Creative arts occupations in therapeutic
Critical review
practice: a review of the literature
Nadia Perruzza 1 and Elizabeth Anne Kinsella 2
Key words:
Creative arts occupation,
literature review,
matrix method.
1Rehab First Inc., London, Ontario, Canada.
2University of Western Ontario, London,
Ontario, Canada.
Correspondence to:
Dr Elizabeth Anne Kinsella, Assistant Professor,
School of Occupational Therapy,
Elborn College, University of Western Ontario,
1201 Western Road, London, Ontario,
Canada N6G 1H1. Email: akinsell@uwo.ca
Reference: Perruzza N, Kinsella EA (2010)
Creative arts occupations in therapeutic
practice: a review of the literature. British
Journal of Occupational Therapy, 73(6),
261-268.
DOI: 10.4276/030802210X12759925468943
© The College of Occupational Therapists Ltd.
Submitted: 23 December 2008.
Accepted: 22 December 2009.
Downloaded from bjo.sagepub.com at UNSW Library on August 2, 2015
The purpose of this study was to conduct a matrix method literature review
of published research on the use of creative arts occupations in therapeutic
practice. Peer-reviewed original research articles, published between the years
2000 and 2008, were included in the review. The research articles studied
creative arts occupations as a therapeutic medium. Twenty-three articles,
located through multiple electronic searches, were identified as meeting the
criteria of the review.
Data analysis included quantitative analysis and qualitative analysis.
The findings suggest that the use of creative arts occupations in therapeutic
practice may have important qualitative value related to health and wellbeing.
Six predominant outcomes were most frequently identified across the studies:
enhanced perceived control, building a sense of self, expression, transforming
the illness experience, gaining a sense of purpose and building social support.
The results suggest that qualitative research may well be the methodology
of choice for the study of this topic and raise questions about the paucity of
research in this area. Further research into the use of creative arts occupations
as a therapeutic approach in occupational therapy and other health and social
care disciplines is warranted.
Introduction
Creativity plays an important part in the engagement of creative arts
occupations. Some believe that creativity has the power to increase self-
esteem, promote a sense of purpose and belonging, empower individuals
and foster autonomy and competence (Schmid 2005). There is no one
core definition of creativity; however, Schmid (2005) defines creativity as:
An innate capacity to think and act in original ways, to be inventive, to be
imaginative and to find new and original solutions to needs, problems and
forms of expression. It can be used in all activities. Its processes and outcomes
are meaningful to its user and generate positive feelings (p6).
Others have described creativity as a quality or capability that is present in
different degrees in all individuals and is evident in essentially all aspects
of life (Hasselkus 2002). Hasselkus (2002) contends that using creativity
in everyday life may be beneficial to the health and wellbeing of individ-
uals, and may improve physical, mental and social wellbeing. Others view
creativity as a lifelong process, which can be encouraged and improved
(Thompson and Blair 1998, Fisher and Specht 1999). According to Molineux
(2004), humans are creative beings; there is an innate need for individuals
to engage in creative arts occupations.
Occupation is anything and everything that individuals do to occupy
themselves; occupation is a group of activities in everyday life, which are
named, organised and given meaning by the people taking part in these
occupations (Hasselkus 2002). In occupational therapy, occupations are
viewed as a basic human need, which help to organise behaviour and
British Journal of Occupational Therapy June 2010 73(6) 261
Creative arts occupations in therapeutic practice: a review of the literature
enable the expression and management of self-identity,
social identity and time management (Townsend 2002).
When faced with illness, engagement in occupations can
be diminished; in these times, creativity can be a valuable
tool in the healing process (Hasselkus 2002). In order
to meet new challenges, such as illness, creative thinking
skills may become important as a means to adjust and
endure (Thompson and Blair 1998).
A study by Fisher and Specht (1999), which focused
on creative occupations as a leisure-based pursuit for older
adults, contended that as individuals deal with a changing
environment and self, the inclusion of creative occupa-
tions may be beneficial. The researchers interviewed older
adults exhibiting their artwork at a senior citizens art
exhibition and found that creative occupations fostered a
sense of purpose, competence, self-acceptance, autonomy
and health (Fisher and Specht 1999). Through engagement
in creative occupations one may follow a creative process,
a path of discovery that guides and enables expression,
which in turn may result in positive feelings of health and
wellbeing (Schmid 2005).
Drawing on the World Health Organisation’s definition,
health is described as ‘A state of complete physical, mental
and social well-being and not merely the absence of
disease or infirmity’ (Schmid 2005, p6). Health can be
influenced by what individuals do in their everyday life;
it may be dependent on people engaging in meaningful
occupation (Townsend 2002). As people move through
their lives, situations that hinder their ability to engage
in meaningful occupation may arise and these periods
may require new patterns of occupation; it is in these
times that creative occupations may offer an alternative
means of engaging in a meaningful occupation and may
contribute to health and wellbeing (Vrkljan and Miller-
Polgar 2001). Law et al (1998) stated that health is a
positive concept, emphasising social and personal resources,
as well as physical capacity.
