Exploring the Role of Art-making in Recovery , Change , and Self-understanding---- An Interpretative Phenomenological Analysis of Interviews with Everyday Creative People

Most creativity theorists consider artists as “agents of control”, capable of overcoming and controlling psychological distress. However, studies have yet to map the “healing” tendency for “everyday creative people” in detailing the process’ effects on perception and change. This study was aimed to examine this process via a phenomenological and Perceptual Control Theory perspective (PCT: see Powers, W. T. (1973). Behaviour: The control of perception. Chicago: Aldine). We recruited and interviewed eleven participants who had engaged in art-making and experienced recovery from psychological distress. Interpretative Phenomenological Analysis was used to identify themes between participant responses, generated from self-created semi-structured interview schedules following Smith and Osborn’s technique (IPA: see Smith, J. A., & Osborn, M. (2008). Interpretative phenomenological analysis. In J. A. Smith (Ed.), Qualitative psychology: A practical guide to research methods, 2 edition, (53-80). London: Sage). Data analysis identified six superordinate themes: 1) “the process of creating as a goal-oriented focus”, 2) “internalising process and product”, 3) “awareness shift and self-focus”, 4) “emotion regulation”, 5) “goal change, bonding, and conflict resolution”, and 6) “feelings and perceptions within the art-making process”. Disconfirming Case Analysis and participant feedback also indicated a seventh theme: 7) “the ‘superficial’ creative process”. The results were interpreted to indicate that art-making involves the purposeful creation of perceptual experience to fulfil higher-order goals and values. The creative process is also a learning process which instigates and promotes positive affect, enhances skills, and facilitates change in higher-order goals. We consider these interpretations in the light of the components of PCT.


Issues with the Contemporary Art Therapy and Creativity Literature
Art therapy is a viable method of treatment and approach for self-understanding, emotional change and restoration to well-being.Art is considered a healing tool.Ostensibly, "healing" is the calming of emotions after distress and regaining of health and feelings of well-being during therapy (Malchiodi, 2007;Ornstein, 2006).Healing in art-making has been shown to work for women with cancer, sub-fertile women, African-Americans with Alzheimer's, and other investigated groups (e.g., Hughes, 2010;Johnson & Sullivan-Marx, 2006;Stafstrom & Havlena, 2003).There are a number of influential theoretical approaches to the benefits of art.Yet each approach is restricted in its breadth and is poorly integrated.These approaches can be broadly considered as: the creative process (e.g., Gaut, 2010), "flow" (e.g., Csikszentmihalyi, 1996), problem-solving and meta-cognition (e.g., Allen & Thomas, 2011), insight and purposeful action (e.g., Dewey, 1934Dewey, (reprint in 2005))), self-actualisation (e.g., Ryder, 1987), emotional self-regulation (e.g., Hamilton, Karoly, & Kitzman, 2004), and occupational focus (e.g., Laliberte-Rudman, 2002).
The aim of the current study was to address the fragmented literature by providing a novel, integrative, mechanistic account of the benefits of art on recovery based directly on first-person accounts.Interpretative Phenomenological Analysis (IPA: Smith & Osborn, 2008) was used to extract the key themes from participant accounts and the framework of Perceptual Control Theory (PCT: Carver & Scheier, 1999;Mansell, 2005;Powers, Clark & McFarland, 1960) was used to build psychological models from these themes.PCT was selected because it is proposed to have the capacity to integrate psychological processes across diverse fields (Stevenson-Taylor & Mansell, 2012;Carey & Mansell, 2009).

Art-making and Everyday People-the Missing Link between Art Therapy Theory, Application, and Connection to Real Life Situations
In addition to the difficulties inherent in integrating widely different theoretical approaches, there is a paucity of research on the detailed creative process and its benefits outside therapeutic or experimental settings (Stevenson-Taylor & Mansell, 2012).It is believed that in order to properly consolidate theory, one must link the implications of art-making to everyday action and distress.This may yield more information about art-making's rehabilitative characteristic and close the widening gap that separates eminent artists, patients, and everyday persons (Stevenson-Taylor & Mansell, 2012).
Seldom is a rigorous exploration given to ascertaining the effects of psychological change in the long-term.When and how these changes occur are rarely addressed (Pelowski & Akiba, 2011).And, more alarmingly, the benefits of therapy are nearly always attributed to the superficial process of art-making rather than individuals' innate capability to self-heal (Stevenson-Taylor & Mansell, 2012).The justification for using "everyday creative persons" is to bridge theory with everyday application, and demonstrate where, when, how and why healing occurs within the creative process.People who have creative talents, but are not "professional artists" represent the majority who consider themselves "creative" but not "eminently creative" ("mini-c" and "little-c" individuals; Beghetto & Kaufman, 2007).

