studiu clinic Elena Chiril Artterapia n tulburrile emoionale ale copilului i adolescentului

STUDIU CLINIC

ARTTERAPIA N TULBURRILE EMOIONALE ALE COPILULUI I

ADOLESCENTULUI
The Use of Art Therapy in the Emotional Disorders of
the Child

Emilia Chiril1, Daniela Laura Cmpean2, Elena Mureanu3, Flaviu Cmpean4

REZUMAT

Procesul art-terapeutic presupune din partea artistului aplicarea unor mijloace artistice n vederea facilitrii exprimrii non-ver-
bale a emoiilor. Pornind de la aceast premis, 50 de copii i adolesceni, grup heterogen din punct de vedere al sexului, vrstei i
provenienei sociale, au beneficiat n cadrul CSM Copii Cluj de avantajele artterapiei. S-a putut stabili astfel un diagnostic clinic
de o mai mare acuratee i s-a intervenit terapeutic multiaxial prin psihofarmacologie, psihoterapie, art-terapie i asisten social.
Prin art-terapie s-au facilitat: Relaionarea interpersonal Comunicarea non-verbal Deprinderile Catharsis-ul
n concluzie, art-terapia alturi de celelalte intervenii (medicaie specific, psihoterapie, asisten social), contribuie la
ameliorarea pn la dispariie a simptomatologiei i are influene pozitive asupra imaginii de sine a copiilor i adolescenilor.
Cuvinte-cheie: art-terapie, tulburri emoionale, imaginea de sine.

abstract

The art therapy process involves the application of certain artistical means by the artist, in order to facilitate the non-verbal
deliverance of emotions. In this respect, a number of 50 children and teenagers (an eterogeneous group in matters of sex, age and
social background) have profited by the benefits of Art therapy at CSM Copii i Adolesceni Cluj-Napoca (The Centre for Child
and Adolescent Mental Health Cluj-Napoca). A more accurate clinical diagnosis has thus been established, as therapeutic inter-
ventions were undertaken in the multidirectional ways of psychopharmacology, psychotherapy, art therapy and social assistance.
The therapy improved the following aspects: The interpersonal relationships The non-verbal communication The personal
skills The Catharsis.
Consequently, art therapy, alongside some other interventions (particular medication, classical psychotherapy, social assistance),
contributes to the amelioration (and sometimes even to the disappearance) of the symptomatology and engenders several posi-
tive results regarding the self-portrayal of children and teenagers.
Key words: art therapy, emotional disorders, self-portrayal.

1
 rtterapeut, terapeut terapie ocupaional, artist plastic, Doctor n Arte
A 1
 rttherapist, occupational therapist, artist, Doctor in Fine Arts, Cluj-Napoca
A
Plastice, Cluj-Napoca 2
MD, PhD, Pediatric Psychiatry, Pediatric Neurology, Cluj-Napoca
2
Medic primar Psihiatrie Pediatric, Medic specialist Neurologie Pediatric, 3
Social worker, Cluj-Napoca
Doctor n Medicin, Cluj-Napoca 4
PhD in Philosophy, UBB Cluj-Napoca
3
Asistent social, Cluj-Napoca
4
Doctorand n Filosofie, UBB Cluj-Napoca
Adresa de coresponde:
Adresa de coresponde: 1
Mental Health Center
1
Centrul de Sntate Mintal 57 Gheorghe Bilascu street, Cluj-Napoca
str. Gheorghe Bilacu nr. 57, Cluj-Napoca
Tel.: 0264 599 001

Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 3 121
Elena Chiril Artterapia n tulburrile emoionale ale copilului i adolescentului
Introducere
Tulburrile emoionale n vrsta copilriei i ado-
lescenei precum i abordarea multiaxial a acestora
din punct de vedere terapeutic presupune o experien
ndelungat i o circumstan temeinic a aspectelor
neurobiologice, a tablourilor neuroclinice, a modalit-
ilor de exprimare verbal i non verbal, precum i a
microgrupului familial i social n care triete copilul.
n tulburrile dispoziiei mergnd pn la riscul
suicidar sunt cunoscute cercetrile n domeniul ne-
uromediatorilor- serotonin, noradrenalin, dopami-
n precum i a axului hoptalamo-hipofizar. n cazul
serotoninei este vorba despre o hipoactivitate, iar n
cazul axului hipotalamo-hipofizar este vorba despre o
hiperactivitate. Importante sunt i cercetrile recente
de neuroimagistic.
Din punct de vedere anamnestic sunt importante
urmtoarele aspecte:
antecedentele heredo-colaterale semnificative
(tulburri psihice, abuz de substan, dizarmonii de
personalitate- la genitori);
tabloul clinic identificat uneori indirect prin
observaie i exprimare nonverbal poate identifica:
tulburri ale dispoziiei, instabilitate, iritabilitate, im-
pulsivitate, agresivitate, tulburri de concentrare, se-
reotipii i bizarerii, anxietate de separare, ticuri.
Anamneza ofer informaii valoroase referitoare i
la funcionarea familiei, performana academic, tul-
burrile de identitate cu impact asupra stimei de sine
generatoare de distres.
Motivarea alegerii lucrrii
Art-terapia reprezint o metod valoroas n di-
agnosticul tulburrilor emoionale ale copilului. Prin
gestul grafic copilul comunic o multitudine de as-
pecte corelate cu tririle sale, cu cutarea identitii,
cu anxietile generate, cu mediul familiar i profesi-
onal cu situaiile de neglijare i abuz. Este exprimat
agresivitatea, frustrarea, tendina de dominare, stima
de sine sczut, rivalitatea n fratrie, absena speranei,
tristeea, mecanismele de compensare i de aprare a
eului, aspecte psihotraumatice semnificative, soluii
de rezolvare a situaiilor traumatice.
Ca metod terapeutic art-terapia are valene te-
rapeutice n:
1. Realizarea unei terapii prin:
detensionarea copilului i familiei
condiionri pozitive repetate
122 Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 3
studiu clinic
posibilittatea exprimrii nonverbale a unor
situaii traumatizante prin anihilarea a sentimentului
de ruine i a criticii din partea celorlali
relaionara interpersonal i comunicare cu
ceilali membrii ai grupului.
developarea unor aptitudini i motivaii
creterea stimei de sine i gsirea unor me-
canisme adecvate de rezolvare a situaiilor trauma-
tizante
adecvarea comportamentului la solicitrile gru-
pului i nelegerea nevoilor celorlali
Material i metod
n studiu au fost cuprini 50 de copii i adolesceni
cu vrste cuprinse ntre 5- 18 ani de ambele sexe, cu
proveniene sociale diferite, din punct de vedere loca-
tiv, instructiv i cultural.
S-au evideniat problemele funcionale ale micro-
grupului familial i problemele legate de adaptabilita-
te n colectivitile de copii i tineri frecventate de pa-
cieni. Diagnosticele au fost stabilite prin colaborare a
echipei multidisciplinare conduse de medicul specia-
list. Diagnosticul principal a fost: tulburri emoiona-
le cu debut n copilrie; diagnosticele asociate au fost:
1.tulburri de limbaj- prezente la 7 copii, repere-
zentnd un procent de 18% ,
2.ticuri prezente la 3 copii, reprezentnd un pro-
cent de 6%,
3.tulburri anxioase prezente la 8 copii, reprezen-
tnd 16%,
4.tulburri de eliminare prezente la 6 copii, repre-
zentnd 12%,
5. ADHD prezente la 13 copii reprezentnd 26%,
6. Retardare mental uoar prezent la 11 copii
reprezentnd 22%.
Fiecare copil a fost evaluat de ctre echipa multi-
disciplinar.
n sala de art-terapie au fost examinai i supui
terapiei att individual ct i n grupuri de cte 4 be-
neficiari urmrindu-se :
- comportamentul copilului
- capacitatea de relaionare cu terapeutul i cu cei-
lali copii
- coordonarea, motricitatea fin i grosier
- capacitatea de comprehensiune a cerinelor te-
rapeutului
- precizia gestului grafic
- mimica i pantomimica,
- structurarea spaial
studiu clinic
- inteligena emoional.
- gndirea vizual
- depistarea de abiliti speciale n domeniul artis-
tic i orientarea profesional
Procesul terapeutic din art-terapie se bazeaz pe
creativitatea artistului, care mpreun cu cea a be-
neficiarului se contopesc ntr-un flux creativ ce este
adaptat abilitilor i nevoilor beneficiarului. n acest
proces, artistul art-terapeut recurge la mijloace prelu-
ate din educaia artistic general pentru a forma de-
prinderi psihomotorii, n vederea facilitrii expimrii
nonverbale, astfel meteugurile artelor transformn-
du-se n metode terapeutice.(1)
Artistul plastic cu abiliti de comunicare non-
verbal, prin nelegerea orientrilor de expresivitate
formal pe care artele le adopt n dinamica evoluiei
lor, are, n art-terapia clinic, un rol unic i de o im-
portan fundamental n cea ce privete: amenajarea
spaiului de terapie (individual i de grup), asigurarea
unui mediu facilitator interveniilor terapeutice prin
utilizarea volumelor i a spaiului exterior n canali-
zarea tensiunilor psihice n exterior; organizarea unei
activiti psihomotrice mai ncordate i mai susinute
(n cazul nostru olritul) cu importan n decontrac-
tarea psihomotorie - fenomen de baz n tehnicile de
relaxare; ajustarea unor materiale din mediu i trans-
formarea lor n obiecte de art, utilitare i artizanat,
pentru a pune n eviden anumite tensiuni interioare
i totodat pentru a asigura descrcarea tensiunilor
psihice prin fenomenul de catharsis, ce contribuie la
1..M.A. sex M, 6 ani Dg. Mutism electiv
Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 3
Elena Chiril Artterapia n tulburrile emoionale ale copilului i adolescentului
creterea stimei de sine i la reabilitarea dimensiunii
socio-afective. Subliniez c, prin antrenare psihomo-
tric, art-terapeutul contribuie la depistarea prin vi-
zualizare a traumelor, abuzurilor i a cauzelor acestora
- n situaii de criz-, i la relaxare, dezinhibare- n
situaii de postcriz. Prin folosirea limbajului non-
verbal n depistarea aptitudinilor practice, de autocu-
noatere, art-terapia contribuie la orientarea colar
i profesional, la dezvoltarea abilitilor manuale, a
calitilor perceptive, a bunei orientri n spaiu, ca
trsturi ale personalitii.
Referindu-se la implicarea direct a artistului vi-
zual n procesul experimental, ca subiect de cercetat,
i la relaia acestuia cu educaia i art-terapia creativ,
Shaun McNiff consider c aceasta este o extensie a
practicii sale...implic transfer i contratransfer i alte
nuane subtile aflate n continu schimbare, provenite
din procesul experimentat...tiinele recunosc rolul
obsevaiei n cercetare. Se poate concluziona, referitor
la participarea personal a artistului la experiment n
cercetarea din art-terapia creativ, ca fiind necesar i
condiionat de practic. In cazul practicrii art-te-
rapiei, artistul i beneficiarul nu pun problema dac
sunt suficient de bun; se elimin judecile de valoa-
re, important fiind plenitudinea exprimrii spontane
Este vorba despre o abordare adaptativ - toi artitii
care practic art-terapia se bazeaz pe activitatea lor
artistic i au o trstur caracteristic comun: sunt
n concordan cu pragmatismul esenial.
Prezentm spre exemplificare cteva cazuri clinice.
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Elena Chiril Artterapia n tulburrile emoionale ale copilului i adolescentului studiu clinic