Wellbeing is seen as an important aspect of health and
can be described as feelings of happiness, pleasure, health
and comfort and a balance in all aspects of one’s life (Law
et al 1998, Wilcock et al 1998). An exploratory survey by
Wilcock et al (1998) aimed to describe the meanings,
perceptions and feelings that people possessed regarding
wellbeing and how these factored into participation in
everyday occupation. Participants between the ages of 13
and 66 years completed a questionnaire that incorporated
demographic questions, as well as open-ended questions
about participants’ experiences of wellbeing. The results
indicated that wellbeing was seen differently in all people yet
commonly encompassed feelings of happiness, self-esteem,
self-respect and confidence. In addition, fulfilment, purpose
and satisfaction were identified as rewards of engagement
in occupation.
Withdrawal, disruption or changes in an individual’s
ability to engage in a chosen meaningful occupation may
have a significant impact on an individual’s perceived
health and wellbeing (Vrkljan and Miller-Polgar 2001).
262 British Journal of Occupational Therapy June 2010 73(6)
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As Vrkljan and Miller-Polgar (2001) point out, the meaning
that is attributed to the occupation an individual chooses
to engage in may change. The arrival of impairment or
illness can lead to a diminished awareness of self as
competent, which may lead a person to feel hopeless and
worthless (Hammell 2004).
Becoming aware of the value of creative occupations
and making these a part of everyday life and occupations
can be a positive way of making the best out of negative
disruptions in life (Schmid 2005). A number of authors
contend that using creative occupations can have a bene-
ficial effect on an individual’s health and wellbeing
(Hasselkus 2002, Reynolds 2003, Schmid 2005). The
ability to participate in creative occupation is a major
feature of human beings and engagement in these
occupations may have a beneficial effect on health and
wellbeing (Molineux 2004).
Despite the proposed link between creativity and health
and wellbeing, it continues to prove difficult to obtain
research support for the application of creative occupa-
tions in therapeutic practice (Thompson and Blair 1998).
This may be one of the main reasons for the apparent
decline in the therapeutic use of creative occupations by
health care professionals (Thompson and Blair 1998).
This decline is the motivation for this literature review.
Although it is recognised that any occupation may invoke
creativity or possess creative dimensions, the focus of
this study is particularly on the value of the creative arts
as a means of creative occupation. Creative arts occu-
pations include any arts-based occupation that evokes a
creative process in an individual, such as painting, draw-
ing, creative writing, music, textile arts and crafts. The
purpose of this study is to review the available research
published between the years 2000 and 2008, on the per-
ceived outcomes of creative arts occupations with respect
to health and wellbeing.
Research design
This literature review followed the matrix method, guide-
lines set out by Garrard (1999). The matrix method is a
framework used to review literature on a specific topic
and consists of four sections: a paper trail, a documents
section, a review matrix and a synthesis section. The paper
trail is a record kept by the researcher in order to keep
track of the search process: in this study, electronic data-
base searches were saved and records of the search name
and password were kept for easy retrieval. The documents
section consists of a printout of all articles included in the
study and is intended to organise the documents in the
review. The review matrix is a table used to abstract the
literature, according to the following categories: reference,
year, purpose, methods, methodology, participants and
findings. The final part of the matrix method is the synthesis;
this section is a review of the literature based on the infor-
mation in the review matrix.
 Nadia Perruzza and Elizabeth Anne Kinsella

Table 1. Electronic database searches

AMED CINAHL EMBASE MEDLINE SCOPUS
Number of Number of Number of Number of Number of
results results results results results
1. ‘Creative Occupation’ ...............................................2 ...............................2 ...............................0 ...............................0 ...............................0................
2. ‘Creativity’ AND ‘Occupation’....................................7 .............................12.............................20 ...............................4.............................64................
3. ‘Art’ AND ‘Occupation’............................................15 .............................24.............................47.............................17...........................318................
4. ‘Creative Occupation’ AND ‘Health’...........................1 ...............................0 ...............................0 ...............................0.............................21................
5. ‘Art’ AND ‘Health’ ...................................................48 ...........................298...........................282...........................317...........................N/A................
6. ‘Creativity’ AND ‘Health’ .........................................22 ...........................182...........................331...........................244...........................N/A................
7. ‘Art’ AND ‘Occupational Therapy’.............................23 .............................46.............................51.............................14...........................N/A................
8. ‘Creativity’ AND ‘Occupational Therapy’...................12 ...............................9 ...............................9 ...............................5...........................N/A................

Method (CINAHL), MEDLINE-OVID and Scopus (see Table 1).

