The participants of these services experienced a range of disabilities including Cerebral Palsy, mild to severe intellectual impairment, Down Syndrome and Autism. The criteria for observation required the participants to be over the age of 18 and to access one of the disability services being studied by the researchers. Purposeful sampling determined the choice of five disability services deemed to provide information-richness to the study of creative arts services. The interviewees were selected due to their role in the co-ordination of the services being studied and ability to provide an all-round perspective of information of the service.

Ethical Considerations

Approval for the study was established by the Human Research Ethics Committee of the University of Sydney. Agreement to undertake the study was obtained from the co-ordinators of the five disability services and detailed written information was provided to these co-ordinators regarding the interview process. Written consent was obtained from each of the interviewees in the study and verbal consent was obtained from service recipients for the researchers to observe the creative sessions that they were a part of and to take photographs.

Data Analysis

Each transcript and the observation data from each individual site were analysed. To identify themes a basic theme analysis was used. In regards to the transcripts, reading and re-reading of the data was required to “identify any recurrent statements or words which are then labelled, described and summarized to portray a persons most frequent and most important experiences or actions” (Luborsky, 1994, p. 189). As each transcript was read a process of annotating and labelling was conducted to highlight interesting, significant and unusual answers to the questions.  They were then grouped together to represent certain themes that appeared in the data and were summarized and contrasted with the literature.

The data from the observations was subjected to similar analysis. During the exploration of data important interactions, symbols, meanings and statements were identified. This information was then collated to represent certain themes that were common among the individual sites.

Following this analysis a mind map was drawn outlining the themes found within the data, allowing for further categorisation (Patten, 1990; Dey, 1993). The three major themes were confirmed by a second researcher’s independent analysis.

Themes

There were three main themes that stood out in support of the need for creative arts within group programs for people with disabilities. These were identified as the development of self-expression and creativity, the development of the individual and the ways in which creative art can enhance disability service programs.

The Development of Self Expression

All service providers who took part in this study were observed to have implemented strategies within their programs that evoked participant self-expression and creative thought. Flexibility within program structure, encouragement within a supportive, familiar environment and participant-facilitator rapport were seen to be influential factors to the level of creative expression demonstrated in the groups.

In a particular movement therapy class the facilitator provided a coloured scarf to create visual stimuli for participants to produce their own unique movement to music. This semi-structured program format was seen to enhance self-expression and self-esteem as participants were applauded and supported by their peers. Creative experiences have been documented in the literature as providing a vehicle by which participants can strengthen their self-awareness and self-esteem through enabling self-expression and ‘voice’ (Reynolds & Prior, 2003). One visual art group facilitator supported this idea by stating:

“The participants learn to express themselves and sort of let loose in the art room.”

The cultivation of creativity was also seen in the context of a drama group, after the facilitator agreed to the inclusion of ‘Christmas ninjas’ into their annual Christmas play following a participant request. It has been asserted that the creative properties of the art-making process, in all its forms, and the meaning that individuals link to participation are crucial to the efficacy of fostering creative expression within a group context (Lynch & Chosa, 1996).  Art making was found to be process-driven, as opposed to outcome-based. This surfaced during an interview with one painting group facilitator as he described a participant’s work:

“You see she is working with long lines, but that one is a process of a few months, one painting can be for a month."

Occupational therapy theory acknowledges the importance of the cultural, social and physical environment that impact upon a person’s behaviour. The person-environment interaction is seen as a transactional relationship that provides cues on how to act within a particular context (Stewart, Letts, Law, Acheson Cooper, Strong and Rigby, 2003). As one program coordinator for a dance class stated:

“It’s safe for them to freely express themselves in ways they usually aren’t allowed to do, so it’s a safe and encouraging environment which allows people to come out as themselves.”

Development of the Individual

The notion of facilitating the development of the individual through participation in creative arts groups was nurtured within the observed organisations. Participants were considered to be vocational artists in the two participating visual arts services. One group had an annual community art exhibition at a local gallery and another operated a separate gallery all year round selling the work produced in class:

It has been contended that we build our individual identities through our occupations and that occupations provide a context in which individuals can create meaningful lives (Christiansen, 1999):

“Members get a sense of achievement and they love having their work sold and they make a bit of money.”

Development of the individual was fostered through spending time and building rapport with participants, as illustrated by the statement of one facilitator:

“There’s one particular participant that took a long time to figure out what is his way, but now, ah!”

The style adopted by participants, in addition to the medium chosen, was tailored to their specific preferences and level of ability:

“One participant sits on one side of the table and works with one colour of acrylic paint. He has a repetitive motor pattern that drives his brush stroke in one direction. Every 15 minutes or so the facilitator turns the paper, which is taped to the desk. The facilitator also smooths all the paint out inside the palate, which he explains prevents any lumps from coming off the brush due to the participant’s style”.

The group context has been found to be an effective platform from which people develop their sense of individuality. “Development occurs within relationships, and interactions help shape our concept of who we are and our roles as social beings” (Spaniol, 2001, p. 227). This idea was seen to be supported in a dance class, where:

“One participant enthusiastically stopped the dancing group from commencing to put on her high-heeled flamenco dancing shoes, followed by a quick flamenco solo in the middle of the group to show she was ready to start and the class could re-commence.”

Creative Art Enhances Disability Services

The inclusion of the creative arts in disability group services has demonstrated efficacy in enhancing the lives of group participants. The various forms of art have brought about a sense of joy, socialisation, self-esteem and purpose to the individuals who attend:

“enjoyment, self-expression and choice making are the key elements of creativity.”

