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The Introductory Guide

to Art Therapy
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The lntroductory Guide to Art Therapy provides a comprehensive and accessible

text for art therapy trainees. Susan Hogan and Annette M. Coulter here use their
combined clinical experience to present theories, philosophies and methods of
working clearly and effectively.
The authors cover multiple aspects of art therapy in this overview of practice,
from working with children, couples, families and offenders to the role of
supervision and the effective use of space. The book addresses work with diverse
groups and includes a glossary of key terms, ensuring that complex terminology
and theories are clear and easy to follow. Professional and ethical issues are
explored from an international perspective and careful attention is paid to the
explanation and definition of key terms and concepts. Accessibly written and free
fromjargon, Hogan and Coulter provide a detailed overview of the benefits and
possibilities of art therapy.
This book will be an indispensable introductory guide for prospective students,
art therapy trainees, teachers, would-be teachers and therapy practitioners. The
text will also be of interest to counsellors and other allied health professionals
who are interested in the use ofvisual methods.

Susan Hogan is Professor of Cultural Studies and Art Therapy at the University
ofDerby, UK. She has written extensivelyon the relationship between the arts and
insanity, the role of the arts in rehabilitation and on women's issues in art therapy.

Annette M. Coulter is a British-trained and Australian-based art psychotherapist

specialising in children, adolescents, families, groups and couples. She has
pioneered art therapy training and professional development in Australia and
Singapore. Through the Centre for Art Psychotherapy, she provides consultation,
supervision, education and customised training.
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 T hel nt rod u c tory G u i d e
to Art Therapy
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Experiential teaching and

learning for students and
practitioners

Susan Hogan and

Annette M. Coulter

i~ ~~o~!~~n~~~up
LONDON AND NEW YORK
 First published 2014
by Routledge
27 Church Road, Hove, East Sussex, BN3 2FA
and by Routledge
7ll ThirdAvenue, NewYork, NY 10017
Routledge is an imprint ofthe Taylor & Francis Group, an informa business
© 2014 Susan Hogan and Annette M. Coulter
The right of Susan Hogan and Annette M. Coulter to be identified as authors
of this work has been asserted by them in accordance with sections 77 and
78 ofthe Copyright, Designs and Patents Act 1988.
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All rights reserved. No part of this book may be reprinted or reproduced or

utilised in any fonn or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any infonnation storage or retrieval system, without pennission in writing
from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library ofCongress Cataloging in Publication Data
Hogan, Susan, 1961-
The introductory guide to art therapy : experiential teaching and learning for
students and practitioners / Susan Hogan and Annette Coulter.
pages cm
1. Art therapy. 1. Coulter, Annette. H. Title.
RC489.A7H64 2014
616.89·1656-dc23 2013027593
ISBN: 978-0-415-68215-2 (hbk)
ISBN: 978-0-415-68216-9 (pbk)
ISBN: 978-1-315-84918-8 (ebk)
Typeset in Times N ew Roman by
HWA Text and Data Management, London
 Contents
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List 0/figures Vll

About the authors V111
Foreword by Judith A. Rubin Xl
Acknow ledgements xv

I Introduction: the scope ofthe book I

SUSAN HOGAN

2 What is art therapy? The art therapy environment: managing

and using the space 9
SUSAN HOGAN

3 Reftections on experientialleaming 26
SUSAN HOGAN

4 An introduction to art therapy: further reftections on teaching

directive art therapy at an introductory level 32
SUSAN HOGAN

5 Becoming an art therapy practitioner 52

ANNETTE M. COULTER

6 Teaching art therapy to other allied health professionals 64

ANNETTE M. COULTER

7 Innovative teaching strategies 77

ANNETTE M. COULTER
 vi Contents

8 An overview of models of art therapy: the art therapy

continuum - a usefu1 too1 for envisaging the diversity of
practice in British art therapy 89
SUSAN HOGAN

9 The ro1e of the image in art therapy and intercu1tura1

reftections: working as an art therapist with diverse groups 105
SUSAN HOGAN
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10 Working as an art therapist with chi1dren 122

ANNETTE M. COULTER

11 Working as an art therapist with offenders 139

ANNETTE M. COULTER

12 Art therapy with coup1es and families 151

ANNETTE M. COULTER

13 Group work with adults and the group-interactive art therapy

model 164
SUSAN HOGAN

14 Art therapy and co-therapy 175

ANNETTE M. COULTER

15 Starting supervision - vu1nerability in supervision: aspects of

hopelessness, inadequacy and anxiety in the initial stages of a
supervisory relationship 187
SUSAN HOGAN

16 Models of supervision and personal therapy 205

ANNETTE M. COULTER

17 International perspectives 217

ANNETTE M. COULTER

18 A critica1 glossary of key terms informing art therapy 232

SUSAN HOGAN

Index 242
 Figures
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2.1 The London Art Therapy Centre 14

2.2 Art therapy rooms need not be sterile white boxes 15
2.3 Paintbmsh mobile, The London Art Therapy Centre 16
4.1 Student handout: reflecting on experiential workshops 39
5.1 My family, by Elizabeth, age 8 57
9.1 Navajo symbolism 118
9.2 Life history 118
10.1 A picture of my name 125
10.2 A picture that tells us something about you 126
10.3 A badge for myself, by Vicky, age 11 126
10.4 A badge for myself, by Sarah, age 12 127
10.5 The group as trees, by Michelle, age 13 128
10.6 A recurring nightmare, by Nathan, age 14 129
10.7 Boring, by Nathan, age 14 129
10.8 A volcano, by Darren, age 7 130
15.1 The Reflective Cycle 190
 About the authors
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Annette M. Coulter studied fine art in Australia (Queensland College of Art,

now Griffith University) before travelling to England, where she completed a
postgraduate diploma in Art Therapy (Hertfordshire College of Art and Design,
now Hertfordshire University) and a Master of Arts in Art Education with an
art therapy specialisation (Birmingham Polytechnic, now Birmingham City
University). She is a registered art therapist practitioner with the Australian and
New Zealand Arts Therapy Association (ANZATA), the American Art Therapy
Association (AATA), and the Korean Art Therapy Association (KATA). As a
clinical family therapist she is also registered nationally with the Psychotherapy
and Counselling Federation of Australia (PACFA), and the Australian Register of
Counsellors and Psychotherapists (ARCAP).
In England, she served on the Council for the British Association of Art
Therapists, (BAAT), as secretary and newsletter editor. Motivated by working in
professional isolation, she drew on this experience to co-found both the Australian
National Art Therapy Association (now ANZATA), and the International
Networking Group of Art Therapists (INGAT).
She has worked as an art therapy clinician since 1976. Her clinical experience
includes adult mental health, a therapeutic community, day hospitals, intellectual
disability, child psychiatry, juvenile detention centres, child guidance clinics,
community welfare, education and supervising art therapy students on clinical
placement. Ongoing professional development includes analytic group work,
family therapy, psychodrama, sand play and child and adolescent psychoanalytic
psychotherapy. She has also completed training as an Interactive Drawing Therapy
(IDT) practitioner and is an endorsed IDT teacher and supervisor.
She specializes in working with children, adolescents and their families and
for eight years conducted ongoing individual, family and group art therapy in
a residential hospital setting for emotionally-disturbed children and supervised
art therapy students from overseas. She worked in a residential school for
marginalized, conduct-disordered, male youth; coordinated adolescent and family
counselling services in regional Australia for thirteen years; and was a clinical
coordinator for Relationships Australia.
 About the authors ix

She has worked as an art therapy educator since 1983, initially coordinating an
undergraduate art as therapy elective at Queensland College of Art. In their first
years of establislunent, she was clinical coordinator and course coordinator for the
Master of Arts in Art Therapy at Edith Cowan U niversity, Perth, and the U niversity
of Western Sydney. For over twenty years, she has taught a one-year foundation
studies in Art Therapy course through the Centre for Art Psychotherapy which
pre-dates the establislunent of Australian art therapy training. More recently, she
was the programme leader on the first Master of Arts in Art Therapy in south-east
Asia at LaSalle College of the Arts, Singapore. Currently, she works in private
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practice in the BIue Mountains, Australia, offering individual, couple, family and
group art psychotherapy consultation, supelVision and education.
Annette's recent publications include: 'Contemporary Art Therapy with
Transient Youth' (in H. Burt, Art Therapy and Postmodernism: Creative Healing
Through a Prism, 2011); "Tame Back - Didn't Come Horne": Returning from
a War Zone' (in M. Liebmann, Art Therapy and Anger, 2008); 'Couple Art
Therapy: Seeing Difference Makes a Difference' (in E. Shaw and J. Crawley,
Couple Therapy in Australia: Innovative Approaches, 2007); and 'Art Therapy
in Australia: The Extended Family', Australian and New Zealand Journal ofArt
Therapy, October 1(1): 8-18 (2006).

Susan Hogan has a BA degree in Fine Art, a postgraduate diploma in art therapy,
a master's degree in Arts Administration (Arts Policy and Management) and a
further master's degree in Social Science Research Methods (Social Policy and
Sociology). Her PhD was in Cultural History (looking at the history of ideas
around madness and the use of the arts) from Aberdeen University, Scotland.
Susan has also undertaken further training in group-analytic psychotherapy.
She selVed for six years as a Health Professions Council (UK) 'visitor'. She is a
former vice-president of ANATA (Australian National Art Therapy Association,
now ANZATA) and has twice selVed as a regional co-ordinator for the British
Association of Art Therapists (BAAT). She has been instrumental in setting up
several art therapy training courses.
Susan qualified as an art therapist in 1985. She has a particular interest in
group work and experiential learning, following early employment with Peter
Edwards MD, an exceptional psychiatrist who had worked with Maxwell Jones,
a psychiatrist who is associated with the 'therapeutic community movement'
in Britain. She is currently a professor in Cultural Studies and Art Therapy at
the University of Derby, where, for many years, she facilitated experiential
workshops and the closed-group component of the art therapy training. This
training is based on the group-interactive approach described by Professor Diane
Waller (summarised in this book). Now most of her time is spent supelVising and
conducting research.
Susan has also undertaken work with pregnant women and women who have
recently given birth, offering art therapy groups to give support to women and an
 x About the authors

opportunity for them to explore their changed sense of self-identity and sexuality
as a result of pregnancy and motherhood. She has published extensivelyon this
subject.
Susan has worked in academia since 1990 for a number of institutions,
including The University of New South Wales, The University of Technology,
Sydney, Macquarie University and the National Art School, Sydney.
Her major intellectual work is Healing Arts: The History of Art Therapy
(2001), described by the late professor of psychiatry, Roy Porter, as 'sure to be the
definitive monograph on this subject for the foreseeable future'. Her other books
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comprise Feminist Approaches to Art Therapy (as editor, 1997); Gender lssues
in Art Therapy (as editor, 2003); Conception Diary: Thinking About Pregnancy
and Motherhood (2006); Revisiting Feminist Approaches to Art Therapy (as
editor, 2012); andArt Therapy Theories (in press). She is currently co-writing on
women's experience of ageing with sociologists from the University of Sheffield
and on the arts and humanities in mental-health rehabilitation with scholars from
Nottingham University. Additional to all the above, she has also published a
number ofboth scholarly and polemical papers on women and theories of insanity.
Particularly infiuenced by the anthropological work of her late mother-in-
law, Dame Professor Mary Douglas, Susan's work has been innovative in its
application of social, anthropological and sociological ideas to art therapy and her
unwavering challenge to reductive psychological theorising.
 Foreword
Judith A. Rubin, PhD, ATR-BC, HLM
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That an American art therapist is contributing a foreword to a book by authors from

the UK and Australia is indeed remarkab1e. A1though there have been chapters by
colleagues from across the Atlantic in books edited on both sides of the ocean,
a foreword is additional evidence of respectful collegial re1ationships. For me,
being included in this way is a further confirmation of art therapy's increasing
maturation. I am not only honored to be invited, but am also p1eased that the fie1d
in which I have spent a half centmy has achieved sufficient security to be ab1e to
reach comfortab1y across borders, whether geographic, politica1, or theoretical.
As I reflect upon art therapy's "coming of age," I am also reminded of how
greatly my own work has been nourished by inspiration - not just from within
the US - but from abroad, and especial1y from the UK. Susan Hogan asked that
I write "a foreword, which perhaps focuses, in an inspirationa1 way, on some of
the art therapy highlights ofyour career." I have therefore 100ked back as well as
ahead, and it has been a personal1y rewarding joumey that I hope the reader will
find informational, if not inspiring.
When I first entered this embryonic profession in 1963, there were only a
handfu1 of books written by anyone calling him or herself an "art therapist," al1
ofwhich I read eagerly, feeling virtual1y "starved" for information. Two were by
a pioneer from Britain, Adrian Hill (1945, 1951); four were by two Americans,
Margaret Naumburg (1947, 1950, 1953) and Edith Kramer (1958). Having been
an art teacher before becoming a therapist, I had already been inspired by the
writings of art educators who viewed their work as therapeutic - authors 1ike
Viktor Lowenfe1d (1939, 1957), F10rence Cane (1951), and Seonaid Robertson
(1963). Scouring the library stacks in search of more such nourishment, I will
never forget the thrill of discovering On Not BeingAble to Paint by British analyst
MarionMilner (1957), orofreadingAustralian psychiatristAinslie Meares (1957,
1958, 1960) whose "shapes of sanity" had a lasting impact on me.
These writers were the first "kindred spirits" I found in my quest for
understanding and, I believe contact, though they were mere1y vicarious
acquaintances from one-way meetings on library she1ves. Yet because I was then
the only art therapist in the city ofPittsburgh, discovering peop1e who articu1ated
in print w hat I was groping to conceptualize for myself in this new and challenging
 xii Foreword

work was helpful in a way that is difficuIt to convey in an era where art therapy
is so well known.
Perhaps the intensity of my response to my newfound literary "friends" was
related to the emotional meaning for me of art therapy at that time in my life. It
is no exaggeration to say that its discovery had been like finding my true self,
reflected in the title of a chapter I contributed to Architects ofArt Therapy, "An
U gly Duckling Finds the Swans" (Rubin, 2006). In fact, I have always feIt that
becoming an art therapist "fit" me in a way that being an artist, art teacher or art
historian (another career I had contemplated) had not. Thus, meeting others with
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a similar passion for "image magic" (Kris, 1952) - even on the printed page -
evoked a deep sense of kinship, and helped to alleviate my feelings of isolation.
It is no surprise, then, that meeting people in person was even more thrilling.
In 1968, I had lunch with a delightful fellow from Scotland who had just given a
stimulating paper on "The Psychology ofU gliness," Ralph Pickford (cf. Pickford,
1967). As one of the hundred people who attended the first conference of the
American Art Therapy Association in 1970, I feIt like I had found my professional
family. I feIt an immediate bond with my roommate for a week-long seminar
(Rubin, 1972), British art therapist Diana Halliday, probably because her work
with children was so like my own. At the next seminar I fell in love with Seonaid
Robertson, a Scottish art educator whose book I had already read and admired
(Robertson, 1963). Soon afterward I met Michael Edwards and Edward Adamson,
also from the UK, also kindred spirits.
As I recall the pleasure of meeting these colleagues from across the Atlantic, I
also remember that for many years I found myself wondering why the literature
from Great Britain seemed so rarely to refer to anything written in America and
vice-versa. Of course there were exceptions, but for the most part it seemed that
art therapy was growing relatively independently in each ofthe two places where
it was also developing most extensively. Whatever the reasons, I am pleased to
see that over time, especially during the past decade, that situation has definitely
begun to change. This healthy development, while due mainly to the maturation
noted earlier, has also been facilitated by the tmly remarkable global blossoming
of the field in recent years.
This growth, reflected in a proliferation of international organizations and
websites, was also the motivation for arecent film with contributions from
colleagues on every continent - "Art Therapy: aU niversal Language for Healing"
(Rubin, 2011). A related film project in 2011 was accomplished with the help
of volunteer translators and monetary support from art therapy associations
around the world - a DVD of" Art Therapy Has Many Faces" (Rubin, 2004) with
subtitles in 12 languages. The idea came from Liona Lu and the Taiwan Institute
of Psychotherapy, who had created aversion of that same film with subtitles in
both simple and complex Chinese a few years earlier. We are indeed learning from
and helping each other, and it is very good.
Collaborating across the miles on both of these recent films was made infinitely
easier by the existence of the worldwide web. The Internet has surely transformed
 Foreword xiii

our lives in many ways, the email exchange of chapters involved in the creation
ofthis book being one small example. I am convinced, however, that even without
that ease of interchange, the current international blossoming of art therapy
would still be happening now. Just as developments in psychology and art in the
beginning of the twentieth centmy made "art therapy an idea whose time had
come" (Rubin, 2004), so "globalization" has made its evolution as a worldwide
phenomenon inevitable in the 21st century.
The therapeutic value of the arts has, after all, existed from the dawn of human
history. Art therapy - a profession that deliberately hamesses that healing power
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for change - is but arecent reflection of that phenomenon. While the discipline has
so far developed most extensively in the US and the UK, in many other cultures
the arts are even more central, inextricably woven into the fabric of society. It is
therefore no surprise that art therapy is growing in a wide variety of ways around
the globe, compatible with the specific cultures in which it is taking root.
Hopefully, those of us from the Anglo-American community will, when
consulting or teaching abroad, be as sensitive to cultural issues as we are to
individual, familial or group dynamics in our clinical and educational efforts. As
with knowing ourselves in order to best help others, we need to be culturally
aware, sensitive, and competent in order to help support local pioneers in the
global development of art therapy. Knowing our own inevitable biases is nicely
acknowledged in this book.
One of the most enjoyable things about reading the chapters by each of the
authors is that both of them are refreshingly frank about the convictions they have
developed over their professionallifetimes. Although the reader might not agree
with everything they have written, he or she will surely be stimulated as I was to
think long and hard about the topics, some of which are not usually considered
in such detail.
For example, the complexities and benefits of doing co-therapy are the subject
of an entire chapter, and are elaborated in a way that should be helpful to any
art therapist who collaborates with a colleague, student or teacher in offering art
therapy to a family or group. Working with a co-therapist can be extraordinarily
rich and beneficial to clients, but it also presents serious challenges to the workers.
Remaining aware of the delicate transference and counter-transference issues
that are inevitably stimulated for each clinician is vital, but is also frequently
overlooked.
This book addresses other issues that are rarely discussed or - if treated - not
in such useful detail. One of these is the art therapy space, the room in which the
healing power of art is made possible; this is a topic that every worker needs to take
seriously in order for true transformation to occur. While art therapy can of course
be offered under less than optimal conditions - like a crowded hospital ward or
homeless shelter - making the space as safe as possible is absolutely essential. If
there is aseparate room, then making sure that the physical environment provides
a "framework for freedom" (Rubin, 2005) requires the most thoughtful attention
from the art therapist.
 xiv Foreword

Another welcome aspect of this volume is the fact that no fewer than fOUf
chapters are devoted to the nitty gritty of teaching - from single workshops to
extended courses - and deal with educating art therapy students, allied health
professionals, and art therapists at all levels of experience. A similarly substantive
contribution is the inclusion of three chapters devoted completely or partiaHy to
supervision. Like those detailing teaching methodologies and rationales, they will
be most helpful to art therapists who train others in supervisory sessions as weH
as in classrooms.
Both authors, having been clinicians as weH as educators for many decades,
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bring their considerable expertise to bear on topics with which they are intimately
familiar. I hope that everyone who reads this book - from interested beginners to
experienced practitioners - will be inspired by its contents to enhance his or her
own efforts to provide and to promote the incredible healing power of art.

Bibliography
Cane, F. (1951). The Artist in Each ofUs. London: Thames and Hudson.
HilI, A. (1945). Art Versus Illness: a Story ofArt Therapy. London: Allen and Unwin.
HilI, A. (1951). Painting Out Illness. London: Williams and Northgate.
Kramer, E. (1958). Art Therapy in a Children s Community. Springfield,IL: C.C. Thomas.
Kris, E. (1952). Psychoanalytic Explorations in Art. New York: International Universities
Press.
Lowenfeld, V. (1939). The Nature ofCreative Activity. London: Routledge and Kegan Paul.
Lowenfeld, V. (1957). Creative and Mental Growth. Third edition. New York: Maemillan.
Meares, A. (1957). Hypnography. Springfield,IL: C.C. Thomas.
Meares, A. (1958). The Door ofSerenity. London: Faber and Faber.
Meares,A. (1960). Shapes ofSanity. Springfield,IL: C.C. Thomas.
Milner, M. (1957). On Not Being Able to Paint. New York: International Universities Press.
Naumburg, M. (1947). Studies ofthe "Free" Art Expression ofBehavior Problem Children
and Adoleseents as a Means of Diagnosis and Therapy. Nervous and Mental Disease
Monograph, 1947, No. 17.
Naumburg, M. (1950). Schizophrenie Art. New York: Grune and Stratton.
Naumburg, M. (1953). Psychoneurotic Art. New York: Grune and Stratton.
Piekford, R.w. (1967). Studies in Psychiatrie Art. Springfield,IL: C.C. Thomas.
Robertson, S. (1963). Rosegarden and Labyrinth. London: Routledge and Kegan Paul.
Rubin, JA. (1972). A Framework for Freedom, in M Perkins (ed.) International Seminar
on the Arts in Education. Laneaster, MA: Doetor Franklin Perkins Sehool.
Rubin, JA. 2004. Art Therapy Has Many Faces. VHS/ DVD. Pittsburgh, PA: Expressive
Media, Ine.
Rubin, JA (2005). Child Art Therapy. Seeond edition. Somerset, NJ: Wiley.
Rubin, JA. (2006). An Ugly Duckling Finds the Swans, in MB. Junge and H. Wadeson
(eds) Architects ofArt Therapy. Springfield,IL: C.C. Thomas, pp. 105-2I.
Rubin, JA. (2011). Art Therapy: a Universal Language for Healing. Pittsburgh, PA:
Expressive Media, Ine.
Rubin, JA. (2011). Art Therapy Has Many Faces, with Subtitles in 13 Languages.
Pittsburgh, PA: Expressive Media, Ine.
 Acknowledgements
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Annette M. Coulter
Most of the material for my contribution comes from short courses that were
developed for the promotion of art therapy in Australia and south-east Asia.
Throughout this time, my clinical supervisors, in particular, Peter Blake, Brian
Cade and Mee Mee Lee, played pivotal roles in the synthesis of my thoughts and
ideas through challenging clinical and teaching experiences.
Dr Marcia Rosal introduced me to the practical experience of North American
art therapy by inviting me to assist her PhD research in Australia, and Shirley
Riley significantly infiuenced my work with adolescents, families and couples. I
would also like to acknowledge gratitude to Maureen Crago, Elizabeth Bums, Dr
Maralynn Hagood, Dr Marcia Rosal and Dr Nancy Slater who contributed to the
final editing of my chapters, as well as David Brazil for his technical assistance
with images. I am especially gratefill to Dr Maralynn Hagood and Liz Sheean for
their ongoing wisdom and interest.
Art therapist, Jean Eykamp had an original vision for this book and encouraged
me to write for publication. Other art therapists who have directly and indirectly
contributed to this researchinclude: Janie Stott, SheilaMumgiah, ElizabethAylett,
Dr Susan Joyce, Claire Edwards, Jennifer Pitty, Jessica Koh, Nancy Caldwell,
Melissa Strader, Susanne Calomeris and Dr Donna Betts.
Thanks also go to my partner Boudewijn Maassen, and my family, in particular
my parents Pauline and Neil, and my grandmother Margaret Springgay, for their
understanding, interest and encouragement.
Finally, I am very grateful to my colleague, friend and co-author, Dr Susan
Hogan whose publication experience, belief in my contribution and patience
to critique my chapters has been tirelessly supportive. There are also the many
clients, students and colleagues with whom I have worked over the years who
have extended my skills, challenged my knowledge and stretched my experience.
 xvi Acknowledgements

Susan Hogan
Earlier versions of chapters three and four were published in the ANATA
Newsletter several years ago; the chapters have been substantially revised. An
earlier version of the OvelView of Models of Art Therapy (Chapter 8) appeared
in lnscape: The International Journal of Art Therapy; this version has been
significantly re-written, partly in view of subsequent feedback. Thanks again to
Dr Andrea Gilroy, Micheie Gunn, Dr Susan Joyce, Rosy Martin and Nick Stein
for their original connnents; I' m particularly indebted to Micheie for her excellent
and detailed critique, to which I hope I responded adequately. Thanks also to
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Micheie for the elegant rainbow analogy. I would also like to thank the lnscape
critical reviewers for their thought-provoking remarks, to which I attempted to
respond in the original version. Tim, as editor of lnscape (HAT), also made some
helpful critical suggestions that I appreciated and which improved the piece. My
chapter on supelVision was scmtinised by university colleagues in one of our
peer-review sessions, so thank you to all those who contributed to the critique.
Regarding Chapter 9, I would like to thank Gary N ash for alerting me to the work
ofLofgren, and for making me think harder about this topic.
General thanks too is required for all those who have been prepared to engage
with me intellectually on these topics, especially my colleagues Jean Bennett,
Jamie Bird and Shelagh Cornish. Final thanks to Annette for her initial suggestion
that we do something together.
Routledge have a rigorous production process, which entails soliciting critical
comment on the manuscript at various junctures during its development, and this
is an important reason why we wanted to publish this book with Routledge. We
would both like to acknowledge the hard work of our editor Joanne Forshaw and
her assistant, Susannah Frearson. Thanks to Rolly Knapp for the excellent layout
and design.
Figures 2.1 and 2.3 are copyright of The London Art Therapy Centre and
photographer Peter Lurie (lightworkerarts.com) (2012), and are reproduced here
by their kind permission.
Figures 9.1 and 9.2 originally appeared in D. Lofgren (1981) Art Therapy and
Cultural Difference, American Journal ofArt Therapy 21, 25-32, and are used
here by permission.
Figure 15.1, The Reflective Cyde, first appeared in G. Gibbs (1988) Learning
by Doing: A Guide to Teaching and Learning Methods (Oxford: Oxford Further
Education Unit, Oxford Polytechnie), and appears here by permission.
 Chapter I

Introduction
The scope of the book

Susan Hogan
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I try not to forget that each painting is a rulique expression of the individual who
painted it - no one else could have done it. It has to be honoured as a unique
creation.
(Elizabeth Colyer, c.1986)

Scope
This book is an indispensable introductory guide for prospective students, art
therapy trainees, teachers, would-be teachers and therapy practitioners. The text
will also be of interest to an increasing number of counsellors, and other allied
health professionals, who are interested in the use ofvisual methods. The overall
aim ofthe book is to serve as a well-rounded introduction to the subject.
The lntroductory Guide to Art Therapy is intended to be a key text for trainees,
a handbook for professional art therapists and a resource for other practitioners
wishing to use art in their work. The text has been written so that it can also serve
as apreparatory text, with careful attention being paid to the definition of key terms
and concepts. The philosophy and main styles of working are elucidated without
one particular model being promoted above others, thus giving an essential, and
previously lacking, even-handed introductory overview ofthe subject. The lucidity
of the pro se makes complex topics easily comprehensible. The book presents the
principles of experientiallearning and reflective practice in an art therapy context. It
moves on to explore professional and ethical issues with an international perspective.
As a good all-round introduction to the subject, it is useful for other
professionals wishing to get a sense of what art therapy is and how it is used. A
would-be employer could pick up this book and, after digesting it, have a clear
understanding of the potential role of the art therapist within their organisation.
The volume is therefore useful in a range of contexts.
The lntroductory Guide will cover all aspects of essential practice. Written with a
self-conscious absence of jargon and 'psycho-babble', this book aims to demystify
art therapy. Therefore, this text should be useful for those coming new to art therapy.
In particular, we hope that trainee art therapists will want to turn to this book as their
starting point, but it should also be of interest beyond a trainee readership.
 2 Introduction

The two authors have distinctive voices and points of view; both are mature
practitioners able to offer different, but complementary, perspectives. We may not
always agree, but there is mutual respect apparent.

Outline of content
The book explores the context and definition of art therapy. Then chapters which
explore experiential learning and teaching (useful equally for the art therapy
trainee and the art therapist who is thinking of mnning workshops) follow. The
book then goes on to explore art therapy theory and aims to give an overview
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before examining art therapy with different populations in several chapters. This
is followed in the last chapters by an examination of the supervisory issues, then
finally concludes with a consideration of professional issues in a global context.

Defining art therapy

This introductory chapter will outline the scope of the book and present a summary
ofthe book's contents as follows.

2. What is art therapy? The art therapy environment:

managing and using the space
The chapter will give an overview of the term 'art therapy'. It moves on to
describe the art therapy room, and explores ideas about managing the art therapy
space, including the storage of art works. The basic principles of good practice
will be articulated regarding the importance of confidentiality. The implications
of sharing a room with other therapists or other art therapy practitioners will be
explored, especially with regard to the pros and cons ofbeing able, or not able, to
put art work up on walls. The disposal of group art objects will also be discussed.
The context of art therapy will be articulated. Different client groups and work
settings will be outlined, from prisons to palliative care. Finally, abrief section on
the history and development of art therapy is also included.

Art therapy - teaching and learning

3. Reflections on experiential learning
This chapter explores the concept of 'experientiallearning' in detail. The chapter
is based on the author's experience ofteaching stmctured introductory courses in
art therapy since 1990, and will discuss how to teach art therapy experientially.
It looks at the role of pictorial symbols, analogies and metaphors, and also at the
overall stmcture of art therapy sessions. The configuration of the workshops, the
ability to compare and contrast different formats and then how these different
formats infiuence the dynamics of the group is discussed; techniques which can
be used to help participants to start to reflect upon this are described and analysed.
 Introduction 3

4. An introduction to art therapy: further reflections on

teaching directive art therapy at an introductory level
This chapter elaborates in detail on the content of an art therapy workshop series.
The aim of the workshops is to present participants with a variety of quite different
formats so that they can see the scope of 'directive' art therapy; all the sessions
are structured. It is possible that participants may discover one particular way of
working they enjoy, or they may go on to employ a range of group formats with
clients if they study further in the subject and become practitioners. The different
techniques are described in detail.
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The chapter also presents a basic analytic 'tool' for students to help them to
reflect on their experience of group work and get full benefit from the experiential
group work. An analytic tool, or aid, is useful because reflecting on the multi-
levelled nature of group work is complex. Students can use the tool as a starting
point for their own detailed analysis of the group work in their reflective diaries;
it is hoped that it won't be used as a reductive checklist. The concept of 'reflective
practice' is elaborated.

5. Becoming an art therapy practitioner

On completing their training, art therapy graduates begin a new phase of their
career: the process of finding employment. This chapter covers important topics
for practice, from negotiating a job description to suitable attire.
There is also a section on commonly used art therapy assessments. The aim of art
therapy assessments varies. Assessment can include assisting in the establishment
of a diagnosis (particularly in those countries in which private health-care
insurance dominates). Assessment can also be used to determine the suitability
of an individual for art therapy (and the chapter outlines several such art-based
evaluations). Assessment also refers to the evaluation ofthe progress oftherapy, as
well as the evaluation of outcomes. In Britain, standard measures of effectiveness
have been developed which focus on the outcome of therapeutic interventions.
Clinical Outcomes Routine Evaluations - Outcome Measure (CORE-OM) - for
example, is being used to try to produce cohesive global evidence of clinical
effectiveness. However, Gilroy, Tipple and Brown (2012) note the presence of a
'hetero ge ne ity of assessment practices' in clinical practice (p. 219).

6. Teaching art therapy to other allied health professionals

Some of our work is about running educative consultation training for established
clinical teams, or professional groups or individuals who want quick instruction
about using art more effectively in their work. These allied health professionals do
not want to complete art therapy training, but often claim to be already 'doing art
therapy' in their clinics and just want to expand these skills further. This chapter
addresses ways an art therapist can sensitively advise about their profession in
 4 Introduction

this context and demonstrate that just using art materials in a clinical setting is not
necessarily 'art therapy , , despite that w hat may be happening can have therapeutic
aspects to it.

7. Innovative teaching strategies

This chapter addresses current training practices when teaching art therapy
techniques to therapists and counsellors who are already experienced practitioners
in their own right and who wish to make more effective use of art in their clinical
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work. Some innovative teaching strategies are discussed that incorporate current
art therapy teaching practices with the skills and experience of other therapist
practitioners who wish to make use of art more effectively in their work. Qualified
art therapists can be over-protective of their skills and unprepared to share their
expertise with non-art therapists. The realities of being part of a clinical team
and involving interested colleagues with effective art therapy practice can be a
rewarding challenge. The art therapist must be able to share their skills with a
sceptical community or group of health professionals as well as to those who offer
professional support. The main emphasis of this chapter is how to teach art therapy
to colleagues, how to facilitate team-building through the use of art therapy, as
well as how to work in co-therapy with other allied health professionals. The
chapter answers how to integrate specialist art therapy skills into an effective
clinical team, in which the art therapist is valued.

Art therapy theory

8. An overview of models of art therapy: the art therapy
continuum - a useful tool for envisaging the diversity of
practice in British art therapy
This chapter will assist in providing some clarity to a situation that, at first sight,
particularly to training therapists, seems extremely confusing. Art therapy today
is rather complex and 'the art therapy continuum' is an attempt to give an at-
a-glance picture, or 'snap-shot', of this diversity. Like any snap-shot, it does
not reveal the entire landscape, but the chapter gives an overview of the main
models of contemporary art therapy practice. As the chapter illustrates, British
art therapy today is fundamentally eclectic with a number of different theoretical
models in practice. In brief, these are a gestalt psychology approach; an analytic
transference-focused model; a group-interactive model which draws from
existential philosophy and symbolic-interactionism (which will be explained) as
well as psychodynamic theory; an art therapy support-group model which is often
'person-centred' in orientation; and finally studio-based approaches, which are
favoured by some art therapists in Britain today, in which engagement with the
art process is seen as fundamentally curative. These main approaches are outlined
in detail.
 Introduction 5

9. The role of the image in art therapy and intercultural

reflections: working as an art therapist with diverse groups
What is the fundamental difference between art therapy and psychotherapy or
counseHing? How does the image function in art therapy? What is the triangular
relationship? This chapter will discuss the role of the image in the art therapy process
and will sUlvey different ideas about this from different theoretical perspectives.
The role of the art making differs in different modes of art therapy. Some of the
tensions between visual and verbal elements will be elucidated. A discussion of
the pros and cons of directive and non-directive art therapy work is touched upon.
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This chapter brings post-modernist theory to bear on the subject of art therapy;
it chaHenges the reductive use of theory and the over-interpretation of clients'
art, giving examples. A sketch of the main work on cultural difference within
art therapy is also presented. The chapter also interrogates the importance of
maintaining a critical awareness of gender norms in clinical work, whilst focusing
on cultural differences and their acknowledgement within the art therapy process.

Art therapy populations and methods

10. Working as an art therapist with children
The particular skills needed to work with a wide range of different young
clients is presented and discussed. Recommendations for training are made. The
contribution of art therapy to working with children and adolescents is increasingly
appreciated by the general population of art therapist practitioners. This chapter
describes establishing an art therapy service in both mental health and community
welfare settings. The chapter includes consideration of individual and group work
contexts, as weH the role of parents, siblings and the extended family. Reflections
on the importance of non-verbal and not-knowing processes on both the part of
the therapist and the child are included. Links are made to other symbolic and
metaphoric uses of the creative processes such as sand play, free play, drama,
music and dance. The non-verbal aspect of creative thinking and the processing
of emotional issues from a neuroscience perspective are included.

