PSYCHIATRIC PATIENT EXPERIENCES WITH ART IN RECOVERY

Exploring Patient Perceptions Regarding the Therapeutic Use of Art
in Mental Health Recovery

Jillian M. Thomas RN, BScN, CPMHN(C), MPN(c)
Student #
Brandon University
Faculty of Health Studies
Master of Psychiatric Nursing

Thesis Advisor: Dr. Jane Karpa RPN, PhD
Karpaj@brandonu.ca
Thesis Committee Members:
Professor Debra Dusome RN, MA, Ex.AT,
Dr. Kendra Rieger RN, PhD

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Abstract
The advantages and potential use for creative therapies in healthcare are innumerable and
clearly established in both the literature and consumer accounts. Therapeutic art practices have
clearly demonstrated benefits to health and well-being through relaxation, improved stress
management and coping, social inclusion, recovery, personal growth, self-expression and the
potential for alleviating distressing physical, emotional, and psychological symptoms. Despite
strong support for the use of art therapy in healthcare by many professionals and members of the
public, there has been much criticism of the intervention due to claims of insufficient evidencebase and debates regarding research practices. There is also a distinct research gap in which
service users are rarely consulted regarding their perspectives on the use of art-based
interventions in their own mental healthcare. The purpose of this research was to explore how
psychiatric patients experience the use of therapeutic art in their psychiatric treatment, and their
perception of its impact on their own mental health recovery. Focusing on the experience of art
therapy from the viewpoint of adult psychiatric patients allowed the researcher an insider view to
a better understanding of perceived benefits of participating creative therapies. Using Interpretive
Description methods, and informed by the Recovery Oriented Model of Care, the researcher
gained key insights on how current techniques and patient experiences benefit clients and their
communities including improved communication, self-regulation, and enhanced intrapersonal
and interpersonal relationships. Gaining insight from clients directly has resulted in enhanced
understanding, awareness and possible actionable interventions for clinical, educational and
community settings to enrich future practice, contributing unique and unheard participant
perspectives noticeably scarce in the current literature on the subject.

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Acknowledgements
“A man who works with his hands is a laborer; a man who works with his hands and his brain is
a craftsman; but a man who works with his hands and his brain and his heart is an artist.”
Unknown
I have always wanted to make a positive impact on the lives of others and was inspired to
become involved in art and healthcare at an early age. I truly believe creativity and community
service has greatly enriched my life and has inadvertently helped me to maintain my own health
and wellness. When choosing my thesis topic, I wanted to focus my study on a combination of
my passions: art, education, and nursing. My goal was to learn about how the use of arts-based
therapies impact recovery to expand its use in wider practice, in hopes to help others in their
artistic and holistic health paths, while offering a small contribution to related literature. As this
study was my first experience as a lead investigator, all aspects of the process were brand new
and a rich learning opportunity for me…from the initial literature review to drafting my study,
navigating ethics approvals, recruitment, interviews, analysis, and everything that comes with
this type of project, I have learned that collaboration is essential! I am so fortunate to have so
many supportive people around me, whether it be faculty mentors, fellow students, colleagues,
family and friends (or ‘friends of friends’) willing to help! While It feels like an impossible task
to acknowledge all of the people who supported me throughout this project, there are several
people that have been instrumental in helping me to achieve this challenging and rewarding goal:
First and foremost, my husband; Clayton. Thank you for everything you do and have done for
me. I am lucky to have you in my life. Your love and support mean the world to me. I love you!
My thesis advisor/mentor; Jane, for generously sharing your valuable time, knowledge, and
guidance with me throughout every step of this program. I couldn’t have done it without you!
My thesis committee members; Kendra and Debra, for your thoughtful suggestions, helpful
resources, and constructive feedback. Your unique insights are greatly appreciated, thank you!
Brandon University, Faculty, Staff, my fellow classmates, and the entire campus community
for making me feel so welcome during my time in the program. Your hospitality is unmatched!
Hospital Staff and Leadership at my worksite, past and present, especially Central and
Support Services, Clinical Nurse Educators, Nursing, and Allied Health and Patient Experience.
My family and friends, for their love and encouragement, especially my parents who
engrained in me the value of education and hard work, and who endured many sacrifices and
challenges to provide as many opportunities as possible for my sisters and I.
Last but not least, my sincerest appreciation to the eleven participants who agreed to take part
in this study. Being able to meet and discuss your most personal experiences with art and your
recovery journey have been an immensely meaningful, inspirational, and humbling experience.
“Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a
preparation as any painter's or sculptor's work; for what is the having to do with dead canvas or
dead marble, compared with having to do with the living, the temple of God's spirit? It is one of
the Fine Arts: I had almost said, the finest of Fine Arts.”
-Florence Nightingale
“The more I think it over, the more I feel that there is nothing more truly artistic than to love
people.” -Vincent Van Gogh

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Table of Contents
Abstract

2

Acknowledgments

3

Table of Contents

4

Chapter 1: Introduction

6

Research Problem
Purpose
Recovery Oriented Care (ROC) Conceptual Framework
Chapter 2: Literature Review
Traditional Treatment Methods in Psychiatry and Mental Health
Complementary/Integrative Treatment Methods in Psychiatry and Mental Health
Arts-based Treatment Methods in Healthcare
Arts-based Treatment Methods in Psychiatry and Mental Health
Art-based Treatments to Promote Therapeutic Environments and Recovery
Arts-based Practitioner Perspectives
Arts-based Service User Perspectives
Chapter 3: Research Design
Interpretive Description: A Qualitative Research Methodology
Historical Contexts
Relevance in Nursing Practice and Research
Methodology Selection
Research Design
Researcher’s Positionality and Role
Inclusion and Exclusion Criteria
Recruitment
Participant Selection
Data Generation and Treatment
Data Analysis
Ethical Considerations
Chapter 4: Findings
Description of Participant Characteristics
Themes
Theme 1: Enhanced Connection with Self Through Artistic Practices
(Intrapersonal)
1: Holistic Health and Wellbeing

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35
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1.a: Mental Health
1.b: Physical Health
1.c: Emotional Health
1.d: Spiritual/Cultural Health
Theme 2: Enhanced Connection with Others Through Artistic Practices
(Interpersonal)
2: Relationships
2.a: Social Health
Theme 3: Enhanced Connection with Environment Through Artistic
Practices (Setting)
3: Setting
3.a: Physical Setting
3.b: Psychosocial Setting
Chapter 5: Discussion
Holistic
Self-Direction
Individualized and Person-Centered
Empowerment
Non-Linear
Strengths-Based
Peer-Support
Respect
Responsibility
Hope
Strengths and Limitations
Implications for Clinical, Educational, and Administrative Practice
Recommendations for Education and Further Research

41
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References

85

Appendices

94

Appendix A: Letter of Invitation and Art Group Presentation Script
Appendix B: Recruitment Poster
Appendix C: Participant Information and Informed Consent Form
Appendix D: Interview Introduction, Script, and Question Guide
Appendix E: Supportive Services Resource List
Appendix F: The Tri-Council Policy Statement Certificate

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Chapter 1: Introduction
There is much acclaim by healthcare professionals and the public to support the use of
complementary therapies, such as art and expressive art therapy, to promote holistic health
(Farokhi, 2011; Hoenders et al., 2011; Kessler et al., 2001; Kuhlman, 2002; Schulz et al., 2018;
Sharma et al., 2013; Simon et al., 2004; Unutzer et al., 2000; Van Lith, 2016; Van Lith et al.,
2011). Art therapy (AT) is a form of psychotherapy related to the process of making images
within the context of a psychotherapeutic relationship and has been effectively utilized for
treatment of patients and service users with a broad spectrum of physical and psychiatric
disorders (Korlin et al., 2000; Richardson et al., 2007; Wright et al., 2017). AT “involves
painting, clay work, and other creative visual art-making…as a form of non-verbal expression, in
conjunction with other modes of communication within a therapeutic relationship in an
appropriate therapeutic setting” (Scope et al., 2017, p. 26) typically facilitated by a trained art
therapist. Art therapy is a specific type of treatment that falls under the umbrella terms “art
therapies” or “creative therapies” which also includes music and drama therapy. Expressive art
therapy is a newer form of art therapy that uses various modalities such as music, poetry,
painting, among others, and supports the belief that artistic expression itself has healing powers
(Hanevik et al., 2013)
The term “art-based therapies”, “art-based treatments” or “therapeutic use of art” will be
used to describe the aforementioned therapies inclusively. The intent of this study was to explore
participants’ perceptions of the impact of engaging in therapeutic art groups using a wide range
of structured and unstructured visual arts approaches (such as drawing and painting with various
media) that could be adapted and applied to treatment according to perceived needs, training, and
experience to promote mental health recovery.

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AT has demonstrated the capacity to contribute to one’s wellbeing and quality of life
(Sandak et al., 2015). Despite numerous affirmations from various sources supporting the use of
art-based therapies as an effective treatment for a variety of diverse needs (Korlin et al. 2000;
Wright et al., 2017), the non-pharmacologic and psychosocial effects are not well understood
(Sandak et al., 2015). As patients and other healthcare consumers are increasingly turning to
non-traditional adjunct therapies for relief of diverse symptoms when not adequately treated by
conventional means, a need for additional comprehensive and rigorous qualitative research on
complementary therapies such as art practices used in healthcare is essential (Feldman, et al.,
2014; Murray, et al.,2017).
Research Problem
There is a wealth of information available on the topic of art-based treatments in mental
health care, and advantages of art therapy as a treatment modality are well documented in
professional literature (Saunders et al., 2000). However, the acceptance and application of artbased therapies in mental health services has been hindered by debates related to relevant
research practices and claims of inadequate evidence (Feldman, et al., 2014; Hanevik et al.,
2013; Murray, et al., 2017; Van Lith, 2016; Van Lith et al., 2013). Despite a growing amount of
research indicating the usefulness of creative therapies for a broad spectrum of psychiatric
disorders (Körlin et al., 2000), almost all academic articles regarding AT indicate the need for
additional comprehensive and rigorous research in the field to quantify therapeutic value.
Furthermore, very few studies are available examining the impact of art-based interventions on
mental health recovery from a patient’s perspective. Despite this scarcity of literature from
patients’ viewpoints, it has been acknowledged that promoting the use of art-based interventions

8
in mental health treatment could produce positive implications for individual participants’ mental
health recovery, in addition to unit, family, facility/organizational, and professional contexts.
Purpose
The purpose of this research was to explore how psychiatric patients experience the use
of therapeutic art in their psychiatric treatment, and their perception of its impact on their own
mental health recovery. This Interpretive Description research study aimed to address the
research question: “What are the experiences and perceptions of psychiatric patients engaging in
arts-based treatment for mental health recovery?” with the intention of identifying and enhancing
current and future opportunities to support and maintain optimal mental health. Following all
ethical guidelines to ensure respect and protection of participants’ human rights, this study
explored the experiences and perceptions of adult psychiatric patients who have participated in
art therapy, expressive art therapy, or a comparable intervention, as a treatment modality. Using
Interpretive Description methodology, the researcher asked adult mental health service users to
describe the impact of art-based interventions on their own mental health recovery.
Asking service users how engaging in art-based practices has impacted their mental
health recovery from their own point of view gives a rarely consulted and often vulnerable group
of individuals a voice, and an opportunity to have say in their own treatment (Van Lith et al.,
2011). Client ability to express their views and preferences on art-based treatment may facilitate
better recognition, insight and understanding of population needs by healthcare professionals,
resulting in enhanced programming and responsiveness (Lloyd et al, 2007; Scope et al., 2017).
Cultivating more responsive, empathetic, and engaged healthcare professionals has many
benefits including improved ability to develop stronger therapeutic alliances and collaboration
with clients, families, and inter-professionally, leading to increased job and service satisfaction

9
for service providers and service users, respectively (Scope et al., 2017). Findings from this
study may inspire mental health professionals to recognize the importance of developing and
facilitating creativity in their own practices, which may result in the development of enriched
educational and professional resources necessary to deliver high quality mental health care.
Enhanced resources will likely result in more effective assessment, application,
management, and evaluation of alternative complimentary and integrative healthcare practices
culminating in more efficient and effective treatment options and personalized strategies which
support ongoing holistic health (Scope et al., 2017). “Future strategies within mental health
services could further integrate these aspects of art making into their practices, which could help
to enhance the discovery of meaning, purpose and hope during the recovery process” in the lives
of many service-users (Van Lith 2014, p. 19).
Recovery Oriented Care (ROC) Conceptual Framework
Art-based practices show promise as a beneficial solution for mental health services
because they are in line with the Recovery Framework currently adopted in psychiatric practice
and experiencing high consumer acceptability. Research is increasingly exploring the role of
participation in meaningful activities in the promotion of mental health recovery (Van Lith et al.,
2011). The term “recovery” focuses on the challenging process of personal growth; the journey
towards wellness through over-coming obstacles such as symptoms, disability, and the stigma of
mental illness, and finding ways to lead a fulfilling and contributing life (Deegan, 1988; Van
Lith, 2016; Van Lith et al., 2011; Van Lith et al., 2012).
People with lived mental health experience have found recovery to be a subjective and
individualized process (Lloyd et al., 2007). Recovery is a fluid practice of continual change in
which individuals strive to improve their health and wellness, live a self-directed life, and reach

10
their full potential. Recovery is an ongoing and dynamic process that is unique to the individual’s
strengths, culture, gender, personal qualities, and experiences which can encompass prevention,
intervention, treatment, harm reduction, monitoring, and long-term recovery maintenance. There
is no one pathway to recovery that works for all; recovery is highly personalized (CCSA, 2017,
SAMSHA; Concurrent Capable Education Session Sept 25, 2020). Unlike the biomedical
definition of recovery, mental health recovery is not a predictable or medically mediated
prognosis, rather an emergence of an evolved identity through self-discovery (Deegan, 2001;
Lloyd et al., 2007;).
The Mental Health Commission of Canada (MHCC) describes recovery as a shift in
perception from patients being passive recipients of care to patients actively engaging in their
own health care journey (2009). Embracing the “whole person approach” driven by the World
Health Organization (2001), ROC “provides a focus for re-orienting the design and delivery of
mental health programs, services and supports, …to define the role of the system: to facilitate the
ability of people living with mental illness to deal actively with the limits imposed by their
conditions (Canadian Senate, Section 3.2.1, 2006). The shift towards ROC has highlighted the
need for effective and diverse treatment modalities for service-users and their supports to ensure
holistic, person-focused care to meet the needs of individuals and families experiencing mental
illness (Anthony, 1993). Through engagement and empowerment, patients are enabled and
encouraged to draw on personal, family, community and cultural strengths sustained through
services, supports and treatments to achieve their full potential and regain a more meaningful life
(MHCC, 2009).
By incorporating the ten core components underpinning the Recovery Model; holistic,
self-direction, individualized and person-centered care, empowerment, non-linear, strengths-

11
based, peer support, respect, responsibility, and hope into all interactions with participants
including the group sessions, interview questions, and overall interview experience (which
informed data analysis), the intended outcome of this study was to inspire collaboration between
service users and service providers to develop strategic guidance for interdisciplinary healthcare
teams; to facilitate optimal support to patients with mental health disorders, and empower service
users to actively engage in their recovery journey of hope, healing and connection.
Conclusion
The recognition of the therapeutic value of creative practice has been accompanied by the
emergence of the Recovery model, recovery-oriented practice, and the notion of mutual
recovery, which extends the concept of recovery beyond an individualized focus. Greater
awareness and utilization of recovery principles in healthcare suggest that mental health
treatments should address a wider social context and extended which include integrative
treatment options, such as art-based interventions, to maximize psychosocial rehabilitation and
support optimal well-being.

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Chapter 2: Literature Review
A literature search on the use of art-based interventions for therapeutic purposes in
mental health was completed using several academic search engines including CINAHL,
PubMed, PsychINFO and various University and the Provincial Health Services library resources
with no year limit criteria. Search terms used in the literature review included a combination of
the following terms in Boolean searches: art therapy, expressive arts, mental health, adult
psychiatry, recovery-oriented care, nursing, creative therapies, therapeutic art, and personcentered care sources. A combination of qualitative and quantitative research studies were
reviewed and analyzed to explore the concept of how therapeutic art interventions are utilized in
traditional and contemporary mental health nursing practices throughout North America and
internationally. The literature reviewed was deemed to be of high quality, including a
combination of several systematic reviews (Maujean et al., 2014; Scope et al., 2017; Uttley et al.,
2015; Van Lith, 2016) and original/primary studies published in reputable journals and academic
websites. For example, Maujean et al. (2014) examined current knowledge about art therapy
efficacy based on findings of eight randomized control trials conducted in adult populations with
high standards of rigor. All but one study suggested short and/or long-term benefits from the use
of art therapy for diverse populations. Maujean et al. (2014) described great need for more high
quality research and identified specific areas for focus including specific measures for
assessment of outcomes, follow up assessments and larger numbers. Similarly, Uttley et al.
(2015) used comprehensive literature searches to conduct a systematic review including 11
randomized control trials (533 patients total) to examine the potential of art therapy as a more
acceptable treatment, in comparison to talking therapies, for clients experiencing non-psychotic
mental illness to systematically appraise clinical and cost-effective evidence for related

13
treatment. Uttley et al. (2015) found Art therapy was associated with significant positive changes
in mental health symptoms in over half of the studies included, which demonstrated costeffectiveness for the intervention and highlighted the need for more research on the subject due
to lacking comparative information. Van Lith’s (2016) systematic review was conducted to
develop the bridge between therapist knowledge and practice in supporting people with mental
illness. The author reviewed 30 studies conducted between 1994-2014 related to various art
therapy approaches, grouped into diagnostic terms to identify areas of research that needed
advancement. Focus areas centered around detailed therapeutic approaches to enhance practice
and transferability, including evaluative components or critiques of applied perspectives by
therapists and inclusion of client perspectives to address relationship between own expectations
and perceived success of art therapies. Overall, the main themes which emerged from literature
include traditional and integrative therapies in psychiatry and mental health, the use of art-based
therapies in healthcare to promote therapeutic environments and recovery, including serviceuser/service-provider perspectives.
Traditional Treatment Methods in Psychiatry and Mental Health
The early scientific explanation of mental illness and addiction was a result of disease or
damage to the brain or hereditary defect as an element of the emerging medical model. People
with mental illness were jailed, cared for within the family home, or by religious groups, leading
to the development of larger asylums (Scott, 2014). Until the latter half of the 20th century,
people with mental illness in North America were generally institutionalized, isolated from the
general population with forced treatments focused on hygiene promotion, and inhumane,
invasive, and often harmful methods of investigation and treatment.
Expectations for care and treatment conditions have greatly improved since the
introduction of the Mental Health Act and various advances in governmental, and societal