1. M.A. sex M, 6 ani Dg. Mutism electiv
La nceputul edinelor de art-terapie beneficiarul nu
comunica cu nici unul din membrii echipei. Comunicarea
a nceput prin modelaj. Se creeaz prin modelaj figurine
cu ajutorul crora art-terapeutul relaioneaz cu benefi-
ciarul, se joac pe un teren de lupt creat mpreun n
care desfar diferite activiti. Copilul este stimulat s
descrie verbal ce se ntmpl n lumea imaginat, mate-
rializt n imagini bi sau tridimensional mpreun cu
artistul art-terapeut. Prin motivaie, dorina de a realiza
acele lumi imaginare, copilul a ajuns la dorina de a arta
de ce performane este n stare att n comunicarea non
verbal ct i n cea verbal.
Rezultate:
descoperirea propriilor abiliti prin art i
cotientizarea propriilor emoii i triri deschid noi
ci de comunicare cu ajutorul limbajului nonverbal,
iar bucuria de a crea, succesele apreciate de prini i
de cei din jur, atenueaz efectele mediului conflictual
n care triete- rivalitate n fratrie
imaginea de sine restructurat i stima de sine
pozitiv ajut la rezolvarea tulburrilor emoionale
datorate mediului social
2. FPC, sex M, 5 ani
lucreaz separat i cu logopedul, particip la ter-
apii de grup fiind integrat n echipe de 2-3 persoane,
merge la grdinia de mas, unde comunic i verbal.
Cu ajutorul art-terapiei prin succesele repetate am
atins obiectivele care au ameliorat comportamentul.
2. FPC, sex M, 5 ani
Diagnostic:
1. Tulburri emoionale cu debut n copilrie
2. Mediu familial conflictual
Copilul este asistat n dezvoltarea sa n ceea ce pri-
vete conceptele despre sine, mediu i modul de funcionare
al acestuia.
Exerciiile de art-terapie se ncep pe roata de di-
mensiuni mici, unde exerciiile de nclzire i concen-
trare sunt stimulate de culorile concentrice (asemenea
mandalelor), apoi se trece la interpretarea petelor de
culoare i spaializare, prin stimularea concomitent a
simului tactil i vizual.
Prin art-terapie se ncurajeaz formarea strategiilor
de rezolvare a problemelor i luarea decizilor n vederea
diversificrilor formale; se descoper abiliti noi, necu-
noscute pn atunci, ceea ce duce la structurarea imaginii
de sine pozitive

124 Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 3
studiu clinic
Se ncurajeaz formarea strategiilor de rezolvare
a problemelor i luarea decizilor n vederea diversifi-
crilor formale; se descoper abiliti noi, necunoscute
pn atunci, ceea ce duce la structurarea imaginii de
sine pozitive
Rezultate:
Descoperirea propriilor abiliti prin art i
cotientizarea propriilor emoii i triri deschid noi
ci de comunicare cu ajutorul limbajului nonverbal,
iar bucuria de a crea, succesele apreciate de prini i
de cei din jur, atenueaz efectele mediului conflictual
n care triete;
imaginea de sine restructurat i stima de sine
pozitiv ajut la rezolvarea tulburrilor emoionale
datorate mediului familiar.
3. BG, sex M, 8 ani - provine din centru de plasament
Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 3
Elena Chiril Artterapia n tulburrile emoionale ale copilului i adolescentului
3. BG, sex M, 8 ani - provine din centru de plasa-
ment
Diagnostic:
1. Episod depresiv mediu
2. Retardare mental uoar
3. Tulburare specific a vorbirii articulate
4. Adaptabilitate sczut
Se ncepe stimularea prin art-terapie cu activiti
simple, sarcini mult sub nivelul vrstei cronologice pen-
tru a asigura succesul, care are rol dezinhibator. Lucr-
rile simpliste, anonime, nepersonalizate, se diversific,
dorete s exploreze noi medii artistice, i stimuleaz
singur creativitatea; a devenit curajos n explorare
(probabil a fost substimulat n copilrie sau folosit pen-
tru a-i ngriji fraii, fiind cel mai mare, poate chiar
abuzat afectiv);
Rezultate:
Emoional inhibat, relaionare deficitar; prin
ctigarea ncrederii n sine este dezinhibat, se sparg
blocajele emoionale, se formeaz abilitile de co-
municare i nteracionare cu alii;
optimizarea capacitilor de autocunoatere
i autoacceptare se obine prin creterea gradual a
gradelor de dificultate, ceea ce-i confer satisfacii n
urma succeselor vizibile;
dezvoltarea capacitilor cognitive (memorie,
atenie, limbaj, gndire etc.) se realizeaz prin analo-
giile cu elementele din mediu i lucrrile executate;
nlturarea frustrrilor acumulate i a sentimen-
talor negative provocate de dezinteresul prinilor
(mai ales al mamei care nu-i viziteaz copiii la cen-
tru nici de srbtori) se realizeaz prin ctigarea
competenelor i a autoritii asupra mediului, prin
perfecionarea unor abiliti i deprinderi deja for-
mate prin activitile artistice;
dezvoltarea competenelor, restructurarea imagi-
nii de sine, stima de sine pozitiv duc la dezvoltarea
competenelor sociale;
anxietatea de a fi pe placul cuiva a disprut, este
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Elena Chiril Artterapia n tulburrile emoionale ale copilului i adolescentului studiu clinic