11. Working as an art therapist with offenders

This chapter will outline the use of art therapy in prisons and other secure settings.
It will also provide a broad context for the use of art therapy in prisons providing
an overview of literature in the field on this subject, and a detailed critique of key
texts.
What are the particular dilemmas faced by art therapists working in secure
settings? Drawing on clinical experience, the particular implications of working
with offenders are addressed. Examples from art therapy clinical practice in the
form of short case studies and vignettes are presented to illuminate and illustrate
this work.
 6 Introduction

12. Art therapy with couples and families

This chapter describes how art therapy is used in couple counselling and family
therapy. This includes examining different theoretical approaches with an
emphasis on systemic family and couple art therapy, but also includes more recent
models, particularly narrative and brief solution-focused family and couple art
therapy. There is an integration of psychodynamic and more cognitive approaches
that acknowledges complexity. The use of art in family and couples work
introduces an alternative way to communicate that provides a visual starting-point
or intervention. For some family members, it is easier to say through an art task
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how they are affected by current relationships. It is important for art therapists to
be able to adapt their skills to suit all members of the family, or to accommodate
different thinking within a couples consultation. This is a highly specialised field
within art therapy that needs to include couple and family art therapy assessment
techniques as well as knowledge of effective strategic interventions and other
therapeutic considerations. Another way to consider work with families and
couples is as intensive group work where dynamics are rich, entrenched and
challenging. It is easy for the therapist to become caught up in the dynamic system
that is operating - art therapy offers a way to examine and reflect on the system
and its operating dynamics.

13. Group work with adults and the group-interactive art

therapy model
The basic principles of group art therapy will be articulated. The group-interactive
method will be elucidated. The basic idea behind the group-interactive approach
is that during interactions with others in the group, individuals reveal their
'characteristic patterns of interaction'; these are seen as constraining people
in their everyday lives (Waller 1993: 23). These 'patterns of interaction' are
acknowledged and reflected upon and provide a focus for group analysis.
Therefore, the method employed involves an analysis of clients' here-and-now
behaviour in the group. This is not a simple discussion of clients' issues so much
as a revelation of their present constraints. Such constraints, or habitual ways of
being and thinking, can be revealed through interactions with other members of
the group or depicted in art works. 'Feedback' from participants is an important
part of this method: 'feedback from members of the group illuminates aspects
of self which have become obvious to others but which are not recognised by
oneself' (Waller 1991: 23).

14. Art therapy and co-therapy

An aspect of art therapy practice that is rarely addressed is the issue of art therapists
working in co-therapy. This chapter explores the advantages and importance of
having a co-therapist in group-work practice to enhance service delivery to both
 Introduction 7

clients and students of art therapy services. There is a focus on co-therapy in the
art therapy training groups, particularly a training group that has ron each year
for almost twenty years. Statements and feedback from various art therapists!co-
therapists will also be included as commentary in this chapter, which has been
written in consultation with other co-therapists.

Supervisory issues
15. Starting supervision - vulnerability in supervision:
aspects of hopelessness. inadequacy and anxiety in the
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supervisory relationship
This chapter provides an excellent resource for would-be art therapy supervisors.
It also gives the trainee art therapist a useful insight into what they are likely to
encounter at the outset of their clinical work placement, which forms an important
part of their art therapy training. The chapter explores the anxiety inherent in the
opening stages of the supervision groups in order that trainee art therapists will
gain confidence and prospective supervisors will have a better idea of what to
expect.

16. Models of supervision and personal therapy

This chapter concems ways in which art therapy can be used within the context
of clinical supervision. This is not only for art therapist practitioners, who by the
completion of their training are familiar with the use of art therapy in the context
of clinical supervision, but also explores the use of art therapy in the context of
the art therapist supervising other allied health professionals. This chapter also
includes ways art-making processes can be used in self-supervision for a daily
debriefing; this is of particular benefit to those in isolated practitioner situations.
Examples of client record-keeping, chart-writing and case note-keeping are
presented.

Professional issues
17. International perspectives
The main differences between the North American and British systems of mental
health care have been neatly summarised by Gilroy, Tipple and Brown (2012).
They point out that Britain has free healthcare at the point of access, regardless of
income. In sharp contrast, in NorthAmerica, private health insurance is ubiquitous
(and may become mandatory). Health insurance companies in NorthAmerica are
referred to as 'managed care'. They point out that other health-care providers are
adopting this 'target-driven' culture.
As Coulter's chapternotes, NorthAmerican trained art therapists are more likely
than their British counterparts to be directly involved in applying standardised
 8 Introduction

assessment instruments and formulating diagnoses. In any case, there is a great

diversity of institutions, which leads to differences in emphasis as art therapists
attempt to work within a variety of contexts and teams. Hagood (1994) has noted
that in North America systematic, cognitive and humanist models are more likely
to be integrated into art therapy and that there is a greater use of theme-based
approaches. However, it is a misconception that British art therapy is, and has
always been, utterly dominated by psychoanalytic theory (Waller 1991; Hogan
2001) and British art therapy offers a plurality of approaches which are outlined
in early chapters in this volume.
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Originally, the vision for the International Networking Group of Art Therapists
(INGAT) was to provide a forum for an international dialogue. Many countries
are faced with theoretical and ethical dilemmas as they attempt to establish
the profession outside Britain and North America. There is also the need for
sensitivity to cultural context. This chapter addresses how the profession copes
with the problems that arise and considers w hat provisions are required for training
standards to adapt to cultural contexts. This is illustrated by a discussion about
establishing art therapy in countries where the profession was largely unknown.
Part of the international field of art therapy that has barely been addressed, despite
a number of articles and chapters ab out multi-cultural aspects of art therapy, is
the fact that applying an essentially Western form of therapy into other cultural
contexts has ethical, moral and theoretical complexities attached to it. The chapter
also looks at the introduction of art therapy into an Eastern cultural context. How
may Eastern medical practices be accommodated? Is it possible for very different
cultural, spiritual and ethical beliefs to be incorporated into a Western profession?

18. A critical glossary of key terms informing art therapy

Though most technical terms will be defined in the text, some of these terms are
expanded upon in this critical glossary. A definition is provided and also a critical
interrogation of key concepts.

Bibliography
Gi1roy, A., Tipple, R. and Brown, C. (eds) 2012. Assessment in Art Therapy. London:
Routledge.
Hagood, MM 1994. Diagnosis or Di1enuna: Drawings of Sexually Abused Chi1dren. Art
Therapy: Journal of the American Art Therapy Association 11(1), 37--42.
Hogan, S. 200l. Healing Arts: The History of Art Therapy. London: Jessica Kings1ey
Publishers.
Waller, D. 1991. Becoming a Profession: The History ofArt Therapy in Britain 1940-1982.
London: Routledge.
Waller, D. 1993. Group Interactive Art Therapy. London: Routledge.
 Chapter 2

What is art therapy?

The art therapy e nvi ron ment:
managing and using the space

Susan Hogan
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The most common misconception held about art therapy is that it involves the
therapist interpreting the art work, and deciphering and unravelling the meanings
hidden within; on the contrary, it is the creator of the image, not the therapist,
who has this pleasure. The role of the therapist is primarily an insightfully
enabling one. However, there are different models of art therapy and these will
be explained. In the 'interactive model', for example, the therapist's role does
encompass articulating group themes and dynamics.

Definitions of art therapy

Definitions of art therapy are in flux, and it would be an interesting exercise in
itselfto look at the ebb and flow ofthese over time. This chapter shall begin with
some analysis of the recent American and British definitions. Here is the current
definition from the British Association of Art Therapists' (BAAT) website at the
time of writing:

Art Therapy is a form of psychotherapy that uses art media as its primary
mode of communication .... The overall aim of its practitioners is to enable a
client to effect change and growth on a personal level through the use of art
materials in a safe and facilitating environment.

The BAAT definition also clarifies that 'previous experience or skill in art' is not a
prerequisite for engaging in art therapy, and that the art therapist 'is not primarily
concemed with making an aesthetic or diagnostic assessment of the client's
image'. 'Primarily' is curious here, for it suggests, perhaps unwittingly, that art
therapists do indulge in aesthetic assessments of their client's work (though what
that might entail is left for conjecture); certainly, in a British context, art therapists
are seldom involved in the act of diagnosis, which is in the medical domain. On
the other hand, some information about the progress of art therapy is conveyed to
medical staff and often contributes significantly to the team case assessment and
treatment planning decisions.
 10 What is art therapy?

The emphasis in the above quotation is on a psychotherapy which uses art as its
primary mode; thoughts and feelings are expressed pictorially and symbolically
using art materials, with personal change and the amelioration of mental suffering
as the goal. The use of the arts is emphasised as useful 'to people who find it
hard to express their thoughts and feelings verbally', but in practice, it is often
the case that discussion of images follows their making and that this in itself is
enlightening. Indeed, some models of art therapy can become very verbal, but art
therapy is still fundamentally different to verbal psychotherapy, because of the
triangular configuration of participant, facilitator and art object.
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The use of the word 'growth' is interesting, and it suggests an expansion of

personal awareness in the art therapy participant, which will help him or her to
deal better with problems and difficulties as they arise. There is the opportunity to
externalise thoughts and feelings, to visualise them and explore them. As will be
discussed in more detaillater on, some of the communication which takes place
in art therapy is by the participant to himselfvia the image: it is a dialogue with
oneself. Not everything is necessarily revealed to the therapist immediately (or
ever), as it may not necessarily be pictorially explicit or obvious. Certain thoughts
and feelings may be revealed in the participant's own time to the art therapist
and other group members; thus art therapy participants have some control over
how emotionally exposed they are willing to be, which is arguably a distinct
advantage over purely verbal approaches (though internal monologue and silence
are potentially creative options in verbal psychotherapy).
The use ofthe word 'psychotherapy' ratherthan 'counselling' is significant, as
counselling is also interested in effecting 'change and growth on a personal level ';
however, counselling still retains historical connotations of giving 'guidance' in
the resolution of emotional problems, whereas 'psychotherapy', though varied in
its approaches, aims at the communication of confiicts and difficulties with the
development of insight into problems at its core. Arguably the line between some
forms of psychotherapy and counselling has dissolved.
The front page of the American Art Therapy Association's (AATA) website
describes art therapy thus:

Art therapy is amental health profession that uses the creative process of art
making to improve and enhance the physical, mental and emotional well-
being of individuals of all ages. It is based on the belief that the creative
process involved in artistic self-expression helps people to resolve confiicts
and problems, develop interpersonal skills, manage behaviour, reduce stress,
increase self-esteem and self-awareness, and achieve insight.

In this definition the resolution of problems features strongly, but also a potentially
broader approach is evident with an emphasis on engaging in art for increased
well-being. Much 'well-being' discourse in the UK is used by the arts in health
movement, and art psychotherapy has become split off from some of these exciting
developments (often community arts and participatory arts) - a split that some art
 What is art therapy? II

therapists are trying to repair. The aim of art therapy in the American definition
is also potentiaHy more wide-ranging, with behaviour management and increased
self-esteem being explicitly stated as treatment goals. We should not overlook the
emphasis on artistic self-expression as pivotal.
In a section entitled 'Defining Art Therapy', the AATA website elaborates
further:

Art therapy integrates the fields of human development, visual art (drawing,
painting, sculpture, and other art forms), and the creative process with
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models of counseHing and psychotherapy. Art therapy is used with children,

adolescents, adults, older adults, groups, and families to assess and treat the
foHowing: anxiety, depression, and other mental and emotional problems
and disorders; substance abuse and other addictions; family and relationship
issues; abuse and domestic violence; social and emotional difficulties related
to disability and illness; trauma and loss; physical, cognitive, and neurological
problems; and psychosocial difficulties related to medical illness.

It is interesting to note that art therapy is seen as art integrated with both 'models
of counseHing and psychotherapy' in this definition.
The Australian and New Zealand Arts Therapy Association (ANZATA) offers
this definition in its 'What is arts therapy?' section:

Arts therapy uses creative processes, including art making, drama, and
movement to improve and enhance physical, mental and emotional weH-
being. It is suitable for aH ages and many life situations, and can be done
with individuals or groups. Arts therapy works by accessing imagination and
creativity, which can generate new models of living, and contribute towards
the development of a more integrated sense of self, with increased self
awareness and acceptance.

Arts therapy is being used as a generic term in the above quotation to include
drama and other disciplines, but art therapists in Australia and New Zealand do
specialise, rather than undertaking a generic arts therapies training. Thus, art
therapists specialise in using fine art materials.
Again, we can note the emphasis on enhancing weH-being, including 'physical'
weH-being, and although 'weH-being' may encompass physical weH-being in the
AATA definition, this explicit reference seems to point to greater emphasis in this
area. In common with both the BAAT definition and that of AATA is an emphasis
on increased self-awareness; however, the next section on how art therapy works
would seem to remain firmly located in the weH-being arena, with its emphasis
on 'accessing imagination and creativity' and developing 'new models ofliving'.
This seems quite broad and open, and oriented to enhancing quality of life.
However, the view appears to narrow slightly in the 'About arts therapy' section,
which describes it as 'an interdisciplinary form ofpsychotherapy' that is 'generally
 12 What is art therapy?

based on psychoanalytic or psychodynamic principles'. The range of work

undertaken may be broader than that ofUK art therapists: 'Some art therapists also
offer phototherapy, play and sand tray work', as well as diagnosis. It continues thus:

Art therapy is a therapeutic and diagnostic tool where therapist and clientls
develop a dynamic interpersonal relationship, with clear boundaries and
goals. It differs from traditional art in that the emphasis is on the process of
creating rather than on the end product.
Art therapy is a creative process, suitable for all ages, and particularly for
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those who may be experiencing life changes, trauma, illness or disabilities

causing distress for the individual and for their family.
Art therapy works by contributing to changes in the client's inner world ...

In a further section entitled 'How does art therapy help?', the ANZATA site
is explicit about potential benefits of art therapy: it can enable the expression of
feelings w hich are 'difficult to discuss'; it 'stimulates imagination and creativity '; it
can contribute to the development of 'healthy coping skills and focus'; it 'increases
self-esteem and confidence'; it can help to clarify 'issues and concerns'; it can
enhance communication skills; and it provides 'a safe nurturing environment'
in which to share feelings. In relation to physical well-being, it 'assists with
development of motor skills and physical co-ordination' and aids the 'ability to
identify feelings and blocks to emotional expression and personal growth'. 'Coping
skills' are rather ambiguous, but most ofthe above is clear enough.

Art as therapy
Small differences of emphasis between countries aside, in all forms of art therapy
participants are encouraged to explore their feelings using art materials, often
paper and paint, but a variety of materials may be employed, such as collage,
clay and sculpture (wood, wire, metal mesh, plasticine, found materials, including
natural materials such as leaves or stones). As noted above, this can be done
individually or in groups. The role of metaphor and symbols in depicting mood
states, which are hard to articulate, is important. How participants use the art
materials can also contribute to the meaning of the art produced. The art materials
(their very substance) can evoke feelings in the person using them. It is possible
that 'magical' powers can be invested in the image or object and that art works
can take on great symbolic significance for the maker of the image or object.
Therefore, how the image is changed, stored, displayed or destroyed can become
relevant (Hogan 2001). Aseries of images viewed together might be particularly
enlightening, as patterns or a 'narrative' may be discerned.
Conversely, the process of making the image or object may be more important
than the end result - it may be a pictorial struggle, perhaps an inability to resolve
an image which is revealing, or the actual process of constructing it or destroying
it (Hogan and Pink 2010). The end result may seem irrelevant.
 What is art therapy? 13

In group work there may be an emphasis on the individual in the group, with
each participant getting an allotted time to talk to the group as a whole about
their art work. Other approaches may be more interested in exploring interactions
between group participants, as part of a process aimed at illuminating habitual
ways of being, and opening these out for scmtiny and contemplation: this is the
'interactive model' (Waller 1991).

The art therapy environment: managing and

using the space
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Owning the space

Many art therapists have a preference for an art therapy room to look like an art
therapy room: it has a studio-like ambience. When conducting experiential work,
art therapists seek to permit their groups to develop a sense of ownership of the
room by putting up art works on the walls. A number of therapists endorse the
view that this is therapeutically useful; it is possible to leave the work in progress,
or the group work just made, and to have absolute confidence that it will still
be there on the wall the following day or week. The work then functions as a
greeting, or a welcome to the space, to participants. The art object, waiting where
it was left, creates a sense of security and continuity.
The ideal art therapy room is therefore that over which the art therapist has
total control. To leave works out and then to have them moved by another room-
user would be counter-productive and could engender feelings of insecurity and
dismption, or indeed violation, in participants. Obviously, this is a potentially
serious issue, especially if works could become damaged or lost.
A compromise is to have a large walk-in cupboard which can be locked, where
art works can be left to dry, or pinned up, but many art therapists prefer an art
studio to look like an art studio.
Conversely, some art works may fee 1 too personal to be left on display, and
so private storage must be on offer. Nevertheless, art therapy participants will
sometimes wish to display their work, and having this option can feelliberating
for both individuals and groups. The 'white walls' approach feels barren and
constraining; however, it may be the only option if the art therapy room is used
by other professionals for multiple uses. It is a worry that some art therapists may
confiate sterility with professionalism.
Intermptions to sessions can usually be dealt with by liaising with other
professionals, so that they understand that the space must fee 1 contained and safe,
and that intermptions impinge on the participants' feelings of safety and privacy
and dismpt the therapeutic process. Informing and educating other professionals
about how art therapy works is an essential part of an art therapist's role.
Secondly, a 'session in progress, do not disturb sign' is often remarkably effective.
Institutional dynamics can be played out in relation to rooms, especially where
there are space shortages or there is ho stile competition between professionals;
this is when intermptions can feel quite persecutory.
 14 What is art therapy?
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Figure 2./ The London Art Therapy Centre (© The London Art Therapy Centre/
Peter Lurie, lightworkerarts.com)

Confidential locked storage for art therapy work

Lockable storage for art works is an essential requirement for confidential art therapy
work. Ideally, this is a spacious walk-in cupboard to which only the art therapist has
usual access. It is, preferably, sufficiently large that work need not be folded to be
stored. A plan-ehest may be included, or participants may be issued with portfolios
in which to keep their work safe. Shelving, or a cupboard with shelves, is necessary
for the storage of sculptural works.
Art works embodied with strong emotions can become highly significant for the
maker of the image. Joy Schaverien's work highlights how the storage and disposal
of art works can be of great symbolic significance within the art therapy process.
Schaverien (1987: 96) writes:

Frequently the therapist is active in keeping the work. One of the first things I
do with new clients is to provide a folder, on which they write their names. This
sets up an expectation that their work will be kept together, safe and private,
in the art room. It is common practice for art therapists to assert the value of
pictures in this way ...
(myemphasis)

Another example Schaverien gives is the therapist who keeps 'a child's work
on the blackboard during breaks, and the importance to that child of finding it still
there on returning. In this way, even in absence apart ofthem remains ensuring that
they are not forgotten' (my emphasis). This is no less important with adults. People
readmitted to psychiatrie hospital are reassured to find that the art therapist still has
the folder containing their art, even when the previous admission was many years
ago. In this way, she asserts 'the art therapist actively places a value on the work, the
person and the relationship' (Schaverien 1987: 96; my emphasis).
There are different 'styles' of art therapy room. Some art therapists allow
participants to decide if they want to take their work with them, put it away in a
storage area, hide it (knowing it will be left) or simply leave it where they had been
working, knowing that it will be safe until their return.
 What is art therapy? 15
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Figure 2.2 Art therapy rooms need not be sterile white boxes (© Susan Hogan 20 13)

Practical aspects
A room that opens out onto an outdoor space is useful so that work that needs to
be sprayed with fixative can be sprayed outside, or next to an open door if the
outside space feels too overlooked to take the work outside. This is because there
may be group members who have respiratory difficulties and fixative spray can
precipitate an attack or discomfort (or it canjust be irritating).
A sink is apre-requisite for a permanent art therapy facility, but for workshops
a line of buckets for swilling out and lots of large plastic bottles full of water will
suffice.
It is obvious that a certain amount of natural light is also useful in an art therapy
room. Having to use overhead fluorescent lighting can become very oppressive.
A washable floor surface is highly recommended, as carpets can be very
inhibiting. Ideally, a room would contain a range of working environments: an
area where participants can work on the floor; an area with tables; and another
area with some artists' easels and donkeys. (Donkeys are a type of seat, which is
straddled so that one sits facing an easel.)
Rubin (1984) makes the pointthat it is less the layout ofthe room that is cmcial,
so much as how the space is used, though she does warn about aspace that is too
cluttered, which can be distracting. Even an ideal space can be badly used. Rubin
tells this cautionary story:
 I6 What is art therapy?
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Figure 2.3 Paintbrush mobile, The London Art Therapy Centre (© The London Art
Therapy Centre/Peter Lurie, lightworkerarts.com)

... the art therapist, highly skilled in relating to her elderly psychiatrie patients,
had pushed four small tables together - creating a nice, large working surface
about eight feet square, where each group member could easily see and relate
to the others. However, she selected the largest size of paper to give each of
the eight patients around the table, despite the fact that there simply wasn't
enough space available for everyone to use such a big sheet (19" x 24"). For
these disturbed older people, this represented a serious problem, solved by a
few who folded the paper, but for the others, frustrating their efforts to paint
throughout the session.
Although this dilemma sounds minor, the art therapist was so involved
with her presentation to the group, which was meant to motivate them to
paint, that she was quite unaware of the frustration she had unwittingly
stimulated.
(Rubin 1984: 81)

How the space is set up depends on the task in hand as much as the innate
physical characteristics of the room: 'If one wants to observe subgroups and
alliances within a family, it is helpful to have things set up to allow movement in
space, so that customary interaction patterns can be easily manifest in a natural
 What is art therapy? 17

way' (Rubin 1984: 82). In the interactive model, which will be described infurther
detail, enabling movement in the space is of cmcial importance. However, other
models may be used. Here is an example:

. .. each patient worked at a small easel on his individual painting, the

physical setup facilitating individual involvement in the work with minimal
interaction. When finished, the patients bought their paintings to another
section of the large room, tacked them up on the bulletin board wall, and sat
in a semicircle of comfortable chairs, where discussion took place when they
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were all assembled. This setup made it possible to view all of the products at
once, as weIl as to focus on individual pictures in the course of the discussion
led by the therapist.
(Rubin 1984: 83)

If using a studio approach, participants could work at easels, or on donkeys,

with minimal interaction with each other, and with the art therapist visiting each
in turn in their working space. Group dynamics do not form part of the analysis in
this studio model of working.
If art work in progress is to be left out, then liaison with cleaning staff and
janitors is essential to prevent work being moved when the room is being cleaned;
if the room is always cleaned on a specific day, it may be advisable to ensure that
no work is left out on this day, to minimise the possibility of accidental damage.
Having a wide range of art materials on displayand easily accessible is very
exciting for participants; having to hunt around in little cupboards and drawers to
find things is, again, potentially inhibiting, and can intermpt the flow of the activity.

Art materials
Sometimes, using simple cheap materials, perhaps materials familiar from
childhood such as crayons or plasticine, can be liberating. Rubin (1984: 7-8)
suggests that it is the time-boundedness of the art therapy session that leads many
art therapists to be drawn to offering relatively simple materials:

There is much to be said for media which permit the creation of satisfying
products within the space of an art therapy session.

It is recommended to offer a range of materials from the most basic to the best
artists' quality (excepting cheap coloured pencils, which tend to be fmstrating to
work with). Basic materials include water-based paints in blocks or tubes; palates
of different types (some with wells for containment of fluid paints or glue, and
others flat for mixing colours); a good variety ofbmshes, from refined thin sable
to large wall painters' bmshes (bmshes are available in a variety of shapes, which
make different marks, so a range from square-ended to long bristled is ideal);
water pots; and a mixing medium such as PVA.
 18 What is art therapy?

Other materials consist of pencils (again, cheap pencils are worth avoiding);
crayons (from children's type to artists' fine quality); chalks; oil pastels; chunky
graphite sticks; and charcoal. Pens, from fine-line to felt-tips and plump markers,
can be included, and so too erasers, including putty rubbers.
A range of paper should be provided in different colours and qualities. Sugar
paper, foil, fluorescent, tissue and textured papers may be included. The basic staples
are cartridge paper in a variety of sizes, and large roUs of paper, so that there is scope
to do something big. Masking tape, or a double-sided fixative tape of some kind,
is a necessity (for joining sheets together). Many pairs of scissors are needed, as it
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is frustrating if there are not enough for group exercises. Stanley knives or pencil
sharpeners, depending on who is being worked with, may be needed. Handing a
person a knife is a strong symbolic gesture showing trust, which perhaps marks me
out as an older practitioner, as many organisations now may have policies preventing
the use of open blades or even scissors, requiring paper to instead be tom (the latter
in some secure settings). Stanley knives are not appropriate with potentially volatile
clients or with children. A simple printmaking kit of some sort, with boards which
can be etched into, enabling reliefwork, may also be made available.
A good range of sculptural materials should be on offer, including air-drying
clay of some sort. It is recommended that a junk box be established, and it is
possible to ask group members to bring in misceUaneous items they don't want
such as old Christmas decorations (but nothing of sentimental value). Staple guns
(which need instruction to use, and must be clearly demonstrated), wire, wire-
mesh and glue of various sorts are also needed. String and yam are also useful.
Giving a range of materials is important, as, if only cheap materials are on
offer, clients may fee 1devalued (Schaverien 1992). An assortment of art materials
also gives increased scope to participants to find materials they want to work with.
As Rubin (1984: 11) points out, 'a thick long-handled brush can seem powerful
to one person and unwieldy to another', and whilst reactions to materials are to
a certain extent to do with what the maker brings to them, art materials da have
different capacities to yield different results, and some materials are much easier
to contain and control than others. Discovering the aesthetic sensibility of the
substances is part ofthe art therapy process. Certainly, art therapy facilitators need
to have a sophisticated understanding ofwhat the materials can do (Moon 2010).

Sharing space
In a shared room, even if it is only used by other art therapy or art-based groups,
consideration will always need to be given to other room-users. If conducting
an introductory workshop series that will include making large sculptural works,
issues of storage, displayand disposal come immediately to the fore, and can
precipitate a useful discussion.
It should go without saying that mess should be cleared up after sessions, sinks
should be left clean rather than with paint residue in them and surfaces wiped
down, otherwise relations between room-users will quickly deteriorate.
 What is art therapy? 19

Leaving art works out or displayed on walls can provoke reactions from other
room-users. Sometimes, groups compete with each other to hang the largest group
painting, or to hog the best exhibition areas; a sculptural work left in the room
may precipitate an even larger one from another group. If these group dynamics
can be acknowledged and discussed, then this shouldn't prevent some exhibition
of work from occurring in a shared room (psychodynamic work is about
acknowledgement, rather than misguided ideas about 'neutrality').
Art therapists mayaiso exhibit non-clinical drawings or paintings to act as an
inspiration. Other facilitators prefer to work with white walls and to have all art
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works always put away at the end of sessions; for rooms with multiple uses, this
may be the only viable option.

The spoce os 0 form of controct

Art therapy is contained within clear boundaries. It takes place at a consistent time
in the same place, and each session is of the same duration. Some group work may
adopt a constant 'shape' with a certain amount of time allotted to thinking about
the previous session, a specified time for art making and a further allocated slot
for analysis of the images. Some therapists sit in the same place in the opening
circle each week (assuming that a circle is part of the ritualistic opening of the
group work), which enables participants to position themselves in relation to the
facilitator or other participants. There could be a lot said here about this, but to
give one example to start, a particular person may decide to work in front of the
facilitator, facing towards her in a performative way. The facilitator's view is
necessarily dominated by the actions of one individual. Why is this? Is this person
a group monopoliser (Yalom 1995) who needs to be seen? Does this person want to
communicate something in particular to the facilitator? Or is this person sticking
close to the facilitator for comfort? So many interesting questions may be raised by
the physical position in the group of an individual (but more on this later).
For clients who have experienced a great deal of instability and inconsistency
in relationships, this regular, predictable space is important. The art therapy
room offers, as far as possible, the same range of materials each week. It is
a secure space into which other professionals will not wander - they do not
disturb sessions in progress. These important boundaries combine to create a
safe space. An experienced art therapist will make therapeutic use of disasters,
nevertheless. For example, a very large printing press was deposited - 'dumped'
is perhaps a more apt word - in the art room I was working in, as part of a
'turf' competition between factions within the institution (a more powerful bit
of the institution wanted the room in question). The press was a massive and
immovable object, and it had been left in the area in which we'd usually put our
chairs for group discussion. The group members were upset by the intrusion;
some were outraged by what they feIt as a defilement of their space. This led
to group themes of violation of space, and abuse, emerging in response to the
incident. What the press represented for different participants was explored,
 20 What is art therapy?

with difficult emotional material being shared in the group; the incident, though
disconcerting, precipitated a deepening of the group work. Once a group is
established, it can withstand shocks, though the therapist endeavours to protect
groups from intrusions of any sort.
This space set apart from normallife offers an opportunity for self-reflection
and self-observation. The art object itself provides further containment, holding
aspects of the maker's inner life, as will be explored in further detail.

The history and development of art therapy

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Art therapy is a discipline which has emerged out of several tributaries. The
eighteenth-century asylum reform movement arose out of a convergence between
non-conformist religion and utilitarian philosophy. Utilitarian philosophy worked
with ideas of causes and effects, and treatments developed which employed the
idea of 'management' of the insane; 'moral treatment' assumed that even the
insane possessed a common core of reason towards which treatment could be
directed. The discipline required for artistic endeavour was stressed. Instilling
self-control in the patient was a key characteristic of 'moral therapy' and the arts
were seen as appealing to the more refined sensibilities of patients. A number of
eighteenth-century physicians were happy to proclaim the therapeutic benefits of
the arts (Hogan 2001).
A rather different set of discourses developed in the nineteenth centmy about
heredity; these were reflected in early psychological and anthropological writings.
Theories of degeneration alongside assumptions about the hierarchy of the races
(and sexes) evident in theories ofbiological determinism were reflected in ideas
about the cultural significance of symbols. Writers such as Lombroso (sometimes
called the founder of criminology) equated symbolism in art and language with
primitive mentality (as primitive or atavistic expression); other theorists saw
artistic symbolism as a form of degeneration, and thus were sown some of the
seeds which were to emerge later into a psychoanalytic theory of symbolism.
The latter has sometimes been proclaimed as the 'roots' of art therapy, but this
assertion is overly simplistic and fundamentally incorrect.
Both (competing and contradictory) sets of discourses are evident towards the
end of the nineteenth century. Florence Nightingale noted in 1860 the effects of
form, colour and light upon a recuperating person. She believed that both mind
and body were influenced (her work was a direct inspiration for art therapy
pioneer Adrian Hill's later work with tuberculosis patients during World War 11).
Ideas about psychology permeated various modem artistic movements.
Symbolism (c.1885-l900) laid great emphasis on the importance ofimagination
and fantasy, with an emphasis in art on feelings and sensations, and with an aim
to evoke subjective states of mind in visual forms (Chipp 1968: 49). Hauser
(1951) argues that symbolism was an irrational and spiritualistic approach that
arose out of romanticism, signalling 'a sharp reaction against naturalistic and
materialistic impressionism'; this was largely in response to the conventionality
 What is art therapy? 2I

of the metaphoric language employed by impressionists and in realist painting in

general (1951: 183).
Expressionism was to emerge as an artistic practice interested in the
'embodiment of spirit', and moved away from concrete representation towards
abstractionism (Chipp 1968: 126). It was an artistic form oriented towards states
of mind and subjective outlooks. Though varied, many works employed bold line
and use of colour, exploring grotesque, emotional and dramatic themes, sometimes
employing cmde, rapid bmshwork, pictorial distortions and bold jarring colours
held in nervous unstable compositions, or simply explored nature with a vivid
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intensity particularly associated with the work of Vincent van Gogh. The artist
Emil Nolde wrote in 1909:

I mbbed and scratched the paper until I tore holes in it, trying to reach
something else, something more profound, to grasp the very essence of things.

(cited in Chipp 1968: 146)

Expressionism as an artIstIc genre was actively suppressed by the Nazis

in Germany and beyond in the 1930s and 1940s as degenerate (Hogan 2001).
However, in its broader sense, expressionism became the predominant form of new
artistic movements of the twentieth century: its emphasis on a highly subjective,
spontaneous form of self-expression is typical of a range of modem art movements.
Many artists were also to become interested in notions of the degenerate, atavistic
or primitive, and went on to explore these ideas in their work. The Surrealists were
to have a great impact on the development of modem art therapy in Britain, with
their preoccupation on 'though freed from logic and reason' (Breton 1924, cited in
Hogan 2001: 94). Surrealists such as Roland Pemose were directly involved with
the early British Association of Art Therapists (Hogan 2001).
Another strand of thought that was of particular importance to the development
of modem art therapy was that of analytic psychology, and a quasi-religious
philosophy arose in the work of Carl Jung, which saw symbols as important
aspects of the unconscious mind. This unconscious could be self-regulating, and
'messages' from the unconscious could be manifest in art and be assimilated
without interpretation. There are different schools of Jungian thought based on
different phases and readings ofhis work; however, all ofthem have some spiritual
accent. These ideas led to a primarily 'non-directive' method being developed in
therapeutic communities such as Withymead, at which a number of the founders
of the British Association of Art Therapists worked (Hogan 2001: 220-89).
Radical education was another important infiuence on the development
of modem art therapy (Waller 1991; Hogan 2001). Sometimes the arts played
a central part in experimental forms of education. Attitudes varied from those
who were more interested in the arts to develop self-control and concentration in
their charges, to others who were more interested in 'free expression' with a more
anarchist, libertarian or idealist orientation.
 22 What is art therapy?

Art therapy today: where art therapists work

Art therapy is used in a wide variety of contexts today, from the rehabilitation of
child soldiers (Kalmanowitz and Lloyde 2005); war veterans (Coulter 2008); or
in former war zones and other areas of deprivation (Levine and Levine 2011);
to work in hospices with people about to die (Pratt and Wood 1998; Waller and
Sibbett 2005). Some art therapists work in the area of medical rehabilitation
(Weston 2008); with people who are recovering from major surgery (Malchiodi
1997, 1999; Waller and Sibbett 2005; Brosh and Ogden 2008); with women
who have been traumatised by their birth experience; with new mothers who are
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having adjustment problems; or with women have been diagnosed as suffering

from post-natal depression (Hogan 1997, 2003, 2007, 2008, 2011). Art therapists
also work in prisons and in the probation services (Laing and Carrell1982; Laing
1984; Liebmann 1994; Tamminen 1998; Hastilow and Coyle 2008; Godfrey
2008; Rothwe1l2008; Pittam 2008). This is sometimes referred to as 'forensic' art
therapy. They work in specialist dmg or alcohol rehabilitation settings (Luzzatto
1989; Waller and Mahoney 1998) or can specialise in certain disorders such as
anorexia nervosa (Rehavia-Hanauer 2003, 2012). Art therapists also work in the
areas of couple counselling and family therapy (Kerr et al. 2007).
Some art therapists work in statutory services, such as education (Welsby 1998);
with children with special educational needs (Stack 1998; Evans and Dubowski
2001); or the Child and Adolescent Mental Health Services (called CAMHS in
Britain). This can be quite varied and might entail working with children who
are self-harming; have a wide range ofbehavioural problems; are suffering from
family breakdown, or bereavement; or who have mental health problems and may
be suicidal (Ambridge 2008). Other art therapists work in the broader arts and
health arenas and attempt to use art to give voice to different 'communities' (Bird
2010; Hogan 2011), or to use art therapy as a research technique. The majority of
art therapists still specialise in mental health work with adults.

