Art therapy

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Michael C. Irving, Ph.D.
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Cheryl Irving, B.A.
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This text presents a brief overview of the field of art therapy and the role of art as healing.
  Art Therapy: Background
Theories of Art Therapy
  Art Psychotherapy (Naumburg)
  Art as Therapy (Kramer)
  Jungian Influenced Art as Therapy
  Jungian Analytic Art Therapy
  Gestalt Art Therapy
  Depth Psychology of Art
  Directed Vs. Nondirected Art Therapy
Healing with Art

Art Therapy: Background

Art therapy developed as a distinct form of psychotherapy in the second quarter of this century. The development of other forms of creative expressive therapies soon followed. There is a wide diversity of approaches and theories in art therapy. Art therapists may be highly directive or quite "hands off". Particularly in art therapy's early development, the art production was seen as something the clinician analyzes and about which the "untrained" patient has little objective insight.

One approach to art in therapy requires the therapist simply to be present and aware as a mostly silent, mindful witness to the client producing art during sessions, and to be non-intrusive, allowing the natural course of healing to unfold. In some approaches, the forms or images created between sessions are treated as rich symbolic material which is discussed in the therapeutic setting. The images in the art work are viewed as representations of the unconscious forces of the psyche.

Others conceive the creative process as the raison d'etre of art in therapy, whereby the individual, on many levels, confronts and further understands her/himself. In discussing the power of creativity, Rogers (1993) emphasizes, "The creative process is healing. The expressive product supplies important messages to the individual. However, it is the process of creation that is profoundly transformative" (p. 7).

Thompson (1989) reports that, "When Adrian Hill [using art while recovering from tuberculosis] first coined the term "art therapy" in 1938, he meant simply that the art does the therapeutic work" (p. 3). Many in the art therapy field debate to what degree the art expression, in contrast to therapeutic interventions, is healing, and/or how much "the doing" of art is the transforming process, or to what degree the product functions as a meaningful symbol. Naumburg (1973) reports:

A vital implication [of] studies...made on children's art expression as an aid to diagnosis and therapy is that imaginative, creative expression is, in itself, a source of growth and sustenance as well as a language of communication in the life of every individual. (p. 89)

From those not involved directly in art therapy, a perception of the field may be obscured with myths and misconceptions. As recently as 1984, Dalley commented, "Art therapy is a relatively new discipline. Outside of a small number of practitioners, its concepts and aims are not widely known or understood" (p. xi).

Before I began formal studies in art therapy, I carried the common mistaken notion that art therapy should be viewed as a kind of quasi craft exercise which fills idle time while the real work of psychotherapy is left to those better trained. I discovered art therapists can be highly trained psychotherapists using all the skills, techniques, and foundational theories of psychotherapeutic healing. Added to these traditional therapeutic skills the art therapist has a background as a trained visual artist with the ability and training to encourage the client to use creative expression as a vital part of the healing process.

Art therapists are in fact highly trained multidisciplinary professionals. An art therapist may have a four year arts degree, a year or two of undergraduate psychology study, two years of art therapy schooling which focus on the therapeutic process, as well as a year of post master's practicum and internship. Consequently, art therapists may have ten years of training for their profession before registration. For an art therapist with a doctorate, this can involve up to thirteen years training, a noteworthy amount of training for a career which is often seen as the "low position on the totem pole" in the psychotherapeutic community. Along with our society's lack of respect for art and artists in general, in our patriarchal society, the fact that the overwhelming majority of art therapists are women likely has much to do with the unwarranted low status of art therapy in the healing professions.

In addition, misconceptions concerning the sophistication of art therapy and art therapists can be understood in the context of the initial introduction of "instructions in art" often as part of recreational or occupational therapy in mental hospitals in the 1940's and 1950's. Rhyne (1984) explains:

The early art therapist was often a person with training in art media whose function was to provide rudimentary instruction in techniques to patients. [The art therapist's job was]...to keep the patient soothed...to kill time; ...to allow him to express emotions in a presumably nonthreatening way (p. xii).

