THE PSCHOCYBERNETIC MODEL OF ART THERAPY
ABOUT THE AUTHOR Dr. Aina O. Nucho (pronounced "Ina" "Nooko") is a professor emerita at the University of Maryland School of Social Work where she taught graduate level courses in clinical methods with individuals, families, and groups. She also taught human behavior, social research, stress management and art therapy. Dr. Nucho obtained her primary and secondary education in Riga, Latvia, and later she studied at the University of Tuebingen in Germany. Dr. Nucho holds a graduate degree in social work and a Ph.D. degree, both from Bryn Mawr College. She is a Distinguished Fellow and a recipient of the 2000 Ernst Kris Prize of the American Society of Psychopathology of Expression, a Board Certified Diplomate in Clinical Social Work (BCD), a member of the Academy of Certified Social Workers (ASCW), a licensed clinical social worker in the State of Maryland (LCSW-C), and a registered art therapist (ATR). Dr. Nucho is the author of Stress Management: The Q,uest for Zest (1988) and Spontaneous Creative Imagery: Problem-Solving and LifeEnhancing Skills (1995), both published by Charles C Thomas, Springfield, IL, and five books in Latvian. She has published articles in professional journals and has presented papers at national and international conferences.
Second Edition
THE PSYCHOCYBERNETIC MODEL OF ART THERAPY By
AINA o. NUCHO, PH.D. A.T.R., A.C.S.W., L.C.S.W.-C., B.C.D. University ofMaryland
With Forewords by
Irene Jakab, M.D., PH.D. and
Akhter Ahsen, PH.D.
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Nucho, Aina O. The psychocybernetic model of art therapy / by Aina o. Nucho ; with forewords by IreneJakab and Akhter Ahsen.--2nd ed. p.cm. Includes bibliographical references and index. ISBN 0-398-07377-5 (hard) -- ISBN 0-398-07378-3 (pbk.) RC489.A7 N83 2003 616.89'1656--dc21 2002035973
FOREWORD
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his book is an instrument of complex knowledge transfer on the subject of art therapy and specifically on the method designed and defined by the author as the psychocybernetic model of intervention. More than half of the book is dedicated to a detailed account of the origins and the rationale of art therapy. These first six chapters attest to the serious background research and include a rich array of historical and biographical data. All this is presented with logical clarity. The precise quotations from the literature are clearly distinguishable in the text from anecdotal data and from the backbone of the author's interpretation and judicious criticism of various theoretical models. The description of the psychocybernetic model and the justification for its use is built on its comparative merit over the other models. It is an interactive model based on well defined phases of the therapeutic process. The second half of the book (Chapters 7 to 11) address in detail the therapeutic process. In this segment the theoretical basis for each phase is again clearly defined and interwoven with illustrative case vignettes and several helpful case discussions. For the therapist who intends to use the psychocybernetic model it is of great value to find detailed case descriptions including the interpretation of the dynamics of various phases in addition to such practical details as the list of materials to be used with different patient populations, the space requirements and the time frame of individual and group sessions. The four phases of the therapeutic process: The Unfreezing phase, the Doing phase, the Dialogue phase, and the Ending and Integrating phase are demonstrated through case material which include the patients' graphic productions under discussion. The author provides several clearly presented graphs in support of her concept of the therapeutic process. v
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The whole second half of the book (Chapters 7 to 11) could stand on its own as a practical guide to the implementation of the psychocybernetic model. Nonetheless, even this segment contains explicit theoretical data in support of the author's views and suggestions. In order to support the clinical effectiveness of her method the author quotes a comparative research study by Lindenmuth on 298 depressed patients in a nursing home exposed to various treatment modalities. The art therapy was conducted by a therapist (MSW) who received instruction in the psychocybernetic model from the author. The results of this study attest to statistically significant (.001 level) improvement of depression scores in the groups exposed to expressive therapies (art, music, and exercise therapy). The book is an important reference volume on the theoretical foundations of art therapy-each chapter in the first half could be used as a separate self-contained paper on its respective subject. The clear definitions of this historical overview introduce the reader to such broad topics as cybernetics, general system theory, information processing, imagery, and the rapport of systems and cognition. While this first half may be considered as being addressed primarily to academicians it is also useful to the practitioner of the psychocybernetic model of art therapy. At the same time, this book in its second half contains excellent practical details which warrant its use by practitioners who are interested to include this new method into their day-to-day work with patients. A comprehensive bibliography and index add weight to this scholarly text. I can wholeheartedly recommend this volume as a reference textbook for libraries and for teachers of expressive therapies as well as for the use by practitioners of various forms of psychotherapy.
M.D., PH. D. Professor ofPsychiatry University ofPittsburgh and President, American Society ofPsychopathology of Expression IRENEJAKAB,
FOREWORD in a Nucho's clinical practice and teaching over the last 20 years has paralleled many of the major developments in the field of art therapy. She is perhaps one of the last persons to interview Margaret Naumburg, the eminent pioneer in art therapy whose stellar contributions to art therapy are well known. Having participated in and witnessed the merging of art and therapy in the United States, it is appropriate that Nucho be the chronicler of this new modality of interpersonal helping. That she has done-and very ably-taking the reader back to the Ancient Greece, down through the ages into the late nineteenth and early twentieth centuries, coming to Switzerland and to Carl Jung and his method of active imagination, and then going further on into the contemporary scene. By depicting the evolution of art therapy, Nucho demonstrates the difference between the art wing and the therapy wing of art therapy and she underscores the need for a new model in this form of psychotherapy. Nucho terms that new model the psychocybernetic model of art therapy. Utilizing the general system approach she develops a model of helping that incorporates what is currently known about human cognition and the functioning of the brain. She introduces the concept of codification to elucidate the perennially perplexing phenomenon of cognition. The reader will welcome the clear, jargon-free discussion of how the mind works and how to facilitate the process of growth and change. Central to the psychocybernetic model is the understanding of the phenomenon of imagery. Nucho reminds us that images are symbols and thus an essential part of cognition; images are both mental and physical, and they derive from both memory and imagination. Images, too, like everything else, form a kind of a system. Images arise spontaneously in the mind, and they can also be created deliberately. Nucho describes how the psychocybernetic model provides ways of therapeu-
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tic handling of both kinds of images so that profound personal experiences may be sorted out and dealt with. Images, as Nucho views them, are part of the cybernetic control system of the human mind. Each experience is considered to be encoded as an image and linguistically in language, and to some the fit may be more or less perfect between these two symbol systems, but she points out, there may be a gap. The gap is filled by somatic response. She is gracious to involve my Triple Code Model of imagery at this phase of the formulation of her theory and it further enriches her psychocybernetic model. Images and words are not like two parallel, unconnected clocks which do not interact but tell the same time; language which describes images is only approximate. It is capable of error. Images, in contrast, just are. They register the experience of the organism directly. If the discrepancy between somatic responses, imagery, and meaning encoded in language persists over time, disease ensues. Images and language are functionally connected. Images are not reducible to language, nor is language reducible to images. Both are needed. And so is the body. The psychocybernetic model shows how to behold and examine images so that balance and wholeness may be attained. Readers will find Dr. Nucho's discussion of the psychocybernetic process immensely helpful, particularly if they wish to combine the traditional, largely verbal means of interpersonal helping with techniques of art therapy. Nucho marches the reader through the various phases of the therapeutic process, guiding the practitioner's efforts and warning against pitfalls and false expectations. Her analyses of case studies and her collection of artworks done by a number of clients all illustrate the appropriate use of the new model of helping. Nucho's achievement will work to the great benefit of mental health practitioners. Far too long have psychotherapists resembled Cyclops, the giant in Greek mythology who had only one eye and hence a distorted and limited perception. The psychocybernetic model of art therapy as stated by Nucho offers the means of using both eyes, both symbol systems, the visual, holistic-imagistic as well as the verbal-analytic. Practitioners who include the psychocybernetic model into their arsenal of skills will increase their effectiveness immensely. AHKTER AHSEN, PH.D.
Editor,fournal ofMentalImagery and Founding Chairperson, International Imagery Association
PREFACE n creasingly, art therapy attracts the interest of forward-looking professionals in the mental health field. Especially those professionals who are working with children and adolescents find art therapy techniques indispensable in their work. Less frequently, art therapy is used when working with adults. The second edition of this book should prove useful not only when working with children and adolescents, but also with various kinds of adults, ranging from minimally dysfunctional to severely dysfunctional, and also with those who are in the final phases of life. Several new art therapy techniques are introduced in this edition of the book to facilitate the work with these populations. It is a pleasure to acknowledge my indebtedness to the people who in various ways contributed to the development of my ideas that are presented in this book. I want to pay a special tribute to my friend, the late Hanna Y. Kwiatkowska, from whom I learned much about art therapy and about life. I am grateful to Drs. IreneJakab and Ahkter Ahsen for their interest in my work and for writing the Forewords. Dr. Vija Lesebrink, a kindred spirit, has my profound thanks for her wise counsel and her sustaining encouragement as the work progressed. The clinical acumen of the late Dr. Mala Betensky has enriched my thinking as we collaborated on various projects over the years. My colleagues at the University of Maryland, Drs. Harris Chaiklin, Oliver Harris, Curtis Janzen, Arthur Schwartz, and the late John Goldmeier, have my appreciation for reading individual chapters of the first edition of this work. My gratitude and admiration go to my friend and colleague Dr. Sandra Snow for her enthusiastic use of the psychocybernetic model of art therapy in her practice and teaching. I thank the founding members of the Maryland Art Therapy Association for stimulating discussions, especially Michelle Flesher, Gwen Gibson, Roberta Shoemaker, and Dr. Lucille Venture. I have also benefited from exchange of ideas with a host of other art therapists, too
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numerous to mention by name. My special thanks go to Virginia Austin, Robert Ault, Gladys Agell, GeorgiannaJungels, Dr. Myra Levick, Dr. Judith Rubin, Dr. Harriet Wadeson, and the late Marge Howard, Connie Naitove, and Marie Reval. The late Dr. Elinor Ulman was gracious enough to read and comment on several chapters of this work. I am particularly grateful to Louise White who helped me clarify my thinking while straightening out my syntax for this book as well as for my other books. Virginia Peggs was immensely helpful as she cheerfully typed and retyped the many drafts of the manuscript of the first edition. Janice Hicks did the same for the second edition of the book. I am deeply thankful to my clients who allowed me to get to know them in a special way and for giving me permission to reproduce some of their artwork. I extend my gratitude and appreciation to my students, who over the years shared with me their thoughts, struggles, and triumphs in the use of art therapy. And to my husband, the late Dr. Fuad Nucho, I am grateful for his unwavering interest and encouragement over many years. Finally, I thank the American Art Therapy Association for permission to reproduce material previously published in the Conference Proceedings 1979, 1981, and 1982. I also thank Rawley Silver for permission to reproduce the Draw-a-Story Form A. Charles C Thomas has my thanks for granting me permission to reproduce the Wartegg blank from E. Hammer (Ed.), The ClinicalApplication ofProjective Draw-
ings (1958). AINA
O.
NUCHO
CONTENTS Foreword-IreneJakab Foreword-Akhter Ahsen Preface
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vii ix
PART ONE: THEORETICAL FOUNDATIONS Chapter 1. AN INVITATION TO CHANGE Paradigmatic Changes Overview Advantages of Visual Forms of Cognition
5 5 7 10
2. ART THERAPY, PSYCHOCYBERNETICS AND SySTEMS What Is Art Therapy? Cybernetics Images and Psychocybernetics General System Theory Information Processing and Imagery Conclusion
12 .12 15 18 21 23 24
3. IMAGES AND COGNITION What Are Images? Types of Imagery Preferred Sensory Modality of Imagery Images and Metaphors Images and Symbolization Ahsen's Triple Code Model of Imagery The Concept of Systems Two Types of Cognition Hemispheric Differences The Process of Codification Systems and Cognition Conclusion
25 26 28 29 30 31 33 34 35 37 40 45 47
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4. THE MERGING OF ART AND THERAPY "Go, Paint, It Is Good for Your Soul!" The Ancient Greeks Jung and the Method of Active Imagination Adrian Hill, the Visiting Therapist Margaret Naumburg and the Free Art Expression Florence Cane and the Artist in Each of Us Forging a New Discipline Trailblazing in Art Therapy Conclusion
49 50 51 53 56 59 64 65 69 71
5. VARIETIES OF ART THERAPY The Art Wing The Therapy Wing Arts and Crafts Theoretical Orientations The Psychoanalytic Model TheJungian Approach The Gestaltists The Phenomenological Trend Conclusion
72 73 74 75 77 78 84 88 90 92
6. CONTOURS OF THE PSYCHOCYBERNETIC MODEL Duality of Knowledge The Function of the Therapist Ipsomatic vs. Nomomatic Seeing Primary vs. Secondary Creativity The Four Phases of the Therapeutic Process When and How to Use the Psychocybernetic Model Personal Qualifications Professional Preparation Art Materials Space Requirements Time Considerations Conclusion
93 93 94 95 96 97 99 .. 101 102 104 107 107 107
PART TWO: THE THERAPEUTIC PROCESS 7. THE UNFREEZING PHASE Common Misapprehensions
111 112
Contents
Preparing the Client for the Experience Limbering Up Structuring The Process of Engagement
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114 117 117 118
8. THE DOING PHASE To Structure or Not to Structure? The Free-flow Technique The Wartegg Technique Diagnostic Procedures Themes Derived from Client Concerns Interactional Drawing Technique Principles of Timing, Gradualness, and Spotlighting Self-System: A Technique Generating Matrix Peripheral vs. Central Concerns Rapport Building, Self-Sharing, and Closure Free Expression, Assemblages, and Perceptual Stimulation What to Do While Clients Work? The Length of the Doing Phase
121 121 122 126 128 132 134 134 136 140 148
9. THE DIALOGUING PHASE The Nomomatic vs. the Ipsomatic Approach Distancing Decoding Closure and Consolidation Format and Length of the Dialoguing Phase The Process of Amplification Dispositional vs. Facilitative Understanding Search for the Inner Design The Dialoguing Process in Groups Salience and Timing
157 157 159 160 163 166 171 171 173 174 175
10. ENDING AND INTEGRATING Ratification Resistance Review Resolution Integration A Practical Hint Conclusion
149 151 153
177 178 179 182 185 192 193 194
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PART THREE: WORK WITH SPECIFIC CLIENT POPULATIONS 11. WORK WITH CHILDREN Indirect Treatment Direct Treatment Therapeutic Styles Tasks of the Therapist Specific Techniques Responsive Communication
199 200 202 202 205 206 215
12. ART THERAPY WITH ADOLESCENTS Tuning In Helping Strategies Specific Techniques Suicidal Adolescents Eating Disorders Sexual Abuse Chemical Dependency
221 222 223 226 231 232 233 235
13. ART THERAPY WITH ADULTS Being Grown-Up Minimally Dysfunctional Adults Moderately Dysfunctional Adults Severely Dysfunctional Adults Late Adulthood
238 238 240 241 245 252
PART FOUR: EFFECTIVENESS OF ART THERAPY AND A LOOK AHEAD 14. CASE VIGNETTES Yearning for the Family of Origin Keeping Up with the Grown-Ups Striving for Reconciliation Pregnant Teenager's Dilemma Stresses of Upward Mobility The Last Leaf
261 262 262 263 264 267 269
15. AN EMPIRICAL OUTCOME STUDY Research Design Findings
272 272 274
Contents
16. LOOKING AHEAD Desirability and Feasibility of Research Life-Long Learning
Bibliography AuthorIndex Subject Index
xv
278 278 279 283 293 297
THE PSYCHOCYBERNETIC MODEL OF ART THERAPY
Part One
THEORETICAL FOUNDATIONS
Chapter 1 AN INVITATION TO CHANGE eraclitus, the ancient Greek sage (c. 536-470 B.C.) declared that everything is in flux. Everything changes, and no one can step twice in the same waters of a river. What seemed true to Heraclitus is even more true in our times. Old certainties give way to uncertainty. Old traditions no longer sustain human behavior. This is true in the personal as well as in the professional realms. Professional monodoxy has given way to a plethora of theories and interventive strategies (Corsini, 1981). Change is all around us, but where is the way to success? This book is written for mental health specialists who are dissatisfied with the extent of success of their current predominately verbal methods of helping. All mental health specialists are surrounded by a superabundance of distress. The discrepancy between the supply and the demand for services is immense. Every program of human services suffers from serious personnel shortages. It is essential to find ways of speeding up our methods of helping.
H
Paradigmatic Changes The method of intervention described in this book has been stimulated by the paradigmatic change that is affecting various areas of human endeavors. As pointed out by Thomas S. Kuhn, paradigmatic shifts tend to occur periodically and simultaneously in all fields of science (Kuhn, 1962). We are now in the midst of such a change. The older paradigms of the vitalistic and the mechanistic kind now are giving way to the holistic paradigm. The holistic paradigm regards the universe as one interconnected system. Matter and energy, space and 5
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time, living and nonliving phenomena are viewed as transformations within the same hierarchically-ordered unity (Battista, 1977). The emerging holistic paradigm is best understood with the help of the system theory. General system theory is a set of concepts about the nature and dynamics of systems. The field of cybernetics evolved out of the general system theory in an effort to develop self-guiding and self-correcting machines. Cybernetics is the study of the flow of information in a system. Fundamental to cybernetics is the notion of feedback loops of information. The flow of information explains how a system maintains itself and how it changes. Information organizes goaldirected activities within a system and between various systems. In the human system, information is encoded on several different levels, ranging from the cellular to the interpersonal level. When engaged in interpersonal forms of helping, the level of information of particular concern is that which occurs through imagery and in the various other forms of verbal and nonverbal cognition. Information encoded in human physiology and metabolism is increasingly better understood. The information contained in words is studied extensively. But information embodied in imagery is the one level of information processing that has been largely neglected in Western culture until quite recently (Horowitz, 1970; Singer, 1972). The psychocybernetic model described in this book provides convenient techniques to tap this level of cognition. Each human being is equipped with two sets of symbolic processes. Since the days of Freud it has been customary to differentiate between the prelogical or the primary process thought which appears mostly in fantasy, imagery and dreams, and the logical, rational, or the so-called secondary process thought. Only quite recently have we discovered that the primary process thought is not necessarily a primitive and an immature form of cognition which we should strive to outgrow and leave behind. Rather, it has to be integrated with the secondary process thought if we wish to attain high levels of creativity and originality (Arieti, 1976). How to benefit from this undervalued and neglected form of cognition is the topic of this book. The psychocybernetic model of interpersonal helping offers the means of increasing the effectiveness of both the help seeker and the help provider by showing how to harness their imagery, this long neglected human resource. The model of psychotherapy presented in this volume will foster your ability to utilize both the verbal and the visual means of cognition.
An Invitation to Change
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It presents ways of capturing the power of fleeting images. A method of amplifying the faint messages contained in imagery is described and illustrated with case excerpts. You will develop the skill to engage your clients in expressing thoughts and feelings through visual means. You will sharpen your perception and ability to discern ideas portrayed visually, and you will know how to respond appropriately to the imagery of your clients.
Overview The book is organized in three parts. Part One contains six chapters which present the theoretical foundations of the psychocybernetic model of interpersonal helping which I have developed and practiced for over 20 years. I have taught this model of intervention for the past 15 years. The theoretical framework of the model is the general system theory and the so-called cognitive theory which is only now taking shape in the behavioral sciences (Gardner, 1985). General system theory, its main concepts and the field of cybernetics are discussed in Chapter 2. This is a complicated set of ideas but once mastered, these ideas help us understand better how the human mind works and how positive changes can be brought about. Chapter 3 considers the cybernetic function of imagery and presents a model of cognition based on the general system theory. What constitutes art therapy is still a matter surrounded by controversy (Ulman, 1975). The discipline of art therapy is of recent origin, and it utilizes several different ways of promoting visual forms of cognition. It is interesting to trace the course of the slow and arduous process whereby art and therapy gradually merged to form this new discipline now known as art therapy. By whom and how art and therapy were forged gradually into one entity is covered in Chapter 4. Chapter 5 surveys the contemporary scene and delineates several kinds of art therapy practiced in the United States and summarizes some of the other major theoretical frameworks used by art therapists. It also outlines the personal and the professional qualifications necessary for the practice of the psychocybernetic model of intervention and suggests ways of acquiring these qualifications. Then it discusses ways of combining the psychocybernetic model with the customary purely verbal methods of psychotherapy and it describes practical matters such as
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considerations of time and space requirements as well as the art materials useful for the practice of this model of helping. Once you have absorbed the general systems ideas and have accepted the fact that imagery is an indispensable form of cognition, the rest is easy. You will be tempted to say about the psychocybernetic model of intervention what Johann Sebastian Bach said about playing the organ. He said that playing the organ is easy: all you have to do is hit the right notes at the right time. Similarly with the psychocybernetic model. It is simple. All you have to do is say the right things at the right time. What these right things are and how to attain the proper timing are matters that are considered in Part Two. Part Two contains five chapters which discuss the implementation of the psychocybernetic model. These chapters take you through the intricacies of the therapeutic process step by step and show you how to proceed in accordance with the psychocybernetic principles. Chapter 7 deals with the warm-up phase of the therapeutic process. This chapter describes ways of introducing clients to visual forms of cognition, especially clients who are not artistically inclined and who may not have used any art materials since their early childhood days. The following chapter discusses the working phase when the clients are engaged in producing the drawing, painting, or the sculpture which is to capture their imagery in a visual format. A number of specific techniques are suggested to promote visual cognition of various kinds of clients. Chapter 9 outlines the process of decoding the visual imagery portrayed by clients. At this juncture of the therapeutic process the visual imagery is translated into the verbal, secondary process thought. Chapter 10 deals with ways of terminating the therapeutic interaction and considers the matter of integrating the gains made in therapy. The final chapter discusses the scope and the effectiveness of the psychocybernetic model of intervention. The psychocybernetic model uses simple art materials to promote the expression of imagery in visual format. Thus the psychocybernetic model may be thought of as a form of art therapy. The art materials, however, are used in a very specific manner. While some art therapists will find the psychocybernetic model quite congenial to their own manner of working, others will think of this model only as a distant cousin to art therapy. Chapter 11 summarizes the results of a controlled empirical study in which the outcomes of the psychocybernetic model of art therapy and two other forms of expressive therapies were compared to
An Invitation to Change
9
the outcomes attained by a number of other frequently used modalities of helping. The expressive therapies provided were the psychocybernetic model of art therapy, music therapy, and exercise therapy. The results obtained by the expressive therapies were compared with results observed in verbal groups psychotherapy, chemotherapy, and a no-treatment control group. The sample consisted of 298 depressed elderly clients. The findings show that the expressive therapies, including the psychocybernetic model of art therapy are most effective. Chapter 11 also presents case vignettes to illustrate the scope of the psychocybernetic model with several different kinds of clients who are usually slow to respond to verbal forms of therapy, especially when the gender and/or the racial background of the therapist differ from that of the client. If you want to enlarge the repertoire of your helping strategies and if you are searching for ways to become a more effective therapist, you are invited to try this new modality of helping. The psychocybernetic model of helping has proven effective with clients spanning the entire gamut of clinical concerns and ranging in age from 3 to 98. The levels of ego development of these clients have varied from minimal to superior. What accounts for the effectiveness of this model of helping? It appears to lie in the very make-up of our cognitive equipment. Every person, however untutored in art, possesses a basic visual vocabulary. Everyone, for instance, has some feeling about colors. Some colors are thought to be pleasing while others are perceived as being unattractive. The same is true for shapes. Some shapes may seem enticing while others may appear to be jerky or bold. This visual vocabulary, once discovered, can be expanded, and it becomes a source of constant enrichment and excitement. Drug dependent clients, for instance, who are accustomed to think of themselves as chronic failures, become quite intrigued by this discovery. It is rewarding to discover one's own visual vocabulary and to see how it converges or differs from those of other members of the group while at the same time having just as much validity (Nucho, 1977). Visual means of expression are more appropriate for the subtle and deeply personal experiences for which language provides no appropriate words. By and large, language, with all its complexity, contains designations for those experiences which are of some social significance but the more private and idiosyncratic experiences are less adequately represented. Furthermore, many important experiences occur
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during the first year of life, well before the person has adequate words to attach to one's experiences. Therefore, some very significant and fundamental experiences become encoded not in words but in pictures in our minds. Also, we dream mostly in pictures, and dreams have long been recognized as providing access to the deeper layers of our being. To severely dysfunctional clients, verbal means of communication are often dangerous and unreliable. Words may have been used to evade, humiliate or deceive another person. In contrast, visual means of expression, used less frequently in our culture, have fewer distortions and negative associations attached to them. Not infrequently, a fresher and more direct expression can be achieved through the visual than through the verbal means of communication.
Advantages of Visual Forms of Cognition Painting, drawing, and sculpting are action-oriented ways of conveying one's thoughts. The eyes, hands, arms and much of the rest of the body are involved. The client is a doer, not a reactor, as is all too often the case in other areas of the client's life. While making the picture, the client's neuromuscular as well as his cognitive faculties are engaged. The client has to decide whether the picture will be small or large, bright or dark. Once the decision is made, it remains as the client made it, unless the client himself wishes to change it. The picture does not argue with him. If the client is not pleased, he can change his decision without the penalties which customarily follow when one changes one's mind in real life. Clients relish this sense of freedom and selfdetermination once they have experienced it. The visual format of communication utilized in the psychocybernetic model is particularly effective when working with clients who are "therapy wise" and who have learned to tell their therapists what they think the therapists want to hear. The customary verbal means of expression permit a client to be more evasive and noncommittal than when engaged in visual forms of expression. In our culture visual expression is not a routine activity and thus a greater degree of thought is required. Visual percepts reflect more of a person's cognition than do words. Visual expression by its very nature is more complete than verbal expression. For example, a statement, "A person runs" does not say anything about the sex, age, size, or speed of the runner. If you draw a person running, you are bound to include more details than in the ver-
An Invitation to Change
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bal statement, and thus convey more information (Piotrowski, 1953). In a drawing it is hardly possible to say the bare minimum. The visual forms of expression tend to contain details which reveal one's attitude towards the subject portrayed. Another advantage of visual forms of expression is that it can overcome the drawbacks of age and education. For instance, drawings done by the entire family in therapy, simultaneously by the parents and their children, provide the means for the children to make their thoughts known just as effectively as do their elders (Kwiatkowska, 1978). By visually depicting those experiences too difficult to put into words, clients develop a sense of mastery that has a way of generalizing to other areas of their lives. Having portrayed feelings graphically on paper or in clay, clients often find these feelings more amenable to effective handling in actuality. In one art therapy group, when the psychocybernetic model was used, a young woman with a long history of illicit drug usage was able to confront her feelings about her mother and attain a mutually acceptable solution to their difficulties after only a few therapy sessions. Another client, a 22-year-old black male who had felt on the verge of resuming his heroin habit, was able to shake off his preoccupation with drugs and his restlessness after the fourth session of therapy. A year and a half later, follow-up reports indicated that he had remained drug free. The psychocybernetic model presents ways of helping clients pin down their depressions and express their angers symbolically. The chaos of their lives is sorted out so that better ways of coping may be discerned. The psychocybernetic model provides a means of combining the visual with the verbal forms of communication. The outcomes achieved with the help of this model often prove superior to those possible when using the older models of intervention.
Chapter 2
ART THERAPY, PSYCHOCYBERNETICS AND SYSTEMS rt therapy, a relatively new modality of helping, is used increasingly by many mental health practitioners. Although its roots can be traced back to antiquity, much of it is still puzzling not only to its observers and participants but to its practitioners as well. Many art therapists are inclined to think that art therapy transcends the confines of logical discourse. What art therapy entails, they maintain, can be understood only through experience, not through verbal description. According to them, it may be easier to square a circle than to explain what art therapy is and how to do it. The concept of cybernetics is useful in understanding what art therapy is and to learn how to do it. The term cybernetics is derived from the Greek word for "helmsman" or "navigator." It was introduced by Norbert Wiener in 1947 and it has come to designate the discipline which studies the flow of information that organizes goal-directed activities of various systems. From the concept of cybernetics I have developed what may be termed the psychocybernetic model of art therapy. This model provides clear guidelines to mental health practitioners for the specific tasks that need attention during the various phases of the process of intervention. It also helps us to differentiate between art therapy and the other activities that may be beneficial but nevertheless are peripheral to art therapy.
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What Is Art Therapy? From the perspective of psychocybernetics, art therapy may be defined as the process of becoming aware of, externalizing, portraying, 12
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and then decoding one's imagery in order to integrate experiences and to discern new avenues for action. Imagery is the central ingredient of the psychocybernetic model of art therapy. Art therapy is the process of cultivating, clarifying, and visually expressing the imagery that arises spontaneously in response to various experiences in life. Images are symbolizations or crystallizations of life experiences. The experiences in life are condensed into images both spontaneously and deliberately. Language itself may be viewed as a frozen system of images. But what is the purpose of this level of symbolization? Why are we equipped with this ability to produce images, both spontaneously in dreams and purposefully in art, and inescapably in speech in the form of metaphors? Although much vigorous theorizing has taken place since the concept of imagery returned from the exile to which it was banished by the early behaviorists (Holt, 1964), the function of imagery is still perplexing to the human mind. From the perspective of psychocybernetics, it may be postulated that the function of images is to regulate the flow of information in the system. Images are information condensers. Images store information so that it may be sorted out, compared with other information already in the system, and transported from one place to another, or from one time to another. More will be said about images in Chapter 3. As any other form of therapy, the psychocybernetic model of art therapy may be thought of as a process of communication. Ideas and feelings are exchanged between the helper and the help seeker. Through the usual forms of psychotherapy, the exchange of information is primarily verbal. Through the psychocybernetic model of art therapy, however, the process of communication is instigated, facilitated and sustained with the help of a visual product. Furthermore, the visual product that channels the communication is produced by the help seeker spontaneously, without the benefit of technical skill or instruction. Additionally, the visual product, be it a drawing, painting, sculpture or other form of expression, is examined by both the maker and the therapist not for its aesthetic merits but for the personal feelings, thoughts and experiences it may convey. How is this possible? How can anyone communicate anything without the technical know-how? Here many art therapists themselves become doubtful. Two distinct schools of thought have arisen among professional art therapists precisely around this issue. The one school of
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thought, known as the "ART as Therapy" wing of art therapy, holds that nothing worthwhile can be communicated unless the client has reached the point where some rudimentary technical skills have been mastered. The other wing of art therapy, known as the "Art PSyCHOTHERAPY" school of thought maintains that the sense of form is innate and the visual sense so prominent in human beings that much information can be conveyed by persons entirely untutored in the visual arts. The psychocybernetic model of art therapy is the use of simple art materials in order to stimulate the imagery of the help seeker so that experiences may be sorted out, inspected, looked at, faced, integrated, and understood better than before. Once externalized, the fearful and perplexing experiences are not nearly so frightening as when harbored secretly within the mind. We know that verbal sharing of difficult experiences also eases the mind. What then is the advantage of visual expression as compared to verbal communication? Words, as suggested earlier, are frozen images. Moreover, words are like hand-me-downs instead of original products. They are not custom tailored to fit the person's experience exactly. Words are like railroad tracks. Feelings have to stick to these "tracks." Where there are no tracks, the feelings cannot "go" and they cannot be communicated. Words have arisen for experiences that have some social significance. Experiences that are private often do not have adequate words to designate them. We all know that certain cultures are rich in words that have survival significance for that particular culture while other experiences are meagerly represented by verbal language. Eskimo language provides a case in point. Eskimos have 20 different words for snow. In contrast, western languages have only a few words to designate this frozen form of precipitation. Visual forms of expression have the advantage of originality while words are rather "shop-worn." One has to be a poet and work at one's language to get rid of hackneyed forms of speech. In contrast, visual expression is closer to the immediacy of experience. We see and deeply experience the world for many months before we possess verbal labels for our experiences that already have shaped us. Later in life some of these primary experiences can be contacted through the visual means of expression. No wonder then that we have the saying that one picture is worth a thousand words.
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There is another profound reason why the visual forms of expression are so potent. This power has to do with the way in which our very brain is constructed. The two cerebral hemispheres appear to be differentially engaged in the processing of information. The one part of the cerebral hemisphere is more active when we engage in the verbal, analytical, and rational forms of reasoning. The other, or the so-called nondominant hemisphere, is engaged more actively when we use intuition, holistic forms of thinking, or perform visual and spacial tasks (Sheikh, 1983). Every human being, however untutored in the visual arts, has both cerebral hemispheres and hence is equipped to benefit from visual forms of communication as used in the psychocybernetic model of art therapy. Our immediate task in this chapter is to present the concept of cybernetics, discuss the general system theory which gave rise to the concept of cybernetics, and to discuss in some detail what significance this concept has for the understanding of the functioning of the human mind and ways of helping of which the psychocybernetic model of art therapy is but one.
Cybernetics Cybernetics is the discipline concerned with the study of the flow of information that organizes goal-directed activities in systems. The term was coined by Wiener to designate the common interests of a rather disparate group of mathematicians, engineers, and physiologists who had joined forces to study various problems of communication and control systems (Wiener, 1947). Despite the extensive public notice the term received following the publication of Wiener's book, its reference has remained rather vague. Sayre uses it to designate the study of communication and control functions of living organisms, particularly human beings, in view of their possible simulation in mechanical systems (Sayre, 1976). The notion of cybernetics was known in physical and social sciences long before Wiener gave it new vitality. Plato used the term cybernetics to describe the prudent aspects of the art of government. A French philosopher, A.M. Ampere, used the term "cybernetique" for the science of civil government (Dechert, 1966). By the turn of the century physiologists like Claude Bernard were fully aware of the processes of homeostasis whereby an organism acts to restore its internal equilibri-
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um. The self-regulatory aspects of neurophysiological phenomena are further discussed by Cannon (1932). By the early 1940s physicists, electrical engineers and mathematicians were at work on servo-mechanisms of self-regulating systems that could be used for industrial and military purposes. Wiener deserves credit for formalizing much of the scientific thinking up to that point in time. These ideas have led now to the so-called second industrial revolution. While the first industrial revolution replaced human energy by mechanical energy, the second industrial revolution now is relegating the control of machines from humans to computers which are designed and monitored by the human mind. Cybernetics, then, is the study of processes that make purposeful goal achievement of various systems possible. The principles of cybernetics permit the construction of goal-directed machines, robots, and computers. The goal-direction is achieved through the so-called feedback processes. Feedback is a process whereby a portion of the energy or informational output of the system is channeled back into the system as information in order to stabilize or direct its actions. The same basic principles of self-regulation are found in organic systems, human behavior, social systems, and in various complex man-made machines. Generally, two forms of feedback can be distinguished. One form of feedback is called positive, the other is termed negative feedback. Positive feedback increases the activity of the system; negative feedback decreases or eliminates the activity. A nagging spouse is an example of a positive feedback that increases the activity of a system, in this instance, that of the marriage. The more one nags the more the other withdraws, and the more nagged spouse withdraws the more the nagging continues. Thus, the nagging and the withdrawal both feed on each other. Or, to cite another example of positive feedback, an insecure child may incite teasing from his peers which in turn further increases his sense of insecurity. Negative feedback "negates" or prevents excessive deviation of the system from a given baseline condition. Many physiological processes are instances of negative feedback. The pupil of the eye, for instance, contracts in bright light and expand when the light is dim. Many other body processes, such as the regulation of temperature through sweating, are examples of negative feedback. The concept of cybernetics can be applied to all levels of organic and inorganic life. The very process of life is now understood as complex
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feedback loops. The process of natural selection, for instance, is an example of a large scale negative feedback which homeostatically preserves life in a changing environment (Sayre, 1976). In physics and chemistry each state of the system is conceived as an effect of a previous state. In contrast, in the realm of organic systems, many life processes are functionally related to subsequent states. Tropism and other goal-seeking activities belong in this category. Here the activities stemming from the present state of the system are actually functions of an anticipated future goal configuration (Sayre, 1976). Cybernetics provide an all inclusive way of understanding complex processes in living nature, human society, and industry. Three branches of cybernetics have been developed. One, known as theoretical cybernetics, deals with mathematics and philosophical problems. The second branch of cybernetics deals with control systems, including problems of collecting and processing information. The third branch is concerned with the application of cybernetics to fields of human activity (Dechert, 1966). The existence of intricate feedback loops at all levels of reality draws our attention to the fact that the universe itself may be regarded as a great thought rather than a great machine. SirJamesJeans, for instance, a prominent English scientist of the Cambridge school, states, "Mind no longer appears as an accidental intruder into the realm of matter; we are beginning to suspect that we ought rather to hail it as the creator and governor of the realm of matter" (quoted in Foster, 1975, p. 164). The principles of cybernetics have given rise to a whole new method of health care in the form of biofeedback. Biofeedback has been greeted as a scientific breakthrough which is expected to bring about the next phase in the evolution of human beings (Kalins & Andrews, 1972). Although the principles on which biofeedback is based are sound, the accuracy, reliability, and the cost of the instruments still leave much to be desired, and these realities have dampened the enthusiasm of its supporters. With the help of equipment that can amplify bodily processes and convert them into readily observable signals, such as a flashing light, movement of a needle, or a steady tone, a person indeed can learn to regulate his brain waves, muscle tension, heart rate, skin temperature, and even the acidity of the stomach. Any neurological or other biological function which can be monitored and amplified by electronic instrumentation and fed back to the person through anyone of his five senses, can in principle be regulated by that individual (Pel-
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letier, 1977). The methods of biofeedback utilize the fact that every change in the physiological state of a person is accompanied by a corresponding change in the mental and emotional state. Conversely, every change in the mental and emotional state, be it conscious or unconscious, is accompanied by a corresponding change in the physiological state (Green, Green & Walters, 1970). Voluntary control of psychophysiology can be achieved if subtle internal states are observed by the individual. Many visceral and glandular processes previously thought to be outside a person's voluntary control can now be regulated deliberately. Many people have learned to control their migraine headaches, lower their blood pressure, and regulate their heart beats (Girdano & Everly, 1979). Whatever happens to or within the human system is registered either as a state of well-being or as a state of distress. These states, however fleeting, leave neurophysiological traces within the system. These traces can be monitored with the help of various feedback devices that implement the principles of cybernetics.
Images and Psychocybernetics One type of feedback device which does not require any elaborate electronic instrumentation, but nevertheless is still generally undervalued in our Western culture, is imagery. Images may be thought of as natural feedback devices in that they are information condensers. Prompted by various experiences in life, images arise spontaneously in the mind. Images can also be activated deliberately in order to monitor the state of the human system. This is what is done by the psychocybernetic model of art therapy as well as by the various applications of imagery techniques which are gradually seeping into the mental health professions (Korn &Johnson, 1983). It can be expected that imagery, this much neglected source of powerful information will be increasingly utilized by mental health professionals. One method of harnessing this potent but often overlooked source of energy is art therapy. Information arrives constantly through the various channels of perception and is symbolized in one of the five sensory modalities. The newly arriving information, both from inside of the system itself and from the external world, has to be sorted out, codified, and integrated with the information already in the system. Unless integrated with the
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previously stored information, the newly received information will act only as noise, not as messages. Additionally, it is important to emphasize that the functioning of the system is hampered both by an information overload as well as by a scarcity of information. When the system is flooded with information from a variety of experiences, the surplus information is automatically made more manageable by condensing it into images. In this manner, the influx of overwhelming information can be sorted out gradually and eventually correlated with the information already available within the system. The assimilation of the incoming information leads inescapably to a reappraisal and recodification of the previously acquired information (Nucho, 1966). This in turn leads to a revision of the goals of the system. This is a never ending process, and it is this process that the psychocybernetic model of art therapy is concerned with and can offer much needed assistance. The psychocybernetic model of art therapy postulates that people are purposeful information seeking and information processing behavioral systems. The task of the therapist is to assist the client in consolidating the information derived from various life experiences in order to construct internal frames of reference for appropriate pursuit of goal directed behavior. Art therapy, in the light of psychocybernetics may be thought of as an information processing enterprise. From the psychocybernetic perspective, art therapy may be defined as the process of cultivating and explicating the internally produced signal system in the form of images that arise in response to the various experiences in life. The task of the therapist is to help the client facilitate the flow of the information contained in the images so that this information may be examined in order to discern the various options available to the person. In the course of the psychocybernetic model of intervention images are examined and gradually transformed into more conventional symbol systems such as verbal language. Unless concretized, images remain ephemeral and fleeting. For this reason, images need to be portrayed in visual or some other tangible form. If unheeded in one form, the same information may reappear in another but perhaps less desirable form. Information that is disregarded when it appears in the form of visual imagery, either in dreams or in art products, may reappear in the form of some somatic symptom or behavioral manifestation. If energy is to be invested prudently it has to be examined and its force
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and direction understood. This is the psychocybernetics of human functioning which undergirds goal-directed and purposeful action. Images extend the information processing and acquiring capacity of human beings without increasing the bulk of their nervous systems. The primary function of imagery is communication, ranging from personal exchange of information between the various levels of the system itself to dissemination of information to external systems. With the help of images, therefore, a broader range of experiences can be inspected and benefited from than would be possible in the light of discrete and unrelated experiences alone. Imagery is a highly efficient form of information processing. Action can be instituted and goals formulated prior to the occurrence of the expected event itself. Images give human beings the capacity to reflect upon circumstances beyond those actually present, and they foster the ability to draw inferences from the particular to the general. Imagery, then, is at the root of the fact that humans excel in the acquisition and utilization of information. Many other species surpass man in various areas. Pigs, for instance, surpass humans in their ability to utilize nutrition. Elephants surpass people in the quantity of energy intake. No animal, however, surpasses human capacity for the acquisition and processing of information. Imagery is one important channel of information processing which has been overlooked far too long. And imagery is one major asset which the psychocybernetic model of art therapy is capable of nurturing. Subsequent chapters detail how this is done. One more comment is necessary about the concept of psychocybernetics. A plastic surgeon made an early effort to apply the ideas of cybernetics to behavior change. Maxwell Maltz had observed that many people who consult plastic surgeons need more than surgery and many others do not need surgery at all. He speculated that by changing a person's self-image, benefits are obtained that amount to a spiritual facelift and a healing of emotional scars. Maltz hypothesized that if a person can accept one's self and feel successful, he will be able to accept his appearance. Maltz correctly identified the power of intentions embodied in one's self-image and how it shapes human behavior. He also called attention to the value of relaxation and several other practices now promoted by various stress management programs (Strobel, 1983). On the whole, however, his work was a rather chatty mixture of inspirational positive thinking and anecdotes about successful
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business people. Although aware of the work of Wiener (1947) and Penfield (1954), the idea of psychocybernetics remained rather meager and generally confined to the building of a positive self-image (Maltz, 1960; 22nd printingJanuary 1973). The popularity that Maltz's work has enjoyed may be partially accounted for by the hunger people have felt to view themselves as more than machines. Since the arrival of the so-called Third Force in psychology, topics of self-determination and self-responsibility which Maltz promoted, have become generally better understood and accepted in the helping professions. Human beings are no longer viewed as complicated machines or enlightened animals but as self-actualizers (Maslow, 1968). Psychocybernetics, as the term is used in this book, is the application of cybernetic concepts to the functioning of the mind. And cybernetics, as was indicated earlier, is an offshoot of general system theory which has by now permeated most branches of the social sciences.
General System Theory General system theory provides a unifying framework for the understanding of the interrelatedness of various levels of reality. General system theory is an outgrowth of biological theories that emphasized the interrelationship between species and their environments. General system theory opposes the simple reaction theories that analyze reality fragment by fragment rather than the interconnectedness of phenomena. Bertalanffy (1968) is generally acknowledged as the founder of general system theory. He defines a system as "a dynamic order of parts and processes in mutual interaction" (p. 208). Another definition of a system is as "an organized complexity" (p. 19). Still another definition Bertalanffy provides is that a system is "a set of elements in interaction" (p. 38). These "elements" in interaction can be cells, organs, organisms, people, institutions, nations, cultures, solar systems, and so on. Every system consists of smaller systems and is a part of some larger system. An individual as a system is determined in part by the system to which he belongs, and in turn, he exerts influence on that system as well as on the subsystems that constitute him. A system is a concept that permits the elucidation of the mutuality of influences between various entities. Instead of straight line cause and
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effect relationships, general system theory explains the reciprocity of effects, the interrelatedness, and the interconnectedness between entities in the realm of nature and society. A system is essentially a reciprocity of effects. The reactions go both ways, not just in one direction. It is more like a water bed-if you press on it in one spot, then the pressure goes all through the waterbed. Or you can think of a system as a net-you pull at it in one place, and the entire net responds. Similarly, the repercussions of social problems can be understood with the help of the system theory more readily than with some of the older models of theorizing. For instance, problems in the larger community have effects on the family, and those in turn, affect each member of the family. When the breadwinner is out of work, the marital relationship deteriorates; there is no money to fix the roof of the house or to buy other necessities; the children get into fights, their school performance deteriorates, and this in turn affects the relationships in the entire family, and so on. Like a stone thrown into a lake, the ripples go on and on. Systems may be classified as closed or open. A closed system is one that does not admit the incorporation of matter from outside. It is therefore subject to entropy according to the second law of thermodynamics. While some outside energy, such as changes in temperature and wind, may affect a closed system, it has no restorative properties and no input from its environment, and consequently it decays. All living organisms are relatively open systems in that in each there is both intake and output of energy and extensive transactions with the environment. In addition, there is a relatively steady state so that the intrusion of energy from outside will not disrupt the internal order and form. Finally, over time, the complexity and differentiation of parts increase and thus there is an increase of order in the system (Allport, 1960). Before systems ideas became known to the social sciences, the analytical approach to problem solving predominated. Even though the helping professions were influenced by the Gestalt notion that a whole is larger than the sum of its parts, phenomena were dissected and analyzed piece by piece. People and events were separated and examined one by one, like the layers of a cake. Now we view people and events not strictly separated but as constantly interacting. The relationship between various influences is more like that of a marble cake than a layer cake. Events are not like a six-pack of beer where each bottle has its own contents. They are more like a punch bowl where all the ingre-
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dients intermingle and affect one another. Reality, as we now understand it in view of general systems, is a system of interrelated entities. Change in one part eventually affects all the parts of the system. General system theory is not a theory in the traditional sense but is, rather, a conceptual model built around a set of core concepts. Some of these concepts are boundaries which can be rigid or fluid and thus give rise to open or closed systems. Another core concept is the steady state or homeostasis, also called the state of dynamic equilibrium. Still another core concept is the self-correcting propensity through the feedback loops which we discussed in some detail in the previous section of this chapter.
Information Processing and Imagery One more of the central concepts deserves to be mentioned in this context, namely that of information. Information is a message or a configuration of signal elements that has meaning for the recipient. Information is data that reduce uncertainty between two or more levels of the system. Information increases predictability and hence the ability to control the system (Sayre, 1976, p. 23). Cognition is a set of information processing capacities about which a great deal more will be said in the next chapter. Consciousness, this mysterious phenomenon that for centuries has been puzzling to philosophers and psychologists alike, is also a form of information processing. In view of the systems ideas, consciousness may be regarded as the cardinal information processing device. Man, as Bertalanffy points out, is a symbol-making rather than merely tool-making creature (Bertalanffy, 1968). One of the symbol-making devices is imagery. Images are the internal sensors that register changes in the internal and external environments and activate processes within the organism that can restore acceptable relationship between the various subsystems of the system and its environment. Images channel body energies according to the cybernetic principle. Images program, direct, and govern the energies of the organism. Images dig the riverbed as it were, and energy like water follows the course of the river bed. This proclivity of images to act as channels for the energies of the organism can be utilized in health care (Simonton et aI., 1978) and in psychotherapy. Body energies do not know the difference between real and imagined events. Muscles contract and glands secrete in response
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to actual as well as imagined experiences. If you do not believe this, try to imagine a cool, fresh, fragrant, yellow lemon which you hold in your hand and then cut and eat, the juices flowing down your chin, and see what happens to your mouth. Similarly, through visual images you can program deeper layers of your mind which we normally consider inaccessible to voluntary control. Through deliberately formed images we devise new concepts and attract new experiences. The power of imagery to channel the energy of the organism is utilized now, among others, by athletes. They pretrain their bodies through deliberate imagery of upcoming events (Winter, 1981).
Conclusion General system theory which originated in biology began to trickle into social sciences in the 1950s. It started to permeate social sciences in the 1960s. By the 1980s, general system approach has become an indispensable tool for understanding the multivariate complexity of human affairs. General system theory regards human beings and societies as complex self-regulating systems interacting among themselves and within a complex environment. Cybernetics is a conceptual tool for the analysis of complex systems and their self-regulating capacities. We now proceed to elucidate further the properties of human self-regulation with the help of symbol systems and imagery. We shall then discuss specifically how the symbol systems can be constructed and decoded in art therapy.
Chapter 3
IMAGES AND COGNITION
T
h e psychocybernetic model is a method of cultivating, portraying, and decoding the meaning of images in order to improve one's functioning. Images are the central ingredients in this helping modality. This chapter explores this still mysterious phenomenon-its major forms, its relationship to cognition, and its place in the creative process. The power of images has been widely acclaimed throughout human history. Images have been used in religion to strengthen convictions; in education, to convey information; and in healing, to evoke positive emotions that affect bodily processes (Korn &Johnson, 1983). Images are used in propaganda to arouse certain passions, and in advertising to stimulate certain desires and cravings. And still, images retain an inscrutable aura. To paraphrase Churchill's comment about Russia, images remain an enigma, wrapped in a riddle, inside a puzzle. The very concept of image is capable of arousing strong passions in otherwise levelheaded scientists. There are two different positions concerning images. While some extol the power of images as the source of highest forms of creativity, others dismiss the very notion. To some, images signal something transpersonal and even sacred. Among the strongest proponents of this position are Hindu theologians who hold that images are the messengers from a supernatural realm. There are several kinds of "avatras" or ways in which God reveals himself. One way is through incarnation, as in Krishna; another is through the presence in the human heart, as in the small voice of conscience; and the third way is through a symbol or an image ("area"). The ancient Hindu philosophers thought that by igniting determination to do God's will, however this will be conceived, images are capable of performing a service to deity (Eliot, 1921). 25
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During the last half century a diametrically different position regarding images has prevailed in Western psychology. John B. Watson defined psychology as a science of behavior in which there was no place for images (Watson, 1930). Images no longer were worthy of scientific study. Psychologists became increasingly skeptical about the concept of images. However, some interest in the study of images remained among psychoanalytically-oriented clinicians. They continued to investigate images as they appeared in clients' dreams and slips of tongue. Computers, cybernetics, and studies in sensory deprivation brought about a reversal of the trend to disregard images. These and other influences have converged now to form cognitive theory in which images occupy a distinct place as one form of cognition (Merluzzi et aI., 1981). In addition to cognitive theory, another impetus for such study arose within behavior modification because some of its forms necessitate reliance on the imagery generated by clients (Wolpe, 1958). According to Singer, this forced behaviorists to "look their own private experience full in the face and once again welcome man's inner experience back into the realm of science" (Singer, 1974, p. 4).
What Are Images? Images are "thought representations that have sensory quality" (Horowitz, 1970, p. 3). An image is a quasi-sensory and quasi-perceptual experience in the absence of external stimulus, irrespective of the sensory modality in which it occurs. Thus an image may be a perception of sound, smell, color, form, movement, or taste-all in the absence of an external stimulus. The stimulus giving rise to these sensations and perceptions may have been present in the past, but it does not exist at the time when the sensation or perception occurs (Gordon in Sheehan, 1972, p. 63). The three main modalities of images are the visual, auditory, and kinesthetic. The other modalities-the olfactory; gustatory, and tactileoften serve to elaborate and strengthen the images in the three main sensory modalities, especially when strong affect is involved. The ability to form images develops as the organism matures. According to Piaget, the image forming ability emerges in children at about the age of 18-24 months. The child is first able to form a recognition image of the primary care-taking person, usually the mother.
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The next step of development is the formation of an internalized mental image (Piaget & Inhalder, 1971). To be alive is to make sense of one's surroundings. Even a simple organism has to distinguish between a friend and a foe. The multitude of factors surrounding the organism can make the difference between life and death. A frog, for instance, has to be able to discern whether the shadow that falls on its retina signals the presence of a predator or the possibility of a feast. The higher an organism is on the scale of evolution the greater the number of factors that require correct perception and interpretation. Images are our tools for making sense of our experiences. We understand things by comparing the new and the unknown to something previously encountered and explored. The distinction between perception and cognition is difficult to make. Traditionally, perception has been regarded as an essentially sensory matter. Cognition, on the other hand, is thought of as a mental process. But perception too entails discrimination and understanding. Otherwise we are dealing only with nerve receptors. Perception and cognition are closely interrelated yet different processes. One distinction is that perception involves recognition of relationships between stimuli currently present. Cognition, in contrast, involves recognition of relationships between past and present stimuli. Thus cognition presupposes memory. Another distinction between perception and cognition is that the outcome of perception is denotative while the outcome of cognitive processes is connotative. The denotative meanings designates a certain object. For instance, a denotative meaning of "mother" is "a female parent." A connotative meaning of the same object might be "care, tenderness, love," etc. Both perception and cognition are processes whereby we acquire knowledge of the world. Both can be expressed in a propositional form, that is, as a statement in which the predicate affirms or denies something about the subject. It is important to keep in mind that while perception refers to a person's knowledge of things, cognition casts a wider net and refers to a person's knowledge of the meanings of things. Perception as well as cognition provide us with knowledge. While perceptions result in signs, cognition creates symbols. Although the distinction among terms like cognition, perception, learning, memory, and attention are difficult to make, these are sepa-
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rate phenomena and should be treated as such (Robinson, 1979, pp. 143-147).
Types of Imagery There are several types of imagery. Dreams are the most widely known form. Dreams are images that arise during sleep as the conceptual material is made perceptual. Dreaming has been defined as "pictorialized thinking" (Hall, 1953). Daydreams constitute still another form of imagery. Images tend to grow from single, fleeting, static images which present only one concept, to increasingly more complex units. Fantasies are the larger, more complex images that symbolize some event and contain visual as well as other sensory modalities. A fantasy usually consists of a series of mental images that have some vague continuity and is usually rather pleasant. Images that arise spontaneously just before falling asleep are termed hypnogogic. Imagery that occurs just before awakening is called hypnopomic. Hallucinations are images that are based on internal information that has gained some personal importance and a high degree of intensity (Horowitz in Sheehan, 1972, p. 286). There is some evidence to suggest that people who pay attention to their imagery and have the ability to form images deliberately are less likely to develop hallucinations when under extreme stress than persons who do not generally attend to their imagery (Horowitz, 1970; Richardson, 1969; Thale et aI., 1950). Eidetic images are another interesting kind of imagery. These are images that are almost photographic in clarity and fidelity. They differ from hallucinations in that the person having them usually recognizes them as being subjective in nature. Children are more likely than adults to have eidetic images. Few adults retain the ability to form eidetic images in maturity. Most images of adults remain vague and fragmentary most of the time. Imagination is the power to create mental images. This is an internal, private level of mental activity that is not accessible to an outside observer unless the person having this level of mental activity chooses to make it available to the outside observer either verbally or in some other form of expression, such as a gesture, a sound, or a visual representation.
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WilliamJames thought that images are born out of sensations. Sensations, once experienced, modify the organism so that copies of the original sensations arise again in the mind after the original outward stimulus has disappeared. James termed imagination the "faculty to reproduce copies of originals once felt" 0ames, 1890, II, p. 44). If these copies are literal, the imagination may be termed "reproductive" or memory imagery. When elements from different original experiences are recombined into a new whole, James termed it "productive." Another term for it is "imagination imagery." And mental pictures formed from data freely combined, not recreating exactly any past combination of data, are "acts of imagination properly so called" Oames, 1890, II, p. 45). On the basis of his extensive studies in this area Gazzaniga maintains that memory or the so-called reproductive imagery is not simply a property of the actual visual system. It is "computation." It is already a cognitive act (Gazzaniga, 1985, p. 132). Memory images result from selective perception and selective recall. Only the salient features of the remembered event are encoded. Consequently, both memory images and imagination images are creative products of the mind.
Preferred Sensory Modality of Imagery An individual may have a preferred sensory modality for experiencing and expressing internal images. Some people depend on sight, others on hearing in order to remember some piece of information. A visually-minded person is inclined to transform kinesthetic and tactile experiences into visual symbols. In contrast to the visualizers, the socalled haptics (from the Greek word for "touch") depend primarily on bodily sensations of touch for orientation when encountering an experience. For the haptic the main intermediary between sensation and cognition is the body itself. While the visually inclined person casts information in visual terms, the haptics proceed the other way around. They tend to recast visual perceptions into touch and movement. Lowenfeld (1952) found in his studies that some 47 percent of his subjects were visually minded while some 23 percent were haptic. The remaining 30 percent were mixed type. Studies confirm Lowenfeld's observations, and, it is interesting to note, the visualizers and the haptics differ in their preferences for art media. The visualizers tend to be more drawn to two dimensional forms of expression such as drawing
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and painting while the haptics are more inclined to use three-dimensional forms like sculpting when portraying their images. Regardless of individual preferences, by and large, the visual sense is the primary channel of information for most people in contemporary society. Furthermore, everyday language reflects the intimate connection between seeing and knowing. The word "idea" comes originally from the Greek word "idein" which means "to see." Many words in common usage link thought with vision. For instance, we talk about insight, foresight, hindsight, and oversight to indicate several kinds of knowledge. Many common expressions connect thinking and vision, as the following: "SEE what I mean?", "LOOK at this from another VIEWPOINT," "FOCUS on the details," "examine the big PICTURE," "take a larger PERSPECTIVE." Often the terms "to know" and "to see" function as synonyms and can be used interchangeably. In summary, images are capable of denoting as well as connoting things from which our senses originally derived the image. Images are the spontaneous embodiments of general ideas (Langer, 1942/1951, p. 128). Recognition images appear to be the first step in the mysterious process of transformation of sensations into perceptions. Once we can form an image we can start making sense out of the stream of events surrounding us. Recognition images, once noted and labeled, serve as tools in understanding new events and experiences. Knowledge grows and develops through this symbolizing ability of the mind. What are the roots of symbol formation? The process of symbolization is essentially a matter of finding an appropriate metaphor to designate the salient similarities and differences between objects we know and objects we wish to understand better. Metaphors are the building blocks of abstractions, and abstractions create systems of several forms of symbols.