These databases were chosen because they index a broad
Locating and selecting studies range of health care disciplines, including occupational
The purpose of the study was to contribute to the occupa- therapy and other allied health care disciplines.
tional therapy literature rather than the broader litera- The key word combinations used for the electronic
ture on this topic and this purpose guided decisions searches were as follows: ‘Creative Occupation’, ‘Creativity’
regarding the parameters of the review. With a con- AND ‘Occupation’, ‘Art’ AND ‘Occupation’, ‘Creative
sideration of occupation as a key construct in the work Occupation’ AND ‘Health’, ‘Art’ AND ‘Health’, ‘Creativity’
of occupational therapists, the researchers intentionally AND ‘Health’, ‘Art’ AND ‘Occupational Therapy’, ‘Creativity’
chose to search for studies that used the language of AND ‘Occupational Therapy’. These key words were
occupation. The years 2000-2008 were chosen, with the chosen based on articles obtained through searches for the
assumption that 8 years would offer a sufficient timeframe background information (initial literature review). Searches
to gain insight into current research on the use of creative were conducted until redundancy in the literature was found.
arts occupations.
Documents from these years were chosen for practical Data analysis
reasons in order to set boundaries on the amount of data Using the search strategies above, 70 papers were retrieved
to be included in the review. The criteria for the inclusion and screened using the inclusion criteria. The articles were
of articles were as follows: available in full text in the reviewed several times. Twenty-three articles met the
English language; peer-reviewed original research articles; inclusion criteria; 47 papers were excluded, of which 21
published between the years 2000 and 2008; and studies were conceptual papers and 26 were research papers.
that examine the perceived outcomes of creative arts occu- The 23 articles included in the study were entered into
pations with respect to health and wellbeing. Creative arts the review matrix and the analysis stage began. Articles
occupations could be therapeutic or leisure based and were first analysed and reviewed based on the categories
could include painting, drawing, creative writing, music, set out in the review matrix: full citation, year, purpose,
textile arts and crafts. The articles adopted any method- methodological design, methods, sample and findings. Of
ology, population and sample characteristics. The search the 23 articles identified, 4 used quantitative approaches,
focused primarily on the fields of occupational therapy 16 used qualitative methodologies and 3 used mixed
and occupational science; however, in light of limited methodologies.
available literature, articles from other disciplines located As the majority of studies were qualitative in nature,
during the search were included. The articles excluded a thematic analysis of common themes was undertaken.
in this study were theoretical peer-reviewed articles, book Thematic analysis was conducted using mind maps. Mind
reviews, letters to the editor, non-peer reviewed magazine mapping is a method used to progress from individual
articles, programme descriptions and newspaper articles, ideas or themes to groups of major themes: through mind-
and articles published before 2000 or after 2008. In mapping, a thoughtful organisation of the literature review
addition, articles that used creative arts occupations as can be accomplished (Heinrich 2001). Each paper was
a means to determine a variable other than health and examined for emergent themes related to creative arts
wellness (as an example, the effect of choice on behaviour occupations and health and wellbeing. A mind map was
during an art programme) were excluded. generated for each paper in order to identify clusters of
The documents were obtained through multiple electronic themes. The mind maps were then compared with one
searches using five databases: Allied and Complementary another and consolidated to identify common themes
Medicine (AMED), the Excerpta Medica Database (EMBASE), across studies. A theme was deemed salient if it was
Cumulative Index to Nursing and Allied Health Literature identified by a minimum of eight studies.

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Creative arts occupations in therapeutic practice: a review of the literature

Table 2. Quantitative results: methodologies Table 3. Publication years Seventeen articles examined
Methodology Studies Authors and year Year the experiences of individuals
Studies
Experimental design 1 Körlin et al (2000) experiencing disability or illness,
2000.............................2......
Observational outcome 2 Zeltzer et al (2003) in 3 articles the views of both
2001.............................0......
measures Ross et al (2006) clients and health care profes-
2002.............................1......
sionals were represented, and
2003.............................3......
Prospective cohort 1 Hamre et al (2007)
3 articles examined health pro-
2004.............................1......
Grounded theory 5 Reynolds (2002) fessionals’ views on creative arts
2005.............................3......
Reynolds (2003) occupations in a therapeutic
2006.............................4......
la Cour et al (2005) environment.
2007.............................8......
Daykin et al (2007) Adults and older adults were
2008.............................1......
Griffiths (2008) the participants in 19 of the 23
Phenomenology 5 Reynolds and Prior (2003) studies and strictly older adults were the participants in
Schmid (2004) one study. Children were the participants in 1 article,
Lane (2005) mixed age groups were used in 1 article and 1 article did
la Cour et al (2007) not mention the age group of its participants. In terms of
Reynolds and Lim (2007) gender, 7 articles had only female participants, 11
included males and females, and 4 did not state the gender
Generic qualitative research 3 Wikström (2005)
of the participants. It is interesting to note that the majority
Reynolds and Prior (2006)
of this research includes adult female participants; no
Lloyd et al (2007)
studies were focused on a solely male population.
