Samenvatting

Effects of art therapy in patients with personality disorders cluster B and C
S. Haeyen

This study is one of the first serious attempts to explore effects of art therapy. Its main conclusion is that art therapy in patients with personality disorders of clusters B or C is effective. Art therapy has several benefi cial effects for personality disorder patients. The results indicate that art therapy is a powerful therapy for reducing psychopathology; as powerful as it is for enhancing well-being (increasing resilience and emotional adaptation). Art therapy is not mainly or only a general procedure for improving well-being and quality of life. It also is a specifi c therapy, with interventions that reduce specific symptoms. It is our hope that this study contributes to the understanding of art therapy and its benefi ts, and provides insight into the scope of art therapy. Although more research is needed, the present study adds evidence to the empirical base of art therapy in patients with personality disorders cluster B and C and asks for a reappraisal of its symptom reduction quality next to the quality of enhancing positive mental health.

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Praten over problemen betekent niet vanzelf dat gevoelens ook bereikt worden. Het kan veel moeite kosten woorden daaraan te geven. Bij heftige emoties kan dit erg oplopen. Het uitdrukken van gevoelens in beeldend werk brengt iemand mogelijk meer in contact met zijn of haar gevoelens, of met wat iemand doet vastlopen. Suzanne Haeyen onderzocht het effect van beeldende therapie bij mensen met persoonlijkheidsstoornissen cluster B/C.

Beeldende therapie – een behandelvorm waarin beeldende materialen zoals klei, schilder- en tekenmateriaal, speksteen, ijzerdraad, stof of collagemateriaal, op een methodische manier worden ingezet – is gericht op doelen die te maken hebben met emotioneel functioneren, zelfexpressie en welzijn voor patiënten. Deze vorm van therapie wordt vrij frequent ingezet in de geestelijke gezondheidszorg. Hoewel praktijkervaringen suggereren dat beeldende therapie een effectieve interventie is, is beeldende therapie weinig onderzocht en is er een degelijke wetenschappelijke basis nodig voor deze interventie (Reynolds, Nabors & Quinlan, 2000; Slayton, D’Archer & Kaplan, 2010; Van Lith, Schofield & Fenner, 2013). Beeldende therapie biedt een wezenlijk andere therapeutische ingang dan praten. Mensen die goed kunnen praten over hun problemen, kunnen soms met woorden hun gevoelens niet bereiken. Door het beeldend werken krijgen zij meer contact met hun gevoelens en met wat hen doet vastlopen. Anderen hebben juist moeite met praten over wat hen bezighoudt. Dan kunnen het…

Literatuurlijst
  1. Arntz, A. (2011). Imagery rescripting for personality disorders. Cognitive and Behavioural Practice, 18, 466-481. doi:10.1016/j.cbpra.2011.04.006.
  2. Arntz, A. (2012). Imagery rescripting as a therapeutic technique: Review of clinical trials, basic studies, and research agenda. Journal of Experimental Psychopathology, 3, 189-208. doi:10.5127/jep.024211
  3. Arts Council England. (2007). The Arts Health and Wellbeing. Liverpool, England: Centre for Public Health, Research Directorate, John Moors University.
  4. Bartholomew, L., Parcel, G., Kok, G., Gottlieb, N. & Fernández, M. (2011). Planning Health Promotion Programs: An Intervention Mapping Approach. San Francisco, CA: Jossey-Bass.
  5. Bateman, A.W. & Fonagy, P. (2004). Psychotherapy for Borderline Personality Disorder: Mentalisation Based Treatment. New York, NY: Oxford University Press.
  6. Chilton, G. (2013). Art therapy and flow: A review of the literature and applications. Art Therapy, 30, 64-70. doi:10.1080/07421656.2013.787211
  7. Corbin, J. & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory. London, United Kingdom: Sage.
  8. Czamanski-Cohen, J. & Weihs, K. (2016). The bodymind model: A platform for studying the mechanisms of change induced by art therapy. The Arts in Psychotherapy, 51, 63-71. doi:10.1016/j.aip.2016.08.006
  9. Gatta, M., Gallo, C. & Vianello, M. (2014). Art therapy groups for adolescents with personality disorders. The Arts in Psychotherapy, 41, 1-6. doi:10.1016/j. aip.2013.11.001
  10. Gratz, K., & Gunderson, J. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behaviour Therapy, 37, 25-35. doi:10.1016/j.beth.2005.03.002
  11. Gunther, G., Blokland-Vos, J., van Mook, C. & Molenaar, J.P. (2009). Vaktherapie binnen klinische schematherapie. In E. Muste, A. Weertman, & A. Claassen (Eds.), Handboek klinische schematherapie (pp. 99-130). Houten, the Netherlands: Bohn Stafleu van Loghum.