Images and Metaphors Jaynes has called attention to the fact that thought is basically a process of finding and applying appropriate metaphors to the events or objects we are trying to understand. A metaphor uses a term for one thing to describe another thing because of a similarity between the two. Metaphors increase the power of perception and understanding. To understand something is to arrive at a metaphor for that thing by substituting something already familiar for an aspect of the unfamiliar. The
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resulting feeling of familiarity is the feeling of understanding Gaynes, 1976, 49ff). A metaphrand is the thing to be understood. The elucidator is the metaphier. The human body is a rich source of metaphors and provides numerous metaphiers. For instance, we refer to the head of a table, a head of a bed, a head of a household, a head of a nail; the face of a clock, card, cliff, or the teeth of a comb, the lip of a crater, and the lip of a pitcher. We have arms of chairs and legs of tables. Language grows through metaphors. Metaphors create new objects. Language itself is a "rampant restless sea of metaphor." "Abstract words are ancient coins whose concrete images have worn away with use in the busy give-and-take of talk." Jaynes suggests that in prehistoric times, language and its referents "climbed up from the concrete to the abstract on the steps of metaphors" Gaynes, 1976, p. 51). To understand, then, is to grope for, to find, or to create an appropriate metaphor that represents the main features of the thing we are trying to understand. In finding an appropriate metaphor one discerns the salient similarities and differences between the metaphier and the metaphrand. Metaphors, once created, eventually become firm concepts, that is, specific designations for a particular class of objects. The mind seems to be a metaphor creating agency. As we create metaphors we try to embody them into something tangible. We are constantly attempting to explain our vague notions by finding some concrete designation for them. James observed that this process of groping for knowledge entails a process of concretization. Inward images "tend to attach themselves to something concrete" so as to gain a certain degree of "corporeity" Games, 1890, II, p. 305). This "corporeity" or concretization may be achieved through words, gestures, chalk marks, straws, etc. "As soon as anyone of these things stands for the idea, the idea seems to be more real." EvenJames when lecturing used a blackboard to symbolize his ideas through lines, circles, and squares Games, 1980, II, 305ff). Here we have the leap of an idea from an image to a symbol. Once discerned and somehow designated, the idea can be retrieved from the flux of experiences much more readily.
Images and Symbolization The beginning of the process of symbolization occurs when an idea attaches itself to something concrete. A symbol is the skirt worn by an image so it can participate in social discourse. When the situation
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demands it, we can remember and apply an image which has been labeled or designated, either lexically or visually. Symbol may be defined as anything that stands for or represents anything else, by denoting, depicting, or exemplifying it (Goodman, 1978). Goodman calls attention to the fact that we have a wide range of symbols. Some symbols exemplify and express, while others denote. Words are the distinctly denotative symbols. Diagrams, graphs, staff notations in music, and some dance notations also denote. According to Goodman's theory, symbols differ on five variables. First, to the extent to which their meaning is "dense," that is highly condensed, and then, in that some symbols may have several of their aspects changed and still retain their meaning. For instance, in a Hokusai single-line drawing every feature of shape, line, and thickness is essential. But the same line may serve as a chart of daily stock market averages where only the height of the line above the baseline matters. The five variables on which symbols differ, and thus different symbol systems may be distinguished, are: syntactic density, semantic density, relative repleteness, exemplification, and multiple and complex references (Goodman, 1978). Only some categories of symbols are discrete, factorable, and conform to rules for combining their features. Other classes of symbols consist of inseparable or unfactorable constituents. Much of the contemporary argument over the symbolic nature of mind is contaminated by the assumption that only the discrete or language-like objects are properly a symbol. Contemporary congitivists have not appreciated the fact that pictures are also symbols (Kolers, 1983, p. 146). Nondescriptive, nonrepresentational paintings function as symbols for features they possess either literally or metaphorically. What does not denote may still refer to an object by exemplification or expression. Serving as samples of some sharable form, such symbols focus attention upon features otherwise unnoticed and neglected. Certain feelings may be highlighted by some symbols. They may induce a reorientation of our customary world in accordance with these newly emphasized features, "thus dividing and combining erstwhile relevant kinds, adding and subtracting, effecting new discriminations and integrations, and reordering priorities" (Goodman, 1978, p. 105). There are several levels of symbols. A word is a symbol. Certain words when used precisely, become concepts. Concepts are symbols. So are signals and signs. Symbols are aggregates of meaning. Meaning
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may be packaged in various ways, ranging from sounds to designations for sounds, from visually perceived objects to pictures, and so on. Every sensory modality produces a distinct class of symbols. Goodman's suggestive variables may be utilized to sort symbols into several categories. Brunner's distinction between the three models of the world is another approach to differentiating between the different kinds of symbols. Brunner describes the enactive, iconic, and symbolic representations of information (Brunner, 1964). Horowitz recasts Brunner's model by shifting the designations of the three systems slightly to enactive, image, and lexical modes of representation (Horowitz, 1970). Paivo (1971) goes a step further and suggests that we can represent the world in two different but redundant coding systems: the pictorial mental representations, also called the analogue, spacial, or visual system, and the propositional representations, also called the linguistic, or the language like, or the symbolic system. It is important to note, however, that written language is both visual and verbal. As Goodman points out, "symbolic" is not a concept that applies only to one of these two systems of representation. It applies to both. For this reason the terminology proposed by Susan Langer in her influential work, Philosophy in a New Key (1942), is more appropriate for these two coding systems. Langer differentiates between what she terms the discursive, sequential, language-like form of representation and the nondiscursive, presentational manner of encoding meaning. This debate has extended over many decades and is by no means over. But it is important to keep in mind that images are also symbols and thus are an essential part of cognition.
Ahsen's Triple Code Model of Imagery Ahsen's Triple Code Model clarifies further the function of images. Images do not simply copy reality, they transform it. Every image is a compressed metaphor. A metaphor brings together two otherwise distant realities. A metaphor is not a mere analogy. It does not just compare or provide a different name for the same thing. Rather, it is an edited version of reality. Image abstracts features from the thing which gives rise to it. An image is a "first order fiction." It is a kind of a mutant which links sensation with cognition. An image, like a metaphor, points beyond itself. Thus, an image provides not only sight but insight (Ahsen, 1986).
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In every image we have a somatic component, a cognitive meaning, and a representation in one of the sensory modalities. According to Ashen, the basic unit of psychological experience which entails imagery is an ISM sequence. Images are neither purely mental nor purely physical. They are both. An image contains experiential, somatic, and semantic features. Ahsen's model proposes that there are always three inseparable components in an image. One is the quasi-perceptual experience in consciousness (I). The second is a psychophysiological component, or a somatic response (S) and the third is interpretation, or a meaning in the verbal-semantic system (M). This triple "ISM" code is normally present for all imagery all the time. Images, in whichever sensory modality, are never free of associated emotions and thoughts. They are both stimulus and response. And every image is a product of both memory and imagination.
The Concept of Systems Ahsen's view of imagery would seem to underscore the point that, like everything else in this world, images themselves form a kind of a system. A system, as discussed in Chapter 2, is an organized collection of interrelated elements characterized by a boundary and a functional unity. The boundary may fluctuate between various degrees of permeability. An image is a system and as such it functions as an entity. It consists of parts which are interrelated. It is destroyed if we slice it up and try to isolate any of its three main subsystems. The subsystems I, S, and M may have different degrees of predominance in different types of imagery, but they are all there all the time. The three subsystems of imagery may appear in different order at times, e.g., there may be MIS, MSI, etc. But whatever the order of the subsystems, an image is always accompanied by a somatic response which may be either skeletal, proprioceptive, motor-neural, sensory, and so on. And there is some meaning or significance attached to it. Not only are images themselves best thought of as systems, but images invariably become part of a larger system. Images consist of subsystems ("ISM"), and images are subsystems in larger systems. This larger system is cognition, or as I prefer to term it, the system of codification. In comprehending the phenomenon of imagery, the systems approach proves to be the most appropriate model of reality. Reality
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does not come neatly sorted out in layers. It is not a "layered look" but rather an interconnected, intertwined arrangement that can be sliced neither vertically nor horizontally. There is an "all at onceness" in reality and its many components. Ahsen's Triple Code Model, although it does not specifically refer to the systems concepts nevertheless presents clearly the basic character of images that is compatible with the systems idea. The three aspects of images may be thought of as having boundaries that have various degree of permeability. There is an exchange of information between the three subsystems. As in any other system, we can postulate feedback loops for each subsystem which regulate each of them in relation to the entire system, in this case, the imagery. Imagery, in turn, functions as a subsystem in a larger system which I term the system of codification. The system of codification is a hypothetical construct I have introduced to comprehend cognition, this still enigmatic phenomenon that has perennially perplexed epistemologists and psychologists alike. It is first necessary to consider the two styles of thought each of which appears to have a specific psychoneurological base and is accompanied by specific physiological consequences.
Two Types of Cognition The notion that we have two distinctly different styles of symbolization was well accepted among artists long before neurological sciences provided empirical evidence concerning the differential functioning of the two hemispheres of the brain. For instance, at the turn of the century, Benedetto Croce, the noted Italian philosopher of aesthetics, suggested that there are two forms of knowledge. One form of knowledge is intuitive and is obtained through imagination. The other is logical, attained through the intellect. Croce believed that imagination precedes rational thought and is indispensable to it. Thus, the artistic image-forming activity of the mind predates its logical, concept-forming activity (Croce, 1929). Similarly, Susan Langer, a prominent disciple of Ernst Cassirer, describes two distinct forms of mental activity or two ways of presenting information. One is discursive, the other is presentational. The discursive modality is employed by language. It strings out ideas side-by-side, as clothes on a clothesline, or beads on a string. We can-
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not talk in simultaneous bunches of words. But ideas, like clothing, are actually worn one over the other. We find ideas, like clothing, crowded one on top of the other. Presentational symbolism operates far below the level of speech. The mind reads this kind of symbolization in a flash. Presentational symbolism consists of visual forms-lines, colors, proportion, and so on. And this form of encoding is just as capable of conveying meaning as are words. But according to Langer, the laws that govern this sort of articulation are altogether different from the laws of syntax that govern language. The most radical difference is that visual forms are not discursive. They do not present their constituents successively, but simultaneously. The relations determining a visual structure are grasped in one act of vision. Consequently, unlike discourse their complexity is not limited by what the mind can retain from the beginning of an apperceptive act to the end of it (p. 86). The nondiscursive mode speaks directly to the senses. Langer thinks that language is a very poor medium for expression of emotions. It cannot convey the ever-moving patterns, the ambivalences and intricacies of inner experience, the interplay of feeling with thoughts and impressions, memories and echoes of memories, and transient fantasy (p. 92). For this kind of information the presentational style of thought which uses visual forms or auditory sounds, is more effective. Image-making is a form of thinking in the nondiscursive modality. According to Langer, "Images are our readiest instruments for abstracting concepts from the tumbling stream of actual impressions. They are our spontaneous embodiments of general ideas" (Langer, p. 128). Mozart's description of his manner of composing exemplifies Langer's nondiscursive modality. Mozart said that first bits and crumbs of the piece he was working on appeared and gradually joined together in his mind. "Then, the soul getting warmed to the work, the thing grows more and more, and I spread it out broader and clearer, and at last it gets almost finished in my head, even when it is a long piece, so that I can see the whole of it at a single glance in my mind, as if it were a beautiful painting or a handsome human being ..." (quoted by James, 1890, I, 255). Note that even Mozart, whose auditory sense was undoubtedly of paramount importance, still resorts to visual metaphors when trying to explain his thought processes. Here again we have the intimate connection between thought and the visual sensory modality.
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Mozart goes on to describe yet another feature of the nondiscursive process of symbolization-its simultaneity: "... I do not hear it in my imagination at all as a succession the way it must come later but all at once, as it were. It is a rare feast! All the inventing and making goes on in me as in a beautiful strong dream. But the best of all is the hearing of it all at once" (inJames, 1890, I, 255). Creative people generally are those who are able to utilize both systems of symbolization, discursive and nondiscursive. In his famous letter to Jaques Hadaman, Albert Einstein highlighted the importance of the presentational or the nondiscursive style of symbolization in his thought. He stated that neither written nor spoken language played a role in his thought processes. For him the entities which seemed to serve as elements of thought were certain signs and more or less clear images which he could deliberately reproduce and combine. He described these elements of his thought as being visual and at times muscular. He would seek for words only in a later stage of thought and finding the appropriate words was a laborious process, coming only after "the associative play" was sufficiently established and could be reproduced at will (Einstein in Hadaman, 1954). Each style of thought has its advantages and drawbacks. When we give the image a name or another type of designation, we have a symbol. Now instead of dealing with things directly we can deal with their stand-ins, their symbols, and thus save time and energy. But the symbol may not contain the entire meaning of the original entity. This is a drawback associated with the discursive style of thought. In most instances it is clear and precise, but it is removed from the source of the original idea. On the other hand, one of the complications with presentational symbols is that they may condense the meaning to an extreme extent. It has been estimated, for instance, that in two seconds we can dream the equivalent of 2,000 words (Osborn, 1953).
Hemispheric Differences The two styles of cognition just described have a neurophysiological basis. Since the epoch making work of Roger Sperry which earned him the Nobel Prize in 1981 it has been generally acknowledged that the two hemispheres of the brain are differentially engaged in the process of handling information. The left cerebral hemisphere which in righthanded individuals controls the right side of the body is more active
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when the person is engaged in intellectual, analytical, verbal, and sequential styles of thinking. The right hemisphere which in right-handed persons governs the muscles of the left side of the body, is more active when the person is engaged in intuition and holistic, Gestalt-type activities, in spacial thought, fantasy, imagery, and daydreaming. When we speak, write, calculate, reason, classify, and name, the left hemisphere of the brain is more active than the right one. When we sing, draw, enjoy colors, listen to music, daydream, or engage in sports that require awareness of space and movement, we activate predominately the right side of the brain. In one study, six-month-old babies were held in their mothers' laps and had electrodes attached directly over the area of the left hemisphere of the brain which is thought to control speech. Electrodes were also attached over the corresponding area of the right cerebral hemisphere. When a tape recording of speech was played, the left hemisphere showed greatest activity. When a tape of music was played or when someone sang, the activity of the brain was greatest over the right hemisphere. It is possible that lullabies stimulate child's later development of functions lodged in the right cerebral hemisphere ayne, 1976, p. 367). Individuals with well developed right cerebral hemispheres may be more inclined to function with the presentational symbols than people whose right hemispheres have received less stimulation. Also it may be noted that there are differences between males and females in this respect. The distinction between the two cerebral hemispheres are somewhat less pronounced in women than in men. Psychological functions in females are not as sharply localized into one or the other hemisphere of the brain as they are for males but appear to be spread over both hemispheres. In females the language functions are also performed to some extent by the right hemisphere. Consequently, the same extent of brain damage in the left hemisphere due to stroke, for instance, leaves women less incapacitated than men. The two cerebral hemispheres are richly interconnected through the corpus collosum. Many of the sensory systems send signals to both hemispheres. All thought is both analytical and synthetic. When enjoying the musical rhythms we engage the experiential, synthetic, analogical processes. But as soon as a rhythm is noticed as a repetition of another previously heard passage, or as a subtle transformation of a rhythm heard earlier, we activate a different set of brain cells which process information analytically and sequentially. We can fluctuate
a
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HEMISPHERIC DIFFERENCES
RIGHT HEMISPHERE
LEFT HEMISPHERE
(The "romantic" side)
(The "logical" side)
Dominates the left side of the body and more active in:
Dominates the right side of the body and more active in:
holistic thinking; intuition, imagination metaphoric thinking, synthesiz ing recognition of faces, perception of gestalts, shapes, sizes, colors, textures, forms; dreaming
intellectual, analytical tasks; sequential, focal, verbal, rational, logical thinking; speech, grammar, naming; math; music (trained).
ESP,
The logician, accountant, linguist.
mediation, music (untrained), drawing, depth perception, complex visual patterns.
Digital codification of information: one aspect at a time
The artists, inventor, innovator. Analogic codification: a multitude of ideas condensed in an image; all at once; patterns; wholes.
Figure 3-1. Hemispheric Differences.
with reasonable ease between the two styles of information processing. This flexibility permits us to understand and be creative (Norman, 1977). It is well to keep in mind that the hemispheric asymmetry is a matter of predominance rather than a matter of exclusion. Everyone is capable of both styles of thought (Ahsen, 1981) although our Western civilization has given preference to the styles of reasoning associated with the left hemispheric activity. This one-sidedness is minimized when the psychocybernetic model of psychotherapy is utilized. The advantage of this modality of intervention is that it demonstrates ways of engaging both styles of thought and thus promotes greater creativity and better problem solving ability than when only a portion of one's cerebral equipment is activated. Images are not inert. Images both consume and produce energy. No longer can we dismiss imagery as an epiphenomenon that merely accompanies but does not influence behavior. Images are not like shad-
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ows that simply tag along but do not influence what happens to the pedestrian. Empirical evidence is accumulating to support the contention that specific physiological changes occur in the organism when we engage in different kinds of imagery. Happy images produce different physiological changes than sad images. A wide range of measures have been used to study these physiological concomitants of imagery and a substantial body of evidence has been reported to indicate that different patterns of physiological responses accompany different types of affective images (Qualls, 1982-83, p. 92). Images of fear and anger, for instance, are associated with increased heart rate and systolic blood pressure. As indicated in Chapter 2, the fact that imagery is accompanied by various physiological changes is now put to work in health care through a number of biofeedback devices. Defusing the potentially noxious imagery a person may be harboring is also one of the functions of the psychocybernetic model of intervention. The psychocybernetic model is a method to attain a cerebral ambidexterity whereby a person can utilize both methods of information processing, the discursive as well as the presentational styles.
The Process of Codification Nothing has been more thought about than thought itself, and still nothing is understood more poorly than this mysterious human attribute. For many decades psychologists tried to circumvent its awesome complexity by following in Watson's footsteps and leaving the process of thought largely out of their calculations. What transpired in the human mind was simply the "black box" which was taken for granted but not subjected to further scrutiny. Psychologists made a Ll-tum when the cognitive theory started taking shape, spurred by the work of Piaget and others. Problems previously left up to epistemologists and other philosophers are now beginning to receive attention. Instead of talking about "thought" and "thinking" contemporary psychologists prefer to use the term "cognition." The definition of this very term, however, is still controversial. To some it designates "all the processes by which sensory input is transformed, reduced, elaborated, stored, recovered, and used" (Neisser, 1967). Other cognitive theorists consider this definition to be much too broad and loose. This group of theoreticians prefer to confine the concept of cognition to the study of
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the organization of perceptual data according to fixed principles. They search for the underlying logic and rules of perception and learning. Robinson, for instance, defines cognition as the study of the possession and application of valid rules of deduction and inference in a manner appropriate to a given problem (Robinson, 1979). Cognition may be better understood if we think of it as being essentially a process of classification. Once we have found a metaphor or a designation of some kind for a thing, we have categorized it. To categorize is to render discriminably different things equivalent. To categorize is to group objects and events into classes to which we can respond more readily and more easily than when we have to discern and find an appropriate response to each item on the basis of its individual characteristics. Once the object is placed in a category, we can respond to it in terms of its class membership. The term "categorization" and "classification" have an aura of intellectualization about them and both have a tinge of the so-called "left brain" processes. Actually, when we attempt to classify or categorize an object, both the left and the right hemispheric styles of symbol formation are activated. Therefore, to avoid misunderstanding, it appears to be more expedient to introduce a new term to designate this process. I have chosen to term this the process of codification to acknowledge the contributions of both cerebral hemispheres and their attendant thought processes to cognition, instead of using the concepts of classification or categorization. The process of codification designates those aspects of psychological functioning whereby objects, both physical and social, are appraised and responded to. This process is hypothesized to consist of subprocesses of perception, evaluation, and classification as an individual assesses one's present and past experiences. Codification combines both the intellectual and the affective aspects of psychological functioning, and it is accompanied by action tendencies. To codify is to note, classify, evaluate, both intellectually and affectively, similarities and differences between objects. The more readily a situation or a constellation of factors is recognized as having aspects similar to a constellation of factors known and dealt with previously, the more readily and effectively it can be responded to (Nucho, 1966). Distinguishing similarities between objects is functional in that it facilitates the ordering of objects so that appropriate behavior patterns may be instituted with minimal expenditure of time and energy.
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A concept akin to codification is Kelly's definition of a construct (Kelly, 1955/1963). To construe means to place an interpretation upon what is construed. When a person forms a construct, "a structure is erected within which the substance takes shape or assumes meaning." The substance does not produce the structure; the person does (p. 50). Kelly's term "construct" combines the features of a concept with that of a percept. A construct is a personal act that involves forming an abstraction (Kelly, 1955/1963, p. 69f).Just as countless previous generations of thinkers, Kelly wrestled with the mystery of how and by what process a perception becomes a cognition, or if a perception already implies a concept. The term "construct" tried to chart a middle course between these two notions. To construe or, as I prefer to call it, to codify an object is to assign it to a category in order to know what meaning it has for us, what value, what it portends for us. It is not just an intellectual process but a matter that entails our entire being. Once formed, the system of codification requires validation, that is, synchronization with the systems of codification devised by other people in our network of relationships. It also requires constant updating and revising as additional information becomes available to us. When we encounter new objects or the same objects under different circumstances, we acquire new data which dictates that our system of codification be either modified or enlarged. As we encounter new objects and discover new aspects of objects already codified, we have to recodify them and reclassify them, using all our sensory modalities. The process of updating one's system of codification may be thought of in terms of assimilation and accommodation, the two terms proposed by Piaget (1962). Assimilation fits an object into the categories or "schemes" already devised in one's system of codification. Accommodation, on the other hand, reshapes, revises, expands, or contracts one's categories. The process of codification is much like eating an ice cream cone. There are two possibilities for the fit between the cone and the scoop of ice cream resting in it. It is either perfect, in which case there is no problem, or it is faulty-too small for the given amount of ice cream, whereupon the ice cream flows over the sides. A larger cone would solve this difficulty. This situation requires what Piaget termed "accommodation." Accommodation is the process of revising the "container"
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in one's system of codification. The slots or categories of one's system of codification are expanded. Another set of circumstances might prompt the creation of a series of new "containers." The process of assimilation is the process of absorbing the incoming information into the already created "containers," "schemas," or categories. In other words, the amount of ice cream is appropriate for the size of the cone. In the real world, however, a perfect fit between the incoming information and the system of codification, is rare. As we grow and change we encounter new conditions, new objects, new relationships. The fit between the influx of data and the system of codification we have devised does not remain perfect for long. The expansion and retraction, the revision and the updating of one's system of codification is a never-ending task. It is interesting to note thatJames viewed the mind much like this process of codification. He said that the mind is like a sort of a sieve. We devise conceptual schemes in which we try to gather up the world's contents. Most facts and relations fall through its meshes, being either too subtle or too insignificant. "But whenever a physical reality is caught and identified as the same with something already conceived, it remains on the sieve, and all the predicates and relations of the conception with which it is identified becomes its predicates and relations too" Games, 1890,1,482). Information arrives constantly from two sources, from the outside world, and from within the organism itself. Information arriving from the external world is received by the so-called exteroceptors, or the sensory organs. The information that comes from the states and conditions of our own organism is received by the so-called interoceptors. For instance, you may register the fact that you feel hungry, and signals are sent to the leg muscles to take you to the refrigerator. Most signals of this kind, fortunately, are taken care of without conscious deliberations. The subconscious is the subsystem in the process of codification that refers to all those psychological functions that are not directly available to conscious inspection during one's customary waking states. This subsystem nevertheless does influence one's behavior and experiences. Freud called this the Unconscious. We do not respond to all information surrounding us. We are aware of some information while other types of information are seemingly
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overlooked. There appears to be an automatic process of selection, as if there were some kind of filter at work. Freud's term for this filtering process was the "censor." Some of the incoming data receive top priority while other information remains ignored. The information that has some relevance to our survival or to the sense of self tends to receive immediate attention. Frequently, as we have all experienced, other words remain unintelligible while the very mention of one's name is heard over the din of conversation in a crowded room. Memory is another component that shapes the process of codification. The incoming information is either diluted or enriched by the information already in the system. We appear to have a short-term memory and a long-term memory. Information stored in the short-term memory disappears into the subconscious quickly unless attention is deliberately directed to this data and thus it is transferred to the longterm memory. Information in the long-term memory remains available after long periods of time. Our general sense of space/time affects how we codify an experience. This component of the system of codification refers to our sense of the flow of time and the structuring of space. It is a combination of our cultural heritage, learning, and internal biological rhythms. The amount of incoming information is immense. Information that is not immediately relevant to our concerns and preoccupations is relegated to the storage termed "subconscious." Information that is repetitive may also end up in the subconscious portions of the system as we habituate to this information and no longer pay conscious attention to it. The categories in which the information is stored are our symbols. The very term describes well this aspect of the process of codification. The word "symbol" comes from the Greek word "syn" meaning "together" and "bolein" which means "to throw." To symbolize is to throw together, as it were, or to group together, information that is perceived as having some common features and therefore as belonging together in one category. To encode information is to symbolize it. Two kinds of symbols are possible for this process of encoding, as we indicated earlier in this chapter. The one form of encoding or symbolization is what Langer termed the discursive symbols. These are the linear, logical, rational, verbal symbols which appear to engage predominately the left cerebral
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hemisphere. The other type of symbols are the presentational or the nondiscursive kind. Here the information is presented visually, auditorilly, kinesthetically, or in any other sensory modality rather than lexically. While the discursive symbols handle the information analytically, the presentational symbols present the information synthetically and holistically. When processing the information discursively the mind functions as a spotlight. When using the presentational symbols, the mind functions as a floodlight. The process of encoding which engages predominately the left cerebral hemisphere results in words. The process of encoding based largelyon the right hemispheric functioning produces images. These images are portrayed visually when the psychocybernetic model of psychotherapy is used. This model combines and utilizes both forms of encoding, the discursive lexical as well as the presentational or pictorial forms of encoding of information. Western civilization has largely ignored or devalued the presentational forms of symbolization. Sufficient amount of empirical evidence has accumulated in recent years to underscore the importance of imagery. There are at least three profound reasons to pay attention to one's imagery. For one, as we have found, images are the building blocks, the ingredients of thought. They form an indispensable part of our cognitive equipment. Two, images have psychophysiological consequences. As discussed earlier, images trigger biochemical changes in the organism, for better or for worse. And three, images prompt action. What we imagine affects how we act. The psychocybernetic model of helping is the method by which one pays attention-effectively and constructively-to one's imagery. A diagram in Figure 3-2 shows the components of the system of codification. This diagram includes several ideas suggested by Tart (1977). It is important to note that each component of the system of codification affects and is affected by every other component of the system. The multiple feedback loops are indicated in the diagram by the arrows interconnecting the various components of the system.
Systems and Cognition The process of codification functions as a system. As in any system, the various components that constitute this system may be thought of as having boundaries which may be more or less permeable, depend-
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<
< Feedback via external world
MOTOR EFFECTOR SYSTEM
=t> .
Feedback via the body
(
(
Figure 3-2. The Process of Codification.
ing on the particular information that is being dealt with and the conditions under which it is handled. The sense of self, for instance, is always there but it may be less involved when processing some objective data than when dealing with some aspect of a personal relationship. Until quite recently, psychologists have tried to understand the functioning of the mind by examining discrete parts of the system. The advantage of the concept of codification is that it emphasizes the systems characteristics of cognition. The interrelatedness and the multidirectionality of the process has to be kept in sight if we want to do justice to this miraculous ability to think and acquire knowledge. It is a mistake to isolate and study separately the components that constitute cognition. Before the systems approach became known in behavioral sciences, the experimental paradigm prompted the examination of each component of the process separately. But this was like trying to learn about the nature of an elephant by making a detailed examination of one of its toes, to use the apt metaphor coined by Marks (1986). Although the systems approach is relatively recent in behavioral sciences, the notion of a systems approach was already foreshadowed, sensed, and obliquely formulated by great minds before the turn of the century. James, for instance, criticized the tendency of his contemporaries to isolate discrete phenomena instead of studying their inevitable interconnectedness. He said that psychologists tend to study phenom-
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ena as if to say that a river consists of nothing but "pailsfull, spoonful, quart-pots full, barrelful, and other molded forms of water. Even were the pails and the pots all actually standing in the stream, still between them the free water would continue to flow." He went on to say that "every definite image in the mind is steeped and dyed in the free water that flows around it. With it goes the sense of its relations, near and remote, the dying echo of whence it came to us, and the dawning sense of whither it is to lead."James then highlighted the function and importance of images in cognition by pointing out that the significance and the value of the image is "all in this halo or penumbra that surrounds and escorts it,-or rather that is fused into one with it and has become bone of its bone and flesh of its flesh" Games, 1890, I, 255). This is what can be accomplished best with the methods that constitute the psychocybernetic model of psychotherapy. By examining the images of things already experienced we create new images of "that thing newly taken and freshly understood," to useJames's phraseology. James appreciated the power of images long before images became fashionable in contemporary cognitive theory.
Conclusion The problem of cognition has daunted humanity since before the dawn of history. Life itself may be thought of as a process of acquiring, sorting, storing, retrieving, and applying appropriate information. How we think and what facilitates thought are questions that take us to the very heart of epistemology. As Titchener put it, asking how thought arises is to "discover a hornet's nest: the first touch brings out a whole swarm of insistent problems." It is necessary to raise these questions because images are a form of cognition, and a central component of the psychocybernetic model. Codification clarifies this mysterious process of how information is acquired and how sensory impressions are transformed into thought and symbols. Many great minds have grappled with this mystery. Some philosophers held that the phenomena of mental life, such as feelings, desires, cognitions, reasoning, and decisionmaking powers, are manifestations of the "soul." These faculties were the "absolute properties of the soul" which were not capable of being further elucidated. The associationists like Hume, Mill, Herbart, and others "described the dance of ideas," and the "weaving of an endless
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carpet of ideas," but "whence do ideas get their fantastic laws of clinging" still remained a mystery 0ames, 1890, I, 11). This much is certain: images are an essential ingredient of cognition. Cognition is a matter of encoding information in the presentational and/or the discursive modality of symbolization. Images arise spontaneously in the mind, especially when strong emotions are experienced, and images can be created deliberately. What to do with the spontaneously arising images and how to stimulate the creation of images so that profound personal experiences may be sorted out and dealt with, is detailed by the psychocybernetic model described in subsequent chapters. Images are not just byproducts or epiphenomena that can be safely ignored. They are powerful cognitive tools. This long neglected form of symbolization has relevance for one's life and for its redirection. When we are at an impasse in life and have to reorient ourselves, we reach out to friends or we seek psychotherapy. In psychotherapy we reexamine our basic assumptions, that is, our system of codification. We search for ways of updating the categories we normally apply. Images help us to remodel our systems of codification. Images permit us to deal with ideas while they are still pliable. With the help of images we can reshape our thoughts before they become set and ossified. When we pay attention to our images we can do a more thorough job of remodeling our manner of viewing and encoding events than when we deal only with the verbal level of symbolization. To paraphrase Pascal, words and images when arranged differently have a different meaning. And meanings differently arranged have different effects on us. Once we understand events differently, we can react to them differently, and they will have different consequences in our lives. This is what the psychocybernetic model of psychotherapy is all about. It is a process of rethinking and recodifying our assumptions and conclusions with the help of both symbol systems. It helps us to function as cognitive amphibians, so that we can use both symbol systems, the discursive as well as the nondiscursive, and in this manner we activate more than the customary amount of brain cells. We become more creative and more capable of solving the dilemmas life confronts us with. How to use both the discursive-verbal and the pictorial-presentational systems of codification are the topics of chapters that follow.
Chapter 4 THE MERGING OF ART AND THERAPY his chapter traces the origins of some of the precursors of the psychocybernetic model. The psychocybernetic model of psychotherapy is a combination of the verbal-rational-analytic thought processes with the holistic-intuitive-presentational modalities of cognition. These two styles of cognition remained far apart in the major forms of interpersonal helping until rather recently when finally the "ostracized" concept of images returned from the exile to which the early behaviorists had banished it, as Holt described it in his much celebrated article (Holt, 1964). In the last decade imagery is increasingly being used in stress management (Lazarus, 1984), in health care (Achterberg & Lawlis, 1980; Ahsen, 1977; Korn &Johnson, 1983; Simontons, 1978), and several forms of expressive therapies are flourishing (Chaiklin, 1975; Lerner, 1978; Tyson, 1981). The expressive therapies cultivate and apply the nondiscursive-presentational forms of cognition. Of all the types of expressive therapies the one of special relevance for the psychocybernetic model is art therapy. The incorporation of the visual arts in interpersonal forms of helping has been slow and tenuous. This chapter explores the gradual process of harnessing the power of visual expression for interpersonal helping. It details some of the major currents of ideas that eventually coalesced to form the discipline of art therapy. It notes the contributions of the main architects of this modality of helping, and marks several milestones in the history of art therapy chiefly as it evolved in the United States.
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"Go, Paint, It Is Good for Your Soul!" The beginnings of most things are shrouded in mystery, and in this respect art therapy is no exception. Art is, of course, as old as mankind. Through the centuries the power of art to soothe the human spirit has not gone unnoticed. In fact, quite a few of the leading professional artists became artists for their own "therapeutic" reasons. For instance, Utrillo, just nineteen and recovering from alcoholism, was urged by his mother to take up painting. Similarly, Matisse, recuperating from an illness, was advised to take up painting. Three years later, he gave up studying the law and, encouraged by a friends, enrolled in an art academy in Paris. Eventually, he became one of the foremost painters of his time. Goethe, the German poet and dramatist (1749-1832), author of Faust, took painting and drawing lessons when he was seventeen and recuperating from a hemorrhage. Although Goethe did not become a professional painter, he wrote important works on aesthetics and on the study of color (Goethe, 1810). There developed also a long line of so-called "Sunday painters" who enjoyed the benefits of visual expression. These amateurs were frequently scorned by the professional artists who regarded them as dilettantes and dabblers in the mysteries of the arts. Nevertheless, some of these Sunday painters were persistent enough to derive considerable enjoyment as well as health benefits from their avocation. Some of them managed to experience not only therapeutic effects from their painting but developed technical skill to an almost professional degree. Winston Churchill was a Sunday painter. After he lost his position at the Admiralty in 1915, and had to change from intensive executive activities to largely perfunctory duties of a counselor, his self-esteem, understandably, was quite bruised. "Like a sea-beast fished up from the depths, or a diver too suddenly hoisted, my veins threatened to burst from the fall in pressure," he wrote in his book, Amid These Storms (1932). Churchill went on to describe how he suddenly had long hours of utterly unwanted leisure in which to contemplate the frightful unfolding of the First World War. "At a moment when every fibre of my being was inflamed to action, I was forced to remain a spectator of the tragedy, placed cruelly in a front seat." He said that it was then "that the Muse of Painting" came to his rescue. Two years later, Churchill entered some of his works in an amateur art exhibit, and one won the
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first prize. The works were of such high quality that the judges, including Lord Kenneth Clark, suspected that they were actually done by a professional painter, not a hobbyist. Later, during the Second World War, when world events again reached a fever pitch, Prime Minister Churchill was able to use painting to relax and as a means to restore his energies. It is well known that President Eisenhower also enjoyed the soothing and healing powers of art. He also attained an almost professional level of proficiency in painting. Both he and Churchill are examples of what may be termed "art as therapy" branch of art therapy. Thus the notion of art as a healing power was well established in Western culture long before anyone had actually heard of art therapy as a discipline. The admonition, "Go, paint, it is good for your soul!" surfaced long before there was any inkling that art and therapy would eventually merge into a distinct modality of helping.
The Ancient Greeks The idea that art is good for you goes back at least to the ancient Greeks. Plato articulated this conviction clearly in his Republic and other works. In Plato's ideal state, the first ten years of life would be devoted to sports in order to develop a strong and healthy body. The Greeks believed that if the body is sound, the soul will be also. Athletics and gymnastics should produce strength and courage, but these two qualities had to be supplemented by still a third quality, gentleness, in order to make the soul graceful and just. This, Plato reasoned, would be accomplished through exposure to music, because music teaches harmony and rhythm. He thought that rhythm and harmony would find their way into the innermost parts of the soul and make the person fair and just in dealings with others. In Plato's ideal state, therefore, the child between the ages of 10 and 16 would study music. But just as exposure to athletics alone was undesirable, too much exposure to music was thought to be dangerous. According to Plato, to be merely an athlete was to be nearly a savage. To be merely a musician was to be melted and softened beyond what is good (Republic, 410). Rhythm and harmony are not confined to music alone but are the properties of all the arts. What Plato said about music therefore can be applied to the other forms of art as well. In fact, at Pergamon, the brilliant center of Hellenistic culture (c. 200 B.C.), the great gymnasium
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contained not only tracks, fields, and baths but also a small theatre for practicing oratory, and a studio for painting and sculpting (Muller, 1958). The power of art to persuade and soothe by conveying certain kinds of information explains the fact that the arts have been closely connected with religion throughout the history of mankind (Gombrich, 1972). The ability of art to transmit information may also account for the fact that many religions have found it necessary to warn their followers against false gods and the making of idols. Occasionally, when the messages conveyed by works of art were thought to be contrary to the teachings of the main segments of a given society, we find periods when iconoclasts and image-smashers were rampant. The qualities of balance, harmony, and rhythm are central to the power of art to heal and ennoble those who are exposed to it. To be an artist is to embody these much desired qualities. Dante, the medieval poet (1265-1321) declared, "Who paints a figure, if he can not be it, he can not draw it" (cited in Schachtel, 1959). The artist must become still, receptive, and a perfect echo of that which he endeavors to portray. By doing so he is transformed. Therefore, many European psychiatrists knowing these traditions, were interested in promoting and collecting the efforts at painting by mental patients. Among these psychiatrists, Prinzhorn (1922) was the best known. Prinzhorn collected some 5000 samples from psychiatric institutions in Europe, dating from 1890 to 1920. He also devised a system of classification of the works by the mentally ill, and he compared these works to works of children and to folk art. The idea about the beneficial powers of art was further promoted in the more recent periods of history by progressive education and its ideological undercurrents most of which can be traced back to the French philosopher Jean Jacques Rousseau (1712-1778). Rousseau held that man is good by nature but corrupted by civilization. Inasmuch as man is basically good, Rousseau thought that spontaneity and self-expression should be encouraged. Rousseau's ideas deeply influenced the thinking of many of Europe's great minds, among them Kant, Goethe, and Tolstoy. Whether specifically acknowledged or not, the ideas of Rousseau permeated the intellectual climate of the Western world and shaped the thinking of those people whose work eventually led to the formation of the phenomenon now known as art therapy. Among these thinkers the most prominent is CarlJung (1875-1961) who, although he
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did not use the term "art therapy," can be regarded as the father of this branch of healing.
Jung and the Method of Active Imagination Even though the beneficial powers of art were well recognized, art and therapy proceeded to develop on separate tracks over the centuries until they merged, finally, in the work of Carl Jung. Jung, the Swiss psychiatrist and psychologist, was an admirer and collaborator of Freud for many years. When the International Psychoanalytic Association was founded in 1910,Jung became its first president and held the position for four years. Freud referred to Jung as his "successor and crown prince." Gradually, however, a rift developed in their relationship. Jung was deeply interested in mysticism, primitive religions, rituals, and the oriental philosophies for which Freud had no taste or understanding whatsoever. To Jung, on the other hand, Freud was entirely too materialistic and ignorant of huge chunks of human history. When in 1909, he asked Freud's views -on precognition and parapsychology in general, Freud's answer seemed to Jung "so shallow a positivism" thatJung had difficulty in checking the sharp retort he had on the tip of his tongue Oung, 1961, p. 155). The two disagreed about Freud's theories of libido. Freud used the term in the narrower biological sense while to Jung libido meant a life force, not simply the sexual energies. For instance, in one of his works, Contributions to Analytical Psychology (1928), Jung commented that we ought to be able to recognize and to admit that "much in the psyche really depends on sex, at times even everything." Then he went on to say that at other times, however, little depends on sex, and nearly everything comes "under the factor of self-preservation, or the powerinstinct, as Adler calls it." He concluded, "At times sex is dominant, at other times self-assertion or some other instinct. When sex prevails, everything becomes sexualized, everything then either expresses or serves the sexual purpose" Oung, 1928). By 1913 the rift between Freud and Jung finally became so pronounced that their personal correspondence ended. The same year Jung decided to resign as the lecturer at the University of Zurich, a position he had held for eight years. He thought now that it would be intellectually dishonest to go on teaching young students when his own "intellectual situation was nothing but a mass of doubts" Oung, 1961, p.
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193). He was 38 years old and immersed in the study of mysticism and the unconscious but, as he put it, as yet he "could neither understand it nor give it form." The year before, he had completed and published his book, The Psychology of the Unconscious, but it was not well received in academic circles.Jung said that he was "utterly incapable of reading a scientific book at this time." This state lasted for the next three years Oung, 1961, p. 193). It would appear thatJung was undergoing what we would now term a severe "midlife crisis." But out of this suffering and crisis Jung gradually forged what we now call art therapy. From early childhood,Jung had been attracted to "beautiful things." He described his fascination with an old painting that hung in the parlor of his childhood home. At the age of six, an aunt took him to a museum. He found the Greek statues fascinating, and lingered well past closing time, unable to tear himself away. He felt "utterly overwhelmed," having never before seen anything so beautiful. He stood there, wide-eyed, unable to stop looking at the statues. As his aunt pulled him towards the exit, he trailed a step behind her, still trying to catch a last glimpse of the wonderful statues. His aunt was indignant, and shouted, "Disgusting boy, shut your eyes; disgusting boy, shut your eyes!" Only then didJung realize that the figures were naked and wore fig leaves. "I had not noticed it at all before. Such was my first encounter with the fine arts. My aunt was simmering with indignation, as though she had been dragged through a pornographic institute" Oung, 1961, p. 16). Jung's fascination with the fine arts persisted. Occasionally he did some water colors. They must have been of high quality because one of his friends urged him to become a professional artist. During this period, near the end of the First World War, Jung began to emerge from his "darkness," as he put it. He credited two events with bringing about his recovery. First, he made a decision to discontinue a relationship with the woman who was trying to convince him that his fantasies had artistic value. He also began to understand the meaning of the mandalas he was drawing Oung, 1961, p. 195). In 1918-1919,Jung was the commandant of a prisoners of war camp in the French-speaking part of Switzerland. Every morning he sketched in a notebook a small circular drawing, a mandala, which seemed to correspond to his "inner situation at the time" Oung, 1961, p. 195). With the help of these drawings,Jung said, he could observe his psy-
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chic transformation from day to day. "In them I saw the self-that is, my whole being-actively at work." He went on to say that at first he only dimly understood his drawings. Nevertheless he guarded them "like precious pearls. I had the distinct feeling that they were something central, and in time I acquired through them a living conception of the self" (p. 196). He noted that "When I began drawing the mandalas I saw that everything, all the paths I had been following, all the steps I had taken, were leading back to a single point-namely to the midpoint" (p. 196). Jung regarded mandalas as cryptograms which designated the state of one's mind. He understood the circular path towards development of the personality, and he thought that he had received confirmation of his theories which for so long had been puzzling even to him. It took ten years before Jung wrote about his experiences with the mandala drawings. By then he was firmly convinced that mandalas were symbols of wholeness which arose spontaneously in the mind as representations of the struggle and reconciliation of opposites Oung, 1961, p. 335). In 1928, while working with a patient from the United States,Jung finally arrived at a point where art and therapy merged harmoniously for him in what we now regard as art therapy. The patient, to whom Jung refers as Miss X, had visited Denmark, her mother's native country. While there, unexpectedly she had the desire to paint some landscape motifs. She had not noticed such aesthetic inclinations in herself before, and she had no ability to paint or draw. Nevertheless she tried her hand at water colors, and her modest landscapes filled her with a strange sense of contentment. Somehow the painting seemed to fill her with new life. After arriving in Zurich, she continued her efforts at painting. When she related these experiences and feelings to Jung, he naturally encouraged her to continue to paint. Jung thought that Miss X had discovered all by herself the "method of active imagination." Active imagination is Jung's term for what we now call art therapy Oung, 1972, p. 6). Miss X persisted but found painting excruciatingly difficult. Jung wrote, "As usually happens with beginners and people with no skill of hand, the drawing of the picture cost her considerable difficulty. In such cases it is very easy for the unconscious to slip its subliminal images into the painting" (p. 8).Jung counseled Miss X to be "content with what is possible and to use her fantasy for the purposes of cir-
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cumventing technical difficulties." The object of this advice,Jung comments, "was to introduce as much fantasy as possible into the picture, for in that way the unconscious has the best chance of revealing its contents" (p. 10). He also advised her to use vivid colors, thinking that colors would attract those ideas which were as yet not fully conscious. Miss X was the first in a long line of patients and students who used the method of active imagination while in therapy withJung.Jung also held seminars especially for English-speaking students, and eventually established a training institute in Zurich to teach his theories and methods to therapists from allover the world. Although Jung's technique of active imagination was only one among his many seminal ideas, it was a central idea. Gradually, the notion that art and therapy could be united for the purposes of healing; took hold and was transplanted to the United States.
Adrian Hill, the Visiting Therapist While these ideas were developing in Europe, across the channel another early effort was being made, independent of the Jungian thought, to merge art and therapy. During the Second World War in London, an artist, Adrian Hill, was recuperating from tuberculosis. While convalescing, he sought ways of easing his boredom. He related these experiences which led to the development of art therapy in his book, Art versus Illness: A Story ofArt Therapy (1945). The subtitle marks the first time that the term "art therapy" was used. It is of interest to trace Hill's thinking because his struggles and efforts are still reflected in some forms of contemporary art therapy. Hill had to give up his work in 1938 when he was hospitalized. Suddenly "time stood still" for him. By drawing he found that he could, to some extent, set the pendulum in motion again. From an "impetuous impressionistic painter" he now became a "diligent and leisurely composer of precise pencil productions" in which he sought to express his reactions to the "unreality" of his existence. Sadly he commented, "My affairs conducted me, not me my affairs" (p. 14). Three years went by while Hill bravely endured his convalescence. In 1941 the hospital established a department of occupational therapy to work with the casualties of the Second World War. Hill noted that the extent of damage to minds, bodies, and hopes far exceeded the
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damage to property and estate, even though those too were extensive. The director of the department of occupational therapy asked Hill to provide instruction in drawing for those patients "to whom the other crafts made no appeal." Hill embarked on his new project enthusiastically, and he gave a rousing speech to the other patients about the benefits to be expected from art lessons. He attempted to convince the patients first that to be happily occupied would ease the distress of their convalescence. "When books bore, wireless wanes, games begin to grate, visitors give one vertigo, drawing and painting come as a boon and a blessing." Art, he thought, "once firmly planted in the heart and mind" would be a germ that can "help enormously in banishing the latter bug," namely the TB. He maintained that this was not "quack medicine" but just common sense because "we are all best employed when attempting to create something. And Art Therapy is constructive. Yes, I know what is in your minds. 'But I can't draw, you would only laugh if you saw my efforts.'" To his fellow patients' apprehensions Hill's response was, "You do not know what you can do until you have tried." He promised that he would not laugh at their efforts. Hill suggested to the patients that they take up drawing from scratch rather than attempt to recall technical tips they may have received while in school. He thought those half remembered instructions were wrong anyway. Further, he advised the patients not to take art too seriously because "to appreciate the profound satisfaction to be derived from drawing and painting, you must enjoy yourself, enjoy yourself hugely" (p. 30). Despite his enthusiasm, Hill was in for a disappointment. Patients were slow to sign up for art instruction, perhaps because they recalled the dull and uninspiring art classes in school. Also, even those patients who took up the art lessons were discharged from the hospital in a few weeks, and that was the end of their investment and interest in art. Art had been for them just a "brief excursion" and a "marking time, similar to the traveler's cursory interest in the platform bookstall while waiting for the train" (p. 28). Hill attempted to persuade the patients that art was good for them, then to "entice" them to "fancy it," and finally to try some drawing and painting for themselves (p. 30). He referred to himself at first as a "visiting teacher." By summer of 1942, however, he used the term "art therapy" freely and considered himself to be a "visiting therapist" (p. 47).
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For Hill, art therapy was an offshoot of occupational therapy, but he was rather uncomfortable with the term "therapy" saying that the word "therapy" had a rather ominous medical flavor about it. He himself interpreted therapy to mean that "a little of what you fancy does you good" (p. 30). Interestingly, Hill had already introduced his patients to a doodling technique which is used quite often by contemporary art therapists (Rhyne, 1973). Hill reassured his patients that setbacks should be considered "indispensable rungs up the ladder to ultimate success" (p. 34). Much as Hill hoped to awaken the "dormant talent" and "resuscitate hope," the results were rather disappointing to him. He intended to use art to "combat the mental and physical atrophy of a long illness," but the pictures produced by the patients remained unimaginative. Hill reasoned that he should try first to awaken "picture consciousness" in the patients and foster their "imaginative faculty." He collected postcard size reproductions of famous paintings and left ten cards with a patient, and asked him to arrange the pictures in the order of preference. He thought that postcards would be more convenient than a heavy book for the bedridden patients. He also placed art reproductions on the walls in patients' rooms. In this manner he sought to encourage appreciation of good art which in turn would positively influence the artwork produced by the patients. Hill found that the patients frequently preferred pictures with lesser aesthetic merit over pictures he considered to be masterpieces. He attempted to reeducate the taste of the patient by subtly pointing out principles of composition. Thus, Hill's art therapy had become art education. He was back to being the "visiting teacher" he had started out to be. The results of Hill's project remained rather mixed. He was still on the very edge of art therapy, and struggling not to revert to art instruction. Other early proponents of fine arts who worked under the auspices of occupational therapy departments encountered similar experiences (Gelber, 1962). The course between art instruction and arts and crafts was difficult to steer. Frequently, the new modality of helping, which the early art therapy practitioners were attempting to shape, was scorned by the older disciplines of occupational therapy and art education. Another attempt to differentiate art therapy from art education was made by Lowenfeld (1957). He used the term "art education therapy"
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which he defined as "a therapy specific to the means of art education which deals neither with the interpretation of symbols, nor a diagnosis reached by speculative inferences based on certain symbols." Lowenfeld stated that this triple hybrid of art, education, and therapy utilizes a motivation that "only differs from any other art motivation in degree and intensity and not in kind" (p. 435). Lowenfeld's efforts to carve out art therapy from the fields of art, therapy, and education did not meet with success, however. The segment in which he discussed and attempted to clarify this new phenomenon which he called "art education therapy" was omitted from subsequent editions of his book.
Margaret Naumburg and the Free Art Expression Art therapy finally emerged full grown in the work of Margaret Naumburg. Her journey started in progressive education which is steeped in the ideas of Rousseau. Later, Naumburg's thinking intertwined withJungian psychology, and it was also tinged with psychoanalytic thought. Who was Margaret Naumburg, and how did she manage to accomplish what so many others had tried but had failed to bring about? Her father was a clothing merchant in New York. He had been born in Bavaria, of German Jewish parents, and came to America with his parents when he was three years old. Her mother was of the same ethnic origin but she had been born in North Carolina. Naumburg was born in New York City on May 14, 1890. Naumburg was the third of four children. She had two older sisters and a younger brother. Naumburg attended a New York public school for one year, the Horace Mann School for three years, and prepared for college at the Sachs School (Rosenfeld, 1924). She entered Vassar College in 1908, but a year later transferred to Barnard College where she majored in philosophy and economics. One of her professors wasJohn Dewey and one of her best college friends was Dewey's daughter. They remained friends for many years. Naumburg was very interested in social reform and was the president of the Barnard socialist club. After she obtained her BA degree in 1912, she went to London to study with Sidney Webb at the London School of Economics. While there she wrote a paper about labor conditions in the then emerging film industry.
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InJanuary 1913, much against her mother's wishes Naumburg left London, and went to Switzerland. The stay in Switzerland proved to be a disappointment, however. She was chagrined to find that her friends did not know how to teach her to ski. And she recalled, she wound up with a bad cold. From Switzerland she went to Rome to study with Maria Montessori. Naumburg had had a French governess as a child. She could speak French, and having studied Latin in school, she managed to pick up enough Italian to get by. But the stay in Rome was not satisfactory. Naumburg found Madame Montessori uncongenial, and in the Fall of 1913 she returned to New York. Again, against her mother's wishes, Naumburg moved close to the Henry Street Settlement and for a year taught a kindergarten class there. This project left much to be desired. The social workers in those days, according to Margaret Naumburg, acted as if they had all the answers (Nucho, 1975). The next year she rented two rooms and started a school of her own. Gradually the school expanded and was named the Walden School. About the same time (1914) Naumburg entered psychoanalysis with aJungian psychoanalyst, Dr. Beatrice Hinkle. Hinkle (1874-1953) was a psychiatrist and a psychologist who was a lifelong friend ofJung and translated one of his books, ThePsychology ofthe Unconscious (1916). Psychoanalysis with Hinkle was somewhat disappointing, because, as Naumburg recalled, Hinkle preferred her male patients to her. However, it is quite likely that if she was not already familiar with Jungian psychology, it now received her full attention. Naumburg remained in psychoanalysis with Hinkle for about three years. Naumburg's next analyst was Abraham Brill, and, according to Naumburg, this was a much more satisfactory experience. Brill (1874-1948) is considered to be the first psychoanalyst in the United States. He was born in Vienna, and between 1908 and 1910, he was the only psychoanalyst in New York City. Freud granted Brill permission to translate several of his most important works. Brill was instrumental in founding the New York Psychoanalytic Society, and he remained in the forefront of psychoanalysis as a lecturer and writer throughout his life (Freedman et al., 1975). His outlook was cosmopolitan. A few years before Naumburg started in analysis with him, he had published a study of Arctic hysteria in Eskimos (Brill, 1913), a fact that could not have escaped Naumburg's attention.
