For an adult suffering with a mental health problem, talking about how they’re feeling can be difficult.
So, for a child with limited language skills, opening up about their feelings can be almost impossible.
That’s where art therapy comes in. It uses activities, such as painting, to help children understand and discuss thoughts they may find distressing.
"We know that children who can’t understand or name their feelings are more likely to 'act them out', so art therapy can provide relief to a child whose only previous option was to dissolve into tears or have an angry outburst in response to overwhelming feelings," explains Mary-Rose Brady, director of operations at the British Association of Art Therapists.
"Art materials enable children to externalise troubling or confusing emotions, giving them form and enabling them to make links between thoughts, feelings and behaviours, perhaps for the first time."
Debbie Thwaites, founder of art therapy charity Shine Again*, believes it can help youngsters in a way regular talking therapy can’t.
She suffered from an eating disorder as a child and had "the kind of therapy where you sit in a room with a therapist and if you don’t say anything, the therapist doesn’t say anything".
She adds: "Talking therapy didn’t work for me at all. Kids aren’t able to intellectually discuss their triggers."
Thwaites didn’t begin to recover from her eating disorder until she joined a church-led support group aged 18. Now a psychotherapist, she believes she would have recovered sooner if art therapy had been available to her.
At Shine Again, Thwaites and her team run one-to-one sessions in primary schools with children who have been identified by teachers or social workers as needing extra help.
"We have children with low self-esteem and children with selective mutism - usually something has happened and, as a result, they have chosen to stop speaking," she explains.
"We also have children with depression and I’ve had one year five child who tried to [take his own life]."
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During a session, a child comes into a room laid out with paints, instruments and puppets and chooses a task.
Although Shine Again also offers music and dance therapy, Thwaites says most children will opt for arts and crafts.
"One young boy I saw just wanted to paint poo. He wasn’t able to say 'this person is making me feel like poo', but he was able to get all the brown and black colours out, make a big mess and say 'that’s what I feel like'," she says.
The therapists will chat to the child about what they’ve drawn or made and sometimes suggest using puppets if they’re having difficulty expressing themselves.
"I’ve had a child using the puppets to demonstrate their mum getting drunk and another using them to show a parent taking an overdose," Thwaites says.
"Using puppets almost gives them permission to say these things out loud because they’re saying them in the context of a story."
In contrast to the one-to-one approach adopted by Shine Again, charity The Art Room works with three adults and eight children in each group.
Founded by Juli Beattie, the charity works with children aged five to 16 experiencing emotional and behavioural difficulties. Some of them have become disengaged from school or are at risk of exclusion.
Rather than focus on specific mental health issues that a pupil may or may not have been diagnosed with, Art Room practitioners take a holistic approach.
Pupils are encouraged to create artworks on objects, such as clocks and lamps, as it’s thought to be less intimidating than being handed a blank sheet of paper.
"It’s a really good way to get them to talk about themselves as they’ll paint things on to objects that matter to them," Beattie says.
Discussions are led by the children, with practitioners taking a step back to listen to the pupils interacting.
Beattie explains: "A group of boys were painting clocks and one of them said 'I’m going to give this to my dad'. Another boy said: 'But I thought you didn’t like your dad, I thought your dad pushed your mum down the stairs'. And the first boy said: 'No, that’s not this step-dad, that was my other step-dad'.
"It gives us an opportunity to listen to their difficulties and it gives them an opportunity to say them but in a very safe environment."
Afterwards, a practitioner will talk to the group about relevant issues such as domestic violence and how that experience might make a person feel.
Social services are informed if a child safety issue has been raised and pupils will sometimes go on to have more conventional individual therapy.
"The children realise that we can’t take away what has happened three or four years ago and we can’t always change the environment they live in but we can give them the skills to be able to say 'something is wrong' or 'I don’t feel well'," Beattie says.
The method works. The mother of one nine-year-old says The Art Room helped after her husband died unexpectedly in front of her children.
"My daughter refused to talk about her father and what she saw and, a week later, she just stopped talking altogether," she says.
"After a few weeks at The Art Room she began to talk about her dad and him dying and how sad and angry and upset she was.
"The box she made at The Art Room is beautiful and she put this on her father's grave. I think it’s really helped her to cope with our family's loss."
Both Beattie and Thwaites believe helping children with their communication skills when they’re most vulnerable will limit their mental health problems as teenagers and adults.
"Eating disorders and self-harm come from young children bottling up feelings," Thwaites says.
"By sorting out problems early they are a lot less prone to these issues later on."
Beattie adds: "This is not only about helping children affected by mental health problems, it’s about avoiding mental health problems."
Young Minds Matter is a new series designed to lead the conversation with children about mental and emotional health, so youngsters feel loved, valued and understood. Launched with Her Royal Highness, The Duchess of Cambridge, as guest editor, we will discuss problems, causes and most importantly solutions to the stigma surrounding the UK’s mental health crisis among children. To blog on the site as part of Young Minds Matter email firstname.lastname@example.org
*Shine Again is part of the Centre for Social Justice network of charities