mndru de realizri, i scrie numele pe lucrri vizibil crederea n autoexprimare, prin perceperea propriilor
(foto), s se tie c sunt ale lui i dorete s-i aduc abiliti, reprezint un factor important n procesul de
fraii la CSM, unde se simte n siguran. adaptare social.
4. AD, sex F, 6 ani Spaiul potenial reprezint o zon intermediar
Diagnostic: ntre fantezie i realitate, ntre subiectivitate i obi-
1.Tulburri anxioase ectivitate, prin utilizarea obiectului, obiectul fiind
2. ADHD neles ca produsul activitii (de exemplu o foaie de
3. Tulburare specific a vorbirii articulate hrtie umlput cu linii), obiect care reprezint obiectul
Desenul i pictura sunt considerate forme de comuni- treanziional, care satisface prin fantezie, dar reflect
care, cu implicare in dezvoltarea contientizrii senzori- n acelai timp i detaarea de sine;
ale a mediului, la aceast categorie de vrst cronologic n cazul copiilor cu ADHD, cum este i n acest
( 4-7 ani); copilul relaioneaz din ce n ce mai mult cu caz, folosim aceast metod pentru a stimula copii
mediul, i mai puin cu propriile micri ale corpului. s se concentreze asupra
Imaginile evideniaz acest lucru . activitii.
Printr-un mediul facilitator care ofer i siguran 5.K R, sex M, 7 ani
pentru exprimarea strilor emoionale, dar i a modali- Diagnostic:
tilor de a regla strile conflictuale, generatoare de anxi- 1. Tulburare reactiv de
etate i frustrare, copilul este stimulat s lucreze jucndu- ataament a copilriei
se, identificnd i crend un spaiu potenial. 2. Tulburare specific a
Rezultate: vorbirii articulate
Ctigarea autoritii asupra mediului scade 3. Carene de mediu
anxietatea, faciliteaz trirea sentimentului reuitei 4. Adaptabilitate sc-
prin implicarea ntr-un proces de creaie, comunicare, zut
i exprimare. Provocarea cu ajutorul mediului duce la Execut pictur pe dife-
dezvoltarea stimei de sine; stima de sine ridicat i n- rite dimensiuni i cu diferi-
4. AD, sex F, 6 ani te tehnici, modelaj pe roata

126 Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 3
studiu clinic Elena Chiril Artterapia n tulburrile emoionale ale copilului i adolescentului
5.K R, sex M, 7 ani
olarului, colaje pe coli de hrtie colorat, exerciii de fa-
miliarizare cu diferite forme si culori n camera de joac (
unde se asociaz cu tehnica jocului de rol).
Rezultate:
Spargerea blocajelor emoionale;
nlturarea frustrrilor acumulate;
stimularea creativitii crearea de stri afective
tonice;
inducerea unei stri de linite i acceptare de sine;
reducerea tensiunii i anxietii;
capacitatea de a nvinge obstacolele de natur
psihic ( barierele nu pot, nu sunt n stare, invin-
gerea amnrii.
6. M. P., sex F, 14 ani
Diagnostic:
1. Tulburri de
nvare
2. Intelect liminar
3.Tulburri de
adaptare colar
Se identific
punctele tariale in-
dividului; n cazul
acesta exist o ncli-
naie pentru expri-
marea vizual-plas-
tic, se dezvolt unele
abiliti de execuie i
exprimare cu ajutorul
limbajului vizual,
eventual se urmrete
o orientare profesio-
Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 3
nal ctre domenii unde este nevoie de asemenea abiliti
(arte decorative, artizanat, etc.);
Prin art-terapie se ofer pacientului o privire asupra
emoiilor, gndurilor i sentimentelor.
Rezultate:
Dezvoltarea inteligenei emoionale;
Stimularea tuturor canalelor senzoriale;
Dezvoltarea capaciii de a se exprima mai re-
pede i mai uor;
Modelarea personalitii prin valori estetice i
orientarea spre ncorporarea frumosului n via i ac-
tivitate;
Dezvoltarea percepiilor i reprezentrilor vi-
zuale, a imaginaiei creatoare;
Facilitarea comunicrii interpersonale, creterea
sociabilitii, creterea adaptrii n societate;
Rezolvarea eficient a conflictelor;
Crearea de stri afective comice;
Inducerea unei stri de linite, acceptare de sine;
Reducerea tensiunii i anxietii;
Capacitatea de a nvinge obstacole de natur
psihic (nu pot , nu sunt n stare, nvingerea amnrii
Se folosete ca metod art-terapia, prin calitatea ar-
telor vizuale, care permite practicantului s se exprime
prin mijloace specifice artelor.
7. M.M., sex f , 13 ani
Diagnostic:
1. Ticuri cronice complexe
2. Fobie social
3. Balbism tonico clonic
4. P. cu anxietate constituional
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Elena Chiril Artterapia n tulburrile emoionale ale copilului i adolescentului studiu clinic