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The two periods of psychoanalysis remained among Naumburg's most cherished formative experiences. In her vita, which she titled "Professional Record in Relation to Art Therapy, Psychotherapy, Research and Teaching" and which she apparently had prepared in 1972, she listed first that she was analyzed by Drs. Hinkle and Brill. In fact, soon she insisted that all the teachers at her Walden school undergo analysis, and about half of them did so (Cremin, 1964). She even tried to convince Dewey that he should enter psychoanalysis, to which he turned a deaf ear. After Naumburg's death, a typed copy of an unpublished article, "A Direct Method of Education," was found among her papers. Across the top of the typed copy Naumburg had written in longhand, "First application of psychoanalysis to education in the US, 1917" (Detre, K.C. et aI., 1983). The two psychoanalyses appear to have helped Naumburg pave the way for the blend of education she developed at Walden School. That, in turn, served as the bridge, during the second half of her life, for the cultivation of creativity and mental health that became art therapy. The Walden School received considerable acclaim in progressive education circles Oohnson, 1923; Rosenfeld, 1924; Beck, 1959; and Cremin, 1964). Like many other progressive educators, Naumburg found the traditional schools stifling. Public schools, as Betrand Russell once said, had demonstrated the "possibility of giving instruction without education" (cited in De Lima, 1926, p. 215). Naumburg set out to change this. In her book, The Child and the World (1928), Naumburg discussed how the curriculum she developed aimed to foster the child's "apparently unlimited desire and interest ... to know and to do and to be." She wrote, "For us all prohibitions that lead to nerve strain and repression of normal energy are contrary to the most recent findings of biology, psychology and education. We have got to discover ways of redirecting and harnessing this vital force of childhood in constructive and creative work." According to Naumburg, this could be accomplished by eliminating the "false dependence on the blind authority of teacher or text book." Instead, she set out to nurture "the independence of feeling, thought and action" in the child (p. 14). By this time Naumburg had given up her earlier hope to find solutions to social problems in the economic and social realms. "Any possibility of an immediate social or economic escape from the impasse of our civilization has become quite remote, and rather absurd to me
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now," she stated in her book. She went on to say, "I have lived to see that whether people fought to save democracy or imperialism does not make the profound difference I had once hoped." She reasoned that one could not change the existing institutions but one could change individuals who would later reform the groups and institutions they came in contact with. The solution to social problems, as Naumburg now perceived, was not in social reform but in individual transformation. This then became the aim of her efforts at Walden School (Naumburg, 1928, p. 40). The curriculum tended to emphasize humanities and the arts. Naumburg thought that the arts and artistic expressions would bring to conscious life the buried material of child's emotional problems. Naumburg could well appreciate the difficulties even normal children had in growing up. Her son later observed that Naumburg had often told him how constrained and miserable she had felt as a child. Interestingly, her sister Florence had also experienced something similar. At the age of eight she began a diary, titled, "Things my mother does to me that I won't do to my children" (Detre et aI., 1983). After returning from Europe her life apparently brimmed with intellectual excitement. She was active in the literary-artistic circles which included the photographer Alfred Stieglitz, the poet Hart Cane and many American painters, particularly John Marin and Georgia O'Keefe. She was exposed to the works of European artists Matisse, Braque, and Picasso who exhibited at Stieglitz's gallery. Naumburg herself wrote articles about education as well as poems, some of which were published (Detre et aI., 1983). Among the artists and writers during this period in New York was Waldo Frank. Naumburg married him in 1916. When her son was born in 1923, Naumburg gave up her position as the director of the Walden School. Her marriage ended in divorce two years later. For the next few years Naumburg lived in the West where she studied art and wrote her book (Naumburg, 1928). During the next phase of her life, Naumburg turned increasingly from education to therapy. She studied with Moreno, the developer of psychodrama, and was engaged in research on drama therapy at Bellevue Hospital in New York. In 1940 Naumburg became associated with the New York State Psychiatric Institute where she worked on two quite innovative research projects, both of which resulted in publications,
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first in psychiatric journals and subsequently in books (Naumburg, 1947 & Naumburg, 1950). The future path that Naumburg's work would take was influenced largely by two colleagues. One was Nolan D.C. Lewis, the other was her sister, Florence Cane. Nolan D.C. Lewis was the director of the New York State Psychiatric Institute between 1936 and 1953. Lewis had studied with Freud in Vienna, and during the Second World War he served as the psychiatric expert at the Nuremberg War Tribunals. He had published an article in 1928 in which he pointed out that graphic art can be used as one of the avenues for exploring the unconscious. Like dreams, mesmerism, and unconscious mistakes, drawings can be used objectively to assess and clarify the experiences of patients. In fact, he said that through drawings the unconscious regions of the mind can be explored "with greater facility than through dream analysis" (p. 345). He proposed that, similar to dreams, graphic art could be interpreted on three levels-the manifest content, the latent content, and the deductive meaning. He thought that drawings were more or less disguised but permanent forms of projection of the person's conflicts, wishes, identifications, displacements, conversions, symbolizations and rationalizations (Lewis, 1928). The Freudian version of psychoanalysis had emerged as the dominant one in the United States-for many decades it was tantamount to a professional suicide to veer away from the orthodox Freudian positions toward rival theories. But Lewis also discussed in detail and endorsed the concept of the collective unconscious advanced byJung. Lewis stated that "Much of the material obtained through careful study of the drawings of psychoneurotic and psychotic patients may be used in support of the concept of the collective or archaic unconscious, which, notwithstanding its denunciation by many authorities who have not yet supplied as satisfactory an explanation of certain phenomena, expresses itself universally in the dream" (p. 346). It is obvious that he was well versed in Jungian thought although his cited references are decidedly Freudian. But by the time Lewis wrote the Foreword to Naumburg's book,
Studies of the "Free" Art Expression ofBehavior Problem Children and Adolescents means of Diagnosis and Therapy (1947), the tone of his remarks were well in line with the accepted Freudian orientation. There was no mention of universal symbols or the collective unconscious. Here, in
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keeping with Freudian theory, Lewis suggested that the material expressed through drawings was usually "of the erotic and aggressive drives of the person in the midst of an involved life problem." It is revealing to note that in the Foreword Lewis referred to drawings as tools for the study of emotional problems of both children and adults. The emphasis was on the means of investigation, not on healing. He stated, "The utilization of drawings for studying the emotional problems of both children and adults is well on its way to becoming an established useful procedure." And he concluded the Foreword by saying that "These studies of Miss Naumburg represent progressive steps in a type of research that promises much for the future."
Florence Cane and the Artist in Each of Us Naumburg's sister, Florence Cane, provided another source of ideas for her conception of art therapy. Florence Naumburg Cane was eight years older than Margaret Naumburg. Her daughters described her as a fun-loving and an out-going person. After high school, she studied art. However, before she found stimulating teachers who furthered her creativity, she encountered several bad ones. "It was primarily those bad teachers who stimulated her to research her own ideas on good art instruction" (Detre et aI., 1983, p. 117). Florence Cane had many interests. Besides being a teacher, artist, wife and mother, she joined the suffragettes and fought for the cause of women. Both Florence and her husband, the writer Melville Cane, were analyzed by Hinkle, Naumburg's first analyst. In addition, Florence Cane was much interested in the philosophy of the mystic Gurdjieff, in yoga, in the work of F.M. Alexander ("I brought him to the United States," Naumburg said later), and in WH. Bates' "Perfect Sight without Glasses" (Nucho, 1975). Florence Cane's daughters attended the Walden school. When Florence noticed that the art teacher was stifling the creative spark of the children, she entreated Margaret to let her try her hand at teaching art there. This she did and she continued to teach there long after Margaret resigned her position as the director of the school. Florence Cane also had her own art school, and for fourteen years she was director of art for the Counseling Centre for Gifted Children at New York University (Detre et aI., 1983).
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After many years of teaching, Cane gathered her ideas into a book,
The Artist in Each ofUs, published by Pantheon in 1951 (revised edition by Art Therapy Publications, Craftsbury, Vermont, 1983). The following spring, Cane died (Detre et aI., 1983). Undoubtedly Cane's ideas influenced Naumburg's efforts to merge art and therapy into a new helping discipline. Naumburg, however, evolved a form of art therapy which may be termed the "therapy wing" of art therapy while Cane remained in the forefront of the "art wing" of art therapy. In Dynamically Oriented Art Therapy: Its Principles and Practices (1966) Naumburg described the use of the so-called "scribble technique" which is generally assumed to have been originated by Cane, although something similar was already known to Leonardo Da Vinci (Kwiatkowska, 1972). However, it may be noted that Cane's name does not appear in the index of Naumburg's book. Furthermore, in the book, Naumburg took a firm stand as to who can practice her brand of "dynamically-oriented art therapy." She stated, "It is often assumed mistakenly that only those with previous art training can work with art therapy. Previous art training can be an asset," she went on to say, "but unless such special training includes background in abnormal psychology and, when possible, some personal psychotherapy, students can not be adequately trained to become art therapists" (p. 14). Naumburg pointed out that, in her experience, a well trained psychotherapist "who has a sympathetic interest in any of the creative arts" was capable of doing dynamically-oriented art therapy. Accordingly, "What is essential, then, to a psychotherapist who wishes to learn how to use the art therapy approach is not that he be able to create pictures himself, but that he have a sympathy for and understanding of the creative efforts of his patients and that he believe in their creative potentiality" (p. 14).
Forging a New Discipline It is difficult for the current generation of art therapists to appreciate the courage and determination of Naumburg and other early art therapists to practice their modality of helping. Art therapy was a double struggle for these early pioneers. The battle was on two fronts. Not only was it a conceptual struggle of reconciling and merging the two chief
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components of art therapy, namely art and therapy, but in addition there was the struggle against the opposition to the very idea that a new modality of helping could be practiced by people without medical degrees. While Freud himself and many psychiatrists and psychoanalysts in Europe were quite willing to permit well qualified nonmedical therapists to practice psychotherapy and psychoanalysis, in the United States the situation was quite different. Here no "lay analysts" were tolerated. During the 1940s and the early 1950s even psychologists had to fight for the right to do psychotherapy. Psychiatric social workers, frequently better trained in relevant psychodynamic theories than many psychiatrists, had to be careful to term their helping efforts "casework" while the same kind of helping efforts on the part of a medically trained professional could be freely called psychotherapy even when these consisted of nothing more elaborate than old-fashioned admonitions and advice. The change was brought about, in part, by the work of Kenneth Appel, then the president of the American Psychiatric Association. In 1953, he called on the profession of psychiatry to examine itself and, in order to gain objectivity, to invite many other disciplines to participate in this study. Appel pointed out that the challenge posed by mental illness was too great to be met by a single profession. Appel's plea led to the establishment of the joint Commission on Mental Illness which issued its report in 1961. One of its recommendations was for the creation of a new pool of mental health professionals. The way was paved for the community mental health movement, and a crack in the door of mental health was opened for the entry of several new mental health professions, among them art therapy. Appel had been instrumental in bringing Naumburg several times to lecture to the psychiatric residents at the Institute of the Pennsylvania Hospital, and he had developed a warm working relationship with her. In 1957 at the International Congress of psychiatry in Zurich, both of them presented a paper entitled, "Treatment of a Schizophrenic Patient by Means of Art Therapy." Art therapy was still a long time aborning. It did not spring readymade like Athena from the head of Zeus. The struggle to carve out art therapy from allied but different endeavors can be charted with the help of Naumburg's writings and presentations at professional conferences during the 1940s and 1950s.
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From 1941 to 1949, when she was a "special researcher worker" at the New York State Psychiatric Institute, the titles of her publications usually contained the term "studies." For instance, there was "A Study of the Art Expression of a Behavior Problem Boy as an Aid in Diagnosis and Therapy" (The Nervous Child, 1944, 3, later included in the book,
Studies of the "Free" Art Expression ofBehavior Problem Children and Adolescents as a Means ofDiagnosis and Therapy, 1947). It is well to note in this connection that the original edition of this work did not sport the title which now greets the reader of the revised edition of the book (1973). "Introduction to Art Therapy" is the 1973 addition. In 1947, art and therapy were still rather far apart. Beginning in 1946, Naumburg prepared almost yearly exhibits of patients' art to be shown at various psychiatric conferences. Although the catalogues she prepared in conjunction with these exhibitions audaciously proclaimed that there is such a thing as art therapy, her papers during this period still continued to hedge on the exact topic of her efforts. Naumburg prepared the first exhibition in 1946 for the Annual Meeting of the American Psychiatric Association held in Chicago. The title of the catalogue for that exhibit was still a general "Art Expression of a Behavior Problem Boy and an Adolescent Schizophrenic Girl." But the following year the catalogue for the exhibition shown at the Fifth Pediatric Congress in New York was boldly entitled "Art Therapy in Diagnosis and Treatment of Behavior Problem Children." Whereas Naumburg had designated her work as that of a researcher, beginning in 1949, she stated in her vita that she was doing "Art Therapy with selected case" in New York at Mt. Sinai Hospital's Department of Child Psychiatry. Between 1949 and 1951, she lectured "on art therapy" to residents at the Institute of the Pennsylvania Hospital in Philadelphia. The ten lectures she gave at the New York Postgraduate Center for Psychotherapy in 1950, however, carried a more general title of "The Use of Art Productions in Diagnosis and Therapy of Emotional Problems." In 1954, Naumburg organized and chaired a symposium on "The Use of Spontaneous Art in Psychotherapy" and presented a paper on "Stereotype and Symbol in the Art Production of an Obsessive Compulsive Boy." Here it would seem that the emphasis was again more on the "study" part than on the "therapy" aspects of her work. But by 1955, however, the idea of art therapy as a distinct modality of treatment had taken shape clearly in her mind, and Naumburg entitled the
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seminar she offered at the Postgraduate Center for Psychotherapy in New York, "The Theory and Practice of Art Therapy." Art therapy as a modality of helping had finally arrived on the scene of professional endeavors. What exactly Naumburg's version of art therapy consisted of will be discussed in the next chapter. The seeds of art therapy were already in Naumburg's work at the Walden School which she established and directed beginning in 1914. It started to take shape in her work at the New York State Psychiatric Institute with the help of her mentor, Nolan D.C. Lewis. It was nurtured by her two periods of personal psychoanalysis with psychoanalysts who themselves were interested in the therapeutic aspects of art expression. By the mid 1950s, Naumburg was boldly proclaiming, clarifying, and teaching the new sodality of treatment she had evolved. At the first annual conference of the American Art Therapy Association in 1970, the first Honorary Life Membership was awarded to Margaret Naumburg in recognition of her distinguished contributions to the field of art therapy. After accepting the award, Naumburg gave a brief presentation on the "Importance of Training Art Therapists in the Adequate Use of the Psychiatric Interview." A lively discussion followed the presentation during which a young art therapist, Harriet Wadeson, then associated with the National Institute of Mental Health, expressed her dismay that Naumburg appeared to be equating the theory of art therapy with the theory of psychoanalysis. Rightfully Wadeson pointed out that there were several other possible theoretical frameworks for art therapy besides the psychoanalytic theory. Naumburg's attendance at that conference proved also to be her last. Naumburg was then 80 years old. Although she lived for another 13 years, she did not participate in any of the Association's subsequent conferences. Characteristically, she had managed to stir up a controversy on this occasion as she had frequently done throughout her life. It was ironic that the criticism hurled at Naumburg on this -occasion identified her with the psychiatric profession, the same establishment against whose vehement opposition she had fought so persistently while forging the discipline of art therapy out of the ingredients of art, education, and therapy. When Naumburg was awarded the American Art Therapy Association's first honorary life membership, she was generally thought to be a proponent of the psychoanalytic school of thought. Actually the version of psychoanalytic thought Naumburg subscribed to was that of the
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Sullivan, Homey, and Fromm variety, also known as Neofreudianism. Furthermore, Naumburg's version of Neofreudian thought was rather thoroughly saturated with Jungian psychology as well as with ideas derived from progressive education. The richness of ideas Naumburg managed to weave together is truly astounding. Perhaps she was able to accomplish what others had failed to bring about precisely because of the immense scope of her intellectual heritage. She managed to blend together the therapeutic ingredients in art with the art of therapy in a manner that had eluded many others before her, and, we might add, is still eluding many of her followers. For Naumburg, art and therapy truly fused into one entity, never to come apart again. This forging of art and therapy into one discipline, however, did not come about without stiff opposition from both the art and the therapy establishments of her day. Naumburg persisted and prevailed. Her fortitude and vision have assured her a place of honor in the history of art therapy.
Trailblazing in Art Therapy Naumburg's vision of art therapy might have faded from the arena of mental health had this vision not been nurtured and reinforced by a number of additional professionals from various disciplines. The disparate notions about art therapy held by these professionals were brought together into a distinct stream of ideas largely with the help of Elinor Ulman and the Bulletin ofArt Therapy which she founded, published and edited beginning in 1961. Renamed AmericanJournal ofArt Therapy in 1969, this publication provided a forum for the exchange of ideas of professionally diverse and geographically scattered practitioners. The Bulletin ofArt Therapy contained theoretical articles, research reports, descriptions of practice, critical reviews, and world-wide news of developments in the field of art therapy. Ulman nurtured, encouraged, pruned, and published the various efforts to carve out a unique method of helping which combined art and verbal psychotherapy. By 1969 the ranks of the professionals who considered themselves to be art therapists had swelled to the extent that it was possible to form a national association of art therapy. This took place in Louisville when about 50 persons comprising the Organizing Ad Hoc Committee charted the American Art Therapy Association.
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The first annual conference of the American Art Therapy Association was held in September 1970 at the Airlie House in Warrenton, Virginia, 45 miles south of Washington, D.C. About 100 people attended the conference, and the membership in the organization was 142. The setting for the first annual conference of the AATA was pastoral and tranquil. Outside the conference center, on the banks of a lake, swans were preening themselves. Inside the building, however, the atmosphere was tense and laced with controversy. The business meeting, scheduled to last for one hour in the afternoon, continued well past midnight, into the early hours of the morning. The shape of the constitution of the organization was heatedly debated. The difficulties surrounding the process of certification of art therapists and the question of the grandfather clause appeared insurmountable. The program of the two-day conference consisted of 18 items and fitted comfortably on three typewritten pages. By 1973, when the Fourth Annual Conference was held in Columbus, Ohio, the program of the conference consisted of 64 presentations. By that time, the membership in the organization had grown to 544, and by 1980-the end of the first decade-the membership was well over 2,000, and still growing. In 1984, when the 15th annual conference of the AATA was held in Washington, D.C., the program consisted of well over 100 items, and was amplified by a number of pre and postconference courses. Several surveys have been conducted to ascertain the status and future of art therapy in the United States. The first was done in 1972 when 468 facilities in the Midwest and 199 facilities in Southern California were contacted by mail. Of these, 237, or 51 percent, of the Midwest sample responded. Of the Southern California sample, 80 facilities, or 40 percent, returned the questionnaire (Anderson & Landgarten, 1974). In the Midwest, 50 percent of the facilities had an adjunctive or activities department, while California sample reported such departments in 36 percent of the facilities. The existence of separate art therapy departments were reported by 12 percent of the Midwest institutions and by 10 percent of the California institutions. However, the comments disclosed that these departments overlapped with other departments, most frequently with occupational therapy. In the 1972 survey, hospitals, mental health centers, correctional facilities, and residential treatment centers indicated the greatest interest in adding art therapists to their staffs in the future. Many of the
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respondents in this survey asked for information and literature about art therapy, and they expressed readiness to serve as training sites for art therapists (Anderson & Landgarten, 1974). Ten years later, a follow-up survey on the status of art therapy in the Greater Los Angeles area contacted 245 institutions. In this survey, 137 institutions, or 56 percent, returned the questionnaires. Responses were compiled from community mental health/family counseling facilities, out- and in-patient units, schools, centers for developmentally disabled, residential and rehabilitation facilities, day-care treatment units, substance abuse treatment centers, and nursing homes. The results of the survey showed that art therapy was well accepted as a viable mental health modality equal to social work and school psychology. In fact, several institutions noted that art therapists were filling positions formerly held by social workers or psychologists with master's degrees or by other degreed counselors. It appeared that art therapy had made impressive gains in the past 10 years, and in spite of funding cutbacks for many institutions, future hiring plans for art therapists were promising. The survey indicated that art therapy had forged its way to an acceptable position among other mental health professions (Landgarten, 1984). From these surveys and the various reports presented at the annual conferences of the AATA, it is clear that art therapy is not only here to stay but is becoming a vital link in the chain of mental health disciplines.
Conclusion And so, from the ancient Greeks, and from the Renaissance, down through the nineteenth century, the threads of a new way of helping were being spun. But it took the 20th century, with its explosion of thinking and practice in the field of human behavior, to refine a philosophy and mold a clinical approach into what is now termed art therapy. Today, in the twenty-first century, with its promise of a radical development of new knowledge in the neurosciences and in behavior, art therapy has come of age, and promises to playa strategic part in the healing arts for future generations.
Chapter 5 VARIETIES OF ART THERAPY his chapter traces several of the major models of art therapy and discusses the theoretical frameworks used in art therapy. It does not intend to provide an exhaustive review of the art therapy literature but rather to place the various models of art therapy in their theoretical and historical context. These various models of art therapy predate the psychocybernetic model of intervention, and selected aspects of these older models have influenced the development of the psychocybernetic model. What is art therapy and how is it done? These are complicated questions and the answers vary depending on the relationship between the definer and the matter to be defined. In this regard, art therapy is something like a pyramid. Depending on your vantage point, a pyramid will appear to you as something entirely different. Looking at it directly from above, you could claim that a pyramid is essentially a square. If you look at it from a side, you could say that it is a triangle. Similarly with art therapy. What it is depends on how you look at it. There are essentially three different kinds of art therapy. These three forms are largely associated with the professional home base of the practitioner. People who are engaged in the practice of art therapy and who are contributing to its development arrive at art therapy by way of two routes. One is via fine arts, and the other is the helping professions. The helping professions in this context may be thought of as including psychiatry, occupational therapy, psychology, and clinical social work as well as various kinds of counseling. Let us take a look at these two professional home bases and the concepts of art therapy generally associated with each.
T
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The Art Wing A considerable proportion of art therapists have been schooled in the fine arts. At some point in their professional development they decided that they wanted to work directly with people. To satisfy this desire, they turned to the practice of art therapy. What kind of art therapy do they practice? Those who have come to art therapy by way of the fine arts tend to emphasize the "art" component of art therapy. Being artists themselves, they tend to feel that beneficial results stem from the exposure of the person to the power of art, whatever that is. They consider themselves primarily artists, and they endeavor to awaken and cultivate the spark of creativity in their clients. Their art therapy sessions frequently resemble rudimentary art lessons. The client is instructed in the basic principles of composition, use of materials, and the understanding of perspective. The visual product, even when it is produced quite spontaneously, is examined for its aesthetic merits. The visual product is approached with objective criteria in mind as to what constitutes "good art." The product is valued more than the process of producing it. The application of technical skills is expected, and the results of art therapy sessions are frequently exhibited for the enjoyment and appraisal of other patients and staff of the institution where the art therapy sessions are held (Kramer, 1958). Art therapists who practice this form of art therapy expect that the private experience depicted in the painting or sculpture will reach the level of clarity where the message is available not only to the art maker but to the onlooker as well. The art wing type of art therapy is appropriate for clients who are artistically inclined. These clients can develop their dormant artistic talents with the help of art therapy sessions of this kind. They can also enjoy the opportunity to mingle with like-minded people. Their circle of friends is enlarged, and they can develop new ways of meeting and interacting with people. New interests are developed and cultivated, and the results often are beneficial and enriching. Enjoyable and enriching as this type of activity might be, however, it falls short of utilizing the full potential of art therapy. The art wing variety of art therapy is essentially what could be termed a hobby therapy in the best sense of the word. Hobbies frequently are beneficial and even essential for the attainment and maintenance of health, both in its physical and emotional aspects. Hobbies can be all absorbing and life-
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enriching. However, there is more to art therapy proper when seen in the light of psychocybernetics than is utilized by the art wing of art therapy. The differences between the art wing type of art therapy and the psychocybernetic model of intervention will become apparent in Chapter 6 which present a more detailed discussion of the latter model. At this point in the discussion it is important to note the several reasons why the art wing type of art therapy is insufficient. For one, only a small proportion of clients are interested in art. Secondly, the majority of clients can not devote to art therapy the amount of time necessary to reach the level of technical proficiency where the art activity itself becomes enjoyable and rewarding. Thirdly, the level of emotional and physical energy of a large proportion of clients is so low that it precludes their participation in the type of art therapy propagated by the art branch of art therapists. It is interesting to note in this context that the difficulties that have been identified with the "art branch" of art therapy were already encountered by Adrian Hill whose experiences as part of the development of art therapy were discussed in Chapter 4. A different kind of art therapy is often practiced by those therapists whose professional identities lie within one of the helping professions. That is the therapy wing of art therapy.
The Therapy Wing In contrast to the art wing, there is a second form of art therapy. It is practiced mostly by professionals with a home base in one of the helping professions-psychiatry, psychology, clinical social work, some form of counseling, or occupational therapy. Practitioners of this persuasion are more attuned to the "therapy" part than to the "art" part of art therapy. They are inclined to designate their form of art therapy as "art psychotherapy," in contrast to the "art" branch which incidentally, is frequently termed the "art as therapy" form of art therapy. Indeed, the titles of two books by Edith Kramer, one of the most prominent practitioners of the art wing, exemplify this controversy. Her second book is entitled Art As Therapy (Kramer, 1971), whereas the title of her first book is Art Therapy in a Children's Community (Kramer, 1958). Practitioners of this second type of art therapy are more interested in the process than the product of the session. The client's experience while engaged in making the visual product is more important than
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the product itself. The purpose of the session is not to produce something of aesthetic quality but rather something that has some personal meaning for the art maker. Although frequently when the client succeeds in contacting some genuine emotion and the outcome is of aesthetic quality, the aim is not to produce something that can be exhibited for others to admire. The purpose of the visual product is to clarify some aspect of the client's life experience. In this regard there is an affinity between this branch of art therapy and the psychocybernetic model of intervention. Those who subscribe to a format of art therapy which emphasizes the therapy aspects of the process discount the benefits of acquiring technical skills in art. As a matter of fact, the client's desire to acquire technical skills is frequently thought to be detrimental to the therapeutic process in art therapy. Naumburg, who may be regarded as the mother of art therapy in the United States, went so far as to make a client choose between continuation in art therapy with her and enrollment in an art class (Naumburg, 1966). Striving after technical proficiency, Naumburg thought, would detract from the therapeutic benefits a client could derive from the art expression.
Arts and Crafts One more form of art therapy can be recognized. It may be called the arts and crafts version and it is the oldest of the three forms of art therapy. It originated and was practiced mainly under the auspices of occupational therapy departments. In the arts and crafts format the emphasis is on acquiring good working habits while making some item, usually of a useful or decorative nature, such as an ashtray, a leather belt, or a book mark. Also, the client may be encouraged to paint pictures by numbers. Little if any spontaneity is expected. The client's greatest accomplishment lies in following directions and staying with the task until it has been completed. This form of art therapy often is quite beneficial to the participating clients. It promotes sociability and a sense of accomplishment. The recognition for the work done received from the therapist and the other clients, no doubt contributes to a sense of well-being and this, in turn, may hasten the client's recovery and may facilitate improved social functioning in general.
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Although this form of art therapy may be useful and enriching for many clients, it is not considered central to art therapy from the psychocybernetic perspective. However, occasionally even a psychocybernetically-oriented art therapist may utilize this arts and crafts version when working with a type of client population for whom it is appropriate. For instance, certain physically handicapped and learning disabled clients can benefit from some form of arts and crafts (Anderson, 1978; Barlow, 1976). The arts and crafts is frequently favored by those professionals in the helping disciplines who have some acquaintance with group work. In social group work, this form of art therapy is subsumed under the "program media" together with activities such as sports, games, and dramatics. From the psychocybernetic perspective, this form has less to do with art therapy than with what might be called activities therapy. It may be therapeutic just as gardening or splitting wood may be therapeutic in that it may help a person feel more effective and worthwhile. But it has very little to do with the information sorting and processing endeavors which are the core of the psychocybernetic model of helping (see Chapters 2,3, and 6). The three clusters of art therapy which we have discussed thus far are portrayed in Figure 5-1. It may be noted that in the American Art Therapy Association, the art wing of art therapy is the most prominent one. The lines of demarcation, however, are becoming blurred as increasingly more art therapists acquire credentials in the various helping professions in the form of advanced degrees and professional licenses. Some professional artists have developed into skillful therapists capable of using the visual as well as the verbal forms of therapy (Kwiatkowska, 1978). Conversely, some practitioners trained in the traditional forms of the predominately verbal modalities of helping have acquired proficiency in the uses of visual techniques of communication (Betensky, 1973). The distinction between the three types of art therapy are still very real, however, and occasionally these differences lead to heated debates within the American Art Therapy Association (Kramer et al., 1982). The psychocybernetic model of intervention has a greater affinity with the therapy wing of art therapy than with the art wing. The psychocybernetic model promotes the client's search for personal, nondiscursive symbols and it stimulates the client's own interpretation of the
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VARIETIES OF ART THERAPY HOME BASE:
HOME BASE:
THE HELPING PROFESSIONS
FINE ARTS (Painting; sculpting, etc.)
(Psychiatry, psychology, clinical social work, counseling, etc.)
B. ART WING:
C. THERAPY WING:
PRODUCT ORIENTATION
PROCESS ORIENTATION
Art lessons; skills; technical proficiency; new interests developed; secondary creativity expected (Maslow).
Visual thinking promoted; search for personal nondiscursive symbols (Langer); clarification of experiences; primary creativity (Maslow).
B
Allo-gnosis; Nomomatic seeing
Auto-gnosis; Ipsomatic seeing (Nucho}.
(Nucho ) •
A.
ARTS & CRAFTS
Sociability; good work habits; sense of accomplishment. A version of Activities Therapy.
HOME BASE:
OCCUPATIONAL THERAPY
Figure 5-1. Varieties of Art Therapy.
visual product through the ipsomatic seeing. It emphasizes the primary rather than the secondary type creativity (see Chapters 2,3, and 6).
Theoretical Orientations The other set of factors that shapes the kind of art therapy the practitioner will adopt, in addition to the practitioner's professional home base, is the practitioner's theoretical orientation. Art therapists, like any other kind of mental health specialists, have had to utilize the theories of human development and functioning that were available to them at a given time in history. When art therapy first evolved, the predominant stream of ideas was through psychoanalytic theory. Psychoanalytic thought itself has undergone several stages of development. These stages of development range from the orthodox psychoanalytic thought to the newer existential-phenomenological versions (Hall & Lindzey, 1957; Weisman, 1965).
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The other stream of ideas that has molded the thinking of many art therapists isJungian thought Oung, 1916;Jacobi, 1959). Two additional theories have shaped art therapy. These are the Gestalt therapy (Perls, 1969) and the existential-phenomenological approach (May et aI., 1958). These four theoretical orientations that still influence the work of art therapists all predate the psychocybernetic model of intervention which is discussed in greater detail in subsequent chapters.
The Psychoanalytic Model The two most prominent proponents of the psychoanalytic model of art therapy are Naumburg (1947; 1966) and Kramer (1958; 1971). While Naumburg represents what was termed the therapy wing of art therapy, Kramer is firmly identified with what we described as the art wing of art therapy. Both Naumburg and Kramer, as well as other art therapists who have followed in their footsteps (Lachman, 1985; Landgarten, 1981; Levick, 1983; Robbins, 1976; Rubin, 1984; Wadeson, 1980), use the psychoanalytic theory to understand the process and the products of art therapy sessions. Several basic concepts shape the practice of art therapy of those practitioners who subscribe to this theoretical orientation. One of the key concepts of the psychoanalytic theory is the concept of unconscious mental processes. Psychic processes are not chance but have a specific purpose even when this purpose is not obvious to the conscious portions of the person's mind. Repression, denial, projection, displacement, and reaction formation are some of the ways in which mental process take place without conscious awareness. Mental processes are ruled by psychic determinism, and energy is associated with these processes. Art therapists who are psychoanalytically oriented note and try to understand the manifestations of unconscious mental processes. According to psychoanalytic thinking, human behavior is shaped by two powerful drives-sexual and the aggressive. In his New Introductory Lectures (1933), Freud stated, "We suppose that there are two fundamentally different finds of instincts: the sexual instincts in the widest sense of the word (Eros, if you prefer that name), and the aggressive instinct whose aim is destruction." It is of some interest to note that Freud himself emphasized "the widest possible sense" when speaking about the sexual instinct and that he suggested the name of Eros as
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another term for this "widest possible sense" of the manifestation of the sexual instincts. Many of his followers, however, overlooked Freud's comments in this context and proceeded to use the concept of the sexual instincts in their narrower biological sense. In art therapy, the psychoanalytically-oriented art therapists are alert to the manifestations and expressions of sexual and aggressive drives in the art productions of their clients. Shapes and objects that are elongated are thought to be "phallic" symbols while box-like shapes are thought to represent feminine sexuality. In Figure 5-2, for instance, a psychoanalytically oriented art therapist would note the sharp claws of the cat, its pointed ears, and the phallic shapes of the tail and the limbs of the animal. In addition to the concept of the unconscious mental process and the instinctual drives, the third set of concepts that influences the thinking of the psychoanalytically oriented art therapist is the distinction between the primary and the secondary process of thought. Primary process thought operates according to the pleasure principle which aims to attain immediate satisfaction of desires. It disregards the laws of logic, reason, and experience. In contrast, secondary process thought is held to be reality-oriented, and it is shaped by the laws of logic (Rapaport, 1951). Primary process thought, according to Freud, takes place in dreams and through visual representations of experience. In his book, The Ego and the Id (1927), Freud stated that thinking in pictures approximates more closely to unconscious processes than does thinking in words. He went on to say that this form of thinking is "unquestionably older both ontogenetically and philogenetically," that is to say, both for mankind as a whole and for every individual person. According to Freud, thinking in pictures predates the thinking which proceeds through the use of words. Freud pointed out, and many art therapists have found this to be true, that it is possible for thought processes to become conscious through a reversion to its visual residues. Naumburg, for instance, stated that art therapy is "based on the recognition that man's fundamental thoughts and feelings are derived from the unconscious and often reach expression in images rather than words" (Naumburg, 1966, p. 1). The psychocybernetic perspective supports Freud's theory that visual thinking or thinking with the help of images is the older form of thought. Early in life, while exposed for a considerable period of time to many deep and formative experiences, we think long before we
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Figure 5-2. The Cat.
have appropriate verbal labels which we can attach to our experiences. But there is sufficient evidence to disagree with the psychoanalytic assumption that this form of thought is inferior to the secondary process thought which is based on logic and which proceeds rationally and incrementally. On the basis of the research on the differential functioning of the two cerebral hemispheres, it can no longer be assumed that these two forms of thinking are qualitatively different. As discussed in Chapter 3, both are essential for adequate codification and processing of information. Instead of using the psychoanalytic concepts of primary and secondary thought with the implication that one form of thought is more rudimentary and primitive than the other, it is preferable to use the concepts of discursive and nondiscursive thought suggested by Langer (1942). Both forms of thought are essential for a full understanding of reality and for the full utilization of the means of information processing available to the human mind. To use only one of the available channels of information processing is to expect a train to run on only one of its two rails.
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Art therapists who have been influenced by the older versions of the psychoanalytic thought which differentiates between the primary and the secondary thought processes tend to favor the logical, sequential, and rational processes associated with the dominant cerebral hemisphere over the intuitive, holistic, global, visual, and spacial processes of thought. These art therapists tend to overinterpret and overanalyze the visual creations of their clients. Perhaps for these reasons Naumburg was frequently satisfied to let her clients produce their drawings at home, and then used the time during her therapy sessions with the client in discussion of the visual product. Before leaving the psychoanalytic model of art therapy, the final set of concepts that should be highlighted are the pleasure principle and the reality principle. The pleasure principle, as has already been indicated, aims at an immediate gratification of desires. The reality principle, in contrast, advocates the postponement of gratification until such time when the desires may be satisfied at a lesser cost and to a fuller extent. According to psychoanalytic thought, art is the bridge that connects the pleasure principle with the reality principle so that both may operate simultaneously. Art is seen as the means of balancing the conflicting demands of these two principles-the pleasure and reality. Art permits the gratification of both principles in that art expresses the desires in a half-disguised, half-concealed manner. In this way, the socalled "censor" is not aroused, and the prohibited and socially unacceptable desires may be partially expressed and satisfied. Art, like dreams, presents desires in a manner that can slip by the "censor" of the conscious mind. It could be said that from the psychoanalytic perspective art is a kind of a bootlegging operation. Through art, socially unacceptable needs and desires can be transformed and expressed in more acceptable manner. This process is known as sublimation. According to Kramer, who may be regarded as one of the most prominent representatives of the older psychoanalytic position, one of the main benefits of art therapy is that it provides opportunities for sublimation of the aggressive and the sexual needs. In drawings and other forms of art the wish is depicted, symbolized and transformed into a socially acceptable expression. Little boys, for instance, may first make replicas of big sexual organs out of clay in their attempts to gain a sense of masculinity. Later they may build
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structures like the Empire State Building and other forms that convey the notion of power and masculinity to them (Kramer, 1971). What does the client gain from art therapy? The psychoanalyticallyoriented art therapists hold that the therapeutic benefits in art therapy stem to a large extent from the opportunity to sublimate the aggressive and the sexual drives. Through the process of sublimation clients learn to attain partial and symbolic forms of satisfactions for their socially unacceptable needs and desires. Another benefit that accrues from art therapy is catharsis or the discharge of feelings associated with painful life experiences. Naumburg cites a case example of a 42-year-old, twice-married woman who suffered from ulcers. In her art therapy sessions, she projected her illness in drawings which contained blood-red masses symbolic of her ulcer. Gradually, the patient was encouraged to interpret her own drawings instead of accepting Naumburg's interpretations. By the seventh month of art therapy, this patient was able to express her anxiety through making pictures about her conflicts instead of panicking or developing ulcer symptoms (Naumburg, 1966, p. 66). The third form of benefit in art therapy frequently emphasized by psychoanalytically-oriented practitioners is the attainment of increased awareness of some recurring pattern of behavior that may be selfdefeating. As one of Naumburg's patients put it, "The patient draws pictures of fears, loves, hates-many of which elude the definitions necessary to capture them in words, whether the pictures are good art or bad art. No mastery of formal technique is required to give a glimpse inside oneself that is more accurate and more deeply suggestive than words usually are...." The patient went on to describe how the process of drawing clarifies matters about which one may not have been conscious before but nevertheless may have been exposed to the crippling effects of these experiences. The patient concluded, "... eagerly one draws, until the trouble's hidden nature is sufficiently revealed to be dealt with adequately" (Naumburg, 1966, p. 113). Another of Naumburg's clients remarked that the more she permitted herself to express her true feelings, the more she grew emotionally. She said, "I found that once you've let hate out when you are making pictures, then the hate gets all used up by the time I've finished drawing" (Naumburg, 1966,p.110). The psychoanalytically-oriented art therapists are prone to conduct art therapy sessions that extend over a relatively long period of time. Naumburg, for instance, worked with many clients for several years. In
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fact, one of her clients was in art therapy with her for four years. Usually the same client was also in psychoanalysis concurrently. Gradually, the time spent with the psychoanalyst decreased, while the time spent in art therapy increased. One client, for example, saw her psychoanalyst once a month for 20 minutes while she spent an hour and a half in weekly art therapy sessions with Naumburg. The frequency of art therapy sessions conducted by Naumburg ranged from once a week to three times a week. Under special circumstances, particularly if the client had to travel long distances, Naumburg could be quite flexible and would conduct either marathon sessions or space the sessions at longer intervals. Throughout her life, Naumburg kept up with the developments in psychoanalytic theory. She was well versed in the contributions of the various Neo-Freudians, such as Homey, Sullivan, Fromm, and others. She was also well aware of the contributions of ego psychology. Furthermore, although officially Naumburg was identified with psychoanalytic thought, it is interesting to note how deeply she was influenced by Jungian psychology. Her concept of the unconscious, for example, is closer to the Jungian than to the traditional psychoanalytic view. While aware of the irrational elements in a person's unconscious portions of the mind, Naumburg was convinced that the unconscious also contained transformative powers. She stated, "While the unconscious contains destructive and fearful forces which some religionists and psychoanalysts warn against, the unconscious is also the source of that generative power which makes it possible for art to become a means of integration and renewal of the human psyche" (Naumburg, 1966, p. 42). The function of fantasy and imagination is another area where Naumburg veers away from the purely psychoanalytic position. Although at times fantasy may be a means of escape from reality, Naumburg nonetheless maintained that fantasy may also serve a unifying function that "deals with a collective past or an individual's future, in theJungian sense" (Naumburg, 1947, p. 51). Like Jung, Naumburg was fascinated by symbolism in various cultures. She decried the narrow psychoanalytic view that regards symbolic expressions as the result of intrapsychic conflict between the repressing tendencies and the repressed (Naumburg, 1966, p. 29). She regarded symbolic expression as a fundamental and creative aspect of human functioning. A considerable portion of her course at the New
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York University therefore was devoted to cultural anthropology and the study of symbols of various religions and ancient cultures (Naumburg, 1966, p. 33).
The Jungian Approach While the psychoanalytic theory postulates that personality rarely changes after childhood, Jung held that we have life-long possibilities for growth and development. According to Jung, life is a process of individuation, that is, a process of becoming uniquely oneself as one actualizes one's every potential. As people grow older, they choose some possibilities and neglect others. They tend to become one-sided. This is what makes us neurotic, Jung pointed out. In order to be healthy, one has to use one's entire potential. One way of developing one's entire potential is through the method of "active imagination." This is Jung's term for what we now call art therapy. Jung's method of active imagination is a way by which a dream or a fantasy image is activated and amplified. In contrast to passive fantasy, it is a technique of introspection in which the stream of inner images are observed and made to come alive by active participation in their unfolding. In a letter to Count Hermann Keyserling, Jung explained the process of active imagination by suggesting that one should "switch off" one's noisy consciousness and "listen quietly inwards and look at the images that appear before one's inner eye." Jung added that "images should be drawn or painted assiduously" regardless whether one is able to do so or not Oung's Letters, Vol. 1, 1973, p. 83). With the help of the method of active imagination one can contact the neglected portions of one's psyche. Or as Lyddiatt put it, this method permits a client to "join up with the unknown side of yourself so that you cease to feel out of joint" and life becomes more harmonious for you (Lyddiatt, 1972, p. 137). Jung held that enrichment and self-development is attained through contacting deeper layers of the psyche, or what Jung termed the collective unconscious. Jung thought that in addition to the personal unconscious, each person has access to the collective unconscious that contains the psychic residues of the evolutionary development of all humanity. The personal unconscious contains the forgotten or repressed impressions and those impressions which may have been too weak to leave conscious impressions. The collective unconscious, on
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the other hand, harbors human predispositions to perceive and react to the world in certain ways. All humans, for instance, have had a mother. Thus, a human infant is born with the predisposition to perceive and react to a mother in certain ways. Jung's term for the structural components of the collective unconscious is "archetype." An archetype is a universal thought form or an idea which is invested with strong emotions. Jacobi points out that archetypes can not be defined but they may be thought of as being invisible energy centers Oacobi, 1959, p. 75ff). These energy fields can be activated through certain experiences. In this way archetypes become conscious and they can enrich the personal unconscious. Archetypal material may appear in myths, dreams, visions, rituals, works of art, as well as in neurotic and psychotic symptoms. Some archetypes have evolved to the extent thatJung regards them as separate systems of personality. For instance, Jung describes persona, or that part of personality that is developed in response to social conventions and one's own archetypal needs. Another system of personality is anima or the feminine archetype, and animus, the masculine archetype. Still another is the shadow which is similar to the Freudian concept of the unconscious, namely the reservoir of the vital and passionate animal instincts in humans.Jung also distinguished ego or the conscious portions of the mind, and the self by whichJung meant the sense of identity and the center of personality. From the Jungian perspective, the task of the art therapist is to provide the materials to the client, to lend a reassuring presence, and to value the activity of self-expression. As Lyddiatt observed, "The essence of treatment lies in helping everyone to express his own individual link with the activity of the mind below the surface of consciousness" (Lyddiatt, 1972, p. 136). Art therapy according to this model is a way of expressing and experiencing one's own imagination. It is a method of linking the conscious with the unconscious portions of the mind to enrich the personality and to augment one's capabilities. This linking of the conscious with the unconscious portion of the mind is accomplished by "deliberate efforts to let a mood speak without seeking to control it and without being overwhelmed by it" (Lyddiatt, 1972, p. 1). The task of the client is simply to watch what one's imagination is doing. The client is encouraged to observe objectively how a fragment of one's fantasy grows and develops. "The important thing is not to interpret and understand but to experience" the fantasy (Lyddiatt,
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1972, pp. 4-10). A client is simply asked to put paint on paper. Lyddiatt noted that the paintings seemed to make themselves. "It is a perpetual surprise to see how quickly scribbles grow and change when valued by the painter as well as by the therapist." Ideas flow around what one is portraying, and fragments of the imagery join and make sense. Harking back to the concept of the collective unconscious, Lyddiatt suggested that, "It is a spark of something greater than ourselves that can lead us on so long as we do not seek to cage it in" (p. 13). Lyddiatt added that those who have tried this seemingly simple method of active imagination know that it is much more difficult to objectify a mood than to allow oneself to be possessed by it (p. 26). Although aJungian art therapist would search for the manifestations of universal symbols and would be inclined to compare the expressions of a client with the symbols known from myths and ancient forms of art, these thoughts are best kept to one's self. No interpretation is offered to the client. As Lyddiatt pointed out, "it is terrifyingly easy to project one's own problems on to the patient and to add to their burdens and bewilderment" (p. 26). In the opinion ofJungians, the client benefits simply from the process of making the images. In art therapy a client searches for another dimension of himself. "One carries on a conversation with an unknown part of oneself in which one gradually comes to believe" (p. 105). When looking at the picture of the cat (Figure 5-2), a Jungian art therapist might speculate about the meaning of the archetype conveyed by the drawing. The therapist may note that cats in Egyptian mythology were thought to be associated with the moon, and that it was sacred to the goddesses Isis and Blast, the latter being the guardian of marriage. Black cats are frequently associated with powers of darkness and death. These musing, however, would remain unspoken in the art therapy session. They can nevertheless alert the therapist to be somewhat more perceptive and attentive to some of the client's comments and thoughts when the drawing is contemplated during the dialoguing phase of the art therapy process. Some Jungian art therapists have endeavored to promote deliberate portrayal of objects that are thought to symbolize certain archetypes. In order to activate the corresponding energy fields, clients are asked to draw, for instance, the sun, moon, fire, water, bird, tree, fish, flower, eye, nose, mouth, ears, and so on Oacobi, 1969). Actually, archetypes can never be fully expressed in either pictures or in words. All forms of
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expression are only approximations. Although the personal unconscious repeatedly produces images, only the spontaneously occurring images have any value for healing. The process of healing stems from being in contact with the deeper regions of the collective unconscious. The Jungian form of art therapy, easy as it sounds, takes time and patience. Lyddiatt reported several case examples where astonishing results occurred after long periods of seemingly unproductive art therapy sessions. For example, a 45-year-old woman who had an IQof 40 and a mental age of 5.5, would sit in a crouched position, pick at her clothes, look at the ground and not say a word. She would sit for half an hour in the art therapy room without touching any materials. Finally, she produced her first picture which consisted of 10 horizontal ragged lines, a blue border and 3 leaf-like shapes. Her second picture was 6 horizontal lines, a green border, and again three shapes, this time rectangular. A month later she still did not talk but she did nod when asked if she wanted more paper. Three months later she drew what looked like yellow animals in a field, and she placed a sun in the sky. From then on, her pictures became increasingly richer in content. After five months, her pictures contained houses with people, furniture, and a garden. Eight months into therapy, she wrote on one of her pictures, "Boys and girls come out to play!" and she listed all 12 names of the nursing and medical staff. She was retested and now her I Q was found to be 73, and her mental age had reached 8-3/4 years. She had matured, her attention span had increased, and she was more content than she had been previously (Lydiatt, 1972, p. 83ff). In recent years, an original development within the Jungian frame work has taken place in art therapy. It is the work with the sand tray, and it is used both with children and adults. This method of working was originally devised by Dora Kalff (1966) who was one ofJung's students. Originally a pianist, she later studied religion and was in analysis withJung. OccasionallyJung's grandchildren stayed with her.Jung was curious to know what she did with the children because they were exceptionally well behaved after visiting with her. She related that she had used the sand tray method which she had learned from Margaret Lowenfeld in London. While Lowenfeld used the sand tray method mainly for diagnostic purposes at that time (Lowenfeld, 1979), Kalff combined this method with the Jungian ideas and gradually evolved a technique which she called the sandplay therapy (personal communication to Nucho, 1974).
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Kalff's sandplay method consists of a specially proportioned tray filled with sand. The sand can be either dry or damp, and it is used to form figures, landscapes, or designs. In addition, the client uses numerous small figures, for instance, humans, predatory animals, birds, etc., to be placed in the sand to give tangible form to one's fantasy. The client also has clay and wood to make new figures, as desired. Sandplay keeps fantasy within physical limits and thus a polarity of freedom and constraints is created. Gradually, the opposites within the personality are portrayed and united. "We find that when totality begins to manifest itself, the patient is deeply moved. One of the most beautiful expressions of this experience is the representation of a mandala in sandpictures" (Kalff, unpublished paper, undated). Several art therapists have incorporated Kalff's sandplay method in their work, notably Rhinehart and Englehorn (1982), and Weinribb (1983). Jungian psychology was scarcely known in this country until about a decade ago. It has been much more widely accepted and used in Europe than in the United States. In recent years, however, there has been an upsurge of interest in Jungian thought (Perry, 1962) in the United States, and it is to be expected that this model of art therapy will exert an influence on the thinking of increasing more art therapists.
The Gestaltists Ideas from Gestalt therapy are used by Janie Rhyne to devise a model of art therapy that may be thought of as representing the "art wing" of art therapy. The Gestalt psychotherapy goes back to Fritz Perls who obtained his MD and PhD degrees from Berlin University and then was trained in psychoanalysis. He was analyzed by Karen Horney and Wilhelm Reich. He came to the United States after the Second World War and was associated with the Esalen Institute in California for many years. Perls himself considered Gestalt Therapy to be one of the existential therapies (1969). He thought that except for his brand of existential therapy, all other forms of the existential therapy borrowed ideas from some other body of thought. He maintained that Buber borrowed ideas fromJudaism, Tillich from Protestantism, Heidegger from linguistics, Sartre from socialism, and Binswanger from psychoanalysis. Although Perls himself did not think so, it would appear that the ideas of Bergson
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permeated his thinking. The central premise in Perls' Gestalt therapy is that neurosis comes from being stuck in what Perls calls "unfinished business." Old hurts, scars, regrets, resentments, and guilts are bottled up, and these mind states contaminate current life experiences. Perls thinks that the unfinished feelings are stored in the various organ systems and are manifested in nonverbal forms of communication such as tone of voice, gestures, and posture. In this, Perls is in agreement with Wilhelm Reich who spoke of the "character armor" as a means of guarding against additional pain (Reich, 1933). Perls suggest that the aim of his Gestalt therapy is to establish a continuum of awareness so that the organism can work on the healthy gestalt principle and finish the unfinished situations which we carry with us and are preoccupied with (Perls, 1969, p. 51). Perls is of the opinion that awareness by and of itself can be curative (p. 16). He points out that emotions are the most important sources of behavior. To Perls, emotions are the basic life force and supplier of energy. The more aware one is of all that one feels, the more alive one is. Feelings that are not admitted to full awareness stagnate and are experienced as anxiety. According to Perls, to be healthy is to be mature. To be mature is to accept and integrate all that one is experiencing. Perls reminds us that maturation is never completed. There is always something new to be integrated. There is always the possibility of taking more responsibility for ourselves. Thus, self-development and creativity are identical to being rich in experience. And responsibility is simply the willingness to accept oneself and say, "I am what I am" (Perls, 1969, p. 64). The opposite is being neurotic, pretending, playing a role, or as Jung might have said, of having only the "persona" and not the "self." Gestalt therapy of both kinds-verbal and art-consists in helping a person grow and mature by taking personal responsibility and by being what the existentialists term "authentic," that is by letting one's outside appearance match what one is truly feeling within. Growth comes about by experiencing all one's emotions and by becoming aware of what it is that one is avoiding and repressing. The means to accomplish this is not through free association as in psychoanalysis nor is this brought about by reviewing past events and experiences but by fully concentrating on the current experiences here and now. Perls points out that verbal communication is not reliable. "Verbal communication is usually a lie. The real communication is beyond words. So do not listen to the words; listen to what the voice tells you, the movements,
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posture, image." Or, "Let the content of the sentence play the second violin only" (Perls, 1969, p. 53). This, of course, is very much along the same line as the "listening with the third ear" described by Theodor Reik (1952). Gestalt therapy has developed a whole series of ingenious techniques for facilitating the translation of the various nonverbal behaviors into verbal messages. Some of these techniques are the principle of the "Now," moving from "It to I," and the "Hot seat" (Fagan & Shepherd, 1970). Janie Rhyne is the art therapist who has utilized the Gestalt techniques in her work with clients. While living and working in HaightAshbury area of San Francisco in the mid-sixties, Rhyne applied the Gestalt ideas in her work with clients from the drug culture. She was convinced about the insufficiency of words, intellect, and the rational approaches. Instead she embarked on the use of fantasy as a way of exploring and expanding personality. She saw art expression as a means of self-expression and a way of extending the scope of experience. Rhyne suggests a series of guidelines for Gestalt art experience, such a trusting one's own perceptions, respecting one's own creativity, giving one's self permission to play with the art materials, and being foolish. She also encourages the participants in Gestalt art experiences to pay attention to their feelings and thinking, and to accept the fact that one has "response-ability," that is, one cannot be passive, and thus one has to choose what sort of response is best for oneself (Rhyne, 1973). Gestalt therapy and Gestalt art therapy are most appropriate for the overly socialized, restrained, constricted individuals who develop various neurotic manifestations of phobias, perfectionism, and depression. Gestalt therapy has proven to be less effective with more severely disturbed, psychotic and acting-out kinds of clients. These clients may need therapeutic techniques that strengthen their contact with reality, strengthen their social skills, and, in general, provide a slower and longer process than what Gestalt therapy entails (Fagan & Shepherd, 1970, 234ff).
The Phenomenological Trend Phenomenology is a descriptive analysis of subjective processes, according to Edmund Husserl (1859-1938), one of its chief exponents.
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A phenomenon is any fact, circumstance or experience that is apparent to the senses. Phenomenology merely seeks to describe without identifying causal explanations. Applied to psychology, phenomenology is a theory that holds that behavior is determined by the manner in which a person perceives reality at any given moment. The phenomenal field, that is, whatever we perceive, shapes our behavior. The most important portion of the phenomenal field is that portion of the field which is ourselves. Our self-perceptions or our self-concept has a great deal to do with how we respond to events in life. The so-called "self-theorists" in psychology-Carl Rogers is one of the most prominent ones-postulate that a person's behavior will change if his perceptions of his phenomenological field, that is, his concept of himself, can be changed (Rogers, 1951). Whatever happens to us in life is filtered through our self-concept. Our self-concept shapes our expectations. Or as Will Rogers, the homespun Western humorist put it, if you thought you deserved to be hanged, you would be mighty happy to be merely whipped. Mala Betensky was the first to point out the relevance of phenomenology to art therapy (Betensky, 1977). A client's art expression may be regarded as a phenomenon. As such, it has an existence of its own, and its qualities are observable. This observation should take place without any preconceived notions in so far as possible, by both the therapist and the client. The client is guided to see his art expression objectively even though he is, of course, subjectively involved with it. The content as well as the structural elements of line, form, color, shading, space, location, tension-and-relief patterns, and abstractions are examined. Through the detailed examination of their art expressions, clients discover new facets of their personalities. The clients learn to perceive more clearly and more accurately the phenomena that abound within them and in their external world. As clients assume responsibility for their art work they also start actively to participate in resolving the difficulties that have arisen in other parts of their phenomenal fields (Betensky & Nucho, 1979). The phenomenological approach calls attention to the importance of an unbiased, objective examination of the clients' art expression. In this regard the phenomenological approach is similar to the psychocybernetic model which also cautions against the dangers of reading extraneous meanings into the art productions of clients. The term for
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this unbiased examination of clients' art productions in the psychocybernetic model is "ipsomatic seeing" (see Chapters 6 and 9).
Conclusion The art wing of art therapy, the art psychotherapy, and the arts and crafts version of art therapy are three distinct models and are practiced by mental health specialists with several different professional affiliations. Their points of view have been developed through exposure to psychoanalytic theory, or more recently, through their understanding and use of Jungian, Gestalt, and the phenomenological approaches. Against this background, lively theorizing and clashes of opinion have emerged. The psychocybernetic model is a younger half-sibling of these several varieties of art therapy and it holds promise for greater accessibility of art therapy to clients and practitioners alike.
Chapter 6
CONTOURS OF THE PSYCHOCYBERNETIC MODEL h is chapter is an overview of the psychocybernetic model. It sketches the specific tasks of the therapist and outlines the various phases of this model. The psychocybernetic model is a method of utilizing the two coordinates of human cognition, the visual and the verbal. As discussed in Chapter 3, the visual means of information processing is generally thought to be associated with the activities of the right cerebral hemisphere while the verbal means of managing information are governed by processes lodged predominately in the left cerebral hemisphere. The psychocybernetic model of intervention presents the means of gaining access to this dual system of encoding. By paying attention to both channels of information processing in their clients and in themselves, therapists can work far more effectively than when only the verbal means of information exchange are heeded. Why hop on one leg when you can walk on both legs.
T
Duality of Knowledge The possibility that human beings normally function with only a fraction of their brain power was noted by WilliamJames who speculated that we customarily use only 10 percent of our brain capacity Games, 1890). Human cognition is like a ten-speed bike, but seldom we use all ten speeds. The pictorial, nondiscursive modalities of thought have been largely neglected and belittled in Western culture, except by artists. For instance, Croce, the Italian philosopher of aesthetics, was convinced 93
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that imagination precedes and is indispensable to thought. The artistic image forming activity of the mind comes before its logical, conceptforming activity (Croce, 1929). Croce held that the essence of artistic activity lies in the effort of the artist to conceive a perfect image. According to Croce, the miracle of art lies not in the externalization, but in the conception of the idea. Croce maintained that the difference between us and Shakespeare or Rubens lies not in the power of externalization of the image, but in the power of inwardly forming an image that expresses the essence of an object. Similarly, Michelangelo is reported to have remarked that one does not paint with the hands but with the brain (Croce, 1929). The externalization of the idea is secondary to its conception, and it is a matter of manual skill and a technical know-how. Maslow (1971) makes a similar distinction with his concepts of primary and secondary creativity. These two concepts will be highlighted shortly.