As art therapists gained experience and sophistication their techniques and approaches for effectively promoting change and personal growth in the client became equally sophisticated. In the 1960's and 1970's art therapy was highly influenced by "the human potential movement and the various therapy approaches that were closely associated with it" (Rhyne, 1984 p. xii). Workshops, conferences, national associations, books, and graduate programs in art therapy and creative expressive therapies seemed to blossom overnight. The first master's degree in art therapy was offered at Hahnemann Hospital in Philadelphia in the late sixties. Until that point art therapy was taught in New York City by Margaret Naumburg, and in Washington, D.C. at the Washington School of Psychiatry. In 1970 the American Art Therapy Association held it first annual conference as a small gathering; by 1980 over twenty master's degree programs had been started and more have developed since. Art therapy was finally able to stand as a legitimate discipline incorporating elements of both art and therapy. The art therapist today may be either an auxiliary therapist or primary therapist with significant issue case loads.

As art therapy moved into the domain of acknowledged psychotherapeutic modalities, its early development was divided into two camps -- "art psychotherapy," originated by Margaret Naumburg (1966), and "art as therapy," promoted by Edith Kramer (1971). Both theories were based in Freudian thought, the former emphasizing interpretation and the latter emphasizing the art process. Although some felt the approaches were incompatible, Ulman (1975) integrated them into her own theory of art therapy. Harriet Wadeson (1987) went even farther, including "not only graphic arts but other modalities of expressive therapies" (p. xxi) and she espoused an eclectic approach to art therapy "shifting gears as the situation seems to require." Rubin (1987) suggests in a practical sense today, "Most art therapists are primarily pragmatic in their orientation, doing whatever seems to work best most of the time" (p. 275).

The practicality of art therapists can be noticed in reviewing a wide assortment of print on the subject. Possibly more than any other modality in psychotherapy, creative expressive therapy literature emphasizes more the practical activity in the therapy session itself, rather than complex and abstract theories about what is happening with the therapeutic process. Perhaps the presentation of the exercises, process and the events occurring in the therapy session tend to be portrayed more frequently because artists and those attracted to art are physical doers; and when using creative expression in therapy one can often visually "see" the therapy process taking place. Furthermore, through the painting or sculpture one can actually physically put one's hands on the aspects of the therapeutic process and the product.

Theories of Art Therapy

Art therapists are not only practical doers who spend time in the clinical setting and try to nab what time they can for retreat to their own art studios, they are also active theorists and have amassed a wide range of theories for why and how art therapy works. The two approaches which started art therapy, "art psychotherapy" and "art as therapy", have gained many sisters, cousins and neighbourly approaches and theories explain the efficacy of creative expression as healing. In Approaches to Art Therapy, Judith Rubin (1987) outlined sixteen major theoretical approaches to the practice of art therapy:

Psychodynamic Approaches:

  • Freudian psychoanalytic theory: Emphasis on uncovering and insight, Judith Rubin;
  • Sublimation and art therapy, Edith Kramer;
  • Symbolism and art therapy: Theory and clinical practice, Laurie Wilson;
  • Object relations approach to art therapy, Arthur Robbins;
  • Self psychology approach to art therapy, Mildred Lachman-Chapin;
  • Jungian analytic art therapy, Michael Edwards;
  • Healing through the visual arts: A Jungian approach, Edith Wallace;
  • Dynamically oriented art therapy, Naumburg.

Humanistic Approaches:

  • Creative arts therapies based on Alfred Adler, Rose Garlock;
  • Phenomenology of therapeutic art expression, Mala Betensky;
  • Gestalt art therapy, Janie Rhyne;
  • A humanistic approach to art therapy, Josef Garai;
  • An Eclectic approach to art therapy, Harriet Wadeson.

Behavioral/Cognitive/Developmental Approaches:

  • Behavioral approach to art therapy, Ellen Roth;
  • Cognitive approach to art therapy, Rawley Silver;
  • Developmental approach to art therapy, Susan Aach-Feldman and Carole Kunkle-Miller

In addition, each of the following authors refers to other theorists and therapeutic approaches which are not part of Rubin's primary list:

  • Sean McNiff (1989), Depth psychology of Art;
  • Aina Nucho (1987), A Psychocybernetic model of art therapy;
  • Tessa Dalley (1984), Art as Therapy;
  • Margaret Keyes (1983), Inward Journey, Art as Therapy;
  • H.Y. Kwiatkowska (1978),
  • Family Therapy and Evaluation Through Art;
  • Arthur Robbins (1970), Creative Art Therapy.

