Original article

Significance of clay art therapy for

psychiatric patients admitted
in a day hospital
Aquiléia Helena de Morais1
Simone Roecker2
Denise Albieri Jodas Salvagioni3
Gabrielle Jacklin Eler4

Significance of clay art therapy for psychiatric patients

admitted in a day hospital

Objective. To understand the significance of clay art therapy for

psychiatric patients admitted in a day hospital. Methodology.
Qualitative, descriptive and exploratory research, undertaken with
16 patients in a day hospital in Londrina, in the state of Parana,
Brazil, who participated in seven clay therapy sessions. Data
collection took place from January to July 2012 through interviews
guided by a semi structured questionnaire and the data were
submitted to content analysis. Results. Three themes emerged:
Becoming familiar with clay art therapy; Feeling clay therapy; and
Realizing the effect of clay therapy. Conclusion. The use of clay as
1 Teaching diploma Artistic Education
a therapeutic method by psychiatric patients promoted creativity,
- License in Plastic Arts, Specialist.
Professor, Escola de Educação Básica self-consciousness, and benefited those who sought anxiety relief.
João XXIII, Brazil.
email: [email protected] Key words: mental health; art therapy; clay; nursing; psychiatric
2 RN, M.Sc. Professor,Instituto Federal hospitals.
de Educação, Ciência e Tecnologia do
Paraná- IFPR/Campus Londrina, Brazil.
email: [email protected]
3 RN, M.Sc. Professor IFPR/Campus
Significado de la arteterapia con arcilla para los pacientes
Londrina, Brazil. psiquiátricos en un hospital de día
email: [email protected]
4 RN, Ph.D. candidate. IFPR/Campus Objetivo. Comprender el significado de la arteterapia con arcilla
Londrina, Brazil. para pacientes psiquiátricos en un hospital de día. Metodología.
email: [email protected] Estudio descriptivo y exploratorio, cualitativo, realizado con 16
pacientes en un hospital de día en Londrina – PR, Brasil, quienes
Article linked to research: Assessment of
asistieron a 7 sesiones de arteterapia con arcilla. Los datos fueron
the effect of clay art therapy for psychiatric
patients in day hospitals. recolectados de enero a julio de 2012 mediante entrevistas
guiadas por cuestionario semiestructurado cuyos datos fueron
Conflict of interests: none. sometidos a análisis de contenido. Resultados. Emergieron tres
temas: acercarse a la arte-terapia con arcilla, sintiendo la
Receipt date: May 16, 2013. terapia con arcilla y percibir el efecto del tratamiento con arcilla.
Conclusión. El uso de la arcilla como medio terapéutico en estos
Approval date: August 20, 2013. pacientes psiquiátricos promovió la creatividad y la conciencia
de sí mismo; también brindó beneficios a aquellos que buscaban
How to cite this article. Morais AH, Roecker
S, Salvagioni DAJ, GJ Eler GJ. Significance alivio de la ansiedad.
of clay art therapy for psychiatric patients
admitted in a day hospital. Invest Educ Palabras clave: salud mental; terapia con arte; arcilla; enfermería;
128 • 2014;32(1):
Enferm. Invest Educ Enferm. 2013;31(3)
128-138. hospitales psiquiátricos. 
 Significance of clay art therapy for psychiatric patients admitted in a day hospital

Significado da arteterapia com argila para os pacientes psiquiátricos num hospital de dia

Objetivo. Compreender o significado da arteterapia com argila para pacientes psiquiátricos num hospital de
dia. Metodologia. Estudo descritivo e exploratório, qualitativo, realizado com 16 pacientes num hospital de
dia em Londrina – PR, Brasil, que assistiram a 7 sessões de arteterapia com argila. Os dados foram coletados
de janeiro a julho de 2012 através de entrevistas guiadas por questionário semiestruturado e os dados foram
submetidos a análises de conteúdo. Resultados. Emergiram três temas: acercar-se à arte-terapia com argila,
sentindo a terapia com argila, e perceber o efeito do tratamento com argila. Conclusão. O uso da argila como
meio terapêutico nestes pacientes psiquiátricos promoveu a criatividade, a consciência de si mesmo e teve
benefício naqueles que procuravam alívio da ansiedade.

Palavras chave: saúde mental; terapia pela arte; argila; enfermagem; hospitais psiquiátricos. 