  12. Gussak, D. & Rosal, M. (Eds.). (2016). The Wiley Handbook of Art Therapy. Hoboken, NJ: Wiley-Blackwell. Haeyen, S. (2007). Niet uitleven maar beleven: Beeldende therapie bij persoonlijkheidsproblematiek. Houten, the Netherlands: Bohn Stafleu van Loghum.
  13. Haeyen, S. (2011a). De verbindende kwaliteit van beeldende therapie. Effecten van beeldende therapie in de behandeling van persoonlijkheidsstoornissen. Antwerpen, Belgium: Garant.
  14. Haeyen, S. (2011b). Vaktherapie: De kracht van de ervaring. In T. Ingenhoven, A. van Reekum, B. van Luyn, & P. Luyten (Eds.), Handboek borderline persoonlijkheidsstoornis (pp. 215-227). Utrecht, the Netherlands: De Tijdstroom.
  15. Haeyen, S.W. (2018). Effects of Art Therapy. The Case of Personality Disorders cluster B/C. (Dissertation manuscript). Radboud University, 14 maart 2018. Nijmegen, the Netherlands: Proefschriftmaken.nl.
  16. Haeyen, S. (2018b). Interventiebeschrijving Beeldend Therapeutische Emotieregulatie Groep. Databank Erkende Interventies GGZ, Trimbos Instituut, Utrecht. https://erkendeinterventiesggz.trimbos.nl/erkende-interventies/ beeldend-therapeutische-emotieregulatie-groep
  17. Haeyen, S., Kleijberg, M. & Hinz, L.D. (2017). Art Therapy for Patients with Personality Disorders Cluster B/C: A Thematic Analysis of Emotion Regulation from Patient and Art Therapist Perspectives. The International Journal of Art Therapy. Published online: 08 Dec 2017. Vol. 0, Iss. 0,0. doi.org /10.1080/17454832.2017.1406966
  18. Haeyen, S., Dehue, F., Van Hooren, S., Van der veld, W., & Hutschemaekers, G. (2018). Development of an art therapy intervention for patients with Personality Disorders: an intervention Mapping study. International Journal of Art Therapy, (23)3, 125-135. doi.org/10.1080/17454832.2017.1403458
  19. Haeyen, S., van Hooren, S. & Hutschemaekers, G. (2015). Perceived effects of art therapy in the treatment of personality disorders, cluster B/C: A qualitative study. The Arts in Psychotherapy, 45, 1-10. doi:10.1016/j. aip.2015.04.005.
  20. Haeyen, S., Van Hooren, S., Van der Veld, W., & Hutschemaekers, G. (2018). EÃ cacy of art therapy in individuals with personality disorders cluster B/C: a randomized controlled trial. Journal of Personality Disorders, (32)4, 527-542. doi.org/10.1521/pedi_2017_31_312
  21. Haeyen, S., Van Hooren, S., van der Veld, W.M. & Hutschemaekers, G. (2018). Promoting Mental Health versus Reducing Mental Illness in Art Therapy with Patients with Personality Disorders. A Quantitative Study. The Arts in Psychotherapy, 58, 11-16. doi: 10.1016/j.aip.2017.12.009
  22. Horn, E., Verheul, R., Thunnissen, M., Delimon, J., Soons, M. et al. (2015). Effectiveness of Short-Term Inpatient Psychotherapy Based on Transactional Analysis With Patients With Personality Disorders: A Matched Control Study Using Propensity Score. Journal of Personality Disorders, 29, 663-683. doi:10.1521/pedi_2014_28_166.
