Research Supporting Art to Help Suvivors of Sexual Assault

Introduction

The Office for National Statistics (ONS) (Flatley, 2016) reported that in 2015–2016, in England and Wales, 7% of adults aged 16–59 years had experienced child sexual abuse (CSA). Eleven percent of females in the population were CSA victims whilst 3% were male. These results are in line with Barth et al. (2013) global figures for CSA. According to the ONS survey, 73% of victims first experienced CSA past the age of 12 (Flatley, 2016).

CSA has significant consequences on psychological development and is an etiological factor in long-term mental health and social issues. Acute effects of CSA may present themselves equally internalizing symptomology (i.e. emotional and behavioral issues) which correlates strongly with psychiatric disorders including depression, feet, suicidal ideation, and posttraumatic distress (Famularo et al., 1990). Studies have also provided a relationship between the physical symptomology caused by child sexual abuses, such as the prevalence of neurological dysregulation, and chronic pain (Glod, 1993). In CSA, psychiatric symptoms can exist nowadays in adulthood, constituting long-term sequelae including unrestrained, aggressive behavior, which may feed the wheel of abuse. CSA can also contribute to difficulties with developing interpersonal relationships and CSA victims may notice it hard to trust others or appoint in intimacy whilst also having low self-esteem and confidence (Davis & Petretic-Jackson, 2000). Emerging work also recognizes the potential for post-traumatic growth (Hartley et al., 2016) and resilience (Kaye-Tzadok & Davidson-Arad, 2016). Commonly, psychological therapies, such every bit Exposure Therapy, Cognitive Behavioral Therapy, Psychodynamic Therapy, Eye Movement Desensitization and Reprocessing, Narrative Exposure Therapy and Stress Inoculation Therapy, take been used to treat children exposed to trauma. Individually, these therapies have varied levels of success in the treatment of CSA (Turner, 2019). This study assesses the impact of Art Therapy on both developed and child CSA victims.

Art Therapy (AT) is primarily used in relation with psychoanalytic theories to promote expression of self and healing, whilst pertaining to the client'south individuality and needs (Eaton et al., 2007). AT incorporates an assortment of media and techniques and is prominently used when an private struggles emotionally to articulate their feelings (Peterson et al., 1993).

The principles of AT, equally described by D. Waller (2006) are:

1. Visual creation of images is an integral aspect of the learning process;

2. The creation of art in conjunction with an fine art therapist can let for communication through a non-exact medium;

3. Art can "encapsulate" strong emotion;

4. Art can provide a communicative link between kid and therapist;

5. Fine art can exist used to highlight the shift of emotion from one person to another.

During the 1950s, American art therapist Edith Kramer wrote most her work with children and adolescents in Art Therapy in a Children'southward Community (Kramer, 1958). Kramer hypothesized that feelings of acrimony, aggression and other negative emotions could be contained within artwork and prevent these emotions beingness expressed physically (D. Waller, 2006). Therapeutic interventions commonly provided to support CSA victims can be split into two broad categories: talking therapies and artistic therapies (Allnock & Hynes, 2011). AT sits within the second group. In this review, nosotros define the "art" in "art" therapy as the production of visual design through a given medium (such as drawing, painting, sculpture or photography).

Method

A systematic search was conducted of the Cochrane Library, PubMed including Medline, Ovid, Eric and Google Scholar databases. Databases were selected based on known specialty and because they would facilitate comprehensive even so efficient coverage. The twelvemonth range of papers included in this study was from 1982 to 2019. Further manual searches were conducted in early 2021 prior to this article being submitted for publication, to ensure – equally far as possible – that the most recent papers coming together the criteria have been included.

We established the population equally "persons exposed to babyhood sexual abuse;" the intervention as "fine art therapy"; and the outcome to what the studies aimed to evidence. The search terms used were: [["creative arts" or "artistic fine art therapy" or "fine art" or "art intervention"] and ["childhood sexual abuse" or "sexual abuse"]]. Figure 1 illustrates a PRISMA flow diagram outlining our search.

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

Published online:

xv June 2021

Figure 1. PRISMA diagram of the inclusion and exclusion of studies in this review.

Effigy 1. PRISMA diagram of the inclusion and exclusion of studies in this review.