Introduction
Mental health is defined as the capacity to Its essence would be the aesthetic creation and
live life within its tribulations, establishing a the artistic elaboration in favor of health.3
balance in the development and strengthening
of a resilient response, in which the person is As a specific field of knowledge, art therapy was
able to deal with problems, overcome hurdles established in the United States of America in
or resist the pressure of adverse circumstances 1940 through Margareth Nauberg’s work, the
without having a psychological outbreak. It can pioneer of art therapy for having established the
be influenced and changed, being that the main theoretical basis for its development, besides
mental changes are caused by environmental, having established it as an area of knowledge.4 Art
physical, biological and hereditary, pre and therapy was influenced by areas of knowledge such
post natal, organic, neuroendocrine, climatic, as Freudian Psychoanalysis that, in the beginning
environmental adaptation, social, cultural and of the twentieth century, became interested in the
economic factors.1,2 The occurrence of these art as a way to express the subconscious through
alterations is called mental disorder and can affect images. Sigmund Freud observed that artists are
clarity, humor, emotion, affection, psychomotor able to concretely symbolize the subconscious in
development, speech, memory, observation and their work, portraying psyche contents. In this
sleep. regard, his researches undertaken about the work
of famous authors such as Michelangelo can
In order to treat mental disorders, several be mentioned.5 Art therapy has become more
alternative and expressive therapies have been predominant in the health area, mainly in the field
used, such as occupational therapy, sports, of mental health. It is essential for the promotion
psychodrama, use of animals, games, stories and of the well-being of people with psychic disorder,
art therapies and, amongst these, theater, dance, since art therapy provides changes in the affective,
music, drawing with painting and modeling. The interpersonal and relational areas, improving the
Brazilian Association of Art Therapy defines it as a emotional balance at the end of each session.3
therapeutic process that uses expression resources
in order to connect the internal and external Within the field of art therapy, the clay therapy
worlds of a person, through its symbolism, that can be highlighted, which is defined as the use
is, it is a way of working using artistic language as of clay in the psychotherapeutic process in order
the basis of patient-professional communication. to promote the release of emotions, and may lead

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Aquiléia Helena de Morais • Simone Roecker • Denise Albieri Jodas Salvagioni • Gabrielle Jacklin Eler

the patients to feel pleasure in the act itself, as providing a more tenuous and less rational care
well as have control over their feelings through that is the result of an affective and solidary
their hands. The deep essence then emerges bond between caregiver-patient and participant-
and allows the communication with conscious or participant.10 Given this context, the present
subconscious contents, expressing feelings and study is aimed at understanding the significance
sensations. Therefore, this activity can provide the of clay therapy for psychiatric patients admitted
release of tension, pleasure and relaxation, since in a day hospital through the expression of their
the person builds something for their satisfaction, statements and feelings.
expressing their truth.6-8

Several studies show the positive effect of the

use of clay in patients with mental disorder. A Methodology
study undertaken with patients in a Psychosocial
Care Center located in Fortaleza in partnership This is a qualitative, descriptive and exploratory
with the Federal University of Ceara used various research. The qualitative research is used
types of arts, including clay, as a result of the with delimited groups and areas and seeks to
project Art and Health. It could be noted that the understand the existing social relations, taking into
artistic techniques allowed users to experience account the subjective and symbolic disseminated
their difficulties, conflicts, fears and anxieties in a in a social environment. In this type of research,
less painful way. It was shown to be an effective the objectification is particularly important to help
way of channeling the variable of mental illness the researcher to have a critical view of their work,
itself in a positive way, as well the personal and besides providing a more efficient way to achieve
family conflicts. It can be noted that there is a the aim of their work.11
minimization of the negative factors of affective and
emotional nature which naturally come with the It was carried out in a day hospital which offers
disorder, such as: anguish, fear, aggression, social a hospital service of mental health care, which
withdrawal, apathy, among others.3 Accordingly, represents an intermediate resource between
the professional nursing activity has been taking hospitalization and outpatient care. Since 1994,
an interest in these new concepts of alternative it has been a unit that intends to provide a service
treatments, especially when addressing the of excellence in mental healthcare to serve the
issue of integral care. The knowledge about non- community in the town of Londrina, in the state
allopathic practices, acquired by nurses, might of Parana, and region through programs of care
indicate a higher ability of humanization, besides by a multidisciplinary team with the purpose of
allowing a broad view about the care possibilities replacing full hospitalization, enabling people to
in relation to mental health.9 have family and social life. It provides assistance to
people aged 18 to 65 who need treatment due to
Nursing professionals’ interaction and mental disorders characterized by severe neurosis
implementation of art therapy in the care of and psychosis, targeting psychic reorganization
psychiatric patients mean a new way of caring. and return to social life. After the authorization of
The way that refers to a humanized, integral and the institution, the selection of participants was
innovative care that values the psychiatric patient carried out according to the following inclusion
and inserts them again in the social environment, criteria: to regularly attend the institution, to
opening doors to unlock the creative potential of have participated in at least seven clay therapy
each person and consequently improving their sessions, to have an appropriate diagnosis for the
health conditions. The non-allopathic therapeutic practice of this therapy such as schizophrenia,
practices, while focusing in the person as an bipolar disorder, as well as anxiety and psychosis
integral human being, not only value their physical disorder, to voluntarily accept to participate in this
aspects but also their emotions and spirituality, activity and not to present speech problems or to