The Function of the Therapist When practicing the psychocybernetic model of interpersonal helping, the task of the therapist is that of a facilitator, mentor, and companion in the client's search for information from internal and external sources. Thus thoughts and feelings may be clarified and integrated, new avenues for action may be discerned, and new courage can be acquired. In this context it is useful to recall that the original meaning of the term "therapy" is precisely that of being a companion. The term "therapy" comes from the Greek word "therapon" which means a companion in arms or a comrade. In Homer's Illiad, Achilles had a "therapon" by the name of Patroclus. He was a friend and an equal, even though inferior in rank. The ancient Greeks called kings the servants of God ("Dios Therapontes"), and poets were the servants of the Muses. The original meaning of the term "therapy" is "to foster and to nurture." Eventually this activity of fostering and nurturing became associated with tending the sick and the functions performed by the medical profession (Liddel and Scott, 1949, p. 315). Now therapy is often thought to designate exclusively activities associated with the so-called medical model where the client is a passive recipient of the ministrations of the helper. The psychocybernetic model reflects the original meaning of the term. In this model, therapy is regarded not as a process of provid-
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ing answers and solutions to be accepted passively by the client, but rather as a joint venture where the client performs most of the work while the therapist assists and facilitates this work. Therapy, it seems, is an activity that is akin to midwifery. The therapist assists in the process of delivery but the delivery is limited to that which the client has conceived and eventually will have to cherish and care for. The outcome is in the hands of the client. In the psychocybernetic model the task of the therapist is to help clients pay attention to their imagery. This is accomplished through the various techniques of structuring and by responding to clients' visual creations in a specific manner. These techniques and principles are presented in subsequent chapters in some detail. The job of the therapist is not to impart some specific philosophy of life. Rather it is to help the clients discern their own inner designs from their previous experiences in life and to understand their various obligations and aspirations. This thinking is compatible with the existential stream of ideas which views the development of the person as being molded by the commitments and future intentions rather than exclusively by past experiences (Bugenthal, 1965).
Ipsomatic vs. Nomomatic Seeing According to the psychocybernetic model, when working with the externalized imagery of clients, the task of the therapist is not to interpret the symbols contained in the imagery. Rather it is to facilitate the client's own seeing and understanding of those symbols. Two different ways of looking at the imagery contained in the client's art works will clarify this distinction. The one is what I term the nomomatic manner of looking at the visual product. Here the visual expression is analyzed according to the assumptions and findings of some theoretical approach. The term is derived from the Greek word "nomos" meaning "law" plus "mntos" meaning "thinking." When using the nomomatic approach, explanations are provided to the client by the therapist based on laws derived from some theoretical position or some empirical research. For instance, a nomomatic manner of looking at the client's drawing shown in Figure 5-2 would be to notice shapes that might conceivably be interpreted as being phallic, if the therapist's orientation happens to be Freudian. Or, a therapist familiar with the research spearheaded by Machover might pay attention, among other
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things, to the presence of buttons in client's self-portraits. These have been found associated with dependency strivings in clients. The other manner of looking is what may be termed the ipsomatic seeing. This term is coined from the Latin word "ipse" meaning "self," plus "mntos" meaning "thinking." Here the clients themselves provide the concepts and the assumptions that make sense out of their visual imagery. These two methods of analyzing the client's art productions are discussed further in Chapter 9. The ipsomatic seeing is one of the core concepts of the psychocybernetic model of helping. The ipsomatic approach enables clients to use their own premises and criteria to decode the meaning contained in their imagery and thus enrich their fund of useful information. Therapists who want to implement the psychocybernetic model of intervention have to incorporate the concept of ipsomatic seeing into their thinking so that they may implement it consistently when guiding their clients towards greater clarity of their various experiences. Subsequent chapters detail how this is accomplished.
Primary vs. Secondary Creativity Another important function of the therapist is to help clients rekindle the joy in the primary forms of creativity. Primary creativity is the idea generating phase of creativity which in many clients may have been squashed by well meaning but misguided parents and teachers who made premature demands for performance. The distinction between the primary or idea generating phase of creativity and the secondary or the execution phase was suggested by Maslow (1971). The first or the idea generating phase, according to Maslow, is the manifestation of true creativity. The next phase, when that idea is given form through persistence and workmanship, is actually more a matter of diligence and plain work than a matter of creativity. When applying the psychocybernetic model of intervention, we attempt to stimulate the primary creativity rather than the secondary type creativity. We ask clients to work spontaneously and fairly rapidly, without worrying about polishing and perfecting their creations. What matters is the process of stimulating imagination and what the client experiences during this phase of activity rather than what the finished product looks like. Primary creativity is the realm of information
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processing. It provides the means for discerning the propitious directions one's life can take after it has bogged down, burdened by various perplexities which have accumulated from the conflicting messages absorbed from contradictory sources of counsel. The distinction between the primary and secondary forms of creativity is not clearly drawn in many other forms of interpersonal helping where art therapy techniques are used. In fact, many art therapists expect their clients to acquire artistic skills of an increasingly greater complexity so that the work created may be meaningful not only to the creator but to the spectators as well. Here the primary creativity is downgraded in favor of the secondary forms of creativity. This is the crux of the controversy between what may be termed the art wing and the therapy wing of art therapy. (See Chapter 5 for a discussion of the differences between these two versions of art therapy.) By harnessing the clients' primary creativity and by externalizing the imagery with the help of simple art materials, the information encoded in the several levels of the human system can be made available for more effective problem solving. Human cognition proceeds with the help of two coordinates, sensory/visual and the verbal/rational. The psychocybernetic model provides the means for combining these two forms of information. The customary reliance on the verbal/rational means of information processing is like trying to function by using only one eye. It is much more advantageous to use both coordinates of human information processing, just as it is so much more effective to use both eyes instead of just one.
The Four Phases of the Therapeutic Process The therapeutic process in the psychocybernetic model consists of four phases which are summarized here. Subsequent chapters detail each of these phases. The first phase is the Unfreezing Phase. At this point the client needs an explanation about the purpose of Visual expression. The therapist has to be aware and respond appropriately to the various fears that clients invariably experience when they agree to engage in art expression. Many clients may not have used any art materials since their very early school days. The therapist also has to clarify with the client how much time can be spent working and what will happen after the picture or the sculpture has been completed.
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During the next phase, termed the Doing Phase, the task of the therapist is to make the art materials available to the client and to structure the experience by either suggesting a specific theme for the visual product or by agreeing that the client will proceed according to his or her own inclinations. From then on the therapist remains an unobtrusive observer and, if necessary, a troubleshooter by fielding interruptions that may arise from some external source, such as the telephone. The length of this phase varies depending on the kind of client one is working with. The clients should be encouraged to work spontaneously and fairly quickly without worrying about the aesthetic merits and the aspects of workmanship. This conforms to the concept of cultivation of the primary forms of creativity as opposed to the secondary forms of creativity referred to previously (Maslow, 1971). The Doing or Execution Phase is usually quite absorbing for the clients, and care should be taken not to distract their concentration during this phase. When the client indicates that he or she has finished the work, the Dialoguing Phase begins. Now the therapist initiates the discussion of the visual creation. The right brain messages are now transposed into the logical, sequential, verbal, and logical terms of the left brain. The final phase of the therapeutic interaction is the Ending Phase when the session or a series of sessions come to a close. A sense of closure has to be attained and the ideas acquired during the therapeutic interaction have to be consolidated with the information previously available to the client. The closure and integration of the ideas derived from the visual expression may proceed bit by bit as ideas tend to resurface long after the therapeutic process has officially come to a close. The four phases of the psychocybernetic model and the extent of client's investment in each are presented diagrammatically in Figure 6-1. The length of each phase varies depending on the kind of client one is working with. With children the warm-up, or the Unfreezing Phase, is quite short. Also, the Dialoguing Phase may be quite short, consisting only of a few comments. With adults the warm-up or the Unfreezing Phase will be more extensive at the beginning but will be quite brief during the latter sessions. Figure 6-2 portrays these distinctions. The specific handling of these four phases of the model with different kinds of clients is discussed in greater detail in subsequent chapters.
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PHASES OF THE PSYCHOCYBERNETIC MODEL AND THE EXTENT OF CLIENT'S INVESTMENT
High
Doing Producing
Dialoguing Examining Sharing
Closure
Unfreezing Warm-up Low
Time
Figure 6-1. Phases of the Psychocybernetic Model and the Extent of Client's Investment.
When and How to Use the Psychocybernetic Model The psychocybernetic model, utilizing the image-making capacity of human cognition, can take several forms. It may be the exclusive modality of therapeutic communication and some visual product may be created by the client during each session. Or the creation of some visual expression may take place intermittently. For some adult clients the visual creation at times is so rich in ideas that several sessions may be required to deal with these ideas and their implications. Depending on the age of the client and other factors which are discussed in Chapter 8, clients may produce one single form of visual expression during a therapeutic session or they may generate a series of creations. When a client is exceedingly prolific, care should be taken to discover if this wealth of visual creation may not be a way of curtailing the Dialoguing Phase of the process. With whom can the psychocybernetic model be used effectively? In my experience, good results can be obtained with clients of all levels of education and from all socioeconomic classes, ranging in age from
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ThePsychocybernetic Model ofArt Therapy RELATIVE LENGTH OF EACH PHASE OF THE PSYCHOCYBERNETIC MODEL WITH DIFFERENT CLIENT POPULATIONS
C
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D
Children
Adolescents
B
A
A
B
Adults
CODE:
D
C
C
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A = Unfreezing B = Doing C = Dialoguing D = Closure
Figure 6-2. Relative Length of Each Phase of the Psychocybernetic Model with Different Client Populations.
three to 93 and beyond. In fact, art therapy was used effectively with a gentleman who was 96, blind, and wheel-chair bound (Doll & Nucho, 1982). He produced a series of clay figures while engaged in what is known as life review (Buttler, 1963). The making of the various figures facilitated reminiscing and sorting out his diverse life experiences. Is it necessary for clients to be interested in art in order to benefit from the psychocybernetic model of intervention? Decidedly not. Many clients have confessed that they disliked art. In fact, some have said that art had been their "worst" subject while in school. In the psychocybernetic model the secondary forms of creativity are not required, and soon the clients discover that this type of "art" is different than what they remember from school. The primary or the idea generating forms of creativity can be resuscitated by a caring and sensitive therapist so that new forms of knowledge can be generated for the improvement of clients' functioning.
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The psychocybernetic model can be used with clients individually as well as in groups. Working with clients in groups does place additional requirements on the therapist but for the clients it also provides added stimulation and opportunity for sharing. Do clients need to have a certain level of verbal or intellectual sophistication to benefit from the therapeutic process conducted according to the psychocybernetic principles? Again, the answer is a decided "no." The psychocybernetic model has been used effectively with learning disabled clients who otherwise have difficulties in expressing themselves and conveying their thoughts. The very fact that there is a concrete self-produced product enables these clients to stick to what they are grappling with and want to convey. Let us assume that by now you are convinced that it is worth to expand your repertoire of therapeutic skills and you have decided to incorporate the psychocybernetic model into your practice. You want to utilize the verbal/discursive as well as the pictorial/presentational modalities of symbolization with your clients. What do you need to get started? Certain personal and the professional qualifications are necessary for the use of the psychocybernetic model of intervention. Practical matters such as the space, time, and the necessary art materials also have to be considered.
Personal Qualifications By and large, the personal qualifications of a therapist who wants to apply the psychocybernetic model are the same as those required for the practice of most other forms of interpersonal helping. To be a therapist you need a certain level of sensitivity and perceptivity. The followers of Carl Rogers tend to subsume these qualities under the acronym WEGs: warmth, empathy, and genuineness. Most standard texts on psychotherapy describe these qualities well (Hepworth & Larsen, 1982). In general, it is best if the therapist assumes the role of a guide and a companion, as the original meaning of the term "therapist" suggests. This was discussed in Chapter 4. Besides the general therapeutic stance, are there specific artistic qualifications? Does the therapist have to have artistic training to be able to use the psychocybernetic model of intervention? In art therapy, two distinct schools of thought exist on the question of art background. As far as the practice of the psychocybernetic model is concerned, no spe-
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cific art training is necessary for the therapist. Actually, the therapist who is not a trained artist finds it easier to adopt the ipsomatic approach to viewing the clients' productions than does a therapist with an extensive art background. The ipsomatic approach discussed earlier in this chapter is an essential part of the psychocybernetic model. Also, a therapist who harbors no ambitions to be an exhibiting artist generally finds it easier to promote the primary creativity (Maslow, 1971) and its ideagenerating features than does a therapist who strives to satisfy some general audience. Therapists who have attained or who aspire to artistic excellence themselves usually want their clients to reach the level of secondary mastery when technical skills and persistence of execution are called for. But as Termo Pasto, one of the early art therapists used to say, in art therapy, skill is not the horse that pulls the cart. To engage clients in the practice of art expression of the kind that leads to good therapeutic results according to the principles of the psychocybernetic model, the therapist needs respect for the creative process and an appreciation of visual forms of expression. This position is similar to the one promoted by Naumburg (1966). She thought that it was a mistake to suppose that only persons with previous art training can use art therapy techniques. Instead, Naumburg thought that professional psychotherapeutic training was the paramount requirement for the practice of art therapy. In her experience, "a sympathetic interest in any of the creative arts" would be sufficient to help the therapist encourage the creative efforts of one's clients. Naumburg said, "What is essential, then, to a psychotherapist who wishes to learn how to use the art therapy approach is not that he be able to create pictures himself, but that he have a sympathy for and an understanding of the creative efforts of his patients and that he believe in their creative potentiality" (Naumburg, 1966, p. 14).
Professional Preparation The psychocybernetic model is a form of psychotherapy and as such, it is subject to the same professional regulations as those of any other form of psychotherapy. Thirty years ago it was generally assumed that only psychiatrists were qualified to do psychotherapy, while psychologists, social workers, and other mental health specialists functioned in an ancillary capacity. In recent decades the immensity of emotional problems in our society has considerably expanded the cadres of pro-
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fessionals who can qualify for the practice of psychotherapy. In recent years, the self-help movement has burgeoned and good results have been attained by helpers who have little or no professional training. Many of these well-meaning helpers, however, soon burn out and go stale. What ever the legal licensing requirements in each state for each level of practice, formalized professional training is necessary for the protection of the therapist's own mental health. A solid foundation in any of the mental health professions, be it psychology, social work, occupational therapy, or as a nurse practitioner, will permit the therapists to function well and add the psychocybernetic model to their repertoire of skills. Perhaps the quickest and the surest way to becoming an effective therapist is by acquiring the MSW degree. This is a two-year, full-time course of study leading to a masters in social work degree. Part of it consists of classroom work and part of it is an internship working with clients in various human service agencies. At some universities, the course of study may be pursued on a part-time basis over a period of four years. This permits the student to hold on to a job and be relatively self-supporting financially while working toward a degree. Once a solid foundation has been attained in one of the primary mental health professions, the skills required for the practice of the psychocybernetic model can be acquired easily by taking courses offered at a number of institutions. Information about these courses can be obtained from the American Art Therapy Association. The American Art Therapy Association holds annual conferences and various workshops are offered at locations allover the United States and in several countries in Europe as well. How to update and expand one's therapeutic effectiveness is a matter each professional learns during the basic course of professional preparation. Supervision is one avenue towards increasing and polishing one's therapeutic skills. If a seasoned practitioner is not available to provide supervision and/or consultation, peer supervision can be worked out whereby professionals of equal level of experience meet periodically to discuss their work in order to learn from each other and safeguard against personal blind spots or biases. A credentialing process has been developed under the auspices of the American Art Therapy Association, and information about it can be obtained from that organization. But long before the requirements for this kind of certification can be satisfied, a person with a solid pro-
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fessional education should be able to derive considerable benefit and enjoyment by trying out the techniques suggested by the psychocybernetic approach. Some of the tangible ingredients needed for the practice of the psychocybernetic model are art materials and adequate space. Time is another factor that is essential to a successful practice of the model.
Art Materials The psychocybernetic model of therapy requires simple art materials of the two-dimensional and the three-dimensional kind. Two factors will generally influence the kind of art materials the therapist will want to use. The one factor is the size of the budget available for this purpose. The other factor is professional affiliation of the therapist. Therapists who have come to art therapy by way of the fine arts generally tend to assume that the art materials needed are rather elaborate and extensive. One art therapist, for instance, who is a noted artist herself, considers the following materials to be indispensable, although she herself has been able to do effective art therapy with far fewer materials: charcoal, tempera paints, pastels, ceramic clay, easels, a kiln, running water, a large sink, and ample storage space (Kramer, 1971, p. 44). Therapists whose professional identification is with one of the helping professions tend to use quite simple and few art materials. For instance, one psychiatrist carries a few colored felt tip pens in his shirt pocket and he uses ordinary writing paper for many of his therapy sessions (Horowitz, 1970). For work with most clients, you will need 12" by 18" white drawing paper, two or three sheets per client per session; a box of semi-hard pastels, either for each client or to be shared by several clients; and a handful of black and colored Magic Markers". A roll of brown or white wrapping paper may also prove useful, especially for group murals, or for continuous work extending over a number of sessions. It is best to avoid using materials which the clients may have used in school, such as crayons, pencils, and ballpoint pens, because these may bring back some unfortunate associations with previous efforts at art expression. The pastels generally turn out to be the most popular material. The colors blend easily and thus the altering of the drawing done in pastels is simpler than when done with crayons or felt-tip pens.
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Additional materials may be offered to the clients from time to time in order to stimulate their imaginations. Poster paints, clay, wire, and pipe cleaners may be used. However, more often than not, these materials are ignored by the clients in favor of the semi-hard pastels and white drawing paper. Pastels come generally in two kinds: semi-hard and oil pastels. The oil pastels have brighter colors, but they are more difficult to use and they do not blend as easily as the semi-hard variety. The semi-hard pastels are somewhat crumbly and messy but generally clients adjust easily to their use, provided that they have access to a place to wash their hands, or they can use paper towels to clean their hands when finished. The pastels come in boxes of 12 or 24 sticks per box. The boxes containing 12 sticks are quite sufficient for most instances of the psychocybernetic model. If you work with clients who are depressed, you will find that the black color will be used up twice as rapidly as any other color. If you want to use poster paints, buy the dry pigment and mix your own. Any brand is fine. You will need to collect some glass jars (from baby food, instant coffee, and the like) for mixing the paints. The best way to mix the paints is to put the pigments in a jar and then add water slowly, stirring with a stick until the mixture is a thick glob. Then add water to attain the desired consistency. It is wise not to use paints until you are certain that your clients, especially the younger ones, can use them without regressing to an acting-out stage. The properties of various materials useful in art therapy are discussed in some detail by Kagin and Lusebrink (1978). This article contains additional suggestions concerning the properties of the various art media. When paint is used, brushes of several sizes will also be needed. The natural bristle house painter's brushes, one and one-half by two inches, are the most appropriate and the least expensive ones available. If storage space is available, you may want to use ceramic clay to encourage the three dimensional forms of expression. The red earth clay is most inviting. It comes premixed in plugs of 25 and 50 pounds. Between sessions it may be stored in some plastic container or bag and covered with some wet cloth to keep it from drying out. Again, consider the age and the developmental stage of your clients. Young clients are sometimes inclined to use clay as ammunition to settle their disputes!
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A base for clay work will also have to be provided. It may be a board, approximately 18 by 18 inches. Masonite or plastic or any smooth surfaced material will do. Some plastic tape, such as freezer tape, 3/4 inches wide, will be needed to attach the pictures on the wall so that the pictures can be displayed when the clients are ready to engage in what is termed the dialoguing phase of the process. It is advisable to have the visual products available for examination at various points of the therapeutic interaction. For this reason, it is useful to store all the drawings in some folder and keep them in the therapist's office until the conclusion of the treatment. A sturdy, folded over sheet of paper can serve as a folder for each client's pictures. If your client is prolific, you may want to select only a representative picture for the folder from each session's crop of productions. The clients may have access to their folders whenever they wish, but the folder should be stored in some safe place by the therapist so that the visual creations may be reviewed by the therapist and the client during the termination phase of the therapy. For pictures made with pastels, some kind of fixative will be needed so that the pastels do not rub off. Fixative can be bought at any art supply store, or you may want to use a hair spray for this purpose. Usually the cheapest hair spray serves the purpose quite nicely. Have a roll of paper towels and a damp sponge handy so that clients may wipe the pastels off their hands at the end of the session. It may also be wise to alert the clients not to wear their very best outfits on the days when art expression is planned for the therapy session. And finally, the size and quality of the paper are important. The quality of the paper used may have to depend on the size of the budget available to you for this purpose. Paper of too low a quality may seem somewhat depreciating to some clients. On the other hand, expensive materials may be experienced as inhibiting and demanding a high level performance by other clients. The least expensive is newsprint paper which comes in large sheets and may be cut to desired size. White paper generally works best, but for the sake of variety you may want to add some construction paper of various colors and some manila drawing paper. The size of the paper will depend on the type of clients you are working with. Aggressive clients may need some sturdier and larger size paper than depressed clients. Aged adults will want smaller size paper than do energetic adolescents. For clients who are in wheelchairs or
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paralyzed on one side, you may want to tape the paper down so that it does not slide around. Finally, it is best to keep the art materials fairly simple. Do not overwhelm your clients with too many choices. Start with the pastels and add other materials later, if your budget permits.
Space Requirements Another consideration is the space requirements. In most instances you can engage clients in art expressions based on the psychocybernetic principles by using simply a corner of a regular office desk. Art therapists who belong to what is termed the art wing of art therapy like to use easels when working with clients. It is quite possible, however, to do without any easels. It is best to be quite informal in this regard. When working with children, adolescents or young adults in groups, clients frequently simply flop down on the floor to find adequate working space. With elderly clients one needs some space at a table. Bedridden clients will need some board to support the paper or the clay they are working with.
Time Considerations A final comment is the time required for art expression. If you normally spend 45 minutes with your client individually when engaged in verbal forms of therapy, allot some 75 minutes when using the psychocybernetic model of helping where some visual expression will take place. The clients tend to find a wealth of information even in seemingly primitive and meager visual productions. Consequently, the process of discussion tends to consume more time than originally planned. Also, time is needed for cleaning up and putting away the art materials before your next appointment. Be prepared to return with your client to the discussion of the visual product during subsequent sessions as additional ideas will have been stimulated by this new modality of expression.
Conclusion The psychocybernetic model is a creative-experiential form of interpersonal helping. It utilizes both the right and the left hemispheric forms of symbolization. Both the verbal and the visual channels of
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expression are engaged. Thus, this model provides a new method of therapeutic intervention and it offers ways of enlarging one's repertoire of therapeutic skills.
Part Two
THE THERAPEUTIC PROCESS
Chapter 7
THE UNFREEZING PHASE
T
h e first phase of the psychocybernetic model of art therapy may be thought of as the unfreezing phase. It is more than simply a warmup phase; the therapist deliberately has to perform several tasks so that the warm-up may take place. These tasks are, first, to deal with the client's apprehensions about the process of visual expression, then, to provide a structure for the process, and finally, to provide the psychological and the concrete means of getting started. As discussed in earlier chapters, the psychocybernetic model differs from the traditional forms of verbal therapy in that it utilizes a process of communication that is not primarily through words but, instead of and in addition to words, it is communication through lines, shapes, and colors. But how do you get a client to use the art materials when they frequently claim to have no interest in art and when they think that they have no artistic ability whatsoever? Additionally, males in our culture often view art to be "sissy stuff," a feminine-type activity which they consider beneath their male dignity. Not infrequently a well-meaning therapist has to cope with clients who instead of eagerly embracing the opportunity to engage in art expression, maintain adamantly, "I cannot draw. Art was my worst subject in school. It bores me to death." Granted that some people are visualizers while others are more inclined to use their auditory faculties, and still others are what Lowenfeld termed "haptics," that is, instead of depending on the sight, even when endowed with good vision, they depend more on the sense of touch (Lowenfeld, 1964), still the visual sense is basic in most human beings. It is a rare person indeed who is entirely bereft of the visual modality of relating to the world, leaving aside for the time being the problems of people who are born blind. Behind the reluctance to
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engage in the visual forms of expression are usually apprehensions and misgivings that clients have acquired through various painfully belittling experiences early in life which have robbed them of their natural ability to utilize what Langer terms the nondiscursive means of communication (Langer, 1942). The first task of the art therapist, therefore, is to be aware of the normal and expected apprehensions of clients when first asked to portray their thoughts and feelings in some visual format. These apprehensions may be voiced openly or they may be lurking behind a brave exterior.
Common Misapprehensions The most common concern of adult clients is the lack of their technical proficiency. "I have not touched paints since I was in grade school." Without engaging in a long scholarly discourse on the advantages of the visual means of expression, all the therapist needs to do is to assure the client that this is a "different kind of art." Or, "you do not have to be an artist to do this kind of art. In fact, you will get more out of it if you do not have the technical skills of a professional artist." Additionally, something may have to be said to explain to the client the purpose of the art therapy session. The therapist should make it clear to the client that the purpose of using the art materials is not to engage the client in an art lesson but to provide a different method of getting hold of some feeling or experience which may be difficult to put in words. "Words are clumsy. Sometimes it is hard to make oneself understood. It is so easy to be misunderstood. See what you can do with this type of expression. See what you can convey with just lines and colors." Or, the therapist may choose to say something like, "This is a different kind of art than what you used to do in school. The purpose is not to find out how well you can draw but to see what you can figure out about yourself." Another frequent apprehension of clients is the possibility of revealing too much about themselves. Basically this is the fear of not being liked and accepted should others find out what one is "really" like. Here the therapist through her own demeanor and through explicit statements has to convey to the client an interest and respect for the client's feelings. Furthermore, verbally and nonverbally the therapist has to make clear to the client that the client and no one else is the final authority on what the client's creation means. The psychocybernetic
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model promotes what was termed the ipsomatic as opposed to the nomomatic seeing (see Chapter 6). The therapist and the other members of the group, if the session takes place in a group setting, can only say how the picture affects them and not what it signifies. As the clients realize gradually that they themselves are the experts and the final authorities on the meanings of their art expressions, their defensiveness and apprehension about revealing too much of themselves invariably wither away. In fact, soon clients themselves openly solicit reactions to their creations from the therapist and their fellow clients in order to deepen their perceptions of what they have conveyed through their work. Still other clients phrase their apprehensions about the process of visual expression by claiming that the activity is "childish." If the therapist is convinced about the benefits to be derived from the use of the so-called nondominant cerebral hemisphere all the therapist needs to say is that it is alright to dally and be child-like at times. "You deserve to have a good time once in a while. To play around is one way to unwind and to recharge our batteries." Or to pseudosophisticates a therapist might comment that there is such a thing as "serendipity," that is, making fruitful discoveries accidentally. Concerning the idea of some male clients that art is a feminine activity ("sissy stuff"), one can remind the client that actually throughout history, as we know it, males have been the prominent artists. Some forms of art require a great deal of physical strength. No particular physical exertion will be required in art therapy. However, there will be mental exertion at times, and that takes courage and determination. Many adults who claim that they have no artistic inclinations or ability actually have engaged in activities which although not usually considered artistic, nevertheless have required discernment of patterns and a combination of ingredients. Many homemaking activities, for instance, entail the use of the right cerebral hemisphere. Cooking, furniture arranging, letter writing, carpentry, gardening, quilting, and so on, engage many of the same mental processes that are used in artistic expression. One additional group of clients deserves a special mention in this context. Although it is a rather small proportion of the general population, not infrequently in art therapy one encounters clients who are either children of, or siblings of, artists who have attained the level of professional expertise in some branch of the visual arts. Many of these
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clients are not only convinced of their lack of talent but, in addition, they have some rather humiliating memories associated with their early artistic endeavors and their inability to compete with their artistically accomplished parents or siblings. For these clients the discomfort with art expression can be eased considerably by making the distinction between what Maslow terms the primary and the secondary creativity. By primary creativity Maslow means the idea generating and inspirational phase, while he terms the phase of execution and application of technical skills the secondary creativity (Maslow, 1971). In art therapy we are interested only in the primary creativity, not the secondary creativity. It should be kept in mind that these clients may have expressed their innate creativity in different ways than what was rewarded in their particular family. When the psychocybernetic model is used, this creativity can be further cultivated and enhanced. Client apprehension which the therapist ignores or overlooks will snowball into resistances which will impede the process of therapy. One young therapist visualized the resistance of her client as a bunch of balloons pulling him away from the therapist (Figure 7-1). If the therapist does not pay attention to the client's resistances the client indeed will be pulled away and he will become a therapy dropout. The client's verbal and nonverbal messages about his apprehensions have to be dealt with both at the outset and as they arise in the course of the session. The therapist's own comfort with this modality of communication goes a long way towards easing the client's fears of the process. No long lectures about the benefits of visual expression are necessary but rather sensitivity to the common expectable worries about the strangeness of the unaccustomed activities. All beginnings are somewhat frightening. Beginning to use art materials is no exception. After the initial fear has been overcome, clients benefit from the opportunity to compare and see that their fears were not unique. One client, for instance, expressed his apprehension about being different than the other members of the group by portraying his experience of a beginning as being the "odd man out" (Figure 7-2).
Preparing the Client for the Experience Inasmuch as all beginnings are difficult, it is best to engage the client in the art experience as soon as possible so as to give the client a taste
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Figure 7-1. Resistance. Reprinted with Permission from the American Art Therapy Association, DiMaria, A.E. (Ed.), Art Therapy: A Bridge Between WOrlds, 1981. All rights reserved.
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of what it is actually like. When already engaged in verbal forms of therapy, depending on the kind of client one is working with, the therapist may choose to alert the client that next time something different would be tried. This gives the client the opportunity to "brace" and gather his wits. With other clients it is best to do the explaining and the doing immediately, one after another, in the same session. With still others, the therapist may choose to be noncommittal and say something like, "Some people have found this way of communicating beneficial. See if it does anything for you." In some instances, the therapist might use a rather authoritative approach. For example, in a setting where the clients are used to being told by authority figures what to do, one young art therapist, desperate that his group therapy sessions were producing only monosyllabic responses from the clients despite his best efforts, told the group, "We are not getting any place. Next time we will try something else which, I think, will help you." Next time he brought along some paper and crayons, and the group, after some initial hesitation, engaged in an unusually rewarding sharing of their hopes and worries through their admittedly primitive pictures. No one method of handling the initial apprehensions will work for all clients and all therapists. The therapist's own style and personality will determine what is appropriate. The main thing is to know that all clients are apprehensive, for various reasons, and do need some reassurance from the therapist. Moreover, once provided,-the reassurance may have to be repeated again at some later point. In fact, it is wise to provide some simple statement about the purpose of the art expression at the outset of each session, even when the client has engaged in art therapy for a considerable period of time and with apparent degree of enjoyment. For instance, one gO-year-old gentleman who was wheelchair-bound had been in therapy for six months. At the beginning of one of his art therapy sessions, he said, "I am going to make a mess today..." Here the therapist had to explore what he meant by "mess" and why "today." As it turned out, he had tried, up to that point, to produce drawings he thought were pleasing to his art therapist. He was in a bad mood that day because the nursing aid had not helped him to get ready for the session in time. Instead of his usual sunny memories he was more inclined to draw a picture of the unpleasant current reality. This, too, he was assured, was quite acceptable, and he felt better once the unpleasant feelings were down on paper, instead of simmering within.
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Limbering Up During the beginning phase, which we have decided to term the unfreezing phase, the therapist's second task is to help the clients overcome their inhibitions and warm up for the art expression process. To some extent, the mental loosening up may have taken place through the explanations and comments offered in response to the various apprehensions of the client. Now the therapist has to get the client to actually make contact with the art materials and use them. Some art therapists simply encourage the client to explore the materials and to experiment and see what can be done with each (Rhyne, 1973). One art therapist used to take a pastel and shows how it could be used like a pencil or on the broad side, and how the colors would blend (Kwiatkowska, 1978). Still another art therapist suggested that physical limbering up exercises help to stimulate the mind and let the images arise. Cane, for instance, suggested to her young artists that they stand with their feet about twelve inches apart, bend down from the hips, and touch the ground. Then she asked them to imagine that they were reaching up toward the sky, or that they had a tree trunk between their hands, feeling its texture as they reach toward the tips of the branches (Cane, 1951, pp. 48-53). Exercises of this kind loosen the clients' muscles and give them a sense of the expansion of their bodies, which in turn facilitate their sense of power and rhythm, and these qualities may then be invested into their drawings. When working with adults who have no previous exposure to the fine arts the bending and stretching, simple circling of arms and the drawing of lines in the air, some wiggly, some straight, some circular, tend to dissipitate the tension which has been generated by the suggestion that they engage in art activity. It also provides a touch of lightheartedness and a sense of enjoyment. The spontaneity generated by the physical limbering up seems to spillover into spontaneity of visual expression. Additionally, the physical activity prompts blood circulation and this has a positive effect on the mood and the mental state of the clients.
Structuring During the beginning or the unfreezing phase, the final task of the therapist is to structure the experience. The therapist should indicate
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how much time the client has to make the picture, to sculpt the figure, or to do whatever else is to be accomplished. Normally, in the interest of promoting spontaneity and easing the fears about the lack of technical skills, it is best to suggest that the client proceed without much deliberation. "Work fairly rapidly. No need to bother with details." The therapist should not impose any specific time limit, but he should have some idea about how much time can be allotted to the working phase and how much will be devoted to the discussion phase, or what I term the dialoguing phase. Usually the therapist finds that it requires twice as much time as anticipated. Usually so many ideas surface in response to even seemingly meager pictures that the sessions tend to exceed the time limits originally set. When structuring, the therapist should either suggest that there is a particular theme for the work or that the clients are free to produce a picture about whatever they wish. More about ways of suggesting specific themes in our next chapter when we turn to a discussion of the doing or the working phase.
The Process of Engagement Here is how an art therapist engaged a group of institutionalized elderly clients in the process of art therapy. Emphasizing two ideas, the therapist first encouraged the clients to produce something that was meaningful to themselves rather than something that might appeal to other people. Then they were encouraged to be imaginative, to experiment, and to find out what appealed to them. These ideas were emphasized as the therapist proceeded to demonstrate what could be done with the semi-hard pastels that were used in the session. First, the therapist suggested that actually everybody is an artist. "To be an artist means that you have a certain freedom to experiment. You do not have to please others. You can be unique. Picasso, for instance, made pictures that look rather weird, and yet no one laughs at him any more because he was an artist." While the therapist spoke, she took a pastel and began to move it across the paper, punctuating her conversation with lines and curves until she had completed several images. 'Just draw some lines. Like this. What do these lines look like? To me they look like a mountain. I can turn them into something. I am an artist now. I can do what I like. Just experiment. To be an artist is to experiment. Just put down all kinds of colors ... then I will see if I can
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turn them into something ... To me it looks like ... a lot of things ... I keep adding to it ... until I am finished ... I keep working at it for a . " I ong time.... Secondly, she conveyed to the clients the notion that uncertainty could be tolerated. In fact, uncertainty is part of the process of creating. "I do not know yet what it will be ... I can turn it into anything I want. It is just a scribble. It does not take brains just wanting to express yourself ... scrubbing it ... and scribbling it just push the crayon around the paper. Then see if you can turn it into something ... perhaps some flowers here ..." Then it was suggested that the same process could be used with different materials. Clay, for instance. "If you do not want to draw, you can use clay. Just press down with your fingers. You can make something out of it ... it does not take long ... you shape it ... you work with it ... and then you finish it anyway you like it." Finally, after the elderly clients had witnessed the apparent ease and enjoyment of the art therapist, they were encouraged to try for themselves. They were ready to respond positively to her question: "Are you ready to do something?" In conclusion, then, we should keep in mind that during the first session, the clients must be helped to overcome their inhibitions, misgivings and apprehensions about art which they may have harbored all their lives. These apprehensions will not be laid to rest once and for all but will resurface periodically in the later sessions. The therapist has to be alert and ready to reassure the client from time to time. Some reassurance can be provided verbally. Sometimes the therapist may choose to provide some simple demonstration about how to use the materials. If the therapist happens to be a skilled artist, however, it is best to avoid the demonstrating. This might inhibit the client whose work, in comparison, might appear quite immature and sterile. One brain-damaged nursing home client could not be engaged in art expression. For three weeks, she came and paced up and down in the room. The therapist tried to demonstrate the process of art therapy by putting some lines on her sheet of paper. Several sessions later when the sheet contained what looked like four boxes, she smiled and said, "It is mine!" Mine what? She proceeded to work on her picture for 45 minutes. At the end of the session the therapist asked her to explain her picture. She said that it was her family. "This is my mother, this is my sister, and this is myself." "And what is this here?" the therapist
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inquired, pointing to the fourth smaller and darker box. "That is my no-good father who left us when we were quite small ..." Lyddiatt (1971) reported a similar example of a slow but eventually successful process whereby a brain-damaged adult client successfully engaged herself in the process of art therapy. A 53-year-old woman with an IQ of 33 and mental age of 4.8 used to go to the art therapy room where she poked around, fiddled with the materials, and drove others to distraction with her restlessness and chatter. One day she suddenly let out a loud "Moo," and the therapist saw that she had produced what looked like a cow. Apparently three vertical lines connected on top with a horizontal line accidentally suggested a cow to her. From then on the woman was never a nuisance again. Each week she made a new and a rather amusing picture. The next picture was again a cow, in violet, with a turquoise blob in a corner suggesting a person milking the cow. Henceforth, there was no shortage of subjects for her pictures. She had succeeded in contacting some meaningful lore of experiences which she was relishing and reliving. Her behavior and experience of her current reality changed accordingly. These two examples illustrate that with certain clients the process at times may not take off immediately. And yet, even brain-damaged clients can benefit from the visual expression. Visual expression may provide a bridge to communication. The drawing, be it as primitive as just a couple of lines, draws out memories and ideas like a magnet. The psychocybernetic model does not look for aesthetically pleasing creations but for ways of stirring memories and sharing experiences, and sorting out what is painful and what is still treasured amidst the painful experiences so that new avenues for action may be determined.
Chapter 8
THE DOING PHASE n ce the client has agreed to engage in art therapy and is willing to attempt to give a visual form to imagery, the therapist is confronted with several major decisions. First, the therapist has to decide whether the client will make a picture or a sculpture of the client's own choosing, or be asked by the therapist to address a specific theme. The first topic in this chapter is what to suggest and when. The second decision facing the therapist is related to the first. Will the client select the materials to be used, or will the therapist ask the client to use a specific medium for the visual creation? The third decision the therapist has to make at this juncture in the therapy process is what to do while the client is engaged in the creation of visual product. Should the therapist sit by and watch the client work? Draw or sculpt alongside the client? Use the time to tidy up the office or proceed to read a magazine? Finally, how much time can be allotted to the doing phase so that a sufficient amount of time remains for the discussion of both the visual product and the process of creating it? This chapter discusses appropriate choices the therapist can make when working with various clients.
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To Structure or Not to Structure? The first of the several decisions the therapist has to make in the execution or doing phase pertains to the topic or the subject matter of the client's visual creation. Several factors shape this decision. One is the level of functioning of the client. Another is the purpose of the art therapy session. A third factor is the stage (early or late) that has been reached in the therapy process. 121
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Clients who are functioning on a relatively high level of ego development usually welcome the opportunity to make a visual product of their own choosing. Especially clients who have some technical skills or some taste for visual expression like to try their hand at a drawing or a sculpture to see what ensues from their efforts. Emotionally impoverished clients, however, frequently have difficulty deciding what to portray. This may be due to their meager imagery, to their fear of self-disclosure, or to their unwillingness or inability to commit themselves to a specific course of action. In general, the lower the level of ego development, or the lower the level of ego functioning of the client, the more structuring has to be provided by the therapist. For instance, one group of elderly nursing home residents had engaged in half a dozen successful art therapy sessions in which the therapist had suggested specific themes for the clients' creations. However, when the therapist left the selection of the theme for their drawings up to them, they became totally immobilized and just sat, unable to make any choices. Children usually need no prodding or suggestions as to what to portray. After a brief period of thought, most of them are quite ready to produce their drawings or sculptures. When the client appears to have some hesitancy about what to work on, the therapist may inquire as to whether there was something specific in mind that the client would like to portray. If not, how about help in getting started? If the answer is yes, the therapist can demonstrate what has become known in art therapy as the "scribble" technique. I prefer to call it the free-flow technique because "scribble" tends to have some demeaning connotations for most adults.
The Free-Flow Technique The free-flow technique is used extensively in art therapy sessions. Its origins go back to Leonardo Da Vinci. In his Notebooks, Leonardo referred to Botticelli's remark that throwing a sponge soaked in various colors at a wall left the stains that can easily appear like a landscape. Leonardo went on to say that one may see all sorts or things in such spots, according to one's fancy: the heads of men, animals, battles, rocky scenes, seas, clouds, woods, and so on, "just as in the sounds of bells we may hear whatever we choose to imagine" (Kelen, 1974, p. 121). In another place in his Notebooks, Leonardo added that similar
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effects could be attained when looking at cracks in walls and blends of different stones. Leonardo suggested that in this manner the mind can be stimulated and aroused "to various inventions" (cited by Cane, 1983, p. 57). Cane described the scribbles as a "kind of play with a freely flowing continuous line." It is made spontaneously, "without plan or design." The line occurs when the chalk or pen is permitted to trail on the paper in any direction as the person moves the arm in some rhythmic pattern. The easy rhythmic movement of the arm is the first step in this technique. The movement may be done first in the air and then transferred to the paper. The free-flow design may be made with eyes open or closed. Cane suggested that the value of having the eyes closed is that in this way the mind is prevented from directing the hand to deliberately represent some familiar object (Cane, 1983, p. 56). The next step is to look for a while at the lines produced in this manner. Soon one will discern some form among the lines, "much as one may find some form in the clouds" (Cane, p. 56). The third step in this free-flow technique is to emphasize or color in the forms one has discerned among the lines. If desired, new lines and shapes may be added and certain other lines may be ignored in order to represent the objects suggested by one's imagination. According to Cane, the objects a young child finds in the jumble of the lines will be simple and part of his life. The child may see animals, or other children, or flowers, or toys in the scribbled lines, whereas objects seen by adults very often reveal their aspirations, conflicts and concerns. Sometimes no object is seen. Instead a design is found. "That also may be useful," according to Cane. "When the design is developed, it serves the purpose of freeing the individual from the inhibitions against getting started. The mere play with form and color frees energy and imagination" (Cane, 1983, p. 57). Occasionally, a client does not seem to be able to detect anything at all in the freely flowing lines. Experience shows that when this happens, it is usually because some object is seen such as a sexual organ the client is either afraid or ashamed to portray. Eventually, as the therapeutic rapport grows, the client will feel free to share these concerns with the therapist. In the early stages of therapy, however, it is best not to persist but to help the client save face. If necessary, the therapist can suggest that the client try another set of free-flow lines to see if something does not emerge from the second attempt.
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The free-flow technique works well with most adults and adolescents, regardless of their level of artistic sophistication. Artistically unsophisticated people find this technique an easy way of getting started with the work. They can use the accidental lines as an excuse that the work is not more finished and accomplished. Artistically sophisticated people enjoy the stimulation of their imagination that this technique affords. In fact, some professional artists use it frequently to find subjects for their drawings. In art therapy, some clients use the freeflow technique in the early sessions until they feel comfortable enough to work directly on a subject. Others like to return to the free-flow technique at various points in treatment when they feel stuck and seem to have run out of ideas of what to portray. Still other clients like to use this technique exclusively to start their pictures. Naomi, a IS-year-old anorexic, was such a client. At the beginning of each art therapy session she made a spontaneous line on the paper and then proceeded to discern a configuration of people in it, and she completed the drawing by elaborating on the envisioned scene (Figure 8-1). There are several variations of the free-flow technique. One of these variations has already been mentioned, namely, the free-flow may be produced with eyes either open or closed. Usually clients who are severely emotionally impaired do best with eyes open while producing the line for the free flow design. In many instances they experience the world as being too dangerous to close their eyes while other people are around. The therapist can suggest that they try to look up at the ceiling instead, or attempt to look away from the drawing rather than at it while producing the spontaneous line. Another variation is the use of the nondominant hand. For instance, a right-handed person may be asked to use the left hand to draw the initial line and then proceed to use the right hand to complete the drawing. Still another variation of the same technique is to have two or more people produce the drawing. For example, the client may make the initial line, and then the therapist may attempt to turn that into a simple drawing. Turns may be taken whereby the next time the therapist provides the initial line and the client attempts to turn it into a drawing of some object or a scene. This variation was first suggested by Winnicott, the British psychoanalyst, who called this form of the free-flow technique the "squiggle game" (Winnicott, 1971).
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Figure 8-1. Naomi's Free-flow. Reprinted with permission from the American Art Therapy Association. Gantt, L. & Evans, A. (Eds.), Focus on theFuture: TheNext Ten Jears, 1979.
Similarly, Kwiatkowska used the free-flow technique in her series of family assessment procedures. She asked each member of the family to make the initial line and then asked the entire family to select and finish one of the lines as a joint project (Kwiatkowska, 1978, p. 41). Betensky comments that this technique is a simple way to foster a richer expression which is "exciting to persons who could be spontaneous, always helpful to persons who were not very spontaneous, and resourceful for persons slow in imaginative thinking" (Betensky, 1972,
p. 315). Generally the free-flow technique is not appropriate with very young children who lack the ability of abstract thinking. However, young children often produce what looks like a scribble and then they proceed to explain their drawings as portraying some quite elaborate, imaginary scene.
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Even when the results of the free-flow technique are rather meager from the aesthetic point of view, the experience of producing it and the product itself is usually deeply meaningful to the clients who succeed in getting in touch with some current or some long forgotten, perhaps painful, perhaps a joyful, but in any event, a very personal and significant experience with the help of this technique. When the client feels tense, the lines do not flow freely but are stiff and jerky. Figure 8-2 shows a picture developed with the help of the free-flow technique by an 18-year-old white female whose prematurely born infant son was in the intensive care nursery. She called her picture "A Cat" but then thought it resembled a sphinx and she proceeded to talk about the mystery of life. The body of the animal suggested a coffin to her and she talked about her grief and her fear of losing her baby. Another young mother whose infant son was also in the intensive care nursery saw a turtle in the jumble of her free flow lines which she had drawn with a green pastel (Figure 8-3). She outlined the turtle in black and said it looked more like a snail than a turtle. She spoke of the slow process of her son's recovery but thought there was still some hope. She derived some comfort from the fact that she had used green color which to her was a color of life.
The Wartegg Technique In some respects, the Wartegg technique is similar to the free-flow technique. It was developed by a German psychologist, Ehrig Wartegg in the late 1920s, and it was further refined by Marian Kinget, a psychologist at Michigan State University in the 1950s. This technique consists of eight spaces or boxes which are produced by first dividing a sheet of paper in half, then dividing it again and again until eight compartments or boxes are produced in this manner. In each space the therapist places one specific shape, such as a dot, a straight line, or a curved line, in a prearranged sequence (Figure 8-4). The client is then asked to utilize each shape or line to make a drawing in each of the eight spaces (Hammer, 1958, pp. 344-364). Originally intended for personality assessment, the Wartegg technique was adopted by some of the early art therapists as a device to help stimulate and prime the client's imagination. This technique also has another advantage. By collecting responses to an identical proce-
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Figure 8-2. The Sphinx.
Figure 8-3. The Turtle.
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dure from a large number of different clients, the therapist's own perceptivity and awareness of individual differences is heightened. Even without a formal and systematic scoring procedure, the therapist acquires a considerable amount of experience in detecting idiosyncratic and unusual responses. The Wartegg technique is a particularly apt device for helping elderly inhibited males with no art background venture into free expression. By having something tangible to work with, they tend to use the stimuli forms provided as starting points for drawings of tools and other concrete objects. Some other clients of both sexes approach this task in the spirit of a crossword puzzle and feel challenged to see what drawings can they develop from the strange starting ingredients. However, impulsive, impetuous adolescents, especially females, are one group of clients who tend to dislike the Wartegg technique and seem to feel hemmed in by it. Examples of Warteggs completed by two different people are shown in Figure 8-5 and Figure 8-6. Both provide a sample of the maker's imagery and preoccupations. When the Wartegg technique is used with elderly, brain damaged, or very young clients as a warm-up device, it is sufficient to use only a few of the shapes rather than all eight. As with any other procedure, the length of the client's attention span and level of energy will be the determining factors in deciding how to proceed.
Diagnostic Procedures Art therapists do not depend on a single drawing for diagnostic assessment of their clients. Occasionally they may utilize some of the drawing tests familiar to psychologists conjointly with other forms of visual expression. The House-Tree-Person Drawing test is one wellknown drawing test which is occasionally used by art therapists together with other sources of data. Although there is an immense amount of literature on the H-T-P drawing test and on the related Draw-a-person test, the validity and reliability of both procedures are still problematic and should be used for diagnostic purposes only along with other sources of information. Information on these two diagnostic procedures can be found in Hammer, 1952; Machover, 1949; and Nucho, 1979. A more recent further elaboration on the H-T-P and the Draw-a-person-test is the Kinetic Family Drawing procedure developed by Burns
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/ Figure 8-4. A Wartegg Blank. Reprinted from Hammer, E.F. (Ed.), The Clinical Application ofProjective Drawings, 1958, courtesy of Charles C Thomas Publisher, Springfield, Illinois.
Figure 8-5. A Wartegg completed by a well-functioning adolescent.
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Figure 8-6. A Wartegg completed by a talented adult woman.
and Kaufman (1970 & 1972). As with the H-T-P and the Draw-a-persontest, the interpretation of KFD is still based largely on clinical impressions although some attempts at devising a systematic scoring system have been made (Elin & Nucho, 1979). Inasmuch as a single drawing may not adequately tap the richness of a person's imagination, art therapists favor the use of a series of tasks for diagnostic purposes. Kwiatkowska, for instance, developed a series of six drawing procedures which she used with excellent results in assessing family dynamics (Kwiatkowska, 1978). The first and the last drawing is a "free" or "anything picture." That is to say, the choice of the subject to be portrayed is left up to each member of the family. Each person, the parents, as well as the children, make pictures of whatever they wish. In many instances, the free or anything picture is a self-representation or a symbolic presentation of one's concerns. The free picture at the end of the procedure helps the art therapist to gauge the impact of the art therapy session. If the last free picture is better organized and richer than the first one, then it is likely that the session had been helpful to the client. If the final free picture is more disor-
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ganized and weaker than the first one, then the art therapist has to recognize the possibility that the client may have more severe psychopathology than originally revealed. After the initial "free" or "anything picture," Kwiatkowska asks the family to make two types of portraits. The first is a picture of the entire family. Kwiatkowska asks simply for a picture of the family, not necessarily a picture of the family engaged in some activity as was the case with the Kinetic Family Drawings. The amount of information contained even in static family pictures is so immense that Kwiatkowska did not consider it desirable to introduce the additional variable of action. After the family portrait has been drawn and briefly discussed, the family is asked to make an abstract family portrait. Here the people may be represented by some of their abstract qualities or interests. After these three pictures, that is, the free picture, and the two types of family portraits have been made and briefly discussed, Kwiatkowska suggests to her clients some simple limbering-up movements to loosen the arm muscles in order to proceed with the free-flow or scribble drawings. First, the family members make individual free-flow drawings. Then they select one of a new set of lines for the joint free-flow. It is of some diagnostic interest to see how the family goes about performing this joint task and whose free-flow line is chosen for the joint enterprise. The assessment procedure concludes with the second of the two free pictures (Kwiatkowska, 1978). For the purposes of family evaluation, all six of these procedures can be used in one two-hour session. However, therapists who want to practice the psychocybernetic version of art therapy will tend to find that two hours are not sufficient to discuss the wealth of material brought forth by these six diagnostic procedures. It may be more realistic to allot an entire session, an hour and a half in length, for each single procedure contained in the Kwiatkowska assessment protocol. The Kwiatkowska assessment procedures are used extensively by many art therapists, and several variations have been devised. One is that by Wadeson who uses part of the Kwiatkowska procedure with married couples. One interesting innovation proposed by Wadeson is to ask the spouses to exchange their self-portraits. Then each partner elaborates and improves upon the self-portrait of the partner, anyway he or she sees fit. This often reveals some of the dissatisfactions arid/or support each partner brings to the relationship (Wadeson, 1980).
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Landgarten is another prominent art therapist who has developed further the Kwiatkowska procedures of family assessment. Knowing the specific concerns of single parent families she has devised a series of tasks, both two- and three-dimensional, that not only bring forth the dynamics of each family member but also provide a way of resolving some of the impasses among the family members (Landgarten, 1981).
Themes Derived from Client Concerns Frequently the topic for the visual creation emerges from the general discussion between the therapist and the client or clients at the beginning of the therapy session. As the client reviews the events of the preceding few days or weeks, or as the members of the group engage in small talk and an exchange of ideas, some common concern or interest gradually surfaces. This common interest or concern can serve as a suggestion for a picture. In a group of heroin-addicted clients in a methadone maintenance clinic, for instance, a series of pictures was produced, one each week, on the following topics: "a picnic," "work," "my best friend," "things that make me angry," "the Clinic," "enjoying myself," and the like. The clients had the option of working on the common theme that had been suggested either by the therapist, or, in later sessions, by another client, or they could engage in producing a work around a theme they had chosen themselves. At times, some clients prefer to work on a picture without any specific theme in mind. When finished, they may decide what the picture is all about. For instance, one young black polydrug user spent several weeks working on pictures that appeared to be experiments with various lines and colors. He was piling one color on top of another while making rather graceful swirls on the paper. At the end of each session, although the final product did not look like anything objectively discernable, the client continued to admire his production wistfully and seemed to have a hard time separating from it. In order to facilitate the decoding of the meaning contained in the picture, the client was asked, "If you had to give a title to this picture, what would you call it?" After some thought, the young man responded, "The Beginnings of a Rainbow" (Figure 8-7). The therapist expressed her interest and suggested that he write the title on the picture. He proceeded to do so with considerable amount of help from the other members of the group on spelling of the words. Some discussion ensued, and it turned out that
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Figure 8-7. Beginning of a Rainbow.
the client was at a juncture in his life where some new feelings were stirring in him, and he was hoping to get away from his dependence on
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chemical highs. His subsequent work and marital performance attested that this picture had indeed marked a realistic and substantial "beginning of a rainbow" of hope for him. The picture helped this young man, it seemed, to lift his wishes from the realm of desire into the realm of determination and implementation.
Interactional Drawing Technique There are times when it may be appropriate for the therapist to engage in some art expression along with the client in order to encourage the client's efforts at art expression. One such instance was already mentioned in connection with the discussion of one of the variants of the free-flow technique, namely the Winnicott's "squiggle game." With this technique Winnicott attempts to engage children in the process of sharing their concerns. Another procedure where the client and the therapist may work together producing a joint picture is the Interactional Drawing Technique. This procedure is appropriate especially with mentally ill adults who are fearful both of their own feelings and of the presence of another person. First, both the therapist and the client engage in drawing separately and finally jointly on the same sheet of paper. This technique was devised by Mardi Horowitz (1970). The aim in this procedure is to provide a sense of security to the client by introducing solid objects in the picture, such as houses, trees, etc., next to objects which may be self-representations of the client. The therapist can also lend support by drawing objects or animals that may be reassuring to the client. The therapist can make connections and promote "object relations" by drawing bridges, paths, or putting up road signs. In one instance while using the interactional drawing technique, the art therapist introduced several protective themes, for example, by drawing an icebag on the cracked head sketched by the client (Horowitz, 1970).
Principles of Timing, Gradualness, and Spotlighting One of the greatest fears of inexperienced art therapists is that they will run out of ideas about what to do with their clients. Similarly, young therapists doing verbal forms of therapy are apprehensive that they will not know what to say to their clients. One beginning therapist
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put it this way, "What if the client just sits there and does nothing?" Very soon therapists discover that this is the least of their worries. It is most unlikely that they will have nothing to say or ask, or that the client would not talk. Soon the task becomes to cut through the stream of verbalizations and get to the core of the matter. But no sooner has the novice discovered that scarcity of both verbal and paralingual communication is not the greatest problem when another trouble arises. Being in too great a hurry to help the client solve his many difficulties results in there being no time for listening and paying attention to what the client is actually conveying through the various channels of communication. The same frequently happens in art therapy. Beginning art therapists must not race from one technique to another without paying attention to what the client is experiencing. Rather, they should pay attention to what is transpiring in the session beyond the creation of the visual product. If the therapist has mastered one of the several versions of the freeflow technique, if the relationship between the therapist and the client is one of trust, and if the client is willing to attempt to portray visually some of his experiences and feelings, then neither the therapist nor the client will ever run out of subject matter for the client's next creation. The danger lies in another direction, namely in suggesting prematurely subjects for pictures in areas the client is not yet prepared to deal with. Just as it is in any other kind of therapy, it is best if the therapist proceeds gradually from the more general to the more personal concerns. For instance, an energetic 89-year-old lady, whom we shall call Bertha, had enjoyed the weekly art therapy sessions for two and a half years. She appeared to derive satisfaction from the group interaction and from her own artwork. Bertha related well to the art therapist, and she liked to prod the other members of the group to experiment with new materials and new techniques. One day the art therapist suggested that the members of this art therapy group make Kinetic Family Drawings, that is, to draw a picture of their families, including themselves, doing something. There was a definite resistance from several members of the group to the suggestion that they include themselves in the picture. Several people commented that they were just too old to be bothered, and that they did not want to look at themselves. Bertha drew a picture that included several people. Then she stated that this was not what she had come to the art therapy group for, got up and
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walked out. She did not rejoin the group for the next six months. What went wrong? Apparently the level of communication between Bertha and the art therapist, even after two and a half years, had remained on a level much different than what would permit the sharing of painful feelings in the current circumstances as well as in one's past. This art therapist may have conveyed to the clients her interest and warmth, but it would appear that there was not sufficient empathy or understanding of what the clients were experiencing, and there apparently was not sufficient genuineness so that all feelings, joyful as well as sorrowful, could be shared comfortably in the group. When a sufficient degree of trust has been achieved in the relationship, a useful technique is to suggest to the client that a second picture be made to highlight some specific aspect of the experience portrayed in a previous picture. This usually leads to a deeper grappling with the experience already portrayed. For example, one art therapist asked a couple who had portrayed their relationship in rather bland and general terms, to make their next pictures about the specific concerns that each had hinted at in the first picture. The wife in this instance had portrayed herself as saying something to her husband. Now she was asked to make a picture specifically about what she was saying to her husband. If the client is not able to comply with the therapist's suggestion, reasons for this reluctance are of interest and can also be discussed to the advantage of the therapeutic process.