14
attitudes regarding mental health promotion as distinct from the treatment of mental illness, on
the premise that mental health is more than the absence of mental illness (Canadian Centre for
Substance Abuse, 2009; Health Canada, 2002; Mental Health Commission of Canada, 2009,
2012; Ministry of Health Services/Ministry of Children and Family Development, 2010;
Standing Senate Committee on Social Affairs, Science and Technology, 2006; Substance Abuse
and Mental Health Services Administration Co-Occurring Center for Excellence, 2007; Scott,
2014). Currently, there are many types of treatment available for people diagnosed with
psychiatric or mental health disorders.
Some of the traditional forms of treatment include psychotherapy (Cognitive Behavioral
Therapy (CBT), Exposure Therapy, Dialectical Behavior Therapy (DBT), etc.), use of
medication (antipsychotics, antidepressants, mood stabilizers, tranquilizers, stimulants etc.),
inpatient hospitalization and/or outpatient/community clinics (group therapy, peer support, case
management, etc.) and/or additional treatment options such as Electro-Convulsive Therapy
(ECT), among others. Newer treatments such as Repetitive Transcranial Magnetic Stimulation
(rTMS), and Eye Movement Desensitization and Reprocessing (EMDR), have more recently
emerged and are steadily gaining popularity and success among users (Sharma, et al., 2013).
However, many clinicians acknowledged that a significant amount of clientele find limited
success with traditional psychopharmacological and verbal psychotherapeutic regimens typically
used in psychiatric care, noting inadequate supportive psychotherapy and only partially effective
medication treatment (Korlin et al., 2000).
As a result, many facilities have worked diligently to reduce stigma around mental
illness, to decrease barriers, and increase awareness of addiction and mental health treatment
options by enhancing accessibility and diversity of programming to meet the complex needs of

15
the population. Examples of the evolving system include the abolishment of asylum-type
institutions for a more holistic and person-centered focus on recovery (Anthony, 1993),
acknowledgment and improvement of outdated systems related to the treatment of multicultural
and indigenous populations, integration of concurrent disorders treatment, forensic and/or
corrections populations, development of initiatives specializing in youth and family services, and
increased recognition of multidimensional human needs such as appropriate vocational, housing
and recreational supports, using evidence-based, and trauma-informed care approaches
(LeCharrois, 2012; LeCharrois, 2013). This monumental shift has highlighted a need for diverse,
effective, person-centered treatment modalities by skilled interdisciplinary teams in therapeutic
settings to ensure holistic, consumer-focused recovery-oriented care is accessible to all.
Complementary/Integrative Treatment Methods in Psychiatry and Mental Health
There is much acclaim by healthcare professionals and the public to support the use of
complementary therapies in promoting both physical and mental health (Farokhi, 2011;
Hoenders et al., 2011; Kessler, et al., 2001; Kuhlman, 2002; Oliveira et al., 2022; Schulz et al.,
2018; Sharma et al., 2013; Shukla et al., 2022; Simon et al., 2004; Unutzer et al., 2000; Van Lith,
2016; Van Lith et al., 2011). Healthcare consumers are increasingly turning to non-traditional
therapies for relief of symptoms when not adequately treated by conventional means in
psychiatry and mental health. Healthcare professionals use a variety of approaches to treat people
experiencing mental illness. Several common non-conventional treatment methods are used in
the treatment of psychiatric and medical diagnoses such as animal-assisted therapy, light therapy,
play therapy, and other complementary and integrative therapies including hypnotherapy, yoga,
prayer, naturopathy, and creative expression through various mediums such as art, music, drama,
and dance (Farokhi, 2011; Oliveira et al., 2022; Ritter et al., 2012).

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Arts-based Treatment Methods in Healthcare
While art has been present as a means to express, communicate, and heal for thousands of
years, art therapy was only formalized in the mid-20th century as a form of “expressive therapy”
through the combination of traditional psychotherapeutic theories and techniques and aspects of
the creative process (Farokhi, 2011; Oliveira et al., 2022). “Since our earliest recorded history,
art has…served as a means of reparation, rehabilitation, and transformation and has been used to
restore physical, psychological, and spiritual well-being” for diverse populations (Malchiodi,
1998, p. ix). The advantages and potential use for creative therapies in healthcare and mental
health recovery have been clearly established in the literature and by numerous positive
consumer accounts. AT has autonomously demonstrated favourable applications in healthcare
(Körlin et al., 2000), proving beneficial to people of diverse backgrounds, age ranges and health
conditions by alleviating a wide range of symptoms and inducing positive therapeutic and
psychosocial effects (Oliveira et al., 2022; Sandak et al. 2015; Shukla et al., 2022;).
Demonstrating extreme versatility, AT is effective in individual, group, couple, and family
therapy in short-term and long-term applications (Oliveira et al., 2022; Richardson et al., 2007).
Since its inception, AT has been utilized to reduce pain, stress, and relieve symptoms
associated with medical diagnoses such as, but not limited to, Cancer (Bar-Sela et al., 2007;
Nainis et al., 2006; Scope et al., 2017), Dementia and Alzheimer’s disease (Sandak et al., 2015;
Shukla et al., 2022), and Acquired Immunodeficiency Syndrome (AIDS) (Murray et al., 2014).
The benefits of the use of arts are also manifested in psycho-physiological measurements such as
reduction of cortisol levels and blood pressure (Sandak et al., 2015). Numerous areas of
healthcare have used arts-based treatment methods to assist clients including community health,
palliative/end of life care, and mental health, among others, to improve holistic (physical, mental,

17
spiritual, emotional) health and wellbeing (Lloyd et al, 2007; Oliveira et al., 2022; Scope et al.,
2017; Shukla et al., 2022;).
Art therapy and other therapeutic creative practices have clearly demonstrated numerous
benefits to one’s general health and wellbeing such as improved relationships with others, better
understanding of self and own illness/challenges, relaxation, improved stress management and
coping, distraction, social inclusion, empowerment and personal recovery, encouraging personal
growth and self-expression alongside the potential for alleviating distressing physical, emotional
and psychological symptoms (Lloyd et al, 2007; Oliveira et al., 2022; Scope et al., 2017; Shukla
et al., 2022). AT has shown significant value in treating many psychiatric conditions and
substance use/concurrent disorders (Hanevik et al., 2013; Oliveira et al., 2022; Scope et al.,
2017; Shukla et al., 2022; Wright et al., 2017) and can also assist individuals to work through
difficult emotions associated with related diagnoses (Körlin et al., 2000; Oliveira et al., 2022;
Wright et al., 2017). The use of art as therapy implies that the creative process can be a means of
reconciling emotional conflicts and fostering self-awareness and personal growth (Hanevik et al.,
2013; Lloyd et al, 2007; Oliveira et al., 2022; Saunders & Saunders, 2000; Scope et al., 2017;
Shukla et al., 2022).
Arts-based Treatment Methods in Psychiatry and Mental Health
AT was originally developed in adult psychiatric in-patient units and was designed for
use with people who could not engage in traditional verbal psychotherapy (Bar-Sela et al., 2007;
Körlin et al., 2000; Nainis et al., 2006; Sela et al., 2007), using visual arts such as a form of
communication (Blomdahl et al., 2016; Malchiodi, 1998; Shukla et al., 2022), a mechanism for
self-discovery and self-expression, to explore feelings and as a method to facilitate healing,
growth and catharsis (Hanevik et al., 2013; Lloyd et al, 2007; Oliveira et al., 2022; Rowe et al.,

18
2017; Saunders et al., 2000; Scope et al., 2017). Art therapy falls into 2 main categories: The first
view involving the inherent healing properties of therapeutic art making, or “art as therapy”. The
second view is the idea that art can be used as a means of symbolic communication, or “art
psychotherapy”, emphasizing the products (i.e.: drawings, paintings etc.). Both art as therapy and
art psychotherapy can be used together, as making art can be a healing process as well as a
mechanism for communication (Farokhi, 2011; Oliveira et al., 2022; Shukla et al., 2022). In
many cases, AT is the “modality of choice for helping children, and adults, who find it difficult
to verbalize their feelings and to acknowledge them to themselves because of their age,
developmental level, lack of trust, fear of acknowledging the unknown, or mental illness”
(Saunders et al., 2000, p.100). AT is often preferred by patients who are uncomfortable with
conventional psychotherapy, struggle with verbal expression, have lower levels of education, or
who may not have fluency in the primarily spoken language (Scope et al., 2017).
Historically, creative arts and non-verbal psychotherapy methods were only introduced as
an alternative or a compliment to conventional therapies but have since demonstrated merit in
treating a myriad of mental health diagnoses and neurological disorders in a wide array of
clinical and community settings (Körlin et el., 2000). AT has shown significant value in treating
psychiatric conditions such as depression (Blomdahl et al., 2016; Gussak, 2004, Rowe et al.,
2017; Sandak et al., 2015; Scope et al., 2017; Shukla et al., 2022; Wright et al., 2017), autism
spectrum (Scope et al., 2017), anxiety (Rowe et al., 2017; Wright et al., 2017), acute psychosis
(Hanevik et al., 2013; Montag et al., 2014; Wright et al., 2017), schizophrenia (Gussak, 2004;
Hanevik et al., 2013; Sandak et al., 2015; Shukla et al., 2022), eating disorders (Körlin et al.,
2000; Scope et al., 2017), dementia (Scope et al., 2017), obsessive compulsive disorder
(OCD)(Wright et al., 2017), learning disabilities (Scope et al., 2017), personality disorders

19
(Scope et al., 2017), post-traumatic stress disorder (PTSD) (Murray et al., 2017; Rowe et al.,
2017; Scope et al., 2017), and substance use/concurrent disorders (Scope et al., 2017; Wright et
al., 2017).
AT uses the modality of art media to help clients express their thoughts, feelings and
experiences and has been shown to assist individuals in working through difficult emotions
associated with medical and psychiatric diagnoses such as sadness, sense of loss, fear, anger,
hopelessness and self-harm and suicidality (Körlin et al., 2000; Oliveira et al., 2022; Shukla et
al., 2022; Wright et al., 2017). For people with psychiatric disorders, these emotions may be
related to illness, hospitalizations, relationships, or other concerns not easily articulated using
verbal communication (Korlin et al., 2000; Nainis et al., 2006). AT and other integrative
therapies are often preferred by patients uncomfortable with conventional psychotherapy,
especially those who struggle with verbal expression due to fewer cultural and language barriers
(Rowe et al., 2017; Scope et al., 2017). Several studies have found AT particularly effective for
patients diagnosed with mental illness and depression (Gunnarsson et al., 2009; Maujean et al.,
2014), which is particularly significant because people with these disorders often describe
feeling as though they cannot always clearly communicate their perspectives to professionals for
fear of stigma, being judged or labeled by their diagnosis, or the nature of the diagnosis (Scope et
al., 2017). The use of art as therapy implies that the creative process can be a means of both
reconciling emotional conflicts and of fostering self-awareness and personal growth (Hanevik et
al., 2013; Oliveira et al., 2022; Saunders & Saunders, 2000).
Art-based Treatments to Promote Therapeutic Environments and Recovery
Many recent studies suggest participation in the arts supports recovery and positively
benefits people with mental health difficulties through increased levels of empowerment; it also

20
has the potential to positively impact mental health and social inclusion by improving overall
quality of life and relationships for individuals and groups experiencing mental health concerns
(Lloyd et al, 2007; Scope et al., 2017). Related literature on the subject identifies several key
areas where art-based practices are beneficial including substantial roles in psychological, social
and mental health recovery through opportunities for self-discovery, increased self-esteem and
identity formation, self-expression, validation and motivation, clarity related to a sense of
purpose, increased focus, improved cognitive functioning and enriched relationships in addition
to benefits to clinical, occupational and contextual recovery (Hanevik et al., 2013; Hacking et al.,
2008; Lloyd et al., 2007; Oliveira et al., 2022; Scope et al., 2017; Van Lith, 2016; Van Lith et al.,
2012).
There is also support for the aesthetics of art in clinical environments in addition to the
therapeutic benefits of art-based interventions in treatment of mental illness. Research indicates
that murals may deter elopements, lower anxiety for patients who are easily confused or
disoriented, and have a calming effect on staff (Kennedy, 2019). Units with colorful art and focal
points make hospitals safer, feel more inviting, increase comfort, promote healing and a higher
quality of life, foster positive moods and a sense of well-being, improving patient and staff
experiences (Kennedy, 2019). Studies have shown that visual art like murals have positive
effects on client and staff well-being and demonstrate positive health outcomes such as potential
for decreased length of stay in hospital and increased pain tolerance. Inclusion of visually
appealing environments, including artwork inspire a spirit of caring and compassion while
brightening up a space that can often be bleak (Kennedy, 2019).
Art-based treatments can be useful in helping patients and their support systems in
numerous contexts including, but not limited to, increasing self-awareness, improving coping

21
abilities related to illness symptoms, and fostering resilience through adaptation to stressful or
traumatic experiences (Nainis et al., 2006). Art-based treatments are further enhanced when
offered in a trusting, safe environment that allows individuals to acknowledge and express strong
emotions and a supportive focus on non-verbal communication through creative processes
(Saunders et al., 2000; Shukla et al., 2022). Clients and their staff/support networks respond well
to such environmental enhancements which may decrease clients' use of more invasive or costly
services, increase visual stimuli/mental distraction leading to lowered distress levels and
potential need for acute levels of supervision, while fostering deeper cultural and/or spiritual
awareness or appreciation (Ballantyne, 2019; Gomez, 2019; Hanevik et al., 2013; Lloyd et al,
2007; Scope et al., 2017), encouraging more opportunities for interpersonal interaction.
Arts-based Practitioner Perspectives
Practitioners of art-based or expressive psychotherapy use the art-making process to
improve social, mental, and emotional functioning and increase feelings of wellbeing by utilizing
the creative process to encourage personal growth and alleviation of symptoms of mental illness
in clients; yet substantial variations exist regarding appropriate evaluation tools and methods
leading to practice ambiguity and lowered practitioner confidence (Rowe et al., 2017). Most
psychiatry-focused participatory art projects claim improvements in confidence, self-esteem,
social participation, and mental health outcomes, though such claims have rarely been subjected
to robust research (Hacking et al., 2008). Still, AT is a relatively inexpensive intervention,
entailing the therapist’s time and cost of art supplies, that may have long lasting positive effects
by teaching individuals’ long-term techniques and self-efficacy. The aforementioned skills and
attributes noted above can be transferred into daily living to improve wellbeing, self-affirmation,
and to support changes in routines with minimal risks to the participant (Blomdahl et al. 2016).

22
Many healthcare providers consider arts-based activities to be a valuable clinical intervention
based on the belief that the creative process involved in the making of art is healing and life
enhancing (Nainis et al., 2006).
As consumers express greater interest in integrative therapies and share positive
experiences related to the therapeutic use of arts in healthcare, interventions such as art therapy
will likely be perceived as having value in providing opportunities for healing, self-discovery, or
formation of a new identity, and used with greater frequency and acceptance in wider
communities (Lloyd et al., 2007; Nainis et al., 2006). Further research in AT and mental health
recovery will facilitate a better understanding and recognition of population needs for those
services including, identification of educational and professional resources, and improvements to
assessment, intervention, management, and evaluation of integrative healthcare practices in
recovery-oriented care.
Arts-based Service User Perspectives
Research indicates that art therapy contributes to recovery from mental illness. Studies
show therapeutic art practices enhance personal growth, self-expression, transformation and
wellness, increases perceived control and sense of self, promotes personal change, reduces stress,
allows for greater ability to transcend troubling circumstances or distressing emotions, improves
one’s ability to meet demands in daily life and problem-solve, while strengthening the
individual’s boundaries and ability to recover from traumatic experiences, including relief of
pain or other physical symptoms (Blomdahl et al., 2016; Malchiodi, 1998).
Despite the large amount of literature written about diverse treatment options for people
experiencing addiction and mental illness, there is scarce attention paid to the firsthand
experiences of people with lived psychiatric experience who engage in arts-based interventions

23
compared to those without access to similar programming and even less so from a recoveryoriented care perspective. Common themes from limited articles focused on first person
psychiatric service-users experiences with art-based treatments included findings that engaging
in creative therapies may benefit individuals in improving their understanding of themselves and
their disorder(s) (Hanevik et al., 2013; Lloyd et al., 2007; Scope et al., 2017; Van Lith, 2014;
Van Lith, 2016), managing symptoms or perceiving increased control over illness (Hanevik et
al., 2013; Lloyd et al., 2007; Van Lith et al., 2011), experiencing enhanced relationships with
others and greater self-confidence, facilitating distraction, personal achievement, self-expression,
relaxation and empowerment (Lloyd et al., 2007; Oliveira et al., 2022; Scope et al., 2017; Van
Lith, 2014; Van Lith, 2016; Van Lith et al., 2011) towards recovery.
Conclusion
Today, AT is considered “a form of psychotherapy where the process of making images
plays a central role in the context of the psychotherapeutic relationship…[and] has been widely
applied to the treatment of patients and service users with a range of health problems and across
all spectra of severity” (Richardson et al., 2007, p. 483). The limited amount of available and
credible information related to firsthand experiences of people with mental health challenges
who participate in art-based therapeutic programs is a noticeable gap in the literature on the
subject. The investigation of this topic from the perspective of psychiatric clients using artsbased therapies in treatment is necessary for ensuring service-user satisfaction via effective
programming and for the development of future services and education that are essential for
facilitating recovery-oriented care while supporting the recovery process. This study will add to
the current body of literature on the effectiveness of integrative therapies and provide support for
initiatives looking to implement holistic, recovery-oriented care.

