Knowledge and skills taught to learners are important, but the ways they are provided and contexts should also be taken into account. Creative approaches in learning refer to holistic methods of promoting a person’s identity formation, knowledge, and communication (Hoyt and Bobele, 2019). The cultivation of creative approaches is largely adopted among children and older adults, whose emotional and behavioral changes show positive impacts of such approaches. This paper presents a critical discussion of an art therapy, drama therapy, and forest school to clarify their principles and goals, as well as review the results of the related studies. In addition, the role of practitioners offering the mentioned creative approaches is discussed from the point of competences and values.
The art therapy (AT) is a direction of cognitive-behavioral therapy that is applied to a variety of mental conditions. According to the American Art Therapy Association, AT aims at supporting relational and personal treatment objectives, which is also beneficial to address community issues (Regev and Cohen-Yatziv, 2018; Hoyt and Bobele, 2019). Among the mediums that are utilized by AT, there are fine arts, such as modeling, sculpturing, painting, and so on. The main idea of this therapy is to help a client in the process of memorizing and experiencing feelings and emotions, which promotes self-reflection and coping abilities. Abbing et al. (2018) emphasize that in comparison to verbal approaches, art therapy ensures an in-depth access to one’s experiences and concerns, thus increasing self-awareness. The detailed description of this creative approach is given in the book by Kapitan (2017), who focuses not only on procedures but also related research themes.
While the effectiveness of art therapy is not yet fully research, the academic literature provides the evidence that confirms its positive impact. In the systematic review by Schouten et al. (2015), it was found that three out of six included studies reported a decrease in psychological trauma symptoms among adults. In addition, one study indicated significant depression rate reductions. The clinical effectiveness of AT was also verified by Regev and Cohen-Yatziv (2018), who systematized 27 studies and revealed that mental health, cancer, trauma coping, older adult, and prison inmate patients felt better. Mandala AT application showed positive results regarding resilience, hope, and well-being in psychiatric patients (Kim et al., 2018; Berberian and Davis, 2019). Kelly et al. (2015) claim that further research needs to focus on randomized-controlled trials and other quantitative methods to synthesize new data with existing findings.
Art therapy effectiveness was also proved in children, whose psychological issues were reduced in the course of the treatment. Cohen-Yatziv and Regev (2019) explored the impact of AT among five categories of children, including non-specific difficulties, juvenile offenders, special education and disabilities, trauma, and medical conditions. The results showed that AT can help them in mastering their coping skills, special education abilities, and addressing such medical difficulties as asthma. In turn, Moula (2020) claimed that in children aged 5-12 years, AT facilitated emotional difficulties, develops problem-solving skills, and reduces anxiety. Accordingly, the mentioned impact improved their quality of life and overall well-being (Newland and Bettencourt, 2020; Uttley, et al., 2015).
The drama therapy refers to creative arts therapies (CAT) that are characterized by the appeal to a person’s relationships and psychological growth. Emunah (2019) and Gaines and Butler (2016) described the procedures that are used by drama therapy, such as the intentional use of theater and drama modalities, imagination, fantasy, and dramatic enactment. People tell their stories and listen to those others during group sessions to better understand their feelings and attitudes to one or another concern. The greatest effectiveness of this therapy was found in older adults as it promotes self-confidence and communication skills (Armstrong, Frydman, and Wood, 2019; Keisari, 2021). The other study indicated that aging clients who received rudimentary life-review interventions showed higher self-acceptance along with sense of life meaning (Keisari and Palgi, 2017). Moreover, the results of the above two articles demonstrated that aging populations improved their relationships and reduced depressive symptoms.
The systematic review conducted by Feniger-Schaal and Orkibi (2020) revealed that current evidence on the role of drama therapy is limited by a focus on children and adults with cognitive and developmental impairments. The search for the articles for this assignment is consistent with the above findings. According to Bourne, Andersen-Warren, and Hackett (2018), adults with different intellectual disabilities improved their self-confidence and built stronger resilience as a result of the group therapy. Drama therapy also facilitated empowerment and communication skills, which helps older adults in making friends (Bourne, Andersen-Warren, and Hackett, 2018). In terms of a role theory, the key purpose of drama therapy is to unleash a person’s role repertoire, thus promoting a dynamic movement between the roles. Since the aging process is associated with various social and mental health changes, the importance of such flexibility cannot be overestimated.
Children are another group that responds well to the interventions of drama therapy. Namely, the North American school system was assessed by Frydman and Mayor (2021), who identified that a lack of the structured therapy implementation is the main barrier, while positive outcomes involved psychological and behavioral changes. Comparing music therapy and drama therapy, Broon, Heidarei, and Ehteshamzhdh (2021) found that the rate of sleep disorders in children with grief decreased. It should be stressed that the majority of the reviewed studies used experimental designs, which proved their credibility. Resilience training was the goal in children with aggression and anxiety, and its effectiveness was verified in a quasi-experimental study by Bakhtiari, Asadi, and Bayani (2020).