Defining sexual abuse (SA) with uniform criteria is challenging due to the lack of clarity equally to what corresponds to exist of a "sexual nature" and what is considered "abuse" (Burke-Draucker, 1992). Vaginal, anal, and oral intercourse that is either attempted or completed is typically considered to be SA. Genital contact of either the victim or the offender, including fondling of the breasts, buttocks, and/or thighs, kissing in a sexual nature (Burke-Draucker, 1992), and "rubbing and touching outside of wearable" is likewise considered SA (DfE, 2018). SA tin can also have a non-contact form where the perpetrator may elicit the victim to appoint in sexual activity past exposing their genitals to the victim (Wyatt & Peters, 1986); coercing the victim into exposing their genitals to the perpetrator, photographing or videoing the victim for sexual gratification or exploitation; or existence forced to watch sexual acts between other individuals (Burke-Draucker, 1992). SA tin also occur online (DfE, 2018). Nosotros divers childhood sexual abuse equally sexual abuse which takes whatsoever of the above forms and has taken place between a perpetrator and victim anile from 0 to 18 years one-time. Furthermore, we accept defined AT every bit traditional forms, such as drawing, painting, music and photography. Whereas play therapy, drama therapy, and writing therapy overlap with AT, these therapies are not exclusive to AT and thus were excluded from our search criteria.

Approach to reviewing studies

A thematic assay (Braun & Clarke, 2006) was performed on all articles in the final set (Mason, 2002). Tabular array A1, found in appendix ane, provides a summary of the reviewed studies. Coding was carried well-nigh past the first author and checked by the second. Throughout the analysis, disagreements or questions were discussed and interpretations were agreed between the authors (post-obit Hudon et al., 2012). Initial codes were consolidated into three chief themes: using AT every bit an investigative tool (due north = vi); using AT to address the psychological consequences of CSA (north = xv); using AT in conjunction with other interventions (northward = 3).

Results

The results are presented under the 3 master themes. In summary, they explore the extent of use of AT and its effectiveness.

Using AT to attain better long-term outcomes

Six publications, mainly qualitative, demonstrated the use of art in investigations by professionals (eastward.g., police or social worker) into CSA claims. These studies explored how particularly the use of drawing could create positive emotions during and after the investigative process, influence retention recollect, and provide show to determine whether a child has been sexually abused.

Katz et al. (2014) ran a controlled study investigating the perceptions of child victims in relation to a researcher interview exploring their CSA claim. The participants were anile 4–fourteen years old and the sample independent 31 boys and 94 girls. The cohorts were randomly placed in a cartoon intervention compared to a non-drawing, control group. After introduction, rapport edifice and interview phase in accordance with the National Establish of Child Health and Human Development (NICHD) protocol, the children in the intervention group were given 7–ten minutes to draw what had happened regarding the SA earlier the interview continued. The control grouping were given a seven–ten minute period of remainder or play. During the interview stage, both the intervention and control group highlighted a more positive experience (SD = 0.80) than negative (SD = 0.42). Mail interview, no overarching difference in positivity was constitute between intervention (SD = 0.fifty) and control (SD = 0.48). The results bear witness that including cartoon during a CSA investigation interview has positive effects though there was no overall benefit of drawing post-interview. However, we must be aware of limitations of the written report: large standard deviations in the results, familial background, and nature of the abuse for all children were not consistent, and the interviewer also conducted the study, which may skew the results as children may want to direct feelings expressed to what the interviewer desires as an outcome (Katz et al., 2014).

Ii further studies (Bhattacharyya et al., 2019; Poole & Dickinson, 2014) assessed whether the quality of testimony was influenced past drawing. Poole and Dickinson (2014) involved 219 children (83.9% of children were from the previous study sample, Poole and Dickinson (2011)) anile between five and 12 years old from the Midwest or New York Metropolitan region of Us. Participants were randomly assigned to a drawing intervention or a non-cartoon command group. The study concluded that during interview, condolement drawing did not touch on the retention of the event under question, the quality of information disclosed or the number of cues from interviewers. Bhattacharyya et al. (2019) establish that AT through drawing prior to giving a narrative account of the abuse they had been subjected to allowed the children a means to disclose detailed data. Even so, few children nether half dozen years old were included in either study, thus making inferences on how cartoon affects preschool and atypically developing children (Poole & Dickinson, 2014) is difficult.