24
Chapter 3: Research Design
Qualitative research methods are ideal for capturing participants’ perspectives on specific
experiences or phenomena due to opportunity to explore rich and dynamic dialogues. There are
various approaches to qualitative research methods and techniques available to researchers.
Interpretive Description: A Qualitative Research Methodology
Interpretive description (ID) is a qualitative research method developed from a need to
better understand clinical knowledge and applied practices in nursing and other disciplines
(Thorne, 2016). Interpretive description has been applied to several areas within healthcare as an
inductive analytic approach to create ways of better understanding clinical phenomena and yield
clinical applications (Thorne et al., 2004; Thorne, 2016).
Historical Contexts
Early ID publications by Sally Thorne, recognized as the founder of ID, described the
possibility of an alternative approach to conventional methods influenced by established methods
used in social sciences such as ethnography, grounded theory, and phenomenology, to lend
credibility and structure (Thorne, 2016; Thorne et al., 1997). ID arose from “the necessity to find
a way to do the kind of applied qualitative research that could generate the kinds of
understandings of complex experiential clinical phenomena that would be optimally relevant and
useful to the practice of nursing and other professional disciplines concerned with questions
“from the field” (Thorne, 2016, p 31).
Relevance in Nursing Practice and Research
ID is a methodology developed and adapted with the intention of answering real world
research questions for practical use in diverse clinical and educational environments. The
professional discipline of nursing is well suited for ID research due to practical application of

25
knowledge to the resolution of human health and illness problems within society (Thorne, 2016;
Thorne et al., 1997). As the focus of nursing expands, particularly in the field of mental health
nursing, research must move beyond theoretical information to include real world applications in
practice to meet the multifaceted needs of a diverse population by diverse practitioners with
varied training, education, and experience (Thorne et al., 1997).
The use of Interpretive Description is appropriate for the goals and rationale of
researching socially constructed elements of human experience (Thorne, 2016). ID has proven to
be a credible and legitimate methodology for nursing research and integration into care due to its
solution-focused approach and ability to address diverse clinical issues in a relevant and flexible
manner. In ID, it is fundamental that clinician researchers’ motivation for research is the
application of findings to real and complex situations involving human beings with challenging
health problems to improve overall quality of life (Thorne, 2016). ID methodology is focused on
solving everyday problems of individual patient experiences as opposed to larger population
generalizations, and therefore extremely well suited to clinical problems requiring personcentered solutions such as non-traditional approaches to psychiatric treatment.
Methodology Selection
The ID methodology was selected by the writer to better understand how qualitative
research can aid in production of knowledge, to gain a deeper consideration of phenomena and
increase engagement with data analysis beyond basic description of client perspectives regarding
the use of arts-based treatment in mental health recovery (Teodoro et al., 2018; Thorne, 2016).
The ability to use non-traditional methodologies in research to provide and capture unique
individual and group expressions of the impact of arts-based treatment on recovery was helpful
to the writer. Equally valuable was ID’s allowance for interesting and non-traditional

26
dissemination of study findings, and study subject matter that would be appealing to broad
academic and public audiences such as the incorporation of artistic renderings, media,
technology, and community engagement (Thorne, 2016), capturing interest, imagination, and
inspiration for future therapeutic practices. Considering AT has not traditionally been thought to
hold significant therapeutic value, likely due to the biomedical focus of disease, the writer
determined an ID method especially powerful to demonstrate the merits of AT in healthcare,
increasing the richness of evidence through patient self-reports, building credibility indicators
through continuous planning and adaption parallel to many clinical practice applications
(Thorne, 2016). Study findings have provided an opportunity for rarely studied firsthand insights
into arts-based mental health programming from the perspective of service users and will inform
future program development, implementation, and evaluation of art-based practices in addiction
and mental health services in alignment with the foundational concepts of Interpretive
Description (Thorne, 2016).
Research Design
This study used Interpretive Description methodology with analytic procedures of
thematic analysis to explore the impact of engaging in art-based treatments on recovery from the
perspective of patients with lived addiction and mental illness experience. The study took place
at a Psychiatric Hospital located in a western Canadian province where the investigator is a
Clinical Nurse Educator and graduate student focused on the experiences of clients attending
therapeutic art-based groups. A purposive sampling strategy selected individuals for participation
based on personal experience with art-based therapies and a desire to share related knowledge
(Streubert et al., 2011).

27
Prior to the Covid-19 pandemic, clients from various units across the site could attend a
supervised drop-in mixed-media visual arts and crafts group facilitated by a Recreation Therapist
twice a week for up to 2 hours per session, post-referral from their Doctor/Psychiatrist. Like
many therapeutic groups, these sessions were designed to serve many purposes such as
facilitation of a safe and supportive environment to learn and practice various skills and selfexpression, develop positive stress management and coping skills, and allow for time away from
the unit to initiate and engage in social and recreational activities, among many other goals and
opportunities. Each session, a pre-designed step-by-step project was available for individuals
who wanted to complete a structured project, with or without support from staff. Alternatively,
participants could also decide to customize their project or complete a project of their choice
using a wide range of supplied arts and crafts materials, with or without staff support. Due to
restrictions throughout the pandemic related to required social distancing and compliance with
wearing Personal Protective Equipment (PPE), the group had been limited to individual unit
participation, as opposed to multiple unit participants across the site.
The Researcher’s Positionality and Role
Qualitative research is a collaborative production of knowledge between researcher and
participant (Karnieli-Miller et al., 2009) and each contributor’s unique personal, and professional
experiences are valued in guiding the research process (Lopez et al., 2004). The researcher is a
Registered Nurse with a Bachelor of Science Degree in Nursing, and currently a graduate student
candidate in Brandon University’s Master of Psychiatric Nursing program. As a neophyte
researcher wanting to contribute to nursing knowledge and motivated to make a difference to
individuals challenged with mental illness, an in-depth qualitative exploration of the perceived
impact of participatory art therapy on recovery in adult mental health service-users at a local

28
psychiatric hospital using Interpretive Description (ID) methods was proposed. The research
study was conducted as part of the educational requirements of a thesis for degree completion
and intended for dissemination through various presentations and publications. The researcher is
certified in Psychiatric and Mental Health Nursing through the Canadian Nurses Association
(CNA). Areas of current practice include acute mental health care and education with previous
experience in post-secondary nurse education in both Registered Psychiatric Nursing and
Registered Nursing programs, community mental health nursing, child and adolescent mental
health, forensic psychiatry and corrections, general medicine, and occupational health and safety.
The researcher’s nursing practice is trauma-informed and recovery-oriented. The researcher
recognizes potential biases related to personal opinions and past experiences that may impact
interactions with others or practices related to arts-based research and treatment of mental health
challenges. The researcher acknowledges subjective beliefs supporting the use of arts-based
practices in addiction and mental health treatment which may impact interpretation and analysis
of participant responses. The researcher utilized several reflexivity exercises including field
notes, journaling, and regular discussions with thesis committee members to maintain awareness
and ensure sensitivity to individual participant experiences.
The researcher has no associated conflicts of interest to declare. While the researcher is
an employee of the hospital this study took place, there is no undue influence or potential power
imbalance relationship between the researcher and participants as the researcher is not a provider
of direct patient care and instead, supports staff educational needs. All participants were
receiving treatment for mental health concerns including but not limited to depression, anxiety,
schizophrenia, bipolar disorder, substance use, among others. However, absolutely no
demographic or diagnostic information was collected nor used in findings summary,

29
dissemination or for future publications due to ethical and confidentiality concerns related to the
population, and only discussed if participants chose to mention their diagnosis in the interview.
This rationale followed mental health recovery principles that require one to look beyond an
individual’s diagnosis to focus on personal growth and other dimensions (Anthony, 1993;
Deegan, 1988; Deegan, 1996; Van Lith, 2014; Van Lith, 2016). The researcher sought and
successfully obtained ethical approval of the study from Brandon University and the Provincial
Health Services prior to participant recruitment and utilized the Provincial Project Ethics
Community Consensus Initiative guideline, formerly the Provincial Research Ethics Community
Consensus Initiative, for quality improvement and evaluation projects to minimize and mitigate
any real or perceived threat or risk to participants.
Inclusion and Exclusion Criteria
To have been eligible for participation in the study, participants must have been at least
18 years of age, able to understand and speak English fluently, and receiving services at the
psychiatric hospital (inpatient or outpatient services). Participants were required to have
previously attended one or more art-based therapy sessions at the hospital, be willing to engage
in the associated interview process, and have been determined medically and mentally stable
(i.e.: no recent or current psychotic episodes, no suicidal ideation or recent self-harm), having
capacity to make their own informed decisions about engaging in the group and study process.
This criterion was indicated through privileges granted by the most responsible healthcare
provider such as individual Psychiatrist/Physician and associated treatment teams.
Recruitment
Direct recruitment occurred through posters and multiple presentations by the primary
researcher to various therapeutic arts groups explaining the study, the nature of participation and

30
related requirements and contact information (Appendices A and B). Additionally, electronic
posters advertising research participation opportunities were circulated to program and unit
managers for distribution amongst interdisciplinary staff for referrals. Hard copy versions were
also posted in the art room and commonly used patient areas on the units and throughout the
hospital to solicit interest from patient self-referrals. Information addressed on posters included
the purpose of the study, criteria and time requirements for participation, participant ability to
withdraw from study prior to the start of data analysis without penalty or explanation, and the
primary researcher’s contact information. The poster also emphasized confidentiality of client
information, the voluntary nature of the study and assurance to participants that no impact would
be had on treatment during hospitalization for choosing or declining to partake in the study. The
likelihood of a confidentiality breech was actively minimized by the researcher limiting access of
information to other individuals through conducting and transcribing interviews independently.
Additionally, had a breach of privacy occurred, the information in question would not put the
participant(s) at a risk of legal liability, nor damage to financial standing, employability, personal
reputation etc. and complied with the Provincial Freedom of Information and Protection of
Privacy Act (FOIPP) and Health Information Act (HIA).
Participant Selection
Eleven research participants were recruited through multiple approaches including
posters inviting participation distributed around the psychiatric hospital, purposive sampling
through direct recruitment via presentations delivered by the researcher to clinical, recreation and
rehabilitation services, and snowball sampling through additional peer referral, to reach the goal
of interviewing five to twelve participants. Potential participants were not offered an honorarium
to participate. Each participant was invited to engage in an individual interview of approximately

31
30-60 minutes, which was audio-recorded, transcribed verbatim and analyzed for central themes
and sub-themes by the primary researcher.
Data Generation and Treatment
The experiences of participants in the study were accessed using semi-structured
interviews and observations, which occurred in a private room close to the therapy area for
protection of patient privacy and familiarity of environment at a time convenient for participant
schedule. Alternatively, telephone/zoom interview options were also offered to participants
based on personal preference and in compliance with Covid-19 related restrictions associated
with minimizing physical contact. Nine participants opted for in-person interviews, and two
participants preferred telephone interviews due to scheduling convenience. Interview questions,
as outlined in Appendix D, were open-ended and responsive based on participant responses. Data
generation was collected via participation in one interview with each participant to gain a
description of the participant’s experiences with arts-based treatments for mental health for ten
of the eleven participants. One participant requested the interview to be completed over two
separate calls on different days due to personal schedule preference, which was accommodated
by the researcher.
The researcher/interviewer demonstrated flexibility and skill in conducting eleven
approximately 30-60 minute conversational interviews (based on participants’ ability/comfort
levels) and adapted questions as necessary in response to participant accounts, to promote
authenticity and limit biases or preconceptions. As per suggested ID techniques described in a
literature search on the subject, the use of semi-structured interviews via a series of predetermined, open-ended questions served as a conversation guide to assist participants to
describe their experience with therapeutic art sessions without influencing or leading discussions

32
(Streubert et al., 2011). A goal of interviewing five to twelve participants had been set by the
investigator in advance of participant recruitment based on comparable existing studies on the
subject, as determining saturation of findings seemed impossible due to the infinite subjective
responses by participants. The size of the sample was considered sufficient when new informants
revealed “no new findings and meanings from all previous narratives become redundant” (Crist
et al., 2003, p. 203) or “when the researcher no longer receives information that adds to the
theory that has been developed” (Malterud et al., 2015, p. 6). Five additional dimensions that will
have a mutual impact on this study’s sample size relate to the concept of “Information Power”
and include continuously evaluating the study aim, sample specificity, use of established theory,
quality of dialogue and analysis strategy throughout the research process (Malterud et al., 2015)
to support data redundancy, as opposed to saturation alone. Volunteer participants were recruited
throughout the study duration and occurred simultaneously with data collection and analysis.
Participant identities remained anonymous, and each interview was assigned a numeric
code for identification purposes. The writer kept a journal of field notes and obtained informed
consent from interested participants prior to conducting semi-structured individual interviews,
which were audio recorded for verbatim transcription, organization, and analysis. Participants
were informed that the study findings may be disseminated via various scientific journals,
presentations, thesis dissertations or other publications and were agreeable to same.
Data Analysis
The process of data analysis in interpretive description involves several steps to increase
the likelihood of a credible study and fruition of clinically relevant findings. Data was analyzed
following the ID process proposed by Sally Thorne, the founder of ID (Teodoro et al., 2018;
Thorne, 2016). The researcher used subjective interpretation of the data, through coding and

33
organization of content to identify and make sense of patterns, notice trends, categorize data,
assign meaning, and consider borrowed techniques, to capture analytic insights and shape
practice with useful applications that are relevant in healthcare and education (Thorne, 2016).
The researcher completed the following steps:
Step One: Carefully read and reviewed literature, field notes and transcribed participant
interviews.
Step Two: Re-read and organized data for immersion. Analyzed individual interview transcripts
separately while noting common themes and experiences among participants using a
combination of Word and Excel documents.
Step Three: Identified meaningful quotes/themes and organize into condensed sub themes.
Step Four: Reviewed and summarized material to cross reference information with initial
literature and participant interviews to confirm understanding and accuracy.
Step Five: Revisited material to deepen understanding and ensure researcher comprehends
content. Considered any misinterpretations or biases and explored same with thesis committee
members for transparency and potential missed patterns or concepts.
Transforming patterns into findings through envisioning possibilities, confirming biases,
expanding associations, testing relationships, capitalizing on outliers, and engaging constructive
criticism or limitations focusing on other elements that required attention and consultation at this
stage (Thorne, 2016). The researcher sought guidance from the thesis advisor and committee
members regarding these considerations, as well as advice and feedback related to data quality,
rigor and avoiding predictable hazards in ID methodology such as premature closure,
misinterpretation of data or over inscription of self (Thorne, 2016).

34
To ensure high quality data, the researcher reviewed and applied The Framework of
Quality Criteria to maintain integrity and trustworthiness commonly used in qualitative research
(Guba & Lincoln, 1994; Lincoln & Guba, 1985). Trustworthiness, or rigor, of a study refers to
confidence in data, interpretation and methods used to ensure quality of a study and focus on the
following five areas: Credibility, Dependability, Confirmability, Transferability and Authenticity
(Guba & Lincoln, 1994; Lincoln & Guba, 1985; Polit & Beck, 2012; Polit & Beck, 2014).
In this study, credibility was promoted through meticulous transcription of interviews to
demonstrate accuracy of participant responses, and exercises with reflexive journaling and field
notes for frequent examination of potential misunderstandings or biases.
Dependability in this study was maintained through ensuring standardized information
sharing through verbal explanations and printed materials to participants for stability of
conditions and environment. The researcher kept an audit trail of process logs through reflexive
journaling and field notes to track decision-making and rationale regarding interviews with
participants and conversations with thesis committee members. Observations of the participants’
non-verbal body language, speech inflections or overall expressions was recorded throughout the
interviews when possible and included in field notes/journaling exercises. Additional
information referenced from field notes throughout the analysis phase included researcher
observations and response to individual interview content and location, reflections on roles,
interaction style, areas for improvement for future interviews, and personal thoughts and
potential ideas for data interpretation. Interviews and observations were analyzed concurrently
during ongoing participant recruitment (Crist et al., 2003). Tracking data, regular self-reflection
exercises and conversations with thesis advisors promoted confirmability within the study by

35
promoting neutrality, awareness and minimization of potential biases for a consistent approach to
participant interviews.
The researcher demonstrated transferability and authenticity by providing information
and recommendations that could be useful to other settings and service areas for a variety of
settings and populations by providing rich and detailed descriptions using a transparent approach
with data analysis while ensuring confidentiality to participants.
Inductive, as opposed to deductive analysis, is the technique supported by ID and the
researcher used several strategies to achieve appropriate analysis by avoiding complex or
premature coding systems and focusing on theoretical or epistemological aspects for coherent
data collection and analysis to support the study. The researcher maintained ongoing immersion
with information gathered from the participant interviews and focused efforts towards deeper
understanding through repeated synthesizing, theorizing, and re-contextualizing of data over
sorting and coding, requiring endurance and attention to detail. The researcher consciously
attempted to increase awareness of potential biases and assumptions that may have affected the
way in which data was collected or analyzed. Strategies the researcher employed to assist in
reflexivity included regular communication with the thesis advisor and committee members, as
well as keeping a reflective journal. The purpose of regular journaling was to assist the
researcher in intentionally enhancing self-awareness by frequent reflection, interpretation and
documentation of field notes including descriptions of methods, thoughts, feelings, and actions
during the research process to ensure rigor and transparency (Thorne et al., 1997).
Ethical Considerations
The study posed little to no harm to the participants involved as discussions related to
individual experiences with arts-based treatments are considered to cause no increase in potential

36
risk than participants encounter in everyday life. However, the complex nature of qualitative
research and potential of past traumas, unresolved emotional conflict, or negative memories to
resurface presented ethical concerns that required careful consideration in the research design to
ensure ethical principles were upheld for the protection of participants (Scope et al., 2017;
Streubert et al., 2011). The researcher obtained a certificate for completing “Tri-Council Policy
statement: Ethical conduct of Research involving Humans Course on Research Ethics” (TCPS 2:
CORE) (Appendix F). Research ethics approval was obtained from Brandon University Research
Ethics Committee (BUREC) and the Provincial Health Services prior to commencement of the
study to ensure the protection of vulnerable populations’ confidentiality and rights, with the
intention of minimizing potential for harm. The researcher also provided a comprehensive list of
support and crisis prevention resources which was distributed to each participant, should any
individual(s) require assistance with distressing circumstances that may have arisen from
participating in the study (Appendix E). The resource was intended to supplement the 24-hour
access to services provided by interdisciplinary staff caring for participants over the course of
hospitalization, in addition to everyone’s personal and community networks.
Informed consent was obtained prior to each interview and reviewed throughout the
research process. Participants were informed of the aim and purpose of the study, that
participation was voluntary, and they could withdraw from the study prior to data analysis
without giving an explanation. Please refer to Appendix C, consent form. No participants chose
to withdraw from the study. To protect the privacy and confidentiality of participants, the
primary researcher was the only person aware of participant identities. Only first names were
used during the audio-recorded interviews. Participant names were removed from transcribed
interviews and replaced with numeric identities or <name>. All identifying information in

37
participant responses was removed by the primary researcher in the transcripts and dissemination
of findings or publications. All hard copy or electronic files were securely stored in a locked
cabinet and/or password-protected devices and will be destroyed following the study completion
(Streubert et al., 2011). Non-identifying data was shared with the researcher’s thesis advisor and
committee members. The primary researcher will delete all electronic files and destroy any hard
copies of same, after five years has elapsed post thesis defence.
Conclusion
There are many kinds of Qualitative research methods available for researchers in
healthcare. Interpretive Description methodology is ideal for use in mental healthcare studies as
one of the methods strengths is capturing participants’ perspectives from specific clinical or life
experiences through dynamic dialogue between service users and service providers from a
research lens to improve clinical applications (Thorne et al., 2004; Thorne, 2016).