Based on the experience of Scandinavian countries, a forest school is a form of outdoor learning that is extensively adopted in primary schools. It is not compulsory, and teachers may choose some outdoor lessons, depending on the subject, students, and time (Williams-Siegfredsen, 2017). Forest school should be provided by qualified professionals, who are expected to contribute to the self-esteem and confidence of children, as well as develop their teamwork and emotional development skills. Knight (2016) stated that such type of learning connects children to the nature, ensures child-focused education, promotes active play, and teaches the ways to overcome challenges. Since the borders set by a classroom are extended, students receive an opportunity to adopt new ways of exploring the world around them (Harris, 2018; Knight, 2016). Students can let off their energy, find a calm place to relax, and also interact with others to resolve issues in cooperation.
A positive impact of forest school on children was tested in various studies that reported great behavioral and educational changes. According to Harris (2017), “forest school frees teachers and pupils from the norms and conventions of the classroom to enable them to adopt different learning styles and engage in more child‐initiated learning” (p. 288). Considering that forest school does not imply special curriculum or time constraints, it gives practitioners the flexibility to design their lessons. The lower levels of fear among students are another benefit as having no specific goals, students experience no anxiety. From the perspective of forest school practitioners, such an approach promotes adopting a range of learning styles, including sensory, kinaesthetic, and experiential (Harris, 2018). Taking risks and self-knowledge are noted by Knight (2016) and Williams-Siegfredsen (2017).
Forest school is an alternative pedagogy that adds diversity and novelty to the curriculum. The study by Waite and Goodenough (2018) reported the importance of forest school, being an integral part of traditional education. Using a play-based learning theory and cultural density theory, the above authors claimed that forest schools should be valued to develop diversity awareness. In their turn, Tiplady and Menter (2020) called such a therapy an environment, in which students can take what they need, especially emotional well-being. Since they learn through different experiences, it contributes to identifying the areas that need improvement and the subsequent changes. These results were received in the context of the change theory that was applied by Tiplady and Menter (2020), which reflected the study validity.
Therapy Provider Competences
Speaking about the effectiveness of the creative therapy approaches, including art, drama, and forest school, the role of the worker providing the service should be noted. Zerubavel and Wright (2012) stated that there is a trauma of the wounded healer that means a worker, who was personally impacted by trauma, or stress, would better understand the needs of the clients. However, Dunhill, Elliott, and Shaw (2009) insisted that engagement and communication with clients and their families are based on open-mindedness and empathy. Skills, knowledge, and values of workers identify the strategies they choose to reach people. Thomas and Johnson (2007) focused on cultural sensitivity, which implies being aware of diverse traditions and values. In terms of Bordin’s theory, the therapeutic alliance of a worker and the client’s family is useful (Johnson and Wright, 2002). To make creative approaches effective, it is critical to integrate a worker’s skills and experience with the recent evidence-based advancements in art therapy, forest school, and drama therapy.
It was found that the art therapy is effective in children with special education needs, trauma, and psychological conditions, improving their emotional states and decreasing anxiety. The main contributions of the drama therapy in children and older adults are better sleep, behaviors, and emotional well-being. Forest school was considered effective for primary school children as it extended their learning ways and promoted teamwork and self-knowledge. Some studies suggested that the combined application of creative therapies can provide greater positive outcomes in clients. In the view of the identified findings, further research should consider the effectiveness of creative therapies in terms of their implementation costs and integration with other therapies to achieve greater mental health and behavioral improvements.
Abbing, A. et al. (2018) ‘The effectiveness of art therapy for anxiety in adults: a systematic review of randomised and non-randomised controlled trials’, PloS One, 13(12), pp. 1-13.
Armstrong, C. R., Frydman, J. S. and Wood, S. (2019) ‘Prominent themes in drama therapy effectiveness research’, Drama Therapy Review, 5(2), pp. 173-216.
Bakhtiari, Z., Asadi, J. and Bayani, A. A. (2020) ‘Comparison the effectiveness of “drama therapy” and resilience training on anxiety and aggression of children with depression’, Journal of Health Promotion Management, 9(5), pp. 34-47.
Berberian, M. and Davis, B. (2019) Art therapy practices for resilient youth: a strengths-based approach to at-promise children and adolescents. New York: Routledge.
Bourne, J., Andersen-Warren, M. and Hackett, S. (2018) ‘A systematic review to investigate dramatherapy group work with working age adults who have a mental health problem’, The Arts in Psychotherapy, 61, pp. 1-9.