Both lists are still not exhaustive of the variety of theoretical approaches under whose form different art therapists have aligned themselves.

Art therapy may be practised with children, adolescents, adults or the aged, with an individual or groups, in private practice, clinics, prisons, medical or psychiatric hospitals, old age homes, schools, or as a form of self therapy. In addition to dealing with psychological issues, art therapy is used in therapy with learning disorders, physical illnesses, and in business management with group dynamics and organizational development. The field of art therapy stands on its own and has undergone many developments and refinements.

Art Psychotherapy (Naumburg)

The integration of Freudian thinking about the dynamics of unconscious communication with its facilitation through the images and symbols of art was primarily initiated by Margaret Naumburg. As one of the first Americans to enter into analysis, she did so with both a Freudian and a Jungian analyst.

In the Walden School founded in 1915 by Naumburg (1928) she recommended that all her teachers undertake analysis and she encouraged the children in "spontaneous, free art expression" which produced "original and amazing images" seemingly "created from their unconscious". This lead to Naumburg's (1926) conviction that, "such free art expression in children was a symbolic form of speech basic to all education...that such spontaneous art expression was also basic to psychotherapeutic treatment" (p. 30).

Naumburg went on to develop Dynamically Oriented Art Therapy as a method of treating neurotic and psychotic adult patients, as well as emotionally disturbed adolescents and children. In 1941 she began her first research in the therapeutic use of art at the New York State Psychiatric Institute and the research work was published in Studies of the "Free" Art Expression of Behaviour Problem Children and Adolescents as a Means of Diagnosis and Therapy (Naumburg, 1973/1950). She spent much time educating both professional and lay public before the first graduate program for art therapy was established at New York University in 1958. Her first comprehensive text-book Principles and Practice of Dynamically Oriented Art Therapy (Naumburg, 1966), followed eight years later.

Naumburg (1958) was clearly Freudian in her approach and theoretical framework which she says based:

its methods on releasing [unconscious material through] spontaneous art expression; it has its roots in the transference relation between patient and therapist, and on the encouragement of free association. It is therefore closely allied to psychoanalytic therapy. (p. 516)

As Naumburg's work developed, she continually attributed less importance to the "clients" experience of the creative process" (Ulman in Rubin, 1987, p. 280). Rather the painted surface became a place which registered the unconscious fantasies and inner conflicts without as much of the censorship or forgetting which occurs in verbal expressive therapy. From the images on the canvas the psychotherapist could derive a symbolic language necessary for the analytical process. For Naumburg (1958), the value of therapeutic art, "is based on the recognition that man's most fundamental thoughts and feelings, derived from the unconscious, reach expression in images rather than words" (p. 511).

When we discuss musings in art therapy, we are not addressing random scribblings on a paper which may be related to idle verbal babble, rather, symbolic and unconscious imagery in art are considered akin to free association or dream work in analysis. The process of creating art is understood to allow the psychological and therapeutic mechanisms of projection, displacement, repression, identification, sublimation, condensation and dissociation. The art work can become a psychologically charged form like the dream which Freud found so useful in following as a path into the inner self. Dalley (1987) claims many parallels "can be drawn between the art processes and dreams" (276). The sharing of a drawing may at times take one even farther than the shared verbal recall of a dream. Freud (1963) elucidates:

We experience it [a dream] predominantly in visual images: feelings may be present too, and thoughts interwoven in it as well: the other senses may also experience something, but nonetheless it is predominantly a question of images. Part of the difficulty of giving an account of dreams is due to our having to translate these images into words. "I could draw it," a dreamer often says to us, "but I don't know how to say it." (Vol. XV, p. 90)

If, as Freud suggests, the drawing of an image will express and explore the dream and its emotional content more clearly and deeply, then the use of art in psychotherapy should be as effective as the verbal exploration of dream material.