38
Chapter 4: Findings
The purpose of this research was to explore how psychiatric patients experience the use
of therapeutic art in their psychiatric treatment, and their perception of its impact on their own
mental health recovery. Participants were asked about their experience with arts-based therapies
in treatment and responded with insightful commentary related to the impact of creative practice
on their mental health recovery.
Description of Participant Characteristics
Eleven participants indicated interest and completed an interview for the study. Despite
intentional omission of demographic information collection for confidentiality purposes,
participants were observed to have a wide range in age, ethnicity, gender, and background. All
participants stated they began using creative outlets in childhood. Most participants noted being
introduced to art by a family member prior to attending formalized schooling. Many participants
described early art experience as simple arts and crafts projects, progressing on to classes in
school and increasingly complex projects into adulthood. A minority of participants went on to
study art and/or design in a formalized post-secondary program, sharing they aspired to
employment in related fields. Participants described diversity in artistic mediums and techniques
such as photography, painting, coloring, drawing, sculpture, digital art, woodworking, textiles,
and various multimedia crafts. All participants were engaged in some form of art, ranging from
daily to sporadic practice. All participants shared they had one or more art projects in progress
for recreational and/or therapeutic purposes. Every participant believed art was beneficial to their
overall health and wellbeing. All interviewees shared they found the most merit in actively
creating art but believed opportunities for passive participation via observing others create,
viewing art displays, or reflection and discussion on art history and interpretation were also

39
beneficial. Each participant emphasized the relevance of arts-based treatments in recovery
related to addiction and mental health treatment, programming, and rehabilitation. All
participants intended on using creative outlets post discharge and saw themselves engaging in
some form of artistic expression for the remainder of their lives.
Themes
Three themes emerged from the data: Enhanced connection with self through artistic
practices (Intrapersonal), including holistic health and wellbeing elements such as mental,
physical, emotional and spiritual/cultural components, Enhanced connection with others through
artistic practices (Interpersonal) or social health, and Enhanced connection with environment
through artistic practices, such as physical and psychosocial settings.
Theme

Sub theme(s):

Theme 1: Enhanced Connection with
Self Through Artistic Practices
(Intrapersonal)

1: Holistic Health and Wellbeing
1.a: Mental Health
1.b: Physical Health
1.c: Emotional Health
1.d: Spiritual/Cultural Health
2: Relationships
2.a: Social Health

Theme 2: Enhanced Connection with
Others Through Artistic Practices
(Interpersonal)
Theme 3: Enhanced Connection with
Environment Through Artistic Practices
(Setting)

3: Setting
3.a: Physical Setting
3.b: Psychosocial Setting

Enhanced Connection with Self Through Artistic Practices (Intrapersonal)
The first theme relates to the impact of arts-based therapies on mental health recovery
and the experience of an enhanced connection with self. Also known as an intrapersonal
relationship, this theme refers to the participants’ ability to be self-aware, set and work towards
goals, and maintain effective coping skills. Study participants described how art helped them to
become reacquainted with themselves on a deeper level. Participants shared that being creative

40
was an enjoyable and therapeutic activity which promoted holistic wellbeing, increased
awareness, confidence, and self-esteem which facilitated a ‘healthier version of themselves’ and
promoted progress in their recovery. Engaging in arts-based therapies allowed meaningful
opportunities for self-reflection, enabling self-acceptance and understanding from others around
mental health challenges. Recovery using art allowed participants to ‘see themselves differently’
promoting introspection, emotional regulation, and increased resilience. Participants noted an
improved ability to consider goals/treatment options, which resulted in advanced motivation,
independence, enhanced functioning and life satisfaction.
Holistic Health and Wellbeing
The sub theme of holistic health arose from the participants' beliefs that art and creative
expression were considered beneficial to one or more areas of their mental, physical, emotional
or spiritual/cultural wellbeing. Participants said that art is attached to their sense of wholeness
and overall health because art provides them with something ‘positive and life giving’.
Participants mentioned that being creative allowed them to recognize potential talents, focus on
their strengths while working on deficits, and fostered personal growth which cultivated selfconfidence and a deeper appreciation of ‘self’. One individual stated making art helped them to,
“see the potential I have inside. I have a chance to not just be constantly [focused on the] bad
side of my personality but see that I can actually do something [positive]. I can improve myself
... That’s what makes me feel better…to see [a] strong side of me”. Another participant said,
“[Making art] is reinforcing this idea that I am capable of doing things that I previously wasn’t
capable of. The best part is learning how to make something that you completely had no idea you
could.” When asked about the effect art has on their life, another person commented, “Getting
some self-esteem or pride out of what has been created. Self-worth, in a sense. I think that's very

41
rewarding too, when you see your artwork come to life.” Participants described a sense of
fulfillment ranging from satisfaction of making art and development of their own style to
immense personal growth and evolving other areas of their personality and lifestyle. One
interviewee said, “I do feel proud… I feel confident…I feel a lot better.” Another participant
elaborated, “As we start to get further into our practice and develop better pieces, [we have] far
more personal and meaningful achievements that can bring self-value because when you're
proud of your own work, then it doesn’t matter what other people think. It's like a form of selflove, a form of self-esteem that's … really important for people. I think everyone needs to have
some sort of creative practice that’s valuable for them.” Another participant noted, “[Art has]
impacted my mental health in that it's a hobby I can do, that I know how to do …and I know I am
good at. I'm confident in what I can create … [It] is constantly around … I can always come
back to doing art. I know that I can express myself that way.” For some interviewees, art and
creative expression were considered a necessity to living their best lives. One participant shared,
“Art is medicine… medicine that I need. [If] I don't have that … something dies in me.” Another
reflected, “I was fully hospitalized for months. We went to different types of therapy, but I would
say the only thing that took me out of this [poor health] was art therapy.” Art is absolute
medicine for me and is going to help a lot of people... I really believe it's something positive and
life giving …nutrients to your mind, your heart and soul.” The sub theme of holistic health and
wellbeing can be further broken down into the individuals mental, physical, emotional, and
spiritual/cultural health.
Mental Health
This subtheme refers to the participants’ descriptions of the cognitive aspects of their
health which included talking about their overall functioning of the brain, or their ability to think,

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comprehend and communicate information, solve problems, and recall information. The
participants articulated that art helped them with achieving a better state of mental health and
wellness through improving self-expression and awareness, communication skills, and an
enhanced ability to perceive and interact with the world around them. One individual stated that
creating art, “helped me in my own psychology and my relationship with people”. Another
participant shared, “[Art] can promote wellness. It has kept me sane. It improves my mental
health 100%.” When asked to describe the connection between making art and mental wellness
one person said, “Art is mental health for me … [It has] helped me to pause, breathe, release
stress, and bring a sense of completion of something, while inspiring me to move onward.
Another offered, “If you want your mental health to improve…you need to be strengthening your
brain and mind. Just like going for walks, working out, eating healthy [improves one’s physical
health] … It's just as important to strengthen the brain. If you imagine working out so that your
body is [physically] strong…you can work out your brain to also be [mentally] strong.”
Participants noted parallels between artistic skillsets and activities of daily living, which changed
the way they thought, felt, or responded to various life situations. Several participants explained
the use of art therapies allowed them to further develop their mental capacity through improved
brain health and neurodevelopmental functioning. One interviewee shared, “You feel healthier
because you participated in a creative project … It helps! It changes … the chemistry in your
mind. It can increase serotonin and dopamine and endorphins … [which help with] skill building
and … how to be healthy, use different parts your brain and develops you into a more wellrounded person with diverse knowledge, experiences, skills, and abilities”. Participants
described the use of art not only improved their mental wellness and ability to think more
broadly, but also interrupted or decreased their mental illness, negative thoughts and/or

43
perceptions of themselves. One participant said, “[Creating art is] something that's not verbal. It
turns off the narrative part of your brain. I think a lot of the issues with mental health, especially
[for] people who are in depressive states is …the narrative in their head is stuck in this negative
loop. If making art is something that's getting you out of the [negative] narrative … it's
positive.” This participant shared they experienced noticeable changes in their thought patterns
and felt beneficial effects of making art immediately. They elaborated, “Art lets you come [to]…
your own conclusions…It helps you learn. It helps you make sense of your own self and the way
you interpret things … your mental processes. I believe …art practices like learning spatial
awareness and color differentiation also expand the way you're able to comprehend the world
around you.” In addition to the benefit of better brain health and enhanced mental processes,
participants noted increased interest and the ability to learn and retain information were helpful
by-products of arts-based therapies. An individual with English as a second language described
their perception that illustrating diagrams in school assisted her to learn and more deeply
understand complex concepts by visualization, increasing her ability to retain and recall content.
Several interviewees explained they built resilience from working up the courage to ‘try
again’ after failed attempts or dissatisfaction with artwork that would have previously been
abandoned. The concept of perseverance, whether it be artistically or otherwise, can be applied
to other aspects of life including improving one’s overall health, interpersonal relationships and
independence. One person noted, “[Before becoming involved in art] I didn't really have any
aspirations in terms of an outward life… just kind of go to work, buy junk food, and play video
games. I think having something that's challenging, that’s difficult to learn, is so important. It is
just like lifting a weight. You aren’t going to gain any muscle if you only lift ten pound weights.
You eventually have to increase the intensity, increase the difficulty. I think giving yourself a

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healthy challenge, a healthy amount of resistance, and [a manageable level of] negativity is
important to develop yourself into a more resilient person for your future.”
The majority of the study participants communicated a connection between engaging in
arts-based therapies and experiencing an increased ability for self-reflection, a stronger sense of
self-identity, and understanding. One interviewee stated that art is a “great pathway to learning
and sharpening yourself as a person” which fosters a “deeper connection with your inner self.”
Others highlighted a heightened sense of self-satisfaction or acceptance of self, including their
mental health-related challenges. One participant explained, “I'm finding my real personality… I
feel at peace with who I am.” Many participants commented that making art assisted them in
self-discovery which led to increased ability to lead more ‘grounded’ and ‘authentic’ lives.
Participants shared engaging in arts-based therapies was helpful for developing self-awareness
which led to an increased ability and desire to connect with others. One person shared,
“Whatever I learned [from art group], it's an immediate thing… it brings some results, whether
it be socially or [in] whatever way. Every time I go to an art thing, I'm always learning
something about myself that is new, or about others, which with the other therapies … isn’t that
way.” Another person described immense pressure they had put on themselves prior to coming
to terms with their diagnoses or practicing art regularly, sharing “I no longer go chasing after
something in a needy way. I feel more grounded … this is really who I am. I think I developed
an external personality [previously to please others] … that ‘sort of’ worked, but truth being
said, I think I feel more like I know myself when I'm doing art quietly in a room alone with some
music.” Developing one’s voice and unique style were concepts many participants found
beneficial because of engaging in creative practices. Numerous interviewees verbalized
experiencing feelings of enhanced communication and empowerment from expressing their

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thoughts and feelings through artwork and discussed the benefits of keeping track of their
personal and artistic progression through methods such as journaling, sketchbooks, electronic or
photographic albums of their work. Several interviewees mentioned these tools were helpful in
recording additional thoughts, feelings, interpretations, art ideas, and reference materials for
inspiration and organizational purposes. Many participants agreed having a sketchbook or
journal was extremely beneficial for reviewing and documenting their growth and development
in a tangible way. One person commented having a sketchbook “shows you your progress over
time.” Another person stated they liked “being able to look back and see what I have done. It's
nice to see where I started, and where I am now… [my] evolution as an artist and as a person. If
you write in a journal every day, you are more aware of your progress… you see the way your
thought progress changes... I think art is just a visual way of doing that.” Another person shared
they used journaling to archive reference imagery through collages they could look back on for
inspiration when they experienced ‘creative blocks’ or distressing mental health symptoms.
Several individuals shared keeping some type of record was useful for documenting current and
past projects, cathartic self-expression, planning and organizing projects, marking significant
milestones or accomplishments, and/or private reflection of personal and artistic journeys, with
the potential to share content with other people such as a partner, friends/peers, family members,
or various therapists/staff members. One participant explained, “[Having] that visual
representation [is important] so you can see your progress. You can look at when you just
started compared to more recent ones in development, or even the emotional kind of journey it
evoked. I like that reflection …you can share it if you want to, but it can be very personal and
kind of an intimate way to look back at your experiences, whether it's artistically or emotionally,
psychologically, or whatever. I know people will do art pieces and then pin them up on the wall

46
and like that's wonderful, but I think having it be private is just as important. I think that is part
of the beauty of having the sketchbook … you don't have to show it to anybody.” Another person
shared they occasionally display their art for others to see to foster connections, invite
dialogue/constructive critiques, but more so for the purpose of a visual reminder of their
accomplishments, and motivation for when they are feeling less productive.
Every person interviewed about their experiences with arts-based therapies described
feeling a sense of calmness or peace when creating. Several people acknowledged that feeling
relaxed enhanced their ability to think, feel ‘centered’, and express themselves more clearly.
Another participant stated, “Art helps train the brain to focus. Because you are doing something
pleasurable, that indirectly helps to focus and build concentration. It can help to regulate
emotions and find connectedness … with self and with others.” Another participant explained,
“It [making art] definitely helps you. If you … can't figure out what it is that you’re wanting to
do or … supposed to do ...doing something arts-based where you can just ‘shut your brain off for
a bit’ … allows your brain to just relax enough to process the minimum amount, and all of a
sudden, your brain ‘kicks into gear’.” Many participants expressed that engaging in art ‘put them
at ease’ and brought comfort when they were unsure of what to expect from treatment. One
participant said, “I feel better after doing art. I find it very helpful [and would recommend it]“for
anybody to find what it is that that makes them feel peace in the moment.” Another mentioned,
“[being hospitalized] could be really scary at first…[art] activities can … calm people down,
and even make people … laugh, smile, play… just put them in a good mood in general.”
Another interviewee expressed that by engaging in arts-based therapies, “You’re going to be in a
different mind space … Art makes me happy and joyful, and it gets me thinking positively, and
out of that dark, sad, sort of gloomy, depression state, and into the light.” Others emphasized

47
that creative therapies were an enjoyable ‘highlight’ of their treatment that gave them ‘relief’,
and “something to look forward to.” Another noted, “The calming aspect is definitely something
that really helps. It's like, ‘mindfulness’ … giving you some time to just ‘be free’, be present with
your mind, and have fun.” In addition to the therapeutic benefits of art for mental health and
recovery, many participants offered that art was a great leisure activity or ‘distraction’ from their
daily struggles and the monotony of being in hospital. One participant said making art “gives you
more things that make you feel happy” and is “something you do for fun.” Another person
explained, “Art is about playing”, elaborating, “It got us off the unit and allowed us to be in a
different mindset for the time being.”
Participants described enhanced feelings of empowerment based on the accomplishments
they were able to make creatively and in their lives. One participant noted, “If you have some
mental health problem … you tend to isolate and maybe give up on daily tasks. But when you do
some art, even if it is something small… you get results…. You are doing something…with your
life. Art makes me feel like even if I am not doing much… I can still have some results …that I
can see, that I can admire, that I can be proud of.” Similarly, another participant stated, “I feel
so much better. I feel like it [making art] increases your self-worth, that you were able to do
something and didn’t have to ask someone to help you.” They shared that working on something
creative helped them to ‘work through challenges’ and ‘feel good’ about themselves. When
asked how the other therapies differ from creative programming, one participant commented,
“Art is more of a relaxing therapy. You still have tasks and are thinking, but you are also solving
your problems at the same time.” The participant elaborated that non-arts-based therapies are
“focusing on problems, which has to be done, but it's more…negative and problem focused. Art
is more expressive and positive. [Art -based therapies use] unique ways…showing me that by

48
using my capacity to create, I am able to get past my stumbling points and show that I can do
things. It doesn't matter that I have a medical condition or several, it just means that I have to
think about things in a different way. I may have to do things in a different way, but I could still
create something. It might not make sense or be exactly what I wanted, but it's something that I
am happy with, that I have created. The art therapy is something that you're actively doing
yourself … because you are an active player in the process.”
In addition to responses of ‘finding their voice’, increased self-awareness, and feeling
‘more understood’ by others, many participants also reported enhanced verbal and non-verbal
expression using art, such as “how to tell a story, …emit feeling and emotion, storytelling and …
an ability to communicate with a mass audience.” One participant noted, “Expression is one of
the positive outcomes. [Art] allows you to… say things that you wouldn't know how to say with
your own words.” Another individual shared, “I know a lot of times when I make art, I’ll start it
off as just being like purely aesthetic and then as I'm working through it, I'm like adding
elements that are, you know, based on my own life, and then slowly it just becomes a personal
representation of how I'm feeling.” Another person reflected, “I think my coloring wasn't
anything extravagant, per se…but it just allowed me to… just express how I was feeling… to
express who I truly am.” While all individuals who participated in this study discovered an
increased form of internal self-regard or confidence from engaging in arts-based practices, many
described a different type of validation when their work was recognized by others. One
participant shared, “I definitely feel that there's this outward validation that I received [from
making and displaying artwork]. So … someone else commenting ‘that is so awesome’… even if
it's a nurse who is saying that cause they have to {laughs}…sometimes like that is even just
enough.” They noted, “It aids in that self-esteem… ‘look how far I've come from that project’ or