6. M. P., sex F, 14 ani

5. Adaptabilitate sczut REZULTATE GENERALE

Stimularea canalelor senzoriale prin culoare i modelaj
Realizri:
Dezvoltarea capacitii de a se exprima mai re-
pede i mai uor;
declanarea proceselor complexe de asimilare i
fixare afectiv la nivel individual a valorilor estetice;
crearea de stri afective comice
inducerea unei stri de linite i acceptare de sine;
reducerea tensiunii i anxietii;
capacitatea de a nvinge obstacolele de natur
psihic (nu pot, nu sunt n stare, nvingerea amnrii).
7. M.M., sex f , 13 ani
Muli terapeui consider c terapia prin art, din
punct de vedere analitic, poate fi luat ca i o proiecie
a gndurilor, sentimentelor, produsul artistic fiind o
proiecie; ei accentueaz importana dialogului sau a
povestirii clientului despre produsul elaborat, n tim-
pul sau/i dup realizarea acestuia.
n cazul persoanelor care nu au o stim de sine
pozitiv, care sunt nemulumite de ele nsele, prin in-
termediul terapiei individuale sau de grup, printre fac-
torii care asigura eficiena terapiei se numr: trezirea
speranei, universalitatea, mprtirea informaiilor,
altruismul, recapitulerea cunotinelor, dezvoltarea
tehnicilor de socializare, comportamentul imitativ, n-
varea interpersonal, coeziunea grupului; membrii
grupului pot nva din feed-back-ul altora.
n cazul terapiei de grup se pot experimenta noi
roluri prin observarea reaciilor altora i beneficiarii
pot fi susinui sau reinformai.
Grupurile pot fi catalizate prin dezvoltarea lent a
resurselor i abilitilor.
n cazul educaiei/art-terapiei creative, procesul te-
rapeutic favorizeaz apariia a trei reele de comunicare:
1) ntre terapeut i beneficiar
2) ntre beneficiar i artefact;
3) ntre terapeut i artefact.
Procesul creativ i comunicarea crete stima de
sine, curajul, asumarea riscului, experimentul nva
noi deprinderi, mbogete viaa, acestea avnd ca-
liti terapeutice incontestabile. Apar idei noi, noi ci
de comunicare, noi ci de autoexprimare i noi mo-
duri de a vedea lucrurile.
Educaia/art-terapia creativ este eficient i dez-
volt abilitaile de adaptare atunci cnd participa-
rea beneficiarului este voluntar. Prin abilitile de
adaptare dobndite n cadrul edinelor de art-terapie
beneficiarul dobndete autoritate asupra mediului
nconjurator, fapt ce contribuie la setimentul de com-
petena. Prin competen crete capacitatea individu-

