When one generally thinks of art therapy, its use with some of the most dangerous individuals in society does not come to mind. Inmates are a unique group living in an unnatural environment. Cognitive or behavioral problems may have contributed to an individual being incarcerated and confined to a single facility for potentially long periods, raising challenges for rehabilitation. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay This literature review will examine five studies conducted approximately over the past 10 years in chronological order, ranging from reducing depression in prisoners to applying art therapy for difficult cases involving schizophrenia. We will conclude by outlining some potential shortcomings that have emerged in the studies; although the overall results are promising with the implementation of the use of art therapy within the prison environment. Pearson and Wilson (2009) attest that art therapy provides a mechanism for expressing and communicating personal experiences from the depths of the human soul. Not only does it allow for the expression of nonverbal thought, but the act of creating within a therapeutic space is a time to focus energetic drives, process personal behaviors, and seek a unified emotional and mental state (pp. 169-170 ). Nowhere does this seem more necessary than in a population that is sometimes forgotten by the majority of the population; that of female prisoners in prison. The history of the use of art therapy in the prison environment can be traced back to the work of Levy (1978) in her work with female prisoners who exhibited aggressive behavior. Levy discovered the use of art therapy as a nonverbal therapeutic technique effective in realizing “unexploited material” (p. 157) that may have explained the origin of the prisoner's aggressive behavior. Within the prison environment, the benefits of art therapy endure thanks to ongoing studies led by David Gussak. Gussak's (2007) study examined the effectiveness of art therapy in reducing depression in prison populations. In an environment where clients may have an inherent distrust of verbal disclosure and rigid defenses for basic survival (p. 444), art therapy has been seen as an alternative avenue for developing the essential sense of trust and security required for the therapeutic alliance to thrive. (Pearson and Wilson, 2009, p. 170). The study was conducted with male inmates in a medium- to maximum-security North Florida prison selected by the mental health counselor. All participants had an Axis I diagnosis of depression, despondency, or manic-type bipolar disorder. Gussak used the Formal Elements Art Therapy Scale (FEATS); the Beck Depression Inventory-Short Form (BDI-II) (Beck, Rial, & Rickets, 1974, as cited in Gussak, 2007, p.454); and a self-developed 6-point Likert-type survey once before the intervention and once after. The art tasks started with simple individual exercises such as name embellishment and self-symbol activity, to more complex group work such as collaborating to build a paper bridge and group work on the mandala. These were used in conjunction with an art directive, which consisted of each inmate drawing a picture of a person picking an apple from a tree (PPAT) using standardized art materials, to ascertain any therapeutic changes (Gussak, 2007, p. 444-448).Gussak (2007) found that post-test PPAT drawings reflected greater space use, vastly greater detail, and greater integrationcompositional; it thus reflected a greater awareness of their surroundings. Results also showed that participating inmates exhibited greater investment in the therapeutic process, greater demonstration of compliance with staff directives, greater socialization skills, and a significant decrease in depressive symptoms with improved mood (pp. 449- 456). The results of this study were promising as they worked in a particularly challenging environment. A year later, Michael Hanes took the art therapeutic modality a step further by working with the most at-risk inmates; those on suicide watch. Hanes (2008) applied his art therapy modality in an American county prison where clinicians, with limited availability of resources, were tasked with assessing an inmate's suicide risk based solely on self-reporting of his or her status internal mental and its behavioral models. and life history. The use of road designs was implemented for their ease of use with limited safe materials so as to reduce potential safety risks; a 2B pencil (shortened to 3 inches), 8 crayons and paper (pp. 78-80). Hanes (2008) theorized that the use of drawing a road, which he believes is a universally understood symbol, can function as a metaphor as the inmate's “road of life” (p. 79); thus bringing to light vital information that the inmate may be reluctant to reveal in a standard verbal therapeutic context (p. 83). Hanes found that inmates were able to reflect on their Road Drawings as a way to self-evaluate their capacity for change, transform destructive patterns of thought and action, and instill hope and optimism for their future (p.83). This “process design,” outlined in Pearson and Wilson (2009), supports ventilation and catharsis through the use of colors, lines, and