A systematic review by Allen and Tussey (2012) aimed to sympathise if projective techniques such as drawings could help professionals make up one's mind whether children have been sexually driveling. The review found studies conducted in the tardily 1990s–2000s take mixed findings in supporting this hypothesis, compared to overall support for this technique in prior decades. Indicators employed to previously discover CSA included drawing of genitalia, the absence of hands, and failure to integrate the torso in drawings. Even so, when further investigated, the review found that the indicators listed did non e'er support the hypothesis, which was maybe due to methodological weaknesses, lack of replication and low reliability and validity of the studies (Allen & Tussey, 2012).

Individually assessing House-Tree-Person (H-T-P) drawings in CSA claims further supports the previous systematic review (Allen & Tussey, 2012) that drawings provide weak show in evaluating the history of CSA. H-T-P drawings aim to aid the clinician in gathering information on the "sensitivity, maturity, and integration of a discipline's personality" (Buck, 1948, p. 151) through drawing a house, tree and person. A controlled study (Palmer et al., 2000) assessed 47 sexually abused and 82 non-sexually abused children anile betwixt 4 and 17 years and constitute efficacy of H-T-P is limited. This is potentially due to discrepancy between inter-scorer reliability and lack of consideration of misreckoning variables such every bit civilization and race, parent's education, and previous artistic capabilities. Also, children selected for the comparative group, who were not sexually abused, had a church amalgamation that was called based on a "gross match in ethnicity, gender, and socioeconomic status demographics with that of the clinical sample" (Palmer et al., 2000, p. 171). However, the sample was non generalizable to the population largely due to the differences in the "structure and support they receive" (Palmer et al., 2000, p. 174).

Later, Cohen-Liebman and Cadet (1999) suggested that drawings tin be used to promote rapport between interviewer and child through feelings of "control and mastery", while providing a connector to elicit conversation well-nigh the alleged abuse. By considering the overall patterns of the artwork created, rather than private determinants (Palmer et al., 2000), such as H-T-P drawings, a trained art therapist may exist able to assess the level of evolution of the child while potentially extracting corruption-specific information.

Although the evidence is contradictory in supporting the hypothesis that art could be used to detect and improve the outlook of the investigative practice of CSA, these results propose benefits in using art for its therapeutic and psychological implications.

AT and psychological consequences of CSA

As discussed in the introduction, CSA can result in a range of psychological sequelae; 15 papers suggest that AT tin be used to bring do good to these victims by acting equally a psychotherapeutic tool (Read Johnson, 1987).

V studies (Visser & Du Plessis, 2015; Backos & Pagon, 1999; Carozza & Heirsteiner, 1982; Brooke, 1995; Pretorius & Pfeifer, 2010) used a grouping therapy called AT intervention that aimed to subtract psychological sequelae in CSA victims. Visser and Du Plessis (2015) and Pretorius & Pfeifer (2000) utilized this concept in South Africa. Visser and Du Plessis (2015) found that in comparison to pre- and postal service-, 10 weeks, the AT intervention "improved self-esteem and improved relationships," using the Rosenberg Cocky-Esteem Calibration (RSE) (Rosenberg, 1965) and the Interpersonal Closeness Scale as cess tools. Pretorius & Pfeifer (2000) found that depression and anxiety decreased in the experimental group after 8 weeks of AT, measured using the Briere Trauma Symptom Checklist for Children (TSCC) (Briere, 1995). Pretest mean score for low was 75, compared to a posttest score of 52.33, whereas anxiety had a mean pretest score of 2.5 compared to a posttest score of one.17. Interestingly, low self-esteem remained consistent across the intervention and nonintervention groups. All the same, the report encompassed several limitations; there were inadequate therapeutic resource available which may have hindered the expanse of creativity, a lack of trained professionals to lead the AT, social and economical barriers to receiving AT, pocket-sized sample size, forth with cess tools not being specific to the Due south African context, which may have skewed results (Pretorius & Pfeifer, 2000).

Both Backos and Pagon (1999) and Carozza and Heirsteiner (1982) used a instance study to demonstrate how they implemented AT with CSA victims in the USA. Both studies demonstrated that AT gave victims empowerment either by challenging family unit members on the corruption they had suffered or past reducing isolation through being in a group setting with other CSA victims. In a study working with xx female adult CSA victims, Brooke (1995) farther investigated self-esteem, pre- and post-AT intervention, compared to a command group, which did non receive AT. The results displayed that after AT the experimental group had a "t score" of one.77, which approached significance, in relation to gaining self-esteem.