Freud wrote much about artists and the symbolic nature of art, but in a practical sense he felt art that did not address the issues directly. For Freud, the highly symbolic nonverbal content of art led to an unacceptable level of displacement and verbal inaccessibility of the significant psychological material. He judged that art acted out and reverberated the therapeutically available anxiety rather than resolved it. Throughout the nineteen thirties, forties, and fifties, other traditional psychoanalysts described the use of art in conjunction with therapy (Pfister, 1917; Naumburg, 1928; Liss, 1936; Mosse, 1940; Schilder and Levine, 1942; Spitz 1942; Bychowski, 1947; Hulse, 1949; Auerbach, 1950; Sechehaye, 1951; Stern, 1952; Milner, 1957; and Slap, 1976).

As pioneering art therapists, Naumburg allied more directly with the psychoanalytic techniques; but Kramer, another founding pioneer of art therapy, incorporated Freudian theoretical principles more fully than Naumburg (Ulman, 1975).

Art as Therapy (Kramer)

Kramer coined the phrase "art as therapy" (Ulman in Rubin, 1987, p. 281). According to Rubin (1987), Ulman was the "originator of one of the earliest and most widely used theories of art therapy" (p. 3). Her work was derived from Freudian ideas, although the actual process of creativity interested her more than it did Naumburg. Kramer's premise was that the art process itself allowed the client to recreate primary experiences and feelings, thereby offering the opportunity to "re-experience, resolve and integrate conflict" (Ulman in Rubin, 1987, p. 280). This is a fairly popular theoretical premise for understanding the use of art in therapy.

A number of English art therapists are brought together by Tessa Dalley (1984) in Art as Therapy: An Introduction to the Use of Art as a Therapeutic Technique. Early British art therapists were theoretically much less interpretive and more laissez faire than their American counterparts. British art as therapy was very influenced by the theoretical principles of Winnicott who believed if the clinician is patient the client will naturally arrive at an understanding of her creativity (Winnicott, 1971).

Through the view of "art as therapy", art productions in therapy most often draw their therapeutic essence from the process of creativity, and from the images expressed in the painting or sculpture. Art activity spontaneously expresses inner experiences of the creator. Unconscious forces and a felt sense of life is projected into the work of art. In the process, personal dilemmas of the individual are sure to be presented in the created images.

Art work allows the client to express symbolism, metaphor and feeling with much of the freedom of dreams. Simultaneously with art, the person moves in and out of the repertoire of practical and psychological skills which are part of being an aware growing person. Keyes (1983) finds:

Using art materials to make images and connecting them to feelings and body states brings into the open emotions and thoughts that have been only vaguely sensed. Closure becomes possible for unfinished issues that push for resolution (p. 104)

Jungian Influenced Art as Therapy

Lyddiatt blends art as therapy and Jungian art therapy. Jungians are avid writers about art, yet Lyddiatt's (1972), Spontaneous Painting and Modelling is the sole book available on the application of Jungian theory to the practice of art therapy (Rubin 1987). A pioneer in establishing art therapy in England, Lyddiatt opened up an art therapy department at Bowden House Clinic in Harrow-on-the-Hill in 1965. Thompson (1989) reports that Lyddiatt was influenced by Jung's perceptions on "active imagination and saw her role as a facilitator and one who `stayed around'" (p. 1). Lyddiatt's approach was to provide the sanctuary and art materials where the person in conflict could go about her own healing process and find her right way. One of Lyddiatt's (1972) patients commented:

The art therapist struck me as woolly, vague and edgeless, and the lack of shape, direction and order in her department irritated me. But in looking back I see that in my insanity it was just those qualities that I needed (p. 119).

While working through his self-analysis, Jung used sculpture, drawings and paintings as a method of objectifying fantasies. Dalley (1983) tells us Jung believed that:

art represented a new synthesis between the inner and subjective world of the artist and external reality. The artist selects, often unconsciously, material from both external and internal reality. The work embodies a conjunction between the two, and this integration gives a sense of reconciliation and resolution (p. 9).