The Basic Premises of Art Psychology and Art Therapy Theory
Each of seven theoretical approaches to the benefits of art will now be summarised.First is the creative process-the dynamic model of creativity working across four spheres: the person (artist), the environment (domain), the product, and the viewer of art (audience) (Csikszentmihalyi, 1999;Mace, 1997;McIntyre, 2008).It has three stages: a) Stage 1: consists of choosing the elements of your creative endeavour, ignoring the problematic and unproductive; b) Stage 2: unconscious juggling of ideas propel the person to create, subliminal aesthetics setting in for free-play of ideas to invoke insight; and, c) Stage 3: the person implements the ideas and reviews the results (Bindeman, 1998;Gaut, 2010).This is not an automatic process and requires conscious deduction (Cohen-Shalev, 1986;Gaut, 2010).There is sense of agency and purpose behind creativity (Gaut, 2010).Researchers suggest that creativity helps clarify goals that are intrinsic and the individual wishes to reach (Jones, Runco, Dorman, & Freeland, 1997;Lubart & Getz, 1997;Lindauer, 1992).Second, we cover the "flow" experience.Several theorists explicate that artists are normally intrinsically motivated, stemming from inner desires and goals perpetuating the act of creation (Burleson, 2005;Csikszentmihalyi, 1996;Getzels & Csikszentmihalyi, 1976)."Flow" is the threshold state in creative activity.It states that intrinsic motivation happens because people will meet their goals, as directed by their needs (Csikszentmihalyi, 1991(Csikszentmihalyi, , 1996;;Carl III, 1994).Theory of flow assumes that high achievement is associated with complete immersion in creative activity, to an "autonomic", euphoric state.This is seen in some artist accounts, creating related to "automotive", "unconscious" movement-allowing "flow" of ideas in art-making (Bindeman, 1998;Cohen-Shalev, 1986;Csikszentmihalyi & Csikszentmihalyi, 1988).However, the creative process requires cognition along with periods of flow in order to achieve product-creation in art-making.
The third approach to creative thinking involves how it is facilitated by cognitive controls-"patterns of thinking that control the ways that individuals' process and reason about information" (Jonassen, 2000, p. 70;Allen & Thomas, 2011;Mace, 1997).Creative thought involves a search for "order" in "chaos".Within a higher-order perspective, creative individuals are better able to deal with conflict in creative pursuits (Barron, 1990;Mace, 1997;Ziv & Keydar, 2009).It has been proposed that deeper immersion in the project yields more ideas and possible solutions to conflict, garnered over successive transformations of the concept in the artwork (Mace, 1997).This successive organising of concepts and decision making within creativity instigates meta-cognition: affective elements aiding in an imaginative identification process between artist and the artistic problem (Gardner, 1988;Mace, 1997;Wakefield, 1989).Meta-cognition is inherent in problem-solving and insight within art-making (Burleson, 2005;Pelowski & Akiba, 2011;Pankova, 2009).
Fourth, it is suggested that sudden insights emerge from the ability to freely express (Bournelli, Makri, & Mylonas, 2009;Doyle, 1998;Fraser, 2006;Hellström, 2011).The act of expression and its experience is a process in "duality"; it is the act of creating and the act of internalising the act of creating (Brown, 2008;Dewey, 1934Dewey, /2005)).We can integrate the early theoretical points if we consider that expression instigates realisation, illustrated as a reaching to intrinsic goals and enhancement in "flow", confidence, and self-esteem.This promotes the formation of a purposeful being, or an agent in society (purposeful action; Fidler & Fidler, 1978).
Links are seen here to a fifth theoretical approach guided by humanistic psychology.According to Abraham Maslow and Carl Rogers, there is a connection between the creative person and self-actualised person (Musick, 1977;Ryder, 1987).Self-actualisation is the search for becoming more "genuinely" human via realisation of the self and its potential (Maslow, 1968;Musick, 1977;Ryder, 1987).It can also make life's conditions more meaningful and expand one's capabilities (Rogers, 1969;Maslow, 1971).The stages of self-actualisation unfold awareness via openness to thoughts and experience, despite possible fear.Successful awareness depends on how close composition matched intrinsic ideas, (AKA: "creative unity"), which is necessary to achieve in creating (Arieti, 1976;Ryder, 1987).Becoming mindful of one's own emotions and goals (i.e., the ability to self-actualise) is also an important aspect of art therapy.
Moving to the therapy literature itself, emotional self-regulation and mindfulness are goal-centred modes, problem-solving and conflict strategies parallel with regulatory activity.Emotion is key in self-regulation, and activities linked with personal goals are likely to be perceived as important to the individual (Hamilton, Karoly, & Kitzman, 2004;Karoly, 1991Karoly, , 1999)).People who ruminate about goal-related stressful events are more likely to provoke focus on threat-reduction against the conflict and perceived unattainability of goals.This causes psychological distress (Cantor, Norem, Langston, Zirkel, Fleeson, & Cook-Flannagan, 1991).Research suggests that creative pursuits help to establish "mood clarity"-the ability to distinguish clearly between / tolerate negative emotions and control its intensity (Hamilton, Karoly, & Kitzman, 2004;Zautra, 2003).There is emerging evidence that mindfulness in therapy builds one's emotional complexity, broadens schemas, and strengthens resolve and adaptability against negative affect, which lowers focus on threats (Monti, Peterson, Shakin Kunkel, Hauck, Pequignot, Rhodes, & Brainard, 2006).
Finally, a separate field describes occupation involving art and its beneficial effects on healing without therapy (Laliberte-Rudman, 2002;Reynolds, 1997Reynolds, , 2002Reynolds, , 2003Reynolds, , 2004aReynolds, , 2004b)).In her studies, Reynolds researched how textile art-making beneficially affected women with chronic illness (Reynolds, 1997).Engaging with leisure activities helped to preserve a satisfactory self-image, sense of achievement and competence.The women gained a sense of identity in an active process of interpreting, constructing and reconstructing their personal and social identity.Creative pursuits improved quality of life and promoted feelings of self-worth and control-a catalyst for motivation and sense of mastery over craft (Reynolds, 1997(Reynolds, , 2002;;Reynolds & Prior, 2003, 2006).
In summary, the seven theories are linked because these different uses of art implicate the same basic premise: art-making's purpose is to help artists control their perceptions, attain their goals, and achieve final product creation (Stevenson-Taylor & Mansell, 2012).Creativity happens through the creative process, which incorporates the individual, the product, the environment, and aesthetical reflexivity.The creative process is also a problem-solving endeavour, comprising of strategies which invoke higher-level cognition and meta-cognitive states.Meta-cognitive states then affect changes to mood and emotion, shifting cognitive schema and inducing positive affect whilst reducing stress and prompting insight.Thus, the creative process enhances feelings of being a unified, purposeful person with meaning in their lives and understanding of this meaning.It is an emotional process, cathartic in power.The art "realm", its metaphoric language and imagery help to convey feelings and bring deeply felt concepts and philosophies to the fore.

Research Aims
This research was aimed to investigate the healing potential of art-making in everyday people, in order to "grasp the essential nature of, and deepen the understanding of [art therapy's] meaning" (Junge & Linesch, 1993, p. 63-64 & 66).According to several studies which examined how people recovered from psychological distress, PCT can help to inform how change is experienced (Carey, Carey, Stalker, Mullan, Murray, & Spratt, 2007;Gianakis & Carey, 2011;Higginson & Mansell, 2008).Currently, the existing literature does not connect all creative process theory together with its healing after-effects.There are also few accounts of the role of control on mental and lifestyle changes at different stages of the art-making process (e.g., Reynolds, 1997Reynolds, , 2002Reynolds, , 2003)), and the literature rarely discusses the possible negative effects of art-making (e.g., Bensimon & Gilboa, 2010).Therefore, the aims of this research were: 1) To explore what freedom of expression does to the artists' perceptions and cognition while experiencing their individual modalities; 3) To identify how art uniquely contributes to personal recovery and change.

Participant Characteristics
All participants were White/Caucasian, and eight were citizens of the UK (73%).Ages ranged from 21-48 years (average 26.2 years).See Table 1 for a summary of participant demographics.The demographics for study participants are shown in Table 1.As a note: X's indicate that the participant had reported having experienced the relevant item, either in the pre-interview questionnaire or their face-to-face interviews.Also, leisure reading included fiction and non-fiction from a variety of text-based material (comic books, novels, online blogs, etc.) Participants also rated artistic interest via a Likert scale questionnaire in increments from 1 (Not Very Interested/Curious about the Arts) to 10 (Very Interested/Curious).This was to gauge commitment to the arts.On average, participants were highly interested in the arts (M = 8.8, SD = 1.17).Participants did leisure reading an average of 1-2 hours daily, and engaged with their creative pursuit from 1-4 hours daily to a few times per month.
Respondents covered a wide range of artistic modalities, including: poi (fire-dancing), drumming and singing (within the alternative and punk rock genres), fiction prose and script writing, poetry, abstract painting, and textile work/arts and craft.

Sampling Procedures
Participants were purposively sampled from undergraduate and postgraduate programmes, via poster adverts and the research volunteer website at the University of Manchester.Eleven participants were recruited, eight females and three males.To keep with IPA requirements for having a homogenous sample, and for ethical reasons, participants had to meet the criteria presented below to be eligible for interview.
Principle inclusion criteria declared: 1) Participants had to have felt change and maintain the use of their artistic craft for a minimum of two years (e.g., no more than 2-3 months apart from last creative project, pending lifestyle and personal circumstances); and, 2) …be stable and satisfied with their personal issues for at least a year.
Principle exclusion criteria included: 1) Persons who have not done anything artistic; 2) Persons who had little to no interest in the arts or creative pursuits; 3) Persons who were not 18 years old or older (for consent purposes); and, 4) Persons who could not speak, read, and write English fluently.
Respondents were notified of their rights of participation, and that participating was voluntary.All participants were required to sign an informed consent form to be audio recorded after reading the information sheet, and guaranteed that their information would be completely confidential.All information was kept securely on password protected / encrypted computers, data anonymised and audio recordings destroyed after transcription, per agreement with the ethical review board.In case of distress, participants were invited to take breaks, withdraw from the study, and/or call Samaritans or the University Counselling Services.This study was given ethical approval by the University of Manchester Research Ethics Committee.