Self-System: A Technique Generating Matrix As one's experience with the psychocybernetic model grows, the therapist spontaneously generates appropriate suggestions for the client's productions. Also the therapist is able to encourage the client to make relevant choices for each session depending on what is going on in client's life. Less seasoned therapists have difficulty in shaking off the fear that they will not know how to proceed with their clients. To them it may be helpful to use the concept of the self-system to guide their effort to structure the therapy sessions constructively. What is a self-system, and how can it be used to generate appropriate techniques for visual expression? In psychology, the concept of self is one of those elusive ideas that periodically surface and then disappear. It is prominent in the Jungian
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psychology Oacobi, 1959) but it is avoided by the behaviorists (Ford & Urban, 1963). It is interpreted differently in the Eastern cultures than it is in the West (Chang, 1982). WilliamJames was one of the first psychologists to call attention to the importance of the concept of self in the West. He attempted to clarify the concept of the self by differentiating between the "I" and the "Mine." He was forced to conclude, however, that the line of demarcation between the two is rather fluid. He said, "The same object is sometimes treated as a part of me, at other times as simply mine, and then again as if I had nothing to do with it at all. In the widest possible sense, however, a man's self is the sum total of all that he can call his" Oames, 1890, p. 291). In a similar vein, the existential philosopher Martin Heidegger (1953) holds that a person's world is as wide as the reach of his care and concern. As a person grows, his sense of self grows, and it includes more than just the immediate organism and its surroundings. Piaget (1976), on the basis of his research, concludes that at first one's world is as far as the arms can reach. Then, it is as far as the eye can reach. Finally it is as far as the imagination can reach. The self-system, from the psychocybernetic perspective, is a cardinal self-regulating component. If one can change the way in which a person perceives himself, then his views of his situation will change. As the person's view of his situation changes, his behavior will change accordingly. The strengthening and the modification of a client's self-system, therefore, is central to the efforts of a psychocybernetically-oriented art therapist. What are the components of the self-system? When you think of who you are and what gives you a sense of pride and accomplishment, you are likely to describe experiences which fall under five headings. These five components of the self-system are interrelated and may be thought of as having semipermeable boundaries. The five interrelated components of the self-system are portrayed in Figure 8-8 and are summarized as follows: First, there is what might be termed the Body Self. This is the physical body and the concern here is with one's physical appearance and performance. Second, there is the mind, consisting of one's mental and emotional endowment and abilities.
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Third, there is the Interpersonal Self which consists of one's various relationships. These may range from intimate to peripheral, and from positive to hostile. The fourth component of the self-system is what might be termed the Achievement Self. It may be thought of as consisting of work performance and other accomplishments, including the roles one carries and the supports one is capable of providing to other people. The fifth segment of the self-system is what can be called the Transpersonal Self. This portion of the self-system contains a person's values, ideals, heroes, reference groups, and other matters pertaining to one's ethical and ethnic influences. The five factors constituting the self-system may be used to generate and select art therapy activities appropriate to the particular client one is working with. The therapist can deliberately highlight the various experiences that have contributed and are still contributing to the formation of each of the four parts of the self-system.
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The client may be asked specifically to make a drawing or a sculpture to portray some aspect of the five components of the self-system. Or the self-system paradigm may be used to examine the visual products already created by the client to see which portion of the self-system receives attention and which remain underdeveloped. A spontaneously created free picture, for instance, may portray anyone of the five aspects of the self-system. One 28-year-old white female drug addict, for example, drew a picture of a closed door with a dog sitting outside it, begging to be let in (Figure 8-9). She explained that she felt like the dog in her picture when she could not find her car keys to drive to the hospital for her appointment with her therapist. Another patient, a 23-year-old white male produced a picture of a duckling from a scribble (Figure 8-10). After a number of sessions it became clear that the duckling was an abstract self-portrait that captured well how he felt in his world. An example of the interpersonal portion of the self-system is shown in Figure 8-11. In this drawing a 26-year-old white mother of a 5-yearold boy portrayed herself with her son. She commented that her son appeared to be pulling her forward, and she said that this was quite true to life. "I can never keep up with him," she said. And she added, "Neither physically or mentally." A 27-year-old black female polydrug user drew a head of a lamb from her free flow lines (Figure 8-12). She then talked about one of her early foster homes where she apparently felt some affection for the farm animals and had received some warmth from some of the people there. Since then she had found no closeness in any of her subsequent relationships. The next three pictures show examples of the achieving self. Figure 8-13 portrays a young professional woman at work. She is surrounded by piles of books, some on the floor, some perched precariously on her desk. The drawing in Figure 8-14 was made by another young woman whose professional career as a dancer had been interrupted by her pregnancy, much to her distress. She noticed, however, that she had portrayed herself on the stage as if she was about to fallon her face. She then talked about the many obstacles she had encountered and admitted that her dance career had not been going well even before she became pregnant and had to give up her professional ambitions.
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Figure 8-15 contains a drawing made by a 28-year-old black woman after an unsuccessful job interview. The most prominent feature of this bleak picture is the sign which proclaims that no jobs are available. The client has portrayed herself sitting in a chair, her feet not reaching the ground. The sense of helplessness and discouragement are obvious and these feelings need to be dealt with if the client is to have the courage to face another job interview. Aspects of the transpersonal self are contained in the next two pictures. The racing car in the so-called liberation colors of black, green and red was drawn by a 28-year-old black male (Figure 8-16). The tiny figure in the middle of the car he said represented himself. His sense of ethnic identity appears to be a source of strength to him. The size of the human figure in relation to the car, however, would seem to bode ill for his ability to implement his ambitions. The drawing shown in Figure 8-17 was made by a 37-year-old black male whose hero was Muhammed Ali. This man said he too wanted to be a champion but he was not certain in what realm of endeavor he could attain the status of a champion. In the meantime he was drifting from one low paying job to another. When one examines the various techniques of art therapy, one is likely to find that these activities can be arranged under the five headings which designate the self-system. Examples of some of the various activities frequently used in art therapy which can be utilized to strengthen each portion of the self-system, are listed in Figures 8-18 through 8-22.
Peripheral vs. Central Concerns The therapist must pay attention to the rate at which the client is able to disclose painful and embarrassing feelings and experiences. It is best to start with rather neutral subjects, such as, "My favorite holiday," or various reminiscences, such as, "When I was in High School." Or, "my best friend," or "My wedding." Gradually one will be free to address directly the losses and disappointments one has encountered and may still be reeling under, such as "My saddest experience," "A problematic relationship to someone or something:" Or, "One of my greatest disappointments:" In short, the therapist should start with more peripheral themes and then, after the sense of trust has been established, proceed to the more personal and traumatic experiences,
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Figure 8-9. A Begging Dog.
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Figure 8-10. The Duckling.
Figure 8-11. A Mother and a Son.
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Figure 8-12. The Lamb.
Figure 8-13. Achieving.
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Figure 8-14. The Dancer.
Figure 8-15. AJob Interview.
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Figure 8-16. The Race Car.
Figure 8-17. The Champion and the Loser.
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BODY DOMAIN What can I do? How do I look? 1. Self-portrait, full length, realistic 2. Self-portrait, abstract 3. Self-portrait, a year ago 4. Self-portrait, ten years from now 5. Favorite activity 6. Favorite vacation 7. How would your best friend portray you? Figure 8-18. Body Domain. Reprinted, with modifications, with permission from the Art Therapy Association, DiMaria, A.E. (Ed.), Art Therapy: Still Growing, 1982. All rights reserved.
MIND DOMAIN Mental and emotional endowments, moods, feelings, temperament, and abilities 1. A happy day 2. A real sad day 3. A disappointment 4. Best vacation 5. Three wishes 6. What I let people see about me 7. What I do not let anybody see 8. Three wishes 9. Telegram or e-mail I want to receive Figure 8-19. Mind Domain. Reprinted, with modifications, with permission from the Art Therapy Association, DiMaria, A.E. (Ed.), Art Therapy: Still Growing, 1982. All rights reserved.
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INTERPERSONAL DOMAIN Relationships: intimate, distant 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Realistic family portrait Abstract family portrait Kinetic family drawing My family ten years from now My best friend Sculptures or pictures of important people in my life You in grade school You in high school House you lived in that you liked best What are some of the pleasant/unpleasant aspects of being single/divorced/widowed?
Figure 8-20. Interpersonal Domain. Reprinted, with modifications, with permission from the Art Therapy Association, DiMaria, A.E. (Ed.), Art Therapy: Still Growing, 1982. All rights reserved.
ACHIEVEMENT DOMAIN Work Performance, Accomplishments 1. An ideal place of work 2. Your place of work 3. If you could be anybody, who would you be? 4. Doing something your father would approve 5. Doing something your mother would approve 6. The proudest moment of your life 7. One of the most difficult situations you have lived through and what made it bearable 8. What do you like most/least about school, work, being retired? Figure 8-21. Achievement Domain. Reprinted, with modifications, with permission from the Art Therapy Association, DiMaria, A.E. (Ed.), Art Therapy: Still Growing, 1982. All rights reserved.
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TRANSPERSONAL DOMAIN 1. Favorite team 2. Favorite actor/actress 3. An ideal friend 4. Favorite movie/show 5. A favorite fairy tale 6. Sad vs. happy holiday 7. A person you envy most 8. Your necessities vs. your luxuries 9. A person you admire most 10. Collage about an ideal person Figure 8-22. Transpersonal Domain. Reprinted, with modifications, with permission from the Art Therapy Association, DiMaria, A.E. (Ed.), Art Therapy: Still Growing, 1982. All rights reserved.
especially when working with adults who pride themselves in their selfsufficiency and fortitude.
Rapport Building, Self-Sharing, and Closure It is wise to group all the various activities and themes one can suggest to one's clients according to the level of self-disclosure each presupposes. Some of the activities and themes are appropriate for building trust and for establishing a rapport. The "Free" or "Anything picture" referred to at the beginning of this chapter is one such technique. Another might be the making of a picture by incorporating in it the client's initials. Or, a making of a "name plate." Such a name plate would contain the client's name and whatever he may wish to add to indicate some personal interests and activities. In groups, the making of a joint free-flow with another member of the group usually accomplishes the purpose of setting people at ease with one another.
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Many of the themes concerning specific experiences already discussed in this chapter may serve to promote self-disclosure. For instance, self-portraits, family portraits, picture of a problematic relationship, doing something your mother or father would approve/disapprove, etc. It is important to keep in mind that all these themes touch on experiences one is not likely to want to share if the therapeutic climate is still of questionable quality. Finally, there are activities and themes that are appropriate for attaining a sense of closure at the end of the session. Often if the art therapy session has been rather intense, it is wise to suggest that the client simply make a picture of what the session was like. This produces a sense of being in charge rather than at the mercy of the intense feelings of anger, loss or whatever else may have been touched upon in the session. Another method of helping the client to attain a sense of closure is to do a mandala, that circular drawing favored by art therapists ofJungian orientation, discussed in Chapter 4.
Free Expression, Assemblages, and Perceptual Stimulation Simple two-dimensional art materials such as pastels and paper are used most often in art therapy. But for some clients, something other than drawing materials may be appropriate. The various properties of different materials have received some attention in art therapy literature and those interested should refer to it (Kagin & Lusebrink, 1978). In this context, the art therapist should keep in mind not only the various properties of the materials themselves and the specific interests of one's clients but, more importantly, the extent of the clients' physical and mental capabilities. When working with very young, very old or mentally impaired clients, the therapist essentially has three types of procedures to choose from. First, there is the free expression. Second, the client may engage in producing what may be termed the assemblages. Finally, there is simple perceptual stimulation. Free expression is by far the most common type of activity in the various forms of art therapy. Here the client works on either a two dimensional or a three-dimensional product to portray a self-selected theme or a theme suggested by the therapist. Free expression types of creations are appropriate with most clients across the entire span of the
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life cycle. But when working with the very young, the very old, or the mentally impaired, two other types of activities may be indicated. One type is assemblages. There are two kinds of assemblages. The first are designs made from shapes, cut-outs or some objects, such as stones, cones, shells, or beans. The second are collages made of pictures found in magazines and books. When assemblages are appropriate for the clients, the therapist must provide the necessary materials and help the client select a theme for the creation. Then the client is asked to select the shapes, objects, or pictures and arrange them in some order so that they convey some information or tell a story. Making an assemblage stimulates the client's thinking, promotes verbal communications between the client and the therapist, lessens the sense of emotional isolation, and focuses the client's attention on some aspect of the external world (Doll & Nucho, 1982). There may be additional gains from this activity, such as the improved fine motor coordination. The use of collages with patients in a psychiatric setting is discussed sufficiently elsewhere in the literature, particularly Moriarty (1973). It may be noted in passing that the assemblages work well not only with the kind of clients already mentioned but also with adults of normal intelligence who are rather inhibited and uncertain of their creative capabilities. When the assemblage is finished, the therapist must help the client tell what the creation means to him, just as it would be done if it were a free expression. Ways of facilitating the decoding of the meanings contained in the visual creation are part of the Dialoguing Phase of the therapy process (see Chapter 9). Perceptual stimulation used simply to stimulate imagination may be appropriate with any kind of client. With the very young, the very old, and some types of brain-damaged clients perceptual stimulation may be the only form of activity that produces some emotional sharing and communication. The first part of the process is to provide an object for the perceptual stimulation. The object may be from nature, such as leaves, flowers, a pine cone, or wood chips. Some everyday object, such as a comb, bar of soap, or a mitten may serve the intended purpose as well. Or a symbol of some specific holiday or some object with religious significance, such as pumpkins, Easter eggs, Bible, etc., may be used. The client is asked to explore the object with as many senses
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as is appropriate. The object may be touched, squeezed, smelled, and so on. The purpose is simply to engage the brain cells and the senses, and to stimulate verbal sharing, finding and attaching verbal labels to the various sensations, and, if done with elderly clients, to promote the process of reminiscing. The therapist's task is to encourage the exploration of the object and to call to the attention of the person the specific features of the object in order to encourage the powers of discrimination ("Do you see the dark spot here?" Or, "Do you like this better than that?"). Some objects can be pasted on paper. Others may be traced, and appropriate background may be drawn in. Or the therapist may draw a rough outline of the object, and the client may color it in. When assemblages are produced, art therapy starts resembling what might be termed "activities therapy." However, many art therapists work with clients for whom the so-called "free" expression is not appropriate. The "free" art expression is not the only form of art therapy. Moreover, the imagination of many adults of normal intelligence is rusty and may need some prodding too. Assemblages can serve this purpose. In some instances, the assemblages may even reach a high level of aesthetic merit.
What to Do While Clients Work? The final decision of the therapist in the Doing Phase concerns what the therapist should do while the client is engaged n the creation of the visual product. A beginning therapist frequently feels superfluous and useless while the client is busily producing his or her visual expression. Being at a loss as to what to do, some art therapists work alongside the client. Others, not wanting to overshadow the client with their own wealth of imagery and technical skills, proceed to tidy up their office or do other chores until the client indicates that he or she has finished. Some inexperienced therapists think that their presence might make the client self-conscious and uncomfortable, so they read a magazine or leave the room. From the psychocybernetic perspective, these various solutions are undesirable. The task of the therapist during the Doing Phase is to be an unobtrusive observer and if necessary, a troubleshooter. The information processing does not proceed only on the paper, or in clay. Much information about the client is conveyed through his verbal and
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nonverbal behavior, such as casual comments, grunts, hesitations, and sighs. It is important to note in what order the client proceeds with the making of the visual creation. Where does he get stuck? Where does he invest most of his time and energy? How does the mood of the client change as he goes about his work? Unless the therapist pays attention, much data is lost. Experience shows that a relaxed and alert stance on the part of the therapist is best. Young children in particular appreciate the undivided attention of the therapist while they work, provided the therapist is not intrusive. They like to share their thoughts by brief remarks or questions as they proceed with their work. Often, with young children, a formal discussion phase after the picture or sculpture has been finished, is not feasible. Therefore, it is especially important that therapist pay attention to their young clients as they work. It is true that at times clients indeed do feel self-conscious in the presence of the therapist. Usually an appropriate comment from the therapist which contains some expression of the therapists interest and some encouragement is sufficient to reassure the client. A seven-year-old boy, however, told his art therapist that she should leave the room while he worked. In this instance, it appeared that this was part of the child's way of "calling the shots," and his way of asserting his dominance over adults in his world. The art therapist stood her ground and told the child that her job was to sit and watch while he worked so that they could talk about what he produced. This was acceptable to the child. Had it been otherwise, the therapist could have inquired what in particular was objectionable to the client and attempted to reach some kind of a compromise. Apart from the specific techniques discussed earlier, such as the interactional drawing, experience shows that it is best for the therapist to refrain from drawing during the therapy session. Otherwise it is too easy for the therapist to get absorbed into one's own imagery and lose track of what the client is doing. The therapy session is primarily for the benefit of the client, not for the enjoyment of the therapist. The art therapist should do everything possible to make herself comfortable in the session. Her energy and creativity, however, should be channeled into the understanding of the client and the client's experience. This may entail paying close attention to the imagery that arises in the therapist's mind. Nevertheless, that imagery at this point should remain
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private and should be shared with the client selectively and with great care.
The Length of the Doing Phase Among the decisions the therapist has to make when embarking with the client on the Doing Phase is how long it will take to create the visual product. In arriving at this decision, one has to estimate how much time will be needed afterward for the discussion of both the visual item and the client's experience of producing it. Several factors determine the length of the Doing Phase. The first factor is the type of client one is working with. Another is the theoretical framework of the therapist. A third factor is the specific activity selected for the session. When working with physically ill clients or with the frail elderly, the length of the session, by necessity will have to be shorter than when working with able-bodied adults. When working individually with most able-bodied adults, the entire art therapy session, including the Unfreezing, the Doing, and the Dialoguing Phases, may take about an hour and a half. In contrast, when working with a physically ill person, all three phases may last 15 minutes. The Doing Phase in this instance would last perhaps only 5 minutes. Similarly with children. When working with a child individually, the entire art therapy session may last half an hour, although frequently the therapist will discover that children who normally have a very short attention span are perfectly happy to engage in art therapy sessions that last for two hours and even longer. With children, the Doing Phase will exceed the length of the Dialoguing Phase, and usually the child will want to produce more than just one picture or sculpture. Work in groups, both with adults and with children, will require more time than when working with clients individually. For most groups of adult clients, allow two hours; allow about 45 minutes for group sessions with children. Clients who have some training in art at times wish to spend a considerable amount of time on their art work in order to complete it to meet their own standards of achievement. This kind of client can be reminded of the distinction between what Maslow terms primary creativity or the idea-generating phase, and the secondary creativity or the execution phase (Maslow, 1971). In art therapy we are only interested in a rough sketch of the idea to be portrayed. If the client feels the
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need to polish the work, it can be done outside the art therapy session itself. Clients who do not possess any artistic skills usually welcome the encouragement to work quickly and spontaneously and not to worry about attaining perfection of their idea. However, some compulsiveobsessive clients find it difficult to be spontaneous and to leave something half finished. They often want to stay with the one project until it has been shaped and molded to their requirements. At times it helps to empathize with the client's predicament that things just do not seem to work out the way one wants to. The discussion can be broadened from this one example of disappointment to other similar instances in life where the client aimed for "perfection" but for various reasons could not achieve it. At other times the therapist may suggest a specific time limit and ask the client to do only as much as is possible in the specified time period. ("We are running out of time. Do you think you could try to bring your work to some point of completion within the next 5 minutes? I know there is much more that you still would want to do.") With groups, especially children, some clients will need more time than others. If the discrepancy between the amounts of time required by the several clients is great, sometimes the therapist can suggest that the clients who prefer to work fast make two pictures for each one picture produced by the slow creators. When the dialoguing phase arrives, the fast workers can decide which of their several creations they wish to share and focus on for discussion purposes. At times, especially when working alone with one client, considerable amount of flexibility can be used by the therapist in deciding how to proceed. One teenage boy who had a minimal learning disability had several periods of "Doing" interspersed with periods of "Dialoguing" while working on a single picture. He would think he had finished his picture to his satisfaction and would start explaining what he had produced only to discover additional features that he wanted to add to his drawing. He would then proceed to work some more on his picture, and then resume the discussion of it. Does a picture have to be finished in one session? Occasionally a client may want to spend several sessions working on the same picture. If this is not simply an attempt on the part of the client to avoid talking about what the picture means to the client, there is no reason to dissuade the client from devoting several therapy sessions to working on a single item. However, in light of the psychocybernetic model, it is not
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the final product that is of a paramount importance but the client's experience while producing it. Therefore, sufficient amount of time needs to be allotted for the discussion of the product and the process of producing it. Take, for example, the case of a 32-year-old black male. He came to his usual art therapy group session after his estranged wife was brutally murdered in front of his two young children. He proceeded to work on a picture which he called "The Black Madonna" (Figure 8-22). The Madonna holds a child in her arms. There is a cross behind her, and a peace sign in the lower right hand corner. At the end of the session the grieving man said that he had not finished the picture and that he would continue working on it the next time. A week later, he resumed his work on his "Black Madonna." He did some additional coloring but the picture was essentially left as it had been at the end of the previous art therapy session. His mood had changed during the intervening week, and he was ready to proceed to some other theme. A profound experience requires a profound investment of time and energy for its resolution. Sometimes a client will produce several series of pictures about the various aspects of an experience. In order to help the client grapple with a painful experience the therapist may deliberately suggest that the client portray the experience in step-wise fashion. A foster child, for instance, drew a series of pictures in cartoon style which showed his encounter with his new foster family. Similarly, during a number of art therapy sessions a 63-year-old gentleman produced a series of clay figures representing various experiences from his adult years when he worked as a bartender. This was his own unique manner of engaging in what gerontologists term the "life review" process (Butler, 1963). The type of activity or technique chosen for the visual expression influences the format and the amount of time devoted to the Doing phase. Some activities may require a short period of time while others may need a considerable length of time. For instance, self-portraits may take a long time for most clients. However, in order to lessen the clients' concern with the technical aspects of the drawing, the therapist may arbitrarily set a very short time limit, for instance five minutes, for its completion. When engaged in working on a drawing concerning some difficult experience, for example, "A problematic relationship to something or someone," the therapist may purposefully allocate a considerable length of time for the completion of this picture in order to
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facilitate the clients' coming to terms with the various aspects of these concerns. An additional factor which determines the length of the Doing Phase, besides the physical, emotional, chronological, and other characteristics of the client population one is working with, is the type of art therapy the practitioner has adopted. The several versions of art therapy were described in Chapter 5. By and large, therapists who practice what may be termed the "art wing" type of art therapy will devote more time to the Doing phase of the process than to the Dialoguing Phase. Art therapists of the "therapy" wing are inclined to pay more attention to the Dialoguing Phase than do those of the "art" branch. When engaged in the psychocybernetic model of therapy, the length of the Dialoguing Phase tends to exceed that of the Doing Phase, in most instances. There is one more factor that shapes the amount of attention paid to the various phases of the art therapy process. Regardless whether the practitioner belongs to the "art wing" or to the "therapy wing" of art therapy, the theoretical framework adopted by the practitioner will further determine the amount of attention paid to each phase of the therapy process. Those of the Jungian persuasion (Lyddiatt, 1971) devote time primarily to the Doing Phase. Relatively little time is spent on discussing and analyzing the visual creation. In contrast to the Jungians, the psychodynamically oriented art therapists spend more time on the discussion of the product than on its creation (Naumburg, 1966; Betensky, 1972). The differences between the several theoretical approaches to art therapy and how these differ from the psychocybernetic model of therapy are discussed further in subsequent chapters. For now let us keep in mind that there are several choices open to the practitioner in regard to the length of the Doing Phase and the manner of utilizing the time allotted to it. In summary, there are a number of techniques and procedures available to the therapist. Several principles guide the selection of techniques and procedures appropriate for various kinds of clients. There are decisions the therapist has to make at this point in the art therapy process and invariably, the best guide is the therapist's own experience with the process. These choices and decisions soon take care of themselves, once the therapist has acquired some experience with the psychocybernetic model and has noted the value and enjoyment clients derive from the therapy sessions in which visual expression is used.
Chapter 9
THE DIALOGUING PHASE n old Chinese proverb says that one picture is worth a thousand words. The eloquence of the pictures produced in art therapy, however, is frequently rather muted. These pictures tend to be enigmatic and puzzling, often to the maker of the picture as well as to the therapist. This chapter offers specific suggestions about the process of unlocking and decoding the messages contained in clients' visual creations. The pictures and sculptures made by clients in art therapy present their messages in the language of the non-dominant cerebral hemisphere. (See Chapter 3 for a discussion of the differences between the two symbol systems associated with the two cerebral hemispheres.) During the dialoguing phase the visual language of the non-dominant hemisphere has to be translated into the more conventional language of the dominant cerebral hemisphere so that it may be shared more easily with the therapist and, if necessary, with other significant people in the client's life. The visual language has to be translated into verbal language in order to clarify the information contained in it. While embodied in the visual creation, the message often remains a cryptogram, a term used byJung for a message written in code Oung, 1961). Often the information contained in the visual creation appears mysterious and perplexing even to the maker. How can this information be decoded for the benefit of both the maker and the therapist?
A
The Nomomatic vs. the Ipsomatic Approach Some therapists may object to the notion that the visual product is an enigma or a cryptogram even to a well trained and experienced pro157
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fessional. It is true that the theoretical framework adopted by the therapist casts some light on the visual expressions of the client. For instance, therapists of the orthodox Freudian persuasion tend to regard elongated objects as being phallic shapes, and they would then pursue the sexual implications of these forms. If the visual product contains sharp, jagged, pointed shapes, these therapists would be inclined to regard these forms as expressions of aggressive drives. Similarly,]ungian therapists may have strong convictions concerning the meaning of certain other symbols. These schools of thought are discussed at some length in Chapter 5. Whatever the theoretical persuasion of the therapist-and even a psychocybernetically-oriented therapist will have incorporated some aspect of the other theoretical orientations-it behooves the therapist to approach the client's creation with an open mind. In this respect the psychocybernetic model resembles the phenomenological approach, which also advocates that the therapist discard all preconceived notions when looking at client's artwork (Betensky and Nucho, 1982). The therapist can view the visual creation of the client in two ways. One is the nomomatic, the other is the ipsomatic approach. (See Chapter 6 for a discussion of the two ways of examining the visual product.) The approach is nomomatic when the therapist attempts to apply to the client's visual creation ideas derived from some theoretical perspective or empirical research. The therapist is proceeding ipsomatically when the art work is observed phenomenologically, from the maker's own point of view and, insofar as possible, without any preconceived notions. The psychocybernetic model suggests that the approach in the dialoguing phase be ipsomatic, using the tools, notions and ideas that stem from the maker's own experience rather than from theories, research, or experiences imported from someone else's life. In light of psychocybernetics the ipsomatic approach is more effective than the nomomatic for the decoding and processing of the information contained in the visual expression of the client. There are four aspects of the dialoguing process. First, there is the dialoguing between the maker and the visual expression just created. Next, the dialoguing is deepened by the discussion between the client and the therapist, while the therapist observes the ipsomatic principles and then proceeds according to a specific procedure detailed below. Then there is the dialogue within the mind of the therapist. That might
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be an admixture of the nomomatic approach-those notions the therapist has derived from a theoretical perspective and empirical research coupled with her own professional experiences with other clients whose concerns were similar to those of the present client. And last, there are the subjective messages and feelings derived from personal life experiences that arise in the therapist on viewing the client's production. As suggested earlier, the last two aspects of the dialoguing process should remain submerged and silent while the therapist attempts to facilitate and clarify the first two levels of the dialoguing enterprise. The dialoguing phase consists of three distinct parts. Distancing is the first part. The decoding of the visual messages and the process of translating the visual messages into conventional verbal symbol system is the second part. The third part is the consolidation of the newly derived information and the attainment of a sense of closure.
Distancing In the dialoguing phase the therapist must first encourage the dialogue between the client and his visual expression. This is facilitated by stepping back after the picture or the sculpture has been completed. The stepping back may take the form of actually stepping back physically after having taped the picture to the wall, or setting the sculpture somewhere where the maker can look at it from various angles. The therapist should remember to give the client some time to contemplate the object before intruding into the client's internal dialogue. After the client has had the opportunity to inspect the visual creation, the therapist moves to the next step of the dialoguing phase by simply inviting the client to tell the therapist what has been produced. That starts the process of putting the right brain messages into the conventional left brain symbols. It may not be easy. Some clients may even find the talking superfluous. As one client commented, "If I could say it, I would not have to portray it in pictures." The Jungian therapists are of the opinion that the mere externalization of the ideas has a beneficial impact. They think that the archtypes are activated through the visual expression and this in itself and by itself promotes wholeness and integration of the psyche. Therefore, verbal explanation of the meanings contained in the picture is of secondary importance. But from the psychocybernetic position it can be
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postulated that the clarity of the message will be enhanced and the steering of the system will be more secure and appropriate if the message can be expressed in the language of both and not just in one of the symbol systems. The use of both cerebral hemispheres strengthens and clarifies the information contained in the visual expression so that it may be either heeded or discarded deliberately, as the case may be, rather than left slumbering in the information processing channels of the system.
Decoding Decoding the messages contained in the visual forms of expression is the second part of the dialoguing phase. How is this accomplished? The decoding of the visual messages consists of three progressively more intensive lines of inquiry. These three lines of inquiry are (a) the inventory, (b) the search for affective qualities, and (c) the distillation of meanings. The first line of inquiry during the decoding process concerns the content of the creation. This begins by simply asking the client to describe what is portrayed on the piece of paper or in the clay. "Tell me, what do we have here?" Or, simply, "Tell me about it." At this point the client may go on at some length explaining the production. Or the client may have only a few fragmentary comments to share with the therapist. The process of decoding the meanings contained in the visual product can be facilitated by simply asking the client to point out and name the various shapes and/or objects that are there. Dewdney (1967) called this the "object inventory." Dewdney noted, and I share his observation, that the shape or object mentioned last, or the one that is entirely overlooked by the maker, frequently has some particular significance to the client. When the client has finished describing the shapes and objects in the picture, the therapist may ask, "Anything else?" The client may then point out some additional feature of the production. Not infrequently, however, the client has nothing further to add. But later, the client may suddenly notice some essential feature of the creation. This may occur weeks or even months later. Portions of the picture that had remained entirely blank to the client on first viewing may now take on some special significance. At this point, the client's codification system may have been expanded so that it reaches a level where the additional information can be accommodat-
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ed and integrated with the previously acquired information. (See Chapter 3 for a discussion of cognition as a system of codification.) Another way of facilitating the decoding of the messages contained in the visual creation is to ask the client what in particular stands out for him, what catches his eye, or what appears to be central in the picture. This line of inquiry helps the client organize cognitively the meanings contained in the creation. The more pertinent parts of the message are sorted out from the peripheral ideas. Still anther way of facilitating the comprehension of the visual message is to direct the client's attention to the portions of the graphic expression that have not yet been addressed. The therapist might ask something like, "Can you say something about this area here?" Or, "What sort of feeling do you get from this line here?" These questions lead to the next step in the decoding process. The dialoguing process has now deepened from a survey of the various items, objects, shapes, and portions of the creation, or a simple inventory, to the examination of the affective qualities associated with the various parts and shapes of the creation. First the therapist might pose a general question about the overall feelings contained in the creation. For instance, the therapist might ask, "What kind of feeling do you get now as you look at it? What kind of feeling does it convey to you?" This mayor may not be the feeling the client intended to convey while producing the visual expression. Often there emerges something entirely different from what the client originally intended to portray. The therapist can discover this by asking the client something like this: "Did you plan it to be this way? Or were there some surprises as you worked on it?" Not infrequently the clients report that the picture seemed to have almost a mind of its own, and the visual product took a shape different than what the maker intended it to have. These "inadvertencies" are of interest because they may contain feelings more genuine than those the client deliberately intended to portray. If the client feels secure enough with the therapist, he will readily explore the meaning of the "surprises" that arose in the course of the work. The acceptance and the support from the therapist may provide a sense of adequacy and the necessary courage to consider the feelings and experiences that have been too overwhelming or too humiliating to be addressed before. These concerns and apprehensions may have appeared beforehand only in nightmares. Solutions to these concerns
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are more likely to surface now than when they are harbored in some remote region of one's information processing channels. The distillation of meanings from the visual expression is the final step in the decoding portion of the dialoguing phase. To achieve this, the discussion turns to a more intellectual, "left brain" level than it had been up to this point. The therapist might ask the client to tell about the messages the client gets from the picture or the sculpture. In most instances, this will be a further elaboration and clarification of the ideas expressed in the portion of the inquiry that dealt with the affective messages. The meanings contained in the visual creation may be consolidated and clarified further with the help of some Gestalt-type questions. These questions personify the visual creation. For instance, the therapist might ask the client what the sculpture would say if it could talk. A 48-year-old woman, for example, thought that her sculpture conveyed to her the idea, "Be bold, do not buckle under." Next, the therapist might ask what the client could say in response to the message received from the visual creation. "How would you respond to it, or what would you like to say to your sculpture?" The woman in question told her sculpture, "It is not going to be easy but this time I will do it!" Sometimes asking the client to give a title to the picture or sculpture helps to distill the meaning contained within. A 28-year-old black man drew a head in the lower left hand corner of the sheet. The head appeared to be bandaged and had blood dripping from it. A sun occupied the upper right hand corner of the page. After he had explained the picture to the therapist and had talked about the way the person with the head injury was feeling, he decided that the title of the picture could be "Endurance." He summed up the meaning of his picture as containing the notion that although there was much pain and suffering in his life, he was still able to endure life. By "enduring life" he meant that he would be able to continue to abstain from taking heroin for still some time longer, and that he would stay away from his former friends (Figure 9-1). When the level of trust between the therapist and the client is adequate, the client is able to share with the therapist feelings and experiences that up to now have been painful and embarrassing. Now experiences and concerns are permitted to surface into awareness so that they can be dealt with and disposed of. Thus the system can be stabilized and steered into some more beneficial and constructive direction.
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Figure 9-1. Endurance.
Closure and Consolidation The final part in the dialoguing phase is the attainment of closure and consolidation of the meaning. At this point the client should have the opportunity to reflect on the entire experience of creating and discussing the product. The client will welcome the opportunity to explain what came easily, and what had to be labored over. He will want to reflect to what extent the production turned out to his satisfaction, and what would he want to change, if that were possible. For instance, the therapist might say, "Now suppose you had a professional artist who could help you with your picture. What would you want him to touch up? Any parts you would want him to go over and improve upon? How?" Curiously enough, even when the pictures are obviously in poor perspective or otherwise distorted, clients seldom notice the distortions because the pictures reflect the clients' own sense of the world and their place in it. One 22-year-old black man, for instance, drew a self-portrait where the large head sat precariously on a rather weak body, with one huge foot going in one direction while the other foot went in another direction. When he finished the self-portrait, he was
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quite pleased with it. He thought he had accurately portrayed his life at that time. Indeed, he was going in all directions at once, and he rather relished this opportunity to capture this sense of noncommittal and freedom (Figure 9-2). Not all pictures will turn out to the client's satisfaction. At times the client should have the opportunity to reject a work. If the visual product contains ideas and feelings the client is not yet prepared to deal with, and if the client is dissatisfied with how it turned out, the therapist may ask what in particular he dislikes about the picture, and what would make it more acceptable to him. At times the spotlighting technique described in Chapter 8 can be used at this juncture in the therapy process. Also, the client may be asked to make a picture about the feeling that his picture conveys to him, or what it felt like to work on that unsatisfactory picture. Thus, the experience becomes externalized and can be inspected and placed among other life experiences. The information processing in art therapy is for the benefit of the client, and not the therapist. However, at this point the therapist might indicate some feature that seemed aesthetically attractive while acknowledging that the client's externalized feelings were rather scary or otherwise unpleasant to him. The making of a picture about the experience of the picture making itself is one way to help the client attain a sense of closure. Inviting the client to make a free choice picture or a picture about anything is another method. The concerns touched upon in the previous picture will be portrayed in the free picture, and frequently some resolution will emerge. With a few strokes, for instance, a 33-year-old black woman produced the sad looking puppy shown in Figure 9-3. During the dialoguing phase it turned out that the client's own sadness stemmed from her desire to go back rather than to go forward in her life. The affection the miserable puppy evoked in her gradually mobilized her own determination to take care of herself and proceed with her life. Finally, many clients find the process of mandala making to be a way of achieving a sense of consolidation and a closure. A mandala is a circular drawing produced usually by starting at the center and then proceeding outward toward the boundary of the circle. The mandala shown in Figure 9-4 was done by a professional woman in her twenties. Prior to her encounter with art therapy she thought that she did not have any artistic ability. But within a few weeks her innate creativity was flourishing. Not only did the mandala making help her sort out her
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Figure 9-2. Carefree.
thoughts and feelings but it also gave her the pleasure of creating aesthetically attractive intrinsic designs.
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Figure 9-3. A Sad Puppy.
The work to be done in the Dialoguing Phase may be summarized as shown in Figure 9-5.
Format and Length of the Dialoguing Phase The format and the length of the dialoguing phase of the art therapy process are shaped by two sets of variables. The first are the characteristics of the clients one is working with. The second set of variables which determines the format and the extent of the Dialoguing Phase is the theoretical orientation adopted by the therapist. These two sets of factors are important considerations for the art therapist. When working with children, the doing phase will be far more time consuming than the Dialoguing Phase. Children enjoy picture making, and unless the therapist persists, they may offer only a few snatches of verbal comments. In contrast, when working with adults, the Dialoguing Phase in most instances will be longer than the Doing Phase. Here is an example of a Dialoguing Phase with a developmentally normal and physically healthy six-year-old girl whom we shall callJen-
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Figure 9-4. Mandala.
nifer. Jennifer had been an only child for all six years of her life, and much affection and attention had been lavished on her by her parents. Within the last four months, however, two factors had assaulted the stability of her world. Her mother had become pregnant and was suffering from severe nausea and fatigue. Suddenly her mother was less of an active factor inJennifer's life and she was, in general, less accessible. Jennifer's father tried to fill the gap but he could not fully compensate for the loss of her mother's attention. AlthoughJennifer expressed joy at the prospect of having a little brother or sister, she also verbalized her considerable anger and sadness, wishing that her mother would get back to her normal level of activities quickly. Her recent promotion from kindergarten to the first grade was the second factor affecting Jennifer's life. While kindergarten had been a thoroughly enjoyable experience, the first grade with its rules and regulations, plus a new and somewhat intimidating teacher, appeared to
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THE DIALOGUING PHASE The Nomomatic Approach The Ipsomatic Approach Application of ideas derived from theory Use of ideas derived from client's own or empirical research life experiences: Distancing Decoding Object Inventory Affective Qualities Cognitive Meanings Consolidation/ Closure Reflecti ve on Process Acceptance of the Product Portrayal of the Process
Figure 9-5. The Dialoguing Phase.
lower Jennifer's threshold of frustration tolerance. Her sense of confidence and competence seemed to crumble. She tended to have temper tantrums or dissolve in tears. In her art therapy sessionJennifer produced a huge tree with a sizeable knothole, a small house next to the tree, and two flowers on the other side of the house. A smiling sun adorned the upper left-hand corner of the picture (Figure 9-6). The picture was entitled, "The Outside Picture," and it filled the entire page. Jennifer's description of the items depicted tended to center around her technique and choice of colors: "The tree is fat and big. The curtains are made of light orange. The picture is made of crayons. The sun with a happy face is made of lemon yellow and black. The flowers are pretty. I worked as hard as I could." In an attempt to move Jennifer away from the concrete to the affective aspects of the picture, the therapist askedJennifer who lived in the house. Her response was, "My UncleJohn, my Aunt Elsie, and my cousinsJulie and Dannie. That's all I can tell you." The therapist praisedJennifer for the lovely picture she had produced and pointing to the knothole, asked further about the "black space in the tree." Jennifer identified it as a knothole. When asked if anyone lived there, she responded, "A squirrel lives there with her whole family-mommy, daddy, grandma, and grandpa, and there are many nuts to at in there. It's a very fat tree." The therapist then inquired if there was enough room in that tree for all those squirrels to live there without fighting and getting in each other's way. Jennifer
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Figure 9-6. The Outside Picture.
thought that there was enough room for everyone, adding, "And besides, they all love each other very much, and they are very happy together." At this point she drew the heart on the knothole. She was asked to tell the therapist something about the flowers. Jennifer said, "They are roses and they are closer to you than the house. The house is further away, and that is why it seems smaller. Actually, it is almost as big as the tree. That's all there is to say about it." The therapist still
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persisted and askedJennifer which was her favorite part of the picture. Jennifer said that the sun was her favorite part of the picture and added, "I worked very hard on the sun." She was asked if there was any part of the picture she did not particularly like. Jennifer replied that she wished she could have drawn the flowers better. "They are not as pretty as I wanted them to be." In general,Jennifer seemed pleased with the drawing which she had produced with great care and attention to detail. She appeared to experience some anxiety over doing what she perceived to be a "good job." This example shows how a skillful therapist can facilitate the verbal discussion of the picture even with a young child who thought on several occasions that she had nothing further to say about her production. The therapist introduced themes verbally that were depicted by implication in the child's picture, including her concerns about space needed for the next addition to the family. The second set of factors that shapes the format and the length of the Dialoguing Phase is the theoretical framework adopted by the therapist. And here, in the Dialoguing Phase of the art therapy process, the differences between the various theoretical frameworks become most apparent. Art therapists who have adopted the psychoanalytic orientation tend to emphasize the Dialoguing Phase over the Doing Phase. Often the Dialoguing Phase is considerably longer than the Producing Phase. This theoretical perspective differentiates between the so-called primary process thinking and the secondary process thought. According to Freud, thinking in pictures approximates more closely the unconscious processes than does thinking in words. It is assumed to be older both for mankind as a whole and for each individual person, that is both ontogenetically and philogenetically. The visual thinking or the primary process type of thinking is held to be inferior to the secondary process thinking. The visual expression therefore is explicated in great detail into the verbal or the secondary process thought. Experience shows that when Freudian therapists do art therapy, they are prone to the dangers of overanalyzing, overcommenting, and oververbalizing. Art therapists of the Jungian orientation, on the other hand, tend to err in the other direction. Many Jungians dismiss as unimportant the verbal dialoguing with the visual creation. They hold that the process of expression is healing in itself. In their opinion, as previously indicated, the archetypal forms portrayed do not have adequate verbal
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equivalents, and even when attempted, the process of dialoguing will fall short of the meanings captured in the visual expression itself. Consequently, the dialoguing process in this form of art therapy is very short or even omitted altogether. It may very well be true that the visual expression indeed transcends the confines of verbal language. However, in light of the psychocybernetic concepts, the process of dialoguing should not be shortchanged. It is one form of feedback to the system. Even though the dialoguing process will not capture all the nuances contained in the visual creation, it still has value because it facilitates the process of codifying and integrating the new information with the information already stored in the system.
The Process of Amplification In this context it is well to note the process of amplification which Jung himself used to clarify the messages contained in dreams. The same process of amplification is needed also to understand the messages contained in the visual forms of expression produced in art therapy. The message contained in the visual creation is less likely to evaporate or remain effervescent if it is poured into a lexical symbol system. What doesJung's process of amplification consist of? Jung thought that the various aspects of dreams could be understood by relating them to images and symbols which they suggest. By using analogies, a common theme might emerge, and in light of this common theme, each separate part of the dream might be examined to further elucidate its meaning. In this painstaking manner, the probable sense of the dream might be deciphered. However, Jung thought that this "objective amplification" would not be sufficient. He pointed out that also a "subjective amplification" would be necessary. When only a few archetypal motives are contained in the dream the dreamer must supply personal association from his own life experiences in order to make sense of the dream Oacobi, 1959, p. 130ff).
Dispositional vs. Facilitative Understanding Jung's method of amplification of dream content indicates thatJung himself was not averse to the efforts to find appropriate verbal equiva-
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lents to the dream imagery. The same holds true for forms of purposeful visual expression in the course of art therapy. Here too a process of "amplification" is needed. What Jung terms the "objective amplification" parallels what been designated as the nomomatic seeing while his "subjective amplification" corresponds to the ipsomatic seeing. According to Jung, the subjective amplification may provide the means of understanding dream content that cannot be explained by the means of the objective forms of amplification. In the context of art therapy, when is it appropriate to engage in the nomomatic seeing, and when is it more appropriate to use the ipsomatic seeing? Experience shows that the nomomatic approach to visual forms of expression leads to an objective understanding of the client and his experience. When is it important to achieve an objective understanding of what the client is going through? It appears that an objective method of understanding is indicated in those circumstances where the therapist is expected to provide solutions for the client's difficulties. This may be termed the "dispositional" diagnostic understanding of the client. This form of understanding is necessary if the therapist has to provide a disposition to the client's problem-in recommending that the client be treated in a certain manner or in certifying that the client is entitled to certain provisions. In many instances, however, it is not the therapist who will take the necessary steps to resolve the client's difficulty. It is the client himself. These instances call for a "facilitative" diagnostic understanding or a form of understanding that facilitates the client's own grappling with the problem. Here the client has to make a specific decision, or take certain steps to insure that his behavior will change and be more in his own best interests. If this is the case, the ipsomatic seeing is necessary because it enables the client to know how to proceed. Whether the therapist sees the solution or not is of a lesser importance than the client's own knowledge of what he should do next. The decoding of the meanings contained in the visual product, done nomomatically at the exclusion of the ipsomatic features, results in what usually is thought to be an objective understanding of the visual creation. Actually this type of understanding may be very slanted and contaminated by the therapist's own proclivities and life experiences. This occurs because therapists feel drawn to, and tend to adopt certain theoretical positions that are congruent with their own philosophies of life which in turn have been shaped by their own life experiences.
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The nomomatic or the so-called objective approach, when utilized exclusively, results in psychological testing. This is in contrast to the psychocybernetic model of where the understanding of the client himself has to be cultivated so that his life experiences may be properly understood and responded to.
Search for the Inner Design With most clients, even with very young children, the main impetus for a beneficial and lasting behavioral change comes from their own efforts rather than from the efforts and desires of the therapist. The sense of clarity and determination that needs to be attained is that of the client and not necessarily that of the therapist. In the psychocybernetic model of art therapy, the dialoguing process unlocks the information contained in visual expression so that one's life may be steered dependably and securely with an adequate supply of information. In the model, the information processing utilizes two coordinates-the visual and the verbal. Both the primary and the secondary processes are essential for adequate information processing. Both cerebral hemispheres have to be heeded. Information is embedded in a dual coding system in humans, and the psychocybernetic model pays attention to both. The steering and the functioning of the human system may be impeded by scarcity of information as well as by an overload of information. Experiences that may have been too overwhelming and frightening are frequently compartmentalized. They are not admitted to full awareness where this information can be sorted out and inspected in the light of contemporary reality. Such information may remain stored at the kinesthetic/sensory level and may be represented by various bodily symptoms. By interconnecting and integrating the information stored at the various levels of the system, energy is made available for goal-directed functioning. The psychocybernetic model postulates that imagery is one of the most important channels of information processing. Experiences in life are encoded into imagery of the various sensory modalities. Of these, visual modality is one of the most paramount and strongest. The visual forms of expression are like the conveyor belts that bring forth information. They deliver the meanings like fossils which can be transformed into their original state. They can be resuscitated, as it
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were, and the energy contained in the original experience can be reactivated. Or, like frozen vegetables which when properly treated, can be restored almost to their original state. The relationship between the information stored at various levels of the human system and the functioning of the entire system may be thought of as something akin to a shoe store. There are all kinds of styles, sizes, and colors of shoes. However, they are all useless until the proper size and style is found for the particular occasion in mind. The same with information. The information stored in the system has to be codified and tried on "for size" for the particular tasks one is about to engage in. This is accomplished with the help of the dialoguing process. Anxiety is experienced if the input-output sequence of information processing is interrupted. Gradually this anxiety coalesces into psychopathology and undesirable behavior. This sequence of events takes place not only in the human system but in animals as well (Sebeok, 1962). In rats, for instance, information overload created by overcrowding produced various abnormal internal cognitive and affective processes, particularly frenetic activity and pathological withdrawal. According to some scientists, repeated interruptions of the completion of the normal input-output sequences by new inputs lead to what has been termed "future shock" (Toffler, 1970). In affluent industrialized societies the individual is flooded with an excess of attractive information inputs. He is pressured by social influences to choose from among attractive inputs which creates a conflict over which alternatives should be chosen. He attempts to cope with the information overload by filtering, escape, repeated approaches to many different goals or sources of information, aggressive behavior, or passive surrender. Young people are particularly vulnerable to the effects of excessive information overload because they have not developed ways to choose from among alternatives and to strive in a sustained manner towards selected goals (Spitz, 1964).
The Dialoguing Process in Groups When art therapy is done in a group setting, it is well to keep in mind the cardinal principle that only the artist knows what the creation means. The other group members can only say how the item affects them, not what it means. Often the reactions of the other members of the group to the visual expression are quite diverse. Each reaction,
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however idiosyncratic, is accepted and respected as a rightful experience of the commentator. Each person has the right to personal likes and dislikes, but only the artist knows which of the comments is correct or actually fits. Sometimes the perceptions of some members of the group differ markedly from those of the rest of the group. That being the case, they may eventually want to explore the possible reasons for their particular perceptions. The art maker should have the opportunity to present and explain his production to the group before others offer their comments and reactions. After the artist has explained what he tried to do and after he has mentioned the feelings evoked while looking at the art production, the other members of the group may comment and react. This experience of sharing the different reactions to the same picture or sculpture is usually quite satisfying to the maker, particularly if the therapist has succeeded in developing a no critical atmosphere in the group. Clients thrive on this attention even when they themselves have little to say about their productions. The client may insist that the therapist give her own interpretation of the visual production. If this is a genuine desire on the part of the client to understand his creation more deeply and not simply an attempt to avoid revealing his own thoughts, the therapist may say something like this: "If it were my picture ... if I had made it ... I would think perhaps that ... etc."
Salience and Timing In the Dialoguing Phase, the therapist has to keep in mind two specific considerations. The first consideration pertains to the depth of the inquiry. Should the inquiry exhaust all the possible information contained in the visual creation, or should some information remain dormant? The second consideration is timing. In most instances the therapist can get beyond the cliches and the global statements of the client. As we saw withJennifer earlier in this chapter, the child indicated several times that she had nothing further to add to the discussion. Still, the therapist was able to elicit additional information. It takes clinical seasoning to know when to continue with the inquiry and when to stop. The dialoguing process is for the benefit of the client and not for the sake of satisfying the therapist's sense of completeness of the process. Yet, timidity is no virtue during the Dia-
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loguing Phase. While working with a depressed woman client, an art therapist in psychiatric hospital noticed in the client's picture what appeared to be a loop of a rope. The therapist did not proceed to explore the meaning of these mysterious shapes in the drawing. The woman was permitted to go home on a weekend pass. While at home, she hung herself. This is one instance where the therapist needed to attain what we have termed the dispositional diagnostic understanding. Steps should have been taken to institute suicidal precautions for this client. If the meaning of the suicidal implements had been verbalized during the dialoguing phase, it is possible that the client might have attained for herself what we term the facilitative understanding. She could have been helped to realize that suicide was not the only alternative open to her. In addition to the considerations of what information is salient and at what point in the therapy process, the therapist has to keep in mind the distinction between eliciting the client's own thinking and imposing her thinking on the client. It is difficult if not impossible for most clients to contradict the therapist. Comments need to be phrased gingerly and tentatively if the client's own ipsomatic seeing is to be facilitated by the therapist. For instance, instead of telling the client that something "is" or "means" a certain thing, the therapist might say something like, "What do you make of this part here? Am I way off to think that . . . Does this look like that to you, too, or is this just my fantasy?" The conclusions the therapist is tempted to draw either on the basis of professional experiences with similar clients or on the basis of the theoretical orientation she has adopted, should be regarded as "soft" data. That data has to be substantiated with information obtained from the particular client one is now confronting, rather than treated as "hard" data that can be regarded as firm evidence. In summary, the psychocybernetic model advocates a phenomenological or what we have termed an ipsomatic approach whereby the art maker's own ideas are used to explain the meanings contained in the visual creation. The three steps of the ipsomatic approach are distancing, decoding, and consolidation. Ideas derived from some theory or empirical research, or what was termed the nomomatic approach, may help the therapist form hypotheses about the significance of the various aspects of the visual product but these ideas should remain hypotheses until they can be supported with information obtained from the art maker or some other appropriate source.
Chapter 10 ENDING AND INTEGRATING h e handling of the ending phase in therapy is frequently more complicated than that of any other phase of the therapeutic process. It presents special difficulties in art therapy as well as in other forms of therapy. Several factors conspire to make the final phase of the therapeutic interaction complicated for therapists and clients alike. For one, treatment frequently ends unexpectedly and prematurely. Many clients decide unilaterally simply to drop out of treatment. Many endings come about not because the goals of treatment have been achieved but because clients-and in many instances their therapists as well-have run out of hope time, and energy. Often the desired outcomes are as distant at the end of the interaction as they were at the outset. Other endings come about due to external factors, such as the reorganization of services at the institution or agency where treatment is offered. Still others are necessitated by the therapist's departure from the institution because of advancement and change of employment. Many treatment interactions are cut short when the client is discharged and insurance payments run out. For these and other reasons the topic of termination is distressing for many therapists. The handling of the ending phase is further complicated by the fact that professional literature is quite meager on the topic of termination. This is true for art therapy as well as for other forms of treatment. The process of termination appears to be shrouded in a conspiracy of silence. Some of the major works on art therapy avoid the mention of termination entirely while others devote only a few sentences to it. So far only one art therapy theoretician has incorporated consideration of
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termination in her discussion of the therapeutic process (Landgarten, 1981). This chapter presents several principles that can make the management of the final phase of the therapeutic process effective and constructive for both clients and therapists. It identifies and discusses specific tasks of the therapist in the ending phase of treatment. The ending phase of art therapy process can be managed effectively if this portion of the therapeutic interaction is regarded as consisting of four components: ratification, resistance, review, and resolution. They are not strictly consecutive and linear but rather they intertwine and overlap. Applying the concepts from the General System Theory which were discussed in Chapter 2, these four components of termination may be thought of as subsystems of the therapeutic process. They are identifiable but their boundaries are semipermeable, and thus each subsystem is affected by the other subsystems.
Ratification Ratification is the first step in the process of termination. This is the attainment of an agreement with the client on how long the contact between the client and the therapist will last. The approximate number of sessions is agreed upon and the rationale for the use of these sessions is discussed. This discussion generally takes place during the contracting phase of treatment. During these early discussions a tentative date of termination is set. Determining the anticipated length of treatment helps to shape the interaction so that it proceeds realistically and economically. Energy is focused on the tasks that can reasonably be expected to be accomplished in the time allotted for the interaction. For instance, a therapist at a methadone maintenance clinic worked with a group of heroin addicted adults who were notorious for their lack of investment in any of the modalities of treatment that had been offered to them previously. The therapist agreed with them to conduct six art therapy sessions with the stipulation that during the fifth session a decision would be made whether to extend the contract for another six sessions or whether the sessions would be terminated altogether. This contract was renegotiated and clarified during the second session. Although several members of the group voiced skepticism about the possibility of art therapy making any difference in their lives, none dropped out. During the fifth session the progress attained up to that
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point was discussed, and the contract was renewed for an additional period of six weeks: At that point two of the 12 members of the group decided to discontinue and two new members were added to the group. In this manner the group process was not detrimentally affected by the departure of the two members. Although unanticipated dropouts often negatively affect the remaining group members, that was not the case in this instance (Nucho, 1977). Some therapists, while contracting, attempt to preclude the possibility of members dropping out precipitously. Clients are free to discontinue treatment at any point prior to the date set for termination. But they are asked to agree to come back for one additional session in order to discuss their reasons for their decision to terminate treatment (Shulman, 1984). Ratification then is a matter of attaining clarity about the expected duration of the therapeutic interaction. Both the client and the therapist should be clear on this so as to focus their energies effectively instead of stumbling along indefinitely. There is increasing evidence in the professional literature that relatively short-term treatment, if planned ahead of time, is just as effective as indefinite, open-ended treatment (Puryear, 1979). In settings where long-term, open-ended treatment is the norm, the practice of establishing specific segments of short-term treatment helps the clients mark the passage of time and gain a sense of accomplishment. An aura of "graduation" can be achieved by having completed, for instance, two or three 6-week periods of treatment.
Resistance Resistance is the second component of the ending phase that requires careful attention. Resistance to the necessity of facing the fact that the therapeutic process is coming to a close is an inevitable, if frequently subtle, manifestation on the part of clients as well as the therapists. This resistance is fed by two sources. One is the realization that many of the hoped for radical improvements have not materialized. The client has to face and mourn the death of the fantasy of living "happily ever after" as in some fairy tale. Therefore, to eliminate this form of resistance to termination it is essential that realistic goals for the therapeutic interaction be set and agreed upon at the very beginning of the contact.