Jungian Analytic Art Therapy

Although not trained as an artist, Jung was acquainted with the use of personal discovery through art activity from a first hand perspective. Through much of Jung's life:

particularly at times of personal crisis, Jung drew, painted, and sculpted representations of his inner experiences. He makes it clear that this was not a peripheral activity, but on the contrary was a vivid source of personal insight into his situation (Edwards in Rubin, 1987, p. 93)

Jung's theoretical work emphasizes the importance placed on imagery, symbols and the role of creativity in the unconscious. Jung's affinity with art as a means of personal insight and change agent is commented on in 1931 in The Practice of Psychotherapy in which he describes his reasoning for encouraging his patients to spend time at creating art:

he begins to play an active part. At first he puts on paper what has come to him in fantasy, and thereby gives it the status of a deliberate act. He not only talks about it, he is actually doing something about it. Psychologically speaking, it is one thing for a person to have an interesting conversation with his doctor once a week -- the results of which hang somewhere or other in mid-air -- and quite another thing to struggle for hours at a time with refractory brush and colours.... the effort to give visible form to the image enforces a study of it in all its parts, so that in this way its effects can be completely experienced (Jung 1966).

Jung's perception expects that the patient interact with the painting, that it is not just the simple painting of pretty pictures, but, (1966) "It is necessary besides to have an intellectual and emotional understanding of them: they must be consciously integrated, made intelligible, and morally assimilated. We must subject them to a process of interpretation." (Jung, 1966) Predating the formal development of art therapy by two decades, Jung is fairly accurately describing some of the basic essentials of art as therapy.

The psychoanalyst Kris's (1952) viewpoint was that relaxation in artistic activity allowed a purposeful and constructive form of regression separate from the fantasies of dreams. For Kris the dilemma for the artist is to balance a personal dance between creation and criticism; the creative letting go is poised with a finely controlled functional regression. As Dalley (1983) clarifies, "When regression goes too far, the symbols become too private, whereas when there is too much control, the result will be cold, mechanical and uninspired" (p. 9).

As a means of opening up to inner experience, the controlled regression of the creative process grants a disintegration of the ego, allowing emergence of material from the deeper levels of the psyche. Additionally, creativity and its organizing forms encourage ego building, catharsis and integration on the higher levels of cognitive consciousness. The creation of personal art moves one back, down and in -- and then correspondingly forward, up and out. One is connected to the present day issue, its origins and its reintegration.

Gestalt Art Therapy

Janie Rhyne writes that many of the difficult to explain and rather abstract connections between the theories of gestalt psychology and gestalt therapy are far more "easily observable in the activity of art therapy...the concepts are transposed into vivid percepts as we engage in expressive art experience." (Rhyne in Rubin, 1987, p. 172). Rhyne (1984) in Gestalt Art Experience describes the psychotherapeutic use of art as "gestalt art experience" and often uses that phrase rather than "gestalt art therapy" to describe her work. The three constituents of Gestalt, Art and Experience are described directly following: dreaming, feeling, thinking, acting, expressing, and being aware at the same time that you are the person who is doing all of this" (p. 6).

In the creative process, the artist reconnects with that too often lost awareness and "beingness" which the child brings to creative painting or other activity. In art activity, one may experience delight, anger, joy, sorrow, or splendid play. In Rhyne's (1984) view, whatever the experience, the client is encouraged to let it be and to have awareness of the experience.

-"Gestalt" is describe by Rhyne as "the ability to perceive whole configuration - to perceive your personality as a totality of many parts that together make up the reality of you" (p. 9)

Gestalt theory concerns itself with: the perception and relatedness of the whole; the closure and connectedness to those things incomplete; configurations of "figure/ground relationships, dynamic movement, contact/boundaries, coherence and fragmentation" (Rhyne, 1980, p. 77). These are visual and perceptual concepts of the environment. Gestalt therapy applies these elements of perception to human relationship, and to the organization of the internal psyche. Fagan and Shepherd (1970) explain:

Gestalt psychology originated as a theory of perception that included the inter-relationships between the form of the object and the processes of the perceiver.... Gestalt thinking emphasized "leaps" of insight, closure, figure-ground characteristics, fluidity of perceptual processes, and the perceiver as an active participant in his perceptions rather than a passive percipient of the qualities of form (p. 3).

