Table 4.
The 19 domains of therapeutic factors in the CATs.
| Domain of TF | CATs factors (joint and specific) | Mixed-type factors (joint, specific, and common) | Common Factors |
|---|---|---|---|
| Embodiment (n = 14) | • Embodiment • Embodiment (DT/PD-JF, AT-JF, DT/PD-SF) • Body awareness • Body awareness (AT-JF) • Kinesthetic awareness (DMT-JF) • Body-mind connection (DMT-SF) • Body self-perception (DMT-SF) • Getting in touch with the body (DMT-SF) • Physicality of the arts • Physical experience with the body (DT/PD-JF) • Tactile quality (AT-SF) • Enactment (DMT-SF) • Physical act of music making (MT-SF) • Altering of inherent body-rhythms (MT-SF) • Experiencing the body • Experiencing the body (DMT-SF) |
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| Concretization (n = 10) | • General • Creating something visible (DT/PD-JF) • Artistic product facilitates verbal reflection and self-knowledge (CAT-JF) • Re-enactment (DMT-JF) • Self-display (DMT-JF) • Performing biographic themes (DMT-JF) • Designing dynamic themes (DMT-JF) • Role reconstruction (DT/PD-SF) • Changing and embodying of roles (DMT-SF) • Visual narrative of life (AT-SF) • Portraying feelings of past/future (AT-SF) |
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| Symbolism and metaphor (n = 8) | • Symbolic work • Enhancing symbolic elaboration (CAT-JF) • Shifting between symbolic and knowing realm (DMT-JF) • Metaphor (CAT-JF) • Unconscious processes via arts • Unconscious self-expression (AT-JF) • Interpreted symbols and images (MT-JF) • Transference to the artistic product (AT-SF) • Dramatic projection (DT/PD-SF) • Movement metaphor (DMT-SF) |
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| Agency (n = 24) | • Artistic agency • Artistic agency (MT-JF) • Agency in music making (MT-SF) • Jumping rhythm (DMT-SF) • Offering music choices (MT-SF) • Discovering materials and possibilities (AT-SF) |
• General agency • Enhanced self-concept (CAT-JF) • Activating self-agency (DMT-JF) • Offering control and choice (DT/PD-JF) • Ownership (MT-CF) • Strengthened agency (CAT-CF) • Empowerment (CAT-CF, DT/PD-CF) • Empowering experiences (MT-CF) • Productive behaviors (DT/PD-CF) • Self-efficacy (DMT-CF) • Agency (MT-CF x2) • Enhancement of self-esteem (DMT-CF) • Developing sense of achievement (AT-CF) • Motivation • Vitality/vitalization (DMT-JF x2) • Music as motivating (MT-CF) • Motivational force when unwell (AT-CF) • Impacts present energy level (MT-CF) |
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| Interaction through the arts (n = 19) | • Empathy • Non-verbal attunement (MT-JFCAT) • Musical attunement (MT-SF) • Mirroring and movement (DMT-SF) • Doubling (DT/PD-SF) • Role reversal (DT/PD-SF) • Dialogue • Interacting with one another in movement (DMT-SF) • Intramusical connections (MT-SF) • Musical dialogue (MT-SF) • Shared musical experiences (MT-SF) • Turn taking (MT-CF) • Complex interactions • Relational aesthetic (AT-JFCAT) • Transference during artmaking (AT-SF) • Triggering musical encounters (MT-SF) |
• Synchronicity • Therapist working alongside the client within and outside of the drama (DT/PD-JFCAT) • Moving in synchronicity (DMT-SF) • Musical synchronicity (MT-SF) • Joint attention (MT-CF) • Moving with the therapist (DMT-SF) • Modeling (MT-CF) |
|
| Structure (n = 17) | • Structure of the art form • Structuring nature of music (MT-SF x2) • Structuring/repetitive nature of music (MT-SF x2) • Structuring/safe nature of music (MT-SF) • Repetitive rhythm (MT-SF) • Tempo of the music (MT-SF) • Slow and steady music tempo (MT-SF) • Musical simplicity (MT-SF) |
• Structure of session • Structuring emotional outlets (DMT-JF) • Implementing structure (MT-JF) • Rituals (DMT-JF, AT-JF) • Programmed classical music (MT-SF) • Tailored structure/content to fit the client (CAT-CF) • Bringing it all together (CAT-CF) • Predictability (MT-CF) |
|
| Developing skills (n = 16) | • Artistic skills • Developing artistic talents (CAT-JF) • To learn or practice artistic skills (AT-JF) • Learning new ways of living in the body (DMT-SF) • Connecting movement and language with one another (DMT-SF) • Learning and practicing of motion sequences (DMT-SF) • Musical expansion (MT-SF) • Enhancement of control through musical improvisation (CAT-SF) • Enhancement of concentration through music improvisation (CAT-SF) |