128 Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 3
clinical study
lui de a face fa problemelor existeniale, de a-i n-
deplini rolul social prin contactul cu factorul uman i
de mediu. Antrenarea empatiei n relaiile interperso-
nale, dezvoltarea unor strategii intrapersonale i inter-
personale de rezolvare a problemelor i a conflictelor,
spargerea blocajelor emoionale, optimizarea capaci-
tilor de autocunotere i dezvoltarea capacitilor
cognitive (memorie, atenie, limbaj, gndire etc), eli-
berarea de tensiuni, anxietate, nlturarea frustrrilor
* *
Introduction
The approach of the emotional disorders in child-
hood and adolescence through a multidirectional
therapy involves a long experience and a thorough
circumstance of the neurobiological aspects, of the
neuroclinical pictures, of the means of verbal and
nonverbal communication, as well as of the family
and social group of the child.
In respect of mood disorders, especially regar-
ding the risk of suicide, the researches in the field of
the neuromediators are well known - serotonin, no-
radrenalin, dopamine, the hypothalamic-pituitary
axis. In the case of the serotonin, a hypoactivity can
be inferred, while in the case of the hypothalamic-
pituitary axis, its a hyperactivity that can be conclu-
ded upon. The recent neuroimaging researches are
also important.
From the anamnestic perspective, the following
aspects are very important:
the relevant family background (mental disor-
ders, substance abuse, disharmonies of personality
concerning the genitors).
the clinical picture, often identified indirectly
through observation and nonverbal communication,
suggests: mood disorders, instability, irritability, im-
pulsivity, aggressiveness, concentration disorders, ste-
reotypes and oddities, anxiety of separation, tics.
The anamnesis offers valuable information regar-
ding family life, academic performance and the iden-
tity disorders that undermine the self esteem and ge-
nerate distress.
Motivation of the choice
of the theme
Art therapy represents a valuable method in the
diagnosis of the emotional disorders of the child.
Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 3
Elena Chiril The Use of Art Therapy in the Emotional Disorders of the Child
acumulate i a sentimentelor negative, perfecionarea
unor abiliti deja formate (colaj, pictur, modelaj etc)
i dezvoltarea competenei sociale, se numr printre
beneficiile educaiei/art-terapiei creative, practicat
de noi cu metode ce au la baz domeniul ceramicii
cu artele conexate acestei (sculptura, pictura, grafica),
ceea ce sintetic exprimat este o educaie/art-terapie
multimodal centrat pe ceramic.
*
Through the graphic gesture, the child expresses va-
rious issues related to his feelings, like the search of
his identity, the generated anxieties, the family and
professional environment, the situations of neglect
and abuse. Accordingly, the following reactions can
be identified: aggressiveness, frustration, tendency to
dominate, lower self-esteem, brotherhood rivalry, lack
of hope, sadness, compensation mechanisms and self
defense, other significant psychotraumatic aspects,
solutions for traumatic situations.
Consequently, the art therapy method proves itself
useful in the achievement of a therapy through:
stress relief of the child and his family
repeated positive conditionings
the possibility of a nonverbal manifestation of
the traumatic situations by the annihilation of the
sense of shame and criticism from others.
interpersonal relationships and communication
with other members of the group.
the development of attitudes and motivations
the increase of self esteem and the finding of ap-
propriate mechanisms in order to solve the traumatic
situations.
the adequacy of behavior at the requests of the
group and understanding the needs of others.
Material and method
The study included 50 children and teenagers aged
5 to 18 years of both sexes, different social backgro-
unds in terms of housing, culture and education.
The results pointed out the functional pro-
blems of micro-clustered families, as well as the
issues concerning the adaptability to the collec-
tivities frequented by the respective children and
young patients. The diagnoses were established
by the collaboration of a multidisciplinary team
129
Elena Chiril The Use of Art Therapy in the Emotional Disorders of the Child
which assessed each child, led by the specialist phy-
sician. The basic diagnosis was: emotional disor-
ders with onset in childhood; the complemen-
tary diagnoses were, as it follows:
1. language disorders, in 7 children, a rate of 18 %
2. tics, in 3 children, a rate of 6%
3. anxiety disorders in 8 children, a rate of 16%
4. elimination disorders in 6 children, a rate of 12%
5. ADHD in 13 children, a rate of 26%
6. mild mental retardation in 11 children, a
rate of 22%
The patients were examined and subjected to the-
rapy both individually and in groups of four, accor-
ding to the following guidelines:
the childs behavior
the ability to interact with the therapist and with
the other patients
the coordination, the fine and coarse motricity
the ability to comprehend the therapists demands
the precision of the graphic gesture
the mimic and the pantomime
the spatial structuring
the emotional intelligence
the visual thinking
the discovery of special artistic abilities and the
professional orientation
The art therapeutic process is based on the artists
creativity which, alongside that of the patient, merges
into a creative flux adapted to the latters necessities.
Throughout the process, the art therapist (and artist
as well) makes use of specific means that belong to
1..M.A. sex M, 6 years Dg. Selective mutism
130 Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 3
clinical study
artistic education, in order to form psychomotor skills
and with the final purpose of facilitating nonverbal
expression. Thus, the artistic crafts are being reinven-
ted as therapeutic methods.
The plastic artist particularly skilled in nonverbal
expression has, by virtue of understanding the direc-
tions of formal expressivity that fine arts embrace in
their evolving dynamic, a unique and fundamentally
essential function regarding: the laying out of a space
for therapy (both individual and group therapy), the
assurance of an appropriate environment for thera-
peutic interventions through the use of open spaces
in order to vent the psychic tensions, the framing of
a more involved and continuous psychomotor acti-
vity (for example pottery, in our case) which plays an
important part in psychomotor alleviation a fun-
damental phenomenon in relaxation techniques, the
adjustment of plain elements in the context by trans-
forming them into art and handicraft objects, all of
them with the final purpose of highlighting various
inner tensions and to insure the alleviating catharsis
of the rehabilitation of self esteem and, implicitly, of