Narrative inquiry 1 Reynolds (2000) Occupational therapy was represented in 8 of the articles,
Case study 1 Spandler et al (2007) 4 represented nursing practice, 6 articles were in the fields
of psychotherapy, psychology or psychiatry, 1 article was in
Narrative discourse analysis 1 Stickley et al (2007) general rehabilitation, 1 was conducted in the discipline of
Mixed methodologies 3 Daykin et al (2006) art therapy and 3 articles represented unknown professions.
– RCT and grounded theory Odell-Miller et al (2006) In 12 of the studies, the researchers studied a variety of
– Experimental and generic Griffiths and Corr (2007) creative arts occupations, including crafts, painting and
qualitative research drawing. Four articles used strictly textile /needlecraft
– Grounded theory activities, 4 articles did not describe which creative arts
and observational occupations were used and 2 articles used music therapy.
cross-sectional survey The publication years of the studies are presented in
RCT = randomised controlled trial. Table 3; most of the research articles were published in
2007. It is noteworthy that the one randomised controlled
trial study did not show significant results. In the other
Results experimental and qualitative research, however, a number
of positive themes emerged.
Quantitative findings The results indicate a need for further research across a
Twenty-three articles were included in the literature review. broad range of ages, genders and disabilities. In addition,
A number of methodologies were used in these studies, different study designs may be used in order to determine
as presented in Table 2. Qualitative methodologies were the best means of conducting research on this topic. A
found to be the most prevalent approach for studying question is raised with respect to which research designs
creative arts occupations. are best suited to the study of the therapeutic potential of
The articles were most frequently published in the creative arts occupations.
United Kingdom, with 14 studies; 5 studies were published
in the United States, 3 studies in Sweden and 1 in Australia, Qualitative findings
with none in Canada. Most of the research adopted a qualitative approach and
In terms of client groups, people living with mental identified qualitative outcomes based on participants’
illness were represented in 10 of the articles; people living experiences with creative arts occupations. In the quali-
with cancer were represented in 5 articles; people living tative analysis, 16 qualitative studies were included as well
with other disabilities, including arthritis and multiple as 3 mixed methodology studies, for a total of 19 studies.
sclerosis, were represented in 5 articles; and people living Six predominant themes were identified as the outcomes of
with kidney disease and in palliative care were each using creative arts occupations most frequently represented
represented in 1 article. Mental illness was the disability across studies. These were (a) enhanced perceived control,
most frequently represented; there appears to be a lack of (b) building a sense of self, (c) expression, (d) transforming
research that examines the use of creative arts occupations the illness experience, (e) gaining a sense of purpose and
with other populations. (f) building social support.

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Enhanced perceived control
An improved sense of choice and control in participants’
lives was a frequently identified outcome. In a study by
Reynolds (2002), interviews were carried out with 35
women, aged 29-75 years, who all had long-term health
problems and saw textile arts as a way of coping with their
illness. From these interviews it was noted that a sense of
powerlessness was commonly reported by individuals who
experience illness, yet by increasing one’s sense of control
over negative emotions, through engagement in textile
arts, improved psychological states were identified.
Similarly, Lloyd et al (2007) studied the ways in which
involvement in an arts programme contributed to the recovery
process of individuals who were faced with mental illness.
They found that participants experienced a sense of control
through engagement in artwork. By using creative arts occu-
pations to express feelings and moods, participants were
empowered to decide what feelings and emotions they would
express and how much of that emotion. The participants
had the ability to choose what they wanted to express and
how much they wanted to express, and to express feelings
and emotions directly or through the use of symbolism.
This sense of control and choice carried over into other
aspects of their lives, resulting in an increased perception
of control and independence and the ability to take risks
and to deal with the consequences of these risks.
Griffiths (2008) explored the clinical use of creative
arts activities as a treatment medium by occupational
therapists working with people living with mental illness.
Through a grounded theory study, which employed
methods of observation and interviews with clients and
occupational therapists, they theorised that the capacity to
control the choice of creative arts occupation was an
important factor. The creative occupations were seen to
empower individuals by facilitating mastery over their
surroundings, while choice allowed participants to work
comfortably and to control the pace and challenge of
their occupations. Reynolds and Prior (2006) conducted
interviews to gain an understanding of how participation
in arts for women with cancer helps them to live more
positive lives. By engaging in creative arts occupations,
the participants in this study indicated that feelings of
achievement came about through the sense of autonomy
and control experienced in art making.
Daykin et al (2007) undertook a survey of 80 clients at
cancer care organisations to develop a grounded theory
about the role that music and music therapy play in
cancer care. The researchers found that the participants in
their study expressed feelings of power, freedom and
release when describing their experience with creative arts
occupations. In summary, an enhanced sense of perceived
control was a frequent outcome identified through an
analysis of the research considered in this review.