• Personal and interpersonal skills • Skills training (DMT-JF) • Improving feedback skills (AT-CF) • Prosocial behavior (MT-CF) • Verbal and non-verbal skills (MT-CF) • Developing mastery in processing/communication of emotions (CAT-CF) • Enhancing emotional intelligence (DMT-CF) • Mastery of dynamic challenges (DMT-CF) • Increased social skills and connection (CAT-CF) |
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Active engagement (n = 15) |
• Engagement with artistic activity • Dramatic engagement (DT/PT-SF) • Therapeutic activity (CAT-JF) • Mobilization (DMT-JF) • Engagement with the musical experience (MT-SF) • Musical engagement (MT-SF) • Use of specific art materials and techniques (AT-SF) |
• General involvement • Encouraging active engagement (CAT-JF) • Active engagement (MT-JF) • Being actively involved (DT/PD-JF) • Being actively involved in therapy (DT/PD-JF) • Client involvement (DT/PD-JF) • Client targets (CAT-CF) • Personal responsibility (CAT-CF) • Client in-session behaviors (DT/PT-CF) • Experiencing level (DT/PD-CF) |
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| Creativity (n = 13) | • General • Creativity (CAT-JF) • Creative self-expression (MT-JF) • Spontaneity • Spontaneity (DT/PD-JF) • Moving spontaneously (DMT-SF) • Experimentation • Trying out new ways of being (DT-JF) • Opportunity to explore (AT-JF) • Designing and testing (DMT-JF) • Artmaking in session as a form of exploration (AT-SF) |
• Letting go of control • Losing control (DMT-JF) • Loosening up of movement (DMT-SF) • Mobilizing/loosening-up in movement/making flexible (DMT-SF) • Non-goal orientation of dance and movement (DMT-SF) • Resistance decrease (DT/PD-CF) |
|
| Artistic pleasure (n = 13) | • Playfulness • Playfulness (DT/PD-JF) • Play (AT-JF) • Playfulness involved in playing/sharing instruments (MT-SF X 2) • Aesthetics • Experience of beauty (DMT-JF) |
• Pleasant feelings • Pleasure (AT-JF) • Aesthetic pleasure (CAT-JF) • Pleasure of movement (DMT-JF) • Pleasure from play (MT-JF) • Experiencing positive affect (CAT-JF) • Enjoyment (MT-JF x2) • Hope and optimism (DT/PD-CF) |
|
| Modulating time and space (n = 14) | • Flow experience • Flow state (AT- JF) • Experience of flow (MT-JF) • Transcending thinking of product/process (AT-JF) |
• Here and now • Surplus reality (DT/PD-SF) • Point of focus/link to the present (MT-CF) • Being in the present moment (MT-CF) • Working with the here and now (CAT-CF, DT/PD-CF) • Presence in the moment (CAT-CF) • Experiencing the present moment (AT-CF) • Distraction • Distraction of stress-increasing thoughts (MT-JF) • Temporary distraction from illness (MT-CF) |
• There and then • Getting to the root (CAT-CF) • Facing deeper issue from the past (DMT-CF) |
| Group processes (n = 25) | • Encounter • PD “encounter” between group members (DT/PD-SF) • Encountering one another (DMT-SF) |
• General • Group process (AT-CF) • Community engagement (CAT-CF) • Yalom's therapeutic factors • Yalom's therapeutic factors for group therapy (DT/PD-CF x4). • Altruism (MT-CF) • Instillation of hope (MT-CF) • Interpersonal learning (MT-CF) • Validating feedback of group members (MT-CF) • Group cohesiveness • Group cohesiveness (MT-CF x8) • Establishing cooperation and (group) cohesion (DMT-CF) • Connecting to others (DMT-CF x2) • Feelings of togetherness and bonding (MT-CF) • Acceptance of self/others (AT-CF) |
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Non-verbal expression (n = 11) |
• General • Expression (MT-JF, AT-CF) • Non-verbal expression (CAT-JF, DMT-JF, AT-JF x2) • Expressivity in movement (DMT-SF) • Form of visual self-expression (AT-SF) • Use of tone (MT-SF) • Expression of emotion (DMT-CF x2) |
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Connection with self (n = 12) |
• General • Focusing to oneself (DMT-JF) • Connection to inner self (AT-CF) • Connecting to self (DMT-CF x2) • Self-exploration (DMT-CF) • Establishing inner connections (DMT-CF) • Finding inner balance (DMT-CF) • Strengthen sense of self (MT-CF) • Connection with self through the arts • Acceptance of artwork (AT-JF) • Portraying self-image (AT-SF) • Pride (MT-CF) • Personal values (MT-CF) |
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| Remembering (n = 5) | • General • Music stimulated autobiographical recall (MT-SF) • Reminiscence (MT-CF) • Stimulation of memory (CAT-CF) • Remembering (DMT-CF) • Reconnect with key moments (MT-CF) |