the socio-affective dimension. We need to emphasi-
ze here the contribution of the art therapist, by way
of the psychomotor training aforementioned, to the
measurement through visualization of trauma, abuse
and their causes and to the relief and disinhibition in
the posttraumatic situations. Through the use of non-
verbal language to identify the practical self-knowing
aptitudes, art therapy facilitates school and professi-
onal orientation, the development of several perso-
nality features, like manual skills, perceptive abilities,
clinical study
and space orientation.
Sean McNiff, speaking about the direct involve-
ment of the artist in the experimental process and
about his relationship with education and creative
art therapy, states that the latter is an extension of
his practiceimplies the transfer and the counter-
transfer and other subtle nuances in perpetual fluc-
tuation, which rise out of the experimental process
The sciences acknowledge the role of observation in
research. It may be concluded then that the personal
participation of the artist to the experimental research
is mandatory and conditioned by the artistic practice.
Moreover, in the context of art therapy, neither the
artist, nor the patient asks himself Am I good enou-
gh, the judgments of value being therefore excluded
in favor of spontaneous expression. The approach is
an adjustable one all artists who practice art therapy
rely on their own artistic activity and present a recur-
rent common feature: they are always in accordance
with the essential pragmatism.
To exemplify, we present several clinical cases.
1. M.A. sex M, 6 years Dg. Selective mutism
At the beginning of the art therapy sessions the pati-
ent didnt interact with any of the members of the team.
The communication started by way of modeling. Various
figurines were crafted, by means of which the therapist
could interact with the patient, for example by staging a
battlefield. Thus, the child is verbally stimulated in order
to describe what happens in the imaginary bi or tridi-
mensional world. Being motivated in this manner by the
wish to make the world come true, he manifests considera-
ble progresses both verbally and non-verbally.
2. FPC, sex M, 5 ani
Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 3
Elena Chiril The Use of Art Therapy in the Emotional Disorders of the Child
Relevant Results:
The discovery of ones skills through art pro-
duction and the consciousness of ones emotions and
feelings pave the way for an effective communication,
especially a non-verbal one. Moreover, the joy of cre-
ating and the success related to it, properly appreci-
ated by the parents and by all people in the childs
vicinity, have, in this case, mitigated the conflictive
environment of the brotherhood rivalry. Consequent-
ly, once the self image and the self esteem having been
improved, the emotional disorders due to the social
environment can be surpassed. We also mention in
this respect that our patient is currently working in-
dividually with the speech therapist while taking part
on the other hand in group therapies, alongside other
two or three patients. Due to the favorable results, the
patient is attending a normal kindergarten, after hav-
ing begun to communicate verbally. Our objectives in
improving his behavior were thus achieved with the
aid of art therapy.
2. FPC, sex M, 5 years
Diagnosis:
1. Emotional disorders that started in childhood
2. A conflictive family environment
The child is assisted in his development concerning his
self conception, the environment and its functioning.
The art therapy exercises are initiated on the small
wheel, where the warm up and the focusing labor is
stimulated by the concentric colors (similar to man-
dalas). The next stage consists in interpreting the co-
lorful stains and in the spatialization through the si-
131
Elena Chiril The Use of Art Therapy in the Emotional Disorders of the Child
multaneous stimulation of the tactile and of the sight.
In art therapy, the development of problem sol-
ving strategies and the decision making with an eye
to formal diversification are encouraged; new skills,
unknown up until then, are always discovered, rende-
ring a positive structuring of the self image.
Results:
The discovery of ones skills through art pro-
duction and the consciousness of ones emotions and
feelings pave the way for an effective communication,
especially a non-verbal one. Moreover, the joy of creat-
ing and the success related to it, properly appreciated
by the parents and by all people in the childs vicinity,
have, in this case, mitigated the conflictive environ-
ment Consequently, once the self image and the self
esteem having been improved, the emotional disorders
due to the family environment can be surpassed.
132 Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 3
clinical study
3. B.G. sex M, 8 years comes from an orphanage
Diagnosis:
1. Medium transient depression
2. Mild Mental retardation
3. Specific disorder of articulated speech
4. Low adaptability
We began the therapeutic stimulation with simple ac-
tivities, tasks way below the skill and intelligence level
of the chronological age, to insure the primary objective
of disinhibition. Throughout the process, the patient star-
ted to develop his first simplistic and impersonal works,
to explore new artistic spheres and to stimulate himself
in his creativity, stating his courage to explore. (He may
have been poorly stimulated during childhood or put to
take care of his brothers as the eldest child, maybe even
affectively abused once in awhile).
Results:
The overcoming of the emotional blockings, the
disinhibition and the forming of the communicati-
on and interaction abilities. The optimization of self-
knowing and self-acceptance capabilities through the
gradual increase of the difficulty levels and, implicitly,
a growing satisfaction following his successes. The de-
velopment of cognitive skills (memory, attention, lan-
guage, thinking) accomplished by virtue of analogy
between the real objects and the artistic products. The
disappearance of the frustrations and of all the negative
feelings due to the parents disinterest (particularly the
mothers, who doesnt visit her children, not even at ho-
lidays) was achieved through the gain of authority over
the environment and through the improvement of the
pre-existent skills. The restructuring of the self image
and the positive self esteem led to the development of
social competences. The anxiety to please has vanished,
while the patient is now proud of his accomplishments,
since he now signs his works so that everyone knows
they are his own and, moreover, he wishes to bring his
brothers to CSM, where he feels safe.
4. A.D., sex F, 6 years
Diagnosis:
1. Anxious disorders
clinical study Elena Chiril The Use of Art Therapy in the Emotional Disorders of the Child