Our review also identified a body of enquiry into how AT can relieve symptoms of dissociation resulting from CSA. In a case study, Hatlevig (2006) establish that cartoon could be used as an associative tool to prompt discussion into the narrative of a CSA claim. Furthermore, Hirakata (2009) investigated how dissociation could be treated with "creative writing, guided imagery and expressive art" in adult CSA victims using the Dissociative Experiences Scale (Carlson & Putnam, 1993), and a 2–3 60 minutes interview equally cess tools. Information technology was institute undertaking AT had positive impacts including reducing dissociation and assistance with expressing emotion, which survivors institute hard to limited verbally. Pifalo (2002) quantitatively investigated the link between AT and dissociation. The results displayed a statistically significant Fisher t-value for overt-dissociation (t = ii.50) when comparing pre- and post-, x-week, AT programs, forth with statistically pregnant Fisher t-values for reducing mail-traumatic stress and feet. When assessing dissociation in general and dissociation-fantasy, the results were not statistically significant, possibly limited by small sample size and all-female participants (Pifalo, 2002). Therefore, the results are not generalizable to gender.

O'Brien (2004) hypothesized that "mess" created past the child in AT may be connected to the CSA, by interim out the trauma suffered. The mess created may exist a way of expressing emotion to the therapist in response to anxiety and may act as a dissociative mechanism. Lev-Wiesel (2008) further commented that AT "can exist a container or organizer that mirrors internal object relations and their associated defenses," whilst Emunah (1990) hypothesized that AT may bridge the gap between imagination and reality, thus preventing dissociation by allowing the victim to imagine the future through a physical outlet.

In summary, AT appears to accept a positive affect in the treatment of psychological sequelae, particularly regarding dissociation and eliciting positive emotion. However, the studies must increase external validity to build on these findings.

Combining and comparing art therapy with other CSA interventions

The results of the systematic search flagged 3 studies combining or comparing AT with some other form of therapy in the treatment of CSA. In a follow-up study to Pifalo (2002), Pifalo (2006) extended her inquiry to explore whether Cognitive Behavior Therapy (CBT) combined with AT could reduce symptomology of PTSD in victims of CSA. Pifalo'southward study included xiii female victims of CSA aged between 8 and 17 years old and utilized the TSCC (Briere, 1995) equally an cess tool. Pifalo found statistically significant p-values betwixt pre- and posttest scores for nether-response, anxiety, depression, anger, postal service-traumatic stress, dissociation, dissociation-overt, sexual business organisation, sexual preoccupation, and sexual distress (Pifalo, 2006, p. 182). Thus, AT and CBT combined showed statistically significant results for seven more variables compared to AT lonely. Therefore, this casts dubiousness on whether AT has the potential to elicit greater effects when combined with CBT or that CBT is the driver backside the improvements and produces greater effects as a standalone therapy when treating CSA than AT.

In a study conducted by C. S. Waller (1992) with fifteen adult female incest survivors, group AT (which comprised drawing, painting and exact processing) was compared to both private psychotherapy sessions and group therapy in the treatment of CSA. Catharsis (significant release of emotions) and cohesion between grouping members of the AT intervention and insight into the corruption were assessed. The written report concluded that AT significantly improved the variables investigated in conjunction with the talking and individual therapies; however, AT equally a standalone therapy did not bear witness overwhelming improvements in comparison to the talking therapy and private therapy when each utilized as isolated therapies.

A further narrative publication by Pifalo (2007) assessed an intervention that combined CBT and AT to treat CSA victims. She believed that if the treatment outcomes of CBT were extracted, predominantly from the reduction of post-traumatic stress symptomatology, an AT model could be designed to achieve them. Pifalo discusses how AT tin bridge emotion and real life and how information technology can be used as another form of communication (as found in the studies discussed above) to make sense of the traumatic event. Pifalo (2007) suggests that AT tin can provide a coping tool for a child as well as "mapping the narrative" (p. 173) and "highlighting support" (p. 174). Notwithstanding, Pifalo'due south word in this 2007 paper is hypothetical and an experimental assessment is needed to validate these points.

Concluding from these results, AT shows no overall advantage when used every bit a single therapy. It is suggested from the studies that AT may be more impactful when used in combination with other therapeutic interventions such as CBT. However, it is possible that the methodological design in these studies may positively recognize CBT as a viable intervention and fail to recognize the value that AT holds.