Research Materials
An interview schedule, pre-interview questionnaire and focus group questionnaire were used and self-created.A digital audio-recorder was used for later transcription via the Express Scribe program, and a laptop was taken for participants' Internet use and file uploading.Memo notes were typed as a Word document.Interviews were transcribed, coded, and thematised by hand (Note 1).

Procedure
A pilot study was conducted before interviews commenced.The pilot helped to inform which questions could be kept, omitted, or reshaped for subsequent interviews.To further assist with the analysis, participants were invited to show and talk about examples of their work, and encouraged to give feedback about the interview at the end.All interviews were done within the University of Manchester's Psychology department.

Pre-interview
The pre-interview questionnaire was given to respondents prior to interviewing.After the questionnaire, a final statement of withdrawal was prompted to ensure that respondents were fully aware of their rights.Participants were also advised to keep the details of their personal issues to a minimum.In the case of personal disclosure, identifiable information was replaced with '[…]'.

The Interview
Interviews were conducted at the University of Manchester.Each interview took 45-60 minutes to complete.Discussions began with introductions, to establish a rapport with interviewees as part of IPA protocol (Eatough & Smith, 2008).The finalised interview schedule asked 12 questions across three parts (see Table 2).Interviews ended with respondents giving feedback (if able) or asking questions about the interview.Table 2 shows the basic structure of the interview questions.The table includes the parts of the questionnaire and their relevant questions, but further and/or added prompts (such as the why and how queries) are not included.

Post-interview
A debrief of the study was sent to respondents via e-mail.Research authors' contact information was made available for further questions or comments.After data analysis, some participants (upon request) sent 1-3 examples of their artwork and summarised the works' meaning and purpose.This was to substantiate findings, follow-up questions created asking about how the examples affected respondents and their means to "heal" and "express".Some works were given consent for reproduction here by two respondents, presented later in this paper.

Focus Group
An amended version of the original focus group session questions and forms were sent to respondents by e-mail for member check purposes.Member checking is a way to help ensure results accurately reflect what participants had reported in their interviews (Elliott, Fischer, & Rennie, 1999;Lincoln & Guba, 1985;Mays & Pope, 1995, 2000).Four participants responded accordingly.A summary of study rationale and findings was included with the questionnaire.

Rationale for Qualitative Analysis
Qualitative methods provide a rich analysis encompassing effective techniques that facilitate the making sense of personal experience (Smith, 2008).Important nuances can be examined closely-unlike in quantitative methods (Smith, Flowers, & Larkin, 2009).This is exceptionally helpful when analysing personal change and the mechanisms that characterise the process (Junge & Linesch, 1993;Richards & Morse, 2007;Smith, 2008).

Interpretative Phenomenological Analysis
Interpretative Phenomenological Analysis (IPA: Smith, Flowers, & Larkin, 2009) is committed to the detailed analysis of an individual's lived experience.It is a dynamic process that constantly revisits the transcripts.And, there is consistent awareness of both participant's response and researcher's interpretation of that response (double hermeneutics; Smith & Osborn, 2008).IPA states that the primary concern of the researcher is the understanding of experience from the participant's point-of-view.

Creation of Interview Schedule
The interview schedule was created based on the research aims.The schedule was semi-structured, why and how prompts motivated from suggestions by Smith and Osborn (2008).Probing questions yielded deeper responses, ideally unveiling stronger data and more opportunities for open discussion, to achieve a greater rapport between interviewer and interviewee (Smith & Osborn, 2008).Three different interview schedules were cross-analysed with the co-author and an independent researcher before finalising and implementing the final schedule.

Approach to IPA: Transcribing Interviews, Thematising, and Data Analysis
Interviews were transcribed verbatim.Conceptual interpretations were written aside target sections and memo notes through an inductive procedure (Braun & Clarke, 2006), in an open, multi-step process (Figure 1) (Note 2).
Figure 1.A diagrammatic representation of the stages of IPA Figure 1 is a visual representation of the stages of transcription and analysis of the interview recordings.IPA analysis was undertaken in a cyclical, 'flowing' procedure to create codes and themes from the data.This was an integrative approach, assimilating concepts of analysis from Fereday & Muir-Cochrane (2006), Braun &Clarke (2006), andSmith &Osborn (2008).
Interviews were analysed in a random order to see if similar themes emerged, and saturation occurred after six interviews.The other five interviews were triangulated with the existing cases through Disconfirming Case Analysis (DCA) to test emerging hypotheses, systematically searching for data that did not fit the existing themes (Yardley, 2008;Mays & Pope, 1995).

Emergence of Themes
The analysis was done case-by-case.Themes emerged from initial comments made, and connections forged between themes were then organised.Themes that demonstrated participants' similar idiosyncrasies best were transformed into a superordinate theme.Subthemes which defined superordinate themes followed, along with identifiers which marked where supporting data could be found.

Trustworthiness and Credibility: Establishing Commitment, Coherence, Rigour, and Demonstrating Validity in the Research
Qualitative guidelines were used to monitor research reliability and validity, to aid in strengthening the research's publishable quality (Aldridge & Aldridge, 1996;Elliott, Fischer, & Rennie, 1999).Trustworthiness was established via IPA analysis and coherence between interpretation, data, and theory.Methodological skill and theoretical depth are evident by gathering a 'paper trail' of the research methods.Participant feedback was also used as part of triangulation, and the main researcher's themes were also shared with the co-author (as a second analyser), for validation purposes.
The focus group questionnaire helped with DCA and self-reflexive analysis on research procedures.'Deviant' cases were also analysed to consider if any data did not fit the original findings.An additional theme was identified from an analysed case.

Summary of the Superordinate and Subthemes
Using IPA, six superordinate themes emerged and one from DCA.Each main theme had several subthemes, illustrated by in-text examples (see Table 3).Pseudonyms were used to protect participants' identities.

The Process of Creating as a Goal-oriented Focus
This superordinate theme was interpreted to be the physical creative process.In this stage respondents initialised, planned, and executed their creative works.It goes down levels, from being aware of the outside world to immersion into creating.Participants began the process by obtaining creative ideas from "seed incidents" (e.g., everyday life, conflicts) and motivational factors (e.g., parents, genre of music, role models, etc.) 4.2.1 Planning and Implementation, Part 1: The Seed Incidents and Artists' Motivations This part of the process (i.e., "zone") was interpreted to be where planning and thought are given to creating a product, for what and how to make it.Participants reported that products were normally inspired from their current ideals.
One participant spoke about getting ideas for her drawings from dreams (Sally: 4.26).(Note 3) Another participant spoke about getting inspired from daily life (Eliza: 2.16).Mood also affected planning.One participant wrote a poem based on her feelings of loneliness as a teenager: For participants, modality had to match mood and skill when planning, seemingly to optimally achieve the creative goal.Art-making apparently was not only motivated by "seed incidents", but intrinsic needs.
Participants also matched artistic modality with philosophical beliefs and goals to make them feel true.For example, Steven said punk rock was the "appropriate modality" for "spreading" his ideas to others (Steven: 3.9).And Nathan similarly related this to prose, saying it was the only means of relaying his ideas and analysing himself: Participants described this stage as using their style and skill to create and translate their thoughts and feelings into something physical.Respondents also recalled being concerned about the "craftsmanship" and "execution", before considering the product's connection to themselves (Laura: 20.17; Steven: 10.2).