3. B.G. sex M, 8 years comes from an orphanage

2. ADHD satisfaction regarding success through the involve-

3. Specific disorder of articulated speech ment in the creative interactive process. The stimu-
Drawing and painting are universally known as lation by the environment
means of communication with a direct implication into increases the self esteem,
the development of the sensorial consciousness of the en- which alongside the ac-
vironment between 4 and 7 years; the patient interacts quired self-confidence
with the environment increasingly more, while using the throughout the accurate
self-referent gestures increasingly less, as the images above perception of ones skills,
prove it. The child is thus stimulated to work by playing, builds up a steady social
by creating a potential space in the frame of an appropri- adaptation. The potential
ate environment which inspires safety and self-assurance space represents an inter-
in respect of emotional expression. mediate zone, between re-
Results: ality and fantasy, between
The gain of authority over the environment leads subjectivity and objectiv-
to the decrease of anxiety facilitates the expression of ity, and also a medium for

4. AD, sex F, 6 YEARS

Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 3 133
Elena Chiril The Use of Art Therapy in the Emotional Disorders of the Child clinical study

5.K R, sex M, 7 years

perpetually using the object the object being de- and of tonic affective atmosphere, the inculcation of
fined as the product of artistic activity (for example a peaceful state of mind and of self acceptance, the
even a piece of paper with drawn on it), as a transi- reduction of tension and of anxiety, the capacity to
tional object that satisfies through fantasy and, at the overcome psychic obstacles (like I cant do this or
same time, reflects a self-detachment. In the cases of that, Im not able to..), the giving up of postponing.
ADHD patients like this one, the method aims to
stimulate the focusing on a particular activity. 6. M. P., sex F, 14 years
Diagnosis:
5.K R, sex M, 7 years 1. Learning di-
Diagnosis: sorders
1. Reactive disorders of childhood attachment 2. Liminar in-
2. Specific disorder of articulated speech tellect
3. Environment deficiencies 3. School adap-
4. Low adaptability tation disorders
The patient executed several paintings of different di- The strong
mensions and using various techniques: modeling on the points of the pati-
potters wheel, collage on colored paper, exercises of acqu- ents were identified.
aintance with forms and colors in the play room (associa- In this case we are
ted with the technique of role playing). dealing with a par-
Results: ticular inclination
The overcome of emotional blockage, the disap- to visual and plastic
pearance of frustrations, the stimulation of creativity expression, that ena-

6. M. P., sex F, 14 years

134 Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 3
clinical study
bled us to further develop- the execution skills and the
visual language. We also aimed an eventual professional
orientation of the patient towards areas that exploit such
skills (decorative arts, craftsmanship etc). By way of art
therapy, the patient consequently formed a perspective of
his own emotions, thoughts and feelings.
Results:
The development of emotional intelligence, the
stimulation of all sensorial channels, the development
of an easy free-floating expression, the outlining of
the patients personality in accordance to the aesthetic
values and the incorporation of the concept beauti-
ful in everyday life, the development of visual percep-
tion and representation, the facilitation of interperso-
nal communication, sociability and social adaptation,
the efficient solving of conflicts, the staging of comic
affective states, the inculcation of a peaceful, self-ac-
ceptance atmosphere, the decrease of tension and an-
xiety, the capacity to overcome psychic obstacles (like
I cant do this or that, Im not able to..), the giving
up of postponing.
7. M.M., sex F, 13 years
Diagnosis:
1. Complex chronic tics
2. Social phobia
3. Clonic and tonic balbism
4. Constitutional anxiety
5. Low adaptability
6. The stimulation of the sensorial channels by
way of color and modelling
Results:
The development of easy free-floating expression,
the triggering of the complex processes of assimila-
tion and affective fixation of the aesthetic values, the
staging of comic affective states, the inculcation of a
peaceful, self-acceptance atmosphere, the decrease of
7. M.M., sex F, 13 years
Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 3
Elena Chiril The Use of Art Therapy in the Emotional Disorders of the Child
tension and anxiety, the capacity to overcome psychic
obstacles (like I cant do this or that, Im not able
to..), the giving up of postponing.
General Results
Many therapists consider art therapy, form an
analytical point of view, a projection of thoughts and
feelings, the artistic product being itself the projec-
tion as well. They also emphasize the importance of
the conversation and debate on the artistic product,
during or after its accomplishment.
In the cases of low self esteem patients, the fun-
damental characters that insure a successful thera-
py (both individually and group therapy) are, as it
follows: the stimulation of hope, the universality, the
exchange of information, the altruism, the regular
restatement of the acquired knowledge, the develop-
ment of socializing techniques, the mimetic behavior,
the interpersonal learning, the groups cohesion, the
feedback learning process within the group.
The groups can be sustained by the gradual deve-
lopment of their members skills and resources.
In the sphere of the educational creative art the-
rapy, the therapeutic process favors the building up of
three axis of communications:
1) therapist-patient
2) patient-artifact
3) therapist-artifact
The creative process and the interaction increases
self esteem, courage, taking of risks; the experimental
aspect favors the learning of new skills, enriching the
patients life according with the therapeutic purpo-
ses. New ideas, conceptions and ways of expression
emerge.
In conclusion, when the patients engagement is
135
Elena Chiril The Use of Art Therapy in the Emotional Disorders of the Child
voluntary, the creative art therapy proves very effici-
ent in developing the adaptation abilities by which a
thorough authority over the environment and, impli-
citly, a general feeling of ableness is gained. Thus, the
individual becomes more prone to voluntarily facing
his existential problems and to assume a social role
appropriate for him in the interaction with the envi-
ronment and with the others. Finally, its worth noting
and revising some of the manifold advantages of cre-
ative art therapy, particularly in connection with the
craft of ceramics and its associated techniques from
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136 Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 3
clinical study
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