Give-and-take

Regarding the utilize of AT in CSA investigations, Katz (2015) highlights the important residuum when interviewing children who have been sexually abused between coming together the legal requirement of an accurate and strong testimony from the child to enhance the investigation, and thereby to provide justice, yet as well maintaining the child'due south wellbeing. Katz et al. (2014) state that the investigation should empower victims and ensure that it does not exacerbate "the child's feelings of anxiety, stress, guilt and cocky-blame" (p. 859).

Whilst the results from the thematic analysis provide mixed evidence on the use of cartoon to benefit the legal weight of the child'south testimony, AT has been proven to enhance the therapeutic aspect of the investigation. For instance, in a model transferable to CSA victims, Pynoos and Eth (1986) proposed a iii-phase interview process that encourages cartoon to permit the therapist to assist the child in their trauma. The showtime phase involves projective drawing and storytelling to build rapport between therapist and client, which leads onto word of the trauma, followed by discussion of the sequelae for the victim. Each of the three steps incorporates drawing. Therefore, it may be better viewing art equally an accompaniment tool to build rapport between investigator and victim whilst drawing out abuse-specific information in the context of the child's development rather than focusing on using art equally an investigative tool (Reynolds et al., 2000). Drawing allows the child to brand sense of their outside earth and connects it with their emotional perception in a manner that is amended and governed by them (Longobardi et al., 2015). Thus, the power of AT may lie in its use as a complementary tool addressing the emotional needs of the kid or its use for a specific function in isolations, such as its furnishings on overt dissociation.

In relation to trauma, the limbic arrangement (hypothalamus, hippocampus, and amygdala) is important in relation to recovery from CSA due to its functioning in sensory memory (Malchiodi, 2003). Physiology and psychology are inextricably linked in trauma equally the ground of trauma is on the body; to overcome trauma therefore, sensory memory must be considered (Schore, 1994). As AT is a sensory modality, AT has the potential to exist advantageous as it accesses the limbic system'south sensory properties, in a way that verbal interventions cannot (Lusebrink, 2004). AT tin can target the body's mitigating response, reducing anxiety, and allowing individuals to experience relaxed with the therapist, stimulating verbal expression, and boosting retention retrieval (Gross & Haynes, 1998). These results provide further evidence of the positive effects constitute in the results section to AT.

Utilizing positron emission tomography (PET) and functional magnetic resonance imaging fMRI studies, Frewen and Lanius (2006) found that dissociation in traumatized children could be acquired by breaking of neural pathways that usually connect self-awareness to emotional perception of the trunk. Mollon (2001) hypothesized that trauma damages the right hemisphere of the brain, which unremarkably regulates emotion and understands social interaction. Furthermore, Van Der Kolk (1996) plant that during trauma the right hemisphere has a heightened response whilst the left hemisphere which encompasses Broca'due south area, responsible for language, is inactive. This highlights the need for an intervention that does not encompass speaking, such as AT. Tinnin (1990) and Gantt and Tinnin (2007) hypothesized that to recover from CSA, the right and left hemispheres must become "reconnected" in neural circuitry. This might exist accomplished past the formation of a narrative, stimulated through exact and not-verbal therapies such every bit AT, thereby restoring duality in the encephalon's hemispheres. Therefore, the role of AT in CSA cases is in stimulating verbal expression and preventing dissociation. Malchiodi (2003) considers that AT may be useful psychologically due to its links with explicit (facts, concepts, ideas) and implicit retention (senses, emotions, memory). Trauma causes disconnection between implicit and explicit memory, resulting in the context and the emotion surrounding the context becoming disjointed; this can be linked to a distorted perception of self (Malchiodi, 2003). However, AT may provide a narrative to explore and make sense of the retentivity, thus regaining a sense of self-actualization.

Evidence-Based Practice (EBP) is borne of the idea that clinical practice has relied on tradition rather than testify of efficacy (Chaffin & Friedrich, 2004). EBP in relation to child abuse is divers every bit "the competent and high-fidelity implementation of practices that have been demonstrated prophylactic and effective, usually in randomized controlled trials (RCTs)" (Chaffin & Friedrich, 2004, p. 1098). The UK government and other funding bodies are increasing the drive toward EBP, resulting in AT being in a compromising position, due to a lack of quantitative data used to support AT as a credible intervention. As AT relies on the unique bond created past the characteristics of the art therapist and the individual client and their specific experience of CSA, it is hard to see how AT could comply with the level of prescriptiveness required by an EBP approach (Chaffin & Friedrich, 2004). Presently, AT manuals are in being, for example, The Formal Element Art Therapy Scale (Gantt & Tabone, 2012) and Handbook of Fine art Therapy (Malchiodi, 2011). On one hand, these manuals provide a scaffolding for teaching and inquiry; on the other, they may restrain the therapist'southward inventiveness, practice style, and the essence of individuality which constitutes the handling style of AT (Cadet & Dent-Brown, 2014).