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 Significance of clay art therapy for psychiatric patients admitted in a day hospital

be under the effect of drugs that could interfere The study was started after the approval by the
with their understanding of the issues addressed Research Ethics Committee of the PUC/PR in
in the interview. 16 November 2011, under registration number
6325 and opinion 5517/11. The criteria of
The sessions were held at two large tables placed the Resolution 196/96 of the National Health
on the veranda of the hospital and the activities Council were complied with. In order to maintain
were performed in free groups, being two groups anonymity, the extracts of statements were
for each session which alternated in the daily identified with the letter P for patient, following by
activities of the place where they spent their days, Arabic numbers which indicate the order in which
such as cleaning, organizing, preparing meals, the interviews took place.
marketing the hand made products they had made,
among other activities. At the end of the sessions,
the materials were put away in a closet on the
veranda and they took care of the work during
Results
the week by dampening them on the warmer
days and avoiding them to break or damage.
Knowing the participants of the study
Data collection took place in the institution from Tables 1 and 2 present some information about
January to July 2012, through interviews guided the patients studied, such as socio-demographic
by a semi structured questionnaire with open data, history of the disorder and therapy. It is
questions about before, during and after the clay observed that 62.5% of the patients are over 46
therapy sessions, as described below. Prior to years of age, with the minimum age being 34
staring the therapy, the participants were asked: and the maximum 65, most of them are male
Have you performed any activity involving paint, (62.5%), single (75.0%), live in their own home
clay, colored pencils, crayons, collages or others? with the family, being nine of them (56.2%)
Which one have you done? Do you know how to brown or black skin.
work with clay and have any idea of what clay
therapy is? Concerning the health conditions, 43.8% had as
main diagnosis schizophrenic disorders, the first
During the clay sessions, it was asked: What is signs and symptoms having appeared more than
your opinion in participating in the clay therapy 20 years before, and deny a history of psychiatric
session? What memories and feelings do you have disorders in the family. Three thematic categories
while working with clay? In the last session, it resulted from the process of contents analysis of
was asked: What is your opinion in participating the statements, which outline the expression of
in the whole clay therapy workshop? Has anything speeches and feelings of the psychiatric patients:
changed in your life outside the institution? The Becoming familiar with clay art therapy; Feeling clay
interviews took place after the application and therapy; and Realizing the effect of clay therapy.
signature of the Informed Consent Form (ICF)
and were fully recorded and transcribed for later Becoming familiar with clay art therapy
analysis. After collection and transcription of the When asked whether they had known clay therapy
data, some steps to organize the statements were before the beginning of the activities, different
used: data ordering, data classification and final answers were given, some of them which showed
analysis, in which the two previous stages make knowledge about clay therapy and others which
an inflection on the empirical material. From the did not. Among the participants who were aware
design of the content analysis, the statements of clay therapy, some defined it as follows: It is to
were categorized on the basis of theoretical squeeze the dough and play with water. To learn
relevance in order to be compared with scientific a lot of things, it is good for people (P2). It is to
literature.12 stir and organize our minds better (P3). […] it is

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Aquiléia Helena de Morais • Simone Roecker • Denise Albieri Jodas Salvagioni • Gabrielle Jacklin Eler

a healthy therapy, an old thing from years ago. As therapy still showed to be open and optimistic in
you play and create, it will be good (P13). relation to the new activity: I do not know. It is
good because I will learn things (P6). I do not
It can be noted that the participants, when know how to explain what it is but it is good for
showing awareness about clay therapy, define the mind (P12). It must be a therapy to relax
such activity as something good that will help (P16). It can be empirically noted that, either by
them to improve their mental processes, which way of modeling the clay or of different artistic
leads to the conclusion that they are aware about techniques, is an important tool to help groups of
their health condition and their current health people with mental disorders, showing satisfactory
treatment. And those who were not aware of clay short-term results.