The Finalised Product and Dissemination: Improvement of Skill and Sharing with Others
At the process's end, participants recounted making their final considerations before storing art or further sharing with others.However, as expressed, dissemination was not necessary and often not sought for until the time was right.It was creating in and of itself that was most important to a majority of respondents.

Internalising Process and Product-"What it Means to Me"
Many participants described their creative process as going from physical to mental awareness, then back again.Nathan called these "intervals", cycles between working, review and analysis between self and product (Nathan: 5.15).This interpretatively represented the (re)-workings of creating, to strengthen self-to-art attachment by making connections between pursuit, cognition, and emotion.Respondents seemed to engage in the physical process whilst instigating aesthetical reflection about their art.

Stage 1: Initial Connection-Meta-Cognitive Level
Respondents recalled moments of logical thinking in-between moments of creating.In this stage, some participants reported thinking on their situational issues and its relevancy to the product while attempting to establish an emotional connection to the art.Many times these connections seemed "implicit", hidden conflicts expressed "without realising it" (Laura: 24.4 & 24.20; Nathan: 3.6).But others remembered propelling this explicitly.Elena professed this as an "analytical way" to think (Elena: 2.13).For example, Nathan personified himself as a character to view another person's perspective, to "objectify" the situation and "analyse [his] behaviour without being emotional" (Nathan: 7.30).The creative process seemed to inform participants of their individual feelings, and art-making helped to "translate" feelings into the product (Eliza: 4.17).

Stage 2: Intimate Connection-Transcendence Level
Continuous drawing motions seemingly placed artists in a state where a "relationship" (between subject and product) could be made.And this "cerebral" "confrontation of the self" supposedly happened at any moment during the process (Elena: 7.23, 7.25 & 14.5).However, some respondents also reported moments of just "being" while creating, these moments recalled as a sudden lift to a "higher level" of "awareness" or "becoming one", as in being in a different "mode".There is no thinking, only the feeling of being present.This was interpreted as a "pull" away from reality to prompt self-awareness ("syncing" body to mind, or what Laura called being "expansive") (Sally: 3.15; Laura: 10.31, 13.5).Respondents reported a final step where important realisations, sudden insight and changes are made after-process.It is speculated that depth of relationship and analyses ignite an insightful moment primarily near the end of the creative process.Most participants experienced insight and made intimate life and work changes accordingly.However, these changes were also influenced by other factors such as dissemination and feedback.For example, poetry made Laura realise that she was reinforcing her own isolation away from people.In changing into a more independent person with improved goals, she stopped making poetry: "After my parents split up, I realised that it was the dwelling over things that made me an "outsider" in school. . . .It was a holistic shift.I stopped being that angsty teenager. . . .I came here to get my shit sorted, and poetry didn't match with that."(Laura: 19.5 & 5.2)

Art-making as Awareness Shift and Self-focus
Respondents considered art-making as an autonomous way to be reflective about the past self or become aware of and focus on the present self.One participant proclaimed that painting and drawing was the "only way of really seeing herself" (Eliza: 5.27).For respondents, art-making was the means of "exploring the way [they felt] about things" (Elena: 11.26).
4.4.1 Awareness of Self and Issues: Personal Affect, Mood States, and Elation of Feelings towards Self and Others Respondents proclaimed that the creative process affected their awareness.Art-making increased or decreased their personal affect and mood states.Making art also seemed to reinforce positive and negative feelings associated with the art, others and the self.Respondents recalled moments of calming down and "cheering up", enjoyment, and changes in feelings (Sally: 2.27).The creative process helped all participants understand their own mood and feel "whole" again after conflict, awareness a way to "break down" the issues and "dissect" them bit by bit (Laura: 8.29; Nathan: 9.31).
The creative process worked to make some participants feel happier and amplify positive emotions: "It's like a spiral, I would say.The better I feel, the more I feel.The more I write, the better I feel afterwards, and it just charges all the members of the band this way.So it becomes this 'exclamation' of emotion."(Steven: 2.28) The process can also amplify negative feelings as well: "They're not as good as they could be, because I rush right through them.And that annoys me, that I'm just that impatient.But, I think that's more something I feel about myself than what I feel about my art. .." (Elena: 9.5)

Negative-to-positive Affect Shift
To become aware and have a more positive attitude, respondents frequently seemed to engage in negative-to-positive affect shift ("transformations") while working.It was deemed an effective way to change negative feelings to positive ones, and a skill which carried on in handling other life situations.Both visual artists and writers used metaphors or imagery to change negative situations into something positive.The musicians even reported using their anger to create beautiful music or lyrics which reflected the conflictions in their beliefs.Shifts were shown to happen both in the literal physical rendering of the issue and its perceptual outlook.An example of this was given by Laura in regards to her poetry writing versus diary writing: "And instead of putting it down, like: "oh, this happened today. . ." I could write in a way that I thought was…beautiful.And my favourite thing to do was to write about quite horrific things, but using very beautiful metaphors."(Laura: 15.22)

Art-making and Emotion Regulation
Art-making allegedly helped respondents to regulate emotional states, attain clarity of mood, and understand where these originated from.The process was perceived to enable validation and clarification of feelings, which included accepting or rejecting the current or past identity.Respondents claimed each aspect helped them feel in control and be more stable after conflict (speculated to be the "6 C's of Creative Healing").Art-making was referred to as a safe "haven" to shield against life stresses.

Conflict
Conflict was reported to be the foremost topic in product-creation.Some respondents characterised the creative process and conflict as being reciprocal; their issues influenced creation and creation influenced thinking on the issues.Internal and external conflict invoked Steven's lyrics, Laura's poems, and Nathan's book "Symphony of a Paedophile".For example, metaphors in Laura's poem of the crushed orange captured the moment of her father abusing her mother, showing powerful consideration between conflict and product: "It was all that whole bit of prose was based around.…An orange.When they get crushed and the skin splits.In a way, it should be violent, but the colours underneath…the pure orange flesh is so vibrant and so beautiful. . .." (Laura: 18.29)

Catharsis
Catharsis was presented as one of the most important aspects to art-making.The ability to "purge" the self of negative emotions and "cleanse" the mind was significant, the word "cathartic" present in every account.
Picture 1. "Embroidery with Mice", needlework piece, (completed late 1980s, early 1990s) Comments from Pamela: "I did this when I was still married to my ex-husband, at a time when I had considerable pressure from my job but no family responsibilities.As I think I told you, this marriage ended unhappily and although at the time I thought I was using my craft work to relax outside my job, I now suspect I was also possibly escaping the pressures of my personal life.I often felt lonely and misunderstood at home, and craved going out to socialise, which I suspect was to compensate for this.The hobbies I had at that time were all solitary (e.g., knitting, sewing, embroidery) and I would choose the most involving and intricate patterns to attempt, which needed great concentration…."