  23. Huckvale, K. & Learmonth, M. (2009). A case example of art therapy in relation to dialectical behavior therapy. International Journal of Art Theory, 14, 5263. doi:10.1080/17454830903329196
  24. Jacobs, N., Kleen, M., de Groot, F. & A-Tjak, J. (2008). Het meten van experientiële vermijding: De Nederlandse versie van de Acceptance and Action Questionnaire-II (AAQII) [Measuring experiential avoidance: The Dutch version of the Acceptance and action Questionnaire-II (AAQII)]. Gedragstherapie, 41(4), 349-361
  25. Keulen-De Vos, M.E. (2013). Emotional states, crime and violence: A Schema Therapy approach to the understanding and treatment of forensic patients with personality disorders. Maastricht, the Netherlands: Datawyse/Maastricht University Press.
  26. Lambert, M.J., Burlingame, G.M., Umphress, V., Hansen, N.B., Vermeersch, D.A. et al. (1996). The reliability and validity of the Outcome Questionnaire. Clinical Psychology & Psychotherapy, 3, 249-258. doi:10.1002/ (sici)1099-0879(199612)3:4<249::aid-cpp106>3.3.co;2-j
  27. Lamers, S.M.A., Gül, P., Kovács, B.E., Kroeze, R., Müller, A.M.K. et al. (2014). Conceptualizations of Mental Health Across Europe: Comparing Psychology with Science and Engineering Students. Journal of European Psychology Students, 5, 3-7. doi:10.5334/jeps.bt
  28. Lamers, S.M.A., Westerhof, G.J., Bohlmeijer, E.T., Ten Klooster, P.M. & Keyes, C.L.M. (2011). Evaluating the psychometric properties of the Mental Health Continuum-Short Form (MHC-SF). Journal of Clinical Psychology, 67, 99-110. doi:10.1002/jclp.20741
  29. Landelijke Stuurgroep Multidisciplinaire Richtlijn ontwikkeling in de GGZ (2008). Multidisciplinaire Richtlijn Persoonlijkheidsstoornissen. Richtlijn voor de diagnostiek en behandeling van volwassen patiënten met een persoonlijkheidsstoornis. Utrecht, the Netherlands: Trimbos Instituut.
  30. Leckey, J. (2011). The therapeutic effectiveness of creative activities on mental wellbeing: A systematic review of the literature. Journal of Psychiatric Mental Health Nursing, 18, 501-509. doi:10.1111/j.1365-2850.2011.01693.x
  31. Lub, V. (2014). Kwalitatief evalueren in het sociale domein: Mogelijkheden en beperkingen. Den Haag, The Netherlands: Boom Lemma.
  32. Malchiodi, C.A. (2012). Handbook of Art Therapy (2nd ed.). New York, NY: Guilford.
  33. Malchiodi, C.A. (2015, August 31). Art is about resilience, it always has been. Retrieved from https://www.psychologytoday.com/blog/arts-andhealth/ 201508/art-is-about-resilience-it-always-has-been
  34. Neumann, E. (2001). Forschungsperspektiven integrativer klinischer Kunsttherapie am beispiel einer borderlineproblematik. Musik-, tanzund Kunsttherapie, 12, 171-187. doi:10.1026//0933-6885.12.4.171
  35. Raad voor Volksgezondheid en Samenleving (RVS). (2017). Zonder context geen bewijs: Over de illusie van evidence-based practice in de zorg. RVS publicatie 17-05. Den Haag, The Netherlands: Author.
  36. Rankanen, M. (2016). The visible spectrum: Participants’ experiences of the process and impacts of art therapy. Doctoral Dissertations (141), Aalto University, Espoo, Finland.
  37. Renner, F., van Goor, M., Huibers, M., Arntz, A., Butz, B. & Bernstein, D. (2013). Short-term group schema cognitive-behavioural therapy for young adults with personality disorders and personality disorder features: associations with changes in symptomatic distress, schemas, schema modes and coping styles. Behaviour Research and Therapy, 51, 487- 492. doi:10.1016/j.brat.2013.05.011
  38. Reynolds, M., Nabors, L. & Quinlan, A. (2000). The e ectiveness of art therapy: does it work? Art Therapy, 17, 207-213. doi:10.1080/07421656.20 00.10129706
  39. Rubin J. (2001). Approaches to Art Therapy: Theory and Technique. New York, NY: Routledge.
  40. Schnetz, M. (2005). The Healing Flow: Artistic Expression in Therapy. London, United Kingdom: Jessica Kingsley.
  41. Schweizer, C., Bruyn, J., Haeyen, S., Henskens, B., Rutten-Saris, M. & Visser, H. (2009). Handboek beeldende therapie: Uit de verf. Houten, the Netherlands: Bohn Stafleu van Loghum.
