This is where art therapy can help. By using art, music or drama, people can tap into feelings and memories they cannot reach or express through words. Those feelings can then be explored through the art form under the guidance of an art therapist, who will draw on years of artistic knowledge and psychological insight to help the client reach a deeper understanding of who they are, why they behave in certain ways and how they can change and grow as a person.
This is not about using art to de-stress or build confidence (although these side-effects can be very therapeutic), or about passing judgement on someone's proficiency with paints or the piano. Art therapists aren't there to instruct on the correct fingering or use of oils. The end result isn't the piece of art: it's the insight gained during the making of the art that counts.
"You are inviting your client to participate in some kind of art-making and using the form of the art to help them express things they may or may not be conscious of," says Angela Fenwick, a music therapist and director of the Birmingham Centre for Arts Therapies. "It's about improvising a piece of music to explore feelings. The therapist will offer support and encouragement, perhaps by using imitative chords and notes, and gradually build up a relationship through the music."
There may be some verbal exploration of the art and the feelings it provokes, but this isn't necessary. Fenwick likes to quote the composer Robert Schumann who, when asked to explain the meaning of a piece of music, sat down and played the piece again. "The art only works because it allows people to express something they cannot put into words," says Fenwick.
It may sound rather New Age (although Fenwick points out that the arts have been used in healing for thousands of years and art therapy, in its present form, has been around for about 60 years), but many of those who have experienced art therapy say it has had a real and tangible impact on their lives.
"I consider this to be the most successful thing that has happened to me in my mental health history," one former client of the Creative Therapies Service in Exeter told researchers at the University of Exeter. Another said the art therapy had been a release from the prison of depression. "I'd rather die than go through another dark time, but this has given me a new way of being and shown me a different way of coping with being me."
Art therapists work with a wide range of people, from those with mental health problems - including depression, self-harm, eating disorders and schizophrenia - to those with learning disabilities, addiction problems or terminal illness. Clients may be referred to an art therapist via their GP, community mental health teams, social services or psychologists. As well as NHS roles, there are posts for art therapists in the criminal justice system, education, social services and charities. Many of them also have private clients.
Training is rigorous and to postgraduate level. Most art therapists will have a first degree in one of the arts (although it is possible to enter from a background in nursing or social care, as long as the candidate can show a long-standing personal commitment to art, music or drama). It's also important to have at least one year's work experience, either paid or unpaid, to show you have the life experience, maturity and what the University of Derby calls "emotional robustness" to handle the training.
Most postgraduate art therapy programmes are two years full-time or three years part-time. The part-time option is popular, as it allows people to juggle work and studying to offset the costs of the training (Queen Margaret University College in Edinburgh, for example, charges £3,500 a year for its MSc in art therapy). Students must also pay for personal therapy, which is a requirement of all psychotherapy courses. Only a limited number of colleges offer the training so, despite the costs, demand for places is high.
Malcolm Learmonth, a practising art therapist and a regional co-ordinator for the British Association of Arts Therapists, has been trying to establish a training course in Devon and Cornwall for the past ten years.
"I could fill it tomorrow with no problem," says Learmonth, "but therapy training is very people-intensive, which means it's not a money spinner and so not popular in today's higher education environment."
He advises would-be art therapists to take a taster course or talk to a practising professional before committing to the expense and hard work of a postgraduate programme.
"This isn't for everybody," says Learmonth. "It's not enough to be well intentioned and interested in art. You are often working with people who have been traumatised, and that can have a profound impact on you."
Under their code of conduct, art therapists are obliged to have regular therapy themselves to talk about their work and its impact. But it's not just the nature of the work that can be demanding: getting work can also be a challenge.
"You have to be fairly tough and resourceful to get trained and then be fairly tough and resourceful to get established professionally," says Learmonth.
Fenwick echoes this. "I have never had a job created for me," she says. "You have to be proactive because although the job opportunities are growing, they will not be handed to you on a plate."
Combines art, music or drama with psychotherapy to help clients access feelings or thoughts they find difficult to express in words. Art therapists are state-registered with the Health Professions Council (HPC).
You will need a first degree in your chosen art form, plus a postgraduate diploma in art, music, drama, therapy or psychotherapy. The HPC keeps a list of approved training providers.
Under the NHS Agenda for Change proposals, a newly qualified art therapist would start on £26,000, while a Head of Art Therapy in an NHS Trust would earn £69,000. The professional bodies are pressing for the NHS pay scales to be applied as a benchmark for rates of pay in social services and education.
Art therapy is growing in recognition and more posts are being created. But provision is patchy, so be prepared to move for work, particularly at the lower levels. Many arts therapists work as freelancers, mixing part-time NHS work with sessions in education and private practice.
Some useful contacts:
British Association of Art Therapists, www.baat.org; British Association of Dramatherapy, www.badth.org.uk; Association of Professional Music Therapists, www.apmt.org; HPC, www.hpc-uk.org.
'It's about getting people to explore how they feel'
Clare Hubbard is a drama therapist with the Hertfordshire Partnership NHS Trust
"I heard about drama therapy when I was applying for my drama degree, and because I'd done psychology at A-level I kept the idea in the back of my mind. I moved away from the idea of wanting to perform so when I graduated I did care work for a year and then applied for the postgraduate programme in drama therapy. You have to be 23 to start the training because they like you to have some experience and maturity.
"It's really hard to get a job afterwards. When I finished training I did voluntary work for Mind in London and then approached my local hospital about doing work with a mental health group. You do have to be proactive and market yourself and the work you can do. These skills are valuable as even if you do get a job in the NHS you may have to sell your service to other healthcare professionals.
"I now work with adults with mental health problems, both in an acute unit and with outpatients. They have a range of issues, from depression to psychotic illnesses. I work one-to-one and in groups. We do interactions and role plays but it's not about saying 'this is your problem, let's act it out'. It's about getting them to explore how they feel. We use role plays or work with projective objects, such as model animals, shells and stones, to get people to think about how they relate to one another and explore how they would like to be and how that would feel. People feel safer expressing these feelings because they are not saying 'this is me and my problems' as they would in psychotherapy.
"It's rewarding work although we hear difficult things. It can be frustrating but I'm amazed by how creative people are."