A fundamental role of the creative arts group facilitator is to display an innate ability to read the group dynamic and to reflect this reciprocal understanding in activity planning:

“The facilitator keeps the energy of the session going with humour and encouragement.”

“Facilitators constantly provide positive feedback and encouragement to clients, and use positive and open body language, facial expressions, voice tone and volume appropriate for group settings.”

The joy experienced by participants emersed in these groups provides a constant source of motivation to continue to actively participate, hence perpetuating the positive effects on their everyday lives:

“there’s no right there’s no wrong, its something that’s important to them… It can be about nothing, it doesn’t matter, so long as they’re enjoying it that’s all that really matters.”

Creative arts programs within disability services provide an opportunity to those with limited community access to experience new engaging activities and skill acquisition in an area other than activities of daily living or instrumental activities of daily living:

“I think a lot of it is being able to participate in mainstream activities. Normal people go to dance parties and out on the weekends with friends, or acting classes and things like that in their spare time, so again these are mainstream activities that they are able to freely participate in.”

Discussion

The data collected from the five art services was both rich and interesting. The three core themes that were most prominent: the development of self-expression, the development of the individual and how creative art services enrich disability services, all suggest that creativity is being facilitated amongst these services. The results advocate use of art within disability services and provide evidence that it is an enriching and positive experience for the participants.

By facilitating the development of self-expression within art services an environment is created where participants can be themselves and explore their inner thoughts and feelings. As Spaniol (2001) states “artists’ use of art as a bridge to their inner lives is certainly no surprise for creative arts therapists” (p. 222).  The art services observed all encouraged personal interpretation within their mediums using mostly semi-structured group facilitation. Within this forum, intense feeling may be poured out into an artwork or other creative medium without the restraint of a predetermined outcome (Schaverian, 1991). In essence a person’s true self may appear when not bound by lack of talent or ability, an opportunity that may not always be accessible to those with disability.

Development of the individual through participation in art programs is an important premise established in the data. A person with a disability may have experienced a lack of success in other skilled activities such as work or sport due to their physical or cognitive limitations. The ability to participate in different art mediums with less pressure to acquire certain regimented skills can build self-esteem and provide the participant with a sense of mastery (Lynch & Chosa, 1996). This can afford participants with the tools to develop confidence in their abilities. “Art provides a means to fill the occupational void with satisfying, creative activity, paving the way for a positive re-evaluation of lifestyle, and self-image” (Reynolds, & Prior, 2003, p. 12).

The use of art as vocation was also observable within the data. Some art services held annual exhibitions or operated year round art galleries, which were used to exhibit and sell the participants artwork. This aspect of the art service provided the participant with a financial incentive along with a sense of achievement gained through their artwork.

The group process was a common aspect of the art services researched, as an added value of creative arts within disability services. Working within groups has been associated with the development of a person’s sense of individuality (Reynolds, & Prior, 2003) and in essence “the human mind is, in its very origins and nature, a social product” (Jordan, Kaplan, Miller, Stiver & Surrey, 1991, p. 18). This sense of belonging can aid in the development of participants’ concepts of who they are and an understanding of their role as social beings (Spaniol, 2001).

The majority of the data collected was overwhelmingly supportive of art services. It was seen to contribute to providing meaningful activity for people with a disability in our community. These services and others like them should not be overlooked or undervalued for the role they play within the disability sector.

Implications to occupational therapy

Occupational therapy is typically goal based and orientated to achieve outcomes. This study focussed on the intrapersonal aspect of creative activity.  Chapparo & Ranka (1997) suggest that intrapersonal attributes such as valuing, satisfaction and motivation can be stimulated by a task. Creative art can be viewed as a meaningful purposeful activity benefiting the person’s body, mind and spirit.  Chandani & Hill (1990, as cited in Holder, 2001, p. 104) viewed therapeutic activity in a similar perspective addressing the person as a whole rather than the sum of their parts.

Holder (2001) expresses concern that creative activity is no longer taught as a fundamental part of the occupational therapy profession.  As a practicing occupational therapist Holder (2001, p. 105), shares her personal account of a creative arts session stating “I was influencing the state of my own health; after starting the session feeling that I no longer had the capacity to cope with difficulties I was experiencing, I finished feeling refreshed in body and mind, ready to resume my normal occupations”. This statement highlights how creative activity can benefit the body, mind and spirit.

Strengths & Limitations

The strengths of this study lie in its broad scope of service genres studied in the art services across Sydney’s metropolitan region.  Participant observation focused on validating creative components comprised in the facilitation of the services. Observers had the opportunity to discuss observations with the facilitators and to clarify and gain information regarding techniques used to facilitate the session.  
Limitations of the study include the impact of the participation of the observers in all settings, which unavoidably changed the dynamics of the groups and may have directly influenced the behaviour of participants.  It was also possible that the interviewees confounded the study by mentioning only positive aspects of their services or by providing personal opinions according to their perception of the study aims.

Conclusion

This project makes a valuable contribution to the evaluation of current community art services in the Sydney metropolitan area.  The themes found in this study were the development of self-expression, the development of the individual and how creative arts enhances disability services. The findings reveal that many disability services in Sydney are taking on the responsibility of providing creative opportunities to their participants.

This study has found qualitative evidence to support the existence of intrinsic benefits of participation in creative arts to people with disabilities. We recommend further research into how creative expression contributes to the development of an individual’s sense of self across the lifespan, and how creative arts services are situated among other activity programs in their ability to improve the quality of life for those with disabilities.

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References

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