  42. Slayton, S. C., D‘Archer, J. & Kaplan, F. (2010). Outcome studies on the effi cacy of art therapy: A review of fi ndings. Art Therapy, 27(3), 108-118.
  43. Soler, J., Pascual J., Tiana, T., Cebrià, A., Barrachina, J. et al. (2009). Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: A 3-month randomized controlled clinical trial. Behaviour Research and Therapy, 47, 353-358. doi:10.1016/j. brat.2009.01.013
  44. Spring, B. (2007). Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know. Journal of Clinical Psychology, 63, 611-631. doi:10.1002/jclp.20373
  45. Springham, N., Findlay, D., Woods, A. & Harris, J. (2012). How can art therapy contribute to mentalization in borderline personality disorder? International journal of Art Therapy, 17, 115-129. doi:10.1080/17454832.201 2.734835
  46. Stoffers, J., Vollm, B., Rucker, G., Timmer, A., Huband, N. & Lieb, K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 8, CD005652.
  47. Taylor, K., Fletcher, I. & Lobban, F. (2015). Exploring the links between the phenomenology of creativity and bipolar disorders. Journal of Affective Disorders, 174, 658-664. doi:10.1016/j.jad.2014.10.040
  48. Trimbos Instituut. (2017). Zorgstandaard persoonlijkheidsstoornissen: Kwaliteitsontwikkeling GGZ. Utrecht: Author. Utrecht: author.
  49. Van Erp Taalman Kip, R. & Hutschemaekers, G. (2018). Health, well-Being and psychopathology in a Clinical population: structure and discriminant validity of Mental Health Continuum Short form (MHCSF). Journal of Clinical Psychology, 3, 1-11. doi:10.1002/jclp.22621
  50. Van Lith, T., Schofi eld, M.J. & Fenner, P. (2013). Identifying the evidencebase for art-based practices and their potential benefi t for mental health recovery: A critical review. Disability & Rehabilitation, 35, 1309-1323. doi:10. 3109/09638288.2012.732188
  51. Van Vreeswijk, M., Broersen, J., Bloo, J. & Haeyen, S. (2012). Techniques within schema therapy. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley-Blackwell Handbook of Schema Therapy: Theory, Research, and Practice (pp. 185-195). Chichester, United Kingdom: John Wiley.
  52. Van Vreeswijk, M., Spinhoven, P., Eurelings-Bontekoe, E. & Broersen, J. (2014). Changes in symptom severity, schemas and modes in heterogeneous psychiatric patient groups following short-term schema cognitive behavioural group therapy: A naturalistic pre-treatment and post-treatment design in an outpatient clinic. Clinical Psychology & Psychotherapy, 21, 29-38. doi:10.1002/cpp.1813
  53. Veerman, J.W. & van Yperen, T.A. (2007). Degrees of freedom and degrees of certainty. A developmental model for the establishment of evidence-based youth care. Evaluation and Program Planning, 30, 212-221. doi:10.1016/j.evalprogplan.2007.01.011
  54. Verfaille, M. (2016). Mentalizing in Arts Therapies. London, United Kingdom: Karnac Books. Wilkinson, R. & Chilton, G. (2013). Positive art therapy: Linking positive psychology to art therapy theory, practice, and research. Art Therapy, 30, 4-11. doi:10.1080/07421656.2013.757513
  55. Young, J., Arntz, A., Atkinson, T., Lobbestael, J., Weishaar, M. et al. (2007). Schema Mode Inventory (SMI version 1). New York, NY: Schema Therapy Institute.
  56. Zanarini, M. & Frankenburg, F. (2008). A preliminary, randomised trial of psychoeducation for women with borderline personality disorder. Journal of Personality Disorders, 22, 284-290. doi:10.1521/pedi.2008.22.3.284