shapes to express and release internal feelings (pp. 181–182). This is a projective technique that allows you to focus on restorative methods instead of starting with a problem-focused approach. It facilitates the opportunity for inmates to create their own story and express their unique perception of reality, rather than focusing on established literal facts (p, 172) that may be presented in their medical history. Since depression has been found to be the main predictor of suicide among prisoners (Suto & Arnaut, 2010, pp. 294-295, 302-304), a study was conducted to investigate this further. Gussak (2009b) revisited her study from 2007 with the inclusion of female prisoners, thus advancing her previous research base. At the same time he theorized whether art therapy would help improve the inmate's mood, socialization skills, problem-solving skills, and Locus of Control (LOC) (p. 6). Since LOC is the degree of control an individual feels they have over their environment, with external LOC indicating a tendency to believe that external influences control their behavior and internal LOC feeling like they are in control of their destiny (Bayse, Allgood and van Wyk, 1992); Gussak (2009b) believes that prisoners may have a tendency to display greater external LOC. This was related to his findings that there is a direct relationship between LOC and depression; the higher the external LOC, the greater the chance of showing depressive symptoms (p. 6). Gussak (2009b) followed a similar format to how therapy sessions were conducted in his 2007 study; starting with simple individual art work that progressed to group-oriented art work, thus facilitating problem-solving skills. Adding the scale ofNowicki-Strickland adult locus of control (ANSLOC) was used to assess interpersonal and motivational areas for a change in LOC. This was achieved using a simple Yes and No questionnaire (p. 6-7). The results were a significant change in male and female inmates' ANSLOC scores from outside to inside. Gussak (2009b) concluded that through art therapy, inmates learned to manipulate art materials to achieve the desired effect and learned cause and effect through this creative therapeutic process; this knowledge was then internalized (p. 10). Gussak (2009a) revisited her findings and found substantial improvement in mood and internal LOC in participating female prisoners compared to males. Because female prisoners have been shown to be potentially more susceptible to depression (Harris, 1993), they experience greater difficulties with depression (Butterfield, 2003) and exhibit greater external LOC (DeWolfe, Jackson, & Winterberger, 1988); Gussak (2009a) concluded that her findings highlighted the idea that female prisoners who undertook art therapy had a greater chance of change (pp. 202-207). Up until this point, art therapy had shown flexibility in working with both male and female prisoners. It was possible to investigate its adaptability with another therapeutic modality. Breiner, Tuomisto, Bouyea, Gussak, and Aufderheide (2012) used art therapy within a cognitive behavioral therapy (CBT) framework at Wakulla Correctional Institution in Florida. It targeted anger management with inmates who previously had a history of anger problems or interpersonal violence. The basic assumptions of CBT are that problematic thinking leads to problematic emotional and behavioral consequences, and this problematic thinking is learned or is the result of a lack of learning. The goal of CBT is to identify these errors in thinking and help the client correct them by acquiring cognitive skills to assist in eliminating the problematic behavior (pp. 1125-1127). Breiner et al's (2012) reasoning for incorporating art therapy was to tailor the treatment to the unique characteristics of the individual prisoner which they believed was beyond the scope of standard CBT tools. The flexibility and variability of art therapy allowed them to undertake treatment with clients who displayed different levels of verbal ability and intellectual capacity (pp. 1139-1140). This was achieved with an art therapy directive known as “The Water Contamination Exercise.” A 3 part drawing of contaminated water from 3 different sources and the effect it has on the water produced at the end of an irrigation system. It is designed to help inmates understand how underlying attitudes can generate the thoughts that may occur in response to a trigger (p. 1135-1136). For prisoners this was a simple pictorial way to understand cognitive restructuring using the ABCD model of CBT developed by Albert Ellis (Ellis, 2006). Breiner et al (2012) found that art therapy better engages prisoners in the therapeutic process by assisting group members to access emotions that may be difficult or problematic to express. It helped calm inmates who showed signs of nervousness or distress at being in this particular group setting. They found that art therapy homework complemented the CBT material by making it more easily accessible to inmates with different learning styles, intellectual barriers, and personality traits that may have influenced their ability to understand the material (p 1140). These results showed adaptability &. 170-171, 190).