Building a sense of self
Throughout the studies, creative arts occupations were
seen to contribute to participants’ evolving sense of self. In
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Nadia Perruzza and Elizabeth Anne Kinsella
a narrative study undertaken by Reynolds (2000), the par-
ticipants’ views about the personal meanings of engaging in
self-chosen needlecraft activities and the part they played
in the self-management of depression were examined. This
study found that participation in textile arts contributed
to building a healthy self-image in the face of depression.
Needlework occupations afforded participants with evidence
of mastery and competence and a record of their achieve-
ments. Confidence was built through the admiration and
acknowledgement of others (Reynolds 2000). In a study
by Odell-Miller et al (2006), a randomised controlled trial
investigated art therapies as a treatment modality for indi-
viduals with continuing mental health problems. In this
study, the participants valued art therapy as a way to increase
self-confidence and to gain a sense of achievement. One
participant expressed this as follows: ‘You’re actually taking
part in something, and achieving something’ (p130).
As part of a national study to evaluate the influence of
participatory arts provision for people who have mental
illness, Spandler et al (2007) explored how the arts may
help to facilitate recovery in people with mental illness.
This study comprised different strands of research, including
a survey, a follow-up survey using standardised outcomes
measures and a series of qualitative case studies. The
participants in the study indicated that the arts gave them
the chance to rediscover the self they knew prior to illness
or to build a new identity, seeing themselves as people
capable of achievement. Similarly, in a narrative study by
Reynolds (2000), one participant described this sense of
a capable self: ‘If I’m tense or stressed, a few hours of
stitching gives me back a feeling of confidence in myself
when I see what I can achieve’ (p111).
In a grounded theory study by la Cour et al (2007),
interviews were conducted with older people dealing with
a life-threatening illness and with occupational therapists
who were participating in creative workshops using crafts
at a nursing home. The findings of this study suggest that
creative arts occupations can expand the experience of self as
an active person when faced with a life-threatening illness.
From the qualitative analysis of these studies, a consistently
reported outcome was that creative arts occupations have
the potential to contribute to an enhanced sense of self.
Expression
Creative arts were frequently depicted as offering opportu-
nities for non-verbal self-expression. Reynolds (2002)
found that people living with a chronic illness used art as
a means of expressing feelings about their illness experi-
ence. Some participants were unable to express their
feelings verbally, owing to the complexity of these feelings,
and art provided an alternative vehicle through which
they could express themselves more fully. Reynolds and
Prior (2003) quoted one participant as stating: ‘When I
look back now, I did the most gruesome scary drawings …
Obviously that was how I was feeling inside’ (p788).
In a study by Lloyd et al (2007), individuals living
with mental illness depicted art as a preferred way of
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Creative arts occupations in therapeutic practice: a review of the literature
expressing thoughts and emotions for the majority of
participants. The participants were not only able to reflect
their illness in their artwork but also able to express their
hopes and dreams. The participants with mood disorders
indicated that expressing their feelings, thoughts and
emotions was beneficial to their ability to overcome
suicidal ideation and fears. Similarly, in a narrative dis-
course analysis conducted by Stickley et al (2007), the
participants, who had attended arts workshops organised
by mental health service providers, indicated that they
were able to incorporate an understanding of themselves
and their thoughts by making it solid and real through the
artwork they produced.
Transforming the illness experience
Creative arts occupations were frequently depicted as
a means of coming to terms with an illness and as a way
to transform negative emotions and events into more
positive interpretations. In addition, creative arts were
seen as a way to turn negative thinking about the illness
experience toward more generative aspects of life expe-
rience. Reynolds and Prior (2006) found that participants
described being so immersed in their artwork that it
helped them to diminish disturbing thoughts and feelings
about their illness for the period of time in which they
were involved. This notion of deep immersion in artwork
is similar to the notion of ‘flow’ (Csikszentimihalyi 1997),
highlighted in Griffiths’ (2008) study which notes the
ways in which engagement in creative activities contributes
to a sense of ‘flow’ that transforms the illness experience.
Reynolds (2000) found that planning for the artwork also
helped to draw participants’ attention away from negative
thoughts about illness.
In the study by la Cour et al (2007), engagement in
creative arts occupations during a life-threatening illness
appeared to facilitate an alternative way of dealing with
the illness and its consequences, one that transformed the
illness experience into an experience that was part of a
larger life picture. They found that participating in creative
occupations promoted a positive and healthy focal point
and facilitated the coexistence of negative aspects of
people’s lives, with the more generative dimensions
revealed through creative occupations.