These concepts are often too easily abstracted and distanced and objectified in the exchanges of verbal therapy; but in a therapeutic painting, the internal self is opened up and laid out on a piece of paper or in a sculpture. It can be approached and realized. Through the images of the art these gestalt perceptual concepts are observable. The perceptual meaning of inner experience to the person often becomes obvious, and visual concepts of movement, relationship, boundary and closure take on a clearer significance and resolution in viewing and therapeutically processing a person's work of art.

-"Art" of the gestalt art experience Rhyne (1984) considers as: "the forms that emerge from our individual creative experiencing" (p. 7).

Rhyne sees humans as having an inherent desire to make things. The forms created in the gestalt art experience become an extension of that desire to make. In gestalt art experience, the how, and why, and what of that making are often left up to the client. The form which unfolds is as wonderfully unique and individual as the person who makes it.

According to Corey (1982), the gestalt art therapist encourages the client to "carry out their own therapy as much as possible" (p. 98). The emphasis is on experience and awareness in moving through to closure of unfinished business. Like gestalt therapy, gestalt art experiences are often practised in groups, and the mutual support and sharing in the group process is seen as a vital part of the closure and completeness.

Through association with existential philosophy and phenomenology, gestalt therapy encourages personal responsibility and authentic and innate potential. The therapist attempts genuine contact with the client and transference is not encouraged; rather the therapist enters into a mutual, present-centered, person-to-person therapeutic relationship which allows for changes in both therapist and client.

Depth Psychology of Art

Another group argues that art therapy should not be over-analyzed and the productions of art therapy belongs in part to the realm of other and transpersonal. In Depth Psychology of Art, Shaun McNiff (1989) tries to wrestle away the hold analysts have on art therapy. Allen (1990), in a book review states:

McNiff questions the conventional view that art therapy owes so huge a debt to Freud for defining the unconscious, since that legacy also contains the misguided certainty that images which form the unconscious can be explained rationally. He suggests that analytic judgement arrests the process of discovering meaning in an image. (p. 115)

McNiff suggests we place art in a context which it has historically often served, as an artifact that embraces the human search for sacred meaning and a spiritual order. "To express the purpose of art he coins the term "Ensoulment," to make manifest the soul" (Allen, 1990). McNiff (1989) suggests taking art away from the fortification of science and acknowledging its role today where it has served humanity for millennia as "a manifestation of primary religious instincts" (p. 20).

Directed Vs. Nondirected Art Therapy

The degree to which the therapist should comment on and direct or simply observe and acknowledge the client's art therapeutic process has been debated. In the far extreme of art in psychotherapy, the analyst can be traditionally Freudian. As in dreams, the creation of art can be allowed spontaneous unfolding, but when it comes to gaining understanding, the "good Doctor" "knows" what the patient is unable to see, encourages transference and clearly directs and controls the understandings of symbolic significance of the picture. Ulman (1975) suggests, in its most patriarchal forms:

Expressive therapy centers on the expression of emotion within the framework of the therapeutic relationship. It is an integral part of psychotherapy and should be strictly the doctor's province, for it is often so profoundly revealing to the patient as to be extremely dangerous in any other hands. (p. 7)

Moving to less rigidity while still retaining Freudian theory, Naumburg shifts the application of the analyst's perceptions and suggests:

Unlike the psychoanalyst, the art therapist does not interpret a patient's imaged projections but encourages the patient to assume the active role of explaining his creations.... A therapist's questions as to the mood in which the patient's designs were created, or the order in which the colors were used, or just what the pictures meant to the patient may release his free associations. (p. 6)

I believe it is this perspective of accepting the client's experience and not imposing a therapist-generated interpretation on the client which allows many of Naumburg's clients to create significant natalistic womb imagery.

In another mode of highly directive art therapy described by Oster and Gould (1987) in Using Drawings in Assessment and Therapy: a Guide for Mental Health Professionals (pp. 85-107.), the client is asked to draw very specific types of pictures, and as the therapy develops is asked to combine images from certain pictures or to redraw images in a different light all in what appears to be an effort to control and direct the treatment towards very specific objectives which the therapist has chosen.