Table 1. Socio demographic characteristics of psychiatric patients

undergoing clay therapy in a day hospital. Londrina, 2012.

Variables (n=16) n (%)

Age
26 to 35 years old 3 (18.8)
36 to 45 years old 3 (18.8)
46 to 55 years old 6 (37.5)
56 to 65 years old 4 (25.0)
Gender
Female 6 (37.5)
Male 10 (62.5)
Marital status
Single 12 (75.0)
Married 3 (18.8)
Widowed 1 (6.2)
Housing status
Own 13 (81.3)
Renting 1 (6.2)
Ignored 2 (12.5)
Who do they live with?
Parents 4 (25.0)
Alone 3 (18.8)
Spouse 3 (18.8)
Siblings 5 (31.3)
Others 1 (6.2)
Race
Caucasian 3 (18.8)
Asian 4 (25.0)
Mulatto 8 (50.0)
Black 1 (6.2)

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 Significance of clay art therapy for psychiatric patients admitted in a day hospital

Table 2. Information concerning the health of psychiatric patients

undergoing clay therapy in a day hospital. Londrina, 2012

Variables (n=16) n (%)

Main diagnosis
(CID-10)
Affective bipolar disorder - F31.6 (P1, P2, P11) 3 (18.8)
Severe mental retardation – F72.0 (P7, P14) 2 (12.5)
Mixed schizo-affective disorder - F25 (P4, P8, P12, P13) 4 (25.0)
Schizophrenia - F20 (P9, P10, P15) 3 (18.8)
Other specified mental disorders due to a brain damage and dysfunction and a physical 2 (12.5)
disease - F06.8 (P3, P6)
Depression - F32 (P5) 1 (6.2)
Severe and temporary psychotic disorders - F23 (P16) 1 (6.2)
Time of appearance of the first signs and symptoms
Less than 5 years 1 (6.2)
5 to 10 years 2 (12.5)
11 to 15 years 3 (18.8)
16 to 20 years 1 (6.2)
Over 20 years 7 (43.8)
Ignored 2 (12.5)
Time of treatment in the institution
Less than a year 4 (25.0)
1 to 2 years 4 (25.0)
3 to 5 years 4 (25.0)
Over 5 years 4 (25.0)
Psychiatric family history
Yes 5 (31.3)
No 11 (68.7)

with mud balls (P5). Now I learned that I can

Feeling clay therapy
create the object and finish it. I felt affection and
During the sessions, interviews were conducted love for the object […]. Ah! I was concentrated.
with the participants, seeking to understand the One person helping another, I realized that I am
feelings, opinions, memories, and sensations that able to do it, I can do it. I helped my father to
the therapy provided them with. Based on the look after the garden, I like clay (P13). I did
answers, it could be noted that some reminded something that reminded me of my past, a man
the past: I remember when I used to go fishing, with a shot gun. I liked to play with clay, a good
pulled the worms. I miss this, I cannot do this therapy, it stirs the mind, very good, while there
nowadays. My motor condition, I cannot do it, is some I will do it (P16).
I cannot run, everything has to be slow. I had
to learn everything like a newborn baby (P3). To others, it served to soothe, relax and release
Ah! I always feel good playing with mud. I felt the negative energy: I released it on clay. It
a positive energy. It reminded me of my father, resulted in something abstract. I was stressed
of when he was alive and he used to hunt birds and the stress ended (P1). It relaxes your mind.