Terminology
All disciplines develop a particular vocabulary, and abrief glossary of key terms
is induded at the end of this volume; however, the book is written in such a way
that difficult terms are generally defined and explained as encountered, especially
in the early chapters. I am making one distinction which is quite tricky, and that is
between 'analytic' art therapy, which is an approach drawn from psychoanalysis
which privileges the relationship between the dient and the therapist as the main
focus, or most important aspect of the work (in a 'transference relationship' ,
which will be explained), strictly speaking this is psychoanalytical and group-
interactive approaches which nevertheless are 'analytical' in the sense that group
processes are analysed, and patterns ofbehaviour and inconsistencies identified as
part of the therapeutic process.
 What is art therapy? 23

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 What is art therapy? 25

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Websites
American Arts Therapy Association: http://www.americanarttherapyassociation.org
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Australian and New ZealandArts Therapy Association: http://www.anzata.org/

BritishAssociation ofArt Therapists: http://www.baat.org/
 Chapter 3

Reflections on experiential
learning
Susan Hogan
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Experiential learning
This chapter will elaborate on the idea of experiential learning and will then
proceed to explore the content of an introductory art therapy course, which is
taught experientially. Experiential learning is something that many artists who
have explored their thoughts and feelings through experimentation with art media
take for granted as straightforward, even self-evident. But it's easy to forget
that this is quite an alien way of being for many of our dients and students and
sometimes we are bewildered as to why they 'don't get it'. This chapter will
explore some of the problems involved in attempting to do experiential teaching.
The Macquarie Dictionary describes 'experiential' as 'pertaining to or derived
from experience'. This is straightforward, we might think: learning by doing.
The word 'experience' is defined as 'a particular instance of personally
encountering or undergoing something' or 'the process or fact of personally
observing, encountering, or undergoing something'. I' d like to latch on here to
the importance of seeing it as a 'personal' and 'particular' encounter. In teaching
art therapy, it is important for students to realise the uniqueness of their own
perception and the advantages and dis advantages of this. Our personal awareness
distorts our perception of the here and now (the jargon for this is 'parataxic
distortion'). Students can be asked to begin to think about this. Perhaps it is not
something they are used to doing?
Of course every act of understanding, and every formulated question, has an
interpretive element. Why do I ask my dient about the red mark rather than the
black streak? Perhaps one feels more insistent to me, and I have indulged in an act
of interpretation in getting to that point of formulating the question.
When I started doing experiential workshops over twenty years ago, I thought
that this simple understanding of what experientiallearning is would be enough.
'Imagine you are ahouse and paintwhatyou'd look like' , I'dinstmct, forexample.
However, not everyone could make the leap of imagination: 'Yes, I've painted a
house, but what's it got to do with me though?' someone would retort. 'No, I
don't know why the front dOOf is open, but I found it relaxing to do ... ' There was
a disjunction, a gap between their self-expression and their self-understanding.
 Reflections on experientiallearning 27

Experience is not enough: there must also be a process of active critical reflection
and self-analysis. Indeed, this is the absolute key.
Stimulating a process of critical self-perception and laying the foundations
of reflective practice is not so straightfonvard. Perhaps this is because we have
aH been brought up with the concept of objectivity, which needs de-bunking. As
Thomas Kuhn made dear in his tremendously influential book, The Structure of
Scientific Revolutions (1962), there is no such thing as 'value-free observation'.
Nevertheless, it's an entrenched idea: that we see what is going on and can report
on it in an objective fashion. I'H elaborate on this further.
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So already we have realised that the definition of 'experiential' doesn't give us

enough, in terms of definition, to adequately describe what we hope will happen
in an experiential art therapy workshop.
What is a student learning in the workshop? WeH, at the outset:

• They are learning to be in a group that has particular boundaries and mIes.
• They are participating in establishing these boundaries and mIes.
• They are learning to express themselves in this environment (sitting in a
cirde and talking about oneself isn't something everyone is used to).
• InitiaHy, they are forced to make statements about themselves, which means
making adecision for some people; for others it may be more reflexive: 'My
name is Susan Hogan and I'm blah blah blah ... ' Perhaps I've trotted the
same thing offbefore. However, making a definite statement about oneself
is difficult for some people, let's not forget that.
• They will have to tolerate being the focus of the group's attention.
• InitiaHy, there may be anxiety to overcome about manipulating materials
and anxiety ab out one's performance.

So we see that even at the outset of the group, before we've actually got
started, in OUf terms, we are into quite complex emotional terrain. I am sometimes
fmstrated that groups can be so frightened and defensive. However, there are
potentiaHy profound existential aspects of personality engaged and already at
stake:

• How do I fee I about mIes? Can I cope with the rules? Do I want to challenge
or flout the mIes?
• Can I assert myself? Will I be heard? Why wasn't I heard? Some people
complain at the outset that they' d rather be sitting at a table and feel
uncomfortable having their entire body visible to a group of people.
• Who am I? How do I wish to be seen? Is there something happening for me
which will influence how I present myself in the group?
• Why do I hate being the centre of attention? Why do I have to be the centre
of attention? Why am I complaisant ab out articulating something about
myself?
• I can't paint. I must paint weH.
 28 Reflections on experiential learning

As art therapists we are aware of these aspects of group work. There are reams
and reams of articles on group dynamics and the initial fear that participants can
experience when they join a new group, so this chapter won't dwell on this here
further except to say that it doesn't hurt to remind oneself of this. I have often
mshed this bit of group work because I was keen to 'get on with it'! I have leamt
that it is useful to give participants time to settle in to the situation and to modify
my expectation about how much to fit in to the session, if necessary.

Reflective practice
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When students are asked to perform an art therapy task, such as the
aforementioned draw yourself as a house task, they leam from other group
members. Participants do realise, by listening to other people describe their
house, the rich metaphorical potential ofthe exercise. Cellars, attics, turrets are
described and explored. The terrain on which the house stands may be relevant,
or perhaps there is a relationship between the house and other houses, trees,
cars, etc., that enables significant relationships to be explored. Seeing how an
exercise can be tackled and viewing the immensely rich and diverse pictorial
material produced by different people is educational for group members
who have had difficulty in grasping it. Conceivably they even become self-
conscious and embellish future drawings with ostentatious symbolism - there
might be competitiveness between certain group members about dramatic use
of metaphors.
So, even people who find expressing themselves using pictorial symbols,
analogies and metaphors difficult get the idea from listening to others and
seeing what they have done. However, I want students to start to think about
the totality of the experience, not just their image and what it means for them
although, admittedly, this is an important aspect of the workshops.
The workshop series I mn is aimed at presenting a variety of group formats to
students. I want students to start to think about the shape of the sessions. I want
them to think about the stmcture of the workshops, to compare and contrast
different formats, and then to think about how different formats infiuenced the
dynamics of the group and to start to reflect upon this.
This essay completed after the experiential component of the course I'm
currently mnning asks students to compare and contrast two different modes of
art therapy, so students are obliged to think about stmcture. My experience is
that without the reflective diary, which I'm about to discuss, students often don't
reflect deeply on the workshops and, indeed, cannot even clearly remember
what they did by the time it comes to submitting the essay.
How to push them on to a deeper level of analysis? I want students to start
to think about the overall dynamics of the group without losing sight of their
personal material and to develop a deeper analysis of that too. Latterly, I have
been asking students to keep a reflective diary. But how are they to know what
to record? I give them an aid, which breaks down the group experience into
 Reflections on experientiallearning 29

different segments, asking for reflection on each segment, which some students
find immensely useful and others may find overly simplistic.
At an introductory level, part of the problem for the facilitator is that they are
dealing with people with markedly different levels of self-awareness and analytic
skills. Some people naturally notice the body language of others, for example, or
group dynamics, or the particular symbolism employed by an individual, and can
recall precisely what that person did three weeks ago. We bring an impressive
range of different skills into the group. Part of the reason I like group work so
much is because it combines all our skills in the group's facilitation.
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Using the 'how to analyse a group' handout out as a starting point, students
begin to think about all the aspects of group work, they notice how different group
members are sitting, responding, talking and participating, and they then reflect
on and begin to share their feelings about this. They are noticing how different
stmctural considerations affect the group. Participants have the experience of
making images as a group, in pairs, in small groups and individually. They perform
a variety of exercises, induding a guided fantasy. They receive adescription of
each workshop in advance that outlines the aim of each session to help them
understand it.
Participants practise analysing their own imagery while other group members
sit quietly and respectfully hear what they have to say. Then group members
can respond to the image in two different ways: they can share what the image
stimulated in them personally or, with sensitivity, they can practise being in the
facilitator role and ask questions about the image. Perhaps they can highlight an
aspect of the image (or sculpture) which was not commented on. For example,
they can practise asking open-ended questions such as, 'If you feel comfortable
doing so, could you say more about the red area at the bottom of the picture?',
or more informally, 'If you feel okay ab out it, would you like to tell us more
about. .. ?'
In the 'dient' role, students may be preoccupied with their own emotional
material, the meaning of their art work and perhaps unable to focus on other
people's work. In the 'dient' role, they may respond to other people's art work
very much from a personal point of view: 'I feel very bleak when I look at that
washed-up looking debris'. This is perfectly acceptable, as trainee therapists must
become aware of their emotional reactions and practise continually monitoring
and containing them (and using them constructively to help facilitation). We leam
to simultaneously acknowledge our emotional responses whilst not allowing them
to engulf our attention, which remains focused on our dients. At an introductory
level, students develop empathy with their future dients by allowing themselves
to feel emotionally vulnerable in the group.
In terms of group work, the emotional reaction I've given above could lead to
a number of scenarios. Perhaps it acts as a facilitative remark to the person who
made the image, who might respond by saying, 'Yes, it feels really bleak', and
then elaborate on why. Or conversely, they might explain that it's not bleak, or
simply refute the re mark: 'That's not how I feel about it'. The group's attention
 30 Reflections on experiential learning

might turn to the person who made the remark or someone in the group might
intelject and say how they feel ab out it. U sing the 'Group Interactive Model',
described by Diane Waller, analysing these interactions becomes the central focus
of group work. Trainee art therapists leam to work in this way. However, at this
introductory level, I am merely hoping that students will start to notice significant
interactions, be able to record them or even comment on them in the group.
Students may find themselves primarily in the role of the facilitator in relation
to other participants' images or primarily in the role of 'client' , or they may move
back and forth between these two positions. I don't expect a ten-week, or even a
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twenty -week, introductory course to reach the innermost depths of the participant's
psyche (this can happen at professional training level). However, a certain amount
of personal disclosure is necessary in order for participants to become emotionally
engaged. Sometimes an individual in a group will be very open about themselves
and this can be helpful in encouraging others in the group. I find it is difficult to
achieve an intimate atrnosphere with a group of more than sixteen participants;
twelve is a comfortable number to work with to avoid too much pressure in terms
of people having time to talk, if they want to. At advanced training level, the
groups are usually recommended to have around eight participants.

Reflecting on the process of making the image

The final thing I hope students will ac hieve during participation in an introduction
to art therapy course is an awareness of how the process of making the art
object, not merely analysis of the finished product, is significant. The emotions
engendered whilst splashing, tearing, covering, hiding, destroying, scribbling
or otherwise struggling to use the materials are highly significant. They can be
considered and recorded in the reflective diary.
Here is the description of my stmggle with art materials in a group (incidentally,
not in an introduction to art therapy group, in which I would tend not to make any
personal disclosures unless the group insisted upon it):

At the group's invitation I did make one art work. I painted a picture of myself
breast-feeding. However, I stmggled with the piece. I had wanted the quality
of the paint to be very watery creating an image like a reflection on apond.
Whilst painting it I became aware of the fact that Iwanted to depict my baby
both inside and outside of my body simultaneously. I imagined her suckling
one breast whilst stroking the other with her little hand. But I was not able to
achieve a satisfactory result with the materials and I spent the session working
and reworking the image - stmggling with the boundaries. The finished art
work, unresolved though it was, embodied my experience of merger and
separateness. The act of painting brought to awareness and illustrated my
feelings of conflict and ambivalence about these processes - my emotional
struggle. Indeed, my inability to resolve the image pictorially was highly
revealing. I had not experienced through conversation the full force of these
 Reflections on experiential learning 3I

confiicting emotions. Participating in the group reminded me of the power

and poignancy of the art therapy process which yields the possibility for
the articulation of powerful embodied feelings and responses which cannot
necessarily be experienced or evoked through a verbal exchange alone.
(Hogan 2003: 168; original emphasis)

Context
Regarding institutional art therapy trainings, free-floating institutional anxiety can
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'land' in a workshop series. Likewise, umesolved institutional psychic material

can infiuence a group in ways that are unlikely to be able to be acknowledged at
introductory level. The only means I can think of to minimise these risks is for
staff teams of institutional art therapy trainings to have psychodynarnic group
staff meetings to ensure that unresolved psychic material is acknowledged and
resolved; otherwise, it will pollute the group work in subtle or obvious ways.
Most departments are rife with interpersonal rivalries or worse and these do have
an infiuence. However, many art therapists offering introductory workshop series
will be offering these to institutions in which they are not permanently based so
these complications need not arise.
In conclusion, I have summarised some of my stmggles in trying to introduce
the idea of art therapy to groups of students using experientiallearning. In my next
chapter I'd like to elaborate further on the content of workshop sessions. Even
using the same material, groups vary tremendously. Some take off immediately;
others remain resentful, defensive, afraid and surly even, depending on the
balance of personality types in the group. Don't be put off if your first experience
of mnning training workshops is hard work - it might be much easier the next
time.

Bibliography
Hogan, S. (ed.) 2003. Gender Issues in Art Therapy. London: Routledge.
Kuhn, T. 1962. The Structure 0/ Scientific Revolutions. Chicago: University of Chicago
Press.
Waller, D. 1993. Group Interactive Art Therapy. London: Routledge.
 Chapter 4

An introduction to art therapy

Further reflections on teaching
d i rective art the rapy at an
i ntrod uctory level

Susan Hogan
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The last chapter reflected on the nature of experiential learning and how this
related to mnning introductory courses on art therapy. The chapter was written
mainly for the interest of art therapists who are thinking of offering art therapy
workshops and courses, as well as students coming new to the subject. In
this chapter I shall talk in further detail about the content of my introductory
workshops and what I hope to achieve.
Let me stress that these are not professional training workshops; they are
an introduction to the subject, though they may form part of the beginning
of a professional training course. The closed training group, which forms an
important component of the full professional training in art therapy, is a 'non-
directive' psychodynamic group using Diane Waller's Group Interactive Model.
These workshops, in contrast, use a 'directive' approach in that they are highly
stmctured and designed, quite explicitly, to give participants a feel for different
group compositions. All employ a different structure, which is noted and
analysed. In this chapter I shall describe a number of workshops: working in
pairs, group painting, group sculpture, guided fantasy, a body image workshop
and a theme workshop. I shall also discuss different ways of analysing the work.
I shall also present the basic analytic 'tool' I give to students to help them to
reflect on their experience of group work and get full benefit from the experiential
group work. The reason why I give the students an analytic tool or aid is because
reflecting on the multi-levelled nature of group work is complex. I stress that
students can use the tool as a starting point for their own detailed analysis of the
group work in their reflective diaries. I hope that it won't be used as a reductive
checklist.
Before I move to the subject of how to analyse introductory group work, I
shall elaborate further on the content of the workshop series. My aim is to present
students with a variety of quite different workshop formats so that they can see
the scope of 'directive' art therapy (all the sessions are stmctured). It's possible
that participants may discover one particular way of working they enjoy or they
may go on to employ a range of group formats with clients if they go on to study
further in the subject and become practitioners.
 An introduction to art therapy 33

I explain to the group that the workshop series should be regarded like a
toolbox full of tools. You can take out the monkey wrench or screwdriver in a big
house or a little house or use it for arepair on a bicycle. The tools themselves,
many of them, can be adjusted for use with different jobs. So it is with the
workshops - they are 'tools' to be modified as appropriate. If participants decide
to engage in full professional training in art therapy, they will experience non-
directive interactive art therapy as part of their training - a rather different way of
working with which most qualified therapists are familiar, in which interactions
between group members, along with analysis of the art work, form the focus of
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attention. In these introductory workshops analysing group interactions is not the

primary focus, but interactive elements of each workshop are noted.

The students
The students are a mixture of people. Some of them have decided to complete
full professional training in art therapy and come to complete the introductory
module as preparation; others are curious as to what art therapy is and may have
no intention of attempting to employ art materials with clients - they are more
interested in using art therapy techniques to explore their own creativity.
I do think it's incumbent upon the facilitator to point out that art therapy
can stimulate strong emotions and deeply cathartic reactions, and that it is not
something that non-qualified people should attempt to do. On the other hand, if
attending the introduction to art therapy workshop series enables a schoolteacher,
for example, to use more creative and varied exercises with her pupils in her art
class, then I'm more than happy for these new skills to be acquired. However, if
we think that participants might be considering attempting to offer art therapy to
others after only attending an introductory workshop series, we have a duty of
care, in my opinion, to attempt to dissuade them. I don't want to dwell on this
issue which Annette M. Coulter is going to explore in further detail, but fee 1
that in introductory material, publicity material and at interview, it is important
to reite rate that the full professional training for art therapists is a rigorous two-
year, full-time Master's degree-level course with substantial supervised clinical
placements. The introduction is aimed to give participants an overview or 'taster'
of the subject. It will enable professional health workers, for example, to work
closely and constmctively with art therapists, having gained an understanding
of what art therapists do. It will enable potential art therapy trainees to decide
whether or not art therapy is really for them. However, it is perfectly possible
that an introductory course may attract individuals who have an entirely
umealistic idea about how easy it would be to set up as an art therapist, and this
is problematic.
I shall now outline a number of workshops I customarily offer. Generally, I
have offered these in university or college settings. The order of these workshops
mayvary.
 34 An introduction to art therapy

Boundaries and introductions

Some form of introduction will take place prior to the first art therapy exercise.
This can be quite simple - such as each person saying their name and a sentence
or two about why they have come to the group. Normally, 1'11 start this off. I
ask participants to regard personal material which will be shared in the group as
confidential. I explicitly ask participants not to discuss the group in their coffee
break. Analysis of the processes of the group will be kept in the group. Other
group boundaries or 'ground mIes' might be discussed. Further discussion might
arise spontaneously as someone has to leave early for an appointrnent, or a mobile
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phone goes off, and then group members express feelings about that.

Working in pairs
This uses the following format, which will be explained in detail:

• Introductions and discussion about group 'ground mIes'.

• Explanation ofworkshop.
• Participants divide into pairs, get one sheet of paper and select art materials
to work with.
• I ask participants to tell each other something about themselves non-verbally
using the art materials.
• After 15-20 minutes I divide each pair up into an A and a B.
• I explain the next section of the workshop (that person A will tell person B
what they thought person B was trying to tell them, whilst person B tries
not to nod or otherwise indicate agreement or disagreement; because this
is hard, as it feels mde to 'blank' someone talking to you, I actually role-
play someone giving clues and then someone being 'impassive' to try to
reinforce this point).
• I swap them around after five minutes, reiterating the instmctions.
• I give couples the opportunity to talk openly about their interpretations to
'check out what they got right and what they got wrong'.
• After 10 minutes or so we form a group circle and talk about the concepts
I am about to discuss, and couples share their experience with the larger
group.
• There will be a short 'comfort break' before the group painting.

I quite often start by contrasting the experience of working as a couple with a

group piece. I explain at the outset that participants will be making an image with
a partner and then, later, doing a group painting and will have the opportunity
to compare these two contrasting experiences. Students have already received
abrief description of the workshop explaining that we'll be doing 'non-verbal
communication exercises' and discussing the ideas of 'projection' and 'group
dynamics'. I ask students to pair up (if there's an odd number then an individual
 An introduction to art therapy 35

can sit as an ob server to a particular couple). I instruct the couples to select a range
of materials they' d like to work with and to choose one sheet of paper to work
on, as they will be sharing the same piece. This has to be emphasised, otherwise
people assume that they will not be sharing a sheet. The therapist must check that
this instmction has been heard and check that each couple is sharing a sheet. Once
participants are ready, I ask them to tell their partners something about themselves,
what kind of person they are or what interests them, but to do this pictorially. I
explain that they should attempt to express themselves solely through the use of
the materials and not talk at all. I suggest that all negotiations about how to use
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the page are conducted non-verbally. I tell them that they have fifteen minutes (if
there are several couples who seem to be working slowly and tentatively, then I
might welliet the exercise continue for twenty minutes). After they have finished,
I divide each pair up into an A and aB (normally I let them nominate themselves,
as the more assertive and confident often choose A, who will start).
Then I explain what we'll be doing. First, person A will tell person B what
they thought person B was trying to tell them. However, person B will receive the
information without responding. Indeed, person B will sit impassively without
nodding, smiling, gesturing or giving any clues whatsoever as to whether person
A's interpretation is correct or incorrect. I explain this will be very difficult
because it feels mde not to respond. Even though the As have been told that the
Bs will not respond, they still give the As imploring looks to check out how they
are doing with their interpretations!
Before person A gets going, I give some pointers about what students might
note during their pictorial analysis. They can note:

• the relative size of objects;

• the juxtapositions of objects;
• the manner in which things were done (tentatively, with ferocity, etc.);
• the general use of space and the manner in which the space was controlled
during creation;
• how B responded to A's lines;
• their use of analogies, symbols and metaphors;
• their body language in relation to the page (learning over it, or daubing
tentatively) ;
• actual pictorial content;
• mood conjured up by the use of the materials.

After five or six minutes, A and B swap so that B now interprets A's image
while A sits impassively.
After the fmstrating business of having to listen to each other's interpretations
without responding, I do give participants the opportunity to check out where they
were right and where wrong, and normally a very animated discussion ensues
between partners. Afterwards, I point out that there's no right or wrong response
to the exercise. Sometimes, couples ac hieve a high degree of accuracy in their
 36 An introduction to art therapy

interpretations through intuition and correct interpretation of body language,

coupled with the use of symbols and metaphors, which the other managed to
understand. Sometimes quite stylised or impoverished image-making is used by
someone who is keen, above all else, to be understood in a literal way. Others find
that their interpretations are way off the mark.
The point is that the 'reading' of images is complex and works on a number
of levels. Abstract works may reveal a lot about mood. As noted, reductive
symbolism may be employed to prioritise the conveyance of facts. Pictures vary
tremendously. The participants' skills of interpretation vary. Some participants find
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it impossible not to nod or to otherwise indicate agreement or disagreement with

the interpretation proffered, even though I have asked them not to do so - therefore,
they give more clues to their partner to help their interpretation than others in the
group. Consequently, I'm not anticipating some sort of standardised result.
After the couples have discussed their images, I invite everyone back into a
big circle. The exercise gives me the opportunity to introduce participants to the
idea that interpretation of images is problematic - indeed, fraught with difficulty.
Hopefully, some woefully incorrect interpretations by couples are shared to the
group as a whole and underline the point. Often this is done with humour.
It is important in art therapy that the client is allowed to explore the meaning of
their work. The art therapist's role is as a facilitator. Art therapists should be wary
of using language that might foreclose meanings. I point out that art therapists use
open-ended questions to encourage clients talking about their work. Of course,
any comment or question by the therapist is based on an act of interpretation - why
draw attention to one thing rather than another? But I don't go into philosophical
analysis at this point. Therapists are constantly deciding what is important and this
might be more to do with their own preoccupations than with those of the client.
Likewise, what we hear is also an act of constmal - why do we remember 0 but
not P? Or, perhaps more significantly, why do we think that 0 is significant and P
trivial? Or why does P seem exciting and 0 mundane? Or do we hear something
else entirely, something not actually said? This is analysis for a later date.
The main emphasis of the workshop is to: a) introduce students to the idea of
non-verbal communication with art materials; b) get students to think about the
component parts of a picture during their analysis; c) encourage the participants to
be wary offurnishing interpretations oftheir clients' work; and d) become aware
of the idea of 'projection', a useful term referring to how we project our own
meanings onto others.
Generally, I don't like jargon but the notion of projection is a useful one and
essential for the would-be therapist. Projection is the attribution of qualities or
characteristics to aperson, which they do not necessarily possess. It is the result
of a distortion of perception - although we all view people through our particular
lens to some extent, and so some 'projection' is therefore inevitable and total
objectivity impossible. Nevertheless, would-be therapists need to think about
whether they are letting their own emotional responses get in the way of their
relationship with others (I shall discuss this concept in further detail elsewhere).
 An introduction to art therapy 37

So, as you can see, a fairly simple introductory exercise is actually immensely
complex. First, participants drink about how they can portray sometlring about
themselves through the use of art materials. Students tlrink about the notion of
interpretation and how to ask open questions. They think about body language and
how we convey information to each other through the use of our bodies. Students,
perhaps for the first time, realise how strange it is talking to someone who is not
giving off normal signals of acknowledgement; they tlrink about how we 'read'
each other's gestures. They also tlrink about the component parts of a picture
during their analysis: the relative size of objects; the juxtapositions of objects; the
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mannerin which tlrings were done and so forth (see the check-list above). All ofthe
students are bringing with them different amounts ofknowledge of all these tlrings.
Some may be trained counsellors already, for example, so very fanriliar with the
idea of 'reading' body language; others may be artists well used to expressing
themselves through art materials. For others, all these things will be quite new.

Group painting
The second half of the workshop is a group painting. Normally, I give the group
a break. Coffee breaks can be used to allow people to relax. I have often found
in private practice, and training work, that changing the length of the break can
have an important effect. For example, a group that is beconring over-intense
can benefit from a slightly longer break. Try changing the length of breaks and
observe the effects.
When the group returns from the break, I give the group a large roll of paper
and suggest they create a piece about six feet square. They will have to use
masking tape to stick two or three widths of paper together, depending on the size
of the roll. I let the group do this.
I ask them to get materials they would like to use. Then I instmct them that
they have twenty nrinutes to say something about themselves. After about fifteen
nrinutes, I give the further instruction that they should each try to made pictorial
contact with each member of the group - in other words, that their image or images
should link up in some way with those of each member of the group. This nright
already have occurred, but sometimes, especially if the paper is an oblong, rather
than a square, individuals can remain quite isolated, having taken hold of an area
of the sheet of paper as their own territory. This is especially true when bold
dividing lines have been drawn which are difficult to cross, or a person has depicted
sometlring that others feel they cannot approach. This is when the work can become
very interactive: perhaps a link cannot be made with someone because their work
is perceived by an individual as fragile or, conversely, as aggressive. Or perhaps
someone else nright feel quite upset, or delighted, by someone else's encroachment.
This is grist for the nrill, if I may be perrnitted the use of tlris cliche. Students can get
an inkling in their analysis of the power and potential of a group painting experience.
I stop the exercise before it gets too challenging and participants get the opportunity
to reflect on how working in a group feIt different to working in a pair.
 38 An introduction to art therapy

If I've been working with a large group and two group pieces have been
produced, I suggest that the participants stay gathered around their particular
painting for their analysis of it. If one group painting was produced, I suggest that
we place it on the floor in the centre of the room and sit around it in a circle so that
it's easy to look at while we discuss the group experience. Quite often people want
to point at the image while they talk.

Ending the first session

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I then introduce students to the idea ofkeeping an analytic journal. In the course
information, this will have been mentioned already. Participants' reflection on
their experience is a cmcial part of experientiallearning. (I discussed this topic
in the last chapter.) I suggest they use the handout as a starting point for a more
detailed piece of analysis, if they find it useful. I go through it point by point
with them (without asking them to answer the questions) and this helps to act
as a 'cool down' to the session. Figure 4.1 shows the sort of analytic tool I hand
out.
I ask the last question to get students to think about the shape and form of
workshops. They are stmctured quite differently and the different group stmctures
produce different effects, which I want students to start to think about (remember
the 'tool kif analogy). A lot of the questions ask participants to reflect on their own
emotional responses, as maintaining critical self-awareness is important for art
therapists or would-be carers in general. I also want the group members to develop
sensitivity towards, and empathy with, their prospective clients. Hopefully, having
experienced something as challenging, threatening or emotionally exposing will
help them to be less insensitively gung-ho if they go on to work with clients using
art materials.
Finally, I ask everyone to bring in lots of old junk, cardboard boxes, old
Christmas decorations, etc., for the following week.

Group sculpture
The second workshop in the series is a group sculpture. The workshop is designed
to illustrate how working on a collective project can lead to group cohesiveness
and provide scope for analysis of group dynamics. The workshop offers the
opportunity for participants to work in three dimensions, which can be challenging
in terms of manipulating materials. This exercise, in my experience, is often fun
and can enable group members to get to know each other better. It is therefore
quite a good one to have fairly early on in a workshop series.
This uses the following format, which will be explained in detail:

• I put out a range of materials that will be helpful for three-dimensional work
such as string, cardboard, Stanley knives, wire, staple guns and scissors.
• Materials brought by participants are put together.
 Reflecting on experiential workshops

• What initial feelings did the exercise provoke in me?

• Did I talk to others during the exercise?
• At the beginning?
• As a necessity to achieve the task?
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• At the end in the group discussion?

• At any other times?
• How did each phase of relating to others feel?
• Did I express myself verbally in the way that Iwanted? How did that
feel?
• How did I relate to the subject matter of the workshop?
• Did any group themes emerge?
• How did my position in the room and/or my use of space contribute
to my experience?
• How did I express myself pictorially?
• Through the use of analogy?
• Metaphor?
• Symbols?
• Expressive use of materials (scratching, tearing, splashing, scraping,
sticking, overlaying, subtle or brutal brush strokes, etc.).
• What compositional elements were employed (think about the
relative scale of objects and how things are juxtaposed)?
• Did I express myself pictorially in the way that Iwanted? How do I
feel about that?
• How did I feel about comments made by others about my contribution?
• What was the ending of the workshop like?
• Can you imagine in what ways this workshop might be useful with
people who have special needs?
• How was this workshop different from the last workshop?

Figure 4.1 Student handout: reflecting on experiential workshops

 40 An introduction to art therapy

• Participants sit in a circle and are invited to say a few words about how they
are feeling or whether they had any thoughts or feelings about the previous
workshop they' d like to share with the group.
• I explain the workshop.
• I pass round the bag of pieces of paper on which are written different parts
ofthe body.
• I pass round the bag of pieces of paper on which are written different
positive emotions.
• I pass round the bag of pieces of paper on which are written different
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challenging or negative emotions.

• I give a safety warning to participants about the staple guns and stanley
knives and indicate how they are used. In particular, I point out that you
cannot put your hand behind astapie gun to hold materials in place;
otherwise the staple may fire into your hand. Probably, participants are not
yet using fixative spray, but just in case I ask that this be used outside the
room, as some people are allergic to the spray.
• I ask participants to commence the task.
• After the 'person' has been constmcted, I ask participants to sit around her/
him and to say a few words about how they found the experience.
• I close by making sure that everyone has had the opportunity to say what
they wanted to say.
• I introduce the topic of 'disposal'.
• Finally, I discuss the next week's workshop.

I tend to approach this is in a quite light-hearted manner. It starts off rather like
a party game. I ask participants to sit in a circle and, after explaining more about
the workshop, I send round a bag full of bits of paper. Each student must pick a
piece of paper, 'without peeking at it first'. It's a lucky dip. I've already explained
that on each piece is written a body part: 'heart' , 'lungs', etc. There are sometimes
strong reactions, groans or shrieks of excitement as the bag goes round (usually
at least twice so that everyone has at least two body parts to work on). I put 'sex
organs' rather than specifying which sort, so that there is scope for choice. Then I
send round two furtherbags - one full ofuplifting and positive emotions: 'love',
'joy' and so forth and another full of negative emotions. I put a lot in the bags,
as I want participants to have three or more emotions from each bag. This might
seem slightly laborious, but having the positive and negative emotions separate
saves some poor person getting 'chagrin', 'sorrow', 'hatred' , 'abhorrence' and
'disgust' , for example, as their set of emotions ...
I then tell the group that they are going to construct a person and ask them
to think about how to depict, and where to place, the emotions in the body. It's
important to spell out that the particular body parts picked by a person don't
have to embody the emotions picked by that person. So if someone has 'feet' and
'happy', they don't have to make happy feet, for example. I always hope that the
materials will be used in an interesting way - my heart sinks when the person
 An introduction to art therapy 41

with 'love' produces a flat, red love heart ... What could 'anger' look like? It's an
opportunity to experiment.
Primarily, the workshop functions to force group members to interact with
each other, as they have to co-operate to produce one large figure. So, at its most
simple level, this is a workshop format that can be used with people who could do
with interacting more with each other for whatever reason.
Analysis can include how people responded. Did they sit in a corner making
their emotions without interacting, or did they organise others? How did they fee I
about this? Was the actual process of depicting emotions challenging? How did it
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feel manipulating the art materials? Was thinking about where different emotions
are located in the body illuminating? Emotions are embodied, but the exercise also
gives scope for an examination of how we feel ab out different parts of our bodies.
Body-image issues may arise. I have had, over the years, disclosures of childhood
sexual abuse, domestic violence, self-harm, anorexia and rape disclosed in such
workshops. However, if placed early on in a workshop series, serious disclosures
may not arise and the workshop may function primarily as a 'feel-good' and
group-bonding exercise.
I have started to tell students at the outset, 'if you get the word "love", don't
just draw a big pink heart; instead try to think about what the embodied feeling
is like and try somehow to depict that'. The metaphors used in exploring the
emotions can sometimes be very multi-Ievelled and sophisticated. Students often
tell me that they found the exercise very challenging in terms of how to depict
complex emotions with the materials.
Even though these group sculptures often look like a peculiar version of
Frankenstein's monster, groups tend to like what they have produced. Finally, the
concept of 'disposal' can be introduced to the group. The group has made a large
piece ofwork and must think what they would like to do with it - how to dispose of
it. There has been emotion invested in this piece of sculpture, so its 'demise' must
be handled with sensitivity. Participants may have strong feelings either about the
piece as a whole or their particular components of it. Often groups would like to
photo graph the piece before it's dismantled. So, ifthere is no storage, the facilitator
can bring in a camera for this session (although mobile phones can suffice). Unless
the group say they would like to dismantle the sculpture there and then, which they
sometimes do, I like to give the sculpture a horne in the art therapy studio for a few
weeks to help the group develop a sense of the room being their own. People like
to come into the room and see their creation still there.
This is a good point to discuss the importance of the storage and disposal of art
work in art therapy and this discussion can serve as the 'cool down' for the session.

Guided fantasy
There are many, many types of guided fantasy, and I like to introduce one fairly
early on in the introductory series as it adds contrast. The particular fantasy I
often use is one adapted from the work of Dr Janek Dubowski. It's about being
 42 An introduction to art therapy

on aboat, waking and rowing to a tropical island, and having various experiences
(which I shall elaborate on elsewhere).
Before I begin with the fantasy, I ask participants to get a life-size piece of
paper and lie down on it, making any shape they'd like to. Someone else will
draw round them to record an outline on the page. Some of these look a bit like
the outlines drawn by police around a dead body in the murder scene in American
cop movies - however, others don't look like a human form at all.
I start off by providing cushions and dimming the lights and getting everyone
to follow a simple meditation exercise. Participants can banish thoughts from
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their mind using one or two standard techniques. One is to observe one's breath
and, if one's mind wanders, concentration is simply returned to the breath - over
and over again. Group members should be asked to breathe in through their
nose and exhale through their mouth. Then a further prompt can include asking
participants to note the sensation of the air entering their nostrils and then passing
out of their mouth. 'If a thought arises, simply let it go and return your attention
to your breath', I instmct. The temperature of the air can be noted: cool entering
the nostrils and slightly warmer leaving the mouth. This is a basic meditation
technique taught in some Buddhist monasteries.
Another technique, which I offer too because I much prefer it myself, is to
imagine a clear blue sky. When a thought arises it can be attached to a passing
cloud and let go. It's possible to visualise the cloud drifting off and then the mind
returns to the clear blue empty sky. The idea is to stop the train of thoughts that
often dominate our minds. The effect is relaxing. The body becomes calm and
one's blood pressure falls; endoIphins are released. Such basic meditation is very
good for the body. We should all make time to do it!
However, in this instance I use the meditation to get participants in a receptive
state to visualise a story I tell them. Many of the aspects of the story are quite
vague so that people can attach their own meanings to them. The story starts with
someone waking from a deep sleep (or being born). I playatape of water lapping
on a beach while I tell the story.