Broon, L., Heidarei, A. and Ehteshamzhdh, P. (2021) ‘Comparison of the effectiveness of drama therapy and music therapy on sleep disorders in children with grief’, Iranian Journal of Psychiatric Nursing, 8(6), pp. 1-8.
Cohen-Yatziv, L. and Regev, D. (2019) ‘The effectiveness and contribution of art therapy work with children in 2018 – what progress has been made so far? A systematic review’, International Journal of Art Therapy, 24(3), pp. 100-112.
Dunhill, A., Elliott, B. and Shaw, A. (2009) Effective communication and engagement with children and young people, their families and carers. London: Learning Matters.
Emunah, R. (2019) Acting for real: drama therapy process, technique, and performance. New York: Routledge.
Feniger-Schaal, R. and Orkibi, H. (2020) ‘Integrative systematic review of drama therapy intervention research’, Psychology of Aesthetics, Creativity, and the Arts, 14(1), pp. 68-80.
Frydman, J. S. and Mayor, C. (2021) ‘Implementation of drama therapy services in the North American school system: responses from the field’, Psychology in the Schools. Web.
Gaines, A. M. and Butler, J. D. (2016) Routledge international handbook of drama therapy. New York: Routledge.
Harris, F. (2017) ‘The nature of learning at forest school: practitioners’ perspectives’, Education 3-13, 45(2), pp. 272-291.
Harris, F. (2018) ‘Outdoor learning spaces: the case of forest school’, Area, 50(2), pp. 222-231.
Hoyt, M. and Bobele, M. (2019) Creative therapy in challenging situations: unusual interventions to help clients. New York: Routledge.
Johnson, L. N. and Wright, D. W. (2002) ‘Revisiting Bordin’s theory on the therapeutic alliance: implications for family therapy’, Contemporary Family Therapy, 24(2), pp. 257-269.
Kapitan, L. (2017) Introduction to art therapy research. New York: Routledge.
Keisari, S. (2021) ‘Expanding the role repertoire while aging: a drama therapy model’, Frontiers in Psychology, 12, pp. 559-573.
Keisari, S. and Palgi, Y. (2017) ‘Life-crossroads on stage: integrating life review and drama therapy for older adults’, Aging & Mental Health, 21(10), pp. 1079-1089.
Kelly, S. et al. (2015) ‘Reviewing art therapy research: a constructive critique’, Sheffield Hallam University. Web.
Kim, H., et al. (2018) ‘Effects of mandala art therapy on subjective well-being, resilience, and hope in psychiatric inpatients’, Archives of Psychiatric Nursing, 32(2), pp. 167-173.
Knight, S. (2016) Forest school in practice: for all ages. New York: Sage.
Moula, Z. (2020) ‘A systematic review of the effectiveness of art therapy delivered in school-based settings to children aged 5-12 years’, International Journal of Art Therapy, 25(2), pp. 88-99.
Newland, P. and Bettencourt, B. A. (2020) ‘Effectiveness of mindfulness-based art therapy for symptoms of anxiety, depression, and fatigue: a systematic review and meta-analysis’, Complementary Therapies in Clinical Practice, 41, pp. 101246.
Regev, D. and Cohen-Yatziv, L. (2018) ‘Effectiveness of art therapy with adult clients in 2018 — what progress has been made?’, Frontiers in Psychology, 9(1531), pp. 1-19.
Schouten, K. A. et al. (2015) ‘The effectiveness of art therapy in the treatment of traumatized adults: a systematic review on art therapy and trauma’, Trauma, Violence, & Abuse, 16(2), pp. 220-228.
Thomas, B. S. and Johnson, P. (2007) Empowering children through art and expression: culturally sensitive ways of healing trauma and grief. London: Jessica Kingsley Publishers.
Tiplady, L. S. and Menter, H. (2020) ‘Forest School for wellbeing: an environment in which young people can ‘take what they need’, Journal of Adventure Education and Outdoor Learning, pp. 1-16.
Uttley, L. et al. (2015) ‘Clinical effectiveness of art therapy: quantitative systematic review’, Systematic review and economic modelling of the clinical effectiveness and cost-effectiveness of art therapy among people with non-psychotic mental health disorders. Web.
Waite, S. and Goodenough, A. (2018) ‘What is different about Forest School? Creating a space for an alternative pedagogy in England’, Journal of Outdoor and Environmental Education, 21(1), pp. 25-44.
Williams-Siegfredsen, J. (2017) Understanding the Danish forest school approach: early years education in practice. London: Taylor & Francis.
Zerubavel, N. and Wright, M. O. D. (2012) ‘The dilemma of the wounded healer’, Psychotherapy, 49(4), pp. 482-491.