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The other source of discomfort connected with termination which produces various forms of resistance is the inevitable reawakening of the pain associated with previous endings in one's life. Ending therapy invariably reactivates in clients as well as in therapists the old scars caused by previous endings in life. Rarely does a person manage to go through life without having had to endure the pain of having been left behind by some emotionally significant person. Most of us have experienced the distress of various forms of separation, be it through a death, a divorce, or some other kind of dissolution of an important relationship. These painful feelings about having been previously abandoned by-or having had to abandon-someone or something, tend to resurface when the client and the therapist face the ending of a treatment relationship. Resistance to termination takes many forms. To guard against the possibility of reexperiencing the old hurts occasioned by earlier endings and losses of supports, people automatically engage in various avoidance behaviors. In clients this avoidance often appears in the form of forgetting the fact that a specific date for the termination of the treatment had been ratified at the outset of the treatment interaction. Other clients suddenly lose interest and start missing appointments as the date of termination approaches. They seem to want to reject the therapist before the therapist has the chance of "rejecting" them by terminating treatment. Still other clients suddenly reveal an overabundance of problems as if to prove to the therapist that treatment should not possibly come to a close. In therapists the same need to guard against the possibility of reexperiencing old hurts associated with previous losses of important relationships often surfaces in the form of reluctance to broach the topic of termination with their clients. Many therapists avoid bringing up the topic of termination as long as possible. They frequently permit their clients to stagger through the ending phase without help, or they let clients terminate treatment prematurely. There are ways the therapist can cope with resistance to termination and two things need to happen in order to lessen the therapist's discomfort. First, the therapist has to take time to grieve and come to terms with personal losses of meaningful relationships. Having the personal psychological house in order, the second task can be addressed. That is to attain clarity about levels of improvement that can be realistically expected for various clients. Instead of hoping to cure each and
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every client, the therapist has to set realistic treatment goals that can be achieved in the time allotted. Naturally, this ability to estimate and establish realistic treatment goals comes with experience. Unrealistic goal setting is one of the predicaments of unseasoned therapists. They tend to be devastated if they do not succeed in turning their clients into the fully functioning and self-actualizing persons which they themselves aspire to be. What are realistic treatment goals when working with severely dysfunctional clients? The psychocybernetic perspective which was discussed in Chapters 2 and 3 provides some rough guidelines for deciding what are appropriate treatment goals when working with clients who have been chronically deprived both emotionally and socially. Some of the specific client concerns will be resolved. But the majority of their concerns will still be there after termination. In most instances what can be accomplished with chronically dysfunctional clients is to set in motion the process which will help them go on living with somewhat less wear and tear on themselves and on others than before. It is useful to think in terms of inputs, both material and emotional, that steady the system. Clients should be able to leave treatment with some greater clarity as to what realistically can be changed in their lives, and to have the resolve to pursue the means to do so. They should be clear about what supports, both emotional and material, they need and where and how to get them. They should be more certain about their own goals in life, and more aware of their own personal assets. The tenacity and the courage many of our clients display while often enduring subhuman living conditions is an impressive source of strength for which they can be justifiably proud. They should be helped to feel part of some superordinate system, some "whole," or what Andras Angyal termed "homonomy" (Angyal, 1958). From isolation and a mentality of a victim they should be helped to move toward being more in charge of their own lives. They should feel the possibility of change, with all its risks and rewards. Their boundaries should be reasonably firm in the sense that they know who they are, aware of their identity while having the courage to seek energy emanating from other systems, such as other people, institutions, and belief systems. This process can be set into motion but not brought to a completion, no matter how extensive therapy may be. If the therapists are realistic about the extent of change that can be anticipated in clients' external and internal worlds, their reluctance to
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deal with the matters related to termination will be lessened. They will be ready to help their clients cope with the approaching termination. What specifically can a therapist do to ease a client's discomfort with termination before it has blossomed into full-fledged manifestations of resistance? The first and most important thing that can be done to help clients enter the ending phase constructively is to keep reminding them of the passage of time and of the number of sessions remaining. Even if it is a short-term treatment, clients should be involved in planning how to utilize whatever length of time still remains. Another essential activity for the therapist is to notice, anticipate and acknowledge empathically the feelings that the fact of termination awakens in the clients. If the therapist is aware of the nature of the previous endings in the client's life, this empathic acknowledgment will come naturally (Puryear, 1979). The emphasis at this juncture in treatment should be on the "Now." The question that should be raised in various forms with clients is, "What does it mean to you that we have only X number of sessions remaining?" As the termination approaches, one art therapist likes to suggest that the client "Make something that shows how you feel about the fact that this is our next to the last session" (Landgarten, 1981). In this manner, the client is helped to sort out the conflicting feelings associated with termination instead of being permitted to run away from these feelings. Now the ground has been prepared for dealing with review, the next component of the ending phase.
Review Review is the third component of the ending phase. At this point in treatment the entire experience is surveyed, even if this experience may have lasted only a few hours or a few days. Now is the time to identify the changes that may have occurred in the clients and in their external circumstances since the beginning of their contact with the therapist. Ideally, the process of review takes place also in the verbal forms of treatment. In verbal therapy, however, the process of review is frequently hampered by the lack of tangible markers of the changes that may have taken place. By the time the review process takes place, both the client and the therapist may have reached new mind states. Traces of their previous mind states may have faded by then. Growth and
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change usually proceed so gradually and imperceptibly that the indices of change are difficult to establish. Art therapy has a decided advantage over the verbal forms of therapy in this respect. The visual creations produced while in therapy serve as permanent sources of information that indicate the progress made, or the lack of it. The thoughts and feelings experienced at earlier junctures in therapy as one wrestled with one's concerns are clearly documented. The visual creations are there despite the tendency to remember and forget selectively. During the process of review at the end of therapy clients frequently are able to discern their own growth quite vividly. A 32-year-old professional woman, for instance, noticed during the process of review that in an early picture she had portrayed herself as a small, shadowy figure who was reaching in a manner of a supplicant towards several large and overbearing figures. Upon reflection she realized that she no longer assumed a little girl's demeanor as she had done previously when dealing with her superiors at work. Now she was able to hold her own and present her ideas in a grown-up manner. Behavioral changes of this kind are usually more obvious to outside observers than to the clients themselves. It is essential, however, that clients be helped to become aware of such changes in order to prevent the possibility of their backsliding into old habits after the termination of treatment. The examination of their visual creations during the process of review tends to highlight so clearly the changes the clients have experienced while in therapy that subsequent experiences in life can no longer obliterate the progress they have achieved. Several methods of review may be followed. The therapist may choose to ask clients to inspect their creations serially, from the first to the last session, noting the changes in themes and in the means of expression. For instance, clients may notice some recurring symbols, or subtle changes in their use of color, line, and form. Clients are often able to connect these changes in their means of expression with changes in their moods and attitudes. Their system of codification, that is, their manner of sorting out and appraising their experiences, has changed. Another way of facilitating the process of review is to ask clients to select their most and least meaningful creations from among those produced while in therapy, and to say what makes one creation meaningful and the other not meaningful to them.
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For most clients the most meaningful creation usually turns out to be the picture or sculpture in which they had invested genuine emotion, positive or negative. Their works may portray a dreaded and traumatic experience but if the client has grappled with this experience, however damaging, the results are frequently quite satisfying personally and attractive aesthetically. In several groups, for instance, the majority of clients selected as their most meaningful picture the one which portrayed the theme of "A problematic relationship with someone or something." A 47-year-old black male, for example, depicted his relationship with his 13-year-old stepdaughter. His picture portrayed the turmoil his stepdaughter was creating in his life, and included many symbols of her defiance of him. Upon examining the picture he noticed some of the gentler colors on one side of the cyclone-like shape which was supposed to represent the girl. He realized that the child had some positive qualities which he could cultivate while respecting her need to grieve the loss of her biological father. The least meaningful production usually turns out to be the one the client has produced hurriedly but not spontaneously. It is important for clients to identify what makes a picture meaningless to them. A meaningless picture or sculpture usually is the one in which the client has not invested much of himself. Frequently the lack of investment signals the client's unwillingness to grapple with a certain experience or concern. If this is so, the client eventually may want to ponder the reasons for this. This may be the place where some additional work may have to be done at some future point in time. Still another way of facilitating the process of review during the ending phase of treatment is to suggest to the clients that they try to portray what the entire experience in treatment had been like for them. This may be done in the form of a drawing, painting, sculpture, collage, and so on. For instance, one group of clients who, having been heavy users of heroin were currently on methadone. A 22-year-old white male drew a picture in pastels which covered the entire sheet of paper, 9 by 12 inches in size. It portrayed a yellow hazy looking sun, surrounded by red (Figure 10-1). He explained that for him the experience had been like being in a warm, sunny place. This young man had the habit of muttering threats under his breath, directed at people who he thought had slighted him in some way. In the art therapy group, however, he had felt safe, having been permitted to participate at his own
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Figure 10-1. A Warm Place.
pace. Having a place where he was not attacked and criticized apparently was a rare experience in his life. While reviewing their productions, clients at times wish to redo a picture or a sculpture that had not turned out to their satisfaction. One 32-year-old woman, for example, was dissatisfied with her self-portrait which she had drawn during an early session. In the meantime, having faced and resolved some of her conflicts with her mother, her sense of herself as a person had changed considerably. She drew another selfportrait, and the results clearly reflected the growth she had attained while in therapy. The process of review serves like a bridge which helps clients move from the resistance and avoidance to the resolution. Knowing clearly where one has been and where one is going provides the courage and the determination to face one's future with all its threats and promises.
Resolution Resolution is the fourth and final component of the ending phase. The ending phase begins by asking the client to address the question,
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"How is it with you Now?" The emphasis is on the immediate reaction to the fact of termination and how this fact affects clients' mind states. This is followed by the review process, when the client considers the entire experience in treatment. During this review process the question to the client in various forms is, "How has it been for you?" Now in order to facilitate the process of resolution, the client is asked to project into the future, and to what awaits after treatment has ended. Now the question the client grapples with is, "What comes next for me?" It may be something the client is anticipating with pleasure. Or it may be something the client is reluctant to face. In any event, the future, whatever it holds, is inexorably on its way. What matters now is that the client feels the courage to face the future, whatever it contains. Two factors comprise the component of resolution which follows. First is the resolution of the conflict over one's reluctance to cope with the fact that the therapeutic relationship is coming to an end. The second is the formation of a resolve or a decision about one's future course of action. This course of action may be short-range, comprising the next few hours or days. Or it may be long-range, dealing with several years or even decades. One way of facilitating resolution of the conflicts and feelings surrounding the ending of therapy is to ask clients to look ahead by making a picture or sculpture about what they hope they will be doing, .or what their lives will be like next week, next month, next year, three years from now, or whatever seems to be an appropriate interval of time. Another method of aiding clients to work through to a state of resolve and resolution during the ending phase is to ask them to make a picture about what they are leaving behind as they end therapy, and what are they taking with them. Some experiences may be left behind gladly, others may be left behind reluctantly. Even the leaving of a burden may create ambivalence. This may be inferred from a picture drawn by a well-functioning and a successful professional woman (Figure 10-2). The huge, heavy, black anchor represents the burden she is leaving behind. A link in the chain is broken, and yet the tiny human figure, instead of being liberated, appears to be falling into the abyss towards the anchor. Having portrayed one's current state of mind this clearly one can take precautions to avoid the dangers inherent in this situation. One foster child who was returning to the home of her own parents, made a picture about leaving behind assignments, chores, and the
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Figure 10-2. The Black Anchor.
enforced curfews. These were matters she thought she could well do without. The one thing she wished she could take with her was her foster mother's cat. Apparently the cat was a symbol of the ambivalent affection she was feeling towards her foster mother. One art therapist draws the outlines of two hands and then asks her clients to make pictures in these hands showing what they will hold on to, and what will they let go (Landgarten, 1981). The process of resolution can also be facilitated by the therapist's singling out for a special mention a work of the client which marks some important turning point. With some imagination, the therapist may be able to offer a token of appreciation to each member of the group, if art therapy has been done in a group setting. For instance, there may be a prize for the best free-flow creation, for the best self-portrait, for the best use of black color, for the most effective use of lines, and so on. The resolution that one should strive for is not in the sense of insuring that the client can live "happily ever after" but rather in the sense that the client is capable of facing the trouble that may be lurking during the next phase of life. In response to the question of what was she
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leaving behind and what was she heading towards after therapy, a 36year-old white professional woman drew a picture consisting of two parts. She professed a desire to devote more time to her family by giving up some of her professional commitments. Between the two parts of the picture she had drawn a bridge. On the bridge was a car. Although it was supposed to be going in the direction of that portion of her drawing which represented her family life, the car was obstinately turning in the opposite direction, towards the items depicting her professionallife. She was able to recognize that she had not resolved her ambivalence concerning the demands placed on her by her family, and that she still had to continue to struggle with the balancing of her several roles in life. In long-term treatment, the ending phase of art therapy may extend over a number of weeks. In short-term treatment these four components of termination-ratification, resistance, review, and resolutionmay be touched upon very briefly in one or two sessions. Nevertheless, they should be there. Even when the contact with the client lasts only for a single session, attention must be paid to them. To end is to reconnect with where you were at the beginning of the process. The distance traveled, emotionally, cognitively and in any other way has to be appraised and noted. The distance traversed can be estimated by comparing what it felt like at the beginning, and what it feels like now. What were the apprehensions then, and what are they now? What were the hopes then, and what are they now? The extent of change can be estimated by comparing the first with the last picture produced in therapy. This method of assessing change is particularly convenient when working with young children whose verbal ability is limited. A five-year-old black male whose therapist was of the same racial background, provides an example. His first picture was a rather disjointed affair consisting of several lines (Figure 10-3). He explained these lines as portraying a boat, water, and a shark. He also mentioned a truck. None of these objects are actually discernable in the picture. His next picture was better organized and more age appropriate (Figure 10-4). It contained a house with his parents on the left. On the other side of the house he portrayed himself climbing a tree while his sister watches him. The figure representing him was less well developed than the figures of his parents and his sister. A small partial moon, two stars and a dark sky complete the picture.
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Figure 10-3. A Boat, Water, Shark, and a Log Truck.
Nomomatically, on the basis of empirical research and clinical experience, the execution and the placement of the objects in Figure 10-4 suggest a rather immature and a depressed child. The last picture produced in the same therapy session, however, bespeaks a much more mature and secure child (Figure 10-5). It shows a well drawn human figure in a multicolored outfit, wearing a jaunty hat and juggling 12 well placed balls in the air. He called the figure "Boy Lee" although that was not his own name nor was it a name of any of his friends. The contrast between this last picture and the first picture produced by the child in the same therapy session is astounding. This therapist obviously succeeded in fostering a sense of mastery in this child which is bound to strengthen his growth. Without the pictorial evidence the impact of the session on the child would be much more difficult to judge. Termination has an element of mourning and an element of triumph. If all has gone well, there may be an aspect ofjoy and a sense of accom-
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Figure 10-4. Climbing a Tree.
plishment. Frequently there will be a tinge of sadness, because reality hardly ever lives up to one's expectations. A mark of maturity is to recognize and come to terms with the inevitable shattering of dreams.
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Figure 10-5. Boy Lee.
Like the Roman deity Janusis, represented with two faces the ending phase looks both backward and forward. One face looks backward to the past, the other forward to the future. This double look of surveying
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both that which lies behind and that which lies ahead, serves the cybernetic function of steadying the system. Informational inputs are provided by surveying these two directions so that the proper course of the system may be determined.
Integration The human system is steered by the information that arrives from various sources, both internal and external. This information has to be codified, that is, sorted out and integrated with the information already in the system so that the next phase of activity may be charted propitiously and appropriately. How information is codified and organized will determine how the energy of the system will be utilized. It may be squandered aimlessly, or it may be invested prudently in goal directed activities. The information contained in the imagery that was portrayed in the visual creations during the therapy sessions and which was generated through the dialoguing process is not decoded entirely when treatment comes to an end. Some of the meaning of the experiences portrayed will remain enigmatic. Other portions of the meaning of the experiences will be unlocked and incorporated into one's cognitive and behavioral systems gradually as the client encounters subsequent experiences of either similar or contrasting kind. Some of the information condensed in the imagery will remain dormant, like a sleeping beauty, or a slumbering monster. The nature of the therapeutic relationship may make the difference in this regard. If it has been constructive, it will continue to radiate energy and provide constructive information even if there are still some slumbering monsters that have not been dealt with adequately during the treatment. On the other hand, if the therapeutic relationship has been toxic, it will continue to exude detrimental messages about one's worth and abilities long after treatment has come to a close. Like a melting ice cube, it will dilute future experiences. It is worth keeping in mind that the work does not go on only during the face-to-face interactions with the therapist. It continues between sessions and long after the sessions have ended altogether. During the therapy session, questions were posed that required thought and effort. These questions focus one's mental energies. Both cerebral hemispheres were engaged in grappling with these questions.
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One's mind, like a net, had to cast for answers, sorting out past and current life experiences. The various exercises of art therapy and the discussion of the visual creations could not provide all the answers and solutions but they set the process in motion. The search for appropriate solutions reverberates throughout the various subsystems of the mind. Having engaged both cerebral hemispheres, the solutions that finally present themselves are bound to be more appropriate than when only a portion of one's mind is utilized. Like modules of energy, the questions posed in therapy generate energy and attract new energy in the form of thoughts, feelings, intentions, and decisions. By observing the psychocybernetics of human functioning, the process began with the help of the therapist. The mind continues this process, nibbling at those questions that can make a difference in one's life. In a cybernetic manner, the information obtained in this way is used to steer the course of one's life. More importantly, in therapy the client learns to pay attention to the images that arise spontaneously in the mind. They are bearers of information that have to be sorted out and processed unceasingly even after therapy has come to a close.
A Practical Hint The process of termination can proceed effectively as discussed above only if the visual creations produced by the client in the course of therapy are readily available for examination when the ending phase has arrived. For this reason it is wise to establish the practice of keeping the drawings and the other items produced by clients in the therapist's office. Make a folder of some sturdy material. After each session, ask the client to date and sign their creations and then place the twodimensional products in the folder; the three-dimensional objects can be stored in whatever place can be made available to the clients for this purpose. The clients should have access to their creations whenever they wish to see them. But it is best to agree that these works will not be taken out of the therapist's office. They are the documents of one's therapeutic progress, or the lack of it. They are not made to entertain one's friends or family. There is one more reason why the art therapy products should not circulate outside the therapist's office. Most people who are not familiar with art therapy will approach the work produced in art therapy as they would approach any other works of art. In a museum or at an art
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gallery, the works of art are examined for their aesthetic qualities and merits of workmanship. In contrast, the works produced in art therapy are not produced with aesthetic criteria in mind. What matters in art therapy is not the aesthetics but the thought processes that are prompted in the maker while producing the visual creation. Especially when working with children, the therapist has to guard the client against unfair criticism that may be hurled at the child by the parents who use artistic yardsticks to evaluate their child's work. Most children will want to share their works with their parents and teachers. If so, these adults should be apprised of the purpose of the artwork made in art therapy so that they do not dampen the child's enthusiasm for this form of information processing. Clients are free to take all their creations with them after treatment has been concluded. Some of the pictures and sculptures are very meaningful to the clients, and they cherish them as reminders of the therapeutic interaction and the resolutions made while in treatment. Other works are discarded, or left with the therapist for safekeeping. Many clients like to leave with the therapist those works that signify parts of themselves that they have now outgrown.
Conclusion The Ending Phase consists of four parts. Ratification is the agreement reached with the client about the approximate length of therapy. Next, as the date of termination approaches, resistance surfaces. The therapist must watch out for the various indications of resistance as the client attempts to avoid the necessity of dealing with the discomfort of the separation. This is followed by the process of review, instituted when the client surveys what has happened while in treatment. The review of the process leads to the final component of the Ending Phase, namely the resolution when clients are helped to chart their future directions. Life is a never ending process of sorting out the messages that arrive ceaselessly to us through our various sensory modalities as we cope with our manifold tasks and expectations that we have for ourselves and for those with whom we interact in our various roles. Ideally, during the therapy, clients learn to pay attention to the messages that arrive from outside themselves and those that arise from within. The visual products created in art therapy are the means of halting the flow
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of this information temporarily so that the various messages may be examined and integrated with the information already stored within the system. The therapist is an assistant in this process of sorting out the various forms and levels of information in which the human system is submerged. After therapy, this process of sorting out the influx of information has to go on without the immediate assistance of the therapist. If the relationship with the therapist has been a constructive one, the therapist will nevertheless remain symbolically a very real presence in the life of the client from then on.
Part Three
WORK WITH SPECIFIC CLIENT POPULATIONS
Chapter 11 WORK WITH CHILDREN h e theoretical foundations of the psychocybernetic model were discussed in Part One. The several phases of the therapeutic process were considered in Part Two. Brief case examples illustrated the various phases of the therapeutic process. Part Three will deal with specific matters that need to be kept in mind when working with particular client populations. Using the notion of life stages as the organizing principle, factors are highlighted that are specific to work with children, adolescents, and the various kinds of adults. How do we work with a child who is symptomatic? Suppose the child has a problem. It may be a problem at home or in school. Maybe the child is being picked on; or he is a bully and picks on other children; or is restless and cannot sit still in class, even for a few minutes. Now, not only does the child have a problem, but he is a problem to his teachers and his parents. What is the therapist to do? The art therapist's first impulse is to have the child draw some pictures to find out what is going on. After all, according to Rhoda Kellogg (Kellogg, 1969), to a child, drawing is as natural as eating a cookie. But what if he refuses? A child diagnosed with Attention Deficit Disorder with Hyperactivity would not simmer down long enough to draw a picture and would be even less inclined to talk about the drawing. The unfreezing phase of the psychocybernetic model, discussed in Chapter 7, would have to be considerably expanded. Some vigorous physical activity would be indicated (Hensely, 1998). One art therapist has found that doing a mandala drawing helped calm hyperactive children (Smitheman-Brown & Church, 1996). When the child is a problem or has a problem, the art therapist should consider whether working directly with the child is the best
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approach before proceeding any further. Although art therapists are trained mostly to work directly with children, that is only half of all the possible considerations. In addition to the direct treatment mode there is the indirect treatment modality where the child is helped through work with the parents. Often, working with the parents is the most expeditious way to help the child in trouble.
Indirect Treatment A child is a part of his family system. Inescapably, the child absorbs the parental distress, be it financial, social, health, or some other difficulty. He is the more sensitive, delicate part of the system. The parents may still be able to "grin and bear" their troubles, and sometimes they put up with their difficulties "for the sake of the children." But the child feels the pain and the tension. He may start acting out the tensions, or start to daydream or becomes depressed and develop health problems. He is like a barometer in the family, showing the stresses the family is enduring. In these situations, working directly with the child would be like being in a leaky boat. You may try to scoop out the water in the boat, but that does little good unless you can fix the hole. This is true especially with young children. However, there are situations where the parent is not available or willing to seek help. The father may be incarcerated. Or the mother may be deep in narcotics. What then? Think of a case where the father is sentenced to life in prison for having shot the mother in front of the child. The mother is dead. The father is in prison. What else can you do but try to "scoop out the water?" But even while in prison, the father is still a father. He is the only father the child has. It would help if the father could be convinced at least to write to his child. The father could then assure him that he is sorry for what happened, that the child is in no way responsible for what happened, that the father loves him and is eager to know how he is doing in school, etc. When working with an older child or in a situation where the parents are unavailable, the therapist can provide some form of life enrichment. Establish a relationship with an adult who can be counted on-a Big Brother or Sister, for example, who plans trips to the zoo, or sports, or some other kind of activity. Although the art therapist may not know enough about available forms of life enrichment, she can make referrals and consult colleagues from another profession. Usually, social
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workers are good at such things. Turn to direct treatment of the child in trouble only after you have explored all possible avenues of indirect forms of treatment through the parents, grandparents, and the social environment. Indirect treatment may also be effective when used concurrently while the child is in direct treatment with the art therapist. The separation of indirect and direct treatment was well established in the mental health field when the current generation of the Baby Boomers came on the stage. It was called the Child Guidance Model. The psychiatrist worked directly with the child, occasionally using some form of art expression, while the parent, usually the mother, spoke with the social worker. As the mother sorted out her troubles with the help of the social worker, the child improved. And who got the credit for the improvement in the child's condition? The psychiatrist! The first thing to do when working with a young child who is a problem or has a problem is to see if the parents can start solving their own problems. They may need hard services, like financial aid, or they may need marital or employment counseling. In other cases, they may need family therapy. Family therapy may be appropriate even for a fractured family, and in such cases, the grandmother and/or the mother's boyfriend may participate in the process. Consider, also, some form of life enrichment. It has been said that "It takes a whole village" to raise a child, and we have to see if some semblance of a "village" community could be activated to help the family and through it, the child. Working directly with the child should be the last resort of help, when other forms have been considered and explored.
Direct Treatment Direct Treatment is appropriate for working with children when the parents are not available. It is appropriate with children in institutions and in foster care. Direct treatment is actually a "fire-fighting model" of helping. The trauma has already taken place-maybe long ago. Now try to foster so-called "secondary mastery" to help the child heal the pain and develop a more positive self-image. Through new relationships, the child comes to feel valuable, competent, and lovable. He also develops new identifications, new skills, new reference groups, and heroes. In art therapy, one may proceed from the visual expression to the verbal, or from the verbal to the visual. The younger child does picture making first, and then tries to attach words to what the picture portrays
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(see Chapter 9). He learns to recognize and deal with his troublesome feelings. Attaching words to feelings gives the child a certain degree of sense of mastery. Now he is in control, instead of somatising or acting out behaviorally. The therapist can also proceed from the verbal to the visual form of expression. The Mutual Story Telling Technique lends itself well to this procedure (Gardner, 1971). First, the child tells a story about a dilemma. Then the therapist tells a story that has a more positive outcome. Finally, the child draws a picture. The picture helps to retain the experience of the solution to the predicament. It is now further explored with the help of the "right brain" thinking (see Chapter 3). Figure 11-1 summarizes the procedure.
Therapeutic Styles There are three therapeutic styles of working with children-the psychodynamic, the participant observer, and the behavior modification style. These styles may appear in art therapy as well as in various forms of play therapy.
Psychodynamic Style In the psychodynamic style, the therapist acts like a sounding board, eliciting and responding to the child's actions and words. The therapist may reflect back to the child what he says and does, and perhaps do some "editing," selectively emphasizing his strengths and providing words for the feelings the child has exhibited by his actions and verbalizations. All feelings-not only the good, positive feelings, but the angry and the taboo feelings as well-receive attention and are noticed and accepted. All feelings are legitimate. The only question is what to do with them. Acting out angry feelings in real life is not permitted because that would get the child in bigger trouble than before and would make him feel guilty. First, the therapist might say, "You feel like hitting your baby sister ... because you are angry ... because she gets everything ... and you fear that nothing is left for you...." Some time later, the therapist would try to educate the child. After his feelings have been acknowledged and accepted, the therapist can say, "Yes, it makes you angry ... it is sad... But she is just a little kid ... She knows no better ... " Then the therapist could proceed by saying, "What can you
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MUTUAL STORY-TELLING TECHNIQUE PREPARATION 1. Invite the youngster to be your guest on a make-believe TV program. 2. If you have a tape-recorder, get the child used to taping by asking questions he can easily answer, i.e., name, address, grade in school, name of the teacher, etc. Then play back to let the child hear his own voice. 3. Explain the rules: the story must have a beginning, middle and end; it must be made up on the spot, not something that he has read or heard about; and it must have a moral or a lesson. Tell him that you will also tell a story. 4. The child may begin when ready. Give him some reassurance: "Try, you will be surprised to find that you have millions of stories in your head." PROCESS 5. If necessary, help the child get started. "Once upon a time ... a long, long time ago ... in a distant land ... there lived a...." Then give the child a sign to continue. 6. If the child has difficulties, you may help out with some connecting phrases, e.g., "And then ...", and "And the next thing that happened was ..." 7. When the child has finished, ask for the moral, or the lesson or the title of the story. 8. Ask clarifying questions if needed, e.g., was the dog angry? Was it a he or a she? 9. Praise the child for having told a fine story. THERAPIST'S STORY 1O. You may want to take notes while the child is talking to help you construct your own story. Use the same characters but a different setting or different props. Try to find a healthier resolution to the dilemma the child may have hinted at. 11. Be sure you know which character in the story represents the child himself and who are the other significant figures. At time the various figures may stand for the different aspects of the child's own personality. 12. In your story try to provide the child with more constructive alternatives and options than he had in his/her story. Figure 11-1. Mutual Story Telling. Based on Gardner, Richard, Therapeutic Communication with Children. New York: Science House, Inc., 1971 (also in Am. J of Psychotherapy, July 1970, 419-439).
do when you are very angry? ...go out and kick a ball? ... " If the feelings are accepted and granted, and shared and understood, there will be no need to act out on them.
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An inexperienced art therapist was working with an eight-year-old boy. He was referred by his teacher because he was restless in class and was causing all kinds of turmoil. Not knowing how to proceed, the art therapist recalled Virginia Axline's book on play therapy (1947) and hoped to emulate her method. Walking down the hall from the boys' classroom, and not sure about the location of the room allotted for the children's play therapy sessions, the therapist noted that the boy knew where the room was. He also knew where to get the key. She also noticed how his little chest expanded as he showed the way. Soon they reached the proper room and the therapist took out the toys and paper and crayons she had brought along. She tried to entice the boy to sit down at the little table to see what she had brought, hoping something would spark his interest. But the boy just flitted around the room. After a while, he went to the window and looked out. It was quite warm and the window was open. The classroom was on the second floor of the building. The boy asked, "Would you like to see me jump? I can do it!" What was the therapist to do? Get up and grab the boy and close the window? Fortunately, the therapist was able to hear the message the boy was sending. He was trying to say that he was not afraid of therapists, or of a situation that was new and strange to him. His tone of voice clued the therapist in. He was trying to assert himself. She said, "I know you are not afraid of anything. You are brave...." That was all it took, and the boy then turned away from the window and approached the table. Axline's basic philosophy had saved the situation. Once the feelings are expressed and accepted, they do not need to be acted out. Expression can take place either verbally or visually, or both. In play therapy, feelings are expressed mostly through play action and some verbalization; in art therapy, feelings are expressed visually either on paper or in some three-dimensional production, such as clay or mobiles or collages and the like. The psychodynamic style in art therapy and in play therapy is used by Rogerians, the followers of Axline and other psychodynamicallyoriented therapists.
Participant Observer Participant observer is another therapeutic style. There the therapist may enter in the play scene, bending and affecting the plot. Betensky, for example, describes a case situation where she dispatched a heli-
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copter to a scene the child was creating (Betensky, 1973). Interactional drawing technique, discussed in Chapter 13, is another example of the participant observer style of helping. There the therapist draws objects that may provide a hint of help or empathy to the patient. As participant observer, the therapist must be careful not to negate the pain the client needs to communicate. In many instances, the best policy is to let the child figure out by himself what could be done to alleviate the predicament.
Behavior Modification In the behavior modification style, the therapist rewards the child's desired behavior by giving him a token, which can be exchanged later for candy or a toy. If the child draws a picture, he may receive a reward. If he makes up a story about the picture, he could earn another reward. Richard Gardner is a prominent child psychiatrist who started out as a psychoanalyst. Currently, he is applying this form of helping in work with resistive children from upper income families (Gardner, 1975). Behavior modification has vociferous proponents and opponents. These techniques are widely used with children as well as with adults. Parents and educators, as well as therapists, do have to shape the child's behavior. The child has to be socialized to know what is acceptable and what is not. This is best done in the family as the child grows up. The material forms of reward are replaced gradually by social rewards and self rewards in the form of self-esteem and a good conscience. From the psychocybernetic perspective, in most situations, behavior modification is the least desirable modality. The child's own thinking and search for appropriate rewards should be promoted. This will become clearer when we review the therapist's overall tasks.
Tasks of the Therapist The therapist structures the session by making it clear what will be done, where and for how long. How to proceed is left up to the child. Then the therapist notes and puts into words feelings the child expressed verbally or through his behavior, and in his art productions. The therapist's main job is to provide a safe atmosphere and a relationship in which feelings can be shared. When the child feels accept-
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ed and valued, he will start to value himself, he will be considerate, and his behavior towards other people will be appropriate. The therapist accomplishes a number of things while promoting the child's ego development through play and art activities. Working with the therapist, the child acquires a sense of mastery as he imposes order on the art or play materials. The child experiences himself as a doer, not as a victim (see Chapter 8). He can rework or re-experience painful situations, but now from a safe place. The painful experiences can be portrayed symbolically. He can now understand and reformulate situations he could once only endure. This is what is termed the "secondary mastery," in which one can sublimate unacceptable feelings by symbolic expressions. Making and killing monsters is a good example of secondary mastery. Through the various art activities, the child forms a new sense of identity. Various self-representations are produced and tried on "for size." He strengthens his self-esteem and subsequently his behavior becomes increasingly more satisfying and socially rewarded. As he engages in the various art activities, he stimulates his "right brain" and he becomes more creative and a better problem-solver in the various areas of life. (See Chapter 3 for a discussion of right and left brain hemispheres.)
Specific Techniques The doing-phase of the therapeutic process, discussed in Chapter 8, presented a number of specific techniques that are useful when working with children and other age groups. Let's take a closer look at some of these techniques and add some additional ways to proceed. If the child is anxious and reluctant to engage in the art therapy activities, the therapist must ease the child into picture making, building rapport and setting the child at ease. With some children, one needs only to ask if they ever draw pictures. The child then proceeds to make a picture of his choosing. If, on the other hand, the child responds that he is not good at art in school, then the therapist must reassure him that this is a different kind of art. It does not have to be "just so." No one will criticize his production and he is the only one who will decide if the picture is good or bad. In fact, one way to get him started is to have him "make something ugly, deliberately." Have him do an "icky" picture on one part of the paper, and something good looking on another part (Landgarten, 1981). This leads naturally into a discussion about good
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and bad behavior at home and school, and how the parents or teachers respond. If the child is still reluctant, ask if he would like to see an easy way to start a picture. Introduce him to the "Free Flow technique," also known as the scribble. "First I go like this on the paper (and the therapist makes a squiggly line), and then I look to see what I could make out of the line. What does this look like? Maybe this could be a flower? Or could this be something like a bird? What happens if we add dots here? Could we then make this into a face?" etc. "The Winnicott Squiggle Game" is similar to the Free Flow technique. (Winnicott, 1971). The therapist can ask the child ifhe ever plays the "squiggle game." He will most likely shrug his shoulders. Would he like the therapist to show him how to play it? The response again may be something noncommittal. Proceed to show the beginnings of the free flow. "1 go on the paper like this. And then you see what you could turn it into. Then you go like this on the paper, and I will see if I can turn it into a picture. Who will go first, etc." Pretty soon most children decide that they can draw a better picture all by themselves, and the process if off to a good start. "A Name Design" is another useful procedure to break the ice. Ask the child to write his name anyway he likes, but encourage him to write it as big as possible and to use as many colors as he likes. This conveys the message symbolically that the child's name is important and worth "fussing about." Next have him embellish the letters and add any objects he likes. This technique can help reveal some of the child's interests. "Draw around your name things you like and what you enjoy doing-show some of your hobbies." If the child is young and still does not know how to write his name, the therapist can write it for him and then have him embellish and color the various letters. "Body tracing" is another technique that small children enjoy. It serves to strengthen the sense of identity. Tape a large sheet of paper to the wall and have the child stand in front of it. The therapist traces the outline of the child's body. Then the tracing is further defined and maybe some clothing is drawn in. Usually a child is quite impressed that he or she looks "that big." When working with children in groups, do body tracing in pairs. Have the children take turns tracing each other. The tracer has to name the body part he is tracing, and if he cannot name it, he has to stop. Also the tracer has to stop when the tracee
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says so. This way the child who is being traced has control over the process and does not feel at the mercy of someone else. Once the child feels comfortable with the art therapy situation and is willing to either draw pictures, form sculptures, build mobiles, or make collages, the therapist must then decide how much to structure the sessions and how much initiative to leave up to the child. Generally the lower the client's ego development, the more structure is needed. At the start of the session, simply ask the child what picture he would like to make that day, and what materials he wants to work with. If time is limited, conduct theme-oriented sessions to explore the dynamics of the child's personality and social situation. The theme-oriented sessions help ascertain the child's self-perceptions and perceptions of significant people in his world. The "self-system" idea, discussed in Chapter 8 is a simple way to keep track of the various dimensions of the client's life.
The Body Self The body self can be understood and self-image can be improved by making pictures and sculptures that represent the child, as body tracing, discussed above. In another procedure, the therapist outlines a body and then asks the child to "color in where he feels pain" or where he "feels various feelings" (see Figure 11-2). The child selects the feelings and the colors appropriate for each feeling, or the therapist gets him started by suggesting some feelings and some of the colors that could be used.
The Domain ofthe Mind The domain of the mind can be explored with themes related to one's endowments, abilities, prides, and wishes. Ask the child to portray a "Happy Day" or a "Sad Day," for instance; or "what an e-mail to the child should say"; or what would be his "Three Wishes" were he to meet a "Fairy Godmother" who would promise to grant the child everything he wants. Malchiodi has used the latter theme with children in a battered women's shelter. She found that the picture usually turns out to be of something the child has lost or is afraid of losing-for example, the old neighborhood, a home, a friend, or a bicycle (Malchiodi,
1990).
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Figure 11-2. Feelings in the Body.
The Interpersonal Domain ofthe Self-System The interpersonal domain of the self-system can be explored and strengthened through pictures and sculptures showing one's "Best Friend," "School Mates," "Favorite Teacher," "Coach," and the like. The "Kinnetic Family Drawing" (KFD) is the best technique for exploring the family situation. However, use it carefully with children in foster placement and from fractured family situations. Introduce it only after the therapeutic relationship is firmly established, and only if you, as the therapist, have sufficient therapeutic skills to cope with the pain such a picture might open up it. One child refused to draw a picture of
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his family. The therapist encouraged him to make a picture of any kind of family, not necessarily his own, or even a human family. It could be a family of kittens, or birds. He could also draw a "Picture of an Ideal Family." With the standard KFD, when asking the child to draw a picture of his family, it is important to tell him to include himself in the picture. Say, "Make a picture of your family, including yourself, doing something." Leave the "doing" up to the child and let him choose. Some children draw a picnic, or a family at the dinner table, or at the Thanksgiving table. But in most KFD, we see each person in the family doing something separately.
Achievement Domain Achievement domain can be highlighted and strengthened by asking for pictures about school. "Draw about when you were in first grade," "Draw about you doing something your mother approves," or "doing something that would make your father proud." "If you could be anybody, who would you be?" "What are you most proud of?" "What do you like most or least about school?"
The Transpersonal Domain The transpersonal domain of the self-system highlights one's values, ideals, and philosophy of life. "Pictures of a specific holiday" might reveal something about the family's stance with respect to religious observances. Inquiries about the child's "favorite sports team" or "television show" reveal what he admires and aspires to be. Asking him "what he wants to be when he grows up" sheds some light on his current value orientation and could serve as a springboard to further clarification of his ideas. Similarly, inquiry about his favorite toy or possession would reveal something about what he regards as important. The boundaries between the various parts of a system are semipermeable. This is true also for the domains of the self-system. What happens in one domain affects the other domains. For instance, if there is a problem with the physical body, the mind would be affected also, as well as the interpersonal relationships. The achievement realm would
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Figure 11-3. The Dragon.
suffer, too. And a picture that highlights one domain might shed light on one or more other areas of functioning as well. The "Dragon Technique" demonstrates this clearly. Tell the child, "Imagine you have stumbled onto a treasure but a dragon is guarding it. Make a picture to show how you get to the treasure." Give the child a sketch of a dragon's head, with open teeth, or have him draw the dragon from a sample picture. One seven-year-old girl drew a little figure in the dragon's mouth. The little figure was yelling "Help!" The girl said that she would throw her little brother in the dragon's mouth "and then run to the treasure, and run home." This gives us some idea of the girl's ability to solve problems and how she might fare with her achievements. But we also learn about how she feels about her little brother, that is, about a portion of her Interpersonal Domain. We also discern something about her current value stance (e.g., her treasure is more important than the life of her little brother). Now the therapist can proceed in several ways. The therapist can recognize the little girl's resourcefulness and quick thinking. But the therapist must then find out in what way the little brother is a nuisance to her and what she can do about it besides "throwing him
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into the mouth of the dragon." In her family, she may very well be a "parental child" who is burdened with the caretaking of younger siblings and may need some help from the adults in the family. The dragon picture is quite popular with many art therapists. Malchiodi regards it as a metaphor for how one gets around problems in life. The dragon may be the abuser, or some painful situation in the child's life. Children create a variety of solutions: some kill the dragon with a sword, some put it to sleep; others make friends with it (Malchiodi, 1990). Some well-adjusted children find a grown-up to help them to get the treasure. "The heart" is another technique that is useful when working with a young child. The therapist draws the outline of a heart and then asks the child to draw, inside the heart, pictures of "people who are in your heart." One child drew a picture of her mother and the head of her best friend. Then she added wings to the heart to show that her mother had died, and "Now she is an angel." Another child left the heart empty because he said he did not love anyone. The therapist can gain a considerable amount of information with the help of the outline of the heart. Having drawn a heart, one therapist asked, "What does a heart stand for?" One nine-year-old boy responded that a heart symbolizes love. When asked to make a picture of someone he loved, he answered that there was "no one" whom he loved. The therapist then inquired if there had been someone he loved "a long time ago?" Again the answer was "no." After a pause, he said, "My family." Now the therapist said, "Draw a picture of your family." The boy responded that he could not do that, but he wrote the word "family" inside the heart. Then he told the therapist that they did have some good times when he was younger. But now, "it is hard to love Mom because she does not seem to care" about him. She never visits him at the institution where he now lives. He cannot love his father because "he hit everyone" and then abandoned them. And he cannot love the stepfather because "he drinks everyday and is mean." The therapist then asked, "Who do you wish could fill your heart?" The child said that if he had to choose someone, it would be his family, but even they could not fill his whole heart. He said he wished there were enough people he really loved to fill every space of his heart. He said he hated to see the heart so empty. No wonder that the child is depressed. He also has the diagnosis of Oppositional Disorder. That would indicate that he is still fighting and
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Figure 11-4. A Heart.
trying to get his affectional need met. Later he was asked what would be a symbol of sadness. The boy said, "a tear drop." He was then asked to "draw a teardrop." Having done that, he put in a picture of a table with a telephone on it, "because Mom never calls." The child was able to share his deep grief with the therapist, and he felt understood. Now he had at least one person in his world for whom he might have some positive feeling. Another child drew a picture of rain and lightening inside the teardrop, symbolizing his sadness. Some children portray events that cause sadness. A similar procedure is for the therapist to "draw an arm with a fist" and to ask the child to make a picture of someone he is angry at. A boy drew a picture of what appeared to be a bully and two other figuresone was smiling, the other seemed ready to fight back. Using a similar technique, simply draw two parallel curved lines and say that it is a hug. The therapist then asks whom the child would want to hug. Between the two lines symbolizing "the hug," one child drew both of her parents, her big brother, and her two little brothers and three of her cousins. This child has an ample supply of positive interpersonal relationships.
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Figure 11-5. The Tear Drop with Rain and Lightning.
Using the concept of the Self-System, therapists can select specific techniques to employ for a child who represents particular diagnostic category. For sexually abused children, first develop the relationship with the child by asking for a "free/anything picture," or a "picture about school." Or try the "Winnicott squiggle." Then ask for a "picture of yourself." Here, note the feelings of being ugly or fat, etc. Then ask for a picture about the "child's room," and then a picture about "something good or bad that happened" to him in his room. Focusing more specifically on the possibility of being abused, ask him to make a picture of a person, or a "picture of a child," and then "tell a story about that child or person." A picture of a "bad dream" might disclose what has happened to the child. As with any client, try to conclude the session on a positive note. A picture of the "three wishes" or a "mandala" might serve this purpose.
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Figure 11-6. The Tear Drop and the Killings.
Responsive Communication The production of a picture or some other visual item helps the child sort out and clarify the multitude of feelings that burden him. After the so-called "right brain" thinking, verbal communication, when words are attached to what is portrayed in the picture, often serve to further the child's problem-solving efforts. In the psychocybernetic model, the dialoguing phase is the term for verbal processing of the visual product. With children, even though talking about the visual creation tends to be quite short, the dialoguing serves two important purposes. First, the therapist gains additional information about the situation and has the opportunity to check out the diagnostic clues that might have surfaced while looking at the created product. Second, the therapist may offer the child support and strengthen the therapeutic relationship with him.
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Figure 11-7. The Arm, Fist, and the Bully.
An example of the first purpose was given in Chapter 9 where the work ofJennifer, a developmentally normal and physically healthy six year old, was described. Having drawn her picture,Jennifer indicated several times that she had nothing further to say about it. Skillfully the therapist gained additional information by verbalizing themes that had been depicted by implication in the child's picture. The therapist touched on the child's concern about the space that was going to be needed for the next addition to the family. A new baby was expected. Parenthetically, the prominent knothole inJennifer's picture does suggest the possibility of some physical injury. It does not seem to have left any significant scars in the child's personality at this stage, but is a factor that may deserve some further attention. (For the significance of knotholes in trees, see Bolander, 1977.)
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Figure 11-8. A Hug.
The art therapy session with another child whom we shall call Leonard illustrates how a therapist can provide considerable support and build a warm therapeutic relationship while helping the child to discuss his picture. Leonard, an eleven-year-old black boy, came from a deprived, abusive, and chaotic background. The art therapy session took place at a residential treatment facility for children who are severely emotionally and mentally disturbed. The boy has had no contact with his mother since he was six years old. His current diagnosis is attention deficit disorder with hyperactivity. He resorted to physical violence to solve conflicts with his peers. The goal of the session was to lessen Leonard's violent acting-out behavior. The room was set up with two different sizes of paper and various markers, paints, and crayons. Leonard chose the thick, bold markers and a large sheet of paper. He was told that he could draw a picture of whatever he wanted. He worked for about 10 minutes and then informed the therapist that he was finished. The description and appraisal of the picture followed. During the Dialoguing Phase the therapist used mainly responsive communication style. Here are excerpts from the dialoguing phase: Therapist: "Wow, this is some picture. You are a great artist. Look at all the colors you used here. This looks like a person; could you tell me who this is?"
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Leonard: His name is Lemme. He is a boy!" T: So this is a boy and his name is Lemme. How old is this boy? L: His name is Lemme Cooper, and he is eight years old." T: I see you only drew his face. Can you tell me if Lemme is tall or short? L: He is short. He wears glasses. See, here are this glasses (pointing to the thin circles around the eyes). He likes reading. That is why he wears glasses. T: So Lemme wears glasses, and these are his glasses that he uses for reading, right? Are these his eyes? (pointing to the orange and red circles inside the black lines) L: Yes, those are his angry eyes. T: These are his angry eyes. Why do you think he is angry? L: He is angry 'cause kids agitate him. T: Kids agitate him and he gets angry, right? L: Yes. By simply following the lead of the child, the therapist has succeeded in letting the child touch on his own difficulty, namely that other children "agitate" him. He is starting to share his own feelings with the therapist, though indirectly. The discussions continues: T: L: T: L:
Where do you think Lemme is going? He is going to school. It is not me, OK? I know it is not you. It's Lemme, and he is going to school. Does he like school? Yup, except other kids agitate him.
Leonard had to emphasize that he is not talking about himself. The discussion was starting to get too close to himself. So the therapist reassures him of his personal boundaries. T: L: T: L: T:
What does he do when the other kids agitate him? He beats them up. Oh, so he beats up the kids who agitate him. That is kind of what you do, right? Yes, but this isn't me. It's Lemme Cooper. OK. I was just noticing that Lemme deals with his anger the same way you do. Where does Lemme live?
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He lives in a house by himself. He lives alone. He has no parents. Oh, where are his parents? They are dead. They got killed. They got shot.
Here Leonard has revealed how he feels all alone. He has nobody he can count on. These feelings can now be explored further, behind the guise of Lemme. T: L:
T: L: T:
So does he like being all alone? Yeah, but he can't tell anyone he's alone because then if they find out, they will put him in Hospice Maris. (A residential treatment facility). And he does not like Hospice Maris? No, he does not like it there ... He is going to die soon. He is going to die? How do you know he is going to die?
At this point, the therapist considers the possibility that the child might harbor some suicidal plans. So she zeros in on the possibility of dying. L:
He is going to die because he is all alone and he can't work. So he can't get a job, and then he can't get money, and with no money, no food. No food and he will die.
This sounds quite logical. There is no specific plan for committing a suicide. It is just that the boy feels helpless and sees no solution to his predicament. T:
So Lemme is all alone in his house and he is going to die soon because he has no food and no parents ...mmm. What do you think he can do to protect himself?
L: T: L: T: L:
He can go to karate (at this point he adds the TeenageMutant Ninja Turtle face). Is this Ninja Turtle? (pointing to the green face below in the drawing). Yes, but he cannot go to karate because you need parents to take you there to sign you up and to pay the money. Did you ever do karate? Yes, that is how I know all this stuff.
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The therapist has managed to learn much about the boy's inner landscape. He has revealed his depression and hopelessness, but he also has reached the point where he is aware of something he can be proud of, namely, his knowing about karate. Eventually, more realistic problem solving can take place, after his feelings are explored, accepted, and understood. This session was a constructive experience for the boy, and he will be able to work further with this therapist in subsequent sessions. The responsive communication employed by the therapist put the child in charge, and the session proceeded at his own pace. He was the authority on his drawing and he was able to express his feelings and apprehensions through the character he had drawn. His personal boundaries were respected. Children naturally think visually, in pictures. The so-called "right brain thinking" is more effective for them than the logical, sequential, analytical "left brain thought processes." By encouraging children to make pictures, the therapist can enter more fully into their world. Pictures, however meager and primitive, contain a wealth of feelings and ideas. They are like a bridge that let the adult and the child meet each other at least halfway, deepening their understanding and strengthening their relationship. Feeling understood and accepted, the child can proceed to use his own abilities to ease some of his predicaments, to some extent.
Chapter 12 ART THERAPY WITH ADOLESCENTS dolescents come in all sizes and colors. Some are bright normal adolescents with "growing pains." Others are dull and mentally delayed or physically handicapped. Some come from stable homes, others from broken homes whose absent fathers or drug-abusing mothers provide no adequate role models. Some are loners; others are delinquents who belong to gangs. This is a period of transition, a period of change, socially and physically, for all adolescents. It contains all the ingredients for a crisis-even under the best of circumstances-because the previous problem solving devices are no longer adequate. Physically, there are spurts of growth and bodily changes-voice change for boys, menses for girls-that produce clumsiness, dissatisfaction, and self-consciousness. Socially, an adolescent is in no-man's land. In some situations, the adolescent has no rights. In others, he is expected to function as an adult. One moment he is made to feel like a child, but in another he is regarded as an adult. Psychologically it is difficult to keep up with one's self and others. Adolescents have difficulty sorting out the "reality principle" from the "pleasure principle," the immediate pleasure vs. the longrange gains. They seem unpredictable, inconsistent, impatient, in a hurry, and want to have all the answers immediately. How does one work with an adolescent? It helps to keep in mind the developmental tasks of adolescence. It is a period when the sense of identity is formed, vocationally and sexually (Erikson, 1950). In forming his own identity, an adolescent attempts to emancipate himself from his parents, who had been his most important source of affection. Often, this emancipation takes the form of a rebellion. He has to break away and find new role models. He needs to belong and wants to conform to
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his peer group. His search for a new identity leads to conformity in dress, jargon, behavior, and sometimes it leads to drinking and drugs.
Tuning In Therapists find it useful to try to "tune in" to what it is like to be an adolescent by recalling their own adolescence. Was it a happy period? A sad one? And if sad, what made it difficult, and during what periodearly, roughly 11-14; middle-lS-17; or late-18-19? Try to portray your feelings and recollections by drawing a picture. Then, on the reverse, write a sentence or two about what it was like for you to be an adolescent at that stage of your life. If you find yourself blocking, think about an adjective to describe that period of adolescence and then transform the adjective into a picture. In a group of 15 therapists in a masters program, 13 said their adolescence was chaotic and confused-a period of breaking away from family. About her early adolescence, one said, "It is like a roller coaster. Your feelings are never stable and grounded, but are always up and down, and most of the time you cannot understand why." Another mentioned that in middle adolescence, she felt independent enough to drive and work, yet still felt dependent on her parents and struggled to define herself by acting differently in different groups she interacted with. The theme that appears frequently is one of feeling "vague," imposed upon, sorting out levels of chaos and feelings of order, inside each other. The most troublesome period appears to be middle adolescence. According to one member of this group, adolescents use external stimuli to define themselves, and those stimuli act as a cover up for the fact that adolescents do not know who they are. In Figure 12-1 hair spray, belly button piercing and jewelry serve this purpose. Note also that there are no facial features, perhaps symbolizing a lack of a clear sense of identity. The hands are missing, too, suggesting a sense of helplessness. Only two therapists in this exercise had some positive feelings about late adolescence. One felt his strengths and described himself as unique, independent, and full of energy. Another said that her late adolescence was a relatively carefree time, full of friends and laughter, with the only worry being what to wear and how to get ready for the prom. In another group of 16 art therapists in training, 10 described their adolescence as a stressful period, five used adjectives such as "con-
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Figure 12-1. The Adolescent.
fused" and "exciting," and only one considered his adolescence a positive period in his life.
Helping Strategies In work with adolescents, the overarching principle is to help them attain a sense of identity and mastery. If an adolescent feels more self-
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sufficient, he will feel less hostile and rebellious. Therefore, therapists should be alert to situations where the adolescent might benefit from concrete help with reality problems, such as how to handle a situation in school or in the family; how to get some grooming advice; and how to implement one's hopes and aspirations. Think of yourself as an "auxiliary ego" for the adolescent, namely that portion of the personality that organizes and integrates experiences by testing reality and appraising the expectations of others and weighs those against the potential consequences of actions contemplated. In various situationsrunning away, for instance, or getting into a fight, ask, "How will that help you?" or, "Does it help you to get what you want?" The therapist takes the side of the young person and looks for ways to increase the "pay-offs." "Calling attention to the choice points" is another technique that increases the sense of mastery. Sprinkle your language liberally with expressions such as "You could do that ... or do that; or, "The choice . yours... "; or, " 1t IS . up to you.... " IS "Constructive arguing" is another technique that fosters the sense of mastery. Here the therapist or parent offers another point of view while encouraging the youngster to "stick to his guns." One should not be too quick to puncture the youngster's arguments. And after the verbal exploration when one has to draw the line, at least give him credit for his vigor in defending his ideas. Constructive arguing is a verbal exploration method which allows people to consider the matter from all sides in order to find means of solving the problem. While working with adolescents, it is essential for therapists to be direct and open when talking about difficult topics. It is better to be blunt and forthright than circumspect. Nothing derails a relationship quicker than pretense and phoniness on the part of the therapist. The therapist is a potential role model for the adolescent on what it is like to be an adult. Do some self-sharing about how to deal with negative emotions. How do you, the therapist, cope with frustration, boredom, and anger? Adolescents can be infuriating and they relish the opportunity to make a dent into an adult's feelings. Haim Ginott has some sound suggestions for parents on coping with anger that can apply to therapists, as well. Anger is a fact of life. Failure to get angry at certain moments indicates indifference, not love. Do not pretend not to be angry when you are angry. Be genuine, but do not insult the young person. Simply describe the situation and say how you feel. For instance,
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instead of attacking the noise maker by screaming, "What's the matter with you? Don't you know better? Stop this minute," simply say, "Noise makes me very uncomfortable." At home, the parent often has to state clearly what needs to be done in order to change the situation that generates the anger. For instance, "When I see good towels on a wet bathroom floor, I get mad! I get furious! Towels do not belong on the floor. They belong on the rack." Instead, the parent might be inclined to say, "What are you, a slob? Your girl friend should see the way you really are, messy and inconsiderate" (Ginott, 1969, p. 96ff). Many teenagers have an inner radar that detects what irritates their teachers and parents. If the parent values neatness, the teen, in his search for his own identity, will be sloppy. He becomes disobedient and rebellious, less to defy his parents than to experience his identity and autonomy. It is bewildering to watch his shifting moods and to listen to his never-ending complaints. Family therapy could help parents live through this turmoil. As a general principle, remember that this is a time of uncertainty, self-doubt, and suffering for adolescents. Teens do not want instant understanding. They feel unique, complex, mysterious, and inscrutable, and they would feel insulted if you said, "I know exactly how you feel. At your age, I, too, felt the same." It is wise for the parent and adults in the adolescent's world to differentiate between acceptance and approval. If the parents accept the outrageous hairdo, they destroy its value as a symbol of autonomy and rebellion. The young rebel might have to substitute a more obnoxious behavior. Do not collect "thorns," as Ginott puts it. Parents want their children to be perfect and tend to call attention to small defects in their character. Let them be. And do not step on "corns." If the youngster is short, he will be called "shorty," if tall, he will be called "a bean pole." The youngster should not be teased, even in jest. And by all means, do not remind him of his babyhood (Ginott, 1969). When working with adolescents in trouble with the law, it is important to keep in mind that no one can become a responsible mature person without having experienced a relationship with a mature and caring person. If the parents do not provide such a relationship, a substitute has to be found, and the substitute could be the therapist, a teacher, Big Brother, or another member of the community. William Glasser's Reality Therapy approach is useful when working with youngsters who do not have stable home situations (Glasser, 1965). The first thing Glasser does in therapy is to find out what goals
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the youngsters may have. If they have none, then the first imperative is to develop some goals to work toward-to earn money for something, a new pair of shoes, for example. Glasser manages to point out to the young person that reality is so constructed that there are consequences to one's actions. It matters what you do. You are not powerless. You do not have to go to school, but if you don't, certain things will follow. You will not be able to get a well-paying job, for instance; nor will you be able to enlist in the Armed Forces. Many adolescents feel unhappy most of the time. Glasser tends to provide some "reality education" for them. Reality, he tells them, is so constructed that the only way to be happy is to make someone else happy. It may sound old fashioned and trite to the young person, but it is true. There is no straight path to happiness. Rather, it is like a boomerang. Only by making someone else happy do we attain happiness. Glasser would ask, "You feel unhappy? No wonder! Whom have you tried to make happy recently?" But to want to bring some happiness to someone else presupposes that there is a close relationship, at least potentially. To actualize a close, rewarding relationship with someone means taking the initiative and acquiring some social skills.