Trauma-focused CBT (TF-CBT) has been suggested (evidenced in the results section) to be the near constructive EBP in treating the sequelae of CSA. This has been further concluded when evaluating the show from randomized control trials (Chaffin & Friedrich, 2004). All the same, could this conclusion exist inaccurate equally other therapies have non been as widely and methodically researched in comparison? In measuring the effectiveness of AT in the treatment of traumatized children, Eaton et al. (2007) found that many studies investigating AT effects had weak methodological outline, failed to mention the specificity and content of AT, lacked experimental control, and held the conventionalities that qualitative results (which many AT studies are based on) are empirically unattainable. The common apply of instance studies to present findings of AT also ways that the results plant are not generalizable to the population: they are exclusive to that participant. Even so, information technology could also exist argued that using these qualitative case studies allows researchers to give context to the victim's testimony and to provide a richer and more than nuanced evidence base for CSA in comparison to quantitative results (Eaton et al., 2007).

Conclusion

This thematic assay and discussion of the employ of AT in working with CSA victims suggests that interventions are generally positive. Inferring from the studies, AT has a role in establishing a positive therapeutic relationship between client and therapist, relieving some psychological symptoms of sexual corruption, peculiarly postal service-traumatic stress, anxiety, overt-dissociation, and improving self-esteem (Cornman, 1997; Pifalo, 2002; Pretorius & Pfeifer, 2010; Visser & Du Plessis, 2015).

When utilizing art in CSA investigative practices, drawing has a limited place in the process of determining whether the child has been sexually driveling or not; it has been shown that its strengths lie within helping the child to produce a narrative and developing a rapport with the investigator when being interviewed (Cohen-Liebman & Buck, 1999). Thus, ATs ability prevarication within the psychosocial context. It is justified to say that past studies researching AT have somewhat lacked methodological clarity with respect to qualitative and quantitative findings. Improving methodological clarity has been suggested to improve the efficacy of AT (Eaton et al., 2007). AT could have a firm place in effective therapeutic do in CSA cases. This could be enabled by providing a template of AT interventions where there is prove of effectiveness, which is in turn tailored to the needs and strengths of the individual and therapist.