49
… because they have put it up [on display] or there are other people complimenting me or my
art.” Another individual described a similar experience related to an opportunity to work on art
conservation projects in their community sharing, “When people came by and took photos, I felt
so proud to be part of such an amazing project [restoring a cultural building]. And anytime I go
... I want to take a look … ‘hey I did that’ … that was my project alone … it's pride.”
Experiencing boredom, repetitive routines, and ‘playing the waiting game’ were three
complaints repeatedly referenced by in-patient study participants. Many of the individuals
interviewed shared frustration with the lack of activities available on the units. Aside from
appointments with healthcare providers, patients felt they had a lot of unstructured time and little
resources to engage in anything of ‘real value or interest’. A lack of engagement was especially
apparent throughout the Covid-19 pandemic, due to increased strain on resources such as space,
budget, and restrictions on visitation/off-unit passes and/or privileges due to requirements for
physical distancing and regular cleaning and disinfection. The aforementioned factors
exacerbated participants feelings of isolation and boredom which worsened mental health
symptoms, creating a ‘vicious cycle’ from interviewee perspectives. Many participants turned to
creative therapies to cope with boredom, frustration, loneliness, emotional dysregulation and/or
other distressing symptoms. One participant stated, “I find when I'm not in art [programming]
and focusing on one thing…I am going to one thing, then the next and so there's no resolution
anywhere…. like an endless game of waiting that feels awful … I know that a lot of the other
patients are experiencing that.” Another participant commented, “When you are doing
something that is positive, and you're creating something, you're utilizing your brain capacity
[constructively] … because you could be generally just doing nothing … like sitting there
watching TV for hours on end. For sure it's better to be doing something than it is to do

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nothing.” Another person explained, “making sure that you are able to make the connections
[from therapeutic group activities to applications in daily life] and able to use your power to
work forward, rather than just sit there because…[otherwise] you're just at a standstill, you’re
static. [Art] does help me process my emotions, [and] gives me a present focus.” Another
individual stated, “It is more productive if you are creating something. If you are spending your
time in a wise manner. Art … is an easy way to do that.” Several people explained due to the
nature of the units’ daily routine, there were many times that they were kept waiting between
appointments or tasks that could be used more productively. Many participants described ways
of adapting creative activities for mobile and convenient use during hospitalization or use in the
community. One individual detailed they often carry around art supplies and find it helpful to use
them while waiting for various activities throughout their day. Another individual commented,
“It is better to pass the time doing something you like doing than waiting there for the next
person to visit or your doctor. If you are not doing art, you could seriously just be sitting there…
waiting and waiting…for whoever you have to see… turning your brain to jelly and mush.”
Most of the people interviewed noted a feeling of independence and empowerment when
it came to making the choice to engage in arts-based activities. Several individuals stated they
‘felt better’ when they had the option to attend group, and experienced heightened confidence in
their ability to make choices regarding what project to work on or which materials used which
translated into other elements of their lives. Many disclosed that autonomy and self-assurance
were not feelings they often experienced during hospitalization, and that they resented having
‘every decision made for them’. One participant stated, “I feel so constricted by everybody
making decisions for us, none of them that we like… It’s a feeling of hopelessness … and it takes
a very strong person to even push over that and to be patient. I noticed that whenever I can make

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a decision … I feel more in control of my being.” Several people interviewed highlighted that
they appreciated the flexibility offered from staff regarding open invitations to attend arts-based
programming and the ability to determine which activities to engage in. Several interviewees
emphasized there are many things that they do not have any control over such as medication
administration and associated side effects, being diagnosed with a mental illness, appointment
scheduling, or treatment orders, so the ability to make decisions for themselves, regardless of
how seemingly small or innocuous such as the subject of their artwork, was ‘refreshing’ and a
‘boost to their confidence’. When asked how arts-based therapies contributed to their wellbeing,
one participant responded, “Because you have to choose your own brushes, you have to choose
your own colors. If you haven't been doing that in a long time, even that [choosing materials is]
an important skill to learn in life in order to make a simple decision … otherwise you're not
making any decisions here for yourself”. Several individuals described the ability to choose their
therapeutic activities, as opposed to something pre-determined by staff, was a motivating force
that often led to feelings of freedom, satisfaction with treatments, and accountability for future
decision-making. Another commented, “Confidence is the big thing…That's what [art] is
teaching me. I've learned it before, but I've learned again. I'm very grateful for that … I'm
making the decisions that are immediately seen and the way it feels. You are accountable to what
you are doing.”
Most individuals interviewed noted a connection between the use of arts-based therapies
as a coping mechanism for stress or other unwanted symptoms of addiction and mental health
challenges. One individual stated, “It [making art] just helps me cope with stress … from having
trouble at home with, say relationships or something like that. It gets me to take my mind off my
troubles.” Another shared, “It [being creative] helps you to relax when you're in the hospital

52
and maybe get your mind off of other things like a bit of an escape or a distraction.” Others said
engaging in groups or working independently on creative projects brought relief from anxiety,
depression, and sadness, and other uncomfortable emotions. Many participants described artsbased activities as a welcomed diversion from medication side effects, rumination on negative
thoughts or distressing experiences such as delusions, hallucinations, self-harm and/or suicidal
ideation. When asked about what people who are considering joining arts-based therapies should
know, one individual shared, “I just want them to know that art can help you cope with your
stress and depression and remove some of your troubles.” Another participant emphasized the
importance of keeping an ‘open mind’ and advised others to not base art group attendance on if
they considered themselves a ‘good artist’. When reflecting on the impact of attending art group,
a participant who was approaching discharge from the hospital noted, “The one thing I really
noticed is [attending art group] brought back my want to do it more and to be able to use it as …
a positive coping mechanism. Where on evenings [previously], I might have binge watched TV,
or scrolled social media, or gone out drinking, I'm now thinking: ‘I was doing a lot of art at the
hospital, I want to do that again’. I am going to do some more painting at home and invite a
friend over [to paint].” Several participants distinguished art was a ‘healthier replacement’ or
‘better alternative’ to previously used and potentially harmful coping mechanisms. A few
individuals detailed their practice of using art to distract or replace time previously spent on
activities such as substance use, dysfunctional relationships, self-harm or risk-taking behaviors,
video games and/or social media.
Physical Health
This subtheme refers to how the participants spoke about art connecting to their physical
health. They spoke about sensations they experienced, overall fitness and conditioning. Several

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participants highlighted the tactile significance of arts-based therapies, specifically the ‘mind body connection’. One participant shared, “That sensory or grounding effect is huge… I think
[physical elements of art] are really good because … it gets you out of your mind, [and] more in
tune with your body.” Almost all participants commented that making art engaged multiple biopsychosocial experiences which were interconnected and influential over other areas of life. For
example, one interviewee commented art is a “very active thing. It gets you physically involved,
mentally focused on what you're doing, and can be very calming.” Another explained, “It [art]
gets people doing activities when they otherwise would just be …laying in bed all day. I would
say that [art is beneficial] not just for your mental health, but for your physical health as well …
gets you breathing, helping with … blood flow, blood oxygen levels to your brain, and that can
definitely help improve your thoughts and … how you're feeling.” Many participants mentioned
they experienced decreased ailments such as nausea, pain, or medication side effects, and
attributed boosted energy, mood, and better sleep, to active participation in arts-based therapies.
Several people commented on the experiential aspect of making art as therapeutic, describing a
‘power’ in using one’s own hands to create and engage with materials in a sensory-focused way.
Another participant emphasized the versatility of arts-based therapies to engage a diverse
spectrum of people with varied physical abilities, interests, and attributes. This individual
expressed their view of art as an extremely person-centered and adaptable therapeutic modality
to individual needs and capabilities, supporting an inclusive approach not always possible with
other types of treatments. From their perspective, arts-based therapies are more engaging and
easily modified to meet the needs of people with various sensory, physical or psychological
disorders and have the potential to “include people that would otherwise be totally excluded from

54
these activities”, minimizing potential for relapse, feelings of isolation, or other symptoms
reminiscent of poor mental health.
Other participants described their belief around the healing power of physical touch.
They shared people with addiction and mental health challenges had decreased physical
interactions with others due to stigma because of mental health challenges, likely experiencing
sensory stimuli differently than most people. Several participants stated they believed therapeutic
art materials could be useful as a supplement to lacking physical contact with others, as
participants could benefit from the tactile experience of creative activities. One stated that it was
important to allow people the ability to experience the sensations felt during the use of various
art materials. This participant recalled several meaningful exercises using clay, plasticine, and a
type of ‘slime’ their therapy group made which could be shaped and molded as a sensory tool, as
well as experiential activities such as fingerpainting or soothing repetitive motions used for
knitting or other textiles. Another participant suggested making art is like “giving self-care to
oneself. The doctors or nurses can help, but it's something that touches something on a different
level. A lot of people probably … haven’t had a lot of touch … they haven't had that sense of
warmth. Maybe people didn't have a lot of affection, or maybe they experienced abuse … having
those grounding sensations or feelings might comfort them.”
Emotional Health
This subtheme refers to an individual’s mood or general emotional state and can include
the ability to recognize, express, and regulate feelings and/or memories effectively. Participants
shared engaging in art reminded them of relationships with loved ones, particularly family
members such as children, a spouse or romantic partner, or parents/grandparents. Most
participant responses described positive, ‘happy’ memories spending time with loved ones,

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reminiscing about relationships, or recalling skills passed on to them related to family traditions,
holidays, or customs. Some responses included nostalgic themes including childhood memories,
family interactions, educational, religious, cultural, or community experiences related to specific
crafts or activities. However, most of the participants interviewed disclosed they had few close
relationships and struggled with loneliness and isolation. One individual shared, “I've had lots of
[mental health]diagnoses…It has left me really isolated and alone. I feel like I'm an invisible
person”. A few individuals shared that making art occasionally brought up difficult emotions
such as grief, regret, remorse, or loss. These participants mentioned creative projects were
mostly enjoyable but could trigger feelings of missing a loved one, especially if the individual
who had introduced them to art had passed away, lost touch or were physically or emotionally
separated. Other participants shared art was a way to connect with others and being creative was
often used as a strategy to cope with losses or a distraction method from distress. Another
individual mentioned they did art as a way to honor the memory their grandmother who had
introduced them to many creative outlets because it “makes me feel close to her.” Other
participants seemed to feel remorse or regret related to missing out on opportunities to share artsbased activities with loved ones. When asked about past experiences with art prior to
hospitalization, one interviewee shared it was difficult to think about as those were “things I
should have done with my son.” Negative connotations such as uncomfortable memories or
feelings of guilt or sadness related to arts-based activities were a rare occurrence in responses but
worth noting for resource planning and client support in clinical settings. Some participants
described art as a mechanism to ‘work through’ emotions, release built up tension or
inadequately expressed thoughts and feelings. One individual stated, “I definitely find that it
[art] aids in recovery; letting out what is inside.” Others shared making art was cathartic and

56
allowed for opportunities to ‘get things off their chest’, ‘out of their head’, and on paper or
canvas. Another mentioned, “Coloring helps me just let out the emotions that I am carrying … I
just struggle with letting the words that I want out. Coloring allows me to release those
emotions. When I color it's almost like all the emotions I’ve been feeling, just sort of disappeared
... it erases all the cares… in the world I have … bringing me back to reality.” Another person
explained, “Art helps with ‘feeling your feelings’ and processing them. It takes the pressure off.
It helps release tension in the mind and body” versus ruminating on distressing memories or
experiences.
Spiritual/Cultural Health
Participants verbalized a connection between creativity and their cultural identity and belief
system. One participant described an Eastern philosophy of ‘connectedness’ between creative
practices and ‘being one with nature and the universe’. Another individual did not ascribe to a
particular belief system but noted feeling a connection to a ‘higher power’ by making art sharing:
“You are going to feel ‘yourself’ more. It is very spiritual. It's really magic. It helps ground me
back down. It just gives me a sense of security.” Others described a ‘bliss-like’ state, often referred
to as ‘flow’ in Positive Psychology literature. One participant described their perception of flow
as, “A very healthy thing for the brain, but also just a very … cool experience to be in, [where]
hours start passing away. A very meditative and calming experience.” Every person interviewed
about therapeutic art referred to a lifetime process of self-discovery, experimentation,
development, and exploration. One interviewee reflected, “It's a lifelong journey each person will
experience differently.” One person mentioned art has helped them to “think more [like a]
‘Buddhist’… If you think of the Tibetan Buddhists, they do those sand mandalas. They make
beautiful stuff, and they know that it's the process, it is not the end product…[which] is just going

57
to get swept away. I tried to see [things from that perspective]. They [Tibetan Buddhists] never,
ever put a signature to their art.” This participant elaborated that forgoing the need to sign artwork
allowed for a decreased sense of ‘ownership’ which permits the maker to experience the freedom
of ‘letting go’, ‘forgetting’ painful memories, and to experience ‘forgiveness’ of self and others.
Another noted, “It’s an individual journey … it belongs to you. So, as you develop it, as you grow,
it's proving something to yourself, for yourself. I think this is one of the most powerful forms of
growth.”
When examining the spiritual and cultural aspects of arts-based therapies, the topic of
mindfulness often came up in conversations with participants. One individual stated, “You are
doing mindfulness when you are doing art.” Another noted that art “works better for me as a
mindfulness practice because [painting] is something to focus on so that I can take my mind off
of everything else. [With traditional] mindfulness, there is no distraction. You are removing all
types of distraction and therefore you start ruminating and focusing [on negative thoughts].
[Making art] removes rumination for me. It allows more creativity for me … which opens up
pathways … for problem-solving. If a situation comes up, rather than being stubborn and stuck
in one way, it allows me to be more creative in what I can do to solve something for myself. It is
mindfulness for me. It allows me to clear my mind, [focus on] whatever in front of me is being
created and therefore, I don’t ruminate. I think that [art] opens up that pathway for me, [and
for] using that skill in other situations.”
Several participants connected the use of arts-based therapies to an increased sense of
hope, identifying their creative practice as a protective factor against suicidal ideation and/or
self-harm behaviors. Many individuals shared art assisted them in feeling hopeful ‘things would
get better’ and attempt to achieve an ‘uplifted mood’ and find ‘balance’. One individual stated,

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“Without art, I am totally ‘off”. Without [art] it felt like … a living hell … because I got more
depressed. [If I had maintained creative practice] I would not be here [hospitalized] and I would
not be here [would have taken their own life].” Another person explained making art “allows me
to relax, let go of tension that I might be holding on to due to stress, anxiety, depression. I have
in the past struggled with suicidal ideations, which is why I was in the hospital. When you
experience [distressing feelings] you not only mentally experience it, but you physically
experience it. You get like the tight shoulders and pain in your neck, lower back… but when you
do art …and have some quiet reflective time, it allows your body to relax and that really helps
disperse and get rid of a lot of sadness.” When discussing the impact of art on hope, one
individual commented, “I think art, in all forms, writing, music, whatever it is, …it saves
people’s lives. It really, really does.” Another stated, “[Art has] been a lovely secret that has
kept me alive during such dark spells in life. When people are really in the depths of darkness,
feeling extremely suicidal, they’re very depressed. They’re even terrified. They are here [at the
hospital] because they need help. Art can be not only the light to turn on, but it can also be the
ladder to climb out of the dark…” Another individual described their use of art as an outlet to
‘work through’ the past stating, “It was really about processing trauma and transforming it.”
Enhanced Connection with Others Through Artistic Practices (Interpersonal)
The second theme to emerge from participant responses regarding arts-based therapies
and mental health recovery was the perception of improved interpersonal relationships and
connection with others. Interpersonal relationships are associated with a person’s social health
and individuals who engage in socially healthy relationships typically possess valuable skills
such as the ability for effective communication, problem-solving, and empathy through
collaborative interactions with other people.

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Social Health
This subtheme refers to the participants’ capacity to initiate and maintain meaningful
relationships with others and expressions of associated benefits such as a sense of community
and belonging, decreased stigma, and increased feelings of pride, acceptance, confidence, and
empowerment. Both individuals that aspired to working in creative fields in the future found that
monetary payments from creative work afforded them some financial independence, and fostered
a sense of pride, personal satisfaction, independence, and outward validation from others for
their efforts. Other participants described feeling closer to their birthplace, culture or family
origins through various creative practices and traditions. All participants interviewed perceived
better relationships with others within and outside of arts-based groups because of their
involvement in creative activities. One participant stated, “It's about the art itself, but it is also
about that social connection, meeting with other people, positivity and learning from them …
appreciation of what they're doing … a continual reaffirmation for everybody…personally and
socially.” Another stated, “I pushed a lot of people away. So, I am very alone right now. I'm not
lonely when I'm creating art. I'm going to do whatever it takes to not be lonely... I've been so
isolated because my mental health has been declining so badly.” Many people interviewed noted
a positive bond to their art facilitator, fellow group participants, and those who observed their
artwork including co-patients/peers, friends, family and community members. Other responses
referred to profound personal growth and reduced experiences of stigma while engaging in artsbased practices. Several people said they felt more understood by others, and more ‘open’ to
understanding others. Many participants recalled using art to receive support and acceptance
from others. One participant stated, “I really feel like doing art makes me feel better … more of a
human being. Sometimes when you have a mental condition, you are labelled with that condition,

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[it] kind of sticks with you and makes it so that you don’t feel normal. The ‘normality’ of doing
art is something that [helps me] feel more normal.” Others described a heightened awareness of
similarities to others and a deeper appreciation for diversity through sharing artistic
interpretations. One person commented, “I made it a point of noting that people were doing
something creative in a group setting … in the same atmosphere but creating so many different
things … The color, the palette, the subject, the meaning …you wonder what it means for them.
You also want to understand what you’re doing … when you hear other peoples’ answers about
the painting, you feel more understood. You want to feel understood and supported, and do,
especially when they ‘get’ or guess what you think.” Many shared that working beside other
artists with mental health challenges helped them to feel empathy because they have experienced
similar challenges and did not judge or discriminate against them. Almost all study participants
shared they felt ‘different’ from others due to their mental health diagnosis, symptoms, or related
behaviors which negatively impacted their social interactions. A few shared they were treated
poorly and often excluded from groups in the community due to their illness, leading to isolation
and loneliness. Others felt misunderstood due to stigma, discrimination, or their own inability to
communicate effectively with others within and outside of the hospital setting. One person
stated, “I don't feel like I'm on the same level with people anymore because I know I'm not. I
have friends who ‘get’ what I am saying, and then you are with other people … they're talking
about something that makes you uncomfortable. I'm hoping …by joining… a group with likeminded people…. I can be with people that resemble me because I have a really hard time with
identity.” Others shared that they were ‘their own worst critic’ and experienced feelings of ‘selfloathing’ because they were ‘not as good as others’, did not ‘fit in’ with peers, or meet society’s
expectations of ‘who they were supposed to be’. Another person shared finding like-minded

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people in art groups helped them accept themselves to a greater extent and gave them courage to
‘try something new’, ‘put themselves out there’ or ‘be inspired’. Another stated, “The nice thing
about artists … there isn't that criticism that we do towards ourselves. The other artists are very
supportive and uplifting.” One individual shared they had received more support and
encouragement from the group facilitator and other group members during hospitalization then
they had from friends and relatives their whole life, stating: “The positivity that [other
participants] contribute back is really helpful so that things really become a lot less negative.”
Many of the participants interviewed described the positive outcomes of attending art groups as
being beneficial to their self-perception, self-esteem, perceived value, and self-confidence. One
participant noted, “People admire you and your work, and it gives you confidence. [It] builds
you up and gets you involved … helps you to become a part of a community and it gives you
opportunity.” Others described having a better sense of ‘who they were’ due to enhanced selfreflection and self-expression through chosen imagery and artistic exploration. When asked
about the experience of creating art independently and within group contexts, one participant
shared, “Group environments can work well, to just find little parts of yourself that you didn't
realize you were good at … that's the piece you take away when you’re healing a wound.” Many
participants described feeling more productive around other artists who they had developed trust
and rapport with via constructive criticism and encouragement which reinforced feelings of
accomplishment and pride. One participant stated, “The social support… [has an] impact on
your confidence or self-esteem, whether that's… your confidence as an artist, or maybe
something else. I’d say it definitely gives me some confidence when I'm working hard, and I
know I am making good art you know … it just feels good.”

