*3.5. The Unique Contribution of The Participants to Parent-Child Arts Therapy* 3.5.1. The Children's Role in Therapy

Most arts therapists remarked that the participation of these children depends on their level of functioning: "I worked with very low functioning children and it was very difficult to get a reaction from them. I also worked with high functioning children who would come into the room and immediately initiate play together." Most of them noted that in order to feel secure, children will often turn first to a familiar activity: "The children go to a game they know, something they are used to doing." Most arts therapists noted that in parent-child arts therapy, the children express their needs to the parent: "Children's play is often their way to tell the parent what preoccupies them, what they would like to change, what they want from the parent." The arts therapists stated that during parent-child arts therapy sessions the child and the parent share an experience, even though sometimes it can be less than pleasant: "Her communication with him was through very basic games . . . At first, he would indicate that it was a little too much for him . . . but little by little, this was their way to communicate." This is how the child learns to adapt to the parent. The therapists remarked that the children benefit from the parents' presence as they continue to live their lives with the parent outside the arts therapy room: "This is the most important thing because in the end, they go home with the child and their interactions with the child

continue throughout the day." Most arts therapists mentioned that the bond between parent and child becomes stronger and more secure through the process of learning, and through the child's ability to express him/herself: "The bond between parent and child becomes much stronger and more secure."

#### 3.5.2. The Parents' Role in Therapy

Most arts therapists noted the parents' difficulties coping with their child's disability: "For a parent it is unbearable, the parent comes into the room and sees the autism and sees this repetitiveness, the rigidity and the fact that nothing changes." Most arts therapists described how during the encounter with the parents, the need for professional mediation becomes clear: "Parenting a child with special needs, especially with ASD, does not come naturally, it requires a learning process, and it often needs this professional mediation." Most arts therapists said they understood the parents' difficulties in attending therapy at the Milman Center in terms of scheduling: "It's once a week and she comes for four hours. It's a lot", and in terms of coping: "You need to go on taking care of the child and watch him/her with the other children, and cope with the behavior patterns that may be unanticipated and not easy", and from an emotional standpoint: "It's so easy to feel criticized, so easy to feel I am not doing the right thing as a parent who comes to parent-child arts therapy." Most arts therapists were able to relate to the parents' difficulties in taking part in therapy: "For some of the parents it is hard to be in a room with another adult who can see their relationship very closely; they feel exposed and it's not simple." Some of them prefer to sit on the side and watch or detach themselves by using their phone: "There is one mother who often says: 'No, I will sit on the side, I will watch and learn as an observer' when asked to play" Sometimes parents struggle to deal with the mess in the arts therapy room: "I gave him gouache and told her that . . . I prepared her of course, that it will be messy and to be ready for it," and coping with the boredom of the repetitive play of the child: "The father sometimes tries to encourage the child to play different games." Four therapists remarked that with time, most parents learn to become more playful: "Little by little, they understand what we do here and how you do it and they can become more playful."

All the arts therapists said that in parent-child arts therapy, the parents discovered new aspects of the child's character and the child's new abilities: "The mother said: 'Wow this is new, this is the first time he has shared his drawing with me.'" The parent learns to understand and accept the child: "Because the parent goes through a process and participates in so many therapy sessions and learns to accept the child more and to understand him/her better . . . everybody benefits," and simply to love him/her: "It's very significant for parents to be able to connect and to love their child the way they are . . . Because it is not self-evident, especially when children have difficulties communicating."

#### 3.5.3. The Arts Therapists' Role in Therapy

All the arts therapists related to their need to understand the dyad and how to approach it in a way that can provide an appropriate response: "One moment, I see something good is happening between them so I back off, or one moment I have something good going with the child so I tell the mother go in this direction, you try it." About half the therapists talked about how important it is to find their most beneficial place in relation to the child: "I now try to find how I can be with him, so that I feel him and he feels me and we play together and relate to each other even when he turns his back to me . . . so it will have meaning," but in a way that the parent will not feel threatened: "With some parents I feel the need . . . to keep my distance more, that they might feel threatened maybe . . . if I get too close . . . and there are parents who I feel allow me from the very beginning to be very actively involved."