Author (year)	Sample	Study Blueprint	AT Outcomes	Assessment Tools	Relevant Findings	Mediating Factors
Visser and Du Plessis (2015)	6 female CSA victims aged 13–18 years	Descriptive Study	Developing positive self-esteem and positive relationships with others	Group process notes, pre-and mail-intervention individual interviews, pre- and post- intervention quantitative scales	'trust, commitment, self-disclosure and empathy unfolded.' 'improved self-esteem, improved relationships, value of group intervention for participants.'	Limited resources and lack of trained professionals to conduct out AT; social and economic barriers; pocket-sized sample sizes; researcher was a co-facilitator and interviewer
Katz et al. (2014)	31 boys and 94 girls, aged four–14 years, who had been sexually abused by someone other than a family fellow member	Experimental Written report	To understand if drawing throughout investigative interview for CSA improved the overall experience for the children	Qualitatively assessed how children felt earlier, during and afterward they were investigated for CSA co-ordinate to NICHD protocol	Increased positive phrasing used to depict the drawing intervention, compared to the non-cartoon group	Interviewer for the investigation was the same person who conducted the written report
Poole and Dickinson (2014)	219 children aged 5–12 years old who had been sexually driveling	Experimental Study	To empathize if 'comfort drawing' throughout the investigative procedure of CSA improved experience	Behavioral Inhibition Questionnaire for parents of younger children and children with inhibited temperament. Qualitative assessment of older children.	'Condolement drawing' did not significantly decrease or increase 'the corporeality of data they recalled, the accuracy of their answers, or even the extent to which interviewers needed to prompt for answers.'	Few children under half-dozen years erstwhile
Hirakata (2009)	1 male person and 6 females, anile 34–53 years who were sexually abused as children, engaged in some form of therapy from the point in fourth dimension of sexual abuse to when the study was conducted and who demonstrated a middle to high range of dissociative behavior measured by the Dissociative Experiences Calibration	Descriptive Study	N/A	Dissociative Experiences Scale (Carlson & Putnam, 1993)	Undertaking AT allowed the victims to 'remain nowadays and expand the therapeutic window of tolerance,' 'express the inexpressible' and 'give vocalization to those parts of themselves that lacked verbal language.'	Pocket-sized number of participants
Hatlevig (2006)	5 female children aged 6–xiii years interviewed within 3 years of being sexually driveling	Descriptive Written report	Northward/A	Qualified art therapist used to interpret the drawings	Drawing can be used as an associative tool and a prompt when verbal advice breaks down. An 'contradistinct perception of self and a less developed apply of symbols' was found in the children who were sexually driveling.	All female participant and a small sample size
Cornman (1997)	11 children anile 12–17 years who were sexually abused and 11 adolescents who were not sexually abused. Participants were from Seattle, Us	Analytical study	How projective drawings can be used to assess emotional disorders and somatic complaints	Interview questions, self-report questionnaires and projective drawings	The subjects who were sexually abused had higher levels of feet, muscle tension and cognitive disorganization	Modest sample size; all female person participant; participant were all from Seattle
Allen and Tussey (2012)	Varying sample sizes of children who have been sexually driveling based on a collation of studies	Literature Review	The utilise and cess of children's drawings to identify if they take been sexually abused	No specific graphic assessment tool identified	Possibly the cartoon of genitalia, sexually related features, body parts/organisation, less ambiguous gender and use of faint lines are signs of corruption	Lack of consistency of estimation of drawings; quality of studies varied
Palmer et al. (2000)	47 sexually abused children and 82 not-sexually abused children, aged between 4–17 years	Controlled Study	How House-Tree-Person drawings tin can exist used to psychologically assess children who have been sexually abused, compared to those that accept not been	Firm-Tree-Person drawings and questionnaires	Weak evidence that House-Tree-Person drawings tin be used to evaluate the history of CSA and in that location may be more use of identifying 'interrelated patterns of features across drawings' rather than 'individual sign'	Interrater reliability was not standardized; confounding variables of culture and race, parents level of education and 'previous creative education'; children selected for the study had a church affiliation
Pifalo (2002)	xiii female children who were sexually abused aged 8–17 years old	Descriptive Report	To provide evidence that supports AT as an constructive handling of sexually driveling children to reduce astute and long-term effects	Briere Trauma Symptom Checklist for Children conducted before and after the group AT intervention	At that place was 'reduced anxiety, posttraumatic stress, and dissociative symptomatology scores' later on the art intervention in comparison to the scores registered before the intervention took place. There was also a decrease in 'depression, acrimony and sexual concerns.'	Small sample size; participant were all female person
Pifalo (2006)	This is a follow-up study to the study above, thus uses the same participant	Extended research, follow upwardly report to the report detailed above	If CBT combined with AT could reduce symptomology of PTSD in victims of CSA	Trauma Symptom Checklist for Children before and after the intervention was conducted	The results suggested that CBT and AT combined could be beneficial for reducing symptoms of PTSD for victims of CSA	Modest sample size; participant were all female
Pifalo (2007)	North/A	Narrative review	A review that assesses a handling intervention that utilizes CBT and AT in CSA victims	North/A	AT: 'accomplishes goals of TF-CBT,' 'aids touch on,' 'speeds melancholia processing,' 'facilitates coping skills,' 'maps trauma narrative,' and 'highlights support.'	No evidence as this commodity was non a study
