POSSIBILITIES OF ART THERAPY IN THE CORRECTION OF PSYCHOSOMATIC DISORDERS IN CHILDREN

POSSIBILITIES OF ART THERAPY IN THE CORRECTION OF PSYCHOSOMATIC DISORDERS IN CHILDREN

Authors: A.I. SMIYAN, N.A. SAVELYEVA-KULIK, Medical Institute of Sumy State University

The problem of psychosomatic health is a significant part of the diseases of civilization and over the past decades has been the object of intensive research in the framework of the so-called psychosomatic medicine.

Recently, the frequency of psychosomatic pathology in the structure of general morbidity has increased so much that some researchers have begun to call modern society “psychosomatically oriented”[13] . So, according to B.V. Mikhailov, the prevalence of borderline pathological psycho-emotional states in Ukraine ranges from 15 to 40%.

In the age of increasing information flow, reduced physical activity, exposure to adverse environmental factors, it becomes relevant to consider the issues of mental and somatic health in the unity of their influence on each other. The term “psychosomatics” was proposed by J. Heinroth in 1818, and the phrase “psychosomatic medicine” was proposed by F. Deutsch in 1922 [4, 13]. Today, psychosomatic disorders are primarily understood as somatic diseases, in the etiology of which, at least in some patients, psychological processes play a significant role. These “classic” psychosomatic diseases, according to the new classification criteria, are diagnosed as organic diseases. Psychological processes are given significant importance in the occurrence and maintenance of these diseases. The latter emphasizes the unity of the biological and socio-psychological mechanisms of “soma” and “psyche” in the origin of both psychopathological and somatic disorders. Along with this, the share of somatovegetative and neurological components in the structure of neuroses has recently been rapidly increasing, and, accordingly, the manifestations of mental symptoms proper are decreasing [9].

Associated with the concept of “somatization”, as a rule, is the notion that overloads associated with psychosocial and emotional problems manifest themselves primarily in the form of somatic symptoms. Although the patient usually focuses on only a few symptoms, the anamnesis often reveals numerous other physical disorders.

In the population of children and adolescents, the prevalence of diseases with complex interrelated mental and somatic manifestations is also significant and has a steady upward trend. Up to 40% of children observed by pediatricians do not have diagnostically verified diseases, although they present with many somatic complaints [7]. Classifying individual types among the pathology proposed for consideration, there are psychosomatic (functional stages of somatic suffering caused by psychosocial stress), somatoform (somatic masks of mental illness) and somatopsychic (diseases of internal organs complicated by mental disorders and increased fixation on unpleasant bodily sensations) diseases [ 7, 11]. According to modern views, the development of such conditions is associated with the presence of autonomic dysfunction (AD) in the body, reflecting mainly the psycho-emotional status [3]. However, despite the world practice standards of rehabilitation of adolescents with IA by psychologists, psychotherapists, psychiatrists, in Ukraine it is vegetative dysfunctions that determine the majority of non-communicable diseases of children and adolescents in the work of a pediatrician [1, 3].

Therapy and rehabilitation of children and adolescents with psychosomatic disorders combines a wide range of therapeutic and preventive measures that require the participation of not only internists, but also psychotherapists and psychiatrists. So, psychotherapy is considered the basic direction in the treatment of this pathology.

Among the various methods of correcting emotional and personality disorders in children, along with traditional psychotherapeutic methods (rational therapy, autogenic training, hypnotherapy, group, analytical, behavioral, positive, client-centered therapy), such as game therapy, fairy tale therapy, art -therapy (AT).

AT is an interdisciplinary approach that combines various fields of knowledge – psychology, medicine, pedagogy, cultural studies and others. The word “art therapy” (art therapy) was first used in the 1940s. in English-speaking countries by such authors as M. Naumburg (Naumburg, 1947) and A. Hill (Hill, 1945), to refer to those forms of clinical practice in which the psychological “accompaniment” of patients with emotional, mental and physical disorders was carried out during their involvement in fine arts for the purpose of treatment and rehabilitation [6].

Most authors who use the concept of “art therapy” follow the definition accepted in the international literature and consider it as one of the forms of psychotherapeutic practice based on the use of visual, plastic means of self-expression by patients in the context of psychotherapeutic relationships [2, 6, 12]. However, this point of view is probably not completely exhaustive and correct, since only one of its types (painting) is unreasonably identified with the concept of “art”, thereby limiting the understanding of the essence of therapy to art, and therefore creativity as such.