The fantasy
You are in a foetal position. You are surrounded by darkness and warmth. Colours
begin to invade the darkness and you begin to move. You realise that the space you
are in is moving gently back and forth ...
You feel warm and relaxed - you feel a rocking sensation ...
You stretch and wake to find yourself on the top bunk of a bunk bed in a dark
space.
However, when your eyes adjust to the darkness you can see a door and you
climb out onto the deck of a boat and look up at a sky full of stars ...
As you look around you realise that the boat is moored off a tropical island - you
can see that at the far end of the island is a small volcano belching out smoke and
lava.
 An introduction to art therapy 43

A small rowing boat is floating next to your big boat. You decide to climb down
the rope ladder and row to the island.
As you row to the island there is a spectacular sunrise and mist rolls off the water.
You tether your rowing boat and wade into what looks like a cave; the tunnel
becomes quite narrow and dark.
You persevere as you can see some light ahead.
You hear the sound of water; the noise intensifies as you progress through the
tunnel.
You end up stepping into a magnificent underground cavem with a spectacular
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vast thundering waterfall.

You have the impulse to walk into the waterfall.
After some time, you continue to walk towards the light source. You emerge into
a dense jungle.
You make your way through the jungle and then find yourself in a clearing. The
sunlight warms you.
You see some rubble and decide to take a closer look. Two large statues lay
overgrown, broken, bits jumbled in an indecipherable mass.
Then in the distance you see a tree house and walk towards it.
When you reach it there is someone friendly-Iooking beckoning you to come up.
You climb the suspended vine-Iadder and you have an immediate rapport with
the person inside.
After spending some time with this person, you take a last appreciative look at
the panorama and climb down the ladder.
You explore the island.
You make your way to the beach and then, walking along the beach, you
eventually come to where you moored your boat.
You reflect on your experiences as you row away from the island ...

Painting the fantasy

After I 've finished the fantasy, I ask people to open their eyes and to move very gently:
to shake their hands, to move their heads gently and slowly to the left and right. I
tell participants that they will now paint their story as they imagined it on the island
(they have already created the island - their body outline). This gives extra scope for
certain things from the story to be placed in certain areas of the body: the volcano
might be placed in the head, stornach or crotch area. It's for participants to decide
whether the placement of things in their body is relevant or not. Most participants see
the outline as the island and forget it is also their body shape when they are painting
so are not placing items on the body in a self-conscious manner; nevertheless, such
placements, though not preconceived in a conscious way, might be revealing.
I ask the group if they'd like to keep the music on while they work. My
long experience of conducting workshops has informed me that someone will
be irritated by the music... However, this soundtrack of waves and birds is
sufficiently innocuous that it has yet to receive complaint!
 44 An introduction to art therapy

Pairs or group discussion

Tbis is an opportunity for participants to experience using analogies, symbols and

metaphors in exciting ways. (I tell or give participants a definition of each of these
terms.) Every aspect of the story can be revealing - some people breeze through
the jungle, others find it hard-going with their machetes; some people want to
be engulfed by the waterfall, others avoid it. There is a possibility of the statues
representing a significant figure, such as a person in authority or a parent, or that the
person in the tree house is a would-be mate, the sort of person they' d like to meet if
not in a relationsbip. Sometimes a deceased person is in the tree house. Tbis gives
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scope for a discourse with the lost person. The interpretation of the picture is done
by the person who made it. I only ask facilitative, 'how did you fee!' -type questions.
Depending on the size ofthe group, I divide participants up into pairs to discuss
their work or, if the group is eight or under (and therefore able to feel intimate),
ask participants to put their picture in the middle of the group and talk about it for
up to ten minutes. I never nominate someone to start.
At tbis early stage of the workshop series, I don't worry too much if someone
doesn't get the chance to put their image in the centre. However, as compensation,
I offer the opportunity for those who haven't 'shared their work with the group'
(do I really talk like tbis?) to have the last word. Those who simply don't want to
reveal much about themselves at that particular moment or those who are lacking
in confidence or assertiveness are given the opportunity to say how they are
feeling. They might say sometbing along the lines of Tm not very good at being
the centre of attention', indicating an ongoing problem with assertiveness, or 'I
feIt that other people might have more important tbings to share' , indicating a self-
depreciating tendency. Their small contribution can still be significant. Indeed, a
person left slightly fmstrated in tbis session often comes forward in the next (and
I help to facilitate tbis by saying 'we've got twenty minutes left', or whatever,
'and I wonder if there is anyone who didn't speak last week who would like to
discuss their work in the group'. Some people are not good at being the centre of
attention, so it is helpful to provide tbis opportunity). I've already said that it's
fine for those who feel they don't want to share their work not to (if the group was
divided into pairs these issues don't arise). As noted, I give those who don't speak
the opportunity to say a few words at the end - I say sometbing along the lines
of 'don't fee 1 obliged to comment, but I'm wondering how people who didn't get
to talk about their work in the group fee 1 ab out thai'. Helping people to air their
feelings is normal practice for art therapy facilitators. Some people confirm that
they were happy not to have spoken, that they leamt a lot from listening to others
or declare that they intend to speak the following week. Listening to those who
speak at length is illuminating for those who don't. In a different model of art
therapy, the group interactive model (best described by Diane Waller), the amount
of disclosure by each participant becomes absolutely cmcial (non-disclosure by
one or two participants can really arrest a group), but that is discussion for another
time. In tbis very early phase of the workshop series, I don't think it matters if
some people don't speak at length.
 An introduction to art therapy 45

I end by thanking those who talked about their work to the group and I remind
the group, having articulated this is the first session, that if anyone is left feeling
emotiona11y chumed-up then I am happy to spend time with them after the
session. It's important to end the session on time and to release participants at
the agreed hour, but to offer this extra support to anyone who needs it. Having
ron introductory workshops since 1990 (that's twenty-three years at the time of
writing) up to three times a year, I can say that on only six or so occasions has
this offer been taken up, always fo11owing serious revelations, such as childhood
sexual abuse and so forth. Some facilitators may fee 1 afraid to make this offer
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for fear of being swamped - but this is not my experience. It's comforting for
participants to know that 1'11 stay and chat with them after the group, if necessary,
so I reiterate this throughout the course.

Adding some theory

Depending on the context in which I'm teaching, I may or may not offer a theory
session. If there's a half-term break, a 'reading week' or another interruption early
on in the course, 1'11 give group members the fo11owing homework: please go to
an art gallery and find two images - one you think is disturbed or 'mad' and the
other you think is 'healthy'. Please bring reproductions of these images to the
next session (or a sketch of the images). This ensures that participants continue
to think about the course during the break. Of course there isn't a right response
to this request. When participants share their 'healthy' image, some members of
the group will find it sinister, disturbing or repugnant in some way. When others
share their 'mad' or 'disturbing' image, others willlike it or find it comforting.
The point is to realise that images are open to varied interpretation. We can talk
about composition and the use of materials and how these contribute to gene rating
certain moods. The artist does not have monopoly in establishing meanings that
can be attached to their painting. A lot of art history has been written ab out the
'artist's intention', how their psychological make-up has shaped their work, and
so forth, but the work is actually up-for-grabs conceptually. If you know ab out
nineteenth-century ideas on phrenology (a theory which saw the shape ofthe head
and indentations of the scu11 indicating personality) and theories of degeneration,
then you cannot view Degas' ballet dancers in quite the same way, for example,
as someone just viewing them as pleasing aesthetic objects. The actual subject
matter of the art work might indicate preferred meanings, but the viewer of the
work always brings their unique perception to bear in their emotional reaction to
the work: so, the art works might not be seen as the artist intended.

Body image workshop

This is the most substantial exercise participants will undertake in the
introductory series. In this workshop, participants explore confiicting perceptions
of themselves. The instmction is simple: make two images - one of how you
 46 An introduction to art therapy

perceive yourselfto be (your 'real' or interior 'authentic' self) and another image
of how you feel other people see you. If you have difficulty recognising how
other people perceive you, you could pick four of five significant people in your
life and think, quite explicitly, about the way you feel they view you (e.g. your
mum, your lover, your boss, etc. - whoever is most significant). The images
should be life-sized.
I go on to clarify that the images don't have to be figurative, that abstract work
is fine. Normally, I write down the instmctions on a white board, as it saves being
asked to repeat them several times.
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The workshop allows participants, possibly for the first time in their lives,
to explore the tensions between how we feel inside and the confiicts that arise
between this self-perception, or self-image, and how other people see uso This
is very challenging emotionally. It is challenging in terms of representing these
complex states; it may be challenging conceptually, as some people have a fluid
self-identity and others a more fixed and constant one. Some people will have
thought about what effect the perceptions of significant others has on their sense
of self and well-being. However, for some people in the group it will be the first
time they have ever analysed their feelings about these things. Some people are
pleased to think about the question in a generalised way and others will want to
plot out in a very careful manner the different way that selected others impact
on them. What do other people's perceptions of us do to us emotionally? It's a
powerful question. The exercise can help participants to analyse their relationships
and also the way different perceptions of us shape our experience and, in turn,
create internal confiicts.
I want participants to be challenged at this point in the course, emotionally,
conceptually and in their use of art materials. I ask them to use life-sized sheets of
paper for each of the images. This may be the biggest individual work they have
ever completed. The workshop mns over two weeks. The first session is spent
painting. The first fifteen minutes of the second session is spent finishing off.
This is partly to give group members the opportunity to reconnect emotionally
with their work. Then a full two hours is spent analysing the work. I prefer, at this
point, to invite participants to put their work into the middle of the circle and to
receive group support to talk ab out their image. Occasionally, I am in a position
where this is untenable because of the size of the group, so the analysis can be
conducted in pairs with some sort of group sharing at the end.
Because of the power and potency of the exercise, strong emotions can be
expressed. It is particularly important to have some wind down or 'cool down'
time for this session. This could be a discussion about the disposal of the group
sculpture, if not yet dealt with, or I might ask if anyone has any questions about
the theory and practice of art therapy and/or if anyone wants further reading
suggestions. I might talk about the essay at this point, if it's the kind of introductory
course that has an assessed written component.
 An introduction to art therapy 47

Theme workshop
By ab out the seventh session I will offer a theme workshop. This is to offer a
contrast to some of the tightly structured work already completed. Also, because
the body image workshops, already described, are frequently quite intense, the
groups often appreciate having a fairly open session the fo11owing week. Why
are themes useful? At this stage of the group, using a theme can help to unify
the group; it is helpful for group-improving cohesiveness because it is stressing
commonalities between people. On the other hand, the imagery produced can be
remarkably varied. Some students articulate that they feel some relief that they
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were given more 'freedom' at this time.

At this point in the course, I highlight how symbols, metaphors, analogies
and compositional elements function in art work. What is an analogy? What is a
symbol? What is a metaphor? I go over this ground again. This is when 1'11 give
students a handout defining key terms, if I have not already done so.
The session also illustrates how symbols and metaphors can be used to bypass
conscious intension to make statements about oneself. Students are often surprised
by their images at this point. This is when the 'penny dropped', as one student put
it to me recently. The tremendous expressive power of art-making may already
have become evident but some students can get to this point in the introductory
course making images in a very contro11ed, consciously-intentioned manner. But
as participants relax and enjoy the themes, they often surprise themselves.
There are a lot of themes I rea11y like and I imagine you have your favourites
too. There are two I particularly like and have used repeatedly. One is 'my life on
a plate'. This always gives a good overview of the person's life and also illustrates
very vividly how they compartmentalise their life. Some people depict their life
as food (so the sausages are their job and the tomatoes are their parents, etc. and
you can see at a glance how they divide up significant aspects of their lives),
others will produce a more metaphorical plate. Or there can be a mixture of literal
and symbolic aspects: Tve got a big mound of cabbage here and I don't really
know why because I don't like cabbage ... ' Indeed, food for thought! Others can't
contain their life on a plate at all- perhaps they'd like to be able to but can't (this
can be explored); others use the total environment anyway (perhaps they are the
table and other elements of the composition). There is scope for a multi-leve11ed
exploration of one's life with this exercise.
Possibly my favourite theme is 'myself as a house'. If you were a house,
what would it look like? This gives even more scope for self-exploration, as
the house may be flamboyant or ordinary looking. It may have ce11ars, secret
rooms, lifts, lofts or turrets. Different parts of the house might have quite different
atmospheres. It may have open doors and windows or be fortified. The interior
may be obscured by undergrowth or hidden by thick drawn curtains or behind
large formidable bolted doors. It may be welcoming or not. Perhaps the curtains
are gossamer thin; the viewer may get a glimpse of something, but what is it?
The interior tantalises the viewer. There may be fences and paths, or not. Perhaps
 48 An introduction to art therapy

the house is loved despite its flaws, or disliked. Perhaps particular bits of it are
disliked. 'It wasn't supposed to be black', said a black women of her house. 'This
bit is a bit claustrophobic', said another women, whose sibling, it transpired, used
to lock her in a cupboard as a small child as part of a regime on ongoing abuse.
Quite accidentally, the emotional terrain can become very serious.
The environment, which the house inhabits, is important. Perhaps the house
has a relationship with other pictorial elements such as nearby trees, for example.
Perhaps the floodwaters are rising and threaten to engulf the house? Perhaps the
house is big and strong or rickety and precarious? Maybe it is weather-beaten?
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The elements may be harsh or benign. It might be a houseboat on a rising body of

water, able to slip out oftrouble.
There may be trap-doOfs, look-out towers or guard dogs. Perhaps there is no
way in to the house at all. 'I forgot to draw a front dOOf, but actually you can get in
but you have to walk round to the back and climb over the fence and then there's
a key hidden ... ' 'Actually, perhaps I do make it rather difficult for people to get to
know me ... ' And the 'penny drops'. The revealing image makes sense. The idea
of art as therapy makes sense. And in a way, my job is now largely done in terms
of providing an introduction to the subject, though I'd like participants to think
more about the nuances of different stmctures.

Analysis and role play

Most discussion of art work takes place with participants sitting a circle and
taking turns to put their work in the middle of the circle. The person who made
the art work gets to talk about it, without interruption, and then I ask that person if
they are happy to answer questions from other members of the group or to receive
comments, and usually they are. However, at some point during an introductory
workshop series I divide the group up into groups of three, after they have
produced individual art works, and ask each to take turns being:

• the 'therapist'
• the' client'
• the ob server who will comment on the therapist's technique.

In terms of the therapist's role, I ask them to ask open questions: 'what's
happening here?' or 'how does this part ofthe painting feei?' ratherthanforeclosing
meanings by offering interpretations. Students in the therapist's role also practise
using speculative questions, such as, 'where do you feel the bird is going?' or, 'if
you situated yourself in this part of the picture [pointing], how would it feei?' or, 'if
there was a storm, how do you think the tree house would fare?' Sometimes it can
be appropriate to offer a feeling response, if handled sensitively and tentatively:
'this bit feels sad to me'. However, it is better to use open questions whenever
possible. I also ask the 'therapists' to practise reiterating what a client has said
at appropriate moments to illustrate that it has been heard and understood, or to
 An introduction to art therapy 49

underline something that sounds significant. They can repeat a significant phrase:
'it wasn't supposed to be black ... ' and then wait for their 'dient' to digest what
they have said. So, reite rating something in the latter example can serve to hold
the dient's attention on a point when they might have moved on. Therapists can
also summarise, when a number of points have been made, and check out whether
they have heard things correctly when several points have been made in quick
succession, or in quite a jumbled or incoherent manner.
So they may spend fifteen or more minutes in each role. I ask the ob servers to
note:
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• Whether the therapist asked leading questions or open questions.

• To comment on whether they responded to everything said by the dient or
whether they missed opportunities to respond.
• Whether they were able to summarise or reite rate things said by the dient
in a natural-seeming way.
• To comment on the therapist's body language and tone ofvoice.
• To note whether there were compositional elements passed over by the
therapist.
• To give any other constmctive feedback they can think of. Perhaps questions
are asked in quick succession, giving the dient no pause for thought or
conversely perhaps the 'therapist' is too tentative. Perhaps they mumble or
prod the picture in a way that feels intmsive. Perhaps there were more open
ways offormulating questions, which might have been employed, and this
can be pointed out.

The feedback I get from participants is that they find the opportunity to be
observer and then therapist very useful. I move around the room and act as an
observer too. It's important to say at the outset that those in the dient role must
say so when they've had enough!

Student-Ied workshops
Still the course hasn't finished yet and, depending on whether it's a ten-, sixteen-
or eighteen-week introduction, has many or few weeks to mn. If it's a ten-week
course then the end must be mentioned. Everyone knows that there are only three
weeks left but nevertheless this fact needs to be underlined. The emotional reality
of the forthcoming ending must be assimilated. Themes of loss often arise towards
the end of a group. Ifthe group is mnning longer, further themes can be explored
and some non-directive work undertaken for contrast. In a ten-week course I often
dedicate a couple ofweeks to student-led workshops. These can be co-facilitated
by a couple or led by an individual. I give the students who have volunteered to
mn a workshop a pro-forma which asks them to write their workshop title, aims,
method and to state potential dient groups for which the workshop might be used
and why. The form ends with a participant feedback section. I make photocopies
 50 An introduction to art therapy

of the workshop leader's completed form and circulate it to students before the
workshop starts so that everyone is clear about the aims and objectives of the
workshop. At the end ofthe workshop participants write down what they thought
of the workshop in the participant feedback section of the form. These are then
retumed to the workshop leader. I prefer to use a manual method for immediacy.
I ask workshop leaders if they would like me to join in or to sit on the edge
and make notes to contribute constmctive criticism. If asked to sit out, I produce
a detailed constmctive appraisal of their performance. If asked to join in, I do so
and fill in the form at the end with everyone else.
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Common problems noted are that insufficient time was given for an exercise,
or that too many different elements were packed in, giving insufficient time for
participants to reflect on their work. Sometimes instmctions were not sufficiently
clear, so participants ended up not doing what the facilitator had in mind.
Sometimes the workshop leader sat with a closed body posture or failed to make
eye contact with participants. This is a valuable opportunity for the workshop
leader to get detailed feedback on how well they did. Doing too much with
insufficient time for reflection on the art work produced is definitely the main
fault of these novice workshop leaders. I have often feIt exhausted after joining in
a too densely-packed session, or fmstrated that there was not enough time at the
end to say what Iwanted to say.
Towards the end of an experiential group, especially a group that has become
cohesive and enjoyable, there can be a collective sense of loss. The ending of
the group can be evocative of other endings in participants' lives and therefore
generate emotions. Depending on the length of the group I will work with the
theme of endings and new beginnings.

Structured ending exercise

I end the group in a highly stmctured way. The last workshop I mn is a gifts
workshop. This is always enjoyable, though it mayaiso be serious; it is often
celebratory in tone. I ask participants to make a gift for everyone in the group
but not flowers or boxes of chocolate - I ask them to think ab out that person and
to make something apt: this can be a resource like inner strength or a quality
that they fee 1 the person needs. Everyone in the group has disclosed something
about their personal situation at some point. It is an opportunity to make a really
personal statement and because the gifts are so personal they are often deeply
appreciated.
To give an example, a fairly light-hearted gift was given to me recently. I'd
talked in the group about feeling almost claustrophobic about the cumulative
demands being placed upon me by caring for young children, doing a long
commute, working more than full-time and having achalienging partner. I'd
talked ab out not having enough personal space or feeling like a fairground plate-
spinner with rather too many plates up on sticks, or like a little caged hamster
(I' d depicted myself as a little hamster entrapped mnning pointlessly and wildly
 An introduction to art therapy 5I

in a wheel, during a student-Ied exereise whieh required us to depiet ourselves as

an animai). One of the gifts given to me was a little plastieine bear juggling balls
as a helper for me to juggle some of my balls. Although it was a light-hearted
statement, it was apposite and motivated me to hire a cleaner, an au-pair and
reduee my hours! Yes, I did need mueh more help! Sometimes the gifts support
a resolve previously artieulated in the group by the partieipant. Someone else in
the same group gave me a little empty box eontaining my longed-for spaee. On
the one hand, she was giving me what she knew Iwanted, but on the other hand,
she was suggesting that I should attain this, so it was a little nudge - a da it! Or an
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affirmative - yau can da it!

The gifts might be 3D works, drawings or eards. I ask eaeh person to give out
their gifts in turn, to aetually give the gift to the person it's intended for and to
say a few words ab out why they have made what they have made. It's an ending
eeremony of sorts.
After eaeh member of the group has reeeived their gifts, I end the group by
reminding everyone ab out the importanee of eonfidentiality, and ask if partieipants
have any last words they would like to say. I think it's important to give this last
opportunity for something to be said so that no one leaves fmstrated.
 Chapter 5

Becoming an art therapy

practitioner
Annette M. Caufter
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Graduating art therapists are beginning a new phase of their career, aiming to
build on ideas and gain clinical experience by working with a range of clients.
However, there may be challenges, such as pioneering art therapy in professional
isolation, for example, when overseas graduates return horne or choose to work
in a remote location. Seeking work where art therapy services are not established
requires acquiring an additional set of skills. This chapter offers advice and ideas
for becoming an art therapist practitioner, particularly when working without the
professional support systems recommended for best practice.
Success for the overseas graduate relies on the art therapist's core sense of
identity, a belief in the unique service they offer and their ability to self-market
and to educate professional communities as well as the general public. They
need to be able to reframe a lack of understanding and support into achalienge
to educate and promote their specialist skills and competencies. Rehabilitative
communities are often sceptical ab out the benefits of art. Published art therapy
resources are available, although the current dominant discourse is mostly British
(UK) or North American (US) and there is little provision to equip graduates to
sell their credibility, validate their clinical effectiveness or adapt art therapy to
other cultural contexts.

Establishing a training programme

Overseas graduates returning horne may have a choice of either securing
employment or establishing a professional training programme. Once local art
therapists have eamed professional credibility, educational authorities are more
likely to approve a training progranune. Course instigators have to translate art
therapy course content to a new cultural context, and foreign art therapists may
have limited knowledge oflocal issues and systems, though some have supported
the establishment of new training courses (Hagood 1993; Gilroy and Hanna 1998;
Campanelli and Kaplan 1996; Slater 1999; Coulter 2006a, 2006b). However,
in most parts of the world, there is an initial UK or US infiuence on training
programmes (Potash, Bardot and Ho 2012).
 Becoming an art therapy practitioner 53

Finding employment
Finding art therapy employment may not always be possible. The following
suggestions are various ways newly-qualified art therapists might ac hieve
employment or enhance better workplace terms and conditions.

Offering a <taster'
Some potential employers may prefer to be offered a session or short series of
sessions that are designed specifically for that agency. A specific package can
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be negotiated and a short-term group or a professional development presentation

offered (see pp. 64-5). Information ab out an art therapy initiative can therefore be
passed on through interagency networks and may lead to further work.

A trainee internship/placement
Art therapy can be introduced through offering a clinical placement or intemship,
which may be useful for agencies with limited funding, and can lead to employment
possibilities in cautious clinical environments.

Extended clinical placement/practicum

Newly-qualified art therapists may often be employed where they did their clinical
placement. When establishing a training programme, matching the student to the
agency often determines the short-term future of art therapy in that facility. The
workplace can see the effectiveness of the work and becomes convinced that
providing this service will benefit clients, though funding issues sometimes mean
initiating a compromised art therapy position, such as apart-time or a time-limited
contract. The art therapist needs to avoid slipping into their previous traineeship
role and has to place remunerative value on the service they offer. They need to
negotiate responsibilities and make recommendations to the job description in
line with professional requirements, aware that, for example, their on-site clinical
supervisor is now their line manager.

Generating funding
After a short block of 'taster' sessions have been delivered, adecision can be
negotiated with the agency to find short-term limited funding from a charity or
service industry. The funds available may not be commensurate with industry
standards fees but the art therapist may agree to be publically profiled by local
media in response to the funding gesture. Pioneering a new profession often means
financial compromise in order to negotiate future employment possibilities.
 54 Becoming an art therapy practitioner

Promoting 0 previous qualification

Sometimes it is more useful for art therapists to play down their specialist skills and
to promote a previous professional qualification. Where art therapy is not known or
understood, a previous professional qualification might be more readily acceptable.
Other therapists who complete art therapy training may find work more easily under
their previous job title, and can then build up adesignated 'art therapist' position.

Negotiating a job description

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Most art therapists do not find themselves working in art therapy departments, and
may have other job titles such as 'counsellor', 'case worker', 'child' or 'family'
therapist, 'project' or 'clinical' coordinator. Whilst art therapy skills may infiuence
successful employment, there is oftenno provisionfordemonstratingthese attributes
within the existingjob description. When negotiating terms of employment, it pays
to delineate between administrative and clinical responsibilities; the art therapist
carries direct clinical responsibility even though their administrative accountability
is to other staff.

Establishing an art therapy service

The newly-qualified art therapist is vulnerable to the terms and conditions that
dictate their employment, especially if they are working in professional isolation.
A new art therapy service must eam respect, particularly in a system that values
medication, cognitive interventions and diagnostic statistics. Art therapists
themselves need to respect and understand other traditional interventions. Mutual
acceptance assists such things as the designation of an 'art therapist' position,
salary improvement, better work facilities, the purchasing of art equipment and
establishing an art therapy referral system.

Referral
The best treatment conditions are where the art therapist has direct contact with the
referral source. Establishing a direct referral system builds professional respect.
In medical settings, the specialist is the direct referrer but it might also be a unit
director or another service. The referrer is directly informed through an assessment
process about case suitability for art therapy treatment, taking into account not
only the treatment offered, but also the therapist's scope of clinical experience.
The advantage of direct referral is that a relations hip is established between
the referrer and the art therapy service provider, so that the referrer finds out
more about art therapy treatment, case discussion can become increasingly
complex and skills and expertise within the working relationship expand. The
referrer gains a better understanding ab out how art therapy might assist their
clients' psychopathology and when the art therapist's skills are appreciated, there
 Becoming an art therapy practitioner 55

are further referrals and recommendations to other networks. Gradually, the art
therapy service becomes indispensable as a treatment modality.

Art therapy assessment

An assessment phase provides an opportunity for not only the therapist to assess
the client's therapeutic needs, but also for the client to assess whether the therapist
can help them.
An assessment is instigated primarily to deterrnine the appropriateness for
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art therapy treatment, and so is more for the benefit of therapist and the referrer
than the client. Referrers more easily accept case unsuitability if an assessment
process has taken place. An assessment also assists case management where legal
documentation is required.
There is often a misunderstanding that through providing an assessment, the
art therapist diagnoses pathology. Art therapists are not trained to diagnose and
assessments should never take the place of therapy. Through image content, the
assessment deterrnines self-perception, psychomotor activity and unconscious
expression through images. Art tasks tap directly into how the maker perceives
their visual world; often clients may not be able to say in words what can be
described through image production.
The therapist explains the limits of confidentiality before the assessment is
administered. The client needs to understand that this is not therapy but is an
alternate way to find out their personal perceptions. Interpretation is substantiated
only by what is said by the client. In order to avoid litigation, it is important when
documenting client statements to quote directly what is said. Recording the image
assists ease of review - for example, an unnoticed theme becomes evident when
the art work is regarded as one completed body of work. Assessment requires a
distinction between what is observed during the art procedures and what is projected
by the client and/or hypothesised by the therapist. Expressive components such as
sequence, size, pressure, stroke, detailing, symmetry, placement and motion show
how art work is executed and content components describe wh at is drawn.
Some art therapists are able to administer specific art therapy assessment
procedures, whereas others focus on the level of initial engagement and the
monitoring of conscious and unconscious processes within the therapeutic
relationship (Case and Dalley 2006; Gilroy, Tipple and Brown 2012). The
following assessment procedures can help work colleagues understand art
therapy; they are easy to explain, administer and are effective.

The Kramer Art Evaluation

Edith Kramer developed one of the earliest art therapy assessment procedures
that is still widely used (Kramer and Schehr 1983). In this procedure, the client
is given three non-directive art tasks: painting, drawing and clay-work, and is
instmcted: 'I am going to ask you to make three pieces of art today with the
 56 Becoming an art therapy practitioner

materials provided foryou. You are to draw, paint, and use clay in whatever order
you choose, and you may choose the subject matter. I will ask you a few questions
when you are finished with all three tasks.' (Kramer and Schehr 1983).

Ulman Assessment

The Ulman Assessment procedure includes an optional scoring system for the
quality of marks made. Art materials include grey paper and a new set of chalk
pastels, a drawing board, masking tape and a stop-watch. Instmctions include:
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ii You will be making four drawings. Please use these materials to make your
first pieture.
ii Follow me in these exercises (physical warm-up); now make these same
movements with chalk on paper.
iii With your eyes closed, make arhythmie scribble on this piece of paper. Look
for images in the scribble. You may see one, you may see several. Select the
images you wish to develop into a picture. You may use the lines already on
the paper, colour over them, ignore them, change them, or add lines.
iv This will be your last pieture. You have the choice of making a pieture
from a scribble or of making a pieture as you did originally - directly on
the paper.
(Ulman 1975: 362-5)

The Diagnostic Drawing Series (DDS)

The DDS is a systemic approach to art therapy evaluation and research, originally
designed as a format for the study of drawings in relation to diagnosis (Cohen,
Hammer and Singer 1988).
Three pictures are produced that reflect how an individual responds to stmcture
and directives, allowing for a range of psychological and graphie responses. Art
materials are a set of drawing pastels and a piece of 18" x 24" paper. There are
three tasks, after each ofwhich the client is asked aseries of questions.

TASK I: MAKE A PICTURE USING THESE MATERIALS (UNSTRUCTURED)

Can you describe this picture? Can you tell me what the colours mean? Can you
tell me what these images mean or represent? What else would you like to say
about the picture? What would you title the pieture?

TASK 2: MAKE A PICTURE OF A TREE (STRUCTURED)

Can you describe this tree? Is this a tree you know or is it imaginary? Where
would it be located? Are there special meanings to the colours? What part of the
tree do you like best? What part of the tree do you like least? What else would you
like to say about the pieture?
 Becoming an art therapy practitioner 57

TASK 3: MAKE A PICTURE OF HOW YOU ARE FEELING USING LlNES, SHAPES
AND COLOURS (STRUCTURED)

Can you describe this picture? Can you tell me what these colours mean? Can you
tell me what these images represent? What would you title this picture? (Cohen,
Hammer and Singer 1988).

Designing an art therapy assessment

There is areal skill in being able to design an assessment to specifically suit dient
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needs. The following ideas can be used.

• A 'free 'picture: The dient is invited to 'draw whatever comes to mind'. Afree
picture is the first task of a number of assessment procedures (Kwiatkowska
1978; Ulman 1975; Cohen, Hanuner and Singer 1988). This open-ended task
provides a choice of content and art media to determine the dient at the outset
oftherapy. Artistic merit is not the primary interest (see p. 69).
• Afamily picture: This task can begin with an instmction such as 'draw your
family, induding yourself, as animals', or a more complex task such as
'draw an abstract family portrait' (Kwiatkowska 1978). Altematively, a
family art task can be designed that is relevant to a specific family event.
This could be an action-oriented task, for example, 'draw everyone in the
family, indudingyourself, doing something' (Bums and Kaufman 1970: 5).
The family can do more than one art task together (see p. 69). Media tends
to favour oil pastels, but three-dimensional media such as day can also be
used (see Figure 5.1).
• The problem: The purpose of this task is to determine the dient's ability to
visually conceptualise the problem. The task might be, 'draw a picture of the
problem, as you understand it'. However, a more specific instruction might

Figure 5./ My family, by Elizabeth, age 8

 58 Becoming an art therapy practitioner

be required, such as 'draw this recurring dream', or 'draw how this person
makes you fee!'. This task is not always suitable because the dient may
have no concept of why they fee 1the way they do, or may not believe there
is a problem. Therefore an image about feelings might be more appropriate;
for example, if they feel depressed, 'in some way can you put those feelings
onto the paper?'
• Self-image: Self-concept tasks are nearly always relevant where issues of
self-esteem are affecting mood and especially in the assessment of young
people. A task might simply be 'draw a picture of yourself', or could be
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more complex, such as 'draw how others see you.' It could be symbolic:
'draw yourself as a tree/animal/object, with any qualities, any colour'; or
abstract: 'describe yourself in shape and colour only', or extended to ' ...
so that when you look at the picture, it conveys asense of who you are at
this point in time'. The task can also be contextual or diagrammatic, such
as 'draw your life as a map, up until now' . A mirror can be used for realistic
self-portraiture (Ault 1999).
• Future focus: The indusion of a future-focused task helps determine
goals of treatment, contributing to the therapist's contract with the dient.
Formulating dear goals might be an agreed condition oftreatment. The art
task might be, 'draw how you would like to be in one/five/ten years time' .
It could also be something like, 'draw how your life/you would be, ifyou
no longer needed to come to therapy'. The task can incorporate the 'Mirade
Question' where the dient is invited to imagine their life problem-free: 'if a
mirade happened, how would your life be different?' (de Shazer 1994: 95).
The art therapist then adds, 'can you draw that?' (Coulter 2011: 88). This
task requires the ability to positively reframe a current difficulty.
• A 'free 'picture: The invitation to complete a final 'free' picture helps indicate
how the assessment procedure has affected the dient's sense of weH-being.
Comparing the first and last 'free' picture is informative (Kwiatkowska
1978; Ulman 1975).

GeneraHy, dient suitability is determined and rapport and safety can be

reasonably established after three sessions. The art therapist might choose to
extend the assessment to six sessions to consolidate their initial impressions or
restrict it to two or three sessions if there are only six to twelve sessions available
because of funding, health insurance or agency in-take policy. Some therapists
have longer initial sessions, so that the assessment is completed in one or two two-
hour sessions. An assessment report determining appropriateness for art therapy is
sent to the referrer after the initial contact sessions are completed.

Writing reports

Anything written about a dient is a legal document. It is therefore important to only

document facts, not unsubstantiated subjective comments. A written report to the
 Becoming an art therapy practitioner 59

referrer is usually required on completion of an art therapy assessment, particularly

in medical settings. It assists the professional profile of the art therapist to have a
pro-forma for report-writing that indudes dient information provided at the time
of referral; the number of sessions to date; abrief history; initial impressions; in
the case of a family, who was seen and the frequency; nature of the assessment or
treatment; and anything significant worth noting such as dient statements, thoughts
and comments; recommendations; further treatment; and conduding remarks.
Client self-evaluation can be a spontaneous gesture drawing in a visual diary
at the beginning and end of each therapy session (see p. 84). Altematively, dient
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feedback can be the completion of a brief form at the termination of therapy,

designed to indicate whether or not the dient has found art therapy beneficial,
induding a question about using art materials in this context.

Designing forms and po/icies

Delivering an art therapy service requires forms to support efficient dinical

practice, especially in a sole worker service. For best practice, the foHowing
should be induded: referral; dient evaluation/feedback; exchange of information;
consent to be recorded; consent that art work can be shared or used for educational
purposes, or permission to exhibit or photo graph dient art work.

Referra/ forms
Collaborative team work
An advantage of finding employment in a dinical team is that the art therapist
is part of the joint case management, and the possibility of working with others
affected by an individual's difficulties. For example, a referral might be to work
with extended family members such as parents, grandparents or siblings of the
dient or another family sub-system.

Ownership and ethical responsibility

Consent forms are always required to share art work in dinical or educational
settings, although it is often questionable whether the dient can refuse such requests.
It is not always in the dient's best interests for art work to be shared with other
team members, parents or the doctor, particularly in the case of child art therapy.
Because signed permission is given, the art therapist meets their ethical obligation,
although the dient' s motivation to sign a release form is often to please their therapist
rather than in their own best interest. However, art work display can demonstrate
art therapy's effectiveness as weH as provide therapeutic gain (Coulter 2008). There
are limitations to confidentiality. The art therapist is ethically responsible to report
imagery that might indicate destructive intent to self or others, and it is mandatory to
report disdosures of abuse or intention to harm self or others.
 60 Becoming an art therapy practitioner

Professional indemnity insurance

When employed within an agency, professional indemnity is usually part of
the employment package, whilst in contract work the art therapist must have
personal indemnity insurance for session work. Some professional membership
is conditional on the therapist maintaining up-to-date indemnity insurance cover.
This protects the art therapist from personalliability regarding a client complaint.