Backos and Pagon (1999)	three females aged xiii–17 years who were victims of CSA	Descriptive Written report	N/A	Pre-intervention interview	A number of themes emerges from undertaking the AT intervention: 'anger,' 'looking alee,' 'beginning to heal,' 'empowerment and healing'	Small sample group; no control group
Eaton et al. (2007)	CSA victims anile between 4–18 years one-time	Literature review	A measurement of the efficacy of AT interventions on the psychological consequences of traumatized children	Diagnostic and Statistical Manual of Mental Disorders (used to diagnose PTSD)	AT may be near successful when used with the youngest victims of trauma and AT is effective in treating negative psychosocial consequences of childhood trauma	Small-scale sample size; lack of control group; some studies did not specify the AT intervention
Bhattacharyya et al. (2019)	6 males and nine females aged 12–16 years old who experienced childhood abuse, including CSA, and fail	Descriptive Study	The study explores 'thoughts, feelings, and how therapeutic interventions through narratives and drawings encourage disclosure'	Juvenile Victimization Questionnaire, Descriptive-Phenomenological- Psychological Perspective	Fine art therapy through drawing, prior to giving a narrative account of the abuse they had been subjected to, allowed the children a means to disclose detailed information	'no comparison between the quality and quantity of preintervention and postintervention narratives'; Small sample sixe
O'Brien (2004)	1 female person, aged 7 years old, subjected to trauma including CSA	Descriptive study	Hypothesis: 'Artwork created during Art therapy may activate neurological structures of the brain enabling non-verbal early feel to become known.'	N/A	'mess' while undertaking AT could be used equally a dissociative mechanism in response to anxiety and connected to early on traumatic relationship experiences;	Small sample size; no follow up written report
Gantt & Tinnin (2009)	Northward/A	Descriptive study	AT could help alleviate mail service-traumatic stress symptoms	Imaging	AT can let the victim of trauma, including CSA, to develop a sequenced narrative that can exist non-verbal and allows the expression of thoughts and feelings through another medium; more cost effective than traditional psychotherapy as an intervention	N/A
Carozza and Heirsteiner (1982)	36 females, aged ix–17 years one-time who had been subjected to CSA	Descriptive study	The study was used to assess if AT could result in a reduction of isolation and anxiety and to model new behaviors and skills to increase self-esteem	N/A	'an increment in figure size of persons; add-on of a body in posttests by girls who initially drew a floating head to correspond a person, greater differentiation between male person and female figures; fewer erasures, decreased pencil pressure, and improved quality of lines; less accent on clothing to conceal the body; more fundamental placement of figures on the page; and more than realistic representation of self'	No control group; small sample size; no follow-upwards study
Lev-Wiesel (2008)	Numerous studies with varying participant characteristics	Literature Review	An cess of the part of AT in alleviating symptoms of dissociation later CSA	Encounter individual studies for specific assessment tools	AT tin can be used in helping alleviate the symptoms of dissociation after being subjected to CSA	No follow up study
Reynolds et al. (2000)	Diverse participant characteristics based on the individual studies	Literature Review	Effectiveness of AT	Individual assessment tools based on the individual studies	The literature review constitute that AT is normally effective just does non prove overarching effectiveness compared to other traditional interventions; many studies combine AT with other interventions, making it difficult to show the true effect and benefit of AT lonely	Validity and heterogeneity issues incorporating age, gender, demographic groundwork, number of therapy sessions, length of therapy sessions, differences in sample sizes
Pretorius and Pfeifer (2010)	25 females aged viii–11 years quondam, who have been sexually driveling	'Quasi-experimental blueprint with not-equivalent groups'	How constructive AT is in alleviating depression, anxiety sexual trauma and low self-esteem	Solomon four-group design, Trauma Symptom checklist for Children	Experimental groups that involved AT had vast improvement compared to control groups in relation to anxiety and depression	Small sample size; nonrandom assignment of participants; groups are non-equivalent
Cohen-Liebman and Cadet (1999)	Due north/A	Review article	The evaluation of cartoon into the interview process of CSA	Northward/A	It was ended that drawings are beneficial to the therapeutic outlook and investigative measures of CSA, just should non exist solely relied upon and should be interpreted past trained professionals	N/A
Read Johnson (1987)	N/A	Review article	Understanding and evaluating how AT can be used as a treatment when working with victims of trauma, including CSA	N/A	AT has the potential to be a useful diagnostic and psychotherapeutic tool when used in patients with trauma	N/A
Emunah (1990)	N/A	Review article	How AT tin can provide 'explosion, expression, containment and expansion' to victims of CSA	N/A	There is heightened creativity in adolescence and AT tin can provide a physical outlet of emotion and allows the victim to imagine the future through a physical outlet of making art whilst bridging a gap between imagination and reality	Due north/A
Brooke (1995)	Treatment group (fine art intervention): 6 women aged between 26–40 years old. Command group; 5 women aged between 26–64 years.	Controlled report	If AT improves self-esteem in CSA victims	Inventories	The ii groups had significantly dissimilar levels of self-esteem before the AT intervention. No statistically significant issue was constitute betwixt the AT intervention and general and social self-esteem categories	Small study sample; no follow-upward study

clarkpriariver.blogspot.com

Source: https://www.tandfonline.com/doi/full/10.1080/10538712.2021.1918308

Share this post