Some researchers in their publications identify AT with “expressive arts psychotherapy” or “art psychotherapy” (expressive arts therapies, creative therapy), linking it with the use of various forms of creative self-expression in order to achieve therapeutic, corrective and developmental effects [8]. Note that the term “creativity therapy” (creative therapy) emphasizes the vastness and diversity of the arts used in corrective treatment, and, therefore, is more adequate to refer to the essence of a particular type of psychotherapy.

Thus, from these positions, art therapy uses a wide variety of creative activities of the patient to help him in solving psychological problems. In this case, any creative activity of a person falls under the concept of art: dance, music, painting, cinema, sculpture, architecture, etc. Therapy is based on both creation and perception of works of art. The mechanisms of physiological and aesthetic perception are involved. AT is one of the methods of psychological work that uses the possibilities of art to achieve positive changes in the intellectual, emotional and personal development of a person. Everyone is able to express himself, his feelings and his condition with a melody, sound, movement, drawing. But for some, this is the only way to let the world know about you, to declare yourself as a creative person. To provide such an opportunity to all those in need is the task of AT. Among the variety of modern psychotherapeutic methods, AT is distinguished by its special “softness”. Role functions are distributed here between the patient and the specialist in a completely different way than in most orthodox, verbal psychotherapeutic approaches: the patient is given the maximum degree of freedom, in many cases he turns out to be the “leader” of the art therapy process, expressing himself in those styles and those forms that meet his condition, personality traits and needs. By its nature, AT in most cases is non-directive, which emphasizes the advantages of using it in pediatric practice.[12] .

One of the types of AT used in working with children and adolescents is music therapy (MT). MT is a psychotherapeutic method of using music, based on scientific achievements in the field of musical and therapeutic acoustics. There are four main areas of therapeutic action of MT: emotional activation during verbal psychotherapy, development of interpersonal communication skills (communicative functions and abilities), regulatory influence on psycho-vegetative processes, increase in aesthetic needs. Catharsis, emotional release, regulation of the emotional state, facilitating awareness of one’s own experiences, confrontation with life problems, increased social activity, acquisition of new means of emotional expression, facilitating the formation of new relationships and attitudes are indicated as mechanisms of the therapeutic action of MT.

There are passive (receptive) and active forms of MT. Receptive MT involves the process of perceiving music with a therapeutic purpose and exists in three forms: communicative (joint listening to music aimed at maintaining mutual contacts, mutual understanding and trust), reactive (aimed at achieving catharsis) and regulative (helping to reduce neuropsychic stress). As part of the anti-stress program, it is recommended to use both forms of MT, but receptive MT is more often used. The group members listen to specially selected pieces of music, and then discuss their own experiences, memories, thoughts, associations, fantasies that arise during their listening. In one lesson, as a rule, they listen to three works or completed excerpts (each for 10-15 minutes). Programs of musical works are built on the basis of a gradual change in mood, dynamics and tempo, taking into account their different emotional load. The goal in this case is a certain emotional, including aesthetic, experience, which should contribute to the response of certain intrapersonal conflicts and the achievement of new meanings of consciousness. As means to promote MT, additional techniques are often used, such as breathing exercises, auto-training, hypnosis, painting or dance. The choice of certain musical works can be carried out on the basis of different criteria. For example, in the so-called American school, passages are offered that evoke a very wide range of emotional states (joy, sadness, sympathy, etc.); in the Swedish school based on depth analysis, the presentation of music is specially individualized to respond to certain hidden complexes.

Active music therapy is a therapeutically directed, active musical activity: reproduction, fantasizing, improvisation with the help of a human voice and selected musical instruments. The use of this variant of MT requires the presence of the simplest musical instruments. Group members are invited to express their feelings or have a dialogue with one of the group members using selected musical instruments. Choral singing can be considered as a variant of active MT. In pediatric practice, music therapy is most effective when working with children suffering from various forms of autism, in the rehabilitation of newborns with perinatal lesions of the nervous system. Of particular interest is the use of the method in pediatric psychosomatics.[14–17] . It should be noted a wide range in the field of application of MT: the development of communication skills, creativity and thinking, aesthetic needs and the ability to relax, correction and development of the emotional sphere, modulation of functional systems[14] .

Thus, various types of AT in general and MT in particular are based on the mobilization of creative potential, which meets the fundamental human need for self-actualization – revealing the full range of one’s capabilities and asserting one’s own way of being in the world. In combination with the absence of a hard directive beginning and the “soft” influence of this type of psychotherapy, AT allows you to bypass the “censorship of consciousness”, makes it possible to express the most important thoughts and experiences, understand their source and meaning, and realize the content of your own inner world. This makes it promising to use creativity therapy in the rehabilitation of psychosomatic disorders in children and adolescents.

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