In the example Oster and Gould discuss, (1987) the therapist directs a highly ambivalent and paranoid seventeen year old male to draw a series of "worst reality," "best reality," "worst fantasy," and "best fantasy." The drawings reveal a variety of controlled and organized views of the world, as well as rather terrifying imagery. The drawings reflect the young man's inner turmoil, yet reveal a high need for control. Oster and Gould (1987) describe how specific therapeutic goals:

The therapist then had David begin a drawing in which he integrated all four of the above fantasies. The therapist's goal with this kind of drawing was to help David see that he did not necessarily have to "split" and withdraw into his fantasies. (Oster and Gould, 1987, p. 93)

In different degrees, apparently, this form of directed drawing continued throughout David's therapy, in an effort to move him towards what the therapist viewed as healthy insights and appropriate changes. The therapist seemed to predetermine the next issue David needed to confront, conceptualize or accept. For David to properly address this next stage of the therapy process, the therapist created the next "drawing directive" which would allow David to make the proper progress.

The therapist in art as therapy may operate on a wide continuum of interpretation, comment and direction. Approaches to using art in therapy can vary, on the one hand, from having, for the client, a defined agenda and a goal which is clearly expressed by the therapist (Clifford, 1986), to, on the other hand, allowing materials and their uses to flow freely and unobstructed with the therapist simply making comments primarily of support and acknowledgment. Keyes (1983) relates from Inward Journey:

I am interested in hearing any reflection he or she might have on what the material evoked. I ask questions to facilitate the telling: Where does it seem to be going? How did you feel when you started? When you finished? What do you sense as you look at it now? Sometimes such questions are unnecessary: the experience itself was sufficient. (p. vii.)

Norma Clifford, a therapist colleague of mine, tells her clients, "My job is not to give answers, but to ask the best questions." Keyes (1983) agrees, explaining, "Art therapy does not answer the questions. It provides a process to clarify and deepen the questions" (p. 4). The therapist serves as a guide while the individuals are left to interpret their own experience and make their own discoveries.

Thomson (1989) points out that the extreme non-interference approach to the use of art in therapy is revealed in a studio note left by Lyddiatt:

No Comments

No Questions

No Standards

In the above approach, the therapist is alert to the therapy process, yet active primarily as a witness to the journey. Lyddiatt (1972) suggests this is an experience of silence and yet of mindful presence. For the therapist this concept is often difficult to understand in our daily western modern busy-ness of the everyday world. Lyddiatt (1972) explains that in a mindful witness there is "a deliberate effort to let a mood speak without seeking to control it, and without being overwhelmed by it" (p. 3).

For much of the work I do with art in the therapy setting I clearly function as witness - I am present, I see and hear, I empathize and acknowledge, and I may ask the client to summarize or clarify. The client, in the end, is the one who knows his/her own truth.

In terms of the perceptions I may have accumulated, and tentative conclusions I may have drawn, I prefer to ask open ended questions leaving discovery and insight to the client. When insights have been shared I will summarize, acknowledge, and support. When an issue seems to be pressing but the client is not talking about it directly, and it seems to me the right time to discuss it I will ask permission to ask about something. Then I proceed with the clear designation that this is my perception, wondering or sense, but it is not something the person should automatically own or accept as truth. There is a continual fine line in seeking client permission and subtly directing choice.

Healing with Art

Harriet Wadeson (1980) in Art Psychotherapy lists six major dynamics which are at play in the healing process of art therapy. These are: imagery; decreased defenses; objectification; permanence spatial matrix; creative and physical energy. The following summarizes Wadeson on these points (Wadeson, 1980, pp. 8-12):

- Imagery: Images made up our thought processes before words, and as word language develops we still continue to form thought through images. Imagery as early conceptual perception forms part of the base for personality and mental development. If dreaming is an accurate portrayal of the unconscious then images flourish in the unconscious.

- Decreased Defenses: Art activity is not the dominant means of communication and organizing of thought processes therefore it lacks some of the habituated defenses associated with verbalization. As creatures of a left brain culture many of our defenses are expressions of rational left brain activity. Art activity, however, bypasses some of these cognitively driven psychological inhibitors.