Private practice
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It is better to consolidate training through successful agency employment before

establishing private practice. Training courses recommend supervised post-
training clinical practice to gain experience because there is no back-up in private
practice. Where there are limited employment opportunities, however, private
practice can become a necessity.
Remuneration as a private practitioner is likely to be greater than agency
work but there is greater clinical responsibility and larger overhead costs, such as
indemnity and third party liability insurance, and hiring private rooms which can
be costly particularly if an art studio is required. It is sometimes easier to invest
in purpose-built rooms or to establish practice rooms from horne. Working from
a counselling room located at a private residence may present boundary issues
and for some is not viable. Where counselling rooms are rented or shared, there
may be constraints on art media usage and the degree of mess that is manageable.
In some countries, counselling, including art therapy, is subsidised through
a rebate scheme or health insurance. In other countries, private health funds
support alternative programmes including art therapy and sometimes these apply
internationally. It is often only those who are financially secure who can afford
art therapy services, although there are special circumstances where govemment
services fund client art therapy treatment.

Personal dress code

In health settings an 'arty' look does not eam the same respect as that of someone
who is easily identified as a fellow professional. Art therapists are greatly
advantaged if they consider their professional persona, including how they dress.
A professional dress code also affects clients' perceptions ofthe art therapist. For
example, no visible cleavage assists the management of sexual transference onto
female therapists, and filled-in shoes the management of a client who may have
an undiagnosed foot or toe fetish. Imposing personal beliefs onto the therapeutic
relationship through attire is problematic. For example, wearing religious symbols
can disturb or offend someone with conflicting spiritual or delusional beliefs. In
some cultures there are demands of dress such as the burka, the yarmulke or a
turban. The potential impact of personal dress on the therapeutic relationship can
be managed through clinical supervision.
 Becoming an art therapy practitioner 6I

Owning the name 'art therapy'

When delivering short training workshops to workers who already claim to 'do a bit
of art therapy', it's helpful to mention that art therapy is a post-graduate specialist
training and that everything cannot be taught in a one-day workshop. Where other
professionals are using art techniques, confusion is avoided by encouraging that
they call this 'creative art , , 'art and self-expression', 'creative expression' or 'art
and personal growth'. When establishing anational association, the term of 'art
therapy' can be claimed through govermnent legislation.
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Forming partnerships: other professional groups

The art therapist is sometimes eligible to join an association that has a more generic
membership such as family therapists or counsellors and psychotherapists. Where
registration for art therapy is not established, belonging to another organisation
can assist in becoming a local registered practitioner, providing opportunity
for professional development and skills-promotion. Conferences and training
presentations can help educate others ab out art therapy practice (see pp. 62-4).
Finding ways to profile one's work, such as collaborative presentations with other
professionals, helps generate referrals and promote an art therapy service.

Establishing anational association

Professional respect, public education and opportunities for art therapy promotion
are greatly enhanced through the establishment of a national organisation. An
information centre can be set up that recommends the growth of art therapy in a
particular country. Knowledge can be made accessible by translating into the local
language. Founding members can promote anational understanding of art therapy
through workshops and conferences, as well as short training courses.
The first step is to form a small local working party of art therapists. This
founding group or steering committee consider: (i) a terms of reference; (ii) a
purpose of intent; and (iii) formulate membership criteria. Policy documents need
to be drafted: (i) a constitution; (ii) a code of ethics; (iii) a standards of practice;
and eventually, (iv) training guidelines. Sometimes differences in overseas
training programmes require debate to assist the adaptation of educational
infiuences to local contexts. When founding members come from varied overseas
training backgrounds, supporting confiicting codes of practice and contradictory
theoretical frameworks, the need for a more global appreciation of art therapy
is required; difference requires integration and respectful compromise (see
Chapter 17). An international perspective better supports the sole worker
practitioner who is pioneering the profession in isolation.
 62 Becoming an art therapy practitioner

Conclusion
Pioneering art therapy intemationally involves integrating aspects of the profession
that have infiltrated the local culture, and which may be challenging to the art
therapist's core beliefs and understandings. Global variances of the profession
need to be resolved from a perspective that is respectful of differences in practice.
Although there are many aspects of becoming an art therapist, increasingly
the challenge is to establish the profession in a resistive environment with few
professional supports.
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Coulter, A 2008. 'Came Back - Didn't Come Horne': Returning from a War Zone, in
M Liebmann (ed.) Art Therapy and Anger. London: Jessica Kingsley Publishers, pp.
238-56.
Coulter, A 2011. Contemporary Art Therapy: Working with Transient Youth, in H Burt
(ed.) Art Therapy and Postmodernism: Creative Healing Through a Prism. London:
Jessica Kingsley Publishers, pp. 83-93.
Gilroy, A and Hanna, M. 1998. Confiict and Culture in Art Therapy, in AR Hiscox and
AC. Calisch (eds) Tapestry o/Cultural Issues in Art Therapy. London: Jessica Kingsley
Publishers, pp. 249-75.
Gilroy, A, Tipple, Rand Brown, C. (eds) 2012. Assessment in Art Therapy. London:
Routledge.
Hagood, MM 1993. Letter to the Editor. The Arts in Psychotherapy 20(4),279-81.
Kramer, E. & Schehr, J 1983. An Art Therapy Evaluation Session for Children. American
Journal 0/Art Therapy 23, 3-12.
Kwiatkowska, HY 1978. Family Therapy and Evaluation Through Art. Springfield, IL:
C.C. Thomas.
Potash, JS., Bardot, Hand Ho, RT.H 2012. Conceptualizing International Art Therapy
Education Standards. The Arts in Psychotherapy 39,143-50.
 Becoming an art therapy practitioner 63

de Shazer, S. 1994. Words Were Originally Magie. New York: w.w. Norton and Company.
Slater, N. 1999. Keynote Address (unpublished). Tenth Annua1 Conference of the
Australian National Art Therapy Association, Coming Full Circle: An Unfo1ding
Joumey, Brisbane, Queensland, Australia.
Uhnan, E. 1975. The New Use ofArt inPsychiatricAna1ysis, inE. Ulman and P. Dachinger
(eds) Art Therapy in Theory and Praetiee. N ew York: Schocken Books, pp. 361-86.
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 Chapter 6

Teaching art therapy to other

allied health professionals
Annette M. Caufter
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When pioneering the profession, the art therapist is often required to nm educative
training. This might be a guest lecture, an experiential workshop or abrief
overview that introduces the use of art therapy in a specific setting. Participants
may include interested allied health professionals, community workers and
employees from other institutional departments such as education, corrective
services or private health agencies and systems. This delivery might also include
the corporate sector, where art therapy can benefit team building, mediate confiict
or contribute to human resourcing within business.
These professionals do not want a qualification in art therapy, but there is a wish
for skills enhancement, and frequently an expectation that staff will be able to use art
more effectively in their workplace. Some allied health professionals may already
use art in their clients' treatment and attend training to enhance their repertoire of
skills, often motivated by awareness that art therapy is a profession in which they
have not completed formal training. When delivering professional development
training, art therapists need to be sensitive to what is already known or experienced.
Delivering professional development is an opportunity to promote art therapy
as a credible profession and to educate and inform the wider community. Finding
out the audience' s understanding of art therapy is a useful first step. Art therapists
wish to protect the profession from misrepresentation and also to promote
awareness about the specialist nature of their work. When educating allied health
professionals, the following questions should be of concern to art therapists: how
effective is the therapeutic application of art from someone who is untrained? Who
is responsible for the effective misuse of art in therapeutic settings? What role do
art therapists have in providing information about effective clinical practice?
By making the profession accessible, the concern is that art therapists nm the risk
of prostituting their specialist expertise and experience. But protecting the profession
from malpractice doesn't necessarily mean remaining mysterious, providing oblique
information and aiming not to give away 'trade secrets'. Allied health professionals
and others may not be skilled in art therapy, but their expertise and professionalism
can challenge an inexperienced, newly qualified art therapist. However, they can
also enhance the quality of the presentation, if the art therapist can deliver from a
position of respect that is open to the knowledge or experience the audience offers.
 Allied health professionals 65

Running introductory training

The art therapist must have a dear training brief. Organisations use their professional
development budgets to send staff to training, which rnight be professional
development either requested by staff members or that a manager or supelVisor
believes will enhance best practice. Personal enthusiasm for using art may be the
motivation orparticipants may be there begmdgingly, having beeninstructed to artend.
A manager or employer may wish them to improve their skiHs or may have concerns
about irregularities or complaints about their use of art in the workplace. When an art
therapist runs professional development training for community agencies, they cater
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for a broad audience. It is important to see these as one-off opportunities to educate

the public about the profession. For the duration of the professional development
training, there is a captive audience of interested professionals.
There are differences in approach, depending on the type of presentation and the
length of time available. The art therapist rnight be called upon to present in a variety
of different ways and contexts, for example, for a government department that is
considering funding some contracted art therapy work; a small agency interested
in professional development for their staff; an organisation that is considering
employing an art therapist; an indigenous group of workers who consider art therapy
rnight complement the work within their culture; or as a selVice for a specific dient
group where it is thought art therapy may have something new to offer.

Presenting a one-off lecture or talk

It's useful to begin by defining art therapy from several perspectives, using both
UK and US official definitions as weH as the local definition if that country has
developed a statement. The belief that art therapists interpret art work, or that the
end product is used in diagnosis, needs to be darified or dispeHed, depending on
the art therapist's model of understanding. What art therapy is and is not needs
to be explained (The Hong Kong Association of Art Therapists 2002), foHowed
by theoretical content that suits the orientation of the therapist and relates to the
audience to whom the presentation is directed. Generally, definition is foHowed by
something on the creative process (see pp. 81-2), psychological factors contributing
to creative thinking, theoretical approaches to art therapy, dinical application which
may or may not indude case material and then a condusion on the values of art
therapy. Case examples can enhance a presentation but dient information is used
rninimally and only to illustrate a particular point.

An experiential workshop
Provide time for the group to introduce themselves to you and to each other,
finding out what skiHs, experience and knowledge they have, as weH as what
their exposure to art therapy has been, in particular, and whether this has been
from a UK or US perspective (see pp. 81-2). This will dictate participants'
 66 Allied health professionals

training expectations. Although an experiential workshop has a practical, skills-

enhancement focus, a theoretical component provides an academic baseline that
helps engage the sceptic who may be present.
The agenda for a two-day introductory training could include: art kits, group
guidelines, processing guidelines, an introductory DVD (Rubin 2004) and visual
diaries. The theoretical components might include: definition and creativity, the
Expressive Therapies Continuum (ETC) (Lusebrink 1990), designing an ETC
intervention, values of art therapy, documentation of art work, ownership and
storage, a book-list and other resources. Experiential content could include:
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communication through art, an exploration of art media, introducing yourself

through art, group art therapy, art and self-image and visual diary entries. At the
end of each day, it's useful to have time for questions and seminar discussion, as
weH as an evaluation at the end ofthe course.

Introductory tasks
These might include a line conversation, an image found within a scribble (see pp.
79, 157, 159) or a 'free' picture (see pp. 57-8,79). Although these Communication
Through Art tasks are usually experienced as fun and engaging, they begin to
demonstrate the effectiveness of art therapy, reflecting an assessment phase of
treatment. Once group trust is established, in-depth, self-disclosure-type tasks,
such as Art and Selj-Image, are reflective of the treatment phase. Resources for
art therapy tasks can be recommended to workshop participants (Lieb mann 2004;
Makin 1999; Malchiodi 1998; Buchalter 2009; Ross 1997). The art therapist also
needs to deliver educative instruction on group guidelines and on processing art
work.

Group guidelines

These are a basic set of parameters for the duration of the training and should be
delivered prior to producing any art work. This helps establish safety, particularly
if a participant is resistant, suspicious ab out art therapy or is there under duress.
As a training tool, these guidelines instil ethical considerations from the outset
and aHow time to clarify understandings and stimulate discussion relevant to the
participant's frame of reference. This prepares for the processing of art work in a
training context, desensitises participant's expectations and introduces strategies
for the non-art therapist practitioner. If there is limited time to teach ab out art
therapy, the inclusion of group and processing guidelines are likely to enhance the
safe use of art in therapy. This is a summary of training group guidelines:

Be responsible (or yoursel(

This is training, not therapy. If unexpected personal insights surface, these can
be discussed elsewhere, outside the workshop. Where possible, work in a private
 Allied health professionals 67

space - avoid looking at others' art work, which can infiuence or intimidate the
art-making process. You do not have to share your art work.1t is the art therapist's
responsibility to provide personal boundaries for participants, and the participants'
responsibility to self-monitor within these boundaries.

Allow 'internal dialogue'

This may take place while making an art work, so do not talk or make distracting
noises. Try and re lax and let the art materials do the thinking. Allow spontaneous,
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unconscious processes to be mobilised.

Maintain therapeutic boundaries

Do not talk about art work outside the room (this can dismpt the 'holding' space
of the room). The room, the art work, the length of time and the art therapist's
presence should also act as the boundary that helps contain content. The workshop
is confidential, and the walls ofthe room are the 'frame' - hence the notion ofthe
'frame within the frame' (Schaverien 1989). Participants should remain in the
room for the duration of the session.

Maintain confidentiality
What is shared remains confidential. You might discuss your own art work with
a partner or close friend, but do not discuss anyone else's. During breaks, art
work is not discussed. Seek permission to photo graph any art work and document
everything on the reverse. Point out that participants are not art therapists and
so not bound by the same professional code of ethics; however, they should be
alerted to best practice within the profession.

Respect art work

Art work is an extension of the person. Do not overlap your work with anyone
else 's and respect their working spaces. The therapist does not touch a participant's
art work without their permission. Maintain confidentiality.

Document all art work

When art work is completed, contemplate and reflect on your personal process,
making notes and debriefing in your visual diary. Document work on reverse
side with name, date, title, time of day and number of art work in a sequence of
completion.
 68 Allied health professionals

The importance of process

Artistic skills are not important, but the process iso Think about what has taken
place for you during the 'internal dialogue'. The art work is not an end in itself,
but a statement of where the process is up to. It does not matter how 'good' or
'bad' the work is aesthetically.

Keep art materials tidy

The art materials are your clinical tools and you have been provided with a basic
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'tool kif to use during and after the workshop. 'Contaminated' art materials should
be avoided. It is up to each participant to look after and maintain their art materials,
and this is more effective when ownership is involved, as opposed to supplying
communal art materials. Art materials should meet the criteria of the Expressive
Therapies Continuum (Lusebrink 1990) and can be used later in clinical settings.

Use visual diaries

Use these for spontaneous ge sture drawing (p. 84). Document all entries, which
are private and only to be shared ifyou choose to. Throughout the workshop, the
visual diary is used to support and reflect on the training process.

Training group processing of art work

Workshop participants can process in pairs, small groups or in the larger group. If
it is workplace training, working with the larger group is more effective because
relationships are already established - the workshop can strengthen team-building.
However, if the team is dysfunctional, sharing in the larger group may not be as
effective because participants want privacy from their colleagues. Decisions on
how work is to be processed are made as the facilitator gains an understanding of
the training group and observes relationships within the group.
More often, participants do not know each other. In this situation, group
cohesiveness or trust needs to be established if art work is to be processed safely.
Therefore, starting interactions in pairs and/or small groups is more effective.
There are definite limitations to what can be achieved from a short-term training
workshop. There are basic points to get across regarding the processing of art
work. It is easier for participants to understand these points with explanation
and example. Processing guidelines (see pp. 69-70) can be combined with
group guidelines (see pp. 66-8) where there are time constraints. However, for
information absorption, it is easier if there is a break, some art work produced and
then the processing guidelines delivered.

Working in pairs

People can join up with someone they know, someone they intuitively feel
comfortable with or with someone they know the least. Try to create a pair
 Allied health professionals 69

situation that reflects a client-therapist situation, so initial workshop tasks

reflect the therapist trying to establish rapport or engage with the client. In this
scenario, it is likely that the therapist and client do not know each other, so
asking participants to pair with someone they know the least will reflect this new
relationship. When doing more in-depth sharing, encouraging participants to pair
with someone they fee I more comfortable with, or someone they know weH, is
better suited to a client-therapist scenario once rapport is established. Encourage
participants to give each other feedback on processing style, so that they leam
from the training experience what worked weH and what aspects need further
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consideration.

Processing guidelines

The foHowing processing guidelines are small and larger group situations. The
advantage of processing art work with the whole group is that it is easier to
demonstrate these points by example.

You don't have to share your work

The art work has only just become conscious and the maker needs time to
contemplate it before verbalising can take place. The making of art work is
therapeutic in itself and words are not always relevant or necessary. Sometimes
the maker may never fuHy understand the work.

Always own your comments

Don't make assumptions ab out other people's art work. Own your own comments;
for example: 'When 1 look at this 1 feel. .. ' It's fine to share your gut response to
someone else's work, but acknowledge this is about your own experience; for
example: 'When I look atyour family, I get a feeling of ... '

Be non-judgemental about artistic merit

Avoid comments on artistic merit (for example, 'What a lovely picture'), even
though we are socially conditioned to congratulate artistic skill. Judgements are
value-Iaden and subjective, and not useful in the context of art therapy, which is
different from the outside world.

Only one person speaks at a time

This can be overlooked if participants get excited ab out the art-making process.
Each person has their own unique visuallanguage based on cultural background,
belief system and personal life experience - listen to their language of 'word-
symbols'. Be respectful.
 70 Allied health professionals

You can stop sharing at any time

A personal insight can break through at any moment - this can be confronting.
You can stop sharing at any time without further explanation, or simply say, Td
like to leave it there', for example. The art work is a permanent record and can
be retumed to later. Important material will be repeated until it is understood and
processed.

You do not have to respond

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You do not have to reply to questions or comments - there are no polite social
norms within the workshop. You can simply nod, say 'uh huh' or just contemplate
the art work.

Phrase a question into a statement

Questions about art work come from a thought - share the thought as an open-
ended statement or comment. The maker does not always want to be bombarded
with questions about their work.

Listen to the language used

When sharing your art work, you are describing your visual world to others - this
can be a surprisingly emotional experience. If you are the receiver, listen to the
language used and do not assume your thoughts are right until they are confirmed.
When responding, use the terms the maker uses.

Let go of a therapist 's agenda

Wait until the person is ready to share their work; don't get carried away by what
you think the work is about. Remember that making art work is therapeutic in itself.

The Expressive Therapies Continuum

Lusebrink's Expressive Therapies Continuum, or ETC (Lusebrink 1990),
packages a dear theory that is easy for the allied health worker to grasp in a
time-limited workshop. Two publications (Lusebrink 1990; Hinz 2009) refer the
participant to further information on the impact of art materials in relation to
the ETC and on the therapeutic process, and their contribution to the process of
change. When providing training for allied health professionals, allocating time
for participants to consider the importance of art materials as an intelVention in
their own right is highly recommended. Allied health professionals have often not
considered the significance of providing an incomplete spectmm of colours or
the impact of 'contaminated' art materials (see group guidelines above) on dient
 Allied health professionals 71

Table 6.1 Art 'tool' kit

He level Art media Purposelnotes
Cognitive/Symbolic I X graphite stick (4B/6B) Although controlled, allows
(CIS) flexibility if wanting to move from
CIS Level
I X box coloured pencils 12 colours, minimum

I X pencil sharpener Pencil shavings can be used to

move from CIS Level

I X visual diary A4 size, white cartridge

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Perceptual!Affective I X box oil pastels 16 colours, water-soluble for

(P/A) media flexibility - frequently used
as are quick, clean and vibrant - a
main requirement

I X box chalk pastels 12 colours, minimum

I X packet plasticine (also Full colour spectrum that includes

known as 'coloured clay') black and white
I pair scissors Rounded ends - for client safety.
Where scissors cannot be used,
paper can be torn

I X glue stick Mainly for collage work

I X 300mlliquid PYA glue A stronger glue and can be

watered down for varnished
effects or to seal something
Kinaesthetic/Sensory 5 tubes X 300ml acrylic Primary colours, i.e. red, blue,
(KlS) paint yellow, plus black and white.
Mixing of secondary colours is
part of the art media training
SOOgm block of air-dry clay Can be painted - no firing
required
3 X paint brushes Hog-hair effective. Sizes are smalI,
medium and large

engagement. The art materials the dient gravitates towards, or that the therapist
chooses to provide, are significant. A focus on art media ensures that allied health
workers are informed about the effective use of art materials in their dinical
practice. The ETC provides a framework that celebrates the constmctive use of
art materials, and can be summarised as follows.
Lusebrink divides art media into three levels of involvement: the Cognitivel
Symbolic, the Perceptual/Affective and the Kinesthetic/Sensory (Lusebrink
1990), which are shown in Table 6.1.
 72 Allied health professionals

Cognitive/Symbolic Level

This level uses refined media (coloured pencils, graphite sticks, compressed
charcoal) involving fine-motor precision and thinking processes that involve
conceptual formulation, abstraction, verbal self-instructions, intuitive, self-
oriented concept formation and synthetical thinking.

• It requires the development of abstract thought.

• Information processing is complex and deals with what is not present.
• It provides arelease from the present.
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• It engages cognitive, analytical and logical thought processes.

• Problem solving through the use of media properties is at the cognitive end.

Provide some case studies - for example, an academic who experiences a

'nervous breakdown' will probably be more at ease on this level because the art
media relates to what is more familiar. Helping clients to gradually experience
more flexible art media with which they are less comfortable will have a therapeutic
aspect because a degree of unfamiliarity with risk-taking is successfully achieved.

Perceptual/Affective Level
There is an emphasis on form and the more formal elements of concrete images.
There is a focus on the expression of feelings and moods, and the use of colour. Art
materials include photo collage, feIt pens, chalk pastels, oil pastels and plasticine.

• Interaction with art materials creates perceptions and arouses affect.

• Visual articulation encourages perception.
• Visual organising creates 'good gestalts' from past perceptions, assisting
closure on the experience.
• Affect is activated through responses to the visual form - emotional
responses to image/art work are encouraged.
• May express intimate and primitive sensations and emotions, ofwhich there
is no previous awareness.

An example here might be a reference back to an art task already completed,

such as the abstract family portrait, or something symbolic of self, such as a
picture ofyourselfas a tree, where there is a focus on colour and how something or
someone is perceived. If working with a limited budget, this level provides the art
materials that have the most flexibility from which to move up or down the ETC.

Kinaesthetic/Sensory Level

This level involves a physical approach to art media such as soft pastel/chalk,
water-based paints and clay, using motor movements, gestures and flexible
 Allied health professionals 73

exploration of the art materials - tactile quality has significance and there is a
focus on inner sensations.

• There is a focus on the release of energy through bodily actionlmovement.

• Either stimulates arousal or allows energy to be discharged, lowering tension.
• SensOlY experience without awareness or involvement of an affective
response.
• No particular goal- potential for how sensation of art materials are utilised.
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There is more likelihood of accidental and more spontaneous interaction

with art materials on this level because of their invitation for less control. A case
example might be the child with ADHD who is likely to enjoy and be familiar
with this level of art media involvement. However, this might not necessarily be
therapeutic for himJher because it can stimulate chaotic feelings and heighten out-
of-control behaviour.
Finally, workshop participants could consider which ETC level resonates as
most familiar for them, and be asked to explore and push art media boundaries.
The use of 'media dimension variables' (MDVs), 'mediators' and 'reflective
distance' (RD) (Lusebrink 1990) can also be considered. There is an invitation
to break mIes, to move from what is known to discovering what is less known,
to mix media, to take risks, to work in a less familiar way and to extend the
boundaries from where participants fee 1comfortable in order to release a freedom
in their approach.
Art therapist trainees aim to become farniliar with all aspects of art media -
for workshops, this is a taster of the same requirement. Ask participants: 'What
happens when you mix water with coloured pencil, or push plasticine around
on the page with your finger or work pastel into the acrylic paint?' Advise at the
outset that there is no expectation to share this art work, apart from a briefviewing,
where different techniques are appreciated and curiosity about how effects were
achieved is encouraged. By allowing time for the extension of media dimension
variables, participants experience an exhilaration as they consider art materials as
a new frontier to their learning and work with clients. The categories above are a
guide that is useful when delivering short training packages but are not absolute, as
how the materials are actually used will also have an impact. Workshop evaluations
often mention how much participants enjoyed the art media exploration part of their
training, possibly because it gives them permission to play in a training context.

Art kits
Rather than supplying a broad range of art materials, an option is to supply art
kits, which can be factored into the workshop fee and are kept by the participant,
providing an immediate and comprehensive starter kit for clinical work. When
demonstrating the Expressive Therapies Continuum, the art materials need to fit
the ETC requirements (see Table 6.1).
 74 Allied health professionals

Coloured paper and cartridge paper are supplied and other collage materials
are also provided, such as glitter, pipe deaners and magazine-tom images
(Landgarten 1993), as well as day tools and a day cutter. (Fishing line wrapped
around a wooden peg, split in two for handles, makes an inexpensive day cutter.)
Further materials can be added at a later date and an extensive list of essential and
optional art media extensions is provided and discussed as a training resource.

Basic art materials

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• pencils: graphite stick, coloured, water-based

• charcoal: compressed, sticks, pencils
• ink: coloured, calligraphy, Indian
• collage materials: threads/wools, natural and found objects, fabric,
cardboard
• photo images: magazine, postcard, family
• coloured paper: crepe, cellophane, wrapping, tissue, cards, brown
• pIaster: moulds, sculpture (for body image work)
• crayons: Conte, wax, water-based
• pastels: chalk, oil, wax
• day: air-dry, terracotta, Fimo, plasticine
• paint: acrylic, finger, water, sticks, tempura, gouache.

A further component of an introduction to art media is the provision of a list of

basic art principles that are also abstract art considerations. These can be briefly
explained or brainstormed, and indude:

• orientation of space - openlcrowded/barriers/vistas

• colour - primary/secondary; contrasting!complementary; overlay of colour
• dominant movement - vertical/horizontal/diagonal
• structure - rigid/loose; unevenlbalanced
• balance - symmetrical/asymmetrical
• relationships within the pieture - repetition; dominance; overlaying; borders
• quality of line - thick/thin; fragile/bold; hard/soft
• shape - geometric/biomorphic
• texture - rough/smooth/pattemed/coarse
• tone -light/dark/gradations of shade
• rhythm - repetitionlflowing/progressive
• proportionlsize - distorted/obscured/incomplete/absent.

Contemplating art work

When participants first process art work, they are invited to take a few moments
to gaze at the work. This viewing of the art work gives participants a taste of
Betensky's phenomenological intuiting (Betensky 1995), capitalising on the
 Allied health professionals 75

existential notion of contemplation of the work, be this the maker or the trainer,
the client or the therapist, or workshop participant one or workshop participant
two.
The instmction to contemplate the work is as follows: decide who is going to
share their art work first. Before discussing the art work, both the maker and their
partner take two minutes to contemplate the marks on the paper. Together, they
contemplate the art work, and the maker moves from personal involvement to a
more reflective position with the art work. The maker becomes the beholder who
in turn becomes the receiver (Betensky 1995: 14-25). The workshop partner then
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asks the maker to consider, 'What do you see?' (Betensky 1995: 17). Encourage
participants to listen to their 'gut' reaction to the art work, before the maker of the
work tells them anything about it. As the beholder, the participant is allowing the
art work to resonate. For the maker, this is also an extension of the group guideline
about allowing opportunity to listen to the 'internal dialogue' (see pp. 67-8).
If the workshop includes instmction to use theoretical approaches, in a
phenomenological approach, the art media component plus this list of basic art
principles assists discussion as well as further self-reflective narratives (see p. 80).
This also extends an understanding of visuallanguage.

Workshop evaluation
At the end of a professional development course for allied health professionals,
success is achieved when there is a new respect for the profession of art therapy.
Evaluation forms allow constmctive feedback that shapes and enhances future
workshop delivery.

End of a training workshop

As in clinical work, the end of a workshop can bring up issues for some participants.
Some facilitators provide their contact details so that participants can follow up
with requests for clinical supervision or to refer a client for art therapy. Some
may want to discuss their workshop experience in more detail. When the training
is over, you need to consider the degree of unpaid availability you are prepared
to offer. It is better to ask people to follow up enquiries away from the workshop
setting. Spending personal time talking to participants who remain behind is not
recommended. If they wish to continue their personal art therapy work, they can
be referred to an art therapist practitioner. Boundaries between workshop training,
delivery and clinical practice need to be clear. Some participants stay behind
because they want more time with the presenter. Some participants choose to
place their art work in the mbbish bin as they tidy up at the end ofthe workshop.
If this is part of someone's personal process, facilitators must not be offended. It
can be disconcerting and easily interpreted that personal processing is not valued.
Remember that a training workshop is not a time for personal therapy and the
therapist delivering training must leave their therapist hat off.
 76 Allied health professionals

Conclusion
When providing anarttherapy introductory workshop for allied health professionals,
treat this as an opportunity to educate about conuuon misunderstandings. Be
respectful oftheir knowledge and expertise. Although the art therapist is an expert
in their field, participants can also contribute to the presentation in terms of fitting
theory to specialist clinical practice and relevant possible case scenarios with art
materials. Work on the assumption that there is always something more to leam
and be humbled by the privilege to impart information about the profession to an
interested group of allied health professionals.
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Rubin, JA 2004. Art Therapy Has Many Faces. VHSIDVD. Pittsburgh, PA: Expressive
Media, Ine.
Sehaverien, J. 1989. The Pieture within the Frame, in A. Gilroy and T. DaHey (eds)
Pictures at an Exhibition: Selected Essays on Art and Art Therapy. London: Tavistoekl
Routledge, pp. 147-55.
 Chapter 7

Innovative teaching strategies

Annette M. Caufter
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Art therapists are often called upon to teach art therapy practice to therapists
and counsellors who are already experienced practitioners in their own right.
This chapter extends ideas introduced in Chapter 6 to provide further practical
implementation of teaching strategies to a range of professional groups,
incorporating current art therapy education techniques with the skills and
experience other therapists bring to such training. These practitioners wish to
make use of art more effectively in their work, but usually do not wish to become
'art therapists'. As argued above, art therapists cannot afford to be over-protective
of their skills or unprepared to share their expertise with non-art therapists. The
reality ofbeing part of a clinical team involves introducing colleagues to effective
art therapy practice. This has the potential to be arewarding experience for both
the art therapist and work colleagues. The art therapist must be able to share her
skills both with a sceptical community of health professionals and with those who
are enthusiastic and offer professional support.

Teaching art therapy to work colleagues

One-off opportunities
An invitation to conduct a presentation is an opportunity to share skills and
educate professional colleagues, whether this is part of a regular internal staff
meeting, a clinical supervision group, a professional development event, a lecture
series or as part of a wider network, such as an interagency meeting, mental health
forum or medical meeting. While the context is an important consideration, so is
a successful presentation. The art therapist may need to clarify what is already
known about art therapy and be prepared to present to achalienging and possibly
diverse group.
A definition of art therapy with an overview on creative process theory is
recommended, as well as relevant case material that demonstrates the diversity
of clinical application. An ethical challenge, for example ab out ownership of
art work, congratulating artistic merit or interpretation of art work can stimulate
discussion.
 78 Innovative teaching strategies

Interpretation

There is a COInmon expectation that art therapy is about learning how to interpret art
work. Ensure you are prepared for questions about this and have a clear position on
your understanding of an interpretive model, ensuring that it respects the historical
dimensions of art therapy. In particular, one strand of art therapy development
originates from early twentieth-century psychoanalysis where attempts to
interpret images using psychoanalytic concepts informed an interpretive model
(Naumburg 1950, 1966; Junge 1994). The origins ofthis notion of art therapy are
well documented (Ulman 1975a; Kramer et al. 1974; Waller 1991; Hogan 2001).
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However, this is not common practice in contemporary art therapy, though it is

important to not confuse interpretation with art therapy assessment procedures
where interpretation must be substantiated by what the client says and does in
terms ofbehaviour or relevance to personal hiStOI)'. Assessment should never take
the place of therapy; however, the US idea of art psychology and the use of visual
techniques in assessment has merit when conducted from an informed perspective
(Betts 2006, 2012).
Assuming the audience is untrained in art therapy, the point to be made here
is that interpretation can be destmctive and damaging, and that it is often due
to the therapist's need or concern to understand the work. Coming from a UK
perspective, an art therapist would aim to remain curious about the client's art
work, to allow a multitude of possibilities to emerge. In art therapy, we wait for
the client to inform us, to explain their image, to reply to the question, 'What do
you see?' (Betensky 1995).

Processing art work

The following points are discussed with examples.

• Casual interpretation or a chance remark can be insensitive, clumsy and

inappropriate.
• Naming an image can cause distress and anxiety - the client may be
depicting something entirely different, which may not be clear. Wait for
explanation - do not assume.
• Interpreting art work disrespects the fact that the client has a mind of their
own.
• Ifthe 'all-knowing' therapist intrudes, the client feels exposed - their sense
of identity or auto no my invaded or attacked.

Points to remember

• Important material will re-emerge in subsequent sessions.

• Cmcial to the interaction between therapist and client is to remain in astate
of 'not-knowing'.
 Innovative teaching strategies 79

• Therapists need to remain in astate of curiosity and allow meaning to

expand and other possibilities to emerge.
• Therapy requires a continuity of respect for the client's personal, private
space - a balance of intimacy and distance, of togethemess and aloneness
(Dalley, Rifkind and Terry 1993).

Experiential conte nt
Scribbles
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Regardless of theoretical explanation and case material, a small experiential task

is often remembered as the highlight of a presentation. For example, an audience
can be invited to make a random scribble. To encourage spontaneity and a less-
controlled scribble, suggest the use of the non-dominant hand or to work with
partially closed eyes, to allow accidental mark-making. Participants then pass
their scribble to someone else who is invited to look for an image within the
random mark(s). This experience, done without special art equipment and while
participants remain in their seats, is non-threatening yet engages the participants
in a quick demonstration about the importance of spontaneity, taking a risk and the
use of unconscious images. A simple art activity visually bypasses language and
is easier to retain in the non-verbal part of the brain. This intervention is adapted
from the Winnicott Scribble Technique (Winnicott 1971b), but in this accessible
context is arguably an effective introduction to art therapy for a conservative,
disinterested or resistive audience. Warm-ups to enhance a 'good' scribble are
also well documented (Kwiatkowska 1978; Ulman 1975b; Cane 1951; Naumburg
1966).

Other experiential tasks

Provide participants with a choice of introductory tasks, such as a free picture
(see pp. 57-8), drawing your name and making an art work that tells something
aboutyou.
There is no right or wrong way to do any of these tasks - they are each designed to
allow the person to interpret the task as best suits their personal frame of reference.
The 'free picture task' is explained as a standard part of a number of art assessment
techniques (Kwiatkowska 1978; Ulman 1975b). The 'picture ofyour name task'
appeals to all age groups from children (see p. 125) to adults to the elderly -
everyone knows their name and it is a great group introductory task because it
helps everyone remember each other's name, including the workshop presenter.
The 'picture that tells the group something about you' can be a significant personal
piece of information one wishes to share, such as arecent medical diagnosis of
a family member, or it can be something minor, such as what the person had for
breakfast that day. This choice will be dictated by how well-established group trust
is prior to the workshop event.
 80 Innovative teaching strategies

Self-image
An introductory workshop could include at least one task that explores self-image,
which may be dictated by art media recommendations. For example, for 'myself as
a tree' (any type oftree with any qualities, including fantasy qualities; any colour,
any shape - all qualities describe you, as a tree) you might encourage the use of
paint, whereas for three full-bodied 'self-portraits' (how 1 see myself - real self;
how others see me - external self; how I' d like to be seen - ideal self) one might use
oil or chalk pastels because of their rich, immediate colour. Provide an explanation
for media recommendation, but allow people to choose media also - they don't
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necessarily have to go with your recommendation. They may choose to construct

themselves a tree from plasticine or clay, or they might choose to use coloured
pencils or paints for their three self-portraits. Media choice can be another point to
discuss in the application of theory to practise as part of the presentation.
Participants can be encouraged to practice self-reflective documentation. For
example, with 'myself as a tree', a diagram might be drawn of the completed
image, and the work documented in a visual diary as a self-reflective exercise and
visual debriefing. This could include writing a narrative description/script in the
first person that describes what you know ab out yourself, for example, 'This is
me, 1 am ... , 1 have ... ', 'I like it when ... ', 'Where 1 am growing ... ' Similarly, for
'three self-portraits', a narrative description/script for each portrait could begin,
'This is ideal me. 1 am ... , 1 have ... , 1 like it when ... '
Encouraging participants to write about a symbol for themselves in the
first person can be a positive training experience because the use of narrative
description encourages insightful responses. People choose how much of any new
insight(s) they wish to share with the larger group but feedback often describes
the self-image tasks as where the most significant learning happened in the
experiential component of the training.