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Most participants described arts-based groups as a way to seek companionship,
strengthen existing relationships, and/or initiate new relationships. Many suggested that art
helped them to feel closer to their spouse or family members, or an opportunity to meet others.
One participant explained, “That is how I made some friends here, through the art sessions.
Sometimes if people are struggling with their mental health, they are going to isolate away from
people. But if they are willing to [join]…an art group or any kind of group, they can make
friends and meet other people who enjoy the same things they do, as well as have a similar
background or understanding of what they are going through.” Several individuals mentioned
they prefer to make art alone but appreciate when other people see their work and want to engage
about projects. One mentioned, “[Art] helps to start a friendship, or even just get you talking to
someone… they’ll compliment you on your art and then you know, you've got a common interest
… or maybe they don't like art, but they're interested in your hobbies and seeing the work that
you've done.” Another said, “Art is good because it gives others something to come and talk
about, open up with, and [improve] mood.” Another offered, “[Art] brings somebody else into
your own zone. If you are sharing your art, it brings a sense of intimacy. I think if you are
intimate with your art ... that opens you up to be intimate with others or be able to listen or hear
others. You can do that for yourself. You can help others do the same. I have noticed [art] has
only positively affected my relationships.”
Another reflection from participants was the bond between people being creative together
and the positive feelings experienced when making something for others. One individual
described a “sense of pride when you give what you have made to somebody that was handmade,
or something you keep for yourself … to brighten the room or remind you of whatever struggle
you have overcome.” Many participants mentioned that gifting artwork was a special way to

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thank someone, commemorate an event or milestone, or simply to let someone know they were
thinking of them. Participants said giving away art was a special and affordable way of showing
appreciation. One commented, “If you are not working, you have no money … you can still
express your appreciation to someone through art. That is the best option rather than going
shopping, which is stressful … especially around the holidays. With Christmas coming up … I
am looking forward to making all of my Christmas gifts and being able to use that as an outlet …
art therapy for myself, [and] as a way to show gratitude to others.” For others, sharing creative
projects with someone else was useful to boost their own mood and ‘feel good about giving’.
One participant noted, “just giving away art knowing that you brightened someone's day.”
Enhanced Connection with Environment Through Artistic Practices (Setting)
The third and final theme of this study’s findings is the importance of creating a
comfortable and effective therapeutic atmosphere, comprised of physical and psychosocial
components to facilitate connection with self and others. This theme relates to the literal and
figurative elements necessary to enable a therapeutic setting conducive to creative exploration,
self-expression, and supportive of holistic health to foster meaningful engagement and recovery.
Physical Setting
Participants provided insightful feedback for making the physical setting more inviting
and conducive to arts-based participation at the hospital. Every interviewee preferred engaging in
arts-based therapies in a ‘less-institutional-like’ environment, favoring arts-based therapeutic
settings to be as ‘home-like’ as possible. Most of the participant comments were related to
ensuring the designated area was well lit and maintained at a comfortable temperature. Many
people interviewed commented they appreciated natural light afforded by windows, which also
was noted as a source of inspiration due to potential natural scenery. Participants noted a clutter-

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free area with clearly labelled and organized storage for a wide range of art supplies, including
access to an easel/table and a tap/sink, was optimal for engaging in arts-based therapies. Several
individuals commented they preferred an ‘open concept’ space with areas for individual and
group work, comprised of comfortable seating and standing options depending on size and style
of art project. Participants mentioned they enjoy the ability to have access to music and/or other
audiovisual media for inspiration, artistic reference, and to facilitate a more informal and relaxed
environment to create their art and promote engagement with others. The majority of individuals
interviewed preferred a centralized location. Participants noted getting off of the unit was
‘something they looked forward to’ and was perceived as an opportunity to ‘get away’ from the
noise and ‘clinical feel’ of the inpatient treatment area, meet others from the same or other areas
of the hospital to ‘network’, ‘find inspiration’, or ‘expand support circles’. One individual shared
that being able to leave their in-patient unit helped them to ‘feel normal’, and to ‘see [copatients] and be seen in a new light’, away from the ‘labels of their diagnosis’.
Psychosocial Setting
Similarly to physical environment responses, participants provided constructive
suggestions for enhancing the psychosocial setting of arts-based therapies to promote comfort
and engagement. Participants alluded to the importance of creating a ‘safe’ and welcoming
environment, advocating inclusivity for all ranges of skills, abilities and experience levels
regardless of socioeconomic status, diagnosis, age, gender, ethnicity or background. Participants
identified that for an arts-based therapy group setting to be effective, the environment had to be
inviting, supportive, encouraging and provide an atmosphere of ‘non-judgemental acceptance’,
especially for new members or those less confident in their artistic and/or social skills. One
participant noted that creating a positive atmosphere for people to participate in creative

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therapies is necessary for the success of the program, acknowledging there will be more interest
and ‘buy in’ if the arts-based activity is offered in “a place they want to come, versus somewhere
they unfortunately have to come.” Participants did not elaborate on specific strategies for how to
foster a positive environment, but several discussed the need for skilled facilitators to ‘set the
tone’, answer questions, provide guidance and be responsive in social cueing if needed, to ensure
adherence to pre-determined ‘group norms’ and mediate appropriate behavior and redirect
inappropriate behavior. Participants elaborated that the facilitator should be proficient in working
with individuals and groups seeking addiction and mental health services, as well as demonstrate
knowledge and skills in diverse artistic methods. Several participants noted that having an
approachable, flexible, understanding, empathetic, and enthusiastic facilitator is more important
to their recovery and treatment experience than having access to a ‘professional artist’.
Conclusion
Three themes emerged from participant interviews regarding client experience with
participatory arts-based therapies in mental healthcare: Enhanced connection with self, others,
and environment through artistic practices. Participants described the positive multi-faceted
impact arts-based therapies had on their recovery citing enhanced intra and interpersonal
relationships and improved holistic health. Participants described increased engagement with
their care and community partners such as improved interactions and strengthened relationships
with peers, family and friend networks, and healthcare providers. Participants also described
experiencing increased comfort in navigating therapeutic spaces in clinical and community
environments including physical and psychosocial settings. Significantly, these thematic findings
suggest arts-based therapies in mental healthcare appear to facilitate holistic recovery by aiding
enhanced connections with self and others which can influence and support ‘quality of life’.

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Chapter 5: Discussion
The benefits of art-based programming as a mental health treatment modality are well
documented in professional literature (Saunders et al., 2000). Yet, the acceptance and application
of creative interventions in psychiatric services has been impeded by criticism related to claims
that there is insufficient evidence to quantify use and questions around practice relevance
(Feldman, et al., 2014; Hanevik et al., 2013; Murray, et al., 2017; Van Lith, 2014; Van Lith,
2016; Van Lith et al., 2013). Regardless of abundant sources indicating the usefulness of artbased therapies in psychiatric treatment, the majority of available studies indicate a need for
more thorough research to prove therapeutic value of art-based therapies in mental healthcare,
particularly from the perspective of service-users.
The purpose of this research study was to assist in filling the gap in literature by
exploring the research question: “What are the experiences and perceptions of psychiatric
patients engaging in arts-based treatment for mental health recovery?” Despite the scarcity of
literature addressing the impact of art-based therapies from a patient’s perspective, available
research has demonstrated that the promotion of art-based programming has a strong relationship
to positive outcomes in mental health treatment and individual recovery, as well as familial,
organizational, and professional contexts. Most of the occurrences described in participants
responses from this study were reflected in current literature on the subject, which strongly
favored the use of art-based therapies to support optimal mental health and holistic wellbeing.
This study’s findings serve to strengthen the existing evidence to support acceptance of art-based
therapies as a legitimate treatment approach in mental healthcare. By better understanding the
perceived use of art-based treatments from the perspective of service-users, researchers and
clinicians can better recognize the potential impact creative therapies can have on patient

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recovery and act towards enhancing current and future practices required to support and maintain
optimal health. The fundamental components of mental health recovery directly align with the
experiences of study participants using art-based therapies in mental health treatment and are
reflected in numerous studies on the subject. The discussion findings from this study will be
organized using the ten principles of the recovery model: holistic, self-direction, individualized
and person-centered, empowerment, non-linear, strengths-based, peer support, respect,
responsibility, and hope (National Alliance of Mental Health, 2022). Current literature on
recovery also refers to the challenging process of personal growth and the journey towards
wellness through overcoming obstacles such as symptoms, disability, and the stigma of mental
illness, in order to lead a fulfilling and contributing life (Deegan, 1988, NAMH, 2022,
SAMHSA, 2004; Van Lith et al., 2011; Van Lith et al., 2012).
Holistic
Recovery is referred to as a journey of healing and transformation which enables people
with mental health challenges to live a meaningful life in a community of their choice, while
striving to achieve their fullest potential (SAMHSA, 2004). Recovery encompasses the entirety
of an individual’s life, including mind, body, spirit, and embraces all aspects of life such as, but
not limited to housing, social networks, employment, education, and general health care
treatment (Farokhi, 2011; Hoenders et al., 2011; Kessler et al., 2001; Kuhlman, 2002; NAMH,
2022; Schulz et al., 2018; Sharma et al., 2013; Simon et al., 2004; Unutzer et al., 2000; Van Lith,
2014; Van Lith, 2016; Van Lith et al., 2011). The concept of holistic health was interwoven
throughout the study findings three themes: Enhanced connection with self, others, and
environment through artistic practices. Participant responses highlighted the importance of
maintaining one’s holistic health condition, including intra and interpersonal relationships. As

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reflected in the literature, participants shared that engaging in arts-based therapies allowed them
to be more aware of their current functioning and assisted them to expand on their abilities by
working towards future goals (Lloyd et al, 2007; Scope et al., 2017). Psychologically, study
participants described creative therapies to be beneficial in cultivating increased confidence,
concentration, mental capacity and enhanced cognitive function through improved thought
clarity, comprehension, memory, and problem-solving skills (Hacking et al., 2008; Lloyd et al.,
2007; Scope et al., 2017; Van Lith, 2014; Van Lith, 2016; Van Lith et al., 2011). These findings
align with recovery literature as participants noted increased ability for self-acceptance,
engagement, and improved mood as a result of engaging in arts-based treatments (Kennedy,
2019; Lloyd et al., 2007; Nainis et al., 2006). Findings also matched current literature which
demonstrated the use of art-based practices were perceived to decrease boredom, negative selftalk, and other distressing symptoms of psychiatric illness (Deegan, 1988; Van Lith, 2014; Van
Lith, 2016; Van Lith et al., 2012; Van Lith et al., 2011). Physically, participants noted an
improved connection to their body due to the experiential and tactile nature of engaging in
artistic practice. These findings aligned with literature on the subject as participants described
feeling more ‘grounded’ and ‘in-tune’ with the ‘mind-body’ connection (Hanevik et al., 2013;
Lloyd et al, 2007; Scope et al., 2017; Saunders & Saunders, 2000;). These findings were
significant as enhanced patient motivation to participate in individual and group art projects
translated to other treatment and life activities. Study findings fit with current literature (Hanevik
et al., 2013; Lloyd et al, 2007; Scope et al., 2017; Wright et al., 2017) as participants noted an
improvement in energy levels, dexterity and hand-eye co-ordination, and decreased focus on
troubling bodily symptoms or psychotropic medication side effects such as tremors, pain, and
nausea (Deegan, 1988; Van Lith, 2014; Van Lith, 2016; Van Lith et al., 2012; Van Lith et al.,

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2011). These findings were important as decreased symptoms improved emotional regulation
and increased empowerment through actively working towards treatment goals in collaboration
with the treatment team. Reflecting on available literature on the subject, art-based therapy aided
participants in deeper connection to themselves, loved ones, and fellow artists, which led to
greater emotional resilience and healthier coping mechanisms. The ability to engage in art-based
treatment (as opposed to negative coping mechanisms they had used in the past) assisted patients
to take important steps towards improving their holistic health. A minority of participants
disclosed art-based therapies occasionally brought up unpleasant emotions of loss or grief related
to past traumas or strained relationships, a finding seldom mentioned in literature reviews. While
this was a rare experience for most of the participants, it is important for facilitators of art-based
therapies to regularly assess and be prepared to provide support for the potential needs of
participants via individual conversations, multi-disciplinary care planning and/or other support
services. Participants perceived a better appreciation of spiritual/cultural health through artistic
exploration of self-identity and a deeper connection to familial/traditional practices which was
emphasized in related literature (Körlin et al., 2000; Wright et al., 2017). These findings were
significant to treatment of patients working towards goals of self- acceptance and improvement,
processing trauma, or seeking mechanisms for avoiding distressing thoughts of self-harm or
suicidal ideation. Social health will be discussed in an upcoming section of this summary.
Self-Direction
Individuals are empowered to determine their own recovery path through choice,
autonomy, independence, and control of their resources (NAMH, 2022; Scope et al., 2017). The
topics related to self-direction were frequently addressed by study participants related to
collaboration with the healthcare team in determining care and reflected in available literature.

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Study findings alluded to participants experiencing greater empowerment and autonomy because
of the ability to choose the subject, materials, and method of artistic expression, commonly
referenced in related literature (Hanevik et al., 2013; Lloyd et al, 2007; MHCC, 2009; Saunders
& Saunders, 2000; Scope et al., 2017). Study findings described promoting participants’ ability
to determine their own therapeutic activities was key to successful programming. As echoed in
available art-based literature, having the choice to participate or not, was considered ‘refreshing’
in the structured inpatient psychiatric environment, often perceived to be overly regimented.
Though many study participants shared they understood the purpose of routine and establishing a
sense of order in an acute psychiatric hospital setting, they felt a negative impact on engagement
and recovery. Conversely, as established in related literature, participants felt that having options
for involvement during art-based therapies had a positive impact on their participation and
recovery (Hanevik et al., 2013; Körlin et al., 2000; Lloyd et al, 2007; Saunders & Saunders,
2000; Scope et al., 2017; Wright et al., 2017).
Individualized and Person-Centered
There are many pathways to recovery based on each individual’s unique strengths,
holistic health and wellbeing needs, preferences, experiences, and spiritual/cultural backgrounds
(Anthony, 1993; LeCharrois, 2012; LeCharrois, 2013; NAMH, 2022). Study findings described
patient appreciation for the variety and adaptability of art materials and methods in therapy,
particularly the flexibility to work on projects for varied durations and frequencies based on
personal preference. As emphasized in literature on the subject, participants felt the versatility of
arts-based therapies led to increased comfort levels and decreased barriers to participation due to
customizable options for involvement and ability for personalization of projects (Scope et al.,
2017; Van Lith, 2014). Study findings described the benefit of being able to start, stop, or

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redirect participant energies as needed, based on staff and self-assessments of their work.
Findings from this study and available art-based literature implied that despite choosing to work
on a project within a group environment or theme, participants were sufficiently able and
encouraged to adapt and modify their work methods to best support their unique skill, interest,
and energy levels, resulting in increased engagement and positive recovery outcomes.
Empowerment
Recovery-oriented and arts-based literature acknowledges that mental health service
users have the power to actively participate in care-planning options that will affect their lives as
a partner in care and are entitled to be educated and supported in the decision-making process
(Lloyd et al., 2007; NAMH, 2022; Scope et al., 2017; Van Lith, 2014; Van Lith, 2016; Van Lith
et al., 2011). Echoed in art-based literature, study findings emphasized the patient benefits of art
including developing new skills or maintaining momentum in creative practices, transferrable to
abilities needed in day-to-day life and future goal setting. Findings from this study are similar to
related existing literature and demonstrate that engaging in art is applicable to building
momentum in non-art-related tasks and development such as initiating new relationships,
advocating for oneself in social or employment settings, or pursuing other interests (Hanevik et
al., 2013; Lloyd et al, 2007; Saunders & Saunders, 2000; Scope et al., 2017). The importance of
these findings are linked to increased participant self-assurance that accompanied overcoming a
challenge, and the newfound ease of engaging in a skill or technique that they had previously
found challenging, which was described as ‘empowering’ and ‘confidence-boosting’ for
recovery outcomes.

