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Creative arts therapies (CAT) provide a safe and creative environment for older adults to process life experiences and maintain personal growth while aging. There is a growing need to make creative arts therapies more accessible to the aging population, as many have limited access to these services. This need has been catalyzed by the advent of the COVID-19 pandemic. Tele-CAT offers a possible solution. This study explored the experiences of older adults who participated in an online creative process of digital photocollage based on CAT. Twenty-four Italian and Israeli community-dwelling older adults aged 78 to 92 participated in this research through Zoom teleconferencing software. Transcriptions of the sessions and the art produced through the photocollage were qualitatively analyzed through Thematic Analysis. The findings show that the projective stimuli of digital photographs supported older adults’ narratives and engaged them in a more embodied emotional experience. Participant experiences involved artistic enjoyment within a positive and safe interaction with therapists. The creation of digital photocollages allowed the participants to process their life experiences and create an integrative view of their life, a vital developmental task in late life. These results point to the advantages and challenges of tele-CAT for older adults.
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Creative arts therapies (CAT) is an umbrella term for healthcare professions employing the creative and expressive process of art making to foster the psycho-social well-being of individuals [1]. CAT include a whole spectrum of disciplines, such as art therapy, drama therapy, psychodrama, dance/movement therapy, music therapy and poetry therapy, all of which foster the creative processing of emotions and experiences. The therapeutic processes are led by certified arts therapists and are grounded in the triangular relationship between the therapist, the client, and the art process and product [2]. As in other psychotherapies, establishing a safe environment and therapeutic alliance are central factors in the therapeutic relationship in CAT [3]. The aim of the current study was to explore the experiences of older adults who participated in an online therapeutic creative process of digital photocollage as a tele-CAT intervention during a period of social distancing. More specifically, we aimed to better understand how the nature of CAT can be integrated into an online format with older adults.
There are several change factors in CAT which distinguish it from verbal psychotherapy [3]. During the creative process of art making, the physical senses are engaged through relationships with paint, clay, images, movements and sounds. This embodied sensual experience fosters the connection and the working through of emotions rooted in bodily experience [4]. This emotional awareness can be further communicated in verbal and non-verbal ways in the therapeutic encounter [2]. The sensory experience also involves pleasure and relief that makes the exploration of difficult content tolerable [4].
In the therapeutic process of CAT, symbols and metaphors are created and explored [5]. This enables individuals to succinctly craft their inner experiences and express their invisible dimensions [6]. The use of colors, shapes and bodily movements also facilitates concretization, the transformation of abstract internal psychological content into an externalized tangible artistic presentation [7]. Artistic expression, through its symbolic concrete language, helps individuals bring the subconscious into conscious awareness and to communicate it with the self and others [8]. This is also connected to the concept of aesthetic distancing, one of the main change factors of CAT, which refers to an individual’s ability to simultaneously be emotionally close enough to the artistic experience yet distant enough to cognitively reflect upon it [9]. Aesthetic distancing provides a safe space for observing and exploring the emotional experience during the creative process.
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Art making is also based on spontaneity, which brings individuals closer to their emotions, thoughts, and imagination [10]. Spontaneity includes vitality, intuition, and the ability to accept each moment as it comes and to respond dynamically to it [11]. Spontaneity induces creativity, which strengthens people’s ability to look at a familiar experience from new and different perspectives [10, 12]. The literature points to an association between creativity and well-being indicators such as adjustment, optimal functioning, and the ability to respond adaptively to stressful situations and changes in life [13].
CAT are also action-oriented interventions that promote active involvement in the creative process, since the participants are actively and physically involved in the process of creating something visible [14, 15]. This process positions the participants in the active positions of “artists” and “creators”, rather than in the passive roles of “patients” or “clients”. In this way, CAT enable individuals to cope better with the stigma attached to mental health services, especially in older populations [16, 17].
There is a growing body of literature concerning the use of creative arts therapy interventions with older adults, and its effectiveness in improving various aspects of mental health [17, 18, 19, 20, 21]. The Dunphy and colleagues (2019) review showed that CAT can support older adults in dealing with depressive symptoms [20]. It pointed to various change factors in the creative therapeutic process that lead to its effectiveness in treating depression that include enhancing emotion processing, increasing social bonding, fostering creative expression and aesthetic pleasure. In addition, CAT for older adults affected physiological and cognitive measurements (e.g., by acting on neurochemicals such as endorphins, and stimulating memories).
The Role Of The Microenvironment In Controlling The Fate Of Bioprinted Stem Cells
Studies show that visual images provide a non-verbal means of expression in the therapeutic process with older adults. The ability to express oneself through these media is also important in cases of decreased cognitive functioning [22]. A review study underscored the efficiency of visual arts therapy in promoting psychological and cognitive well-being among older adults who suffer from decreased cognitive functioning [23]. Studies have shown that using visual images such as photography [24, 25], collages [26], drawing, and video recording [27, 28] can be effective when processing the memories and life stories of older adults. Studies have also shown that creative arts therapies support older adults in processing their life stories and unfinished business from the past [24, 29, 30].