Gaining a sense of purpose
Gaining a sense of purpose through involvement in creative
arts was another major theme identified in the analysis. In
the case study by Spandler et al (2007), the participants
described gaining a sense of purpose and meaning in their
lives, not only with respect to their artwork but in all
aspects of their lives. In a study by Griffiths (2008), the
participants indicated that the creative arts in which they
were involved provided reasons for them to get out of bed
in the morning or to get out of their house. The partici-
pants in the study by Lloyd et al (2007) valued the sense
of being useful and needed by their peers in the art group.
Similarly, la Cour et al (2007) reported that through
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participation in creative arts occupations, such as pottery,
woodworking, gardening and painting, people were able
to recognise their capacities and potential. Stickley et al
(2007) reported that creative arts occupations, including
visual arts, writing, poetry, music and lyrics, gave people
a sense of purpose through ownership of their projects
and a distinctive relationship with their artistic skill.
Phenomenological research, conducted by Reynolds and
Prior (2003), which explored the meanings of art for
women living with a disabling chronic illness, revealed
that art may provide a way to fill an occupational void with
a satisfying occupation, thus leading to the re-evaluation
of lifestyle and purpose. The researchers suggested that
building a sense of purpose and filling occupational voids
may lead to a more positive outlook on the future.
Building social support
The social aspect of engaging in creative occupations was
very important to many participants across the studies.
One study described how social identity may be a central
aspect of confidence, positive self-image and fulfilment
(Stickley et al 2007). Lloyd et al (2007) found that par-
ticipants developed a sense that they could not only influ-
ence their own lives but also contribute to society and
influence others.
In a narrative study by Reynolds (2000), participants
described shared interests in crafts as contributing to the
development and maintenance of friendships. A significant
theme that emerged in the research was the sense of hav-
ing a safe and supportive environment where individuals
engaged collectively in creative occupations. Griffiths
(2008) identified features of this environment as accep-
tance, achievable expectations with no consequences if
things go wrong, predictability and protection. Griffiths
(2008) suggested that an emotionally and physically safe
and supportive environment is an important aspect of
healing and recovery when faced with illness.
In research conducted by la Cour et al (2005), participants
described a generous receptive environment as one that is
characterised by freedom and support. These two aspects
were seen as the main reason for enabling engagement
in creative arts occupations and, at the same time, con-
tributed to participants’ capacity to build their network of
social supports.
Discussion
This analysis of qualitative studies reveals six emergent
themes with respect to perceived outcomes of creative arts
occupations in terms of health and wellbeing. These
outcomes – enhanced perceived control, building a sense
of self, expression, transforming the illness experience,
gaining a sense of purpose and building social support –
indicate important implications for therapeutic practice
and offer practical insights for occupational therapists
who integrate creative arts occupations in their practices.

The findings are of interest given the historical roots of
the profession and recognition that, since the early days,
creative arts occupations have played a central role in the
theory and practice of occupational therapists (Friedland
2003). From the inception of the profession until about the
1960s, occupational arts and crafts were the main tools of
occupational therapy practice (Friedland 2003, Schmid 2004).
Nonetheless, creative arts occupations have largely lost
their place in occupational therapy practice and research
(Schmid 2004) and many therapists and other professions,
particularly in the North American context, still choose to
dismiss this form of therapy (Friedland 2003). Friedland
(2003) argued that the growth of the occupational therapy
profession has led it towards increasingly biomedically
oriented approaches, moving the profession away from its
historical belief and value of creative art as a medium for
therapeutic practice and occupational engagement.
From the literature reviewed, the United Kingdom
appears to have contributed the most research on the use
of creative arts occupations. Given a rise in the recogni-
tion of the importance of creativity (Schmid 2005) and
creative occupation (Reynolds 2000, Molineux 2004) for
health and wellbeing (Wilcock et al 1998), and the lack of
substantive research on this subject, the authors contend
that it is time that occupational therapy researchers around
the world reinvigorate attention to a domain of historical
importance in the occupational therapy profession: the
use of creative arts occupations and the implications for
health and wellbeing.
Creative arts occupation is a challenging topic to study,
because little research on this topic currently exists and
finding the right research design appears to be a challenge.
This raises important issues with respect to the appropriate
research designs for advancing knowledge about creative
arts occupations. Creativity and healing are in many ways
internal processes, yet many research designs focus on
external processes and observable measurement. Although
such experimental research is undeniably important, research
designs that offer avenues for examining people’s percep-
tions and internal life world experiences also appear to be
important for advancing knowledge about creative arts
occupations in therapeutic practice. This finding supports
the trend toward more socially oriented and qualitative
research designs (Higgs et al 2007, Willis 2007) in researching
health and wellbeing generally and creative arts occupations
in particular. It is clear that significantly more research on
the use of creative arts occupations in occupational therapy,
a profession whose historical roots recognised the therapeutic
potential of such occupations, is required.