Specific Techniques Adolescents who come to the therapist's attention usually have a considerable gap between their chronological and psychological ages. Physically they may appear rather mature but emotionally they are often still children. Not infrequently, their development may have been halted by various traumas they have experienced, and perhaps are still enduring. Therefore many of the specific techniques already discussed in connection with children may be appropriate for them also. The Name Design is a good technique to break the ice, especially when working with adolescents in groups. Have them simply choose a color and write their name. Then have them emphasize and decorate their name however they like and draw items around it to depict what they enjoy and what interests them. Draw YOur Initials. This method, used frequently by the noted art therapist Helen Landgarten, resembles the Name Design technique. Landgarten would have adults or adolescents draw their initials, then have them see what form they could discover in them and then elabo-
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rate on the basic design (Landgarten, 1981). For some, the design may suggest an object from which they can develop a picture. Here the initials serve as a starting point to develop something akin to a Free Flow/Scribble technique. The Wartegg technique, described in Chapter 8, is in some respects similar to Landgarten's methods but is not as warm and personal. The Wartegg technique, which works well with adult males and with elderly clients, can also be used effectively with somewhat inhibited young males who are interested in tools and technical things. Depending on the level of energy and attention span, it is wise to use only two or three of the eight stimulus compartments. A Picture ofOne's Choosing. This is a useful warm-up procedure and it is also appropriate at any later stage of the process. Ask the young person to draw a picture, leaving him as much self-determination and initiative as possible. When it is necessary to structure the session to explore some specific area of functioning or some specific experience, avoid the appearance of regimentation by giving him a choice between two or more possible approaches to the task. A Two-part Picture. This is a technique that works very well with adolescents and young adults. Ask the client to make a two-part picture. One part portrays what he is like and lets the world see it. The other part depicts how he feels inside-feelings he won't let anyone see. This can be a two-dimensional drawing or a three-dimensional construction, using a box or a paper bag where one can separate the inside from the outside. It can also be a sculpture or a collage. Other techniques, described in Chapter 8, work well with adolescents. They include a picture, collage, or a sculpture about the "Three Wishes," and the "Telegram." The Interpersonal Domain. Themes of "The Best Friend" and "The Kinnetic Family Drawings" explore and strengthen the Interpersonal Domain of the Self-System. The Achievement Domain. The achievement domain of the Self-System is highlighted with portrayals of one's "hobbies," "interests," "school," "work," and what the person is "most proud of." The Transpersonal Domain. The transpersonal domain can be observed in the pictures and sculptures about one's "Heroes," "Favorite team," "Favorite actor," "Best-liked movie or TV program," "Sad vs. happy holidays," " Person most people envy," and other categories.
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Self-Portrait Drawings Self-portrait drawings are most effective exercises for adolescents because they are generally quite preoccupied with themselves. A single session or a number of sessions can be spent on self-portraits. Self-portraits shed light not only on the Body Domain of the Self-System, but on several of the other areas of functioning as well. For the initial self-portrait, simply tell the youngster to draw of fulllength picture of himself, from head to toe. Give him a time limit in order to avoid getting bogged down in details. "See what you can do in five minutes. Do not bother with too many details. Just make a rough sketch." When you discuss the self-portrait during the dialoguing phase, ask which parts of the sketch he thinks are the best, which ones were difficult to portray, and where did he devote most of the time. During the same session, or in the next, have the youngster draw another self-portrait. For the second image, say, "Make a picture of yourself a year ago." Around it write or draw pictures of the things that were important to you then. How did you use your time? Who were your friends last year? What were your goals and hopes a year ago?" These directions by themselves will stimulate ideas and prompt him to search for goals. This is a good exercise for adolescents as well as adults (see Chapter 13). Focus the next version of the self-portrait on the "current self as compared with the self a year ago." Say, "Change or make a new picture to show what is going on in your life now. Cross out activities you are no longer involved in. Add people and activities that are important to you now." And ask the youngster how his goals and aspirations have changed. Still one more version of the self-portrait can be developed with good results either in the same session or in ones that follow. Say, "Draw a picture of yourself a year from now. Around the picture write or draw the activities you will be involved in. How will you spend your time? What will be your goals and aspirations?" Instead of drawing pictures, youngsters can make collages. This could be a homework assignment, because pondering one's goals and hopes, as opposed to one's immediate needs, takes quite some time. These series of self-portraits have also proven useful with adults as well as with young children. Extend the time frame for adults. Have the client draw a picture of himself, not just a year from now, but three
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years from now; five years from now; and even ten years from now. Elderly people frequently fear that their lifetime is running out and think there might not be much of a future beyond the immediate present. Stimulating their imagery about a possible future can mobilize their energy and improve their outlook. Drawing a picture of one's self "a year from now" has proven to be a difficult but useful exercise for many inner city children. In recent years, in Baltimore, for instance, there have been frequent random shootings in the streets. Grade school children make pictures of their own funerals because they do not expect to be alive the next day. Put on paper, the therapist can deal with this frightening prospect, and can sort it out to provide some emotional support to the children. It is useful to obtain a self-portrait at the outset of therapy and then to compare it with a self-portrait drawn at the conclusion of the therapy contacts. Changes between the two pictures point to the growth that may have taken place and the extent to which it may have been facilitated by the therapeutic interaction between the adolescent and the therapist.
Draw-A-Story Procedure Some children as well as adolescents become anxious when asked to engage in relatively free choice artwork. They say, "I do not know what to draw." "Draw-A-Story procedure" is useful in these situations. It was developed by Peggy Dunn-Snow (1994), and is based on the work of Rawley Silver (1993). This technique was originally intended to assess depression, and also works well to stimulate the creativity and spirit of adventure in children and adolescents. Prepare an array of stimulus cards and let the youngster take two cards or make copies of two of them. Having chosen two of the 14 stimulus cards, the youngster imagines what might happen in the pictures and draws his version of it. After he finishes the drawing, he gives it a title and writes a three-sentence story about it. Dunn-Snow has used the Draw-A-Story-Technique with individuals as well as with groups of children and adolescents. Each group member chooses one stimulus card. Then the group members collaborate on how each of their images can be combined in a single drawing with a common theme, title, and story line. According to Dunn-Snow, the opportunity to choose provides some sense of control and structure so that conflicts in the group are ultimately resolved with minimal or no
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Figure 12-2. Draw-A-Story Stimulus Cards.
adult intervention. However, in the case of unsocialized adolescents, it might be safer to divide the members of the group into dyads to work on the task of developing a story between their chosen cards.
Collages Collages are particularly effective for work with emotionally impoverished, guarded, resistive adolescents. The therapist collects a rich
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array of various magazines and distributes them to the client. The therapist or the clients choose the theme and the client looks through the magazines and cuts out pictures to illustrate the theme. For instance, have the client pick pictures or draw how he sees himself and how others see him. Or have him choose pictures to depict his "current experiences," or "draw the content of the letter in the mailbox." "Devise a collage about the tear that is falling from the eye," or "make a collage about various feelings-loneliness, depression, anger." Clients cut the pictures from the magazines, paste them on paper, embellish them as they wish, and then write a story about the picture on the other side of the paper (Linesch, 1988). Several diagnostic categories-the suicidal adolescent, the anorexicsbulimics, the sexually abused, and the chemically dependent-are particularly difficult to deal with. We now turn to the consideration of how to deal with these kinds of adolescents.
Suicidal Adolescents As with any client, the first thing to do is to get to know him and to establish a relationship that helps him feel valued and accepted. This can be done by first focusing on what it is like to be an adolescent in general. In one useful assignment, the client draws a picture or makes a collage about an "Adolescent's Nightmare." What do adolescents, in general, dread, worry about, struggle with? Next, a picture about the "Three Wishes" gives a glimpse of what is going on in the young person's world and what troubles him. It is important to help the suicidal person to express his negative emotions. Ask him to draw an "Angry Picture," "Real Sad Picture," or a picture or a collage about "Some Disappointment" a person has experienced." Gradually the therapist has to find ways to increase the person's selfesteem. Whatever increases the person's sense of self-worth will make ideas about committing suicide less attractive. One way to do this might be to ask for pictures that portray the person's good qualities. Have him make a picture about "what you admire in people," or a picture of a "person you would like to have as a friend." More personally, have him draw a picture about "something you are proud of." Then perhaps a picture about "a goal I have for my future." Also have him draw a picture or make a collage about "a decision I have made lately I am proud of," or "a decision I would like to make." It could be to give up smoking, for instance, or lose some weight, or start exercising.
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"What I would like people to notice about me," is another picture that lets you explore the person's world. Let the young person choose the people. They could be teachers, parents, classmates, friends, or others. Once the suicidal young person feels that he matters to someone who knows him well, suicidal thoughts will recede. Then, with the therapeutic relationship firmly established, good results can be achieved by asking for a two-part picture or a collage to show "how the person is feeling now" and "how the person would like to feel" (Landgarten, 1981). It is customary to consider suicide as a "cry for help" (Shneidman et aI., 1970). Psychopathology and behavior disturbances are natural reactions to emotional and social deprivation. Problems are distress signals. They are alarm reactions, "auch" signals. One must look for the sources of distress before the distress leads to contemplation of suicide. Many of the young people therapists work with come from broken families and have nobody to satisfy their emotional needs. Therapists have to help adolescents find sources of love, acceptance, and security in their world that would not lead them into greater deprivations. Therapists cannot be a substitute mother or father or girlfriend, but they can help adolescents find such sources of nourishment in their world. And, also importantly, we can help them learn what they themselves are doing to defeat the nourishment that might be scarce but available in their surroundings.
Eating Disorders Two types of eating disorders-anorexia nervosa and bulimia-are on the rise in our society today. These disorders are 10 times more common in women than in men. It has been estimated that two-thirds of all young women have some mild form of problematic eating behavior (Motto, 1997). Physical symptoms of anorexia include a loss of more than 15 percent of body weight, often combined with amenorrhea, hyperactivity, and hypothermia. Psychological symptoms include a preoccupation with thinness, fear of gaining weight, distorted body image, denial of hunger, sense of ineffectiveness, and struggle for control (Crowl, 1980). Some researchers speculate that problems with food have their roots in histories of sexual abuse and may represent an attempt to alleviate post-traumatic stress symptoms (Root, 1989). At any rate, eating disorders are self-destructive behaviors where the per-
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son seems to want to get rid of the body, and thus, in effect is committing a partial suicide. In art therapy, the self-drawings made by anorexics portray themselves as little girls and show very low self-esteem. Mechanical, robotic forms are also frequently seen images. It appears that anorexics, who may be survivors of sexual abuse, try to remain asexual to gain control over their bodies, their destiny, and their lives (Crowl, 1980). A "Self-portrait" done in front of a full-length mirror is a useful technique for work with an anorexic client. The client lists the body parts she thinks are drawn incorrectly or she is unhappy about. Then, she is asked to list three things she likes about her appearance. The discussion can then focus on the tendency to magnify the dislikes and to minimize what she likes about herself. "Body tracing" is another useful approach. First the client outlines her body as she imagines it would look if it were traced. Then, the therapist traces the body. The discussion that follows highlights the discrepancies between the two outlines. "Mask making" is also a useful technique. Some art therapists have clients make a mask and then give the mask a voice and engage it in a dialogue (Motto, 1997). Most of the exercises mentioned previously in work with adolescents are effective with clients struggling with eating disorders. The notion of self-system, discussed in Chapter 8, helps to explore and understand the various domains of functioning. The "Name design," "Pictures of one's interests," "Hobbies" and "Relationships," as well as "Pictures of a range of emotions" lead to a fruitful examination of the various problems the young person is struggling with. In addition, adolescents with eating disorders might also benefit from the Alcoholics Anonymous model whereby clients recovering from the illness serve as mentors and role models to clients still in treatment (Madigan, 1994).
Sexual Abuse Sexual abuse is a serious problem with a wide range of possible psychological consequences. It has been estimated that some 27 percent of women and 16 percent of men have experienced sexual abuse as children (Rodriguez et aI., 1997). Some studies indicate that childhood sexual abuse is two to three times as common in females as males (Richter et aI., 1997). Symptoms common to victims of sexual abuse are intense
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fear, anger, role confusion, low self-esteem, anxiety, social isolation, and self-destructive behavior patterns. Fifty percent of psychiatric inpatients have experienced severe or long-term childhood sexual and/or physical abuse and are at risk of developing dissociative disorders and post-traumatic stress disorder (Van der Kolk & Van der Hart, 1989). Treatment efforts with sexual abuse victims in group format provide mutual support and reassurance that one is not alone. It is important to use the term "survivor," instead of "victim" of sexual abuse. The themes that emerge from the artwork and discussions touch on anger, self-blame, and grief. Anger arises from the fact that the perpetrator receives none or minimal punishment, even when charges are brought through legal channels. Some studies show that less than 10 percent of all reported rapists go to jail, and most go free without even probation (Ledray, 1994). There is self-blame for the survivors who question if they could have prevented the abuse had they behaved some other way. And there is grief about missing out on "normal" childhood. Backos and Pagon (1999) have devised a particularly effective treatment format. They start their sessions with a "check-in" and ask the group members first to create a "mandala" showing "Myself Tonight." Then, next to the drawing, they write how they were feeling (e.g., "jumpy, confused, down"). Their current concerns-school avoidance, depression, suicidal thoughts, homicidal thoughts, explosive outbursts, drinking, running away, promiscuity, and bulimia-begin to emerge. This results in themes for discussion, such as how to deal with anger, how to improve self-esteem, how to deal with other students at school and with family conflicts, and how to build trust. Additionally, Backos and Pagon use a "question jar," whereby each group member can write a question anonymously for the group to explore. This gives the girls the opportunity to discuss topics they might be too shy to address openly. For example, during one week the group clarified the difference between rape and sex, and talked about sexual relationships and sexually transmitted diseases. Thus sexual ignorance was replaced with sexual knowledge (Backos & Pagon, 1999). Although this particular group met for only eight weeks, there were positive changes. The girls started to focus outward and considered how they could empower themselves to help other survivors. Powell and Faherty (1990) describe another, longer treatment plan for survivors of sexual abuse. This group used sand play, as well as
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videotapes, psychodrama, snacks, and prizes in addition to two dimensional drawing. For those who have been severely traumatized over many years, there is a tendency for the least traumatic memories to emerge first and the most traumatic ones to emerge later in the healing process. As new memories begin to emerge, the survivors may be plunged back into some "victim" thinking, feeling, and behaving. Furthermore, an individual may not be at the same stage in all areas of functioning. She may be a thriver in regard to certain relationships, but a victim in others (Matsakis, 1994). Recovery may be a process that lasts a lifetime. For some the trauma may be analogous to an acute infectious disease that can be taken care of relatively easily. For others, it may resemble more a chronic condition, like a diabetes, which requires attention throughout ones life.
Chemical Dependency In our contemporary society, it is most difficult for an adolescent to avoid being sucked into alcohol and/or drug dependency. Peer pressure and one's own curiosity, risk-taking, wanting to appear "cool," and similar factors easily lead into experimentation with illegal substances. For many, experimentation results in addiction when the adolescent is no longer able to function without the chemical "crutch." Adolescents are particularly vulnerable to drug addiction. Some of them, for whatever reason, are unable to deal with the usual stresses of growing up. Drugs to them may represent an escape from feelings of inferiority and disappointments. To overcompensate for feelings of inferiority and helplessness, they set unrealistic goals for themselves which only further reinforce their sense of failure. The adolescent covers up the pain and confusion with a facade of denial, indifference, and anger. Behind the facade is a youngster deeply hurt who feels inadequate, insufficient, incomplete, and guilty for not measuring up to his own expectations. He thinks he has to be a superman or he is a nobody. She is a prima donna, or she is no good. These adolescents regret lost opportunities, lost relationships, lost possessions, and even lost health. They cover up the painful awareness of the many losses by more drinking or drugging. How does a therapist extricate a youngster from the drug culture? Art therapy in group sessions can provide a new circle of companions who gradually find other ways to fill their time. They are no longer
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attracted to drug procuring, gambling, and other risk-taking and selfdestructive activities. They learn new ways of structuring time, and they experience the satisfaction of expressing meaningful emotions without being hurt and slighted. As you ease the chemically dependent adolescent into art therapy, remember that people unaccustomed to visual means of expression exhibit the usual apprehensions. An adolescent is prone to claim that art is his worst subject in school (see Chapter 7). At this point, all the therapist needs to say is that this is a different art than they do at school. "I know you are not an artist. You do not have to be an artist to do this kind of art." Drug-using adolescents are also concerned about what the therapist will find out about them. Verbally and nonverbally, the therapist has to make it clear that only the client himself is the authority on what the picture "means." The therapist and other group members can say only how the picture affects them, not what it signifies. As the client perceives that he is the expert and the final authority on the meanings of his productions, his defensiveness and apprehension invariably wither away. Still, in one drug-abusing adolescent group, it was necessary to reassure the group and explain again that art therapy is just a different way of exchanging ideas and that the only person who knows what the picture really means is the person making the picture. It is not a secret way of keeping a client under surveillance for illicit drug use, and that there is no way of telling from the pictures what drugs a client is taking (Nucho, 1977). Clients can be eased into picture making by the techniques previously described in this chapter and in Chapter 7. "Free Flow technique" works well. So does the "Name Design," or making a "Picture from one's initials." At the beginning of one art therapy group, chemically dependent adolescents and the therapist engaged in a general discussion about the events of the week. A theme began to emerge from this general discussion. The clients liked to have the therapist suggest a theme for their pictures, but they had the option of either using that theme or working on one they, themselves, would choose. The themes that emerged were, "My best friend," "Work," "Things that make me angry," "Picnic," "Enjoying myself," and others." The techniques illustrating the various domains of the self-system, mentioned earlier in Chapter 8, are appropriate as well. The themes that appear in the clients' art work touch on feelings of loneliness, guilt, fear, anxiety, depression, empti-
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ness, anger, and disappointment. Gradually, it becomes clear that the bland exterior facade masks a deeply troubled person. Through the relationship of acceptance with the therapist and support from the group members, the chemically dependent adolescent begins to accept limitations in his life, recognizes his remaining strengths, and thus improves his self-esteem (Nucho, 1977). One art therapist likes to assign a two-part picture for the client to work on. On one part of the picture, the client uses colors, images, and symbols to "portray his weaknesses." On the other part, he "draws his strengths." Then, each member of the group presents and explains his picture to the entire group. The members then fold and pocket their strength pictures for safekeeping. The other pictures are ripped up and thrown away (Potocek & Wilder, 1989). In addition to the various types of self-portraits discussed earlier in this chapter, two kinds of Kinnetic Family Drawings also provide rich sources of information to the therapist as well as to the monosyllabic client. While the customary KFD provides information about the maker's current or past family relationship, in the "Prospective Kinnetic Family Drawing" (Kismiss, 1992), the therapist asks the client to draw a picture of what he thinks his life will be like ten years later. The Prospective KFD promotes thinking about one's future and stimulates goal-setting. The adolescent's choices of whom and what to include in the picture, the size of the items portrayed, and their distortions provide information from which to form hypotheses about the dynamics of the client to be explored further in verbal treatment. The fears and wishes associated with one's future can be discussed, and the person can be helped to modify unrealistic self-expectations and set realistic goals that can provide need satisfaction without resorting to chemical means.
Chapter 13 ART THERAPY WITH ADULTS any people, unfortunately, reach adulthood chronologically but not emotionally. What does it mean to be an adult? Adolescents impatiently wait to be regarded and treated as adults. To them, adulthood means a state of certain rights and privileges. Only gradually do they become aware of the obligations and stresses that accompany those rights and privileges.
M
Being a Grown-up When does a person start feeling like a grown-up? What particular event stands out to mark the arrival of adulthood? For a group of graduate students, the most frequently mentioned event that suggested to them that they had reached adulthood was when they received their driver's licenses. Some thought that they started to feel grown-up when they began paying back their college tuition debts. One young woman recalled that she felt having reached the status of an adult when she was permitted to go to the dentist all by herself. It seems that the ability to assume responsibility for some aspect of one's behavior signals the arrival of adulthood. During late adolescence, young people start making their own decisions. They attain a certain level of financial independence. They no longer spend the entire summer with the family. They start living apart from their families. According to Erikson, during this period, an adolescent decides what he wants to do and with whom he wants to associate. Now, as an adult, he has to decide whom he wants to take care of. To be an adult means to have the ability and the desire to care for someone and something. 238
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This, Erikson suggests, can lead to the crisis of intimacy vs. isolation (Erikson, 1950). Freud emphasized that to be a healthy adult one has to be able to work and to love. An adult must decide what line of work to pursue. Another big decision concerns one's lifestyle-to remain single or to combine life with a life partner. In the Western world, these decisions are particularly difficult for women. Having children means postponing one's career aspirations. Studies show that among women in executive level positions, a relatively small number have children by the time they are 40. Lack of parental leave and scarcity of adequate childcare facilities makes it very difficult for a woman to invest herself in a profession and motherhood at the same time. Women have lost the security of traditional marriages, half of which end in divorce. This, combined with the low earning potential in the job market, makes many women choose whether to be mothers or successful professionals. The Smith College Office of Career Development reports that in the 1960s, some 61 percent of their graduates said that they wanted to be homemakers. In the 1970s, only 15 percent wanted to be full-time homemakers. By the 1980s, less than 1 percent said they wanted to be homemakers. Combining motherhood and a career is a daunting problem for women. To the career, add the needs of one's children and spouse, plus the care for one's aging parents, and stresses for adults reach unbearable levels. No wonder the Diagnostic and Statistical Manual (DSM IV) presents a bewildering array of forms of psychopathology that can assail an adult. Often the hassles and stresses of life trigger a full-blown episode of mental illness, even for those conditions that are thought to have some genetic predisposition, The long list of forms of psychopathology can be made more manageable for art therapists by focusing on the extent of the client's functional impairment. There are the minimally, the moderately and the severely dysfunctional adults. Minimally dysfunctional adults function adequately in most of their roles. They do not present problems to their role partners or society at large, but are dissatisfied with their own level of performance. They may be struggling with a major life decisionwhether or not to pursue a course of action, for example, or to break off a relationship. Moderately dysfunctional adults are capable of functioning in all but one specific area of life. For instance, many alcoholics pride themselves on being able to hold down a job, but their marital relationship causes
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much pain and confusion. They are inadequate as parents, and their children suffer. Some sex offenders are also moderately dysfunctional, and some of them may have even reached socially prominent positions. Secretly, they are child abusers. Severely dysfunctional adults are unable to fulfill most or all of the adult roles in life. They may have had numerous hospitalizations for mental illness. Art therapists encounter severely dysfunctional adults in halfway houses, shelters for the homeless, prisons, and other institutions. The specific art therapy procedures that follow have proven useful with the minimally, moderately, and the severely dysfunctional adults.
Minimally Dysfunctional Adults Minimally dysfunctional adults seek therapy on their own accord rather than being urged to be in therapy by some external authority. They appear to function well in all their major life roles, vocationally and socially. They present no problems to other people, but they may be problems to themselves. They may be dissatisfied with their own performance; they feel that they are not reaching their full potential; or they may be experiencing some troublesome relationship. Professionals term them, facetiously, the YAVIS-type clients. They are "Young, Attractive, Verbal, Intelligent, and Successful." They may be young, if not in years, then in their outlook, and they are young at heart. They mayor may not be physically attractive, but they are able to attract other people and form lasting friendships. They tend to be verbally expressive, but they know how to use their vocabulary defensively, without saying anything meaningful. Art therapy is a less well-known means of communication in our society, and as such, it is particularly useful when working with these clients. Most of them have a normal or above normal level of intelligence. Despite the fact that they have a low opinion of their level of financial and social success, they are successful in the sense that they are capable of supporting themselves. Their ambitions and level of expectations may be higher than what they have achieved so far. Often they come to therapy in order to further personal growth and self-actualization. They may have concerns about some relationships in life, but these tend to be their problems, not problems for their role partners, for other people or for society at large.
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YAVIS-type clients do well in art therapy and their difficulties usually clear up in a relatively short period of time. All the art therapy techniques described in previous chapters are appropriate for them. It is useful to start with various warm-up-type activities, like the "Free Flow" technique, "Anything" or "Free Picture," and various forms of "self-portraits." All of these exercises soon lead into self-exploration and deeper sharing with the therapist and, if the sessions are conducted in a group format, with the other members of the group. Think in terms of the various domains of the self-system (see Chapter 8) in order to explore specific areas of functioning. Mandalas serve well as closure activities, and many clients enjoy doing them at home on their own at the end of a busy and stressful day. The various art therapy exercises help YAVIS-type clients gain a deeper grasp of their own potential and how to proceed to actualize it. Art therapy strengthens self-confidence and promotes confidence in their own problem-solving abilities.
Moderately Dysfunctional Adults Moderately dysfunctional adults function well in one area of life but have problems in another area. This category includes people who can hold down jobs but have difficulties in some relationships; they could also be alcoholics or sex offenders. Some moderately dysfunctional adults eventually get in trouble with the law and are "sentenced" to therapy. Naturally they are resentful and are uncooperative. At first, they just go through the motions. They may be present, but they are not invested in getting anything out of therapy. It helps to work with these clients in groups. Gradually they begin to disclose their hurts and feel supported by the other group members who have similar difficulties. "A name design" picture is a useful initial exercise for art therapy with groups. Each person writes his name and then draws around it something to signify his activities, interests, or hobbies. Early in therapy, ask each client to make a picture or a collage about "a problematic relationship." It can be with a person or an institution-the court, the hospital, the job, or something else. This exercise tends to lead to meaningful sharing and mutual support in a group. Themes that touch on "the difficulty of being a male" in our society provide useful explorations for groups of male sex offenders. Many have not had adequate male role models. It helps to focus on their atti-
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tudes and experiences in relation to their fathers. What were "some of the good times they had with their fathers?" Or what were "some of the good times they would have liked to have had with their fathers?" What was "their father like?" In their opinion, what "would an ideal father be like?" Direct similar explorations to their mothers. What did they "like and dislike about their mothers?" What did they "like and dislike about their wives or girlfriends?" "The Kinetic Family Drawings" help to understand what it was like to grow up in the family. Here the client makes a picture of the family, including himself doing something. It can be a picture of the family when he was young, or his current family. Many dysfunctional adults have not had adequate family upbringing. Perhaps they had been in foster care, or had been taken care of by various relatives, or their parents were cold and disinterested in them. Often there is a stepfather and/or stepmother, and conflict with siblings and half siblings. Family pictures therefore are apt to awaken much resentment and suppressed sorrow. Sharing this with an understanding therapist and group members who endured similar difficulties while growing up can gradually ease the pain. Pictures of the "best dream" or of a "dream I would like to have" can lead to meaningful discussion. Also a picture of the "worst nightmare" is worth exploring. It need not be a nightmare of the client himself, if he is reluctant to disclose his feelings. It can be a particular situation or a nightmare about men, in general. Frequently, treatment has to be quite brief because of inadequate insurance coverage. When clients do not remain in therapy for more than a few sessions, all you can do is to sow a seed, as it were, and let the client continue to think about the question you posed. In one brief program, the therapist asks his clients to draw a block in the lower left corner of the sheet of paper, and another one in the lower right corner. The block on the left represents their problem, and the block on the right is the solution to the problem. Then they are asked to "draw a bridge" between the two blocks to show how will they get from the problem to the solution. In a similar exercise, the client draws a "wall" that is keeping him from achieving his goals. Or the client draws a "treasure map," placing an X anywhere on the paper and another X where the treasure is buried. He then draws a path leading to the treasure and describes what is obstructing his path. One depressed substance abuser said that
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his treasure was "real happiness." Then he spoke about the problems that kept him from getting to his "treasure": medical problems, lack of money, his addiction, his family problems, and his lack of friends. Having revealed those obstacles, it was possible to do some problem solving by partializing his many problems and prioritizing what he could begin to do. Another useful exercise is to "Draw a Mask you wear to cover your problems." One client drew something that appeared to be an angel, with something blue underneath. He said those were his "blues," meaning his depression he tried to hide. Another drew a mask with red eyes and nose and tears that resulted from snorting cocaine. It became clear that this client's drug addiction covered up some deeper emotional problem he was struggling with. If done in a group, clients can comment on each other's pictures and share the feelings the process has evoked for them. The customary verbal treatment methods used with drug dependent and other moderately dysfunctional clients are fraught with many difficulties. Many are ingenious in avoiding their counselors even when some form of counseling is mandatory to obtain the medication. A 30year-old woman with a long history of heroin and barbiturate dependency, for instance, would sit on the edge of her chair in her counselor's office and bolt out the door the moment the discussion became uncomfortable to her. When confronted with this behavior, she claimed that she had double parked, or she invented some other kind of emergency she supposedly had to attend to immediately. Later she was able to admit, "I have nothing to say to my counselor. Maybe if I led a different life, I'd have something to say to her. She keeps sending me these little notes with the help-wanted ads cut out from newspapers...." To a considerable extent, counselors using art therapy techniques can avoid many of the difficulties frequently encountered in the verbal treatment forms. Art therapy is particularly appropriate with clients who are inarticulate and action-oriented. In art therapy, the client is actively involved in producing some visual item. This activity engages his mind but also his eyes, hands, and much of the rest of his body. Here is something concrete and tangible that sustains his interest and provides a rallying point for his attention. For the counselor, the visual creation provides a rich source of information about clients who otherwise might be quite monosyllabic. The counselor can derive a great deal of information from the content and the form of the visual prod-
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uct. The counselor can gain additional insights from the process of producing the item, from the client's comments and reactions to the item, and from the comments and the reactions of the other group members if he produced it in a group setting. In addition, the therapist's own reactions to the visual material are significant. Every person, however untutored in art, possesses a basic visual vocabulary. For instance, everybody has feelings about colors. Some colors are thought to be pleasing while others are perceived as being unattractive. The same is true for shapes. Some shapes may seem intriguing, while others are disquietening. Some lines may seem smooth and soothing, while others may appear to be jerky or bold. This visual vocabulary, once discovered, can be expanded, and it becomes a source of constant enrichment and excitement. Clients who are accustomed to thinking of themselves as chronic failures become quite intrigued by this revelation. It is rewarding to discover how one's own visual vocabulary converges with or differs from those of other members of the group while at the same time it has just as much validity as that of others. Many dysfunctional adults are deeply hurt people who have often experienced words as being dangerous and unreliable. Words may have been used to evade, to humiliate, or to trap another person. On the other hand, visual means of expression have been used less frequently in our society, and have fewer distortions and stereotypes attached to them. Not infrequently, a fresher and more direct expression can be achieved through the visual rather than the verbal means of communication. The visual means of expression tend to be more suitable for the subtle and deeply personal experiences for which there are no appropriate words. By and large, language, with all its complexity, contains designations for those experiences which are of some social significance and neglects the more private and idiosyncratic experiences. In addition, many important experiences are accumulated during the first year of life, well before the person has adequate words to attach to his experiences. It may be, therefore, that some very significant and fundamental experiences became encoded in mental pictures rather than in words. After all, we dream mostly in pictures, and dreams have long been recognized as providing access to the deeper layers of our being. As he makes his pictures, the art therapy client is the doer, not a reactor, as is the case all too often in his life. He has to decide whether
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the picture will be small or large, bright or dark. But once the decision is made, it remains as he made it, unless the client himself wishes to change it. The paper does not argue back with him. If he is not pleased, he can change his decision without a penalty, which is a rare privilege in his real life. Clients truly relish this sense of freedom once they have experienced it. So long as it is art therapy and not art instruction he does not have to justify his decisions nor does he have to try to please anyone else. Many drug counselors have noted the so-called plateau period in the lives of drug dependent clients. After the clients have stabilized their lives to the point where they are able to hold a job and provide for their housing, clothing, and the medical needs, they soon start feeling restless and bored. The drudgery and the tediousness of life makes them feel as though they were stuck and only spinning their wheels, as it were, without getting anywhere. Art therapy introduced at this point can help the clients appreciate the growth that is taking place in them. New shapes, new color combinations and new styles appear in their art work, as they start thinking new thoughts and having new experiences. As one's life style changes, so does one's art. With the help of their art work, clients can appreciate better the strides they are making toward a more satisfying life.
Severely Dysfunctional Adults Severely dysfunctional adults are unable to function adequately in any major role in life. They cannot hold down a job and they cannot fulfill either their marital or their parental roles. They are a problem to their families and to themselves, unless their concerns are covered up by some delusions of grandiosity. They suffer from schizophrenia, manic-depressive disorder, or some other major form of mental illness. They shuffle in and out of mental hospitals. In recent years, they tend to be heavily medicated and the manifestations of their illness are hidden by a bland exterior. Art therapists encounter them while they are hospitalized for relatively brief periods of time, or are in halfway houses, group homes, or shelters for the homeless. They have frail egos, low self-esteem, and a flat affect. Their associations are loose. They are disappointed, suspicious, and disillusioned. It is difficult to form a therapeutic relationship with them because they are not eager to risk emotional investment in yet another potentially disappointing relationship.
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They are beset by chronic stresses, and their problem-solving skills are meager. People with major mental illness generally suffer from what could be termed an overdose of pain. They have overdosed on some traumatic experience. Although there may be a genetic predisposition to mental illness, still it often is triggered by some deep emotional trauma. It is important to keep in mind that, contrary to popular belief, by no means is mental illness limited to the lower socioeconomic levels. For example, one young woman, a member of a prominent professional family, became involved in LSD and developed schizophrenia after her sister was admitted to the Harvard School of Medicine. Another woman from an upper socioeconomic level gradually sank into a major form of mental illness when she gathered that she had disappointed her father who expected her to win the Nobel Prize in chemistry. How does one work with mentally ill adults? Contrary to work with most other kinds of clients, the therapist has to be careful not to be overly warm with those who are mentally ill. For many of them, close personal relationships have caused pain and disappointment. They are distrustful and they need emotional space. Also, it is essential for the therapist to communicate clearly and establish structure so that the client knows what to expect.
The Interactional Drawing Technique The Interactional Drawing Technique, already mentioned in Chapter 8, is appropriate with clients still in the acute psychotic phase. Most very disturbed patients may have to go through several preliminary steps before they are willing to engage in interactional drawing. Some patients do not draw unless the therapist is several feet away. Gradually, the patient may be willing to draw while sitting at the same table as the therapist. Finally, the patient may be willing to engage in drawing on the same sheet of paper as the therapist but would stop if the therapist intrudes into their "territory." The therapist and the client may draw simultaneously or take turns. Materials are simple and only a few colors are used to reduce the complexity of stimuli. Pencils or felt-tip pens are best. The originator of this technique, Mardi Horowitz, simply has a few colored pencils in his shirt pocket and gives one to the patient and keeps one himself. In this
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way, he knows what the patient contributed to the drawing and what he himself added (Horowitz, 1970). Interactional Drawing is kind of a symbolic dialogue where the therapist can provide ego support to the patient by visually introducing protective themes. In one instance, the therapist sketched an ambulance when the patient had drawn a scene of an earthquake with people falling from damaged buildings. The therapist can lend support by introducing certain objects, like pets and people. Connections can be strengthened by drawing bridges, paths, or putting up road signs. In general, solid objects in a drawing, such as houses and trees, convey a sense of security, especially when placed next to symbolic self-representations, like animals, a car, a ship, or a person (Horowitz, 1970). With Interactional Drawing Technique, the therapist must be careful not to overshadow the patient with her technical skills or abundance of ideas and associations. Depending on the condition of the patient, a session would be short, lasting from 10 to 20 minutes. Like art therapy in general, the Interactional Drawing Technique utilizes the visual means of expression that provides a new and undistorted language. The technique may be less threatening to the mentally ill person than conventional language, especially to patients such as catatonics, who have renounced words altogether. The experiences portrayed symbolically may be easier to put into cognitive terms later on. Symbolic discharge, control, and integration of affect occur while drawing. The therapist and the patient both focus their attention on the drawing and thus anxiety concerning the interaction itself becomes more tolerable. If the therapist is perceptive and attuned to the patient, the patient can set the rules and the speed of the discourse (Horowitz, 1970).
Collages Collages are another appropriate technique with chronically ill mental patients. Collage making is more structured and less threatening to patients who are concerned about their ability to draw or paint. All they have to do is cut out and arrange pictures. Collage making presents less opportunity to wander off into autistic thinking because the patient focuses his attention on the external world through pictures of persons, objects, and events of everyday life (Moriarty, 1973).
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The format is as follows: the group sits around a table, and in front of each is a glue stick, blunt scissors, construction paper, and several popular magazines, like Good Housekeeping, Ebony, People, or Sports Illustrated. The patients are told to look through the magazines and cut out pictures and words. Then they have to arrange the pictures and words to make a collage about themselves. They can choose their own theme for their collages or the therapist can offer a new theme in each subsequent session. For instance, make a collage about "the worst thing that ever happened to you" or "the best thing that ever happened to you" or a collage about "the hospital" or "how to become what you would like to be." Some groups of patients may decide on a joint topic for the entire group to work on. This promotes the development of social skills. It also reveals who leads, who follows, who works better alone, who works better in a group project, how close each one's contribution is to the central theme, and how unified or confusing is the end product. The discussion of the process of producing the collage as well as its content can be very fruitful (Moriarty, 1973). A collage-making session requires an hour-and-a-half. It usually takes half-an-hour to make the collage. The remaining time can be spent in verbal interaction. Each patient tells what his collage means to him. Others offer their reactions and comments. The therapist focuses attention on the reality-oriented aspects of the collage and emphasizes the here-and-now, problem solving, and learning alternative behaviors. The therapist reinforces constructive behavior by verbal approval and devotes the last five minutes of the session to tying together the various themes and what can be learned from them. Patients are free to keep their collages in their portfolios or display them on the wall (Moriaty, 1973). The collage-making experience enhances the participants' selfesteem and provides a tangible week-to-week progress record, as well. The group process gives enough structure to be supportive and enough freedom to develop autonomy. Patients can speak, listen, and interact socially. They are free to select their own pictures, arrange them in their own way, and tell others what they mean by them. The process also offers the therapist a rich source of observations. Why do the patients choose these and not other pictures? Why do they arrange them this way? Why do they make these associations? Why are the themes different or alike from week to week (Moriaty, 1973)?
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Art therapists frequently use various other kinds of collages, especially by Landgarten and art therapists trained by her. In one group, for instance, Landgarten asks the patients to choose three pictures that appeal to them and paste them on a sheet of newsprint. Then the patients write a few words under each picture (Landgarten, 1981).
The Art Dialogue Technique The art dialogue technique is somewhat similar to collage in that in both the clients work with images created by someone else, not by the clients themselves. But in addition to the benefits of the collages, the art dialogues offer aesthetic enjoyment to the participants. In Art Dialogues, the art therapist gives the patient an array of postcard size reproductions found in art museums. These are works by prominent artists. However, the patient does not appraise the aesthetic qualities of the works of art or figure out what the artist "really" meant to say. Instead the patient engages in a more receptive and meditative way of looking. The viewer immerses himself in the work of art, enjoys it, and if possible, attempts to derive some personally meaningful message from it. The purpose is not to have the patient evaluate the work of art but to see what light it might shed on the dilemmas and perplexities the viewer is struggling with (Nucho, 1983). In order to accomplish this, the therapist asks the viewer to approach the work of art with three questions in mind. The first question is simply, "What is there? What catches the eye? What stands out there for me?" The second question is, "What kind of feeling or mood is there? What kind of feeling does it evoke in me?" The third and final question is, "What does it say to me? What messages does it have for me?" The qualities of the work of art, such as unity amid variety and the eloquence of expression, affect the viewer both consciously and subliminally. Still, the various feelings of enjoyment or displeasure the viewer experiences depend mostly on his own disposition and readiness to be moved to pleasure or pain. Art may be a universal language, but to each beholder it tends to say something unique. This is the wellknown phenomenon of selective perception at work-a phenomenon regarded gingerly and with suspicion in most instances-but in the art dialogue technique, it is actively encouraged and appreciated. What matters is the meaning, which the viewers actively construct in the light of their own unique life experiences.
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When the art dialogue technique is used individually or in relatively small groups it may be possible for the clients to share their reactions to the works of art spontaneously, verbally, out loud. If the group is larger, or if the clients wish to avoid premature modification of their thoughts and feelings by the comments of the other members of the group, they may record their reactions to the three questions suggested earlier, first in a brief, telegram style and then share and discuss them later. When working with clients individually or in small groups, the works selected for the art dialogue technique may be shown in the form of originals or reproductions. Slides are the most convenient way for large-group viewing. It takes approximately two to three minutes for the client to examine each artwork. This varies, depending on the kind of clients one is working with. Clients who are anxious and not accustomed to looking at works of art may want to see each work two or three times before being satisfied that they have seen all there was to be seen. With most clients, by the time the work is shown for the third time, the apprehension of having missed something is gone. They are now quite ready to share their own reactions and to hear what other members of the group have to say about each work under examination. The number of works considered in each session should be kept quite small. Even seemingly bland and non-problematic pieces of work can arouse intense feelings and memories in some viewers. The three questions that the viewers address to themselves can awaken a deep sense of loss, remorse, guilt, or some other complicated emotion. Usually three works per session are quite sufficient to provide rich material for meaningful sharing of personal experiences. When four or more works are used, the viewers tend to slip into a more detached, museumlike form of inspection of the works, and remain rather untouched personally. The intensity of involvement with one piece of art may preclude the client's ability to engage with yet another piece of work. What types of art works are appropriate for the art dialogue technique? Keep in mind the principle of gradualness when selecting suitable pieces of art. For the early sessions, when the clients have not yet developed a secure and trusting relationship with the therapist and with each other, it may be best to use rather neutral, non-problematic subjects. Sunny pleasant landscapes, flowers, still lifes, and pets may be appropriate. Gradually, as the level of comfort with each other and the
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readiness to share personal experiences grows, introduce works of art depicting people and some more problematic human relationships. The final item in each session, however, should be non-problematic and sunny in order to provide a sense of security and closure prior to the end of the session. Each art therapist can select artworks to be used according to their availability and one's own preferences, depending on the type of clients one is working with. Works by Matisse, van Gogh, and others produce good results. For instance "The Artist in the Olive Grove" by Matisse presents a seemingly sunny, restful scene, which in most viewers evokes a repose and relaxation. Some viewers respond to the heavy black tree trunks and note the scorching sun. Occasionally, a viewer misperceives the easel for a second person in the painting and devises various fantasies about the relationship between the artist and this fictitious figure. Pablo Picasso's "Man on the Beach" is a possible second selection. This figure is often perceived as a sinister, menacing, suspicious person who is trying to get away with something. A minority of viewers respond to the sense of loneliness and man's determination to get someplace in order to accomplish his goals despite the odds. "The Shoes" by van Gogh is appropriate as the third work in the series. The majority of viewers respond to this painting with memories of hikes and outdoor activities. For some viewers this work generates recollections of grandfathers or someone else who might have worked hard and worn shoes like these. Much exchange of memories usually takes place, and the sense of mutual sharing and understanding grows among the participants in this experience. Mary Cassatt's "In the Garden" is an example of a work of art which should be reserved for use in later sessions when the clients have attained a good relationship with the therapist and with each other. It portrays a mother-child relationship and as many similar works of this topic, it tends to awaken ambivalent feelings which for most people are not easy to disclose to others. The art dialogue technique can be used effectively not only with severely dysfunctional clients but with a wide variety of other kinds of clients as well. It requires very little by way of materials and equipment. It can be used successfully with clients who are emotionally and socially impoverished as well as with people who are leading active lives despite their many burdens. It works well with people who are art
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lovers as well as with those who profess no interest in art at all (Nucho, 1983).
Late Adulthood The fastest growing age group in the United States today are people over age 100. But still in Western society there is horror of growing old. The terminology itself for this phase of life reflects our discomfort. We say the aging, the elderly, senior citizens, the golden age, and so on. We do not have a comfortable designation for the final phase of life because we as a society still have not come to terms with it. We are preoccupied with dieting, plastic surgery, face-lifts and physical exercise. Underneath all these efforts at self-improvement lurks the fear of growing old. We are afraid to grow old because we have not solved the mystery of death and what, if anything, comes after death. We joke about growing old. Bob Hope said, "You know you are old when the candles on your birthday cake cost more than the cake." To art historian Bernard Baruch, old age was 15 years older than he was at any given time. He did not feel old at age 70 because then to him old age was 85. And conversely, a 20-year-old girl refers to an 23-year-old person as being "so much older" than she is. The actor Cary Grant reportedly observed, "Had I known I would live so long I would have taken better care of myself." If we are fortunate to live long enough, eventually we all will be the "aged." What is it like to be old? We know that there are physiological changes that come with age. After age 70 there are problems with vision. There is sensitivity to glare and cataracts may develop. There is diminished acuity of hearing. The loss in pitch discrimination can lead to social isolation. Two-thirds of taste buds are lost by the age of 70. Of those over age 65, 80 to 85 percent have at least one chronic health problem. Among the noninstitutionalized persons over 85, 41 percent need assistance with going outside, walking, bathing, dressing, etc. In addition to physical health, there are economic losses as well as psychologicallosses. One's close friends and contemporaries die. Depression tends to be high in this population. Chronological age itself is not a good measure of aging. Instead of lumping them all together, it is important to individualize each person, keeping in mind two coordinates-the extent of physical impairment and the extent of mental impairment. A person may be low on physi-
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253
High
--------A I I I I I I I
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--------,.-----8 ,, ,
E
'-
I I
to 0-
e
I I
to
I
U
I I
--------~----~-------------------c
Low
High
Mental tmpalrment Figure 13-1. The Extent of Physical and Mental Impairment.
cal impairment and high on mental impairment. A person high on physical impairment may be low on mental impairment. Different art therapy techniques are required for each of these types of clients. Depending on the level of the client's impairment, three clusters of art therapy techniques can be used. These are the Free or Anything productions, the Assemblages, and Perceptual Stimulation.
Free Expression Free expression or "Anything pictures" work well with those clients who are low on mental impairment, although they may have various degrees of physical impairment. They may be recovering from an illness or may be suffering from a chronic health problem-a heart condition, diabetes, kidney failure, arthritis, poor eyesight, or diminished
ThePsychocybernetic Model ofArt Therapy
254
High
PERCEPTUAL STIMULATION
ASSEMBLAGES to
0-
S
ro
u
FREE EXPRESSION
Low
High Mental
Impairment
Figure 13-2. Three Clusters of Techniques for Late State Adulthood.
hearing. They are mentally alert, however, and are interested in people and events around them. They are in touch with reality, able to converse and sustain interest in an activity. The same exercises work as well with this group of adults in the late stages of adulthood as they do with younger adults who are minimally dysfunctional. Make clear that this type of art is different than what they may have done in school. It is not to find out how well they can draw but to stimulate their imagination. It is simply a different way of thinking and exchanging ideas (see Chapter 7 on Unfreezing). The emphasis should be on reminiscing. Art therapy activities serve the process of so-called life review (Butler, 1963). The therapist or the client can suggest the theme for the art product. Pictures about the different domains of the self-system work well (see Chapter 8). Clients usually enjoy drawing pictures about their favorite activities or things-"my favorite season of the year," or favorite place, favorite animal, or favorite food. The therapist can simulate reminiscing by asking for a picture or sculpture of a host of subjects, including "my family tree,"
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"my wedding" "my confirmation or bar mitzvah," or "the happiest experience in my life." When the relationship with the therapist is well established, suggest "my saddest memory," "the house/apartment I used to live in," "the place that felt most like home," or "the thing I miss most that I had to leave behind when I moved to the nursing home." Clients seem to enjoy drawing "something that makes me happy." Interestingly, this group of clients tend to portray not their children, but their grandchildren. The purpose of art activities at this stage of life is to review the good experiences and take pride in having endured. The art exercises can promote mourning that which is gone, to attempt reconciliation and forgiveness to one's self and others, and to say good-bye. Sessions may be conducted individually; or clients may work independently on their own project in a group setting; or they can work on a group project, perhaps something that portrays a specific concern common to many seniors. Depending on the level of the clients' physical impairment, it is best to keep the sessions relatively short, doing just one project in each session. Also, remember that with this age group, the warm-up period may extend over several sessions before the clients discover some project they can invest themselves in wholeheartedly. One elderly gentlemen, for instance, first dabbled with paints. Then, he attempted to build something out of wood chips until finally he produced a simple but eloquent picture of his family tree, with himself as the last leaf on the tree, "ready to falloff" (Nucho, 1987).
Assemblages Assemblages work well with clients in the late stages of life who have medium level of mental and physical impairment. Assemblages are designs made from shapes, cut-outs, or various objects, such as pieces of wood, stones, pine cones, leaves, flowers, sea shells, or beans. The therapist provides appropriate materials, helps the client select a theme for the work and the client then arranges the shapes or cutout pictures to tell a story. When complete, the client tells what he has produced. Inquire what special meaning it has for him and what memories it may bring back. If the work is done in a group, try to get reactions and comments from group members and then tie the various themes together.
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This lessens the emotional isolation, stimulates verbal communication and centers attention on the external world.
Perceptual Stimulation Clients with a high degree of mental impairment are confused, have a short attention span, and may have idiosyncratic perceptions of reality. This group includes clients with chronic brain syndrome and Alzheimer's disease. Use perceptual stimulation activities to engage brain cells and stimulate some verbalization. However minimal, verbalization provides some emotional sharing and reminiscing. The therapist must find and provide appropriate objects that can be explored in different sensory modalities. They can be touched, smelled, and seen, and may be from nature, like leaves, flowers, seashells, cones, stones, tree barks, wood chips, and various fruits. They can be an everyday object, like mittens in winter, a comb, a bar of soap, brushes, eyeglasses, or a coffee cup. Use various holiday symbols-pumpkins, Easter eggs, matzos, or various religious objects may be useful, such as bibles, candles, hamentashon, or yamalkas. Clients can paste objects on paper; other objects can be traced, and appropriate background may be drawn in. If possible, the client can sketch the object or color in a rough outline the therapist has made. Stimulate perception by asking the client to explore the object by touch, smell, sight, calling the attention to specific features of the objects. "Do you see this dark spot here?" or "Do you like this better than that...." When working with late stage of life clients, it is particularly important to individualize each one and assess the level of physical and mental impairment. Appropriate materials may have to be provided for those with poor eyesight, such as markers that have a specific smell for different colors. Also tactile media may be useful. A 94-year-old client who had been blind for the previous eight years used clay, which gave him the opportunity to review various life experiences (Nucho, 1982). Therapists must take into account the physical and sensory limitations of geriatric populations. Speak slowly and distinctly, and louder than you would in usual social situations. Be active, structured, and give information in small amounts at a time. State clearly what is to be done and repeat the information because the client may be disoriented
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and have short-term memory difficulties, and use simple, concrete words. Be generous with reassurance and recognize the client's efforts. Support and encourage, but take care not to infantalize him. An important principle is that the more impaired the client, the more structuring has to be provided. Tell the client what to do and how and keep choices to the minimum. Give him just one kind of paper and few colors and keep the session short. When starting to work with a new client who is approaching the final phase of life, guard against your personal discouragement by assessing the baseline. The therapist may rate several variables informally on a four-point scale-from low to high. For instance, the level of energy; extent of attention span; initiative; use of space; acceptance of own work (Likes it? Proud of it?); participation in discussions; interest in work of others. Keep reiterating that the purpose of the art therapy session is not to "perform," but to express and share some personally meaningful idea, recollection, or experience. And do not be discouraged, even if the ratings on the informal baseline show no progress. At this stage of life, just maintaining the current level of functioning can be regarded as an achievement. It is a downhill process at this age, and the best that can be hoped for is to slow it down, mentally and physically. Most art therapists work with the ailing aged in nursing homes or hospitals. In order not to get overwhelmed by the extent of pain and suffering, seek ways to work with some different types of client populations who could affirm the power of life and creativity. Working with children may serve this purpose. Also, it serves well to the therapist's own mental health to remember that besides the ailing elderly, there are the well aged who exhibit an impressive level of courage and creativity. Think of Grandma Moses who, having raised her many children and working on the farm, took up painting and became world-renowned (Biracree, 1989). Or remember Grandma Layton who suffered from depression for many years but was able to overcome her illness when she discovered drawing (Mobley, 1980). The resiliency of the human mind and the power of visual expression are miracles to be admired and gratefully celebrated.
Part Four
EFFECTIVENESS OF ART THERAPY AND A LOOK AHEAD
Chapter 14
CASE VIGNETTES ow effective is art therapy? How do we know that what we do with clients in art therapy does any good? Two types of evidence underscore art therapy's effectiveness. The first are case studies, and the second are empirical research studies. This chapter considers case studies. The next chapter will present an example of an empirical research study. Every art therapist has an array of case vignettes to show that a client is better off after some art therapy sessions than before. At times, only a few seemingly simple art therapy sessions bring about an astonishing improvement in severely dysfunctional clients. Some of those examples have been cited in previous chapters. For instance, a young black man deep in a drug-using habit was able to shed his addiction and remained abstinent for over a year. A drug-using young white woman was able to reestablish contact with her mother with whom she had had a very painful relationship. It took only a few sessions of the psychocybernetic model of art therapy. What is even more astounding are the rich diagnostic clues that the psychocybernetic model of art therapy provides to guide the therapeutic efforts. Even very elementary drawings reveal diagnostic clues hardly available in the usual verbal forms of therapy. The following series of case vignettes highlight specifically the scope and the therapeutic potential of the psychocybernetic model. Although the majority of clients in all forms of psychotherapy are women, the clients in the case examples chosen for this chapter are mostly males. The relative overrepresentation of men in the case examples was chosen to illustrate the usefulness of the psychocybernetic model with this kind of client who is often difficult to engage in therapy that presup-
H
261
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poses the sharing of one's feelings. In some instances, the therapist and client were of the same race; in other instances, the therapist and the client came from different racial backgrounds. These factors are noted in the case examples.
Yearning for the Family of Origin A sexually abused eight-year-old, black male foster child was asked by his white male therapist to draw a picture of his family. The child was not willing to do this but eventually consented to make a picture of a "happy family" (Figure 14-1). This turned out to be a picture of the social worker and his wife, with the client himself in the corner of the picture. It may be noted that the child has outstretched arms as if reaching to something on the left but outside the picture. One could speculate that the child might be reaching for his own parents who are not available and, literally, not in the picture for the child. In addition to inviting many speculations about the dynamics of the case, all of which would need to be substantiated or rejected as information is assembled, this picture provides a glimpse of the quality of the therapeutic relationship and the ability of the therapist to help this child. It is an eloquent testimonial to the effectiveness of the therapist. The child is starting to identify and draw strength from him, even though the child is well aware of his own racial identity as can be seen from the coloring he has added to his own face. This simple picture provides a wealth of information to the therapist to guide the helping process.
Keeping Up with the Grown-ups Difficulties in growing up are not confined to broken and lowincome families. Growing up in affluent families with two loving and caring parents can be difficult, too. Figure 14-2 depicts a picture drawn by a seven-year-old girl who was the youngest member in a family where both parents were professionals. Nevertheless, they managed to do many things together with their children. Despite all their best intentions, this youngster found that growing up in this family was difficult. Note how the child has portrayed herself as the last one in the line, try-
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Figure 14-1. A Happy Family.
ing to keep up with her energetic father, mother, and older siblings. She is about to falloff the cliff. Perceiving the world through the eyes of the child, as this picture permits, can alert the parents to the stresses the child is experiencing, even though the stresses may still be hidden under the excitement and joy of many rich experiences they are providing for her. The therapist in this instance was a white female, and so was the child.
Striving for a Reconciliation The picture shown in Figure 14-3 was drawn by the mother of a 15year-old, white male who was suspended from school for stealing and fighting. The boy's stepfather had left the family, but the mother ardently hoped for a reconciliation. The stepfather disliked the boy, and did not wish to have anything to do with him. The boy's acting-out impeded the mother's desire for reconciliation. Note that in the picture the mother has not only placed the boy behind the tree and on the
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Figure 14-2. Hiking.
other side of a car, but she also has her back turned towards him. All her attention appears to be directed to her husband. The intertwined fingers in the picture (Figure 14-3) eloquently express the mother's desire for a reconciliation with the boy's stepfather. No wonder the boy feels superfluous and unwanted. The picture alerted the therapist to the nature of the family dynamics long before the situation could be sized up through verbal discussion. The therapist in this instance was a white male.