Coping
Every respondent reported their own coping strategies.Some used art to simply "escape", while others to "cope" until being able to deal with the issue head-on.For example, Sally used art primarily to avoid the violence and fear in her home, yet Steven used song-writing to cope with the near-loss of his child (Sally: 2.10; Steven: 9.1).
Cases suggest that primary use for art affects whether it yields to short or long-term benefits, and modality affects strategy used based on individual predispositions (e.g., Nathan used pain in doing kung-fu to ignore his problems, whereas in writing he actively "faced up to" and "analysed" them) (Nathan: 5.1, 5.23).

Communication and Clarification
Respondents used art to communicate and clarify their feelings.Communication could be with the self and with others.Rather than deal with issues, all respondents reported, at one time or another, using art-making as a means to "talk it out" autonomously.Interpretatively art acted as a "proxy-person"; some respondents expressed that the creative piece "understood" them in ways no one else could (Eliza: 9.10).When trying to communicate, art was said to be a means of "getting the point across", whilst attempting to relate to others.
For example, Eliza used her paintings to communicate with her mother.Without words she reconciled the relationship and made peace about past negative feelings between them.Painting helped to clarify these emotions:

"Sometimes when you're confused you don't know what you want. I don't know what happens when I have a paintbrush, but everything kind of makes sense in my head. I guess I try to think of how to present how I'm
feeling right now, and it's a way of usually becoming aware."(Eliza: 3.22)

Change
Changes varied for respondents, and included: "bringing [the self] back to being 'me'", feeling a "great relief of everyday stress" and living the life that is wanted (e.g., being an individual in society, not part of the "herd"), not "needing to analyse" the problem anymore and it feeling "less intense", gaining "sympathy and understanding" (from others), and ones' painting becoming more "colourful" and "full of life" (Laura: 21.7; Steven: 2.15 & 13.28; Nathan: 3.13 & 6.31; Elena: 11.5 & 14.25; Eliza: 9.24 & 8.17).Respondents also increased skills and mastery of modality, finding that the complexity and subject matter of works had changed along with their mood and outlooks on life.
Picture 2. Excerpt of: "Humanity (The Herd)" This is an excerpt of lyrics presented by one of the participants, Steven, for his band BFH (Burned from Hope).

WELCOME TO THE HERD!
In the shell of eternity humanity counts its days.
Running around the vicious circles, drawn to the ground, the sheep has no mind and no face.
And in the bottom of existence it's only a slave to itself -digging to find the meaning of life, sinking deeper in its grave.
There could be answers out there the sheep don't know of.
It never heard of shooting stars.The weather broadcast is more important."The more the rain, the more the grass."

Art-making for Goal Change, Bonding, and Conflict Resolution
According to participants, art-making yielded some long-term effects.Participants reported these moments happening primarily after product completion, but some respondents (e.g., Nathan and Laura) observed ways of solving conflict whilst still at play.This seemed to normally occur around stage 2 or 3 of the internal process.

Creating Higher-level Goals
Respondents recalled moments after creating which lead to different levels of positive and negative change.
Art-making helped participants recognise and achieve higher-level goals, some even making their creative pursuit a goal in itself.In having realisations, some participants self-actualised and uncovered their needs to direct for a new goal, which sometimes included making their art a profession.Sally had pursued a "qualification to teach music" (Sally: 1.3).Laura utilised poi to achieve "more than one goal", now focusing on the goals which were "implicit" since not feeling "distraught" anymore (i.e., no longer working to get away from her father or meet his expectations) (Laura: 23.19).And writing had become a goal for Nathan: "…I don't think I'll be working for that company longer than the next 3 years.I want to get a job, and then while I'm working, try to get my books published."(Nathan: 2.3) 4.6.2Withdrawing / Loss of Art, Bonding, and Dissemination-the Risks Some respondents reported how negative feelings instilled a want to change goals or behaviours, but this was interpreted to be a double-edged sword.Dissemination and loss of art seemed to affect change in good and bad ways.Only five participants mentioned the effects, but dissemination was stated to either: 1) lead to a loss of art, or 2) strengthen/create relationships with others and the artwork.Three participants had loss the will to continue art when it was deemed ineffective against conflict, reinforced negative feelings, or was not accepted by peers or parents.Rejection of art by a parent is extremely detrimental.For Sally, it deepened her feelings of no control over the situation at home (i.e., her mother's dismissal of her rap lyrics made her instantly stop writing them) (Sally: 7.16).
Rejection of art by social peers is also damaging.Laura stopped writing when she felt she was "tricked" into sharing something so private with her classmates and with the realisation that poetry was instilled in her to do by her father's punishments.As part of "letting go" of her past self, she let go of her poetry as well (Laura: 21.13 & 19.8).Disuse of art also affected Eliza, after she realised it was reinforcing her negative feelings towards art school: However, sharing also created bonds with social structures and reconciled failing relationships.Also, some respondents realised that losing art negatively affected them, and later continued the modality stronger than ever.Steven told how life for him without his music was extremely hard, and he felt a "complete lack of productivity" for a long time (Steven: 8.3).This reinforced his bond with his music and compelled him to play or write whenever possible while attending university.Elena also felt sharing made her feel good about herself when accepted, and helped her to bond, especially if "someone [could] relate to it" (Elena: 4.8).When positive connections were made, respondents stated it raised their self-esteem and instilled a sense of pride towards themselves and their work.Pokémon is one of those kiddie obsessions you don't really take any interest in, and can actually be quite irritating to keep hearing about, so you tune it out.But for this, I had to get involved in my daughter's particular interest in order to help her.So, I felt closer to her as a result, which was lovely.Also, I seem to remember she took great pleasure in being able to teach me about Pokémon and pass on some of her knowledge, as I knew nothing (she just had to tell me again who they all were).I also found out for the first time who her favourites were (so we could find the most appropriately egg-shaped amongst them).She seemed to appreciate being "allowed" to tell me all about her Pokémon for once, and for me to be listening and joining in, and I enjoyed visiting "her world" for a while.A good bonding session."

Conflict Resolution
Several participants seemed to find that art-making was useful, even short-term, in dealing with conflict.When conflict was resolved, the creative process also seemed to help develop skills and strategies that could be utilised in other pursuits, including school.Laura's poi gave her the strength to deal with her problems head-on, feeling less like a "fragmented", conflicted person, and able to unify her mind and body together to feel "ready" for anything (Laura: 11.29).Nathan found that his writing was effective for processing and analysing his issues, and dealing with them (Nathan: 2.29).And Eliza simply found painting a way of understanding herself, without outside help: "I didn't have to be asked how I felt.I could just get it down on canvas.It was a way to be autonomous. . ." (Eliza: 7.26)

Feelings and Perceptions within the Art-making Process
Some participants stated that art-making invoked deep positive and negative feelings.Speculatively, this informed the acuity of the creative pursuit's effect on change and its level of importance.The deeper the feeling of attachment to the art modality, the more likely and longer respondents seemed to feel its beneficial effects.
Participants also demonstrated that art closely associated with negative affect tended to become discontinued, and its benefits short-term.However, when respondents identified art with the self, it was regularly used despite conflict and made a stronger, lasting impact on positive change.