The strengths of this study include the systematic
approach to searching, selecting, describing and organis-
ing the literature review, the rigorous application of the
matrix method of literature review, the strength of a
collective analysis of qualitative research and the impor-
tance and timeliness of the topic. The limitations include
the lack of available research on this subject, the need to
limit databases to those relevant to occupational therapy
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Nadia Perruzza and Elizabeth Anne Kinsella
and the need to impose a timeframe for the review that
may have excluded other relevant literature. The focus
on ‘occupation’ as a key word may have resulted in the
exclusion of other relevant studies. An additional limitation
of the study is related to the variability of criteria by which
different qualitative researchers and different schools of
qualitative research address questions of trustworthiness and
the complexity of trustworthiness in qualitative research.
Trustworthiness in qualitative research is frequently related
to readers’ perceptions of the coherence, plausibility and
resonance of the findings (Thomas and Pollio 2002) and is
beyond what could be examined in this review. Further
relevant research beyond the scope of the parameters set
for this study may be present in other fields, such as art
therapy or psychotherapy, or by searching other databases
such as PsycINFO, using other key words such as ‘activity’,
‘art and health’ and ‘music and health’.
Conclusion
The purpose of this study was to gather, describe and
analyse the available research on the use of creative arts
occupations with respect to perceived outcomes on health
and wellbeing. Creativity has been depicted as a healing
force; Hasselkus (2002) contended that it is one of the most
valuable tools to aid in the healing process. Friedland
(2003) drew on an historical analysis of occupational
therapy to suggest that participation in creative occu-
pations has a healing effect. She noted that crafts are seen
to be an uplifting occupation in people’s lives. With this
in mind, researchers as well as practitioners need to
understand better the value that creative arts occupations
can potentially offer in therapeutic practice.
This literature review brings to the forefront six emergent
themes that reflect the documented benefits in the quali-
tative research literature on this subject. These preliminary
qualitative outcomes highlight the value that creative arts
occupations may have on health and wellbeing when
individuals are faced with illness. The findings suggest
that the use of creative occupations may have important
value for individuals living with mental and physical
disabilities and raise questions about the lack of research
in this area. Further research into the use of creative arts
occupations as an approach to therapy is warranted.
Acknowledgements
The authors would like to thank the School of Occupational Therapy and the
Faculty of Health Sciences at the University of Western Ontario for support of
this research. In addition, the second author is grateful for funding from the
Social Science and Humanities Research Council of Canada, which provided
support for this research and its conception.
Conflict of interest: None.
References
Csikszentmihalyi M (1997) Finding flow: the psychology of engagement
with everyday life. New York: Basic Books.
British Journal of Occupational Therapy June 2010 73(6) 267
Creative arts occupations in therapeutic practice: a review of the literature
Key findings
■ The findings suggest that the use of creative arts occupations in
therapeutic practice may have important qualitative value related
to health and wellbeing.
■ Six predominant outcomes, of using creative arts occupations, were
most frequently identified across the 23 studies: enhanced perceived
control, building a sense of self, expression, transforming the illness
experience, gaining a sense of purpose and building social support.
What the study has added
The study contributes to knowledge about the use of creative arts
occupations as a therapeutic approach in occupational therapy.
Daykin N, Bunt L, McClean S (2006) Music and healing in cancer care: a survey
of supportive care providers. The Arts in Psychotherapy, 33(5), 402-13.
Daykin N, McClean S, Bunt L (2007) Creativity, identity and healing:
participants’ accounts of music therapy in cancer care. Health: An
Interdisciplinary Journal for the Social Study of Health, Illness and
Medicine, 11(3), 349-70.
Fisher BJ, Specht DK (1999) Successful aging and creativity in later life.
Journal of Aging Studies, 13(4), 457-72.
Friedland J (2003) Why crafts? Influences on the development of
occupational therapy in Canada from 1890 to 1930. Canadian Journal
of Occupational Therapy, 70(4), 204-12.
Garrard J (1999) Health sciences literature review made easy: the matrix
method. Frederick, MD: Aspen Publishers.
Griffiths S (2008) The experience of creative activity as a treatment medium.
Journal of Mental Health, 17(1), 49-63.
Griffiths S, Corr S (2007) The use of creative activities with people with
mental health problems: a survey of occupational therapists. British
Journal of Occupational Therapy, 70(3), 107-14.
Hammell KW (2004) Dimensions of meaning in the occupations of daily life.
Canadian Journal of Occupational Therapy, 71(5), 296-305.
Hamre HJ, Witt CM, Glockmann A, Ziegler R, Willich SN, Kiene H (2007)
Anthroposophic art therapy in chronic disease: a four year prospective
cohort study. Explore, 3(4), 365-71.
Hasselkus BR (2002) The meaning of everyday occupation. Thorofare, NJ: Slack.
Heinrich K (2001) Mind-mapping: a successful technique for organizing a
literature review. Nurse Author and Editor, 11(2), 4-6.
Higgs J, Titchen A, Horsfall D, Armstrong H (2007) Being critical and creative
in qualitative research. Sydney: Hampton Press.