Overall, there is a growing need to make mental health services accessible for older adults, since many have limited access to these services generally [31, 32, 33, 34, 35]. The COVID-19 pandemic with its social restrictions catalyzed this need and underscored the importance of supporting the older population in their homes [36]. Tele-psychotherapy increases the accessibility of mental health services. Thus, it is crucial to develop tele-CAT for the aging population that will make arts-based interventions more accessible, and at the same time maintain the creative nature of the therapeutic process in the online setting.
Tele-psychotherapy is a form of therapy that is conducted through a digital device, such as a smartphone, tablet or computer, by means of a videoconferencing application (such as Zoom, Skype, Meet) or via the telephone. Tele-psychotherapy can overcome some of the barriers that prevent older adults and the general public from turning to psychotherapy, such as physical limitations, lack of transportation, financial difficulties, and social stigma [37, 38, 39]. This is extremely important in the case of older adults whose mobility difficulties can lead to social isolation, which is associated with a decline in mental health [40, 41]. Sometimes, patients feel more comfortable when engaging in therapy from their homes [42]. Nevertheless, therapists have some concerns about tele-psychotherapy [43, 44], which mainly relate to the lack of user-friendliness with the software, difficulties establishing and maintaining the client-therapist therapeutic alliance, lack of confidentiality, and doubts as to its efficacy.
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Despite these hesitations, studies show that tele-psychotherapy is effective in treating older adults. A randomized controlled trial by Shapira and colleagues (2021) showed the potential of a brief group online intervention to reduce loneliness and depressive symptoms in older adults during the pandemic [33]. In a recent study by Choi et al. (2020), tele-psychotherapy was found to improve social
Art making is also based on spontaneity, which brings individuals closer to their emotions, thoughts, and imagination [10]. Spontaneity includes vitality, intuition, and the ability to accept each moment as it comes and to respond dynamically to it [11]. Spontaneity induces creativity, which strengthens people’s ability to look at a familiar experience from new and different perspectives [10, 12]. The literature points to an association between creativity and well-being indicators such as adjustment, optimal functioning, and the ability to respond adaptively to stressful situations and changes in life [13].
CAT are also action-oriented interventions that promote active involvement in the creative process, since the participants are actively and physically involved in the process of creating something visible [14, 15]. This process positions the participants in the active positions of “artists” and “creators”, rather than in the passive roles of “patients” or “clients”. In this way, CAT enable individuals to cope better with the stigma attached to mental health services, especially in older populations [16, 17].
There is a growing body of literature concerning the use of creative arts therapy interventions with older adults, and its effectiveness in improving various aspects of mental health [17, 18, 19, 20, 21]. The Dunphy and colleagues (2019) review showed that CAT can support older adults in dealing with depressive symptoms [20]. It pointed to various change factors in the creative therapeutic process that lead to its effectiveness in treating depression that include enhancing emotion processing, increasing social bonding, fostering creative expression and aesthetic pleasure. In addition, CAT for older adults affected physiological and cognitive measurements (e.g., by acting on neurochemicals such as endorphins, and stimulating memories).
The Role Of The Microenvironment In Controlling The Fate Of Bioprinted Stem Cells
Studies show that visual images provide a non-verbal means of expression in the therapeutic process with older adults. The ability to express oneself through these media is also important in cases of decreased cognitive functioning [22]. A review study underscored the efficiency of visual arts therapy in promoting psychological and cognitive well-being among older adults who suffer from decreased cognitive functioning [23]. Studies have shown that using visual images such as photography [24, 25], collages [26], drawing, and video recording [27, 28] can be effective when processing the memories and life stories of older adults. Studies have also shown that creative arts therapies support older adults in processing their life stories and unfinished business from the past [24, 29, 30].
Overall, there is a growing need to make mental health services accessible for older adults, since many have limited access to these services generally [31, 32, 33, 34, 35]. The COVID-19 pandemic with its social restrictions catalyzed this need and underscored the importance of supporting the older population in their homes [36]. Tele-psychotherapy increases the accessibility of mental health services. Thus, it is crucial to develop tele-CAT for the aging population that will make arts-based interventions more accessible, and at the same time maintain the creative nature of the therapeutic process in the online setting.
Tele-psychotherapy is a form of therapy that is conducted through a digital device, such as a smartphone, tablet or computer, by means of a videoconferencing application (such as Zoom, Skype, Meet) or via the telephone. Tele-psychotherapy can overcome some of the barriers that prevent older adults and the general public from turning to psychotherapy, such as physical limitations, lack of transportation, financial difficulties, and social stigma [37, 38, 39]. This is extremely important in the case of older adults whose mobility difficulties can lead to social isolation, which is associated with a decline in mental health [40, 41]. Sometimes, patients feel more comfortable when engaging in therapy from their homes [42]. Nevertheless, therapists have some concerns about tele-psychotherapy [43, 44], which mainly relate to the lack of user-friendliness with the software, difficulties establishing and maintaining the client-therapist therapeutic alliance, lack of confidentiality, and doubts as to its efficacy.
Scandia Camp Mendocino 2023
Despite these hesitations, studies show that tele-psychotherapy is effective in treating older adults. A randomized controlled trial by Shapira and colleagues (2021) showed the potential of a brief group online intervention to reduce loneliness and depressive symptoms in older adults during the pandemic [33]. In a recent study by Choi et al. (2020), tele-psychotherapy was found to improve social
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