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Non-Linear
Recovery is not a step-by step linear process, rather one based on continual growth,
occasional setbacks, overcoming challenges, and learning from experience (Blomdahl et al.,
2016; Malchiodi, 1998; NAMH, 2022). Study findings describe participants as experiencing a
combination of progression, stagnation, and/or regression cycles in their artistic, mental health
and associated recovery journeys. Findings suggest art-based therapies are supportive of nonlinear recovery as creative projects are versatile and can be adapted, modified, and revisited to
meet whichever stage of recovery one is experiencing. The ‘fluidity’ of creative treatments is
characterized as a major benefit of participation, as anyone can engage in some form of creative
practice almost anywhere at any time, regardless of diagnosis, symptom experience, artistic
talent, or demographic. Findings from this and other art-based studies emphasize that individuals
must be given freedom of choice to initiate, pause and/or re-engage with art-based therapies
when appropriate for their life circumstances to promote non-linear gains in their recovery
process (Hanevik et al., 2013; Lloyd et al., 2007; Van Lith et al., 2011).
Strengths-Based
Recovery focuses on building upon the multiple strengths, capacities, resiliencies, talents,
coping abilities, and inherent worth of individuals over personal deficiencies. The process of
recovery moves forward through interaction with others in supportive, trust-based relationships
that value individual strengths and unique capabilities (NAMH, 2022). Common themes from
limited literature on psychiatric service-users experiences with art-based treatments include the
connection between creative practices and deepening ones understanding of self to improve
personal health (Lloyd et al, 2007; Scope et al., 2017). Findings from art-based literature
supported by this study demonstrate creative practices can enhance participants knowledge of

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their disorders and serve as a mechanism to increase awareness or absence of symptoms
(Hanevik et al., 2013; Saunders & Saunders, 2000). Additionally, participation in creative
therapies is a person-centered opportunity to develop strengths and abilities in art and other areas
of life, including recognition for areas for improvement which is relevant to improved personal
and therapeutic relationships and overall functioning (Hanevik et al., 2013; Lloyd et al., 2007;
Nainis et al., 2006; Scope et al., 2017; Van Lith, 2014; Van Lith, 2016; Van Lith et al., 2011).
Study findings noted similarities to content found in art-based research related to enhanced
patient self-awareness and ability to engage in relationships with others due to participation in
creative therapies, resulting in improved self-confidence, recognition of personal achievement,
enhanced self-expression, and exploration of healthy recreational interests that support holistic
wellbeing. These findings are significant due to the positive impact of healthy coping
mechanisms on patients seeking mental health treatment and feelings of empowerment towards
resilience on the path towards recovery.
Peer Support
In addition to the care and encouragement provided by family members and care team,
mutual respect and peer support play an invaluable role in social health and recovery. According
to literature on the subject, mental health service users encourage and engage one another by
providing a sense of inclusion and belonging (Hanevik et al., 2013; Körlin et al., 2000; Lloyd et
al, 2007; NAMH, 2022; Scope et al., 2017; Saunders & Saunders, 2000; Wright et al., 2017).
While emphasizing the importance of maintaining established relationships and community
supports, study findings accentuated a key benefit of arts-based therapies as the opportunity to
connect and interact with a peer group of fellow artists and mental health service users who
shared lived experience. Study findings noted a positive reinforcement between developing and

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improving interpersonal relationships with peers though art, which positively influenced patient
ability to initiate, maintain and improve relationships with loved ones and members of the public
outside of the hospital setting. Participants attributed enhanced interpersonal relationships as an
important factor that helped them to feel more ‘human’ and focus less on their mental health
challenges. This was a significant finding in assisting participants to overcome stigma and
discrimination related to mental illness and develop better inter and intrapersonal relationships.
These findings were relevant to the literature on the subject of art-based treatment in mental
healthcare which emphasized the perception that creative therapies assisted them in being better
understood and able to understand others, as a key component of recovery (Lloyd et al, 2007;
Van Lith, 2014; Van Lith, 2016).
Respect
Eliminating stigmatizing discrimination and fostering self-acceptance by regaining belief
in oneself are particularly vital elements of recovery (NAMH, 2022). The importance of respect
for self, others and the care environment came up often in both art-based literature (Kennedy,
2019; Nainis et al., 2006; Saunders et al., 2000) and participant responses in this study.
Respectful engagement in arts-based therapies allowed participants meaningful opportunities for
self-reflection and acceptance, as well as facilitation of a deeper understanding from others
around mental health challenges in a safe, non-judgemental environment. Study findings
illuminated the importance of showing respect for shared art spaces and supplies through
maintaining a clean and orderly environment, showing consideration of the group facilitator and
other artists in the area, and demonstrating care for tools and other art materials.

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Responsibility
Mental health service-users have a personal responsibility for their own self-care and
collaboration with their treatment team, support network, and communities. Individuals can
progress in their recovery journey through active participation in their care, fostering healthy
relationships, identification of stressors, appropriate coping strategies and healing processes to
promote and engage in their holistic health and wellness (MHCC, 2009; NAMH, 2022). The
concept of responsibility was referenced in this study and related literature which described a
sense of participant responsibility to actively engage in collaborative treatment planning and
associated interventions and maintenance related to their care and wellbeing (Canadian Senate,
Section 3.2.1, 2006; MHCC, 2009; WHO, 2001). Study findings noted participants felt a sense of
responsibility to their friends, family members and larger communities in ‘getting and staying
well’ to the best of their ability, to positively contribute to society.
Hope
Hope is the catalyst of the recovery process and provides the essential motivating
message for a positive future and momentum towards achieving one’s potential in their path to
recovery. Hope can come from a multitude of sources such as internal and external support
systems involving beliefs, attitudes, environments and practices (NAMH, 2022). Findings from
from this and related studies on art-based treatment in mental health described experiences with
addiction, poor health, dysfunctional relationships, and previous traumas which led patients to
experience hopelessness that led to self-harm, suicidal ideation or other negative coping
mechanisms, challenging hope for the future (Deegan, 2001; Körlin et al., 2000; Van Lith, 2014;
Van Lith, 2016; Wright et al., 2017). Findings from this study mirrored art-based literature which
revolved around finding hope in mental health treatment, support from loved ones, the treatment

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team and other personal networks, despite challenging symptoms, stressors or strained
relationships (Körlin et al., 2000; Wright et al., 2017). Associated literature highlighted the use
of art-based therapies in conjunction with other health and wellness strategies, to combat feelings
of hopelessness related to a mental health diagnosis and/or symptoms and life circumstances
(Deegan, 2001; Van Lith, 2014; Van Lith, 2016). Study findings emphasized that participants
attributed a newfound sense of hope to active participation in creative therapies. Perceived
increases in participant feelings of hope were significant to engaging in treatment and success in
recovery because patients were motivated to ‘keep going’ despite adversity. Findings from this
study strengthened evidence in literature showing art-based treatments are an effective method
for developing a more optimistic outlook for mental health service users. Art-based therapies as
demonstrated in this and other related studies, can be a key feature in recovery, since being
creative is associated with improved mood, emotional balance, and self-regulation. The
significance of these findings demonstrates a connection to a reinvigorated participant belief in
themselves and abilities and serve to reconnect with themselves and surrounding support
networks in a unique manner not experienced in traditional therapies.
Drawing on recovery principles of holistic health, self-direction, individualized and
person-centered care, empowerment, non-linear, strengths-based, peer support, respect,
responsibility, and hope, the use of art-based therapies contribute to wellness for individuals with
addiction and mental health challenges. Through a lifelong journey of personal growth and
development, art-based therapies show benefit in assisting people with addiction and mental
health challenges as a mechanism for person centered treatment, developing resilience against
stigma, discrimination and assistance in overcoming life obstacles, to leading to a personally
fulfilling and contributing life in their communities.

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Study Strengths and Limitations
There were several strengths and limitations identified in this study. ID is a relatively
new and less widely recognized research approach, sometimes criticized for method slurring in
comparison to more traditional or commonly used methodologies (Thorne, et al., 2004; Thorne,
Reimer-Kirkham, O’Flynn-Magee, 2004). Less familiarity of ID methods may cause confusion
among researchers or practitioners who may not be as familiar with ID philosophies, though ID
is becoming a more widely accepted approach. The use of ID was considered a strength of this
study as the methodology allowed for deep exploration of rich patient experience descriptions
directly related to mental health treatment such as front-line usability and clinical practice
applicability over other more theoretical approaches. A potential limitation was that participants
could be viewed as being biased positively towards art. All participants in this study were
already engaged in some form of art prior to participation and therefore assumed to have a preconceived appreciation for art. As none of the participants were mandated to attend art-based
therapies as part of treatment, participants had chosen to attend art-based groups prior to
interviews and therefore were assumed to be invested in the idea that AT is beneficial or they
would likely not attend. Therefore, it may be inferred that participants believe AT has merit as
demonstrated by attendance alone. While the writer acknowledges this limitation, the purpose of
the study was to glean a deeper understanding of why, how and in what way participants
perceive the impact of participating in art-based treatment has on their recovery from a firstperson perspective to better inform and inspire future practice. Regarding future research and
programming, the researcher also acknowledges that not all individuals receiving treatment for
mental health concerns would enjoy, feel comfortable or be interested in engaging in art.
Furthermore, a modest sample size of eleven participants at a single site via a single interview

78
per participant (two shorter interviews in one instance) may be a limitation regarding
transferability, however, larger samples could be overwhelming, costly, and time-consuming for
a novice researcher, potentially limiting the depth and richness of findings (Thorne, et al., 1997).
As a neophyte researcher, the primary researcher was restricted to working independently with
no additional funding or assistance. Despite the limitations, the benefit of an independent
researcher was that both the interview and transcription process was completed by the primary
researcher, affording a comprehensive understanding and deeper familiarity of the material
through immersion in the data. A significant strength of this study was the increased level of
patient engagement which afforded data saturation to be reached. Additional strengths of this
study include exploration of inclusive, safe, budget friendly and easy to implement therapeutic
interventions that are engaging, clinically relevant, customizable and person-centered. The
experiences of psychiatric clients engaging in arts-based therapies present strong treatment
potential for holistic benefits with minimal risks. Using diverse opportunities, methods, and
mediums to accommodate a wide range of abilities and preferences, the focus of this study
highlights a first-person perspective not often acknowledged in available literature to better
inform, support, and inspire future creative practice and support holistic wellbeing and recovery.
The positive outcomes from conducting this research study are multifaceted and mutually
beneficial to service users, service providers and the greater community at large.
Implications for Clinical, Educational and Administrative Practice
Ensuring art-based therapies in addiction and mental healthcare services are inclusive to
the diverse range of potential participants is essential. Art is a universal language and as such,
attracts people of all ages, cultural, ethnic, religious/spiritual, health and experiential
backgrounds. Successful programming relies on engaging diverse populations in a wide array of

79
materials, activities, concepts and skill levels. The intended outcome of this study was enhanced
collaboration between service-users and service-providers, to develop strategic guidance for
interdisciplinary healthcare teams in the facilitation of optimal treatments for people requiring
mental healthcare.
Findings from this study clearly suggest that non-traditional treatments such as art-based
therapies need to be offered to patients to ensure holistic, person-centered care. A
recommendation from this study is for staff to highlight the art-based therapies available to
patients on admission and provide a schedule with detailed descriptions of various activities to
increase client awareness. Clinicians need to adapt their practice by clearly communicating and
supporting opportunities for creative practices. Recommendations include advertising upcoming
events in common areas, visual and verbal reminders, and general encouragement from staff
prior to group sessions, particularly for people who may have social anxiety, decreased
motivation/confidence or memory impairments. Further potential recommendations include
consistent and frequent access to a wide range of art materials and flexible practice opportunities
(offered on and off unit) at times that do not impact other treatments or services, and to ensure
patient comfort, and decrease barriers to participation. It is important that staff develop and adapt
projects to match the needs, interests and abilities of individual and group participants to engage
and appropriately challenge their clinical and creative development in a supportive manner.
Maintaining a selection of simple to complex projects is suggested for ease of organization,
engagement and person-centered care which promotes choice and client satisfaction at every
experience level. The availability of daily art-based groups and access to loaner kits that can be
used to supplement facilitated group sessions in a supportive practice environment with skilled
facilitation is ideal.

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A bright, welcoming, therapeutic space with a supportive facilitator who demonstrates
organization, adaptability, and is knowledgeable in both clinical and artistic practices is also
recommended. The facilitator should be approachable and able to develop trust and rapport with
participants, skilled at anticipating and responding to participants needs with appropriate cueing,
redirection and encouragement when needed, to promote clinical and creative progression. It is
suggested that participants have the option to attend group on and off the unit at a centralized
studio, to promote interaction with a larger artist group and enjoy time away from acute clinical
environments in less institutionalized settings.
The findings from this study advocate an inclusive approach in art-based practices with
diverse mental-health services users requires obtaining initial and ongoing feedback from
participants. Responses from participants can provide valuable insights for program planning
through formal evaluations and informal conversations pre and post art-based sessions. Feedback
should be obtained at regular intervals to gauge satisfaction with therapeutic programming.
Insights from clientele, in collaboration with assessment and consultation with interdisciplinary
staff, is necessary to determine, design and implement appropriate and fulfilling creative
experiences to enhance clinical outcomes, create meaningful social connections, increase artistic
expression, and improve holistic health and wellbeing. Lastly, to promote diversity and inclusion
within the art-based therapy group, findings from this study suggest that facilities invite
individual artists to collaborate on and display larger group projects to demonstrate the value of
each person’s contributions, promote cohesion and teamwork, and build connection and a sense
of belonging, while creating a positive focal point onsite as a source of pride and
accomplishment, incorporating new and ongoing members’ work.

81
Findings from this study show that administration and supportive policies can play a key
role in a patient’s recovery and can be beneficial to their therapeutic art-based experience. It is
important for administrators to recruit and retain an adequate number of skilled and
compassionate staff to facilitate trauma-informed and recovery-oriented care for clientele. It is
essential for administrators to effectively orient and educate staff to carry out necessary clinical
tasks and duties, as well as provide appropriate ongoing training for services supportive of
holistic wellbeing such as art-based therapies, group facilitation, vocational programming and
other interventions which promote independence and recovery. Recommendations from this
study aimed at administration include promoting a positive culture throughout its leadership and
interdisciplinary teams via inclusive programming, responsive managerial and administrative
leadership, and supportive guiding policies and procedures which accommodate person-centered
care. This holistic focus can be achieved through multidisciplinary collaboration, sharing of
resources and coordination of services that promote holistic health such as the use of art-based
treatments for recovery in hospital and community settings. It is also necessary for
administration and policy to maintain safe, effective, efficient, and therapeutic environments and
opportunities for contribution to the community that are welcoming and engaging to clients and
their support networks. Enhancing the mental health treatment environment could benefit both
service-users and service-providers in improving morale by making treatment and meeting
spaces more inviting.
Showcasing the talents and resilience of people affected by significant addiction and
mental health challenges may be inspiring to potential participants who are looking for nontraditional treatment options to support their care and the motivation some may need to engage in
the next steps of their recovery. This, and other studies from art-based literature acknowledge

82
that looking at art while at the hospital had a positive and uplifting effect on patient mood and
overall outlook (Kennedy, 2019; Lloyd et al., 2007; Nainis et al., 2006). Displaying the work of
therapeutic art-based groups, and art in general, can improve the treatment environment and
encourage more social connection, and engagement (Kennedy, 2019; Lloyd et al., 2007). Other
recommendations related to improving therapeutic environments and improving transitions from
in-patient psychiatric treatment to the community include options for drop-in group participation
post discharge, coordinating visits to local galleries and museums, attending art walks, creation
of artist-in-residence and mentorship programs, and referrals to outpatient programming to
continue each recovery journey of hope, connection and healing.
Recommendations for Education and Future Research
Incorporation of art-based approaches in general and health-based education and research
allows for many beneficial opportunities for holistic support of diverse populations throughout
the lifespan. Inclusion of arts-based programming promote wellness and potential educational,
recreational, and vocational and research opportunities. Including arts-based programming in
youth can expose individuals to different styles of learning and positive ways of harnessing
creativity from an early age. Students who are willing to experiment with learning modalities
through creative programming are more confident and open to broader ways of thinking, which
may translate into other parts of their lives such as diverse social, educational, cultural or
employment experiences. Inclusion of arts-based practices in health education and research, such
as nursing and psychiatric nursing curriculums, encourage people to be more open-minded,
decrease concrete or static perspectives, and increase comfort with ambiguity or abstract
interpretations. Arts-based approaches foster resiliency and encourage better-adjusted individuals
who are more open to diverse ideas and experiences through exposure increasing ability to

83
engage with a wider range of people, resulting in less stigma and discrimination, a key feature in
facilitating and receiving mental health treatment. Exploration and normalization of arts-based
programming in nursing education and research promotes enhanced communication, healthier
coping mechanisms, and increased self-awareness, leading to improved inter and intrapersonal
relationships. Enhanced ability for connection to self and others contribute to better individual
and community wellbeing on a local and societal level through advances in knowledge, skills,
services, and technology, to enhance improve future practices.
It is advantageous for educational, service, and research-based organizations to provide
information, training and ongoing support to students, service-users and service-providers
through education, mentorship, and ongoing research on the subject, to promote a culture of
exploration and life-long learning. Opportunities for incorporating arts-based approaches are
beneficial for any group and setting from school-aged children to specific health or business
clientele and specialty groups, including focused health services. Art-based modalities can be
utilized by the aforementioned areas and settings through various orientation and training
opportunities, ongoing education and support, quality improvement, programming, and research
prospects to promote a positive learning and working environment and culture.
The researcher suggests potential concepts for future art-based research to increase the
number of first-person experience studies in addiction and mental health services, studying
different demographical or diagnostical group populations, broader healthcare viewpoints, the
experience of novice artists engaged in creative practices for the first time, and art-based
research beyond visual arts practices such as therapeutic music, dance, or drama, among others.
Other areas for exploration related to art-based research include studies involving active versus
passive art engagement in art-based therapies in clinical treatment, educational or community

84
environments. Further examination of the impact engaging in creative practices has had on
treatment and recovery directly from participant testimonies will assist mental health service
users and providers in a deeper understanding of the advantages and challenges of art-based
therapies in practice to culminate in effective treatment and stronger participant connections to
self, support networks and larger community environments.
Conclusion
Art as a healthcare intervention is increasingly emerging as a safe, valuable, easilyaccessed, and cost-effective integrative treatment option to the medical management of mental
health problems and alleviation of distressing physical, emotional, and psychological symptoms.
This Interpretive Description research study aimed to address the research question: What are the
experiences and perceptions of psychiatric patients engaging in arts-based treatment for mental
health recovery? Therapeutic art practices have clearly demonstrated benefits to health and wellbeing through relaxation, improved self-regulation, stress management and coping, social
inclusion, personal growth, and enhanced communication and self-expression, among other
benefits to promote recovery. Overall, investigation of patient experiences regarding the
therapeutic use of art in psychiatric treatment have reinforced findings from previous studies
focused on professional and public opinion, adding to the existing body of literature. Exploring
unique and often unheard service-user perspectives often absent from existing literature on the
subject is necessary to improve art-based practices in healthcare to promote mental health
recovery and facilitate holistic, person-centered care. Findings from this study may be of interest
to mental health service users, multidisciplinary healthcare providers and members of the public
affected directly or indirectly by mental illness. Knowledge of the phenomenon from people with
lived experience of mental illness will further serve to provide insights on art-based practices

85
from a first-person perspective; strengthening therapeutic relationships and furthering the
development of effective and creative treatment options that are holistic, person-centered,
trauma-informed, and recovery-oriented, while advancing future educational, research-based,
theoretical/administrative and clinical practices in both healthcare and community settings.