Körlin D, Nybäck H, Goldberg FS (2000) Creative art groups in psychiatric
care: development and evaluation of a therapeutic alternative. Nordic
Journal of Psychiatry, 54(5), 333-40.
la Cour K, Josephsson S, Luborsky M (2005) Creating connections to life during
life-threatening illness: creative activity experienced by elderly people
and occupational therapists. Scandinavian Journal of Occupational Therapy,
12(3), 98-109.
la Cour K, Josephsson S, Tishelman C, Nygård L (2007) Experiences of
engagement in creative activity at a palliative care facility. Palliative
and Supportive Care, 5(3), 241-50.
Lane RM (2005) Spirit body-healing – a hermeneutic, phenomenological study
examining the lived experience of art and healing. Cancer Nursing,
28(4), 285-91.
Law M, Steinwender S, Leclair L (1998) Occupation, health and well-being.
Canadian Journal of Occupational Therapy, 65(2), 81-91.
268 British Journal of Occupational Therapy June 2010 73(6)
Downloaded from bjo.sagepub.com at UNSW Library on August 2, 2015
Lloyd C, Wong SR, Petchkovsky L (2007) Art and recovery in mental health:
a qualitative investigation. British Journal of Occupational Therapy,
70(5), 207-14.
Molineux M, ed (2004) Occupation for occupational therapists. Oxford:
Blackwell Publishing Ltd.
Odell-Miller H, Hughes P, Westacott M (2006) An investigation into the
effectiveness of the arts therapies for adults with continuing mental
health problems. Psychotherapy Research, 16(1), 122-39.
Reynolds F (2000) Managing depression through needlecraft creative
activities: a qualitative study. The Arts in Psychotherapy, 27(2), 107-14.
Reynolds F (2002) Symbolic aspects of coping with chronic illness through
textile arts. The Arts in Psychotherapy, 29(2), 99-106.
Reynolds F (2003) Reclaiming a positive identity in chronic illness through
artistic occupation. OTJR: Occupation, Participation and Health, 23(3),
118-27.
Reynolds F, Lim KH (2007) Contribution of visual art-making to the
subjective well-being of women living with cancer: a qualitative study.
The Arts in Psychotherapy, 34(1), 1-10.
Reynolds F, Prior S (2003) ’A lifestyle coat-hanger’: a phenomenological study
of the meanings of artwork for women coping with chronic illness and
disability. Disability and Rehabilitation, 25(14), 785-94.
Reynolds F, Prior S (2006) Creative adventures and flow in art-making: a
qualitative study of women living with cancer. British Journal of Occupational
Therapy, 69(6), 255-62.
Ross EA, Hollen TL, Fitzgerald BM (2006) Observational study of an arts-
in-medicine program in an outpatient hemodialysis unit. American
Journal of Kidney Disease, 47(3), 462-68.
Schmid T (2004) Meanings of creativity within occupational therapy practice.
Australian Occupational Therapy Journal, 51(2), 80-85.
Schmid T, ed (2005) Promoting health through creativity for professionals
in healthcare arts and education. London: Whurr.
Spandler H, Secker J, Kent L, Hackings S, Shenton J (2007) Catching life: the
contribution of arts initiatives to recovery approaches in mental health.
Journal of Psychiatric and Mental Health Nursing, 14(8), 791-99.
Stickley T, Hui A, Morgan J, Bertram G (2007) Experiences and constructions
of art: a narrative-discourse analysis. Journal of Psychiatric and Mental
Health Nursing, 14(8), 783-90.
Thomas S, Pollio H (2002) Listening to patients: a phenomenological approach
to nursing research and practice. New York: Springer.
Thompson M, Blair SE (1998) Creative arts in occupational therapy: ancient
history or contemporary practice? Occupational Therapy International,
5(5), 48-64.
Townsend E, ed (2002) Enabling occupation: an occupational therapy
perspective. Ottawa, ON: CAOT Publications ACE.
Vrkljan B, Miller-Polgar J (2001) Meaning of occupational engagement in
life-threatening illness: a qualitative pilot project. Canadian Journal of
Occupational Therapy, 68(4), 237-46.
Wikström BM (2005) Communicating via expressive arts: the natural medium
of self-expression for hospitalized children. Pediatric Nursing, 31(6),
480-85.
Wilcock AA, van der Arend H, Darling K, Scholz J, Siddall R, Snigg C, Stephens J
(1998) An exploratory study of people’s perceptions and experiences
of wellbeing. British Journal of Occupational Therapy, 61(2), 75-82.
Willis JW (2007) Foundations of qualitative research: interpretive and
critical approaches. Thousand Oaks, NJ: Sage.
Zeltzer BB, Stanley S, Melo L, LaPorte KM (2003) Arts therapies promote
wellness in elders. Behavioral Healthcare Tomorrow, 12(2), 7-12.