Productivity and Productiveness: Meaningfulness and Being Mindful
According to most participants, being creative made them feel like mindful individuals, with a sense of purpose in their life.Art-making seemed to give them the feelings of being productive with an enhanced sense of self, each product holding personal meaning to the individual.Some participants attributed this as bringing a "contribution" to the world: "At the end of the day, you're left with a drawing, and you feel that you've completed it.So, for me it's an emotional process, in that you feel better.Cause there's a feeling of achievement after doing something, and it's not just pleasure."(Elena: 1.20 & 2.15) 4.7.2Attachment and Ownership: "Art as Self" The creative process is speculated to cultivate the strength of attachment to art.Art was 'owned' and a very personal, emotionally felt matter for participants.Usual terms used to express this were "art is me" and "it's my 'arena'": Four participants felt more competent from the process, identifying it as intellectually stimulating.They reported that art-making increased their sense of mastery, feeling of uniqueness and self-esteem, yet art could also lower these feelings when skill was lost or when the product did not come out the way it was imagined.
Art-making creates elated positive feelings: "I'm gaining a skill that I can take with me everywhere, and it applies to everything I do now.I'm WAY more coordinated now--" (Laura: 11.22) …But may also rouse negative feelings and disappointment: "I would say that I'm a bit crappier at art than I used to be.When I took that little hiatus, I lost a lot of skill.Which I'm most disappointed at.And at times I still get frustrated when I'm doing art now."(Eliza: 15.9) 4.7.4Feelings of Conflict, Crisis and Ill-control: Restoration to Being "Happy" Although there were feelings of conflict in dealing with real-life issues, it was interpreted that the realisation and overcoming of conflict was most helpful for participants like Laura, Elena, and Eliza.For example, despite feelings of no control over the situation at home, Sally still felt "more content" and "accepting" of herself presently (Sally: 15.24).Steven found music to be stressful since moving away from home.Yet, that realisation helped him to overcome those feelings by switching to writing lyrics and using his writing skills for school, outside his band (Steven: 3.26 & 4.8).Feelings of conflict seemed to increase attachment to art, and yield to sudden insight and permanent change for some participants.Laura explained it best when she recalled how useful poi had been to her to restore her happiness: "There were times when I'm really unhappy, and when I get unsure of myself, or parts of myself feels conflicted.Anytime I can feel collected together, that always makes me feel like I have higher self-esteem and better general well-being. . .." (Laura: 13.24)

Disconfirming Case Analysis
In searching for cases deviating from the original themes, a new superordinate theme arose.The five participants reserved for DCA had their accounts briefly compared to the other six.Two participants said that although useful cathartically, they had no serious conflicts associated with art-making.Also, art did not contribute to strong permanent change.This was supported by the feedback from Sam, who reported that she did not go into an "internalising zone", nor was art "all that important".Feedback from Denise and Pamela also noted that personal reflection with art might not always be explicit.

A "Superficial" Creative Process
Sally's re-analysed case presented an auxiliary process for those who did not follow the same process as other cases.This was dubbed the superficial ("quick-method") creative process."Superficial" is not equivalent to negative affect or no change; however, it may be associated with using art as avoidance behaviour.It grants similar benefits like the full process, but these seemed short-term, with limited change.
In Sally's case, the phase of making comprised of her playing music "just because [she] could".She reported no goal in mind, music played to "express herself" only (5.1).Sally said her art was improvised, not planned, and she expressed that her reason for art-making was just to go "crazy" and "vent", because she felt there was "no other solution" (14.9).She had no one to speak about her problems with, and her mother did not listen to her: "I think that (s)he's not going to do anything, in that (s)he's not going to have a solution.I just don't even attempt it.…I'd just rather play around with my saxophone. . .." (Sally: 9.5)She used art to avoid the negativity at home.For her, art-making was a semi-linear process.Little to no thinking was involved, other than some of the realisations she made in the interview (4.14 & 16.31).However, when she played on her saxophone to "escape", she did feel better afterwards.It reportedly helped her to cope (11.22).But these feelings were purportedly only short-lived; true change only occurred when she completely moved away to take residence on campus: "I'd sort of feel better, but I wasn't feeling like 'on top of the world', just because all the issues still remained. . . .I just didn't feel that much better about myself, but it did help me to calm down."(Sally: 6.30) Afterwards, she no longer felt the need to draw, and rarely used her saxophone, now only playing to enjoy it and improve her skills.She reported still feeling her problems were present, and art-making apparently did not help her much.
It appears that art did not help Sally because of the negatives related to it.She never reported positive bonding moments or feelings other than the enjoyment she felt in playing her saxophone.Her main modality was waning in its use, indicating that too much or too little conflict may result in the 'superficial process', and a loss of art.

Reflexive Evaluation of the Qualitative Approach
Upon a review of the qualitative methods, some concerns arose.According to the feedback of three participants, they did not believe they explicitly went into an internalising process, nor felt a strong attachment to their artwork.One participant also seemed displeased with her interview, feeling her account did not "fit the preconceptions" of the researchers.Honestly, personal experiences in art-making aided the analysis and some themes may not have emerged without knowledge of the literature (e.g., the Meta-Cognitive and Transcendental Levels).Probing questions and a "conversational" approach to interviewing helped establish a greater rapport with participants, but may have biased responses.The IPA strategy indeed has pros and cons as a qualitative method (Brocki & Wearden, 2006;Smith, 2007).Further research may be needed to evaluate the degree to which art-making actively facilitates recovery across individuals.
Nevertheless, the interview process seemed to positively impact most participants.Three in particular felt enlightened by their interviews.They reported realising more than what they knew before about themselves, and felt they were becoming stronger attached to art by talking about it.

Summary of Results
In pursuing the aims of the study, the following superordinate themes emerged from IPA and DCA: 1) the process of creating as a goal-oriented focus, 2) internalising process and product, 3) art-making as awareness shift and self-focus, 4) art-making and emotion regulation, 5) art-making for goal change, bonding, and conflict resolution, 6) feelings and perceptions within the art-making process, and 7) the "superficial" creative process.
A process of change was inferred from these themes.The emergent themes are described below, with respect to the theories presented in the introduction.

The Process of Creating as a Goal-oriented Focus
Echoing the literature, respondents engaged in dynamic, goal-directed stages of reflection between the self, environment, and product (Gaut, 2010).Participants chose elements which best suited their creative endeavour, juggled ideas, used aesthetical consideration for free-play of ideas, and reported feeling in "control", with a sense of purpose to creating their work (e.g., Bindeman, 1998).The physical part of the process was not automatic, and required some discipline to initiate (e.g., Gaut, 2010).The findings were also consistent with Mace (1997) and Csikszentmihalyi (1996), who proposed that beliefs and intrinsic needs are motivational factors to achieve creative goals.

Internalising Process and Product
Respondents engaged in an internalising process that appeared to be consistent with Pelowski and Akiba's (2011) model of aesthetical change.Aesthetical engagement helped to block stress-related, "unproductive" ideas, aiding creative immersion through "stages", from logical thinking, to "transcendence", then a threshold where sudden insight occurred.Respondents also experienced "flow"-states via pure immersion and "meditative motion" whilst creating (e.g., Carl III, 1994).It is speculated that "flow" helped participants translate feelings into the product during the transcendence stage.Yet, against Csikszentmihalyi's (1996) "rules" for "flow", some participants seemed conscious of "flow"-states, saying they became "more aware" during those times.This begs the question whether self-consciousness is really absent in "flow".