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Aquiléia Helena de Morais • Simone Roecker • Denise Albieri Jodas Salvagioni • Gabrielle Jacklin Eler

I felt better today (P2). I felt I was putting all work the hands, the mind, what I am going to
the emotion out. To hold and squeeze the clay make, to create. I am already thinking about the
caused a feeling of control over the emotions. […] next one (P8). I was able to make my saint, I
an expectation to be cured. The clay makes me talked to my saint. We have a party in Japan
busy, using my imagination, my creation (P4). I on the day of Buddha’s birthday. I feel better
felt good. It is something that really changes your with the saint, we go and ask him and get better
mind. Instead of sitting down on my corner, we (P12).
move, feel freer, more relieved. We focus there,
working with the fingers (P16). The purpose of art therapy is to encourage long-
term changes that contribute to the improvement
It can be noted that art therapy enables users to of people’s well-being, as well as to emphasize
experience their difficulties, conflicts, fears and the non-verbal communication and the creative
anxieties in a less painful way. It is an effective way processes. However, the expression of patients’
of channeling the variables of mental disorders interior contents reflected in their creation, in
themselves positively, as well as the personal their objects, becomes one of the core elements
and family conflicts. In some of the statements, of art therapy. For some, clay caused them to
it was possible to note that the anxiety persisted, have bad thoughts and this is probably related to
even though they felt good about the activity: I the pathology, such as schizophrenia: I consider
felt good. My body and the nervous system were it dirty. I don´t know how to answer this. I used
relaxed. But I always rush, I cannot do it. I finish to like it, I don´t like it anymore, I don´t know
it very quickly. I do it quickly, there is no way, it how to do anything. I did it today, but I don´t like
is a habit, a vice, there is no way (P9). I feel very playing with mud […]. I don´t like it because
strong when I put my hands on it. I am learning, my hands get dirty and I hear a voice telling me
I really wanted to do it slowly, but I can´t (P14). to spread it over my face, it told me to eat it
because it was sweet, chocolate. I felt like as if
Working with clay causes deep feelings and I were retarded, mental disabled. Because the
emotions on people and, for being a primitive voice says that it is ugly, that I need to die, that I
material, it remits to the subconscious, bringing am not worth it, that a criminal person needs to
up hidden contents that need to be worked on. get me and cook me in the barbecue (P10); I feel
Some people remembered their homes, their lives strange, I was already strange before and after
and routines outside the hospital, like watching playing with it, I am still strange (P15).
movies, cooking, smoking, praying: I always liked
it. It takes out negative energy, bad energy. It The feeling of being in contact with the mud
seems like a magnet (emphasized with the hand). can be rewarding or not for patients. Handling
But today I felt my shoulders tired. I watched the clay may cause rejections and may bring up
the dragonfly movie, then I made a dragonfly, bad feelings and traumas, causing them to relive
there is a girl on the waterfall in the end and unwanted moments. But it can, on the contrary,
the dragonfly, and this was dark […] (P1). I felt cause deep relief and pleasing moments due to
good, cheerful, happy. I smoke and was making the chance of putting out feelings.
an ashtray for me, I had fun. I took my mind out
of things (P3). I made a goblet, tank, like a cup
Realizing the effects of clay treatment
of water. I think about the goblet I have at home
and then I make it. I think about the tank I have In the last session, the participants were asked
at home. I felt like using my brain, taking my whether the clay treatment had changed anything
mind out of things and learning different things in their lives. It can be noted that, for most
(P7). I felt good. Because I like cooking, I made patients, the therapy was of great value, helping
a small saucepan. I make pasta, lasagna, small them to be calmer, have hope, happiness, as well
chicken pieces, steak with onions. Clay is good, as providing positive energies, better relationship

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 Significance of clay art therapy for psychiatric patients admitted in a day hospital