Self-box
The self-box is a popular task that is used effectively both in clinical practice and
in workshops (Keyes 1974), showing how simple materials can be effective in self-
reflective work. For this task, an array of different-sized boxes are supplied. The
outside of the box represents the outside partes) of the person, the part that the
external world sees. It involves self-perception of what is presented to the outside
world as well as, to some extent, feedback one receives from others. The inside
of the box represents the inside aspects of the person, the partes) that are more
private and hidden from external scmtiny. This basic concept is easily grasped
by participants and is an enjoyable self-reflective task that involves engagement
with collage materials and construction. There is a focus on how the surface of
the box is worked and how the inside of one surface relates to the extemal part
of that same surface. One workshop participant was reflecting on an abortion she
had experienced. On the lid of the box, she threaded tom white strips of rag. These
strips remained white on the outside, whereas, on the inside, they were painted red.
 Innovative teaching strategies 81

The surface of the cardboard lid became the area of transition between intemal and
external effect on this physiological trauma to her body. The surface can also be
worked with windows, mirrors, doors, spy holes, etc.
A variation is to introduce a theme for each ofthe six sides ofthe box: family,
physical, emotional, professional/work/school, spiritual, social. This is optional
but appeals to those wanting a stmctured training experience. The six sides ofthe
box are each allocated a surface theme and the inside and outside surfaces of that
theme are then worked - for example, spiritual inside, versus spiritual outside,
looking at how the external surface relates to the internal surface for 'spiritual'.
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What themes are chosen for the top and bottom of the box can also be explored.

Creative processes
All creative processes can be seen as examples of the person testing self against
reality: their subjective internal world of imagination, personal experiences,
fantasy, dreams and images tested against their external world of objective reality
and fact. These ideas can be expanded to indude information on right- and left-
brain theory, conscious and unconscious processes, and personal internal non-
verbal world versus collective/group external verbal world, and the fact that
we respond to the world visually before we have language, so that emotional
development based on attachment to external visuals, such as the mother's face,
is linked to 'vitality of affect' (Stern 1985; Evans and Dubowski 1988).
The creative process can be simplified into four stages (Wallas 1926):

1 Preparation: conscious concern and stmggle - when the task is considered,

researched and exarnined thoroughly. At this is stage, it is often that an art task
has been suggested to the dient, who is considering what they might draw,
paint or create.
2 Incubation: at this stage, a block is experienced that might be a fleeting
moment of hesitation or it may be a protracted period of time, for several
sessions or months as the dient works through their creative block w hat this
means. The dient might say, 'I don't know what to draw'. The therapist's
role is to support the dient through this phase and to not offer suggestions but
might respond, 'let the crayonlyour hands do the thinking'. Such statements
help the dient disconnect from impasses that block creative expression.
3 Illumination: a sudden flash of inspiration, exuberance or elation is
experienced when an idea bubbles in from the unconscious. The source
of the idea is not known but simply appears in one's consciousness,
unannounced and unexpected.
4 Verification: this is when the illuminating idea is tested out and critically
examined. The idea may not work and the person returns to preparation or
incubation expanding the creative process stages being experienced to more
than four but, essentially, these four are a simple way to provide a basic
understanding of creative process theory.
 82 Innovative teaching strategies

Essentially you are also trying to explain what participants might experience in
the workshop, so examples of these stages being applied to common day activity
is useful preparatory theory. For example, when cooking a meal a person might
go through the following process: What's in the fridge? Too hard, nothing to
cook! Wait a minute, I could do something with this egg. Start cooking. When
completing an art task, the process might be as follows: Draw ... Can't start, too
hard, I'm not creative. Sudden flash of idea, pick up art materials and make a
mark. Start doing art task.
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Psychological processes involved in creativity

• Perception: we perceive the world throughOUf senses as a 'reductive system'.
If we experienced everything we sensed we would be overwhelmed but
by editing things out of sensory awareness, important information can be
consciously lost (Gordon 1985). Art therapy can reawaken past perceptions
that have been relegated to the unconscious.
• lmagery: this is based on memory traces of past perceptions that are now
absent. In their absence images can be embellished based upon perceptions.
• Symbolisation: one symbol can have many meanings. There is the intended
meaning but as the symbol is explored, other less conscious meaning can
surface. There is also the wider unconscious which Jung referred to as the
'collective unconscious' (Jung 1964).
• Transitional object: this bridges what is internal with what is external
through the experience of the object. In art therapy OUf interest is in the
art object as the bridge between inner and outer worlds. This notion was
developed by Winnicott, who noticed that a child attached themself to an
object in the absence of their mother (Winnicott 1971a). The transitional
object is a found object from the child's external world, such as a sucking
vest, a soft toy or even a tune, that is invested with meaning and significance
from the child's internal world. The child experiences the world through
this object.
• Play: this focuses on process rather than a valued end-product in play.
Society is generally quite end-focused: for example, we work for a wage or
ac hieve a degree after completing study. In a therapy that focuses on play
processes, the end product is merely a statement ofwhere that process is at
one point in time. A client may make an aesthetically beautiful piece of art
work, but if the play process is that this needs to be destroyed, that might be
what needs to happen in order for therapy to take place.

Interactive drawing therapy (I DT)

This is an effective therapy tool recently developed by Russell Withers, a
New Zealand architect, who noticed therapeutic processes taking place in his
visual consultations with clients, and developed the IDT tool for counsellors
 Innovative teaching strategies 83

and therapists (Withers 2006). It is increasingly popular in New Zealand and

Australia and, as more IDT trainers become qualified, is expanding further afield.
There are similarities and differences between IDT and art therapy that deserve
separate explanation. However, IDT offers an innovative, stmctured framework
for the effective use of 'a unique page-based way of working with words,
images and feelings to access different parts of the psyche' (Withers 2009: 1).
The basic technique involves the dient providing the content and the counsellor
managing the process. The dient's primary relationship is with 'the page', not
the counsellor, and the counsellor assists this relationship by holding the page up,
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inviting the dient to contemplate and add words, images or feelings to the page.
It is a respectful way to work because it allows the dient to dictate content and
the counsellor to facilitate the process. When mnning introductory training, the
IDT tool can be recommended to counsellors and therapists as an effective way to
build on their skills in incorporating images into therapy. The IDT method teaches
the therapist ways to use drawing processes therapeutically: 'The page becomes
a mirror for your dient, helping them see themselves more objectively from new
perspectives, and facilitating insight, inner resourcefulness and profound change'
(Withers 2009: 1). Therapists are taught to follow the dient's lead in terms of
content, regardless of what agenda the therapist might think is appropriate. As in
some schools of art therapy, trusting the process is part of the mantra for the IDT
method, where participants are taught not to impose themselves onto the dient's
material, but to work with whatever the dient brings to the counselling session.

Visual diaries
Part of an ongoing personal process in art therapy training or personal therapy is
the use ofthe visual diary (Coulter 2008). This is like anormal written diary, except
that it has a visual starting point. It is therefore private and is only shown to others
if the author chooses to share an entry with their therapist, dinical supervisor, or
a trainingltutorial or peer supervision group (see Chapter 16). However, there is
no expectation that the diary must be shared - it is a safe place to process feelings
freely. This agreement forms part of a contract with a workshop participant at
the outset of training, as with a dient in therapy (Coulter 2008). The greater the
use of the visual diary as part of the workshop experience, the richer the training
experience is likely to be. Entries are invited at commencement and ending of a
training segment, as well as before and after specific tasks. Entries can also be
made away from the workshop venue.
Any art media can be used; artides, images, poems, thoughts, quotes, jokes
or any other found item that is significant to the ongoing daily diary process
can be induded. All entries benefit from some form of documentation because
it is easy to forget thoughts pertaining to an entry, as visual work is so often a
relationship with less conscious processes. As well as the date, time of day and
title, documentation might indude relevant thoughts and feelings, an account of
some event that has happened in relationship to the entry or that triggered the
 84 Innovative teaching strategies

entry in the first place. When reflecting back through the diary, further personal
insights may be revealed and these can also be documented.
The potential use of visual diaries in clinical work is demonstrated through the
workshop experience, where allied health professionals can be taught the general
use ofvisual diaries, summarised in the six points below (see pp. 65-6,67-8, 146
and 211-12 for further information on the use ofvisual diaries):

1 Dream diary: to record dreams visually and in writing.

2 General visual diary: for general use during training workshops, personal
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therapy or course work. This could include spontaneous diary pictures,

visual journaling and group processing.
3 Group work diary: this is used specifically on art therapy training for art
psychotherapy training groups.
4 Supervision diary: this is used to record responses to issues that arise in
clinical supervision and also to focus specifically on transference and
counter-transference material as it arises.
5 Selj-supervision: this can help maintain the art therapist between sessions,
self-monitoring and recording responses to clients and their issues.
6 Client support: this is used to maintain clients between sessions.

Use of visual diaries in training workshops

Participants are encouraged to use the visual diary as frequently as possible during
a short training workshop to demonstrate that visual journaling is a backbone to
art therapy training and best practice. A visual diary entry is often the first mark
on paper a workshop participant makes.
Spontaneous diary pictures: these are quick ge sture drawings that are reflective
of a feeling state. Participants are encouraged to make marks without thinking too
deeply, in whatever media they are inclined towards, and to work quickly, taking
only two or three minutes to complete their diary entry. The instmction includes
reassurance that visual diary work is private and will not be discussed. The notion
of relaxing conscious concern and struggle, being willing to take risks and even
to let the art materials do the thinking can all be prompts. The less conscious
thinking on the participant's part, the better. It is not necessary to understand or to
try to make sense of these drawings; however, spontaneous gesture drawings can
be a doorway to less conscious information and accidental marks are encouraged.
There is time to think and to understand content and meaning later.
Visual journaling: these entries are used later in the workshop training, usually
in relation to processing and reflecting on a particular piece of work or workshop
experience. There is an intention of pUIpose before a diary entry is drawn, and
time is taken to think and plan it. This is in direct contrast to spontaneous gesture
drawing entries, that rely on accidental marks and promote that less thinking is
better. In the planning and execution of a journaling entry, images are visualised
and words formulated. After completion of the entry, participants are encouraged
 Innovative teaching strategies 85

to reflect on the image. They may be inspired to complete another drawing in

their diary as part of this reflective joumaling process. Visual joumaling is also
used to further process art tasks completed in the workshop content; for example,
a diagram of a larger image might be recorded and documented in the diary with
explanatory notes.
Group processing: These visual diary entries are focused on group reflections
in relationship to art therapy training with a focus on what is difficult to verbalise
in the larger group context. The visual diary provides a place of escape from
difficult group processing and allows some private time in relation to the group-
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training context. Reflecting in the visual diary about the group experience also
allows less conscious images to enter the experience of the particular group,
which can also be related to other groups of which the therapist is apart.

Facilitating team building through art therapy

Corporote art theropy
Art therapy has much to offer the corporate sector, w he re trainers, life coaches and
business mentors, often from a psychology and helping profession background,
are already utilising art therapy techniques in personal training, team development
and small business strategic planning. Art therapy offers the sector innovative
ways to look at its operations, for example, in team-building enhancement or
organisational management, and can also provide a point of referral for troubled
executives who might not otherwise access therapeutic selVices.

Giving 0 presentotion to the business sector:

promotionol pockoging
In order to win a contract in the cOlporate sector, the art therapist needs to make a
presentation portfolio. Preparing something that the therapist thinks is best for the
organisation may not necessarily work; rather, being able to hear the request and
design something specific to meeting that need is how a contract is negotiated and
won. Sometimes, it is better to not title yourself as an 'art therapist' , even though
these are the skins you are utilising forthe consultation. The business sector does not
know what an 'art therapist' does, but they might relate to a 'creativity consultant'
who delivers a creative team-building day, or a 'media motivator' who knows
about symbolic use of digital and visual media, or a 'communication consultant'
who has skins in exploring and improving team communication networks, and
facilitating ways to self-reflect on these and to build on team knowledge.
Consider key words to use in promotional material: language becomes part
of the symbolic system in which a cOlporate art package is approached, with
therapeutic intent. Organisations will seek a trainer who is competent and
insightful, who displays positive communication skins, an ability to problem
solve and sensitivity in relation to specific organisational needs and requests.
 86 Innovative teaching strategies

Team-building
The use of art therapy in team-building is focused on delivering a positive
perception of the team, who are motivated to work together. Art tasks are
designed to heighten staff awareness of their assets, skills, knowledge and values
as a team and to promote individual and team validation. Team-building tasks
are designed to examine participants' ability to work collaboratively on joint
projects and to co-operate through the communication of 'balanced messages',
and working towards common goals, once these are agreed and established. A
team-building task can simply offer improvement because it has a positive future
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focus.
Team-building has both a personal and social focus. Part of a team-building
task has an individual focus, showing the creative and spontaneous assets of the
individual. This builds confidence and a sense of self-validation in the context of
the individual's potential contribution to the team. There can be an opportunity
to develop as an individual within the team, and for increased personal autonomy
and motivation in the team's best interests. Often team members have not had the
freedom to make decisions, to think creatively, to experiment and to test ideas.
Team-building can also assist with the expression of feelings, emotions and
confiicts that may be hindering healthy team function. Art therapy, in corporate
team-building, allows an opportunity to work with fantasy, and to develop a
better understanding of less conscious processes that might be impacting on
team productivity. Art tasks are designed to promote insight, self-awareness and
reflection as participants order their visual and verbal experience.
The social focus of team-building promotes an awareness and recognition
of self, as this is appreciated by others and acknowledged in the team group
forum. This understanding of self in relation to others promotes communication,
and the notion of a cohesive team is stimulated through art tasks that promote
co-operation and provide a safe place to share. There is an experience of
universality, being part of a team where co-operation with others offers social
support as issues of trust are addressed and opportunities are created to work
towards improving negative dynamics between staff. The use of art offers an
opportunity for initial non-verbal expression, bringing great relief about issues
that might be difficult to verbalise. Teams learn more about how they interact
with others, which promotes interpersonallearning as old patterns are examined
and reworked, and staff members are encouraged to behave more assertively and
to manage issues independently.
There is joint processing as the participants' perceptions are dealt with in the
context of working together to find patterns and systems, to create formulations
for change, to explain and to be heard. Joint collaborative exercises focus on
combining team strengths and skills, creating co-operation and something
tangible to draw on with such concepts as 'wish fulfilment' in the context of the
team. Working with colour, metaphor, symbol, myth and journaling in visual
diaries can all contribute.
 Innovative teaching strategies 87

Value of art therapy

When concluding art therapy short-course training workshops, it is reconuuended
that the art therapist provide a list of values that summarise what has been
demonstrated and experienced.
The following list builds on some theoretical concepts and concretises some of
the learning experiences. Art therapy:

• is an expressive outlet that utilises symbolic and metaphoric language and is

therefore less threatening than more verbal forms of therapy for some clients;
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• provides direct expression of inner experiences, such as dreams and

fantasies, that occur as pictures rather than words;
• is usually a new experience for the individual, evoking ideas, feelings and
thoughts that were previously unexpressed;
• can be task focused, thus providing a directed stimulus that helps reduce
anxiety and confusion;
• provides an integrative experience, where thinking is organised around an
activity that has a beginning, a working-through and an end as part of the
private individual non-verbal process;
• draws on cognitive, affective and kinesthetic capacities simultaneously;
• requires active problem-solving within the limits of the various art materials;
• provides a cathartic release that is directed to and contained within a piece
of art work, promoting integration and synthesis of psychopathology;
• provides an opportunity to create something that is uniquely individual;
• provides a permanent record whose content cannot be erased and whose
authorship is hard to deny; the work can be reviewed at a later date and is
therefore an important link to past thoughts and feelings;
• allows projections of unconscious material that escape censorship more
easily than verbal expression;
• encourages individual autonomy - the maker experiences freedom and
control over mark-making and leams to understand and find meaning in
their art work;
• helps the therapist gain access to intra-psychic functioning otherwise
inaccessible;
• heraids growth and integration before language can communicate it.

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Waller, D. 1991. Becoming a Profession: The History of Art Therapy in Britain 1940--82.
London: Routledge.
Winnicott, D.W 1971a. Playing and Reality. London: Tavistock Publications.
Winnicott, D.W 1971b. Therapeutic Consultations in Child Psychiatry. New York: Basic
Books.
Withers, R 2006. Interactive Drawing Therapy: Working with Therapeutic Imagery. New
Zealand Journal ofCounselling 26(4),1-14.
Withers, RW 2009. IDT Information Brochure. Auckland, NZ: IDT Ud.
 Chapter 8

An overview of models of art

therapy
The art therapy continuum - a useful
tool for envisaging the diversity of
practice in British art therapy
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Susan Hogan

I ntroduction
This chapter aims to provide a comprehensible and accessible overview ofBritish
art therapy practice. It is a 'snap-shot' ofthe main styles of art therapy. It presents
an outline of theory in the form of a continuum which illustrates the range of
art therapy practice that is available in Britain today. Although the focus is on
British practice, the model is applicable to other settings. A longer continuum
might appear in North America or Canada, for example, where attempts are made
to use images for diagnostic purposes, but this chapter is an outline of the main
range of art therapy practices within Britain.
I continue to be amazed at the strength of feeling that this chapter, originally a
paper in The International Journal ofArt Therapy: lnscape, continues to generate.
A number of critical readers and students have remarked that they have found it
helpful in helping them think about where they stand (though I have to say that
was not primarily my intention).
The layout of the diagram is not intended to illustrate a hierarchy or judgements
about what I considered to be superior. It could be depicted in a horse-shoe shape.
The theory which informs these different practices varies. My motivation for the
development of the continuum is to assist in providing some clarity to a situation
w hich, at first sight, particularly to training therapists but also to art therapists in
general, seems extremely confusing (and there are some real points of confusion,
especially the diversity ofways in which the term 'analytic' is used in literature).
Art therapy today is rather complex and 'the art therapy continuum' , as I shall
henceforth refer to it, is an attempt to give an at-a-glance picture or 'snap-shot'
of this diversity. Like any snap-shot it does not reveal the entire landscape. Of
course, there may well be nude art therapy being offered somewhere in California
for all I know! I have certainly come across a small minority of N orth American
art therapists combining art therapy with other practices, such as the dubious use
of so-called 'healing crystals', but my intention here is to discuss what most art
therapists are doing in Britain, to help to make it more accessible, rather than
looking at what might be happening on the outermost fringes with respect to
practices of which most of us would prefer to utterly dissociate ourselves.
 90 An overview of models of art therapy

Furthermore, there may be some models of practice which don't quite fit
comfortably into one of the niches described but straddle one or more, using
different elements of each. The framework isn't completely 'neat'. It is, I hope,
conceptually useful though.
Many of us may use more than one type of art therapy practice depending on
context, time frame, client group and brief. The ability to be flexible about the
model to be employed may, arguably, have advantages in the range of work we
are able to undertake.
The idea of a continuum implies both a range of differences and a continuity of
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relationships. For instance, in a rainbow every colour is a colour of light, but the
wavelength of each colour is different. In this continuum the shared characteristic
is the production of art work, but precisely how this is conceptualised and managed
varies throughout the continuum, as will be illustrated.

A
Art as an adjunct to verbal psychotherapy - including a 'gestalt' style of art
therapy.
(The emphasis is not on the pictorial quality of the art work or analysis of its
making, but more as a cue for verbal psychotherapy.)

B
Analytic art therapy - art therapy which has an emphasis on the 'transference
relationship , between client and therapist.
(This is often dubbed as 'analytic' though it is psychoanalytic in origin.)

C
The group-interactive approach - art therapy which is interested in
interpersonal experientiallearning and works with all aspects in a group
'interactive ' approach.
(Including an analysis ofthe marmer in which it is produced, what the clients
wish to say about it and what clients say to each other and how they interact.
This may include cognisance of 'transference relationships', but the latter is not
the main emphasis.)

D
The individual in the group - art therapy concentrated on the personal support
ofthe individual in the group.
(This approach gives equal emphasis to the art work, including an analysis of the
marmer in which is produced and what the clients wish to say about it, but does
not attempt to work with group psychodynamics.)
 An overview of models of art therapy 91

E
Art therapy which has its emphasis on the production ofthe art work and verbal
analysis ofit.
(This may indude an analysis ofthe manner in which it is produced: the
materiality of the piece, emotions generated during different phases of
production, the evolution of the art work. The work may be worked on over a
period of time, rather than fresh art works being produced in each session.)

F
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Aesthetically orientated art therapy - art therapy which privileges the art in art
therapy with minimal verbal analysis.
(The production of art works as a container for strong emotions, which are then
assimilated by the dient without verbal analysis. The art therapist provides
a 'holding' environment, acts as a 'witness' to the process and may offer
encouragement in the course of production. )

A: Art as an adjunct to verbal psychotherapy

U sing images as an adjunct to verbal psychotherapy is a perfectly reasonable
technique employed by aminority of practising arttherapists, orartpsychotherapists
depending on their nomendature of choice. I shall use 'art therapy' as the generic
term, as there are not dearly defined and consistently used established differences
between the terms' art therapy' and 'art psychotherapy' .
Art therapy may be used as an adjunct or aid - what do I mean by this?
Well, the image is used in the context of a primarily verbal exchange. Therapy
is underway and a point may be reached in which the therapist feels the dient
is getting 'blocked' or inhibited. But this is not cathartic paint-splashing being
advocated, but a focused use of imagery we are talking about here.
In the 'gestalt' model, a parallel can be drawn with the use of drama therapy
where it is not uncommon for a technique called the 'empty chair technique' to
be used, which has been attributed to Moreno and Pearls and popularised by
Landy (1994), amongst others. An empty chair is placed in front ofthe therapist.
The therapist asks the dient to imagine that their mother/father/abuser/sibling is
sitting in the empty chair and invites the dient to tell them what they would like
to say: 'I always loved you' ,'1 hate you' or 'you abused me as a child' - whatever
they need to say. Then they can change chairs and imagine they are the mother/
father/abuser/sibling and talk directly to themselves as the other person. Such
drama therapy techniques are widely used.
Similarly, images can be used to stimulate such discourse. As John Birtchnell
puts it:

Talking to the picture, particularly in the here and now, is the most powerful
devise I know ...
(Birtchnell1998: 149)
 92 An overview of models of art therapy

'Draw your mother/father/abuser/sibling', a therapist such as John Birtchnell

might instmct. 'Now draw a phone. Now imagine you are picking up the receiver
and tell them what you'd like to say to him ... ' That's what I mean by art as an
adjunct to verbal psychotherapy. It's essentially a psychotherapy which employs
drama therapy methods into which image-making is then incorporated.
The art work in the gestalt approach is usually a brief sketch rather than an
involved piece aesthetically. As Birtchnell (2003) says:

There is a useful parallel between the therapy that I do (Birtchnell, 1998) and
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psychodrama (Moreno, 1972). What I do has little to do with art and requires
no artistic ability, just as psychodrama has little to do with drama and requires
no acting ability (Birtchnell, 2002b). When I do this kind of therapy with
trained artists, as I sometimes do, their visual productions are no reflection of
their artistic ability and they do not look like works of art. In fact they are not
works of art. The relationship between what I do and conventional art therapy
is similar to the relationship between psychodrama and drama therapy ....

The emphasis is on the dient expressing themselves, and the image provides a
supplementary text, an alternative dis course to that which is spoken. This approach
is not interested in the aesthetic aspects of art making:

. .. the patient depicts, or enacts, his or her own personal reality. It is not
original, imaginative, fictitious or creative. That is not the point of it. The point
is to complement [via the process of making art work] what she is saying, to
convey in visual terms what it is like to be herself, what her relationships to
certain relevant others feellike, to darify these things for the therapist and for
herself, to get in touch with them and to help her and the therapist make sense
of them. I, just like the psycho-dramatist, do not want the patient to create
anything. Creativity is not what therapy is about. Intentionally, I do not give
the patient time to create a work of art ...
(Birtchnell2003)

As we will see later, this approach is rather different to those which are
particularly interested in focusing of the aesthetic aspects on the art-making
process. Birtchnell often works in a fairly intensive way with one individual in the
group, with the other group members in a supportive role. He will encourage the
person under focus to make a succession of images, but also to continue talking.
Towards the end of aperiod of intensive focus on one person, the facilitator may
become very directive and this can provoke an intense emotional outpouring.
Birtchnell explains this approach:

An extremely valuable Gestalt technique is to invite the person to address

his or her remarks to whomever they should actually be directed at. This is
much more emotional than telling the therapist.. .. Similarly, in art therapy,
 An overview of models of art therapy 93

a woman may be drawing her husband, and saying as she draws, 'He's a
bully.' I say, 'Tell him.' She looks at me strangely. I explain, 'Look at the
drawing and imagine it really is him and just talk to him.... Perhaps, as a
way of escaping from this confrontation, she may revert to talking to me, and
say, 'He used to lock me in OUf bedroom.' I correct her by saying, 'You used
to'. She turns back to the drawing and says to it, 'You used to lock me in OUf
bedroom', and then continues to talk to her husband about that. ... Adopting a
here and now approach would involve my saying - 'Draw the bedroom from
above. Put YOUfself inside and him outside. Imagine it is now, and tell him
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what you are feeling now.' She then begins to talk in the present tense. The
whole scene feels horribly real. She is shaking and pleading with him to let
her out.
(BirchnellI998: 148-9)

Because other group members may have resonated with aspects of the story
which has just been told, the focus then returns to the group members as a whole,
who are then given an opportunity to express their feelings about the disclosUfe
made and to explore their emotions triggered by it. The focus of attention returns
to the group as a whole, before the process of working intensively with an
individual may recommence.
Some art therapists might usually use a different way or 'model' of working
but occasionally employ such techniques.

B: Analytic art therapy

The term 'analytic' is being used here in a generic way to indicate all approaches
which are particularly concerned with working with 'transference', but which
also have art on offer. I think because of the current situation being rather 'blurry'
in regard to terrninology (as a colleague of mine put it), it is best to assume that
'analytic' could mean informed by either psychoanalytic thought or by analytical
psychology, but in either case the therapist will be working with the idea of
'transference' (historically, 'analytic' tended to be used to mean Jungian and
'psychoanalytic' Freudian, but this distinction is often no longer maintained,
and many 'analytic' practitioners are psychoanalytic in orientation). What is
the transference relationship? We should all know from OUf training that this is
the displacement of feelings to do with other previous or current figures in the
client's life onto their therapist, resulting in the client relating to the therapist as
if they were that person; in other words, the projection of attributes of the other
person onto the therapist by which the therapist is endowed with the significance
of the other, which then becomes an important part of the therapy. The 'object
representations' are what the client can project and are explored as a central part
ofthe therapeutic process (Rycroft 1968: 168).
It is not my intention to examine claims ab out the superiority of this model of
working. Joy Schaverien discussed the 'transference within the transference' in her
 94 An overview of models of art therapy

work (that is, put simply, the client's transference to the art object contained within
the transference relationship with the therapist). This is an acknowledgement of
the multi-levelled nature ofboth one-to-one and group work in which there may be
both 'projections' to the therapist andthe art object. The projective field, ifI may
use this term, can become quite complex (especially in group work) and ultimately
ambiguous and difficult to work with. However, it is not my intention to provide
a critique here: instead, I wish to focus on distinguishing between different styles
of art therapy. I will permit Joy Schaverien to describe her approach in her own
words, thus:
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Analytical art psychotherapy is the term I use to distinguish the type of art
therapy where analysis of the transference is parallel with the analytical
differentiation which comes about through the picture. This form of art
therapy is composed of two, linked strands; it is both a transference to the
person ofthe therapist, and a transference to the picture. These threads ofthe
transference both have their complement in separate, but linked, strands of
countertransference.
(Schaverien 1990: 15; my/original emphasis)

Her notion of the transference being in 'strands' or in some way split caused some
argument, because most analytic therapists see transference as projected into the
total therapeutic environment. Consequently, her ideas were strongly criticised:

Transference will be made to the person of the therapist, his/her furniture, the
therapist's family, their training, the room, the painting, the institution etc.
That is the reason why the idea of 'transference within the transference' is so
confusing suggesting as it does that there is something separate to or different
from the total transference situation. The painting is indivisible from the total
transference and can be fully understood only in that context. There is just one
transference where the focus may shift from the person of the therapist to the
painting and move back and forth from there. The transference to the painting
is therefore not something within, or different to, or parallel to, or in addition to
the transference to the whole analytic setting. There are not two transferences.
(Mann 1990: 33-4)

Consequently, her distinction between 'art psychotherapy', in which the client-

therapist axis 'is the main focus', and 'analytic art psychotherapy', in which
'the dynamic field is fully activated', is a slightly problematic distinction and
potentially confusing (Schaverien 2000: 61). It is therefore not a term I shall be
using.
Regarding transference, it is quite possible to use a different 'model' of art
therapy but then suddenly to become aware of a client's projection of emotions
to do with another person onto oneself, and to work with such feelings in a
constructive way. We feel other people's emotions; sometimes we can even fee 1
 An overview of models of art therapy 95

engulfed by them. Whitaker (1985: 221) notes of his group work that 'sometimes
a person is carried into the realms of usually avoided feeling through processes
of [emotional] contagion. ' Interestingly, Tolstoy's definition of art also speaks of
'contagion' and if we were to accept this definition of art, then we must accept that
there must be a 'transferential' aspect throughout the continuum:

Art is a human activity consisting in this, that one man consciously, by means
of external signs, hands on to others feelings he has lived through, and that
others are infected by these feelings and also experience them.
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(cited Harris 1996: 2; myemphasis)

Skaife suggests that analytic art therapy groups tend to view art works as
'primarily a reflection of group processes' (2000: 116) and that there is often a
tension between image making and the verbal interaction that surrounds it (2000:
115). Although, art work as a reflection of group processes can be:

. .. helpful in expanding the material in the group and in holding and

containing strong feelings in symbol and metaphor, it can leave other aspects
of art -making unexplored for their therapeutic potential. These are essentially
about the aesthetic aspects of art making ...
(2000: 116)

Skaife's remarks apply equally weIl to the next model of art therapy where a
tension between verbal and visual aspects of the group's processes can also
exist. It is a question of emphasis: some therapists may fee 1 that the transference
relationship is at the very heart of their art therapy practice and this is the particular
distinguishing feature of w hat I am calling 'analytic art therapy' .

C: The group-interactive approach

The group-interactive approach (described by Waller 1991) is an example of a
model of art therapy which gives emphasis to the art work (including an analysis
of the manner in which is produced), what the clients wish to say about it and
what clients say to each other. This may include cognisance of 'transference
relationships'. Group interactive groups may be more or less 'analytic' and may
vary in emphasis regarding their focus on the individual in the group. Subtle
differences of emphasis notwithstanding, some art therapists will want to try to
work with all elements and regard this as areal challenge. As Skaife and Huet
have pointed out, there is simply 'tao much material' being generated in such
groups, causing tensions between different elements and requiring the facilitator
to make choices about what they wish to emphasise (1998: 17):

... one person's contribution to the group process in terms of their image
may spark off a substantial amount of verbal group interactive material. The
 96 An overview of models of art therapy

dilemma is, will the focus stay with the images, or will the images be used as
a spring-board for further interactive work? There never seems to be enough
time for both.
(1998: 28)

The basic idea behind the group-interactive approach is that during interactions
with others in the group, individuals reveal their 'characteristic patterns of
interaction' ; these are seen as constraining people in their everyday lives (Waller
1993: 23). These 'patterns of interaction' are acknowledged and reflected upon
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and provide a focus for group analysis. Therefore, the method employed involves
an analysis of clients' here-and-now behaviour in the group. This is not a simple
discussion of clients' issues so much as a revelation of their present constraints.
Such constraints, or habitual ways ofbeing and thinking, can be revealed through
interactions with other members of the group or depicted in art works. Furthermore,
the art works can represent aspects of the client's self or other 'objects' (in other
words, be used for the projection and containment of transference emotions - see
above regarding 'object representations').
'Feedback' from participants is an important part of this method: 'feedback
from members of the group illuminates aspects of self which have become
obvious to others but which are not recognised by oneself' (Waller 1991: 23).
Feedback which does not seem justified is challenged and its impetus explored.
Indeed, as Waller points out, 'the members' tendency to distort their perceptions
of others (parataxic distortions) provides valuable material for the group to work
on' (Waller 1991: 24).
The theory underpinning this method is particularly influenced by Stack
Sullivan (1953), Foulkes (1948) and Yalom (1975), who regard interactions
with 'significant others' as more important to the aetiology of disease than early
childhood experiences, and indeed, personality is seen in a constant state of flux,
rather than laid down in early childhood (Waller 1991: 22). These ideas drawon
symbolic-interactionist thought:

People create and continually re-create themselves in contact with others;

indeed, the self is ultimately a process.
(Alvesson and Skoldberg 2000: 4)

Philosophically this method is rather different to those which see the aetiology
of disease as laid down in early childhood, and it is arguably more in keeping with
post-stmcturalist developments in psychology and the social sciences.
The group-interactive method is very mobile and multi-levelled, so the focus
can move from an exchange between participants to analysis of an art work, to a
reflection on feelings evoked by a disclosure by an individual, to an analysis of
feelings experienced by a participant during the production of an art work, back to
an analysis of an exchange between two members and so forth. Group dynamics
are reflected upon as part of the therapeutic process. Individuals may also project
 An overview of models of art therapy 97

emotions onto the group as a whole which may be experienced, momentarily, as

an individual. The result is very dynamic and rich.
Some of the interactive elements of the group are evident in this trainee art
therapist's analysis of his experience:

... following her disclosure of childhood sexual abuse .... I made an image
it was hoped would represent what it feIt like - as a man - to be in this
group. These were anger and rage at power abused by men, generalised guilt
for being a man, hopelessness and helplessness that threatened becoming
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overwhelming depression and fear that my desire for affection would destroy
me and the group. These feelings and ideas came together in the image of
the bull .... The articulation of anger seemed to give permission to others
to express their own anger. It is added to the increasing level of honest
interpersonal disclosure and feedback ....
(This quotation was reproduced with kind permission
from the student, now a practising art therapist)

D: The individual in the group

Art support groups and art studio groups are two types of art therapy groups
which include analysis ofverbal disclosures and analysis of art works but don't
always work in an intentional way with group psychodynamics. The individual in
the group is the emphasis.
Edward Adamson's original studio, which he described in Art as Healing, had
participants working individually on artists' donkeys or easels but not coming
together at any point to talk together in a group. Adamson had a relationship with
each individual and talked to each about their art work in turn (Hogan 2001).
However, some groups, which do not include an analysis of group
psychodynamics as their focus, do allow participants to talk about their work as a
group: typically this will involve taking turns and encouraging respectfullistening
by participants of other participants' disclosures (a common 'ground rule' might
be not intermpting others while they are talking). One participant may be moved
to remark upon another's art work or disclosure, but unlike in the group-interactive
model (above), this exchange does not then become the focus of the group's
prolonged attention. Perhaps the person talking about an art work will thank the
other person or disagree with their remarks, but the focus quickly returns to the
person whose turn it is to speak, and to the art work under discussion. (Being
allowed to disagree with an interpretative remark made by another participant
which 'feeis wrong' might be another 'ground rule' established at the outset. See
Liebmann 2004 for more on 'ground rules'.) Turn taking is not necessarily a feature
of this model, but the point is that an analysis of transference reactions between
members, or other interactive features, is not the main focus of the group, which
is more interested in understanding the art works produced, the analysis of which
may be extremely sophisticated. I am not depreciating this model of working.
 98 An overview of models of art therapy

Art therapy support groups work weH, for example, with clients who all have
the same presenting issue: all have had arecent bereavement, for example, or all
are being treated for cancer. So although the group is not focused on an analysis
of group interaction, being with people who you feel truly understand what you
are experiencing can feel very powernd for participants; thus, 'empathy' is an
important, probably remedial, feature. (Of course, similar presenting features can
occur in other types of group so I am not suggesting it as necessarily unique to this
model.)
Like in other approaches, it may be the case that sometimes a group interaction
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is so forceful and dominating that it has to become the focus of the group's
attention, in order for it to be dealt with so that the group can return its focus to
the images and dis course about them. For example, if one participant is mde to
another the matter would simply have to be thrashed-out and resolved, which
might involve an exploration of possible projection and transference (or analysis
of what pattern of behaviour the person might be indulging in). The safety of the
group being threatened in this way might also cause group members to project
fears onto the group as an entity, and an exploration of these feelings could shift
the focus ofthe group's attention temporarily away from analysis ofthe art works.
Those therapists who do not work with a concept of 'transference', or do not
wish to work with group dynamics in an interactive manner, notably Rogerian
or 'person-centred' oriented art therapists, would attempt to resolve safety issues
differently, perhaps by re-stating the 'ground mIes' established at the beginning
of the group, rather than delving into psychological aspects of the exchange (see
the work of Silverstone (1997) for an example of a 'person-centred' art therapy).