Art-making as Awareness Shift and Self-focus
Respondents reported using the creative process autonomously to be reflective and become "aware".Similar strategies are found in work by Mace (1997) and Ziv and Keydar (2009).Respondents' creativeness appeared to help them search for "order" within "chaos" by "breaking down" issues.They did this by transforming negative outlooks to positive ones via metaphorical concept shift within the artwork, which seemingly inspired an imaginative identification process between self and one's own issues (e.g., Eliza transforming her feelings of manipulation by her family into a painting of a game of chess).Respondents claimed that the process affected their awareness by rousing more self-attention, away from the outside world.As in art therapy literature, immersion in art-making was linked to decrease in psychological distress (e.g., Reynolds & Prior, 2003).

Art-making and Emotion Regulation
Art therapy's main posit is the idea that living with illness is an emotional balancing act, and moving attention from negative affect promotes healing.As found in studies like Reynolds ' (1997, 2002, 2003), art-making is propelled by conflict, and catharsis, communication, and clarification of feelings are all strategies of coping and lead to change.These components were identified in the current study.Respondents reported gaining the ability to control and regulate their emotional states through art-making.Like the literature, participants validated feelings and accepted or rejected their current or past identities through their art (e.g., Monti et al., 2006).However, it seemed the coping strategies participants used were determined by perceived level of control.This affected healing and art's utility.Difference in coping methods was the need to "escape" / ignore issues versus the need to "relax" in participant accounts.This strategy variance is rarely recognised by researchers in contemporary literature.

Art-making for Goal Change, Bonding, and Conflict Resolution
Participants frequently reported various changes after the creative process, which included creating higher-level goals and the creative pursuit itself becoming a goal.Similar results were shown in Reynolds' work.Some respondents reported to now be achieving more than one goal, or focusing on more "implicit" rather than arbitrary goals directed by the self or imposed by others (e.g., art teachers).However, not every participant experienced long-term benefit.Some respondents confirmed that "healing" was still an on-going process, and others did not fully overcome conflict solely through art-making (e.g., Sally).
Bonding occurred for participants via sharing their creativity with others.This is similar to the dissemination stage considered by Allen and Thomas (2011).Most participants' reported that sharing helped to create family bonds, reconcile failing relationships, and lead to feelings of acceptance (e.g., Alder & Fisher, 1984;Bensimon & Gilboa, 2010).However, some participants reported that dissemination was not important, and sometimes led to "losing art" and negative affect.Certain literature suggests that rejection of the creative pulse, especially by parents, does lead to a loss of creativity (Bournelli, Makri, & Mylonas, 2009).
The stages of creating reported were relatively parallel to the five stages suggested by Allen and Thomas (2011).
Creativity helped participants to clarify and achieve goals via a problem-solving strategy.This included conceptualising the artistic problem, incubation (setting aside creating to just think about the process), illumination (insight), and verification of creative ideas (via meta-cognitive analysis).Unlike Allen and Thomas's theory, however, most respondents underwent creative thinking for solutions to their issues and the product itself, rather than creative contribution on a social-or domain-construed level (i.e., for "artistic recognition" by superiors of their creative domain).

Feelings and Perceptions within the Art-making Process
Many participants felt emotional side-effects after art-making, which included: gaining feelings of being productive, attained competence in skill and self-esteem, and restoration to being "happy".These positive affects keenly match patient outlooks after art therapy and are considered the basis for becoming a "purposeful being" (Fidler & Fidler, 1978).Respondents seemed to self-actualise and become more mindful of themselves and their goals via the process (e.g., Ryder, 1987).Seemingly the longer and more deeply felt positive emotions were, the more respondents felt creativity's beneficial effects.However, contrasting the art therapy literature, art-making sometimes reinforced negative perceptions, especially if used for "escaping" rather than "relaxing".

Art-making and Change
Findings are supported by previous research on the experience of change without therapy (e.g., Gianakis & Carey, 2011;Reynolds, 1997Reynolds, , 2002Reynolds, , 2003)).Participants detailed feelings of change even minimally after art-making.Changes were derived from motivation and readiness, moving towards a new identity, and perception of the self as a person no longer identified with the problem (e.g., Carey et al., 2007;Higginson & Mansell, 2008).Some participants described change as an "on-going" (gradual) process, and some as sudden (e.g., Higginson & Mansell, 2008).Alike to findings in Gianakis and Carey (2011), change occurred most often with the realisation, acceptance, and experience of strong negative affect (e.g., Laura realising her poetry was reinforcing her negativity).The creative process seemed to work best when negative affect and memories were transformed purposefully by participants (e.g., Laura's poems about the "crushed orange" and "brick").
Comparable to the literature, conflict signalled to participants that current strategies in daily life to maintain control were not succeeding, and change was needed (Mansell, 2005;Mansell & Carey, 2009).Like findings by Bournelli, Makri, and Mylonas (2009) and James, Chen, and Goldberg (1992), rise in conflict (and poor dissemination) helped to generate new ways of dealing with conflict, but also diminished area of interest, which steered some participants to use maladaptive behaviours instead (e.g., Laura and Eliza using drugs and alcohol).Yet, some participants rebuilt interest in a different or the same artistic modality.This seemingly strengthened continuance of art, and increased self-worth and capacity for insight more than working in a single area of creativity would (e.g., Burleson, 2005).
Participants reported experiencing increased satisfaction by matching creative modality to individual needs, which enabled emotional self-regulation without therapy.This matches Reynolds' (1997Reynolds' ( , 2004aReynolds' ( , 2004b) ) and Gianakis and Carey's (2011) conception that there is a self-healing tendency in those who engage with art.Participants' change correlated with maintaining a sense of their own identity, enhanced relationships with others, and changes in their art styles.These ideas of gaining control over disturbing emotional experiences and pursuing personal goals thereafter match the findings from recent qualitative studies (e.g., Alsawy & Mansell, 2012;Brown & Carey, 2012;McEvoy, Schauman, Mansell, & Morris, 2012).
Our findings were often consistent with the literature, yet there were some exceptions noted and the theories are scattered across several paradigms.An integrative framework would therefore be beneficial.First, we have illustrated how the findings are consistent with other studies that have utilised a Perceptual Control Theory framework (e.g., Gianakis & Carey, 2011).Second, concepts of control theory are already introduced in the art literature (e.g., Csikszentmihalyi, 1996;Mace & Ward, 2002;Pelowski & Akiba, 2011).As such, a PCT approach may be used to build a suitable model of the healing creative process because it is a mechanistic theory and provides the components necessary to model controlled processes (e.g., Powers, 2008).

