https://doi.org/10.1177/1039856218822745 Australasian Psychiatry 1–6 © The Royal Australian and New Zealand College of Psychiatrists 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1039856218822745 journals.sagepub.com/home/apy 1 AUSTRALASIAN PSYCHIATRY A rt therapy has been increasingly used in mental health settings, including as an assessment strat- egy for children and families 1 and for trauma- induced symptoms. 2 However, there is limited literature evaluating art therapy in child and adolescent mental health services (CAMHS) units. 3 In mental health inpatient settings, verbal therapies continue to dominate. 2 However, many inpatients are unable to verbalise their concerns, and say they feel nothing or are numb. 4 Young people in inpatient CAMHS units also have high rates of complex trauma and difficulty with verbal expression of distress, leading to unacceptable rates of seclusion and restraint. 5 Art therapy provides an opportunity to manage overwhelm- ing experiences by identifying feelings non-verbally. Art therapy can assist to express an experience, fragmented or otherwise, regardless of declarative memory. An underlying hypothesis of many therapies, including art therapy, is that psychological difficulties are maintained by the individual’s inability to adequately verbalise their traumatic experiences and associated emotions; finding the words is a key step in therapy. 6 Art therapy has potential usefulness in a CAMHS setting (Figure 1); how- ever, there is a need for further evaluation in this area. Art therapy has many forms, but is best described as a form of psychotherapy using images to express and communicate. Many schools of art therapy use a psy- chodynamic approach, where art is used as a vehicle to begin verbally describing unconscious thoughts and feelings. Responsive art therapy is a psychodynamic approach where an art therapist (with specialist qualifications such as a master’s degree in art therapy) creates an in- session artwork as an interpretive relational communica- tion to a patient’s artwork. 7 This interactive role changes the art therapist’s position in the session to active par- ticipant via the non-verbal communication of the art- Evaluating the use of responsive art therapy in an inpatient child and adolescent mental health services unit Fran Nielsen Art Therapist, Walker Unit, Concord Centre for Mental Health, Concord, NSW, Australia Sophie Isobel Acting Nurse Manager, Research and Ethics, Sydney Local Health District Mental Health Services, Concord, NSW, Australia Jean Starling Director, Walker Unit, Concord Centre for Mental Health, Concord, NSW, and; Senior Clinical Lecturer, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia Abstract Objectives: We describe the use of responsive art therapy in an inpatient child and adolescent mental health ser- vices unit, including its acceptability rated through a satisfaction questionnaire. Methods: A patient satisfaction questionnaire was developed to collect feedback from 46 adolescents. Images from therapy were photographed and collated looking for patterns across diagnoses and stages of treatment. Results: Adolescents reported that art therapy helped them learn how to express themselves safely (80%) and under- stand how their thoughts related to their feelings (78%). Conclusions: Responsive art therapy was a useful strategy to support the safe expression of distress and was seen as a positive experience by adolescents in inpatient mental health care. Keywords: art therapy, adolescent, inpatient treatment, trauma informed care Corresponding author: Jean Starling, Walker Unit, Concord Centre for Mental Health, Building 105, Hospital Road, Concord, NSW 2139, Australia. Email: jean.starling@health.nsw.gov.au 822745APY Australasian PsychiatryNielsen et al. Regular Article