Creative arts therapies are forms of psychotherapy that involve the employment of the arts with the aim of bringing change and growth (Pratt & Wood, 2015). Arts therapies require the involvement of three major parties, that is a trained art therapist, a client and an artwork (Waller, 1991). The creative process clients engage in when making art involves both the physiological but also emotional and cognitive level and all three levels constitute the substance of the therapeutic sessions (Shafir et al., 2020). Arts therapies therefore go beyond the final art product and focus on the creative process leading to it, which allows clients to create new narratives, new ways of making sense of their inner and outer worlds and of expressing such worlds. Different disciplines fall within the realm of arts therapies, including visual/plastic art therapy, drama therapy, psychodrama, dance/movement therapy, music therapy and poetry therapy (Orkibi et al., 2021). Creative arts therapies are a very flexible form of therapy which can be adopted with a great variety of clients and in different settings, such as educational facilities, mental health facilities, hospitals, hospices, prisons and private practice. The aims of arts therapies would be the following: creativity, change, control, communication and catharsis (Pratt & Wood, 2015). Mann (1990) defined creativity as the ability to move from something known to something unknown, therefore, the employment of the arts in therapy would allow a better acceptance of life changes and this is why they have often been considered as a suitable form of therapy within those therapeutic settings in which clients are dealing with terminal illness (Pratt & Wood, 2015).
Death has long inhabited the realm of the arts, probably from the very beginning. Some of the first examples trace back to Homer’s poems of the Iliad and the Odissey, where death and loss received a major role within human existence (Walter, 2012). Moreover, Shakespeare’s grief expression in Macbeth “Give sorrow words. The grief that does not speak / Whispers the o’er-fraught heart, and bids it break” (Walter, 2012, p. 75) permeated our language and is still used nowadays. In general, the arts provide a powerful medium to explore, represent and communicate one’s feelings about death and death-related topics, such as bereavement and grief. The arts have been employed even in end-of-life and palliative care settings. The World Health Organization (WHO, 2020) defines palliative care as “Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.”. A key notion in the palliative care framework is Cicely Saunders’ concept of total pain, therefore clients in end-of-life settings are taken care of in a wholistic way, both considering their physical symptoms, mental distress, social and emotional problems (Saunders, 1964; Clark, 1999). Arts therapies take on an enactive and embodied perspective and work with clients approaching the end of their lives in a holistic way, allowing them to express themselves as whole, integrated beings. For instance, the use of visual arts with terminal cancer patients seemed to help them move from a state of existential dread to a greater awareness and later acceptance of their mortality, together with an improved quality of life and meaning-making (Lefèvre et al., 2016; Safrai, 2013). Moreover, music therapy has proved effective in pain management in end-of-life contexts (Gallagher, 2013) and dance-movement therapy has helped patients to reconnect with their ill bodies and to embody in their artworks an integrated and cohesive sense of self (Woolf & Fisher, 2015; Endrizzi et al., 2016). Arts therapies seem to be a very valid tool also at a later stage, that is when facing bereavement and grief, as it seems the case with psychodrama, that combining both the therapeutic action of the group and the surplus-reality would be able to help clients create a concrete narration, a new positive dialogue with the lost person and finally process and resolve their grief (Testoni et al., 2019). Finally, again within a holistic care framework, the arts could enter therapy also to assist them on a spiritual level (Bailey, 1997).
To conclude, it seems advantageous that health professionals working within end-of-life settings attend Death Education courses which also provide them with knowledge on the integration of arts therapies within the aforementioned settings. The use of arts therapies and arts – such as dramatherapy, moviemaking and visual arts – have been used in Death Education courses allowing to improve meaning-making about death and dying, to create new narrations on bereavement and grief and to enhance spirituality (Testoni et al., 2018; Testoni et al., 2021).
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