E and F: Art therapy which has its emphasis

on the production of the art work and verbal
analysis of it and aesthetically orientated art
therapy - art therapy which privileges the art
in art therapy with minimal verbal analysis
At the other end ofthe art therapy continuum is art therapy which has its emphasis
on the production of the art work (this may include an analysis of the manner
in which it is produced: the materiality of the piece, emotions generated during
different phases of production and the evolution of the art work). The work may be
worked on over aperiod of time, rather than fresh art works being produced in each
session, so that the emphasis is on change generated by responses to the art object,
the evolution of the art work and corresponding emotional reactions; or, new works
may be produced in response to the image in an ongoing emotional process.
Working on one piece of art work for more than one session is, needless to say,
also possible in other models, including in group-interactive groups. Skaife and
Huet identify some of the problems identified with making brief works in a group-
interactive group (described above):
 An overview of models of art therapy 99

The time the group allows for art making is just about enough time for the
initial setting out of the visual idea, or for finding of the visual idea. At the
point at which the artist needs to look at what she has done and think about
it aesthetically, they stop. This means the art work is never pushed into the
next stage. It appears that in response to the group process, symbols and
metaphors can be released through spontaneous art-making which then come
to be seen as a reflection of the group process. They can extend the group
process helping to focus the group on important issues ... but clients do not
have the space to fully engage in the creative process of, for example, putting
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the idea down, pushing it on, losing it and moving into chaos, and then finding
it again in a renewedform. [This is aJ creative process which is a microcosm
of life itselj, and so useful therapeutic material.
(1998: 27; myemphasis)

As we can see from the above quotation, there are advantages to being able to
spend more time concentrating on working with the art materials to explore
emotional material: this is what Skaife refers to as the 'aesthetic aspects of art
making' which can sometimes get lost in other more verbally-oriented models of
working (2000: 116).
It may be that, at this end of the continuum, the time spent discussing the art
works produced is relatively brief, or that no analysis of the art work takes place
at all. In E there may be ongoing in-depth conversation, and in F very little.
As one of the people critiquing this paper pointed out, in art therapy there is not
always an 'other', be it an interlocutor, therapist, critic, friend or fellow spectator:
'I think primarily, communication in art is with the self and with the art process
and its subject matter. This is also where communication in art therapy begins'
(Gunn 2007). This is a key point, as it is w hat all these different approaches have in
common. Despite very different ways of working and stmcturing the experience,
this is a feature throughout the continuum, though it may be rather limited in A.
This is what makes all these approaches art therapy.
At the end of the continuum (in F) would be located approaches in which little
or no verbal exchange took place ab out the art works. Michael Edwards, describing
his early work at Withymead, a tremendously influential 'Jungian' arts-based
therapeutic community, recounted that therapists there were seen as 'facilitating
a process' which involved a policy of 'non-interference', a standing back and
allowing emotions to surface at their own pace (cited by Hogan 200: 245). As
another art therapist who had worked at Withymead explained, through painting
the 'individual can experience personally the natural balance and autonomy of
the self-regulating power of the psyche' (Godfrey, cited Hogan 2001: 245). As
Godfrey put it, 'the core of meaning in healing through artistic expression lies
in experiencing spiritual values'; painting was viewed as a means to achieving a
natural healing process, hence the very concept of art as therapy (see Hogan 2001
for a detailed analysis ofthis way ofworking).
 100 An overview of models of art therapy

Of course, there may be aspects of 'witnessing' and 'holding' in other models

of art therapy, and it is not my intention to suggest an absolutely clear-cut division
between these ways of working, but rather a shift in emphasis, which may also be
underpinned with different theoretical ideas.

Discussion
My feeling is that all of these techniques have their particular strengths and
weaknesses and that flexibility on the part of the therapist is advantageous. It is
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possible that having a particular focus on any one aspect of art therapy may blind
us to other aspects. Perhaps 'blind' is too strong: perhaps we merely maintain a
focus and the expense of working with other possible elements. As Skaife puts it
above, there is simply tao much material.
When I do short-term work with women, using art therapy as a support tool to
enable them to explore their changed sense of self-identity as a result of pregnancy
and motherhood, I would locate the practice mainly in D.
When I am training art therapists, facilitating their in-depth closed group work, I
am working mainly with C, with the group-interactive model being taught (however,
there can be movement up and down the continuum - with Amoments - moments
in which the art work functions very much as an adjunct to verbal psychotherapy,
through to F moments - moments in which the group is silent and contemplative,
immersed in the mood-tone of an art work). When I teach a workshop-based
introduction to art therapy I' m located mainly in D again, but I' d hope to create some
time where in-depth reflection on aesthetic aspects might form part of this (taking
participants into E andF). WhenI do in-depthclinical work I'm working inB and C
(oron the cusp ofB and mainly within C, ifI think about it carefully). In fact, all my
work normally straddles B to D and I do not work consistently at either of the ends
of the continuum. This is because of personal preferences, as well as the nature of
the participants. I feel slightly uncomfortable with facilitating intelVentionist drama
therapy-style techniques used in conjunction with art-making. I have used some A
methods in the past. Nowadays, I might very, very rarely use anA technique with a
client who feels exceptionally stuck. As a participant, I have gained a lot from such
groups so whilst I can see the benefit of this way of working, it is not a model in
which I feel I can generally employ myself. We probably all have, or develop, an
intuitive sense ofwhere we feel most comfortable on the continuum (and I da think
personal proclivity is to some extent at play here). Likewise, I can't work entirely
in F because I enjoy verbal analysis and interactive group work, but that is not to
depreciate the powerful work that can be achieved by those so inclined to work in
this manner (and there are elements ofF in the other models in which the non-verbal
assimilation of a powerful image is a component). I also enjoy working analytically
(as opposed to being situated within the analytic model).
I feel that there has been some divisive theorising in recent years, which has
described different models of art therapy in an oppositional way. The continuum
does not invite practitioners to locate themselves in one spot and then to defend
 An overview of models of art therapy 101

their patch. It is not intended to set up false and erroneous divisions. Rather,
movement through the continuum is possible. The continuum is a fluid way of
conceptualising art therapy practice: it depicts practitioners as potentially not
locked into a particular way of working, though some people may weH only work
in one way because of personal preferences and particular aptitudes.
1 am very verbal, and perhaps when 1 am noticing and reiterating what someone
has said, 1 am missing something else - the paint dripping down the side of a 3D
piece. As 1 said earlier, perhaps we maintain a focus on one aspect at the expense
of another. Often we see more happening in groups than we can possibly respond
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to: simultaneously we see the paint-dripping forming a suggestive pool on the

floor; we see her ge sture at him; we see someone else respond to the gesture; two
people are trying to talk at once; someone else sighs; we are fiHed with a particular
emotion generated by an art work or a previous disclosure. Which of the many
possible elements occurring simultaneously we instantaneously choose to respond
to will depend on our emphasis, our place in the continuum - surely? After all, our
responses cannot be infinitely multi1"aceted. Groups are, as has been noted, very
complex, and are multi-dimensional; as has been discussed, movement from one
focus to another can sometimes be very rapid. For those using an interactive model,
there are a wealth of para-linguistic features which may be remarked upon (the eye
contact, body language, etc.), as weH as important prosodic features (pitch, tone,
intonation, stress and so forth); working with these potentially important elements
may mean that some aspect of the art work is overlooked.
Sometimes the aesthetic aspect forces itself to the fore: a woman from a former
war zone says, 'I feellike I'm covered with blood', her arms outstretched, like
those of Macbeth, are covered in red pastel. The art materials have apower of
their own to unlock deep feelings.
To repeat, it is not my intention to suggest an absolutely clear-cut division
between these ways of working, but rather a shift in emphasis, which mayaiso be
underpinned with different theoretical ideas.

Areas of conflict and natural tension within the

continuum
The areas of natural tension are located at the 'ends' of the continuum: A and F are
not best friends. Indeed, they may be anathema to each other.
The first model which uses art as an adjunct to verbal psychotherapy (A) is
sometimes very directive and such intrusive directives are the very antithesis of
the 'natural' and 'intuitive"healing process' of art-making promoted by many
Fs. Some Fs might argue that the assimilation of aesthetic qualities through
interaction with the art materials is at the very heart of art therapy (note Gunn's
re mark earlier) and that what As are doing is not actuaHy art therapy at aH.
1 would just ask practitioners to note that both models are useful and to respect
their differences, without making claims that one model is more efficacious than
another (for which there is no real evidence, as yet).
 102 An overview of models of art therapy

Where is feminist art therapy you might ask? The answer is anywhere throughout
the continuum; again, it is, I would suggest, a matter of emphasis and awareness: of
privileging certain elements over others.
I have discussed areas of natural tension within the continuum. The continuum is,
unfortunately, not a conflict-free way of conceptualising art therapy practice. Con-
ceivably, there is scope for argument within A about precisely how directive to be.
There is plenty of scope in B for different analytical theories to compete with each
other; for example, the Kleinians might disagree with the Freudians, and so forth. In
C there might be divergence of opinion, for example, about how much work with
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transference should be undertaken, or whether transference is a valid concept at all.

In D there could be disagreement about how to handle interactive elements. In E
and F there might be disagreement about the role of the therapist and w hether verbal
analysis is necessary or useful. So w ithin each model there is scope for disagreement.
There is also some scope for disagreement between models. There may be some
tension between A and B, because the first is very directive and the second would
tend towards being non-directive, or those in A might find some Bs' practice of
furnishing interpretations of transference unacceptable, or those in B might view the
role of the therapist in A as intrusive.
There might be tension between B and C in terms of oppositional explanatory
schemas (the universal versus the particular) and theories of the aetiology of illness
(individual pathology originating from early in infancy, versus socially-conditioned
and socially-generated responses formed during social interaction in an ongoing
way), as weH as different ideas arising from these ideas about what is actually
curative. Indeed, there may be disagreement about what the 'self' actually is, based
on these different philosophical positions.
Some F-inclined art therapists might also be suspicious of some analytic (B)
work and might regard psychoanalytically-inclined practitioners who employ art
and subsume it into their discourse to be ignoring vital aesthetic aspects - indeed,
what they regard as the very heart of art therapy: they might view such art therapists
as having an insufficient understanding of art processes. Nevertheless, though
potential for conflict can be found, I feel the continuum is a less divisive way of
conceptualising the totality of practice. I have found some of the assertions made
about differences between 'art therapists' and 'art psychotherapists' irksome; this
emphasis on nomenclature really is a red herring, as many 'art therapists' and 'art
psychotherapists' are doing the same thing at different points of the continuum.
There are aspects of art therapy practice which I would like to critique and
condemn, but that is not the pUIpose of this particular piece of writing (see Hogan
1997 and 2011 for some trenchant criticisms of reductive theorising and discussion of
problematic work with transference, especially on misinterpretations of transference
caused by the therapist's dogmatic adherence to a particular theory - what I have
called 'psychic abuse').
My motivation for the development of the continuum was to help to add some
clarity to a situation which, at first sight, particularly to training therapists but also
to many practitioners, seems extremely confusing. I hope it is useful.
 An overview of models of art therapy 103

Conclusion
The continuum is intended to give a relatively non-judgemental 'snap-shot' of
the rich diversity of practice which constitutes art therapy today. Hopefully, we
can all move about in the continuum, if we wish, depending on what seems most
appropriate in terms of oUf particular client's needs.
Perhaps the main value of this chapter will be, as Gunn put it, to 'stimulate
question, discussion and argument' !
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Suggested further reading

Hogan, S. 2014. Art Therapy Theories. London: Routledge.

Bibliography
Adamson, E. 1990. Art as H ealing. London: Conventure.
A1vesson, M. and Sko1dberg, K. 2000. Reflexive Methodology: New Vistas for Qualitative
Research. London: Sage.
Birtclmell, J. 1998. The Gestalt Art Therapy Approach to Family and Other Interpersonal
Problems, in D. Sandle (ed.) Development and Diversity. London: Free Association
Press, pp. 142-53.
Birtclmell, J. 2003. The Visua1 and the Verbal in Art Therapy. International Arts Therapies
Journal 2 (online).
Gilroy, A. and McNeilly, G. 2000. The Changing Shape ofArt Therapy: New Developments
in Theory and Practice. London: Jessica Kings1ey Publishers.
GlUlll, M, 2007. Personal correspondence, 21 February.
Foulkes, S. 1948. Introduction to Group-Analytic Psychotherapy. London: Maresfie1d
Reprints.
Harris, R. 1996. Signs, Language and Communication. London: Routledge.
Hogan, S. (ed.) 1997. FeministApproaches toArt Therapy. London: Routledge.
Hogan, S. 2001. Healing Arts: The History of Art Therapy. London: Jessica Kings1ey
Publishers.
Hogan, S. (ed.) 2003. Gender Issues in Art Therapy. London: Jessica Kings1ey Publishers.
Hogan, S. 2011. Postmodemist but Not Postfeminist! A Feminist PostmodemistApproach
to Working with New Mothers, in H. Burt (ed.) Art Therapy and Postmodernism:
Creative Healing Through a Prism. London: Jessica Kingsley Publishers, pp. 70-82.
Landy, R. 1994. Dramatherapy: Concepts, Theories, and Practices. Second edition.
Springfie1d,IL: Charles C. Thomas.
Liebmann, M. 2004. Art Therapy for Groups: a Handbook of Themes and Exercises.
Second edition. London: Jessica Kings1ey Publishers.
Mann, D. 1990. Some Further Thoughts on Projective Identification in Art Therapy: a
Partial Rep1y to Joy Schaverien. Journal ofthe British Association ofArt Therapists
Winter 1990, 33--4.
Rycroft, C. 1968. A Critical Dictionary of Psychoanalysis. London: Thomas Nelson and
Sons.
Schaverien, J. 1987. The Scapegoat and the Talisman: Transference in Art Therapy, in
T. Dalley, C. Case, J. Schaverien, F. Weir, D. Halliday, PN. Hall and D. Waller (eds)
 104 An overview of models of art therapy

Images ofArt Therapy: New Developments in Theory and Practice. London: Tavistock,
pp. 74-108.
Schaverien, J. 1990. Triangular Relationship (2): DesireAlchemy and the Picture. Inscape.
The Journal ofthe British Association ofArt Therapists Winter 1990, 14-19.
Schaverien, J. 1992. The Revealing Image: Analytical Art Psychotherapy in Theory and
Practice. London: Routledge.
Schaverien, J. 2000. The Triangular Relationship and the Aesthetic Countertransference in
Ana1ytica1Art Psychotherapy, inA. Gi1roy and G. McNeilly (eds) The Changing Shape
ofArt Therapy: New Developments in Theory and Practice. London: Jessica Kings1ey
Publishers, pp. 55-83.
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Silverstone, L. 1997. Art Therapy: The Person-Centred Way. London. Jessica Kings1ey
Publishers.
Skaife, S. 2000. Keeping the Balance: Further Thoughts on the Dia1ectics of Art Therapy,
in A. Gilroy and G. McNeilly (eds) The Changing Shape of Art Therapy: New
Developments in Theory and Practice. London: Jessica Kings1ey Publishers, pp. 55-83.
Skaife, S. and Huet, V 1998. Dissonance and Harmony: Theoretica1 Issues in Art
Psychotherapy Groups, in S. Skaife and V Huet (eds) Art Psychotherapy Groups:
Between Pictures and Words. London: Routledge, pp. 17-43.
Stack Sullivan, H. 1953. The Interpersonal Theory ofPsychiatry. New York: Norton.
Waller, D. 1991. Becoming a Profession: The History ofArt Therapy in Britain 1940-1982.
London: Routledge.
Waller, D. 1993. Group-Interactive Art Therapy. London: Routledge.
Whitaker, D.S. 1985. Using Groups to Help People. London: Routledge.
Ya1om, I.D. 1975. The Theory and Practice ofGroup Psychotherapy. Second edition. New
York: Basic Books.
Ya1om,ID. 1983. In-Patient Group Psychotherapy. New York: Basic Books.
 Chapter 9

The role of the image in art

therapy and intercultural
reflections
Working as an art therapist with
diverse groups
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Susan Hogan

Responding to art work in art therapy

The art produced in art therapy has already been discussed in previous chapters,
the role of symbolism and metaphor elucidated, and a variety of themes and
their potential discussed in detail. In the last chapter it was made evident that
different models of art therapy have implications for how the art work may be
approached.
This chapterwill reflect infurtherdetail onaesthetics and issues of interpretation.
Art therapy trainees are asked to hold on to their interpretations and to remain as
open as possible to other possible ways of understanding the therapeutic encounter
to avoid premature foreclosure of meanings. On the simplest level, art therapists
practise asking open rather than closed questions:

'That letter box is in the street', says the inexperienced trainee, to which the
disgmntled client responds, 'It's a double-decker bus, not a letter box!'

Of course every act of understanding and every formulated question has an

interpretive element. Why do I ask my client about the red mark rather than the
black streak? Perhaps one feels more insistent to me, and I have indulged in an act
of interpretation in getting to that point of formulating the question (Hogan and
Pink 2010; Hogan 2011).
Art therapists will help facilitate their clients in thinking about their art work
in slightly different ways (depending on w hich model of working they are using),
largely by asking open questions, such as, 'Would you like to tell me about what's
happening?' or pointing out specific elements, like 'How do you feel about the
river?' or even employing speculative questions, such as, 'Where is this bird
flying to?' There is also a technique called 'amplification', which developed out
of earl Jung's work, and this might include asking the bird depicted how it feels,
and thus entering imaginatively into the pictorial schema. Yet another technique
is a 'gestalt' one, in which a character depicted might be talked to as if present in
the room, as elaborated in the previous chapter.
 106 Art therapy and intercultural reflections

As will also be explored in further depth, the process of making the work
may be queried, or commented on: 'I noticed that you tore up your first drawing
and then cellotaped the pieces back together again - what were you feeling
when you did this?' Or, with reference to a 3D piece: 'How did you fee I when
it collapsed?' Not all art therapists do this, and trained art therapists should not
indulge in telling their clients what they think their art work means, based on a
particular psychological theory. It is the art therapy participant who is active in the
interpretation of the work, not the therapist, whose role is primarily a facilitative
one. I say 'primarily', because in the group-interactive model, group dynamics
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may be elucidated by the art therapist (preferably not in such a dogmatic way that
their perception can't be scmtinised, embellished or questioned, but with a view
to enabling participants to reflect on events); furthermore, in ongoing one-to-one
therapy, the art therapist may point out what she sees as patterns ofbehaviour or
emerging themes, to help her client to perceive these. For example, a client may
have said that he feIt dizzy and sick on the way back from his latest visit to his
father. The therapist might see a pattern and reflect on it: 'You were physically
unwell following your last three visits to your father, are you aware of that?' Such
obselVations must be handled with care, and sparingly; there will be more on the
nuances of this later. However, pointing out recurring psychological patterns in an
analytical manner is legitimate and helpful; this could even include reflections on
body language: 'When you talk about your workplace, you hug yourself like this
- what are you feeling when you do this?' is a question an art therapist might ask.

The role of the image in art therapy and

thinking critically about interpretation
Gestalt art psychotherapy
In the gestalt model of working, which was outlined in the previous chapter, the
aesthetic qualities of the art work are not to the fore, and diagrammatic images,
quickly produced, may often be made. As was articulated, the therapist in this model
may become directive and instruct the participant to sketch this or that. As Birtchnell
(2003) points out, he does not give his participants enough time to create a 'work
of art'. However, visual elements can intrude at any juncture, and a client with red
paint or chalk on his hands might say, 'This feels like his blood' - arguably a very
gestalt moment! The art works in this approach are seldom reworked and may be
disposed of at the end of each session, rather than kept as an ongoing reference.
Many brief works may be produced and tossed aside as the dialogue moves on.

(Psycho)analytic art therapy

Terminology is used in different ways by different authors, but I am using the term
psychoanalytic art therapy to mean those approaches that are particularly focused
on 'transference relationships' and are broadly psychoanalytical (as opposed to
 Art therapy and intercultural reflections 107

simply analytical) in orientation (and analytic psychotherapy is properly Jungian).

How does this have an impact on how the art therapist sees the art? In this model
of working, the therapist may offer interpretations of art work to help the dient
discover 'latent content'; the therapist may seek to 'verify its accuracy' by asking
the dient to respond; however, it is dear that the dient is likely to be influenced by
the therapist. Furthermore, the notion of 'premature interpretation' is also intensely
problematic, and 'refers to an interpretation made to a person in therapy before they
are ready to understand it' (Case and Dalley 2006: 281). I think the phrase 'before
they are ready to understand it' is an interesting one, and whilst the complexity
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and multi-levelled meanings within a work may take time to unfold, the meanings
and understandings within it must surely be those ofthe dient and not those ofthe
facilitator?

When latent feelings become manifest through an interpretation, meaning is

generated. The thought or the word comes from either the artistJclient in an
attempt to make sense of the significance of her art work, or from the therapist
who might see some important aspects emerging either in the picture or within
the relationship. This can be either darification of the transference process
between therapist and dient or some feelings, on a symbolic level, emerging
through the image itself.... Direct interpretation might prevent or deny the dient
the satisfaction of discovering and finding out for herself.... The art therapist
waits ... until the client is ready to begin to understand and let the meaning unfold.
(Case and Dalley 2006: 82; myemphasis)

The onus here appears to be on holding back to the optimal moment to interpret
the art work, otherwise it is 'premature'; but this is dearly very problematic, as
the interpretation may simply be wrong, or reductive. The interpretation may
be the therapist's projections. It is my fundamental worry ab out this model of
working that, in the absence of strongly feIt transferential material, the therapist
will fill the space with their own projections. I have highlighted fairly obvious
examples of this in previous work, with examples of outrageous interpretations
being proffered (for example, in Hogan 1997: 37-42 and Hogan 2012: 29-33).
Similarly, in the supervisory relationship, Schaverien and Case (2007) suggest
that the supervisee's personal material may be triggered in relation to the dient
work, 'but it may be unconscious and picked up by the supervisor, who then has
to decide whether to discuss this in supervision ... ' (17; my emphasis). Again,
there is scope here for the more powerful in the relationship - the supervisor -
to project their own psychological material into the dynamics of the therapeutic
relationship, which is being presented in the case material. Consequently, there
is potential here for misinterpretation and abuse, and I have come across this in
my long professional career in giving personal therapy to trainees who are also
undergoing problematic supervision; some of the interventions and re marks made
by supervisors were more ab out the supervisors than the case material. If the
material is 'unconscious', it is out of view to both student and supervisor, except
 108 Art therapy and intercultural reflections

w here there is a peculiar lack of engagement with certain aspects of the client' s art
work on the part of the trainee: the latter may indicate a simple lack of awareness
- a 'blind spot' or something potentially more complex - but supervisors must not
leap to the conclusion that the student has unresolved psychic material in this area.
On a profound level, psychoanalysis and object-relations theory are seductive
explanatory fictions. When various trainees complete 'baby observations'
(fortunately, not a standard part of art therapy training), for example, they imagine
a 'paranoid orientation' or distinguish other developmental phenomena in the
baby. Someone with a different explanatory schema would actually see the baby s
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behaviour differently, and interpret it differently. There is no such thing as theory-

free observation, as Thomas Kuhnfamously observed. These explanatory schemas
have important implications for the conduct of therapy as I have previously noted:

Whilst it may be quite harmless to project material onto a baby who is too
young to notice, on the one hand, it is potentially psychologically damaging,
on the other, to tell a seven-year-old that she thinks her mother is a witch or
that she wishes to eat her father's genitals. I have called dogmatic reductive
interpretations of clients' art work 'psychic abuse' .
(Hogan 1997: 39)

As Dorothy Rowe has pointed out, psychotherapists, by virtue of their training,

knowledge and special insights, sometimes feel that 'they have access to troths
above and beyond the capacity of the patients ... the psychotherapist interprets the
patient's truths and tells them what they really mean' (Rowe 1993: 94).
Unfortunately, dogmatic interpretation takes place in art therapy through
art therapists feeling that they should interpret the art work or the transference
(Hogan 2011). This sort of performance pressure must be resisted.
In earlier writing, I questioned this phenomenon and gave several examples of
reductive interpretation of a sort that I regard as constituting dangerous practice
(Hogan 1997: 37-42). Here I ask the question:

Are those art therapists working with a model of the Oedipus complex or
using the notion ofthe Kleinian 'paranoid-schizoid position' (at which a client
may supposedly be arrested), who couch their interventions in these terms,
actually helping their patients at all? Worse still, is the art therapist working to
an agenda and not making this evident to the client? In simple terms, are such
art therapists just making confused people more confused through their use
of strange interpretative schemas which do not correspond with the client's
sense of reality? I am not suggesting that this confusion is merely the inability
of the patient to understand the peculiar and jargon-ridden language favoured
by some therapists. Are art therapists exacerbating their clients' suffering by
overlaying it with their own version ofreality? I suggest they are, and that
this constitutes in extreme cases a form of psychological abuse.
(Hogan 1997: 39)
 Art therapy and intercultural reflections 109

McNiff (2004) also critiqued the same reductive tendency in NorthAmerica:

I was incredulous when first exposed to catalogs for the interpretations of

art, which reduced images to negative character traits and various forms
of psychopathology. Drawings and paintings were analysed according to
narrow theoretic frameworks. The resulting interpretations were simplistic
and literal, imposing a caricatured and laughably pornographic sensibility
on the individualized expression of patients. With an insistence on finding
hidden confiicts and motives, they dissected imagery and gave no attention to
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the sensibility of the artist.

(p.75)

Recently, I have produced a detailed critique of the reductive application

of object-relations theory (Hogan 2012). It is not just a particular theoretical
orientation I am questioning here (though certain forms appear to predominate
in reductive theorising): I am questioning whether art therapists should make
interpretations at all.
Art therapy, which is primarily focused on interpretations of the transference
relationship, is highly problematic in my view for the reasons outlined.

Interactive art therapy

To add to the general complexity and potential confusion, some art therapists refer
to their work as 'analytic', when what they are doing is art therapy that is broadly
psychotherapeutic. Psychotherapy is an experiential method which includes a range
of techniques aimed at increasing self-awareness in those participating, often through
developing experiential relationships, which lead to an enhanced capacity for self-
obselVation, and in turn to changed thinking and behavior. Art psychotherapy can be
directive or non-directive. Within this model can be seen a continuum of approaches
from those that abutt the psychoanalytic, to more interactive approaches, through to
group work that is more focused on the individual in the group.
In the interactive model, participants are thought to reveal their habitual ways
of behaving in the group and these are then reflected upon (see Chapter 13 for a
more detailed elaboration of this method). This model of art therapy can be more
or less interested in transference relationships depending on the style and focus of
the therapist (and what happens in the group with regard to group dynamics), but
as Skaife (2007) has pointed out, there is 'too much material' and so transference
may not be a particular focus (and it is theoretically possible to use the interactive
model and not work with a concept oftransference at all). The model oftherapy is
'analytical' insofar as it is investigative and there is an interpretative element here
too, in that part ofthe facilitator's role is to comment on group processes; however,
this can be done in a way that is not dogmatic or definitive, and the facilitator may
invite group members to challenge or augment her perceptions so that a collective
understanding is generated. Rudimentary consensus is possible in a group, and this
 I 10 Art therapy and intercultural reflections

is useful if a member of the group has an obviously 'faulty' perception of an event

in the group, where 'feedback' is a useful challenge to habitual unproductive ways
ofbeing.
The focus of the group moves back and forth between the art works and analysis
of interactions and 'events'. A thematic approach can be used. However, if 'non-
directive', there are two main modes ofworking which are as follows: that which
regulates the time (creating a 'frame' in which the non-directed work occurs), so
that a regular amount of each session is spent making art work and then talking; the
second non-directive approach is that which does not regulate the time at all (except
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with respect to the start and end times of the group), so that the group determines
the direction of the sessions. Sometimes there can be a strong consensus in the latter
approach about how the group wishes to organise itself, but on other occasions,
there may be confiict between members about how much time they want to spend
talking and how much time making art work. This can be a productive confiict.
The unregulated or 'group-Ied' approach has the advantage that the aesthetic
dimensions of the art work can be explored more fully; for example, a group may
decide to spend an entire session painting and then the following week talking about
the works. There are pros and cons to this, as work left for a week may lose its
emotional power and impact and the producer of the art may feel distanced from
it. On the other hand, a more complex piece of art can be produced (so there is
potentially more time for self-reflection in the process of actually doing the work
involved). The latter approach can feelless contained than the former, and therefore
less safe - though a facilitator who uses the non-directive structure may insist on a
short 'debrief' following a session comprising only of art-making to help create a
sense of closure of that session. However, the facilitator might just announce that
there is five minutes to the end ofthe session to flag-up the end.
In both non-directive approaches participants talk about their art works (be
they brief or elaborated) and how they fee I about them, and reflect on the process
of making them. Although these differences may sound subtle, they can make for
rather different group experiences, as shall be further elaborated. These subtle
shifts of emphasis do make a difference.

Art therapy support groups

As outlined in the previous chapter, this approach may be more focused on the
individual in the group rather than on group processes. Art works are produced
and then discussed with the art therapist either individually or as a group. There
is potentially great opportunity in this model to really focus on the image, and the
image-making process. This process of image-making can be highly informative
and it is sometimes the struggle of making an image which can be revealing and
can lead to reflections on, and awareness of, one's own interiority:

At the group's invitation I did make one art work. I painted a picture of
myselfbreast-feeding. However, I stmggled with the piece. I had wanted the
 Art therapy and intercultural reflections III

quality of the paint to be very watery creating an image like a reflection on

apond. Whilst painting it I became aware of the fact that Iwanted to depict
my baby both inside and outside of my body simultaneously. I imagined her
suckling one breast whilst stroking the other with her little hand. But I was
not able to ac hieve a satisfactory result with the materials and I spent the
session working and reworking the image - stmggling with the boundaries.
The finished art work, umesolved though it was, embodied my experience
of merger and separateness. The act of painting brought to awareness and
illustrated my feelings of conflict and ambivalence about these processes -
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my emotional stmggle. Indeed, my inability to resolve the image pictorially

was highly revealing. I had not experienced through conversation the full
force of these conflicting emotions. Participating in the group reminded
me of the power and poignancy of the art therapy process which yields the
possibility for the articulation of powerful embodied feelings and responses
which cannot necessarily be experienced or evoked through a verbal
exchange alone.
(Hogan 2003: 168; original emphasis)

Thus the way the art work is constmcted, reworked - areas obliterated and reshaped
- can be deeply revealing, giving immediate access to areas of inner-conflict and
ambivalence. Discussion of these aspects may come to the fore. How the work
is subsequently handled or destroyed can also become relevant, as it is an object
embodied with emotions. Art therapy is a powerful and immediate method; there
is also the possibility of exhibition, and though much art therapy work remains
confidential, for some participants the revealing image being revealed can be both
cathartic and empowering - as a woman said to me fairly recently, 'I fee 1 heard'
(Hogan and Pink 2010). Working with these aesthetic dimensions is not exclusive
to this model as should be evident but, if not working interactively and analysing
interpersonal elements between group members, there can be more space for
making and thinking about the art.
Again there can be a spectmm of activity under this heading, from work which
has many interactive elements, to approaches where the main relationship is
between participant and therapist (with 'ground mIes' to contain the intelVentions
of other group members), to approaches which have a studio-like atrnosphere.

Art therapy studio

As outlined in the previous chapter, there are approaches that may not function
as a group at all. The studio may be open or closed. If open, potential users can
wander in as they choose and use the space; they can choose to come or not to,
and if they don't attend that is not an issue. The pace can be set completely by the
participants in deciding how much art work they wish to engage in. This suits some
people better than a fixed weekly time slot, as some people may not fee 1 they can
be 'creative on demand' , as a mental-health selVices user put it to me recently.
 1 12 Art therapy and intercultural reflections

If the studio is 'dosed' it means that adesignated set of people are invited
in at a particular time, for example on Monday aftemoons. Thus, with the latter
approach, there is potentially more consistency in attendance, and so it feels more
group-like and offers a more uniform and predictable experience. Studios vary
between those that use tables, easels or donkeys (a seat with an easel which is
straddled) or a combination of all of these.
In most studio approaches, the art work is discussed on a one-to-one basis with
the art therapist. In this model, there is time and space to work in a sustained way
on art works, and time to reflect on the art-making process (note Michelle Gunn's
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remarks in the previous chapter).

In arecent online debate entitled 'Questions about Interpretation and
Assessment in Art Therapy', Randall James (2010) provided a summary of the
discussion:

The general consensus is that:

1 Art therapists do not offer psychological interpretations of their dients'
art work to the dients.
2 The art therapist engages in facilitating a mutual dialogue concerning
meaning ofthe art work with the dient and encourages the dient to make
his or her own interpretations.
3 That to offer psychological interpretations of dient art work to the dient
can be dangerous and potentially be seen as abusing the dient.
4 That interpretation of art work can result in 'imagecide,' or the reduction
of the meaning of an image to one single thing that may or may not have
anything to do with the dient.
5 Interpretation is not necessary to help dients fee 1 better.
6 There is a general hesitation about making any interpretation of dient art
work, whether it is shared with the dient or not.
7 The art work has built-in meaning and by exploring the art work with the
dient we can help to unpack that meaning over time.

I am not utterly sure that there is always 'built-in meaning', as the actual making
of the work may create the meaning: it is the active engagement with materials
which can generate significance (Hogan and Pink 2010). However, for much art
therapy work, this statement may hold tme.

Cultural issues and interpretation

The importance of greater acknowledgement of 'issues of culture' more broadly
in art therapy has been highlighted as cmcially important, if we are not to
inadvertently oppress others (Talwar, Iyer and Doby-Copeland 2004). Issues of
interpretation are always important and some acknowledgement of cultural issues
has been made in the art therapy literature to date, most notably Hogan (1997,
2003,2012); Hiscox and Calisch (1998); Dokter (1998); Campbell et al. (1999).
 Art therapy and intercultural reflections I 13

Hogan's edited volume (1997) looked broadly at women's issues and

art therapy, and especially at negative discourses surrounding definitions of
femininity and claims about female instability, especially with reference to the
negative positioning ofwomen within psychiatric discourses (Hogan, Burt, Joyce).
Biological determinism in psychiatry was highlighted and critiqued. Cultural
misogyny and violence against women was also emphasised, as well as lesbian
issues (Jones and Martin). The book also contained an exploration ofblackness in
the art therapeutic encounter and a ground-breaking essay on internalised racism
(Campbell and Gaga). Women's bodies, especially the experience of pregnancy
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and childbirth, also received attention (Hogan, Lewin, Malchiodi, Skaife).