- Objectification: Through art, psychological material can be projected into an external object, thereby distancing from the inner self. As the artworks are mentally, emotionally and physically manipulated and transformed, so too is inner experience. In particular, overwhelming inner experience which is contained in an art object can be held at a safe psychological distance, and from the safety of that vantage point can be investigated and worked through.

- Permanence: Unlike the verbal content of therapy which can be forgotten, or, at least, the detail of discussion blurred with time, productions of therapeutic art will retain their chronicle of the therapeutic work. The therapeutic content in the art can be returned to later for further processing. In addition, as the layers of healing are peeled away, the initial unconscious elements of the art work can begin to have greater conscious meaning and therapeutic significance.

- Spatial Matrix: Art productions are not confined by the linear restrictions of language, time, relationship in space and the rational logic of order. As such, art process and images may better represent the human experience, particularly in areas where linear words are insufficient.

- Creative and Physical Energy: Wadeson (1984) describes a phenomenon of increased energy in the creative process. She believes this charges both the individual and group with greater alertness and participation.

In reviewing my natalistic art therapy and workshop programs I would add to Wadeson's list the following characteristics which art provides: holistic synthesis, unconscious expression, dream material, body expression, emotional discharge, pacing, creating altered states of consciousness, assisting the preverbal to become verbal, natalistic expression, repatterning, psychological induction, communication, ensoulment and interpretation. These constituents are defined below and are further developed in the text: Properties of Natalistic Art.

- Emotional Discharge: Art is synonymous with expression, and expression is synonymous with emotional release. As talk in therapy allows and encourages therapeutic discharge of emotional anxiety, creative expression can also be a means of telling and letting go of a buried or pent up feeling. Emotions which are difficult to articulate with verbal language can have greater opportunity for release through artistic expression.

- Art Activity as Altered State of Consciousness: Artistic expression also allows or even encourages shifts in levels of consciousness or modes of processing. Early, as well as other, traumatic material may be reverberating in dissociated states of consciousness (Stewert, 1987), or non-ordinary states of consciousness (Grof, 1985). Art activity may have particular advantages for reaching these states.

- Assisting the Preverbal to Become Verbal:
Pre- and perinatal experiences are preverbal and, like art, are nonverbal. This may be one reason why they are such friendly partners. Art work brings the preverbal to one level of consciousness. Observation, writing and discussion bring the material to another level.

- Psychological Induction and Suggestion:
Part of personal transformation as a result of art activity derives from the visually implied expectation of change. The energy surfacing in the creative process or the images themselves can imply and therefore release, understanding and new ways of relating. For the artist, consciously and unconsciously, these can serve as concrete suggestions and induction for change. Art images, then, reach deep into the psyche and are actively held there for long periods of time.

- Emotional Repatterning Through Art:
The art process may break through deeply habituated emotional patterns. Through emotional release and through reframing which arise through the art process or the visual content of art, new perceptions of the self and relationships are made possible.

- Physical Repatterning:
Emotional and psychological issues often impact on and are stored in the body. Art work has a particular facility, frequently far superior to words, for permitting the expression of somatic sensation and anxiety. Through visual expression, and, quite importantly tactile experience and kinaesthetic movement, body blocks and patterns can be released and repatterned.

- A Holistic Synthesis of the Person:
Art ctivity engages the individual on numerous levels consciously and unconsciously. As such, art as a therapeutic modality has a innate affinity with a holistic approach to the person. In addition, art activity has a propensity for use in conjunction with other modalities, allowing its efficient use in eclectic or holistic approaches which incorporate a wide range of therapeutic approaches.

The text: Properties of Natalistic Art.discusses each of these healing properties of art in much greater detail, in particular as they relate to natalistic art activity.


Michael C. Irving, Ph.D. and Cheryl Irving, B.A.
have a private practice partnership serving
as psychotherapists with individuals and groups.

For more than 20 years their practice has encompased individual clients and psychotherapy workshops and trainings on - healing emotional trauma through regressive therapies, mind/body integration, dissociative disorders, ego state therapy, primal therapy, art therapy, prenatal parenting and, working with pre and prenatal issues through art.
To book clinical work or

mediation call (416)469-4764

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