and interaction, besides relieving the symptoms

of the illness. It was good, it improved my mind
Discussion
a little more. Clay has a good essence, brings a In art therapy, the experiences, constructions,
nice energy (P5). I like to play with mud. It was destructions, reconstructions and transformations
something different that I have done. Another that the expressive material provides, as a result
type of work (P7). Peace and quiet. In the first of the creation and self-awareness process,
times, I felt like squeezing it like a child playing are shared. The use of art as therapy implies
with mud. […] it is a period when we feel good, recognition of the importance of the creative
stay together with others, I like this close contact process as a way to reconcile emotional conflicts,
(P11). That feeling of being always ill seems to as well as to support self-esteem and personal
decrease (P13). development.13 Thus, it can be noted that the
use of clay therapy as a therapeutic resource in
And it was possible to observe in some statements psychiatric patients provides significant harmony
that the participants started to be more patient and between them and their internal contents in a
believe in themselves and in the future, reporting symbolic way. In this respect, the care can be
their desire to leave that place and restart their improved and complemented by visual images and
daily activities normally. It was very good, now their own creative processes of artistic activities
I am more patient, before I didn´t like to talk in order to mobilize people, their emotion and
intentions to support and maintain the physical,
very much, now I am more playful. I had a nice
mental and spiritual well-being.14
feeling and started hoping to go back to doing
some activity to have my freedom back (P3). It
The characteristics of expressive materials, such
was productive, it was a therapy, it made me as clay therapy, cover several possibilities, since
calmer, each session made me calmer. I started they seek to suit the uniqueness of the person who
to seek perfection in the objects. I felt in peace. creates it, working as instruments to stimulate
We can forget the bad thoughts, being inactive. creativity, resolve emotional conflicts, stimulate
I thought about going back to work one day, like self-awareness, reduce anxiety and bring up hidden
I used to do, I had my things (P4). information. These pieces of information represent
the dark and unknown or repressed sides of human
Through clay therapy workshops, it could be psyche which, when translated to conscience
noted that the participants develop a healthier through the therapeutic process contribute to the
social life, improved their verbal and non-verbal expansion of the entire mental structure.13,14
communication, increasing their freedom, self-
esteem and control of internal impulses. Among One of the aspects of access to the subconscious
all the participants, one of them reported that the through artistic activity is the memory of
therapy did not contribute to their life. It hasn´t childhood or past events. Therefore, art can be
changed anything (P10). Based on these data, it used to represent a conscious form of past events
while working with materials such as clay.15
is possible to infer that there it might be necessary
Sometimes, a person may remember unpleasant
to perform more clay therapy sessions in order to
events that have been repressed for years and,
improve the health conditions of patients with
in this case, making contact with this reality can
mental disorder and, on the other hand, it may be difficult and confronting. Although the event
be possible that in some patients clay therapy itself cannot be changed or deleted, this can be
can stir internal feelings that the patient is not more safely resolved when expressed through an
prepared to deal with and may aggravate their object or image so that people can view what is in
health condition in the beginning of the treatment their memory from another perspective and have
due to the fact that they are not able to deal with some control over their lives and, in this case, the
conscious situations. control over the object specifically created.15

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It can be noted through art therapy that there is and emotional effects. The technique requires the
minimization of negative factors of affective and channeling of appropriate energies for being a
emotional nature which naturally emerge with material that requires spontaneous creation.13,14
the illness, such as: anxiety, stress, nervousness,
fear, aggression, social withdrawal, apathy There are many people who hate mess and
and others.3 Studies show that clay work help reject clay, but the contrary can also take place
release repressed emotions, such as the feelings and cause a deep relief state and pleasure due
of abandonment or depression, contributing to to the possibility of expressing feelings and for
the physical and mental well-being, and guide allowing the handling of a material so close to
to reality.8,14,16 Thus, depressed, anxious and our symbolic roots.13,21 Clay works as changing
apathetic people strengthen their self-esteem by from a state of divergence to a state of balance.
creating a clay object.14,17 For being moldable, it integrates the person with
the outside world, showing that they can adapt to
Clay is a living material and has a calming effect situations, restructure their actions and emotions.
and, when properly used, it promotes significant It is a living material and has a calming effect
internal growth, supporting the release of tension and, when properly used, it promotes significant
and emotional conflicts, as well as stimulating internal growth, supporting the release of tension
the patient to build other ways of life.13 Clay work and emotional conflicts.13 What is created through
is a subject that needs to be carefully proposed. clay work in the end is an image, a symbol
Therapists need to be sure about their conduct according to the artist’s imagination. While
and support the patients when they get in contact working with clay, the images started to form
with their feelings. It is an experience that and there is a relationship between the image
provides a sense of shape, volume, emptiness, and who created it. When the person sees and
internal and external space and plenitude. It can handles clay, they are also handling their ghosts,
generate contradicting feelings in relation to the overcoming the unknown, the fear, the tension
final work.13 Other studies show that clay work concerning the new, accessing the subconscious.
can help patients get into regressive states and Touching clay promotes the development of
as a consequence they can progress their mental positive elements, leading to behavior adaptation
condition, but this material is hard to use and and resilience.8,15,22
may frustrate patients due to patients not being
able to deal with their feelings that were brought When the person touches clay, they are invited
up, such as anxiety, and thus not being able to to establish a completely new contact with them.
overcome their difficulties.18-20 Their sensitivity becomes an integral part of their
action, and the clay also guides each movement
Clay therapy is used to provide activities that led by the psyche in its cognitive and affective
allow creative development and psychic power dimensions. And this action promotes confidence
to meet these needs, the daily life will seem less and self- assurance.23 So, it is believed that through
empty and stressing, having the potential to be artistic work and group interaction, it is possible
an effective practice to intervene in rehabilitation to internally work the feelings of each patient
programs.15 Clay causes contact, the meeting expressed in their objects, in order to reinforce
between people and their innermost being, their the ego functions, develop self-awareness and
entirety. The effect of clay modeling acts in the identity.
physical and visceral feelings; when worked, clay
requires that people use almost their entire body For many patients, the definition of clay therapy
with strong movements of the hands and arms to allowed them to be part of a group in a new way,
mold it, appropriate position postures, attention, to perform their personal skills and improve their
body stability, balance of the limbs, providing self-image and empowerment.15 A study shows
feelings of internal structuring, as well as cognitive the relevance of art therapy groups in a day