The Perceptual Control Theory Approach to Healing in Art-making
Perceptual Control Theory proposes that life is a process of control (PCT: Carver & Scheier, 1999;Mansell, 2005;Powers, Clark, & McFarland, 1960).People control their own sensory input by flexibly varying their behaviour within the world.They achieve their long term goals through setting subordinate goals in a cascading hierarchy.For example, "to be a good person", one might pursue the principles of being honest, friendly and kind.These, in turn, are achieved through lower-level programs such as "greeting a neighbour" to fulfil the principle of "being friendly".PCT postulates that conflict occurs across a minimum of three levels within the hierarchy.The highest-level of the control system sets incompatible goals at the middle-level.The problems people experience generally occur at the lowest-level (e.g., uncertainty, stress, anxiety), whereby a person may strive to satisfy one goal, but increases error for other goals and ignores where conflict may reside.This instigates a problem where neither goal can be achieved.When conflict arises, a learning process called reorganisation occurs (Powers, 1973).It is then important for reorganisation to be directed towards the level that is setting the conflicting goals, and this is experienced as a shift in awareness.

Art-making as a Feedback Loop
We propose that people use art-making to control their perceptual experiences and that this process is driven by higher-level goals (e.g., "I want to be unique").A simple example of art-making acting for a goal is presented in Figures 2 and 3.This figure was based on Steven's account, reporting that he needed to uphold his philosophical beliefs of being productive and doing something that is not a "9 to 5 job".Cross-hatch marks: // indicate that the feedback loop is connected to many other loops within the hierarchy, meaning that other aspects affect the moment of art-making and is not just delineated as a single loop.In this loop, the input function of 'feeling productive' is a high-level perception.The figure was adapted from Mansell (2011) andPowers (2008).The behaviour described here in Figure 3 is that of Steven writing his lyrics to uphold his philosophical beliefs of being productive and doing something that is not a "9 to 5 job".This figure is adapted from Powers (1973), Mansell (2005), and Carver & Scheier (1999).Powers (1973Powers ( , 1998) ) states that program-level control is behaviour carried out to satisfy principle-level reference values (Carver & Scheier, 1999;Mansell, 2005;Mansell & Carey, 2009).In the adequate condition, art-making was utilised to satisfy whatever principle drove it and system concept (self-ideal) the participant held.Most respondents sought to satisfy their system concepts by confirming their pre-existing beliefs, and purposefully maintained perceptions by defending against unsupportive information or reinforcing their self-ideals/identity (e.g., being a musician).Successful control and feedback was demonstrated by artistic modality matching goals and the finished product being created.

5.3.2
The Creative Process as a Reorganisational "Healing Tool" Reorganisation seems compatible with the art-making process.This is because when participants became aware of the cause of their unhappiness, they appeared to change their goals to resolve the conflict.Change was sought and maintained from gaining insights about the self and issues in relation to the creative product.
We propose that art-making utilises and directs reorganisation to the systems necessary to resolve conflict.This is because when daily life became too disruptive for participants, their need to express their art seemed to increase and the creative process took place.Indeed, the participants reported clear goal conflicts and they explicitly controlled their art-making with effort, putting time and craftsmanship into its process as a means of "escape" or "urge" to create.Yet, for most, art-making as "relief" from conflict eventually caused its confrontation and the invocation of insight, which within PCT would be recognised as reorganisation of the higher level systems (e.g., those that involve self-ideals) creating the conflict (e.g., Higginson & Mansell, 2008).This process is followed by a recovery of control as the individual now pursues higher-level goals that are less conflicted.
Notably, some participants engaged in a "quick-method" process which seemingly established "flow", but did not actively invoke self-awareness.This method occurred typically when a participant made art to "escape", rather than to "cope".Within PCT, this is termed arbitrary control-the attempt to control an experience without regard to the other goals that it may interfere with or inhibit.Thus, a PCT account can explain how art-making can both be used as an effective way to recover from distress-through shifting awareness to higher-level goals, and yet at times involve properties that simply shift awareness away from the problem, or rarely, exacerbate it if art-making is systematically used to prevent any awareness of the conflicting goals.

Study Limitations
The limitations of the present study are: 1) its retrospective nature, 2) use of university students, 3) limited participant pool, and 4) caution in generalisation of results.These are presented below: 1) Due to the nature of qualitative research, it is hard to know if participants made realisations during their experiences or their interviews.Past experiences were retold retrospectively, which may not accurately capture change as it actually occurred.
2) This study used university students and staff as its sample.Although care was taken to include persons specifically involved in art, most were from the Postgraduate Psychology programmes in the University of Manchester.
3) Out of the eleven participants, only three were male.Also, most participants considered themselves "White British".There are issues with sample size and breadth of the sample.Also, not everyone experienced change in the same way.
4) This limits generalisability of results and presents some ecological validity issues, like those present in related literature (e.g., Chan & Horneffer, 2006).It is recommended that creative persons outside university be evaluated and compared with this study, to see how accurate current findings are with a more pervasive sample.

Suggestions for Future Research
We could examine art-making's function within specific modalities and how modality directs the creative process of change.Modality, as well other factors (e.g., dissemination) may affect artistic healing and manipulate change in various ways.Findings also suggest that researchers should study art-making as maladaptive avoidance behaviour, to determine the effects of the negative use of art.To note, because this study demonstrates that healing is intrinsic in art-making, and art-making is a survival strategy for everyday people, we suggest that clinicians from diverse disciplines could help facilitate art-making for those who identify that they would benefit from it.

4. 3 . 3
Stage 3: Thinking and Feeling in the Aftermath of the Creative Process-Threshold and Termination Level 's time to say goodbye." Picture 3. "Various Pokémon: Togepi, Happiny and Finneon", in polystyrene egg, boiled egg, plastic fruit beads, pipe-cleaners, etc. (made in 2009) Comments from Pamela: "This was really fun to do.My daughter took the lead on designing the Pokémon as only she knew what they looked like!I contributed by finding potential materials we could use and cutting out shapes until they looked about right, then we assembled them together.I really enjoyed this, partly because

"
I really started to enjoy it.I feel more passionate about my saxophone.So, yeah…it's my baby.Whenever I play it, it's sort of like 'my time', and it's 'my thing', and nobody can take it away from me." (Sally: 1.30) Picture 4. The album cover for Burned from Hope (Steven's band) 4.7.3Competence and Mastery of Skill: Gaining Self-esteem and Self-confidence

Figure 2 .
Figure 2. The simplified negative feedback loop of art-making Figure 3.A concrete behavioural illustration of an artist's hierarchy of control

Table 1 .
A summary of the demographic scores from across the eleven study

Table 2 .
The basic finalised semi-structured interview schedule Part A:

About the Artist & Artist's Identity (Their Creative Environment) Part B: Artists' Views of the World & Perspectives within their Art Part C: Follow-Up Questions and Information
Q3: What do you think about while doing your art / writing?Q6: Have there been past problems or issues that you've dealt with that are associated to your art / writing or made you feel like you needed to create?Q11: Was there anything missed that I should have asked you or you'd like to share more of?Any questions or comments?Q7: Are there differences and/or realisations in how you see yourself and your world now, compared to when you first began making your art?Q8: Are you doing any upcoming works / projects now?

Table 3 .
Superordinate themes and subthemes of the creative process experience

Planning and Implementation, Part 1-seed incidents and motivations P & I, Part 2-matching product to artistic modality and needs Making and creating [style and skill] Final product and dissemination [process-end and sharing with others]
wrote one called 'The Brick'.It was all about how it's part of a building, so it's integral to the upkeep of the whole structure, but no one ever notices the individual component(s). . . .I was kind of feeling like a 'brick'."