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| Therapeutic alliance and bond (n = 10) | • General • Therapeutic alliance (AT-CF, MT-CF, DMT-CF) • Therapist-client bond (DT/PD-CF, AT-CF) • Therapeutic relationships (MT-CF) • Fundamental relational skills and features (CAT-CF) • Developing supportive relationships (CAT-CF) • Receiving and providing support (DT/PD-CF) • Verbal dialogue (MT-CF) |
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| Emotional elicitation and processing (n = 23) | • Release and relief • Deep relaxation (MT-JF, AT-JF) • Release of intrapsychic tension through improvisation (CAT-SF) • Energy discharge/tension release (DMT-SF) • Catharsis (DT/PD-SF, MT-CF) • Releasing and relief (DT/PD-CF) • Confronting • Confronting oneself with emotions (DMT-JF) • Confronting oneself with own actions (DMT-JF) • Emotional reaction to materials (AT-SF) • Seeing own emotions through visual art (AT-SF) • Confronting (DMT-CF) • Emotional regulation • Working within a safe distance within or outside the drama (DT/PD-SF) • Musical cues that are used to ground and modulate distress (MT-SF) • Regulating emotions (AT-CF, DMT-CF) • Acting out and “living through” emotions and directing this process (AT-CF) |
• Expansion of emotions • Broaden-and-build affect (DMT-CF) • Broaden-and-build via experience of positive emotions (DMT-CF) • Enhancing emotional well-being (DMT-CF) • Actualizing emotions (DMT-CF) • Processing emotions • Transforming emotions (DMT-CF) • Emotion processing (AT-CF) |
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| Understanding (n = 24) | • Reflection • Reflection upon art (AT-SF) • Artmaking in session as a form of reflection (AT-SF) • Increased reflective functioning (DT/PD-CF) • Reflection on own patterns (AT-CF) • Witnessing (DT/PD-CF, CAT-CF) • Self-awareness • Self-awareness through artwork (AT-SF) • Awareness of ego function/self-realization (CAT-CF) • Self-awareness (DT/PD-CF) • Awareness/exploring own feelings (AT-CF) • Meaning-making • Shifting between movement and meaning (DMT-SF) • Meaning making (CAT-CF) • High levels of meaningfulness (MT-CF) • Meaning (MT-CF) • Gaining insight • Using bodily sensation as a source of information (DMT-SF) • Understanding the pattern/insight (DT/PD-CF) • Insights in emotions (AT-CF) |
• Perception • Perceiving emotions (DMT-CF) • Perceiving own blockages (DMT-CF) • Metallization (DMT-CF) • Reframing (DMT-CF) • Reframing identity (MT-CF) • Differentiating/clarifying feelings/thoughts (AT-CF) • Cognitive regulation (AT-CF) |
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| Environment (n = 10) | • General • Comfortable and liberating environment (CAT-CF) • Creating a safe place (DMT-CF) • Safe environment (AT-CF) • Safety (AT-CF, MT-CF, DT/PD-CF) • Psychological safe space (AT-CF) • Supportive /familiar atmosphere (MT-CF) • Levels of trust in healthcare providers and treatment plans (CAT-CF) • Positive and safe intervention for developmental stage for children and adolescents (AT-CF) |
In this table the 19 domains of therapeutic factors resulting from the analysis. The left column lists therapeutic factors that are unique to the CATs (SF of one CATs discipline and JF identified across the CATs). The middle column lists the mixed-type therapeutic factors (SF, JF and CF); The right column only consists of CF across psychotherapies.
The n is the number of therapeutic factors included in a given domain.
JF, joint factor across creative arts therapies; MT-JF, joint factor across creative arts therapies found in a music therapy study; AT-JF, joint factor across creative arts therapies found in an art therapy study; DMT-JF, joint factor across creative arts therapies found in a dance movement therapy study; DT/PD-JF, joint factor across creative arts therapies found in a drama therapy/psychodrama study.
CF, common factor of psychotherapy; MT-CF, common factor found in a music therapy study; AT-CF, common factor found in art therapy; DMT-CF, common factor found in dance movement therapy; DT/PD-CF, common factor found in drama therapy/psychodrama; CAT-CF, common factor found in a study with more than one CATs included.
SF, specific factor in a CAT discipline; MT-SF, music therapy specific factor; AT-SF, art therapy specific factor; DMT-SF, dance movement therapy specific factor; DT/PD-SF, drama therapy/psychodrama specific factor; CAT-SF, creative arts therapies studies specific factor.