136 • Invest Educ Enferm. 2014;32(1)

 Significance of clay art therapy for psychiatric patients admitted in a day hospital

hospital, with an activity that provides patients considered unaccepted, not appropriate,
and therapists with a forum to explore the personal despicable, intolerable and hideous.21 For patients
dimensions, new behaviors, and the experience of to work with art therapy, efforts and work that
team work.15 require continuous learning are necessary.15

Clay provides a live and potent experience with In conclusion, it is believed that the results lead
the creation of anything that is significant to the to the conclusion that the patients who attend a
person who creates it, while they realize they are day hospital leave their families and their homes
alive and are capable of carrying out their life in order to find the treatment for their symptoms,
story, being able to resolve and take their final since they wish to have emotional control and to
decisions. Clay makes the personal achievement live again a normal life within the society. Through
satisfactorily possible based on the principle that this study, it could be noted that clay therapy
the clay is in the hands of the person who has has allowed users to experience their difficulties,
complete power to do whatever they want with it, conflicts, fears and anxieties in a less painful way.
being able to decide with total freedom and this It was shown to be an effective way of channeling
becomes an invitation to a complete freedom of the variable of mental illness itself in a positive
expression. Clay offers a symbolical universe and way, as well as the personal and family conflicts.
the malleability of the material is related to the It can be noted that there is a minimization of the
importance of flexibility in life.24 negative factors of affective and emotional nature
which naturally come with the mental disorder,
There is an example of a research undertaken such as: depressive feelings and anxiety, anguish,
which described live and interesting reports of stress, fear, aggression, social withdrawal, apathy
how women with schizophrenia, bipolar disorder and others.
and depression feel after handling clay. The
reports range from the astonishment in finding The study with clay proved to be an important
out how to make the object to the extinction art therapy resource to be used in day hospitals
of shoulder pain, feelings of “turning off” from by the multi professional team, in particular the
the problems or issues which, at that moment, nursing team, for working with people in need of
would be causing suffering and also association trying new ways of living within the world around
to dreams and childhood experience, causing them and with themselves. Therefore, the use
well-being and quality of personal health.25 It of clay was shown to be effective, being able to
was observed that images, insights, affective promote self-awareness and providing several
memories, kinesthetic feelings and body changes benefits for those seeking to relieve their anxieties
occurred. The statements collected reinforce that, and conflicts. Thus, it can be concluded that
when people came out of this experience, they the stimulation of the creativity is an essential
felt more complete and in harmony. The harmony resource for a person to envision new possibilities
with the inner self and the creation of the work towards health and quality of life, and this is the
allowed the emotions and uncomfortable feelings reason why art therapy should be implemented
that were inside to come out and be shown. While continuously by healthcare professionals in the
gaining form outside, they allowed an internal care of psychiatric patients.
space of well-being.25
It seems plausible to define our experience with
The handling of clay leads people to adopt different the art therapy group in the above mentioned
attitudes, since the deepest rejection, given the day hospital as beneficial, in so far as the results
regressive issues the material brings up, related were observed. Hence, the need to broaden the
to the internal aspects like traumas, unresolved work through the creation of new therapeutic
situations, acquired both by cultural dimensions groups that view art as an important tool in the
and those resulting from personal experiences search for the well-being of people with mental

Invest Educ Enferm. 2014;32(1) • 137

Aquiléia Helena de Morais • Simone Roecker • Denise Albieri Jodas Salvagioni • Gabrielle Jacklin Eler

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