Most arts therapists mentioned that they focus on forming a better connection between members of the dyad. They use modeling to do so: "I actually tried to show her how I play with him, how I am with him in terms of what he wants." Four arts therapists noted that at

the beginning of the relationship, they concentrated on forming an initial connection with the children: "In the initial stages I . . . would focus more on the child than on the parent, to form an initial acquaintance . . . " whereas two other therapists thought that the first bond should be with the parent: "I think that the initial bond with the parent is even more important than connecting first with the child." Most arts therapists remarked that their role is to support the parents: "The process that happened there . . . to help her understand that it is not because she is not good, but rather take a moment to look at the strengths." Four arts therapists stressed that the parents must be respected and parental authority acknowledged while maintaining parental competency: "This issue of recognizing parental authority . . . they are the experts when it comes to their child and I try to understand what they know and understand . . . " Three arts therapists indicated that they encourage the parents to share their difficulties: "Talk about it, about the difficulty . . . Encourage the mother to express interest . . . To contain the difficulty, to validate what emerges in this dyad."

#### *3.6. The Different Types of Arts in the Therapy Room*

#### 3.6.1. Methods of Integrating the Arts into Therapy

Most arts therapists mentioned that they would like to find ways to integrate the arts into the therapeutic sessions. Dance and movement therapists noted it was easy for them to integrate their modality because movement is always present: "The advantage is that it is really there all the time . . . It can happen the minute you start throwing a ball or lying on a mattress." These therapists attempt to explore these children's movements and learn about their emotional state: "To try to understand his movements, what his body is telling me about the emotional experience." The art therapists described how they get acquainted with these children by exposing them to the art materials. In the beginning, they only use a few materials to avoid overwhelming the child: "Naturally, in the beginning, a little bit, just to see if the child is not overwhelmed with what s/he sees." They suggested that contact with art materials is part of self-understanding: "A possibility to investigate the body interacting and touching various things. It is another opportunity for the children to get to know themselves." In music therapy, special effort was needed to integrate music into therapy: "With music . . . I felt that they were less open to it, that I was the one who introduced it and it was less their initiative," and the different ways to include it: "Sometimes I would play something during a session and then I can attach a soundtrack to their dynamics. If, say, they start to fight, then suddenly the music is noisier and angrier." Here too movement is integrated into the session: "Sometimes I strike a gong and then everyone freezes into some sort of sculpture."

Arts therapists in all modalities remarked that not all the children like the arts: "You can see that there are children who don't relate to it." Some recoil from contact with the art materials: "Some children recoil when they come into contact with gouache and with certain textures of art materials". Three arts therapists described children who engage in artmaking, but only for brief intervals: "But it is . . . you know, it's three minutes . . . that's it". One of them believes that it generates anxiety: "I felt that it creates anxiety. There is an expectation for an outcome." The therapists described how engaging in play can sometimes create an opportunity to work with the arts: "He played with animals and dipped them in paint and made a footprint . . . After a long period of not using art materials . . . Afterwards he continued creating with gouache, finger paints and glitter." Six arts therapists noted that they do not always work in their modality but rather a different modality that the child relates to more.

#### 3.6.2. The Strengths of the Arts

All arts therapists described arts as an alternative language: "It's a way to discover the rich world around us, that sometimes children with ASD kind of avoid touching," that enables the creation of a playful space: "It involves creating something that is very playful, with art materials." It also encourages closeness between the child and the therapist: "I feel

that I can be part of these movements and it will connect us." The arts therapists specified that arts make it possible to work on the issue of control: "It's possible to play with themes of control through music . . . 'now you play loudly and now softly'," by regulating and channeling violence: "We can channel the violence to other materials rather than to the mother." The arts therapists noted that working with the arts helps the parent share and connect to the experience of the child: "I see great importance in inviting the parent to draw near the child . . . This way the parents can relate to their children's feelings when they draw."