86
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http://www.who.int/mental_health/management/depression/definition/en/
Wright, T., & Andrew, T. (2017). Art therapy in a crisis resolution/home treatment team: Report
on a pilot project. International Journal of Art Therapy, 22(4), 180-189.
doi: 10.1080/17454832.2017.1306572

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Appendix A
Exploring patient perceptions regarding the therapeutic use of art in mental health recovery
Research Participation Letter of Invitation and Art Group Presentation Script
Hello,
My name is Jillian Thomas and I am a graduate student from Brandon University, conducting a
qualitative study regarding client experiences with art-based treatment and recovery here at
Alberta Hospital Edmonton.
The purpose of this study is to learn more about the experiences of people who have participated
in arts-based treatment for mental health. I hope to gain a deeper understanding of the subject as
well as to develop and improve related programming and supports. Education/training, research
and clinical practice/policy may also be influenced by this investigation and presented at
scholarly conferences or in publications.
I am extending an invitation to you to participate in a research study that will be the basis of my
thesis regarding the therapeutic use of art in mental health recovery. If you decide to take part,
you will have the opportunity to participate in a brief 30-60 minute interview to share your
personal insights on the subject. An interview can be conducted at a time and location in-person
onsite or via telephone/zoom, at your convenience. All in-person onsite interviews will adhere to
current COVID‐19 bylaws/restrictions. All interviews will be audio recorded using a dedicated
handheld recording device and transcribed with data securely stored in a locked receptacle and
password protected computer. Though not a requirement to participate, you can choose to use the
video capability for zoom calls, which will also be recorded for transcription. All identifying
information will be removed and I will be the only person that will have access to the content.
My thesis advisor and committee will have access to data once identifying features and personal
information has been removed for data analysis. All electronic and hard copies will be destroyed
or deleted after the study completion, within 5 years of thesis defense.
Participation in this study is completely voluntary. You may choose not to answer any
question(s) or choose to end our conversation at any time with no explanation required.
Participating or declining to participate in this study will have no impact on your treatment or
future access to mental health services.
Should you have any questions, or if you would like to learn more about or take part in this
study, please contact me directly via telephone or email listed below. Please feel free to pass this
invitation (via Recruitment Poster) along to any of your peers and fellow artists who have
participated in art groups and might be interested in participating in this study.
Thank you for your time and consideration of this invitation.
Sincerely,
Jillian Thomas
Brandon University, Faculty of Health Studies
Email: Thomasjm10@brandonu.ca Telephone: (780) 342-5344

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Appendix B
Exploring patient perceptions regarding the therapeutic use of art in mental health recovery
Recruitment Poster

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Appendix C
Exploring patient perceptions regarding the therapeutic use of art in mental health recovery
Participant Information and Informed Consent Form
Hello,
You are invited to participate in a research study about how engaging in therapeutic art-based
therapies has impacted your mental health recovery from your perspective. To help you make an
informed decision regarding your participation, this information and consent form will outline
what the study is about, the possible risks and benefits, some frequently asked questions (FAQ’s)
and your rights as a research participant. If any information provided is unclear, please ask a
member of the research team for clarification prior to consenting to participate. Contact
information for the primary researcher, faculty supervisor, Brandon University’s Research Ethics
Committee (BUREC) and University of Alberta’s Ethics Office is included at the end of this
document. You will be provided with a copy of this form for future reference, if you choose to
participate in this study.
Primary Researcher Contact Information:
Jillian Thomas, Email: Thomasjm10@brandonu.ca Telephone: (780) 342-5344
Faculty Supervisor Contact Information:
Dr. Jane Karpa, Email: Karpaj@brandonu.ca Telephone: (204) 772-0377
Invitation
You are invited to participate in a study conducted by myself, a graduate student from Brandon
University, Faculty of Health Studies in the Master of Psychiatric Nursing Program in
collaboration with Alberta Health Services and Alberta Hospital Edmonton.
Aim of the study
The aim of this study is to explore the experiences and perceptions of people with lived
experience with mental health challenges and/or addiction using therapeutic arts-based treatment
for recovery.
Background
The study investigates the experiences and perceptions of patients’ regarding the therapeutic use
of art in mental health recovery. We are interested in your views on the subject to better
understand the effect participatory arts programming has on mental health recovery with the
intention of improving addiction and mental health education and services.

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What is the purpose of this research study?
The purpose of this research is to explore how psychiatric patients experience the use of
therapeutic art in their psychiatric treatment, and their perception of its impact on their own
mental health recovery. By focusing on the experience of art therapy from the viewpoint of adult
psychiatric patients, the researcher hopes to better understand the perceived benefits of
participation in creative therapies from an insider view. Using Interpretive Description methods,
and informed by the Recovery Oriented Model of Care, the researcher intends to gain important
insights on how current techniques and patient experiences may be enhanced for future practices,
contributing unique and unheard participant perspectives noticeably scarce in the current
literature on the subject.
Why is this study significant?
Despite the large amount written about diverse treatment options for addiction and mental
illness, there is little attention paid to the firsthand experience of people with psychiatric lived
experience participating in arts-based interventions. Understanding the experience of people with
mental health challenges who are participating in art-based therapeutic programs is important for
development of future services, education and overall recovery.
Why am I being asked to consider taking part in this research study?
You have been asked to take part because you are receiving arts-based programming for mental
health treatment at Alberta Hospital Edmonton.
Who may participate in this study?
To be eligible for participation in the study, prospective participants must:
- be at least 18 years of age
- be able to understand and speak English fluently
- be receiving services at AHE (inpatient or outpatient services)
- have already attended one or more art-based therapy sessions
- be willing to engage in the associated interview process
- be medically and mentally stable (i.e.: no recent or current psychotic episodes, no
suicidal ideation or recent self-harm) and have capacity to make your own informed
decisions about engaging in the group and study process.
What does participation involve? What will I be asked to do?
If you decide to take part, you will have the opportunity to participate in one brief 30-60 minute
individual interview to share your personal insights on the subject. You will be asked for your
consent for the in-person or telephone interview to be audio recorded for transcription purposes.

99
All in-person and telephone interviews will be audiotaped for transcription purposes using a
dedicated handheld recording device. If you prefer to complete the interview via zoom, you will
also be asked to give consent to an audio-recording for transcription purposes. Though not a
requirement, you have the option of choosing to use the video capability which will also be
recorded for transcription purposes, though no video recordings will be shared with anyone other
than the primary researcher. The interview will be conducted onsite in a location of your choice
or by telephone/zoom to accommodate COVID 19 restrictions and your sense of personal safety.
For example, you will have access to hand sanitizer, medical masks/eye protection and will be
seated at a distance from the researcher interviewing you. The interviewer will ask you questions
about your experiences using art-based treatments and the impact of these activities on your
mental health recovery. You can choose to answer or decline to answer any question. You can
request that the recorder be shut off at any time. You can ask for a break at any time during the
interview. You can also ask to end the interview at any time. Please note, all in-person onsite
interviews will adhere to current COVID‐19 bylaws/restrictions. You will be required to use
your own personal device for telephone/zoom interviews (i.e.: personal cellphone, tablet, laptop
etc.)
Is participation in this study voluntary? Do I have to take part in the study?
Participation in this study is your choice and completely voluntary. You are under no obligation
to participate. You may decline to answer any question (or you may choose to end the interview
at any time). If you decide to be in the study, you can change your mind and stop participation in
the study at any time with no impact on your treatment or ability to attend art-based
programming.
How can I withdraw from the study?
You can withdraw from the study at any time with no questions asked. In case of withdrawal,
you have the right to specify whether you want the data you contributed to be erased. However,
data withdrawal is not possible after analysis has begun, approximately 4 weeks post-interview.
Please contact the principal researcher in person, by phone or email within 4 weeks of
completing your interview to indicate you no longer wish to participate in this study. Contact
information is provided at the beginning of this document. Please note, withdrawal from the
study will not impact the participants’ relationship with the researcher, Brandon University or
Alberta Health Services/Alberta Hospital Edmonton.
What are the benefits to me? Will I receive anything for participating in this study?
An anticipated benefit from participating in this research study is to be able to voice your
experiences of engaging in art-based treatments with healthcare professionals so that they may
learn from your experiences and adapt or change treatment methods for future use. There is no
payment for your participation in this study.

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What are the risks to me?
There are no known or anticipated risks in participating in this study greater than those
encountered in everyday life. Participation in this study may cause some inconvenience to you,
including the use of your time or recall of past memories and experiences. It is not possible to
know all the risks that may happen in a study, but the researcher has taken all reasonable
safeguards to minimize known risks to a study participant. Please note, by providing your
consent, you are not waiving your rights to legal recourse in the event of research-related harm.
What if the interview questions causes me distress/concern?
A resource list of available support services will be provided to you in case you would like
additional support beyond what is offered by your healthcare team.
How will confidentiality and privacy issues be managed?
All information such as the audio recordings, your name or any identifying information will be
kept confidential. The researcher will securely store all data as required by Brandon University
and AHS guidelines. Transcribed interviews with all identifying details removed will be stored in
password-protected devices and access will be restricted to the primary researcher. Your
participation in this study, and the data collected, is anonymous. While the researcher team will
take measures to ensure your identity and data is kept confidential, depending on the information
shared with, there may be an ethical or legal obligation to disclose information to a third party.
For example, there is compelled disclosure on a report of abuse of children or persons in care.
What about permission to quote?
We may wish to quote your words anonymously in presentations and publications resulting from
this study. In such cases you will remain anonymous and no information that can identify you
will be published.
What will be done with the results?
The results of this research study will help us understand art-making experiences and perceptions
of people with lived experiences of mental health challenges and/or addictions. The results will
inform research project developments. At the end of the study, I will present the results in my
thesis defence, and in presentations such as conferences or through articles published in research
journals. Please provide your contact information on the attached consent form if you would like
the findings summary of this study to be shared with you personally at a later date. There is no
possibility of commercialization of research findings, and the presence of any real, potential or
perceived conflicts of interest on the part of the researcher, and their institutions.

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Contact Information:
If you have questions regarding this study, or would like additional information to assist
you in reaching a decision about participation, please contact:
Primary Researcher:
Jillian Thomas, RN, BScN, CPMHN(C), MPN(c)
Email: Thomasjm10@brandonu.ca Telephone: (780) 342-5344
Brandon University, Faculty of Health Studies, Master of Psychiatric Nursing Program
Or
Faculty Supervisor:
Dr. Jane Karpa,
Email: Karpaj@brandonu.ca Telephone: (204) 772-0377
Brandon University, Faculty of Health Studies, Master of Psychiatric Nursing Program
Or
For Ethics-related questions, participant rights or concerns about this study, please contact
Brandon University Research Ethics Committee (BUREC):
Email: burec@brandonu.ca Telephone: (204) 727-9712
Or
University of Alberta Research Ethics Office: Telephone: (780) 492-2615

Please note, this study has been reviewed and received ethics approval by the Brandon
University Research Ethics Committee (BUREC) and University of Alberta Ethics Office.

Thank you for your time and interest in this research study!

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Participant Consent Form
Primary Researcher: Jillian Thomas, Email: Thomasjm10@brandonu.ca Telephone: (780) 342-5344
Faculty Supervisor: Dr. Jane Karpa, Email: Karpaj@brandonu.ca Telephone: (204) 772-0377
Please circle “Yes” or “No” for each question stated:
Do you understand that you have been asked to be in a research study?

Yes No

Have you read and received a copy of the attached Information Sheet?

Yes No

Do you understand the benefits/risks involved in taking part in this study?

Yes

Do you understand who will have access to the information you provide?

Yes No

Have you had an opportunity to ask questions and discuss this study?

Yes No

Do you understand that you are free to withdraw from the study at any time?

Yes No

Has the issue of confidentiality been explained to you?

Yes No

No

I agree to my interview being audio-recorded (and potentially video-recorded if using
Zoom, if I choose to engage video function) to ensure accurate transcription
Yes No
I agree to be quoted understanding that my name or any identifying information
will not be published in this thesis or other publications.
Yes No
I understand the researcher may have a duty to disclose sensitive information to appropriate
authorities in extenuating circumstances (i.e.: child abuse)
Yes No
I agree to take part in this study:

Yes No

Signature of Research Subject: ________________________________
(Printed Name): _______________________________________Date: __________________
I believe that the person signing this form understands what is involved in the study and voluntarily
agrees to participate.
Signature of Investigator or Witness: ________________________________
(Printed Name): _______________________________________Date: __________________
Would you like to receive a summary of the research findings? Yes: _______ No: ______
If you indicated “yes”, please provide an email address for this purpose below.
Email contact: ______________________________________________________

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Appendix D
Exploring patient perceptions regarding the therapeutic use of art in mental health recovery
Interview Introduction, Script, and Question Guide
Data will be obtained through semi-structured open-ended questions in an approximately 30-60
minute interview. The initial demographic and general question format will be standardized with
the flexibility and freedom for follow up questions or discussion to be responsively adapted
based on participant responses.
General Information and Question Guide
Hello, my name is Jillian Thomas, and I am a graduate student from Brandon University,
conducting a qualitative study for my thesis research regarding client experiences with art-based
treatment and recovery here at Alberta Hospital Edmonton. Thank you for agreeing to share your
experiences using art-based treatments in mental health with me. Over the next 30-60 minutes I
hope to gain a deeper understanding of your perspective as well as discuss ideas you may have to
improve programming. Information from participant interviews may impact future groups,
education/training, research, clinical practice/policy and may be presented at scholarly
conferences or shared in publications in the future.
As you know, this interview will be audio recorded (and possibly video recorded, should you
choose to use video capability option during Zoom interviews only) and transcribed with data
securely stored in a locked receptacle and password protected computer. All identifying
information such as your name or unit will be removed and I will be the only person that will
have access to the content.
My thesis advisor and committee will have access to data once personal information has been
removed for data analysis. All electronic and hard copies will be destroyed or deleted after the
study completion, within 5 years of thesis defense. Do you have any questions about this or your
consent form?
I would like to remind you that participation in this study is completely voluntary. You may
choose to skip or not answer any question(s) you do not want to. You can also choose to end our
conversation at any time or change your mind about participating with no explanation required.
Participating or declining to participate in this study will have no impact on your treatment or
future access to mental health services.
Should you have any questions after this meeting, please contact me directly via telephone or at
the email listed in your package. Please feel free to pass this invitation along to any of your peers
and fellow artists who have attended art groups at Alberta Hospital Edmonton who might be
interested in participating in this study. Any questions before we begin?
If you are ready, I would like to discuss your experience with art and mental health and wellness.
To understand this connection, I would like to know more about your experiences with art.

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Interview Question Guide
Please note: Core questions are bolded. Optional follow up questions are provided subsequently to elicit additional dialogue, if appropriate.

When did you first become involved in art? Did you participate in any creative activities before
your hospitalization or attendance in outpatient programming?

How long have you been attending art-based groups? In general? In a hospital or treatment
setting? In the community? Approximately how many sessions have you attended at AHE?

How often and for how long do you typically spend on arts-based therapies?
Daily? Weekly? Monthly?

What are your preferred methods or mediums to use? Why?
Please describe what a typical art-based group/session is like for you.
Describe any unique ways that art-based therapy affects your mental health compared with
other treatments? How do art-based treatments differ from other mental health treatments you have
tried? How would you describe engaging in art-based therapies compared to other traditional treatments?
Other alternative/complimentary or integrative treatments?

What are some of the positive aspects/outcomes of making art in treatment?
What are some of the negative aspects/risks of making art in treatment?
Are there any barriers or challenges you have faced regarding participating in art-based
treatments? What do you think prevents other people from participating in art groups?
How has engaging in art impacted your mental health and wellness?
How has participating in art groups affected your thoughts? Behaviour? Relationships? Mood?

How has participating in art impacted your mental health recovery? How would your life be
different if you were not making art? How does participating in art influence your daily life?

Do you think other people could benefit from this treatment? (Staff? Public? Peers?)
Would you recommend this form of treatment to others? Why or why not?

How can art-based therapeutic groups be improved to assist individuals in their recovery?
Do you intend on keeping up with similar activities after discharge? Why or why not?
What would you like others to know about your experience with art-based treatment?
Do you think you have to directly make art to benefit from treatment? For example, does
looking at art (as opposed to creating art directly) have any impact on your mental health?

Is there anything else you wish to share about your experience with art and mental health?

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Appendix E
Supportive Services Resource List
If you or someone you know is in immediate danger please call 911 for Emergency Services
Distress and help lines:
211 Alberta, Canadian Mental Health Association (CMHA)
Referrals and information for community, social, health & government resources
Edmonton Distress Line
Edmonton-wide mental health services

211

(780)482 HELP

Mental Health Helpline
Province-wide urgent mental health services & doctor referrals

(877)303-2642

Crisis Service Canada
Canada-wide suicide prevention and assistance services

(833)456-4566

First Nation & Hope for Wellness Help Line
Canada-wide First Nations & Inuit suicide prevention and assistance services

(855)242-3310

Access 24/7
Province-wide non-urgent mental health services

(780)424-2424

Provincial Addiction Helpline/Alberta Quits
Province-wide addiction and substance-abuse & counselling services

(866)332-2322

Provincial Abuse Line
Province-wide abuse and reporting services

(866)443-5722

CASE Sexual Assault Centre of Edmonton
Edmonton-wide sexual abuse services

(780)423-4121

CEASE Centre to End All Sexual Exploitation
Province-wide information on sexual exploitation services

(780)471-6143

Bullying Helpline
Canada-wide counselling and referrals related to bullying

(888)456-2323

Family Violence Information line
Province-wide information on family violence and abuse services

(780)310-1818

If you did not find the information you were looking for on this list, please try searching
https://informalberta.ca or call (780)482-INFO (4636) or 211 for local resources. Thank you!

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Appendix F

Course reviewed again in preparation for BUREC application process, Spring 2021.