Pregnant Teenager's Dilemma A 16-year-old, racially mixed, female adolescent whose mother was white and whose father was black, had been raised in a foster home since birth. Her mother feared raising her in a white neighborhood, and her father would have nothing to do with her. Her foster family was black and was in the process of adopting her just before the girl discovered that she was pregnant. When the picture shown in Figure 14-4
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265
Figure 14-3. A Picnic.
was drawn, the girl had not revealed her pregnancy to her foster family, nor had she mentioned it to her social worker, a black female who was making arrangements for the adoption. Noting the turmoil the girl was in, the social worker invited her to make a Free-Flow picture (see Chapter 8 for a description of this technique). The girl was told that she did not need to be an artist to do this kind of drawing. "When you finish, we will look at it and see what thoughts and feelings it conveys to you. You will have to explain it to me because it is your creation and only you know what it means." After making some free-flowing movements in the air while holding a pastel in her hand, the girl drew some lines on the paper. Next she was encouraged to use these lines to make a picture. When she had finished her picture, the therapist asked her to give a title to it. She called it "Fetus." She then said that the picture showed her growing baby. The dark area (drawn in blue) symbolized her stomach, she said, and the scribbly lines were her intestines. The eyes in the middle symbolized her baby who is looking at her and asking, "What are you going to do with me? Why do you hate me so much? Why do I make you so unhappy?"
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Figure 14-4. The Fetus.
The therapist encouraged the client to respond to her baby in the picture. She said that she felt guilty. She was also afraid that when her foster parents discovered that she was pregnant that they would abandon their plans to adopt her. Now the ice was broken and the client was able to discuss what to do about her situation. Later the same client made a self-portrait shown in Figure 14-5. She said that she left out the lower part of her body because she wished it were not there. She talked about her fat stomach and her sexual organs, and said that if she did not have them, she would not be in her present predicament. She said she omitted her arms and her hands because she could not make any decisions about her life and felt hopeless. Through the two pictures, the withdrawn teenager provided eloquent statements about the dilemma she was facing. The therapist could now proceed to deal with the themes of helplessness and self-rejection and assist the girl in working out ways to approach her foster parents. They also focused on the feelings that were surfacing as the client started to identify with her baby and with her own mother who had left her in the care of strangers.
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267
Figure 14-5. Despairing.
Stresses of Upward Mobility The next client was a 32-year-old black male who had a responsible and well-paying job but suffered from ulcers and was dissatisfied with
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his own work performance. He told his black female therapist that since his promotion at work he thought his coworkers were taking advantage of him and not working as hard as they had when someone else had been the foreman. He was now the boss himself, and no longer one of the boys. Two sessions were devoted to picture making, and the third session was entirely verbal. Work with this client concluded in the fourth session. He summed up his therapeutic experience in a collage which showed what he had achieved in treatment. In the first session, the therapist asked him to draw his name and add whatever else he wished in order to show some of his interests. Neatly executed, his name was surrounded by a wrench, a baseball, a football, and a bolt. As he explained his picture, he said, "I always have to fix something. I left the lower part blank because I do not like clutter." From the picture, one gets the feeling of the man and the orderliness of his life with its still undeveloped portions. The next picture was a free-flow, which he entitled, "Self-perception." It was a rainbow-like arrangement of various colors. He explained that the left side of the design represented his negative side, by which he meant his "picky, tense, angry, and moody feelings." He talked about the situations at work when he got angry but tried not to show his anger. He used purple color for the tension he felt when under pressure, which was most of the time. The color blue signified his mood at the end of a bad day at work. On the right side, he drew colors to suggest his warmth, cheerfulness, and "charm ... mostly with family and friends, not at work." Although not a masterpiece to be admired by others, the picture was most meaningful and precious to the client himself as he tried to sort out his various feelings and conflicts. The next session was devoted entirely to a verbal discussion of his struggles at work. The theme that emerged with the help of the drawings was his desire for perfection. He expected perfection of himself, and also of his subordinates. When they did not measure up to his expectations, he thought they were deliberately defying him. The collage that he produced during the fourth and the last session showed a person sitting in a relaxed position, with his shoes kicked off. The collage was supposed to show what the sessions had meant to him. He said that he had attained a different perception of his conflicts with his subordinates at work. He was able to accept his role as the boss, and was less upset by the imperfections of his coworkers. The anxiety he
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269
Figure 14-6. A House.
had experienced was subsiding, and his ulcers seemed to be less bothersome.
The Last Leaf The last client in this series of vignettes was a 78-year-old white male who had lost a leg to diabetes. His experience with art therapy were already alluded to in the previous chapter in connection with the discussion of Late Adulthood. Figure 14-6 shows his first picture, which he described as a house. His next picture, made shortly before Easter, looked like a somewhat truncated Easter egg, but on some deeper level, perhaps it symbolized the stump of his amputated leg. After a number of seemingly unfinished pictures and some work with wood chips, he finally produced what he named "The Tree" (Figure 14-8). He explained this picture as showing his family tree. Each leaf designated one important member of his family, either on his
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Figure 14-7. An Easter Egg.
Figure 14-8. The Tree.
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271
mother's side of the family on the left, or on his father's side of the family on the right. When asked about the most prominent leaf, he replied, "That is me, the last member of the family, ready to falloff." What is noteworthy here is that the warm-up period extended over a number of weeks and only after several seemingly futile attempts did the client manage to produce a picture that was not only deeply meaningful to himself but was capable of communicating his feelings to an onlooker. If the therapist can tolerate seemingly unproductive sessions, the client eventually succeeds in conveying his ideas more clearly, not only to himself, but to his therapist as well. In the next chapter we turn to a consideration of a controlled empirical research study done with highly depressed elderly nursing home residents, using the psychocybernetic model of art therapy.
Chapter 15
AN EMPIRICAL OUTCOME STUDY Research Design
T
h e effectiveness of the psychocybernetic model of intervention was examined in a study conducted at a nursing home with highly depressed residents (Lindenmuth, 1981). The random sample consisted of 298 subjects ranging in age from 65 to 98. The residents were assigned to one of six different modalities of intervention: verbal group psychotherapy, music therapy, exercise therapy, chemotherapy, art therapy, and a control group. The art therapy groups were conducted according to the psychocybernetic principles outlined in this book. The residents assigned to the control group received the same pre and posttreatment testing but no other intervention besides the usual activities available to nursing home residents, such as eating in a common dining room, participating in church services, and visiting with family and friends. Each modality of intervention lasted for eight weeks and consisted of five weekly sessions, each 45 minutes long. All of the residents of the nursing home were given the Zung Depression Test (Zung, 1965) four weeks after admission to the facility. The administration of the test was purposefully delayed because previous pilot studies showed that most residents suffer a reactive-type depression immediately after admission and that the adjustment period lasted two to three weeks on the average. Those residents who scored high on depression (a score of 50 or above on the Zung scale) were selected for the study. The purpose and the procedures of the study were explained to the residents and their families, and signed release forms were obtained prior to the study.
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273
Ten subjects were randomly assigned to each treatment group for an eight-week period of therapy. None of the participants received any antidepressants or phenothiazines for the duration of the study, except, of course, those residents assigned to the chemotherapy group who received antidepression medication as prescribed by their own physicians. They received no other form of therapy for the eight weeks except for the activities of daily living, church services, visits with family and friends, and eating in the dining room. The verbal group psychotherapy consisted of general discussion of common concerns. It provided the opportunity to share personal observations and reactions to current and past experiences. It was conducted according to the psychodynamic principles, and it was thought to offer the opportunity to universalize the features of the depressive syndrome and thus free ego energies (Deutch & Kramer, 1977). The music therapy offered the opportunity to listen to songs played on a stereo type equipment, especially songs of the 1920s and the 1930s. On some occasions, the selections were chosen by the therapist and on others, by the members of the group. The music stimulated the sharing of painful as well as joyful memories (Palmer, 1977). The participants in this group were encouraged to sing along, tap their feet, clap their hands, or to do whatever else seemed appropriate to express their reactions to the music. The exercise therapy group provided simple physical exercises and some freewheeling discussion during and after the group sessions (DeVries, 1976). The exercises consisted of simple stretching and bending, passing medicine balls, throwing the balls, and some light weight lifting. The exercises were selected with the help of a physical therapist, and the level of their difficulty was appropriate for persons with various physical limitations. The art therapy group was conducted according to psychocybernetic principles. The sessions were rather unstructured in that each participant decided what art materials to use and what topic to portray. If a person had difficulty deciding what to do, some mild encouragement was offered. The therapist in all the groups was the same person, a white male who had a MSW degree and had received instruction in the psychocybernetic model of art therapy. The instruction lasted for one semester (15 weeks) and it was provided on an individual tutorial basis by the author.
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The dropout rate in this study was a relatively low 4 percent: seven residents died, and five dropped out due to early discharge. The mean age for the entire sample was 82. Of the 298 persons in the sample, 236 were women, 62 were men. The large proportion of women in the sample is due to the higher longevity rates for women and the disproportionate number of women in nursing homes. In our society, by and large, wives tend to take care of their husbands at home, and after the husbands die usually there is no one to care for the widows at home, and so eventually they end up in nursing homes. The annual report of the nursing home used for this study showed that 74 percent of the occupants that year were women. Of the 236 women in this sample, eleven were black, two were Spanish-American. Of the 62 men, six were black, three Spanish-American. The low percentage of minorities does not reflect any discrimination but is the result of the low percentage of minorities living in the particular county where the study was done. Each modality of treatment was offered five times to obtain the necessary sample size. Each participant was rotated through each treatment modality and their depression levels were tested before and after participation in each group.
Findings The mean depression scores of the elderly nursing home residents before and after the art, music, and exercise therapies for each treatment cycle are summarized in Table 15-1. In examining the data, it can be noted that the means of the three groups of participants prior to treatment are roughly the same. The mean scores are also about the same after receiving the eight weeks of art therapy, music therapy, or exercise therapy. Of particular interest is the fact that in all three groups the depression scores are considerably lower after treatment than they were prior to treatment. The differences between the depression scores before and after treatment in each of these three treatment groups are substantial and statistically significant (p < .001) when examined by one way analysis of variance test (Lindenmuth, 1981). Table 15-2 contains the mean depression scores of the nursing home residents before and after treatment with verbal group psychotherapy, chemotherapy, and the scores of the control group which received no specific therapy.
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Table 15-1 MEAN DEPRESSION SCORES OF NURSING HOME RESIDENTS BEFORE AND AFTER TREATMENT WITH EXPRESSIVE THERAPIES, BY TREATMENT CYCLE
ART
MUSIC
EXERCISE
Cycle
Before
After
Before
After
Before
After
1. 2 3. 4. 5.
68.9 71.5 71.9 73.2 72.7
55.3 50.7 48.7 54.7 52.9
70.6 71.5 72.0 71.0 69.1
52.1 53.3 51.4 51.6 51.9
73.8 69.5 68.3 68.3 67.9
51.2 48.8 48.5 49.7 50.6
X=
71.6
52.56*
70.8
52.1*
69.6
49.8*
*Significant at the p < .001, Analysis of Variance Test.
Table 15-2 MEAN DEPRESSION SCORES OF NURSING HOME RESIDENTS BEFORE AND AFTER TREATMENT WITH VERBAL PSYCHOTHERAPY, CHEMOTHERAPY AND NO TREATMENT, BY TREATMENT CYCLE
VERBAL PSYCHOTHERAPY
CHEMOTHERAPY
CONTROL
Cycle
Before
After
Before
After
Before
After
1. 2. 3. 4. 5.
68.5 68.2 69.0 68.3 68.2
62.8 61.2 61.8 59.2 62.2
68.4 67.4 68.0 69.0 68.7
59.9 61.9 58.6 59.4 59.6
67.7 65.7 68.6 68.6 68.3
64.5 66.8 65.4 65.5 65.6
X=
68.4
61.44
68.3
59.9*
68.2
65.5
* Significant at the p < .05 level, the Sheffe's Test.
The data presented in Table 15-2 show that the depression scores remained virtually unchanged in groups which received verbal group psychotherapy. The depression scores of the residents assigned to the control group also remained unchanged. The residents receiving chemotherapy did achieve a lessening of their depression scores, but the decrease in depression is smaller than the decrease of depression in the groups which received art, music, and exercise therapy. The difference between the before and after treatment scores of depression in the chemotherapy group is statistically significant at the .05 level. The difference between the before and after depression scores attained by the three groups which received art, music, and exercise therapy, on the other hand, was statistically significant at the .001 level.
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Table 15-3 MEAN DEPRESSION SCORE DIFFERENCES OF NURSING HOME RESIDENTS BEFORE AND AFTER TREATMENT IN ALL GROUPS
CYCLE 1. 2. 3. 4. 5.
x=
ART
MUSIC
EXERCISE
13.6 20.72 23.20 18.50 19.80
18.6 18.27 20.60 19.42 17.20
22.6 20.73 19.80 18.64 17.30
19.16**
18.80**
19.81**
VERBAL
CHEMO
CONTROL
5.70 7.83 7.20 9.10 6.0
8.50 5.50 9.40 9.57 8.42
3.27 -.90 3.40 3.18 2.69
7.16
8.42*
3.33
*Significant p. < .05 **Significant p. < .001
Table 15-3 presents the mean depression score differences before and after treatment in all six groups. Table 15-4 presents the results of the one way analysis of variance and contrasts within the groups. The results of this empirical study show that the psychocybernetic model of art therapy, music therapy, and exercise therapy reduce depression in elderly nursing home residents more effectively than does chemotherapy which is the usual modality of treatment in most nursing homes. Not only do the three expressive art therapies reduce depression more effectively than chemotherapy but the expressive therapies do not produce the negative side effects that are often associated with chemotherapy. It also should be noted that verbal group psychotherapy in this study did not prove any more effective than did the control group condition. In both the verbal psychotherapy groups and the control groups the depressions scores changed very little in eight weeks, and these minimal changes in the depression scores were not statistically significant, as shown in Table 15-3. The results of this carefully designed and controlled empirical study offer a strong endorsement for all the expressive therapies used in this study. The excellent results obtained not only with the psychocybernetic model of art therapy and with music therapy but also with the simple exercise therapy were somewhat unexpected but considering the fact that the nursing home residents are primarily concerned with the various aspects of the physical functioning of their bodies, are not surprising. The simple physical exercises may have improved the
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Table 15-4 ANALYSIS OF VARIANCE OF MEAN DIFFERENCES BEFORE AND AFTER TREATMENT SOURCE OF VARIATION
Between Groups Within Groups
SS
DF
v: EST.
F
1430.17 105.78
5 24
286.03 4.41
64.89
1535.95
29
F(5.24) = 2.62 = .05 3.90 = .01 Fobt = 64.89 P < .001
blood circulation and increased the oxygen consumption, and thus this easily provided form of therapy may have increased the sense of well being of these elderly nursing home residents. More research is needed to determine whether or not similar results can be obtained with exercise therapy in other age groups of participants. This empirical research study attests to the effectiveness of the psychocybernetic model of art therapy. More well-designed and controlled studies are needed, but it is clear that art therapy based on the psychocybernetic principles is a therapy that works. This form of intervention can be mastered relatively easily by clinicians, and it produces excellent results in a relatively short period of time. This model has the advantage over several other forms of art therapy in that it does not just fill the empty hours, but it stimulates thinking and sharing of one's concerns and experiences. Thus, it is not perceived as being childish and demeaning by adults who have no particular interest in the arts and who have no previous exposure to or training in the use of art materials.
Chapter 16
LOOKING AHEAD n some respects, the psychocybernetic model of art therapy is like a bicycle. You can get so much further and faster on a bicycle than on foot. But the bicycle is not self-propelling. It does not roll forward on its own. You have to supply the energy. You have to pedal to get it moving. The same is true with the psychocybernetic model of intervention. The energy that propels this modality of interpersonal helping comes from two sources. One source is the professional training and experience that equip the therapist with relationship-building skills, perceptivity, and understanding of human behavior in all its ramifications, its needs, yearnings, and aspirations, and with knowledge of what happens when these are thwarted. The other source that provides the driving power for the psychocybernetic model is the combination and utilization of the two systems of symbolization discussed in previous chapters. This model not only engages words and the sequential, rational thought processes, but also uses the presentational symbolism and the holistic, intuitive, preverbal cognitive styles.
I
Desirability and Feasibility of Research Within the American Art Therapy Association there is a lively debate concerning the desirability of conducting empirical research studies about the effectiveness of art therapy (Allen, 1995; Gantt, 1998; Junge & Linesch, 1993; Kaplan, 1998; Malchiodi, 1998; McNiff, 1998; Rosal, 1998). There are those who are convinced about the power of the right brain form of thought and they dismiss empirical research as being too pedestrian, one-sided, and inadequate to capture the power of visual expression. In contrast, others point out that unless art thera278
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pists can offer empirical research evidence concerning the effectives of art therapy, the very existence of the discipline is dismal because it will not be able to gain funding for its activities. Once the necessity to communicate with other disciplines and the funding source has been granted, then the question arises about the feasibility of research. Doing research is a costly undertaking, both in time and money. Moreover, it requires skills most art therapists do not have. There is hardly time in the two-year art therapy graduate program to equip art therapists with the basic clinical skills, not to mention research skills. So what is an art therapist to do?
Life-Long Learning Art therapists need to consider themselves as being professionals. To be a professional is to be a life-long learner. To be a professional is to be in training for the remainder of one's life, even after one has finished the two-year graduate program. This involves continuing education courses, whether or not those are part of licensing requirements. Art therapists need to continue to sharpen their clinical skills, and they must acquire some rudimentary skills in research. There they might team up with colleagues from other disciplines, like psychologists and social workers, some of whom may have received more adequate research instruction in the course of their professional training. Undoubtedly, some professionals are more clinically oriented, while others may lean toward empirical research. But to be a professional, nevertheless, is like wearing bifocals. You must be able to do both. You must be a therapist, and you must be able to examine critically the results of your practice. Every beginning is anxiety provoking. One young therapist portrayed her view of a new beginning as a jump off a cliff. You do not know what is below and you wonder if you will land on your feet. No amount of case vignettes and empirical studies will suffice until one takes the plunge and finds out for one's self if the psychocybernetic model as described in this book is worth the effort. It is a new venture, and it takes courage to begin to use a new treatment modality. But once you experience what happens to you and how much faster you can get your clients to go where you think they should be going, you will never again want to be without this new form of helping.
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Figure 16-1. A Beginning.
The story is told of a Texan who visited New York and sawall the sights of the Big Apple. When he was about to return to Texas, he realized that he had not been to Carnegie Hall. He was not particularly interested in music, but he figured that he might as well see everything there was to see before returning home. He got on the subway to go to Carnegie Hall. Stations came and went; still there was no Carnegie Hall. He got off the subway and went up to the street and on a corner he saw an old lady. He asked politely, "Madam, can you tell me how do I get to Carnegie Hall?" The woman looked at the Texan and with a twinkle in her eye replied, "Son, that is simple enough. You just keep on practicing, and eventually you might get to Carnegie Hall." The same is true with this new modality of helping you have read about in this book. The secret of success is practice. Start doing it and see how this vehicle of therapy works for you and your clients. If you are working with children, chances are that you already are using picture making in some form to help your young clients feel more at ease with you. Picture making is a vital if neglected form of cognition adults can use too, based on the differential functioning of the
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two cerebral hemispheres. The paradigmatic change that is affecting all sciences forecasts that this previously neglected form of cognition will not remain neglected for much longer. It is quite likely that increasingly therapists will strive to be experts not only in the verbal and gestural forms of communication, but also in the visually expressive modalities. Growth never ends. Take the next step.
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AUTHOR INDEX A Achterberg,]., 49 Adler, G., 53 Agell, G.L., 76 Ahsen, A., 33-34, 39, 49 Allen, D., 278 Allport, G.W., 22 Ampere, A.M., 15 Anderson, F., 76 Anderson, F.E., 70-71 Andrews, L.M., 17 Angyal, A., 181 Arieti, S., 6 Axline, Virginia, 204
B Backos, A.K., 234 Barlow, G., 76 Battista,].R., 6 Beck, R.H., 61 Bernard, Claude, 15 Bertalanffy, L. von, 21, 23 Betensky, M., 76, 91, 125, 156 Betensky, Mala, 158, 205 Biracree, T., 257 Bolander, K., 216 Brill, A.A., 60 Brunner,].S., 33 Bugenthal, 95 Burns, R.C., 128-130 Buttler, R.N., 100, 155, 254
c Cane, F., 117, 123 Cannon, W.B., 16
Chaiklin, S., 49 Chang, 137 Church, R.P., 199 Churchill, Winston, 50 Corsini, R., 5 Cremin, L.A., 61 Croce, Benedetto, 35, 93-94 Crowl, M., 232, 233
D Dante, 52 De Lima, A., 61 Dechert, C., 15, 17 Detre, K.C., 61, 62, 64, 65 Deutch, C., 273 DeVries, H., 273 Dewdney, 160 DiMaria, A.E., 146-148 Doll, A., 100, 150 Dunn-Snow, Peggy, 229 E Einstein, Albert, 37 Elin, N., 130 Eliot, C.E., 25 Englehorn, P., 88 Erikson, E., 221, 239 Everly, G., 18
F Fagan,]., 90 Faherty, S.L., 234 Ford, 137 Foster, D., 17 Foy, D.W., 233
293
ThePsychocybernetic Model ofArt Therapy
294
Freedman, A.M., 60 Freud, S., 43-44, 53, 78, 79
johnson, K., 18, 25, 49 jung, Carl, 53-56, 78, 84, 85, 157 junge, M.B., 278
G K
Gantt, L., 278 Gardner, H., 7, 202, 205 Gazzaniga, 29 Gelber, B.L., 58 Genest, M., 26 Ginott, H., 225 Girdano, D., 18 Glass, C.R., 26 Glasser, W., 225-226 Goethe, W., 50 Gombrich, E.H., 52 Goodman, N., 32-33 Gordon, R., 26 Gorey, K.M., 233 Green, A.M., 18 Green, E.E., 18
H Hall, C.S., 77 Hall, D.C., 28 Hammer, E.F., 126, 128 Heidegger, Martin, 137 Hensely, 199 Hepworth, D.H., 101 Hill, Adrian, 56-59 Holt, R., 13, 49 Horowitz, MJ., 6, 26, 28, 33, 104, 134, 247 Husserl, Edmund, 90 I
Inhelder, B., 27
J jacobi,j., 78,85,86, 137, 171 james, William, 29, 31, 36-37, 43, 46-47, 48, 93, 137 jasper, H., 21 jaynes,j., 30-31, 38 jeans, james, 17 johnson, A., 61
Kagin, S., 105, 149 Kalff, Dora, 87, 88 Kalins, M., 17 Kaplan, F.F., 278 Kaufman, S., 128-130 Kelen, E., 122 Kellogg, R., 199 Kelly, G.A., 42 Kismiss, 237 Kolers, P.A., 32 Korn, E.R., 18, 25, 49 Kramer, E., 73, 74, 76, 78, 81 Kramer, N., 273 Kramer, S., 74, 78, 82, 104 Kuhn, Thomas S., 5 Kwiatkowska, H.Y., 11,65, 76, 117, 125, 130, 131 L
Lachman-Chapin, M., 78 Landgarten, H., 70-71 Landgarten, H.B., 78, 132, 178, 182, 187, 206,227,232,249 Langer, Susan, 30,33,35-36,44-45,80, 112 Larsen,j.A., 101 Lawlis, G.F., 49 Lazarus, A., 49 Ledray, 234 Lerner, A., 49 Levick, M.F., 78 Lewis, N.B.C., 63-64 Liddel,94 Lindenmuth, F.A., 272, 274 Lindzey, G., 77 Linesch, D., 278 Linesch, D.G., 231 Lowenfeld, M., 87 Lowenfeld, V., 29, 58-59, 111 Lusebrink, V., 105, 149 Lyddiatt, E.M., 84, 85-86, 87, 120, 156
AuthorIndex M Machover, K., 128 Madigan, S., 233 Malchiodi, C.A., 208, 212, 278 Maltz, Maxwell, 20-21 Marks, D.F., 46 Maslow, A., 21, 94, 96, 98, 102, 114, 153 Matsakis, A., 235 May, R., 78 McNiff, S., 76, 278 Merluzzi, T.V., 26 Mobley,j., 257 Moriarty,j., 150, 247, 248 Motto, H.C., 232, 233 Muller, 52 N
Naumburg, M., 62, 63, 64, 65, 75, 78, 79, 82, 83-84, 102, 156 Neisser, D., 40 Norman, D.S., 39 Nucho, A.a., 9, 19, 41, 60, 64, 87, 91, 100, 128,130,150,158,179,236,237,249, 251-252,255,256
o Osborn, F, 37 p
Pagon, B.E., 234 Paivo, A., 33 Palmer, M., 273 Pascal, 48 Pasto, Termo, 102 Pelletier, K.R., 17-18 Penfield, W., 21 Perls, F., 78, 89-90 Perry,j.W., 88 Piaget,j., 26-27,40,42-43, 137 Piotrowski, Z.A., 11 Plato, 15, 51 Potocek, 237 Powell, L., 234 Prinzhorn, H., 52 Puryear, D.A., 179, 182
Q Qualls, PJ., 40 R Reich, Wilhelm, 89 Reik, Theodor, 90 Rhinehart, L., 88 Rhyne,j., 58, 90, 117 Richardson, A., 28 Ritcher, N.L., 233 Robbins, 78 Robinson, D.N., 28, 41 Rodriguez, N., 233 Rogers, C., 91 Rogers, Will, 91 Root, M.P.P., 232 Rosal, M.L., 278 Rosenfeld, P., 59, 61 Roussear,jeanjacques, 52 Rubin,j.A.,78 Russell, Betrand, 61 Ryan, S.W., 233
s Salomon, K., 28 Sayre, K.M., 15, 17,23 Schachtel, E.G., 52 Scott, 94 Sebeok, T., 174 Sheikh, A.A., 15 Shepherd, I.L., 90 Shneidman, 232 Shulman, L., 179 Silver, Rawley, 229 Simonton, O.C., 23, 49 Singer,j.L., 6, 26 Smitheman-Brown. V., 199 Snider, E., 233 Sperry, Roger, 37 Spitz, R.A., 174 Strobel, C.F., 20 T
Tart, C.T., 45 Thale, T., 28
295
296
ThePsychocybernetic Model ofArt Therapy
Titchener, E.B., 47 Toffler, A., 174 Tyson, F., 49
u Ulman, E., 7 Urban, 137
v Van der Hart, 0., 234 Van der Kolk, B.A., 234 Vaude Kemp, H., 233
w Wadeson, H., 76, 78, 131 Walters, E.D., 18
Watson,John B., 26 Weiner, Norbert, 15-16 Weinribb, E.L., 88 Weisman, A.D., 77 Westcott, G., 28 Wiener, Norbert, 12,21 Wilder, 237 Winnicott, D.W., 124,207 Winter, B., 24 Wolpe,J.,26
z Zung, W.W., 2721
SUBJECT INDEX A
American Art Therapy Association, 68, 69-70,76,103,278
abstract family portrait, 131 abstract self-portrait, 139 acceptance, 225 accommodation, 42-43 achievement domain, 138, 139, 210, 227, 147
fig· "Achieving" picture, 139, 143 fig. activeima~nation,55-56,84,86
activities therapy, 76, 151 addiction, 235 "The Adolescent" picture, 222, 223 fig. adolescents characteristics of, 221-222 chemically-dependent, 235-237 eating disorders in, 232-233 helping strategies, 223-226 sexually-abused, 233-235 specific techniques, 226-230 suicidal, 231-232 adults chemically-dependent, 242 late adulthood, 252-257 minimally dysfunctional, 239, 240-241 moderately dysfunctional, 239, 241-245 severely dysfunctional, 240, 245-252 stresses for, 239 YAVIS-type clients, 240-241 affective messages, 162 aggressive clients, 106 aggressive drives, 78-79, 81-82 Ahsen's Triple Code Model of Imagery, 33-34,35 Ahsen's view of imagery, 34-35 alcohol dependency. see chemically-dependent ambidexterity, 40
AmericanJournal ofArt Therapy, 69 Amid These Storms, 50 amplification, 171 amplification of dream content, 171-172 ancient Greeks, 51-53 anger, 224-225, 233 anima, 85 animal instincts, 85 animus, 85 anorexia nervosa, 232-233 anxiety, 89, 174 "anything" picture. see "free" picture Appel, Kenneth, 66 apprehensions, 111-114 about growing old, 252 approval, 225 archetypal forms, 170-171 archetypal material, 85 archetype, 85,86-87,159 Arctic hysteria, 60 "The Arm, Fist, and the Bully" picture, 216
fig· arm with a fist technique, 213 art beneficial powers of, 52 and emotional problems, 62 graphic. see graphic art healing power of, 52 and religion, 52 art as therapy, 14, 51
Art As Therapy, 74 art background, 101-102 art dialogue technique, 249-252 art education, 58-59 "art education therapy," 58-59 art expression. see visual expression
297
298
ThePsychocybernetic Model ofArt Therapy
art materials, 104-107, 149, 246, 248, 256 art psychotherapy, 14, 74 art therapists certification of, 70 during doing phase, 151-153 function of, 94-95 Jungian, 86-87 psychoanalytically-oriented, 79,82-83 psycho cybernetically-oriented, 158 psychodynamically-oriented, 156,204 qualifications of, 101-102 reassurance from, 78, 116, 119 reassurance from, 134 training of, 65, 68, 278 art therapy for adolescents. see adolescents for adults. see adults vs.arteducation,58-59 art wing type. see art wing of art therapy arts and crafts type. see arts and crafts of art therapy benefits of, 81-82 for children. see children definition of, 12-15, 19 dynamically-oriented, 65 and imagery, 18 method of active imagination, 55-56 origin of, 7 research study, 273, 274-277 and schizophrenic patients, 66 surveys concerning, 70-71 varieties of, 77 fig. vs. verbal therapy, 183 wing art type. see art wing of art therapy Art Therapy in a Children's Community, 74 art therapy pictures "Achieving," 143 fig. "The Adolescent," 223 fig. "The Arm, Fist, and the Bully," 216 fig. "A Begging Dog," 141 fig. "A Beginning," 280 fig. "Beginning of a Rainbow," 133 fig. "The Black Anchor," 187 fig. "A Boat, Water, Shark, and a Log Truck," 189 fig. "Boy Lee," 191 fig. "Carefree," 165 fig. "The Cat," 80 fig. "The Champion and the Loser," 145 fig.
"Climbing a Tree," 190 fig. "The Dancer," 144 fig. "Despairing," 267 fig. "The Duckling," 142 fig. "An Easter Egg," 270 fig. "Endurance," 163 fig. "The Fetus," 266 fig. "A Happy Family," 263 fig. "A Heart," 213 fig. "Hiking," 264 fig. "A House," 269 fig. "A Hug," 217 fig. "AJob Interview," 144 fig. "The Lamb," 143 fig. Mandala, 167 fig. "A Mother and a Son," 142 fig. Naomi's Free-flow, 125 fig. "The Odd Man Out," 115 fig. "The Outside Picture," 169 fig. "A Picnic," 265 fig. "The Race Car," 145 fig. "The Raindrop and the Killings," 215 fig. "Resistance," 115 fig. "A Sad Puppy," 166 fig. "The Sphinx," 127 fig. "Teardrop with Rain and Lightning," 214
fig· "The Tree," 270 fig. "The Turtle," 127 fig. "A Warm Place," 185 fig. a Wartegg, 129 fig; 130 fig. Art Therapy: Still Growing, 146-148 art training. see training Art versus Illness: A Story ofArt Therapy, 56 art wing of art therapy, 73-74, 76, 78,88,97, 107, 156 art works, use of, 249-252 "The Artist in the Olive Grove," 251 artistic expressions, 62 artists, 50, 52, 56-59, 118 TheArtistsin Each of Us, 65 arts and crafts of art therapy, 75-77 assemblages, 149-151, 254 fig, 255-256 assessment of change, 188 of depression, 229 diagnostic, 128-132 Draw-a-person test, 128 family, 125
Subject Index of family dynamics, 130-131 House-Tree- Person Drawing test, 128 Kinetic Family Drawing procedure. see Kinetic Family Drawings Kwiatkowska procedures, 131-132 personality, 126 assimilation, 18-19, 42-43 athletics, 51 Attention Deficit Disorder with H yperactivity. see hyperactive children auxiliary ego, 224 avatras, 25 avoidance behaviors, 180, 194
B balance, 52 "A Begging Dog" picture, 139, 141 fig., 142
fig· "Beginning of a Rainbow" picture, 132, 133
fig· "A Beginning" picture, 280 fig. behavior, 82, 91 behavior modification, 26, 205 behavioral change. see changes behaviorists, 137 best dream, 242 Betensky, Mala, 91 biofeedback, 17-18 biological theories, 21 "The Black Anchor" picture, 186, 187 fig. "A Boat, Water, Shark, and a Log Truck" picture, 188, 189 fig. body domain, 137, 228, 146 fig. body self, 208 body tracing, 207-208, 233 "Boy Lee" picture, 189, 191 fig. brain capacity, 93 brain, hemispheres of. see cerebral hemispheres Brill, Abraham, 60-61 brushes, 105 bulimia, 232-233
Bulletin ofArt Therapy, 69
c calling attention to choice points, 224 Cane, Florence, 63, 64-65
299
Cane, Melville, 64 "Carefree" picture, 163-164, 165 fig. case studies 15-year-old male, 263-264 16-year-old female, 264-266 32-year-old male, 267-269 7-year-old female, 262-263 78-year-old male, 269-271 8-year-old foster child, 262 keeping up with the grown-ups, 262-263 the last leaf, 269-271 pregnant teenager's dilemma, 264-266 stresses of upward mobility, 267-269 striving for a reconciliation, 263-264 yearning for the family of origin, 262 case vignettes. see case studies Cassatt, Mary, 251 "The Cat" picture, 86, 95, 80 fig. categorization, 41 catharsis, 82 censor, 44 central concerns, 140, 148 cerebral hemispheres. see also left cerebral hemisphere; right cerebral hemisphere and codification, 41 differences in, 37-40, 39 fig. and information processing, 15 nondominant, 157 preferences of therapists, 81 and types of cognition, 35 use of both, 159-160, 193 cerebral ambidexterity, 40 "The Champion and the Loser" picture, 140, 145 fig. changes assessment, 188 behavioral, 173, 183, 205-206 extent of, 181-182, 188 identity of, 182 in moods and attitudes, 183 chemically-dependent adolescents, 235-237 chemically-dependent adults, 242, 245 chemotherapy, 274-276
The Childand the World, 61 Child Guidance Model, 201 children direct treatment, 201-202 hyperactive, 199 indirect treatment, 200-201
300
ThePsychocybernetic Model ofArt Therapy
inner city, 229 responsive communication, 215-220 role of art therapists, 205-206 sexually-abused, 214 specific techniques, see therapy techniques for children therapeutic styles. see therapeutic styles thought processes, 220 choice points, 224 Churchill, Winston, 50-51 circular drawings. see mandala drawings clarity, 173 classification, process of, 41 clay, 105-106 client apprehension. see apprehensions client preparation, 114-116 client's initials. see initials drawing "Climbing a Tree" picture, 188-189, 190 fig. closed system, 22-23 closure, 148-149, 163-166,251 codification in the dialoguing phase, 160-161, 171 explanation of, 47 process of, 40-47, 46 fig. and processing information, 80, 192-193 system of, 35, 45, 48 cognition definition of, 40-41 and images, 25-26,47,48 and information processing, 23 and perception, 27-28 styles of, 37-40,49 and systems, 34-35,45-47 types of, 35-37 cognitive theory, 7,26,40 collages, 150,230-231,247-249 collective unconscious. see unconscious colors, 244 Commission on Mental Illness, 66 communication verbal. see verbal expression visual. see visual expression complex references, 32 computers, 26 concept, 42 concept forming activity, 94 concretization, 31 connotative meanings, 27 consciousness, 23, 85
consequences, 226 consolidation, 163-166 construct, 42 constructive arguing, 224 consultation, 103 continuing education, 279-281 contracting phase, 178-179
Contributions toAnalytical Psychology, 53 control group, 274-275 corporeity, 31 creativity cultivation of, 61 and hemispheric asymmetry, 39 primary and secondary, 94, 96-97, 98,
102, 114, 153-154, 100 fig. process of, 119 stimulation of, 229 credentialing process, 103-104 crisis of intimacy vs. isolation, 239 cryptograms, 55, 157-158 curriculum, 61-62 cybernetics, 6, 12, 15-18,24,26
D Da Vinci, Leonardo, 122-123 "The Dancer" picture, 139, 144 fig. daydreams, 28 decoding the messages, 157, 160-162 deductive meaning, 63 defensiveness, 112-113 demonstration, 118-119 denial, 78 denotative meanings, 27 denotative symbols, 32 depressed clients, 106 depression, 90, 229, 272 designs, 150 desires, 81-82 "Despairing" picture, 266, 267 fig. determination, 173 diagnostic assessment, 128-132 "The Dialoguing Phase," 168 fig. dialoguing phase with adolescents, 228 with children, 215-220 closure and consolidation, 163-166 decoding the messages, 160-162 dispositional understanding, 171-173
Subject Index distancing, 159-160 explanation of, 98 facilitative understanding, 171-173 format and length, 166-171 in groups, 174-175 meanings of products, 150 nomomatic vs. ipsomatic approach,
157-159 process of amplification, 171 salience and timing, 175-176 search for inner design, 173-174 DiMaria, A.E., 146-148 direct treatment, 201-202 discursive lexical, 45 discursive modality, 35-36 discursive symbols, 44, 45 discursive thought, 80 displacement, 78 dispositional understanding, 171-173, 176 distancing, 159-160 distillation of meanings, 162 distress, 232 doing phase, 121 explanation of, 98 free expression, assemblages, and perceptual stimulation, 149-151 free-flow technique, 122-126 interactional drawing technique, 134 length of, 153-156 peripheral vs. central concerns, 140, 148 principles of timing, gradualness, and spotlighting, 136-140 rapport building, self-sharing, and closure,
148-149 self-system, 136-140 structuring, 121-122 themes from client concerns, 132-134 therapist's role during, 151-153 domain of the mind, 208 doodling techniques, 58 "The Dragon," 211 fig. dragon technique, 211-212 drama therapy, 62 draw a bridge, 242 draw a mask. see mask making Draw-a-person test, 128 Draw-a-Story Stimulus Cards, 230 fig. draw-a-story technique, 229-230 draw a wall, 242
301
dream imagery, 172 dreams, 28, 63, 79, 84, 171-172,244 dropout. see therapy dropout drug dependency. see chemically-dependent duality of knowledge, 93-94 "The Duckling" picture, 139, 142 fig.
Dynamically Oriented Art Therapy: Its Principles and Practices, 65 dysfunctional adults. see adults E "An Easter Egg" picture, 269, 270 fig. eating disorders, 232-233 education art, 58-59 continuing, 279-281 progressive. see progressive education and psychoanalysis, 61 reality, 226 ego, 85, 122,206,208,224
The Ego and theId, 79 ego psychology, 83 ego support, 247 eidetic images, 28 Eisenhower, Dwight D., 51 elderly people, 229, 256-257 emotional problems, 62, 64, 122 emotions, 36, 89,202-204 encoding, 44, 45, 48 ending phase explanation of, 98 integration, 192-193, 195 length of, 188 ratification, 178-179, 194 resistance to termination, 179-182, 194 resolution, 185-192, 194 review, 182-185, 194 "Endurance" picture, 162, 163 fig. energy, 23-24 engagement process, 118-120 enrichment, 84 Eros. see sexual drives Eskimos, 60 executing phase. see doing phase exemplification, 32 exercise therapy, 273, 274-277 existential-phenomenological approach,
78
ThePsychocybernetic Model ofArt Therapy
302
existential stream of ideas, 95 existential therapies, 88 expression in images, 79 expression of emotions, 36 expressions, symbolic, 83-84 expressive therapies, 49 externalized feelings, 164 externalized imagery, 95, 97 exteroceptors, 43
F facilitative understanding, 176 failure, sense of, 235 family assessment, 125 family dynamics, 130-131 family portrait, 131 family relationships, 241-242 family situations, 209-210 family system, 200 family therapy, 201, 225 fantasy function of, 83 and the Jungian approach, 84, 85 and personality, 90 and sandplay, 88 type of imagery, 28
Faust, 50 fears. see apprehensions feedback, 16-18 feedback devices, 18 feedback loops, 17,23,35,45 feelings. see emotions Feelings in the Body, 208, 209 fig. feminine archetype, 85 "The Fetus" picture, 264-265, 266 fig. final phase. see ending phase flow of information, 6, 12 format of dialoguing phase, 166-171 forms, 29-30 Frank, Waldo, 62 free expression, 149-151 free-flow technique, 122-126, 131, 134, 139,
207 "free" picture, 130-131, 139, 148, 164,
253-255, 254 fig freedom, sense of, 244-245 Freud, 53, 66, 79 Freudian theory, 63-64, 79-80, 158, 170
future, projection of, 186-188, 237 future shock, 174
G general system theory, 6,7,21-23,24 geriatric populations, 252-257 Gestalt notion, 22 Gestalt therapy, 78, 88-90 Ginott, Haim, 224-225 Glasser, William, 225-226 goals. see treatment goals Goethe, 50 Goodman's theory, 32 gradualness, 134-136 Grandma Layton, 257 Grandma Moses, 257 graphic art, 63 gratification, 81 Greeks, 51-53 group dialoguing, 174-175 growth, 89
H hallucinations, 28 happiness, 226 "A Happy Family" picture, 262, 263 fig. haptics, 29-30, 111 hard data, 176 harmony, 51, 52 healing power of art, 52 "A Heart" picture, 213 fig. heart technique, 212 Hellenistic culture, 51-52 helplessness, 222, 235 hemispheres of the brain. see cerebral hemispheres hemispheric differences. see cerebral hemispheres "Hiking" picture, 262, 264 fig. Hill, Adrian, 56-59, 74 Hindu theologians, 25 Hinkle, Beatrice, 60-61, 64 hobbies, 73-74 holistic paradigm, 5-6 homeostasis, 15-16, 23 homonomy, 181 Horowitz, Mardi, 246-247
Subject Index "A House" picture, 269, 269 fig. House-Tree-Person Drawing test, 128 "A Hug" picture, 217 fig. hug technique, 213 human functioning, 20 human systems, 18, 19 hyperactive children, 199 hypnogogic, 28 hypnopomic, 28 hysteria, 60 I ice breakers, 207, 226 "icky" picture, 206 ideal state, 51 identity, sense of, 207, 221-222, 223, 225 illegal substances. see chemically-dependent image forming ability, 26-27 image forming activity, 94 image-making, 36 imagery Ahsen's Triple Code Model, 33-34 externalized, 95, 97 function of, 13, 20 importance of, 45 and information processing, 6-7, 23-24,
173 physiological concomitants of, 39-40 preferred sensory modality of, 29-30 productive or imagination, 29 reproductive or memory, 29 the systems approach, 34-35 and therapists, 95 types of, 28-29 images and cognition, 25-26, 47, 48 definition of, 26 eidetic, 28 and encoding process, 45 expression in, 79 as a form of thinking, 36 function of, 33-34 as information condensers, 18-19 inward, 31 and metaphors, 30-31 modalities of, 26 recognition images, 30 and symbolization, 31-33
303
transformation of, 19 types of, 39-40 imagination definition of, 28 function of, 83 and theJungian approach, 85 and knowledge, 35 memory and, 34 and thought, 94 imagination imagery, 29 imaginative faculty, 58 "In the Garden," 251 indirect treatment, 200-201 industrial revolution, 16-18 inferiority, 235 information assimilation of. see assimilation definition of, 23 disregarded, 19 encoding of, 44, 45 exteroceptors and interoceptors, 43 flow of. see flow of information management of, 93 processing of. see processing of information storage of, 44 usefulness of, 174 information overload, 174 inhibitions, 117 initials drawing, 148,226-227 inner city children, 229 inner design, 173-174 inquiry, depth of, 175 inquiry, lines of, 160-162 instinctual drives, 78-79, 85 integration, 171 integration, 192-193, 195 intellect, 35 interactional drawing technique, 134, 205,
246-247 interoceptors, 43 interpersonal domain, 138, 139, 209-210,
211, 227, 147 fig. intimacy, 239 intuitive knowledge, 35 inward images, 31 ipsomatic approach, 91-92, 95-96, 102, 113,
158, 172, 176, 168 fig. ISM sequence, 34 isolation, 239
ThePsychocybernetic Model ofArt Therapy
304
J James, William, 137 "AJob Interview" picture, 140, 144 fig. joint free-flow, 148 Jung, Carl, 52-56, 89, 171-172 Jungian approach, 84-88 Jungian art therapists. see art therapists Jungian psychology, 83, 136-137, 156, 158, 159, 170-171 J ung's technique of active imagination. see active imagination K Kinetic Family Drawings, 128-130, 131, 135, 209-210,237,242 Kinget, Marian, 126 knowledge, 35, 93-94 Kwiatkowska assessment procedures, 131-132 L "The Lamb" picture, 139, 143 fig. Landgarten, Helen, 132, 226-227 language and metaphors, 31 language functions, 38 late adulthood, 252-257 latent content, 63 left cerebral hemisphere, 37-40, 44-45, 93, 220. see also cerebral hemispheres length of dialoguing phase, 166-171 length of doing phase, 153-156 length of ending phase, 188 length of treatment, 178, 182, 194 Lewis, Nolan D.C., 63 life enrichment, 200-201 life-long learning, 279-281 life review, 254 limbering up, 117 lines of inquiry, 160-162 logical knowledge, 35 logical thought. see secondary process thought long-term memory, 44 long-term treatment, 188 Lowenfeld, Margaret, 87
M "Man on the Beach," 251 mandala drawings, 55, 149, 164-165, 199 "Mandala" picture, 164-165, 167 fig. manifest content, 63 masculine archetype, 85 mask making, 233, 242 mastery, sense of, 223, 224 materials. see art materials Matisse, 50, 251 maturity, 89, 190 mean depression scores, 274, 275 table, 276 table, 277 table meaningful productions, 184 meaningless productions, 184 memory, 34, 44 memory imagery, 29 mental health, 61 mental health movement, 66 mental illness, 52, 66, 239, 247 mental impairment, 252-253, 254 fig, 255,
256,253 fig. mental patients, 52 mental processes, 78 metaphors, 30-31, 33, 36 Michelangelo, 94 mind domain, 137, 146 fig. minimally dysfunctional adults, 239-240, 240-241 misapprehensions, 112-114 moderately dysfunctional adults, 239-240, 241-245 Montessori, Maria, 60 Moreno, 62 Mozart, 36-37 MSW degree, 103 multiple and complex references, 32 music, 51 music therapy, 273, 274-276 Mutual Story Telling Technique, 202, 203 fig.
N name design, 207, 226, 241 name plate, 148 Naomi's Free-flow picture, 124, 125 fig. National Institute of Mental Health, 68
Subject Index Naumburg, Margaret, 59-64, 66-69, 75, 79, 81,82-83 negative feedback, 16-17 Neofreudianism, 69, 83 neurophysiological phenomena, 16, 18 neurosis, 89, 90
New Introductory Lectures, 78 New York Psychoanalytic Society, 60 New York State Psychiatric Institute, 62-63 nomenological approach, 158 nomomatic approach, 95-96, 113, 158, 172-173, 168 fig. nondiscursive modality, 36-37 nondiscursive thought, 80 nonverbal behaviors, 90
Notebooks, 122-123 Nuremberg War Tribunals, 63
o object inventory, 160 objective amplification, 171-172 obsessive compulsive disorder, 67 occupational therapy, 75 "Odd Man Out" picture, 115 fig. open system, 22-23 oppositional disorder, 212-213 "The Outside Picture," 168-170, 169 fig. p
painting, 50 paints, 105 paper, 106 parents, 200-201, 225-226, 241-242 participant observer, 204-205 passive fantasy, 84 pastels, 105 peer supervision, 103 percept, 42 perception and cognition, 27-28 perceptual stimulation, 149-151,254 fig, 256-257 perfectionism, 90, 154 Pergamon, 51-52 peripheral concerns, 140, 148 Perls, Fritz, 88 Perls' Gestalt therapy, 89 personal qualifications. see qualifications
305
personal unconscious. see unconscious personality, 90 personality assessment, 126 personification of product, 162 phases of psychocybernetic model, 98, 99 fig; 100 fig· phases of therapeutic process, 97-99 phenomenology, 90-92
Philosophy in a New Key, 33 phobias, 90 physical impairment, 252-253, 255, 256, 253 fig·, 254 fig· physical limbering up, 117 Picasso, Pablo, 118, 251 "A Picnic" picture, 263, 265 fig. pictorial forms. see presentational symbolism picture consciousness, 58 picture of one's choosing, 227 Plato's ideal state, 51 play therapy, 204 pleasure principle, 81, 221 positive feedback, 16 potential, 84 power of art, 52 power, sense of, 117 prelogical thought. see primary process thought presentational symbolism, 35-37, 38,45 primary creativity. see creativity primary process thought, 6, 79, 80-81, 170 problem solving ability, 39, 97 problematic relationship, 241 process and product, 73, 74, 78, 95, 96, 106. see also products process of amplification, 171 process of creating, 119 process of engagement, 118-120 processing of information and imagery, 6, 20, 23-24 and primary creativity, 96-97 in the psychocybernetics model, 173 sensory/visual and verbal/rational, 97 visual means of, 93 productive imagery, 29 products. see also process and product meaningful and meaningless, 184 personification of, 162 storage of, 193 professional preparation. see training
ThePsychocybernetic Model ofArt Therapy
306
progressive education, 59, 61, 69 projection, 78 Prospective Kinetic Family Drawing, 237 protective themes, 134, 247 psychiatric interview, 68 psychoanalysis, 61, 63-64, 66 psychoanalytic model, 78-84 psychoanalytic orientation, 170 psychoanalytic theory, 77 psychoanalytic thought, 59, 68-69 psychocybernetically-oriented therapists. see art therapists psychodrama, 62 psychodynamic style, 202-204 psychodynamically oriented therapists. see art therapists psychological functions, 38, 43 psychology, definition of, 26 psychotherapists, 65 psychotherapy, 66, 69, 103
The Psychology of the Unconscious, 54
Q qualifications, 101-102 question jar, 233
R "The Race Car" picture, 140, 145 fig. "The Raindrop and the Killings" picture, 215
fig· rapport building, 148-149 ratification, 178-179, 194 rational thought. see secondary process thought reaction formation, 78 reactive-type depression, 272 reality, 21, 23, 91, 226 reality education, 226 reality principle, 81, 221 reality problems, 224 reassurance, 116, 119, 134 reclassify, 42 recodify, 42 recognition images, 30 reconnect, 188 references, 32 relationships, 200-201, 225, 226, 241
relative repleteness, 32 religion and the arts, 52 reminiscing, 254-255 repression, 78 reproductive imagery, 29
Republie, 51 research study design, 272-274 desirability and feasibility of, 278-279 findings, 274-277 "Resistance" picture, 115 fig. resistance to termination, 179-182, 194 resistive children, 205 resolution, 185-192, 194 responsibility, 89 responsive communication, 215-220,
215-220 review, 182-185, 194 rewards, 205 Rhyne,janie, 88, 90 rhythm, 51, 52, 117 right cerebral hemisphere, 38-40, 45, 93,
220 Rogerians, 204 Rogers, Carl, 101 Rousseau, 59
s "A Sad Puppy" picture, 164, 166 fig. salience, 175-176 sandplay therapy, 87-88 schizophrenic patients, 66 scribble technique. see also free-flow technique second mastery, 206 secondary creativity. see creativity secondary process thought, 7, 79,80-81, 170 security, sense of, 247, 251 self-blame, 233 self-concept, 91, 137 self-correcting propensity, 23 self-destructive behaviors, 232-233 self-determination, 21 self-development, 84 self-disclosure, 148-149 self-expression, 90 self-help movement, 103 self-image, 20-21, 208
Subject Index self-portrait, 131, 185, 228-229, 233, 223 fig. self-regulating systems, 16-18 self-responsibility, 21 self-sharing, 148-149 self-system, 136-140, 208-211, 227, 228, 138
fig· self-therapists, 91 semantic density, 32 sensations, 29 sense of identity, 207 sense of space, 44 sense of time, 44 sensory deprivation, 26 sensory modality, 29-30, 256 sensory organs, 43 sensory/visual, 97 severely dysfunctional adults, 240, 245-252 sex, 53 sex offenders, 240, 241-242 sexual drives, 78-79, 81-82 sexually-abused adolescents, 233-235 sexually-abused children, 214 shadow, 85 shapes, 244 "The Shoes," 251 short-term memory, 44 short-term treatment, 188 simple reaction theories, 21 social group work, 76 social problems, 61-62 social work degree, 103 social workers, 200-201 soft data, 176 solutions, 193 space requirements, 107 space, sense of, 44 Sperry, Roger, 37 "The Sphinx" picture, 126, 127 fig. spotlighting, 134-136, 164 squiggle game, 124, 134, 207 state of dynamic equilibrium. see homeostasis state of human systems. see human systems stress, 239 stress management programs, 20 structuring, 117-118, 136, 208, 257
Studies of the "Free" Art Expressions ofBehavior Problem Children andAdolescents means of Diagnosis and Therapy, 63 subconscious, 43, 44
307
subjective amplification, 171-172 sublimation, 81-82 subsystem in codification process, 43 subsystems of imagery, 34 suicidal adolescents, 231-232 supervision, 103 surveys, 70-71 symbol formation, 41 symbol-making devices, 23 symbolic expressions, 83-84 symbolic processes, 6 symbolism, 83 symbolization, 31-33, 44 symbols classes of, 32-33 definition of, 32, 44 presentational. see presentational symbolism universal, 63 syntactic density, 32 system, definition of, 21-22, 34 system of codification. see codification system theory. see general system theory systems and cognition, 45-47 systems approach, 34-35,46-47 T teardrop technique, 213 "Teardrop with Rain and Lightning" picture,
214fig. termination phase. see ending phase tests. see assessment theme-oriented sessions, 208 theme selection, 122, 132-134 theoretical cybernetics, 17 theoretical orientations, 77-78 therapeutic interaction, 106 therapeutic process, 97-99 therapeutic styles behavior modification, 205 participant observer, 204-205 psychodynamic style, 202-204 therapy, definition of, 94-95 therapy dropout, 114 therapy techniques for children achievement domain, 210 "The Arm, Fist, and the Bully" picture,
216fig.
ThePsychocybernetic Model ofArt Therapy
308
arm with a fist technique, 213 body tracing, 207-208 dragon technique, 211-212 free-flow technique, 207 "A Heart" picture, 213 fig. heart technique, 212 "A Hug" picture, 217 fig. hug technique, 213 ice breakers, 207 "icky" picture, 206 interpersonal domain, 209-210 Kinetic Family Drawing procedure,
209-210 name design, 207 "The Raindrop and the Killings" picture, 215 fig. responsive communication, 215-220 squiggle game, 207 teardrop technique, 213 "Teardrop with Rain and Lightning" picture, 214 fig. transpersonal domain, 210-214 therapy wing of art therapy, 74-75, 76-77,
78,97,156 Third Force, 21 thought processes, 79-80, 193 three dimensional forms, 29-30, 105 time considerations, 107 time limits, 154, 155 time, sense of, 44 timing principles, 134-136, 175-176 titles, 162 topic selection. see theme selection training, 102-104 transformation of images. see images transpersonal domain, 138, 140, 210, 227, 148 fig. treasure map, 242 treatment goals, 181-182 "The Tree" picture, 269, 270 fig. trust, 136, 140, 148, 162 "The Turtle" picture, 126, 127 fig. two dimensional forms, 29-30 two-part picture, 227, 237
unconscious collective, 63, 84-85, 86, 87 and the conscious, 85 Freud's term, 43 Naumburg's view on the, 83 personal, 84-85, 87 unconscious mental processes, 78, 79 unfreezing phase with children, 199 client preparation, 114-116 common misapprehensions, 112-114 explanation of, 97-98, 111-112 limbering up, 117 process of engagement, 118-120 structuring, 117-118 universal symbols, 63 unlocking the messages. see decoding the messages Utrillo, 50
v validation, 42 van Gogh, 251 verbal exploration method, 224 verbal expression, 10-11, 14, 89, 90, Ill, 244 verbal means, 93 verbal/rational, 97 verbal therapy, 76, 182-183, 273, 274-276 verbal treatment methods, 242 vignettes. see case studies visual expression, advantages of, 9-11,
14-15,244 visual forms of therapy, 76 visual imagery. see imagery visual means, 93 visual modality, 111 visual products. see product visual sense, 30 visual sensory modality, 36, 111 visual thinking, 79-80 visual vocabulary, 9-10, 244 visualizers, 29-30
w
u Ulman, Elinor, 69 uncertainty, 119
Wadeson, Harriet, 68, 131 Walden School, 60-62 "A Warm Place" picture, 184-185, 185 fig.
Subject Index warm up, 117 Wartegg Blank, 126, 129 fig. Wartegg, completed, 128, 129 fig; 130 fig. Wartegg, Ehrig, 126 Wartegg technique, 126-128, 227 WEGs (warmth, empathy, and genuineness), 101 William Glasser's Reality Therapy approach, 225-226 Winnicott's "squiggle game." see squiggle game
works of art, use of, 249-252 worst nightmare, 242
y YAVIS-type clients, 240-241
z Zung Depression Test, 272
309
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