This work has been reissued (2012) in a new edition called Revisiting Feminist
Approaches, which more fully addresses the issue of domestic violence (Jones)
and includes other new voices.
Further work on women's issues includes an examination of women's changed
sense of self-identity and sexuality as a result of pregnancy and childbirth, and a
trenchant critique of the reductive application of object-relations theory, as well
as a critical appraisal of frankly misogynist theories about 'too good' mothering.
Maternal guilt, depression and anger are reappraised in the light of negative
theories about mothers (Hogan 2012).
Hiscox and Calisch, and Campbell's edited collections examined cultural
diversity and highlighted problems of institutionalised racism, as well as the
experience ofbeing a member of a 'visible minority' and an art therapist (Annoual
1998: 14). The 'racial identity' ofthe therapist in relation to clinical practice was
considered. The editors (Hiscock and Calisch) emphasise an acknowledgement of
cultural context:

All human behaviour is infiuenced by, and is a reflection of, the cultural context
within which it is nurtured. Culture includes such features as attitudes, forms
of emotional expression, patterns of relating to others and ways of thought. It
is a patterned, organised and integrated collection of characteristics and traits
like a weaving or tapestry. Members of a culture share common threads with
the group as a whole while also retaining some individuality.
(1998: 9)

Skaife (2007), sununarising some of the concerns put forward by Blackwell

(1994), suggests that issues of racism in group work can get lost when there is
just one 'other' in the white group: 'The single black person will be absorbed into
the group in a beneficent denial oftheir difference' (2007: 146). And, of course, it
is important to point out, that some people of colour will collude with this. Such
'colour blindness', she suggests, can obscure the particularity of the individual.
Dokter (1998) also notes a reluctance to acknowledge difference in art therapy
group work, but sees this arising out of 'deep-seated fears about labels' (1998: 148).
Kalmanowitz and Lloyd (1998) discuss the interaction of traditional forms of South
African healing and Western therapy. One oftheir case examples is very instructive:
 1 14 Art therapy and intercultural reflections

a black woman was being seen by two therapists concurrently - one black and the
other white. Shamanism was recommended by the black therapist, 'who believed
that the girl's anger needed to be addressed to the ancestors, through a medium,
before it could be released' (1998: 122). Only after this process did she think therapy
could be effective; the white therapist was willing to consider this, and then, 'A third
(black) member [of the therapeutic staff team] entered the debate resolute that she
herself would stick with the therapy until the anger found expression. What had
seemed a black-white issue transpired to be more subtle' (1998: 122). Kalmanowitz
and Lloyd's point is that skin colour was not the dividing issue; rather, different ideas
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about therapeutic efficacy in a particular cultural context were to the fore, as weH as
underlying tensions between 'native' and 'Western' treatment models.
Lala (2011) points out her work with a white woman who identified as black,
for complex reasons, and usefuHy reminds us that our clients 'are the experts on
their own lives'. It is those we work with who 'must be seen as self-determining
unique beings who are constantly composing and reconfiguring their own identity,
experiences and struggles' (2011: 33).
When mnning a varied group myself recently, diversity is precisely what came
to the fore, with the British Caribbean women dissimilar to each other in their
experience of being black women, and others, such as a British Yemeni Muslim
wo man, having had a very different life experience, especially with reference to
community expectations and restraints. Explication of different cultural perspectives
was intrinsic to the group process.
McNiff (1984: 104) notes a tendency towards greater and obvious
acknowledgement of differences in 'cross-cultural' art therapy relationships:

The process of intersubjectivity characterizes aH human relations. Cross-

cultural communications simply make the perception of differences more
explicit. Within cross-cultural therapeutic relationships and art therapy
training groups differences tend to increase curiosity and interest.

Lala (2011) also emphasises the recognition of heterogeneity, using the term
'ethnically diverse' to describe her work with womenfrom several different countries;
she writes, 'It was important for me as a clinician to recognize that individuals who
embrace the same ethnicity do not always share the same race, culture or religion'
(2011: 32); furthermore, her interest is in acknowledging women's 'complex self-
identification' in an attempt to avoid stereotyping (2011: 33).
Rosal, Turner-Schikler and Yurt (1998) advocate against separatism in theirwork
with obese teenagers, arguing that the 'diversity of membership enriched the group'
and also brought together young people who did not normally socialise, allowing
them to 'find commonalities and gain respect for each other' (1998: 131).
Conversely, Farris-Dufrene and Garrett (with reference to work with the native
North American population) go so far as to raise questions as to the efficacy of
art therapy across different cultures. Farris-Dufrene and Garrett emphasise that
sickness in a Shamanistic tradition is not seen as just 'located' in the individual
 Art therapy and intercultural reflections 1 15

in Native American culture, and emphasise that cultural sensitivity and insight is
necessary for meaningful engagement:

The use of the arts in healing goes beyond sickness per se and encompasses a
multilevel concern with the weH-being of the individual and the community.
Healing deals with psychological, social and spiritual crises. With its
emphasis on prevention, traditional healing effectively addresses a wide
range of physical and social ills.
(1998: 244)
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Dokter's edited book considered therapeutic work with refugees and migrants
across a range of disciplines, including art therapy. She emphasises complexity,
and points out that ethnic groups tend to be composed of a number of different
cultural groups with varying orientations. Her argument is that cultural differences
between people (including people who look the same) are always important to
self-identity.
Dokter's positionis supported by Annoual, who writes, somewhat disconcertingly,
about 'blacks' in the US as a coHective, but then goes on to assert that:

Black, as an identity, is highly contested and is by no means a static concept.

In fact, it is to be understood as a highly individualistic process in the
constmction of identity. As with other elements of self-identification, one's
blackness is something that may change depending on situation and context.
(1998: 20)

Indeed, it is cultural affiliation that is key; Dokter wams that visible similarities
can obscure heterogeneity. The situation is further complicated, she suggests,
because of intermarriage between different cultural groups.
However, Dokter (1998) points out specific stresses of migration concerned
with cultural transition and potential confiicts of values. Lala (2011: 35) is astute
in summarising the multiple issues at play in work with immigrant and refugee
women:

While going through the immigration process, the constant reminders [of]
traumatic material from the client's past, coupled with an on-going imminent
threat of deportation, pose areal and damaging deterrent to recovery and
healing. For example, women without immigrant status have less access to
services and resources but, at the same time, are dealing with the stress of
multiple settlement issues. Issues such as language, culture shock, financial
constraints, housing security and isolation all impact [on] the client directly
and need to be considered during the therapeutic process.

Chebaro (in Hiscox and Calisch's edited volume) also addresses immigration.
She writes:
 1 16 Art therapy and intercultural reflections

Art helped me open the dOOf between the life lIeft behind and the new one
I was about to adopt. This travel in time (past life and present) was part of
the healing process which I needed to face in order to grieve the loss of my
country of origin and accept my new foreign life.
(1998: 232)

Chebaro wams against the possibility of misinterpretation and against the

over-generalisation of symbolic material. She is particularly critical of pictorial
diagnostic tests, which are more widespread in the US than the UK and Australia.
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She is also disdainful of the cultural stereotyping of Arabs that she encountered,
especially in schools.
Schaverien's (1998) chapter in Dokter explores the transmission of grief and
trauma across generations through collective memory, with reference to Jewish
cultural identity. In this essay she discusses how art works can allow 'previously
terrifying' images to become assimilated. Also explored are the positive aspects
of the 'scapegoat transference' (Schaverien 1987, 1991) in which the art work
may:

... come to be experienced by its maker as the embodiment of the image it

carries .... It may temporarily be experienced as 'live' and, so, if consciously
handled, its disposal may have the effect of a deansing ritual.
(1987: 167)

Case (1998) noted some cultural pressures and constraints in her work with
members of the Chinese population in Hong Kong, who saw themselves as
umepressed and pragmatic, but also as very willing to engage in group work;
however, this was coupled with a strong expectation that she would make
authoritative interpretations (1998: 255).
My second edited collection (Hogan 2003) explored gay, lesbian and
transgendered identities, and particular symbolism and cultural understandings
within these communities that are potentially open to misunderstanding. McNiff
(1984) asked the question whether we might 'view all therapeutic relationships
as meetings between cultures' (1984: 128); the circumspect position generated
by this stance is a useful one for art therapists to adopt in my opinion.
It is interesting that Dokter's comments above, about heterogeneity, echo
those of Modood (2005). How to capture the complexity of cultural identities
today is an interesting question, as 'non-white immigrants do not form aseparate
socio-economic dass, nor are they distinctively located in one dass' (2005: 53);
it therefore seems more useful to consider more cultural information. A critique
of the concept of 'ethnicity , is that, like 'race', it is:

... an extemally imposed identity on a group of people who may not have
thought of themselves as a group ... [Consequently] the categorizations of
a dominant group can create a quasi-group out of those who share similar
 Art therapy and intercultural reflections 1 17

physical appearance, so an ethnic group is a quasi-group based on what are

perceived by non-members to be distinctive cultural characteristics of a given
population.
(2005: 55)

Clearly, this is problematic. More palatable is the idea of 'ethnicity' as a form of

group understanding. This is described thus: 'An ethnic group is, theoretically,
one where the association with both a particular origin and specific customs is
adopted by people themselves to establish a shared identity' (Platt 2007: l7).
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However, Modood (2005: 58) cautions against the use ofthe concept, making
this interesting analogy:

Racial categories may be like the artificial boundaries of some postcolonial

independent states, reflecting colonial administrative divisions and great
powers' geopolitics, forcing together those who do not belong together and
separating those who do.

Even those who feel that the term 'ethnicity' has promise are cautious about
its use. Platt (2007), for example, drawing on the work of Geertz (1993), stresses
the 'contingent and fluid' nature of ethnicity. She suggests that 'ethnicity' is
potentially useful in suggesting 'flexible cultural bonds', but worries that the term
can be abused to suggest fixed hereditary differences which can lead to a rigid and
fixed essentialist view of culture, where 'culture' becomes the preserve of 'the
other' and viewed as an 'additional characteristic' ofthe ethnic groups, ratherthan
the terrain 'through and in which all people live, which is inherently relational
and which gives meaning to the world and all social relations' (Platt 2007: 18).
Clearly, the very concept of 'ethnicity' must be called into question, or at least
used with great caution.
An art therapy writer from NorthAmerica, Denise Lofgren (1981) has highlighted
how some of her assumptions were unhelpful to her understanding of images
made by a Navajo Indian client in the United States. In the first image, Navajo
symbolism is used to represent a guardian enclosing three sides of the paper with
the fourth side containing an opening to allow for the movement of the spirits (see
Figure 9.1); Lofgren was 'dismayed' by the image and thought it was pathological
and impoverished, because she was unacquainted with such symbolism.
A further example of her cultural assumptions, in direct response to the art
work, is described by Lofgren as the introduction of a personal history timeline,
which the therapist assumed would start on the left and work towards the right,
illustrating a chronological sequence of events; however, a more global and
less linear approach was taken, with the image divided into four quarters (see
Figure 9.2). This approach concords with a Native American outlook about time,
but could easily be misconstmed. Lofgren concluded that without more training
towards cultural sensitivity in the analysis of behaviour and symbolism, art
therapists could unwittingly abuse their clients:
 E

Figure 9./ Navajo symbolism

~
0
.!l
E

Figure 9.2 life history

~
~ 0
.....
0 (J)
"(ij"' E
i'; J!!
Z :.:J
'"'4
~ ~
...
Q)
...
Q)
'"
&" '"
&"
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 Art therapy and intercultural reflections 1 19

Everyone can cite examples of individual incompetence or insensitivity within

the mental health field. What I wish to emphasise is that institutionalized
forms of cultural bias affect the practice of even the most conscientious
therapist.
(1982: 29; original emphasis)

It is imperative that art therapists avoid interpreting art and work in a

facilitative manner, especially so with those using unfamiliar symbolic schemas.
To have an in-depth understanding of diverse literary and cultural perspectives
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is probably beyond the scope of basic art therapy training; but a conceptual
understanding and sensitivity towards cultural diversity is imperative. 'How
can a white Australian art therapist work effectively in a plural society without
first having confronted the prejudices so seamlessly inherent in her upbringing
and history?' demands Holloway rhetorically (2009). Certainly, creating some
space in art therapy training to reflect on this feels imperative. As stated earlier,
the safest stance for the art therapist to adopt might be that which 'view[s] all
therapeutic relationships as meetings between cultures' as McNiff had it (1984:
128); this circumspect position is a useful one for art therapists to adopt.

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 Chapter 10

Working as an art therapist

with children
Annette M. Caufter
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Introduction
Working with children is a natural form of art therapy, because making marks
on the external environment is an innate drive in child development. This might
be the delight of imprinting a foot or hand in mud or sand, making a shape from
natural materials - a castle from sand, a man from snow - stroking their finger
down a frosted window or marking the kitchen wall with a feIt pen. Children
have an innate urge to test themselves against their external environment - to
experience their internal, subjective world of fantasy and dream, in relation to
the external, objective world ofreality and fact (Winnicott 1971; Case and Dalley
1990). Recent research in neuroscience notes that emotional expression through
art therapy has links to the non-verbal parts of the brain (Hass-Cohen and Carr
2008; Siegel 2007; Lusebrink 2004). For art therapy to establish a scientific
platform in the health sciences, the links between art, trauma and neuroscience
are an area for further research (CouIter 2009). Emotional inteHigence linked to
cognitive processing with non-verbal parts of the brain and visual processes has
potential implication for child art therapy in educational settings.
Art therapy provides an opportunity for the child's instinctual, emotional part
of the brain, the amygdala, to make sense of confiicting experiences between
inner needs, wishes and fantasies and the constraints of their external world over
which they have less control. This is resolved through greater rational cognitive
processing in the more logical part of the brain, the hippocampus. We now know
that the child is born with a fuHy functioning emotional brain and that cognitive
understanding is acquired (Siegel 2007). Childhood experiences vary based on
the quality and consistency of parenting, early infant attachments to significant
caregivers and the child's initiation 'into the emotional, political, and social
world' (Case and DaHey 1990: 1).
Group work in child treatment settings is more cost effective than individual
therapy because more children are seen at one time, and it can be conducted
alongside and in adjunct to other treatment regimes being undertaken. For
example, art therapy can be used effectively with children suffering suspected
mental illness such as phobias, conversion disorders, eating disorders, unresolved
 Working as an art therapist with children 123

trauma, depression, as weH as for those with medically invasive treatments or

developmental issues. Most art therapists are not trained to diagnose: however,
they may work in a facility where clinical staff are expected to contribute to
diagnostic formulations. When labeHing children with amental disorder, it is
sometimes safer to use the more flexible codes (American Psychiatric Association
2013) until presenting symptoms are confirmed.
Funding for child art therapy is not always available and service provision is
determined by the health scheme in place. The context in which the art therapist
works with a child or young person becomes a determining factor in assuming a
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therapeutic role. Working in a state-funded mental health service for emotionaHy-

troubled children or teenagers contrasts dramatically with a specialist school
or a community-based non-government agency, where continuation of service-
delivery is determined annually through performance indicators, statistics and
funds availability.

Processing art work with children

The reason art is such an effective way to work with children is that it provides an
alternate way to speak about feelings. Children generaHy do not know why they
have made or drawn something a certain way. There are many ways to explore an
image with a child individuaHy, in a group, or in a family context.

Therapeutic art education

Possibly the best area for art therapists to consider practice with children is
in education. The term 'therapeutic art education' was first used by Henley
to describe the benefits of the art process in art education (Henley 2002: 16).
Henley's ideas are developed from the work ofVictor Lowenfeld, who believed
the art process was inherently therapeutic for children's emotional learning
(Lowenfeld and Brittain 1987). Lowenfeld's work supports the premise that
making art involves aesthetic awareness and the gaining of skills, as weH as
offering therapeutic experiences that facilitate creative thinking, self-expression
and interpersonal growth. An art therapist provides a specialist service in an
educational setting regardless of their role or job title. As an art educator, a
therapeutic slant is implemented in the lesson plan. As a school counseHor,
individual and parental advice is offered or group therapy might be provided.
As a 'specialist consultant' under contract, the art therapist can provide a
preventative service, where problems are immediately addressed, before
behavioural disturbance becomes more entrenched.
Edith Kramer proposed that art educators would benefit from clinical training
in order to deal with the potential of what might surface in the classroom from
non-verbal expressive language (Kramer 1971). This idea makes good sense,
but is yet to be taken up by educational authorities. The use of art therapists,
employed as skilled clinicians rather than special educators in school settings,
 124 Working as an art therapist with children

remains an area of controversy within the profession. Incorporating art therapy

techniques into essential curriculum studies offers educators an alternate way
to stimulate a child's neural pathways, and current brain research supports the
importance of the non-verbal visual expressive part of the developing brain.
When creative processes are mobilised in a classroom setting, art therapy can
stimulate academic achievement (Rosal1993; Stepney 2001). Rosal's research
supports the beneficial impact of incorporating art therapy programmes into
school-based settings. Her original doctoral research conducted in an Australian
primary school exarnined the impact of an art therapy group work programme
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on classroom behaviour (Rosal 1985). Further research by Rosal successfully

combined an art therapy programme with English curriculum studies 'to reduce
school drop-out rates, to decrease school failure, and to improve students'
attitude about school, family and self' (Rosal, McCulloch-Vislisel and Neece
1997: 30).

Conducting a children's art therapy group

Group themes
For the art task, focus on the group dynarnics rather than the task. The task is
designed to facilitate the group dynarnic. A therapist can easily impose their
agenda by deciding group themes; however, the challenge is to follow with
relevant themes that facilitate the ongoing group process. It is useful to have a
prepared choice of group theme options, so that individual and specific group
relevance can be met. The following list of group work tasks can be a basis for an
art therapy group-work programme. Some discussion of alternatives for different
contexts is included.

Session one: (ree picture

In a stmctured group, the best time to have expressive freedom is at the beginning,
when relationships are more cautious and less likely to cause damage. It can also
be a time for art media exploration, working with accidental marks, exploring
what materials have been made available and giving perrnission to re lax conscious
concern and control. Children respond to a less stmctured task because of their
naturally more active emotional brain.
This task is used in several art therapy assessment procedures (Kramer 1971;
Ulman 1975; Kwiatkowska 1978; Cohen, Mills and Kijak 1994) and involves
drawing whatever comes to rnind, letting the hand do the thinking or just playing
with the art material. Later the therapist rnight suggest using the non-dominant
hand. There is perrnission here, in the fact that there is no right or wrong way, that
allows for an externallocus of control (Rosal 1985) or how the child rnight adapt
to an art task (Rosal1996).
 Working as an art therapist with children 125
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Figure /0./ A picture of my name

Session two: something that introduces you to the group

This could include drawing your name (see Figure 10.1) and drawing a picture
that tells something about you (see Figure 10.2).
Figure 10.1 is an example of a name pieture completed in an in-patient art
therapy group where the child has managed to include patterns and symbols to
describe different parts of hirnself. In Figure 10.2, the child tells the group about
their horne. This child was witnessing domestic violence and had symptoms of
trauma-related afflictions - sleep disturbance, physical aggression towards other
children, refusal to attend school generated by fear and concern for his mother's
safety and disturbed thoughts presenting as an inability to attend to tasks.

Session three: a self-focused theme

There are many options for self-image work (Liebmann 2004). Some useful
themes are drawing yourself as a tree, an animal, a building, a plant, a toy, etc. The
therapist can stick to one item for the whole group or give the children a choice.
To explore self-perception, older children enjoy making a badge for themselves
(Lieb mann 2004: 228) or drawing a life map to describe where they've come from
and where they're going (Lieb mann 2004: 230).
Figure 10.3 is a badge by a girl who was exhibiting oppositional defiant
behaviour expressed in non-compliance with diabetic treatment. As she engaged
in art therapy group work, her non-compliance settled down as her anger about
her debilitating medical condition found an alternate expression.
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Figure 10.2 A picture that teils us something about you

Figure 10.3 A badge for myself, by Vicky, age I I

 Working as an art therapist with children 127
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Figure 10.4 A badge for myself, by Sarah, age 12

Figure 10.4 is a badge by a girl who was suffering trichotillomania, exhibiting

non-compliant behaviour towards her treatment for diabetes. The central badge
or shield is a clear 'mandala-like' centre point, framed to be separate from other
marks external to the badge, which is quite a different style of media application.
Her description was that 'this is me', indicating the centre point, 'and outside
[me] is all the mess in my life'. Her parents had recently separated and her self-
mutilation meant she had to wear a headscarf to cover her baldness.
Another suggestion is to draw Me, Myselj and 1, an art task which can evoke con-
cepts of self as viewed from within the family and other extended life perspectives.

Session (our: (amily theme

The individual self-perception tasks above can also be used to describe family or
group members, who can be portrayed symbolically as animals, buildings, fmit,
vehicles or any other group of objects. Whatever way the family or the group is
portrayed, it stimulates the child's cognitive, thinking faculties.
Figure 10.5 is a portrait of a group of children with cystic fibrosis who
have known each other since infancy and meet whenever they are admitted for
medically-invasive treatment; the group is like a family away from horne. The
therapist has a significant place on the child's page.
Kwiatkowska points out the importance of establishing who is in the family
(Kwiatkowska 1978) and that, depending on the prevailing culture, it might be
particularly important to include the extended family.
 128 Working as an art therapist with children
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Figure 10.5 The group as trees, by Michelle, age 13

Family portraits might be realistic or abstract family self-portraits or family

members doing something together (Coulter 2007: 219; Kwiatkowska 1978: 95-
106). Placement on the page can be significant and children can be assisted with
the concept of abstraction (Coulter 2007).

Session five: dream images

Dream work provides opportunity for less conscious symbolic exploration and
non-verbal brain activation. Some art therapists pre-draw a sheet of a figure
sleeping in a bed in the bottom corner, connected to a think bubble in which the
dream is articulated. If the child says they can't remember any dreams, ask them
to think of a daydream.
Figure 10.6 was drawn by a young person who had been admitted to a child
psychiatry unit suffering suicidal ideation. He described the picture as 'a repetitive
dream I have of a person falling off the cliff ... I wake up just before he hits the
rocks - wish he would hit the rocks. He wants to die.' Later in the same session,
he disclosed, 'It's me.'
Figure 10.7 was completed in Nathan's first art therapy group and was about
his resistance to attending the group, during which he was fidgety and passive-
aggressive. In both art works he is expressing different feelings behind his anger,
related to his hospital admission and imposed group attendance.
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Figure 10.6 A recurring nightmare, by Nathan, age 14

Figure 10.7 Boring, by Nathan, age 14

 130 Working as an art therapist with children
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Figure 10.8 A volcano, by Darren, age 7

Session six: letting the monster out

Allowing cbildren to acknowledge feelings that are difficult to verbalise - particularly
negative, destructive feelings such as anger, fear, frustration and guilt - can be done
through a collective group art instruction. There is a message given that it is okay to
have not-so-good feelings and to leam that other cbildren/people have these feelings
also. Working symbolically provides space to reflect on feelings together that are
less socially acceptable. Letting the monster out helps children deal with their
shadow-self or darker side. To only focus on the positive to enhance a strengths-
based approach colludes with the denial of negative thoughts and feelings. Tbis
does not help the more troubled cbild. Cox suggests the use of volcano drawings
as a metaphor for anger (Cox 1985). Facilitated discussion includes when, how or
whetherto release angry feelings. The symbolic release of negative feelings prevents
the festering of internalised themes of self-destruction and suicidal ideation.
In Figure 10.8, the boy, who is a victim of cbild sexual assault, symbolises bis
anger about the court case through the volcano that is in astate of overflowing.

Session seven: draw a miracle or a wish

Tbis task builds on notions of hope and therapeutic goals in treatment. Consid-
eration of a perspective of potential is challenging for some cbildren. The cbild
moves to a solution-focused frame of reference (Coulter 2011) and self-esteem
is elevated as potential empowerment is the focus. The group is now halfway
 Working as an art therapist with children 131

through and internal strengths can be built upon. In the previous task, the inner de-
structive self is released and accepted by the group. The therapist now facilitates a
process ofwish-fulfilment, acknowledging the possibility of change. Liebmann's
suggested themes, any of which are appropriate for a children's group, include:
where I would like to be right now? What would you do with a million dollars?
What would you like to find in a treasure chest? What present would you like to
receive or give? What's on the other side ofthe river? (Liebmann 2004: 239).

Session eight: (ree collage

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This is particularly effective for older children who are more self-critical of their
artistic merit. The use of photo collage frees up imagery choice and provides a sense
of personal satisfaction, as difficult concepts are symbolically articulated through
found images. Landgarten recommends two boxes ofpre-cut images: people and
miscellaneous items (Landgarten 1993: 5-7) that are 'culturally homogeneous'
with the client group. Landgarten also provides a four-task assessment protocol
that can be adapted to a group context (1993: 9-12; see also Chapter 12 of this
book, pp. 158-9). Liebmann also provides collage suggestions for exploration in
groups (Lieb mann 2004: 231).

Session nine: group art task

Group art tasks are effective throughout group art therapy treatment (Lieb mann
2004: 262-71), but when used towards the end of the group, they provide
potential expression of established group cohesiveness as well as opportunity
to symbolically address any group dynamic that may have arisen. The group
begins to say goodbye and group mural tasks specifically focus on closure issues.
Group mandalas are effective extensions to a group art task. Liebmann suggests
group mandala tasks and Stepney modifies Liebmann's 'Mandala of Rands'
(Stepney 2001: 81-2). A circle is divided into segments and participants outline
their hand in their segment. Their hand is enhanced to convey their personality
and then incOlporated with the rest of the picture to create a group mandala.
Children experience pleasure in this task because it externalises a portion of their
phenomenal field, uniting them with others.

Session ten: a (areweIl experience

Further group closure continues in session ten. An opportunity for feedback from
group members is offered. For example, a task such as draw something that
represents the group gives individual members a prompt to consider and make
comment to each other. The art therapist can direct a specific farewell task or
provide time to explore what ending means for each individual member of the
group. This stmcture can include making two drawings: something to take away
and something to leave behind. Articulating what is being taken away assists
 132 Working as an art therapist with children

individual validation of group life. Defining what is to be left behind considers

what will be discarded from the group experience. This is a conscious verification
that reflects on group process and considers what has been gained and let go, as
part of self-learning. Umesolved issues of loss or grief often surface when groups
end. Examples of ending themes that might come up at this time include: the death
of a family pet; illness or death of a family member; an accident witnessed; or
something seen on television or in a computer game.

Session eleven: gift-giving

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Part of the group ending experience is to have opportunity to receive something

to take away that has been given. An effective final group task is symbolic 'gift-
giving'. The context of the group is significant to this task. For example, a group
of adolescent girls suffering eating disorders might give each other representations
of chocolate bars and other illicit foods amongst great frivolity. Generally, the
'gift' can be a tangible, concrete item such as in the above example, or it can be a
thought or a feeling. The gift is either represented on paper or it can be a sculptural
representation of an object or abstract notion. However the 'gift' is visually or
sculpturally articulated; the task includes writing to whom it is intended and from
whom it is given. It can also be wrapped or folded. Older age groups write an
explanation, such as, 'I am giving you confidence so that you kick a goal next
time' or 'I have made you a heart because I think you are brave' .

A world without words

Blake reminds us that not all children have the capacity to play when they first
come to therapy (Blake 2008: 121). The therapist'sjob is to engage with the child
and to be comfortable working with non-verbal primary processes and primitive
states of mind (Case and Dalley 1990: 143). This requires that the therapist
genuinely enjoys working with children who instinctively know when an adult is
not being their true selfbecause the child's right-brain intuitive faculty is highly
developed. The adult therapist has often lost touch with their ability to play.
Adults can be uncomfortable with the notion of sitting with 'not knowing', yet
this is largely what one must do, at least at the outset of child art therapy.

Establishing 0 relations hip

Children do engage in some way and most are open to giving the adult therapist
a fair chance. Aresistant, troubled child does not engage as easily but is likely
to be subtly assessing the therapist in some way. In this situation, the therapist
remains genuine to themself and does not focus specifically on the child or
gaining their trust, because a resistant child is used to adults trying to engage
them - they have leamt ways to protect themselves. When the therapist is able
to respond genuinely to the child, the child is instinctively curious about the
 Working as an art therapist with children 133

therapist. GraduaHy, trust within the relationship will emerge. This trust, however,
is dependent on the therapist's ability to maintain consistency and genuineness.
Art therapy offers the less verbal child an opportunity to find expression through
the image as object, finding links to feelings affecting behaviour. Withers takes
the therapeutic application of art one step further, encouraging the child to find
key words associated with the image and feeling (Withers 2009: 74-5).
The first contact is quite significant for a child and the therapist aims to make
it count. Children want to trust significant adults in their lives. If their experience
is that adults have betrayed their trust, then they are going to be more guarded
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in their first contact with the therapist, but this first meeting sets the scene for
the ensuing relationship. If the first contact is difficult, the work is likely to be
difficult. If the first contact is engaging and provokes curiosity, the therapeutic
relationship is off to a good start.
A damaged adolescent will thoroughly test the therapist before they engage in
the therapeutic processes. A younger child is less likely to test the therapist with
the same degree of sophistication as a damaged adolescent. The most competent
therapist can be caught off-guard w hen working with teenagers (Coulter 20 11) and
years of experience does not prepare the therapist for the next troubled adolescent.
The sub-culture of the young person is ever-changing and it is unlikely that the
therapist can keep up with this. The young person will be interested to test the
therapist's knowledge of their sub-culture, and it is likely the therapist will fail
this test. However, the young person can be surprised by the genuine concern the
therapist has for their plight. In working with damaged adolescents, it is likely
there will only be that first appointment to engage or lose the dient. A solution-
focused approach is recommended for this initial session (Coulter 2011) as the
young person or their immediate problem is the target, not the personal history, an
interest in the family system, or a focus on external others.

Therapeutic relationships with children

The complexity of the world of the child is never dearly defined nor fuHy
understood. Maintaining a positive regard for the child's process is strongly
supported (Axline 1969; Kramer 1971; Rubin 2005). Too much structure risks
denying the creative potential the child brings to the therapeutic relationship. The
child can remind and teach the therapist about lost creative transitional processes
between less conscious states of mind and cognitive thinking.
It is not always easy to maintain positive regard for the child's process. The
therapist needs to be able to set a limit, if the child is going to physically harm him
or herself, the therapist, equipment or the facilitating environment. Being dear
about limits provides a safe context in which a positive therapeutic relationship
can flourish. The therapist's presence is part of the context of the external world.
The therapist establishes only those limitations that are necessary to anchor the
therapy to the world of reality and to make the child aware of their responsibility
to the relationship (Axline 1969: 73-4).
 134 Working as an art therapist with children

Art play therapy

The way a child chooses to respond to using art materials indicates their ability to
engage in the play process. Blake describes 'emotionally alive play' as 'play that
bridges the subjective inner world, and outer objective reality is ... fascinating to
watch ... time seems to fly. Alternatively, play that is emotionally disconnected feels
boring and tedious' (Blake 2008: 121). Working with children demands an ability
from the therapist to artend to their 'gut' reaction to the child's play. The process
may not foHow a logical sequence to the adult mind. It requires an ability to have
faith in the process. 'Just moving toys around, drawing or teHing stories' does not
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necessarily mean that the child is engaged in a process ofplay (Blake 2008: 121).
When a child is emotionaHy engaged with art-making processes, they are
exploring the variable qualities of art media extensively. The art therapist focuses
on what feelings the child is expressing through their engagement with art materials.
The therapist observes the child's attitude towards the materials, how they are
handled, as weH as what is created. The therapist's presence is as witness to the
child's art play process, validating whatever it is the child is engaged in doing.
This is Blake's account of spontaneous play:

You feel the child is making it up as he or she goes along. It is not rehearsed ...
This enables thoughts to find a partner, a new combination that provides a
new idea, the next piece of play. .. real play conquers depressive anxieties
because it is pretend; nothing will really happen. Things will not be destroyed
or damaged within the safety of play.
(2008: 122-3)

In child art therapy, cogmtIve leaps are stimulated as creative risks are
achieved. A wide range of playful approaches to art media are possible that lift the
child beyond their comfort zone. In accepting and entering the child's world, the
therapist enhances the child's confidence and self-esteem.
Child art processes provide a form of symbolic language that is an alternate
means of communication. Through symbolic and metaphoric art play processes
that are predominantly non-verbal, the child seeks expression of feelings, desires,
fears and thoughts that are central to their inner experience, generated from their
ability to create images based on past perceptions that are no longer present, but
that are imbedded in their explicit memory.

Deve/opmental awareness
Children go through stages of artistic development, and noticing developmental
delay or advancement depends on the therapist's ability to identify these stages.
Evans and Dubowski' s research (2001) is thorough, supporting the work of VIktor
Lowenfeld, who sees art activity as a valuable educational tool as weH as a means to
describe the child's emotional and social adjustrnents (Lowenfeld and Brittain 1987).
 Working as an art therapist with children 135

Art therapists should be aware of developmental stages of artistic development.

Not all children manage to reach graphic milestones and are sometimes referred
for therapeutic help (Levick 1983). For example, a child suffering intellectual
delay may be stuck at a certain developmental stage of artistic growth and may
be drawing repetitive spiral shapes. An art therapist can assist the cognitive
perception of the child's world through following developmental sequence
drawing to enhance more rounded shapes, in line with moving from random
scribble to circular shapes. The behavioural responses of an intellectually disabled
dient are likely to improve when a developmental art therapy programme is
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implemented, simply because they begin to ac hieve the developmental stages of

visual perception. However, this may take a long time and requires considerable
patience from the therapist, who is motivated by the potential reward (Kellogg
1970; Lowenfeld and Brittain 1987; Rubin 2005).

Adolescent art therapy

Adolescence is a time of intense creativity, where self-expression through body
art, music and fashion is an acceptable part of their psycho-social sub-culture.
Engaging in expressive activities provides opportunity for self-motivated,
personal narrative in the external world that is beyond the family of origin
and is a continuation of internal processes linked to deeper-level struggles
and concerns (Coulter 2011). Art therapy provides an expressive outlet for
confusing emotions at this time, but other creative therapies are equally
valuable in the psychosocial development of the adolescent brain, because
non-verbal unexpressed parts now seek a language through which to be heard.
Cognitive brain development is highly charged as their ability to think laterally
increases. Group art work is particularly relevant because individual marks are
achieved with peer support. The process of separation from the family of origin
relies on the establishment of peer relationships enhancing a more autonomous
world that exists externally to the family. Self-focused, open-ended art tasks
shift from a narcissistic focus to decision-making processes that have a broader
symbolic content. The art work can be stored for the future, the therapist
accepting that the young person is not ready to discuss their work. Any form
of interpretation is potentially destructive to the fragile sense of self and self-
doubt, often contributing to low self-esteem.
Photo collage is a particularly useful medium to use with adolescent populations
because photo images relate to popular external world culture, as well as to the
fact that their use avoids any consideration of lack of artistic merit. Although
Landgarten proposes two boxes of pre-cut images (Landgarten 1993: 20), pre-
tom images are just as effective, if not more so, because the young person does
the cutting which feeds their wish to not be treated like a child, that they can do
things for themselves.
 136 Working as an art therapist with children

Art and childhood trauma

Traumatised children experience a range of emotions that are difficult to grasp, let
alone express. Psychological problems such as anxiety, helplessness, fear, phobias,
conversion disorders, depression and eating problems may aH be symptoms of
an umesolved childhood trauma. Children may be traumatised by removal from
horne as a result of domestic violence, being assigned to a foster placement or care
horne, or they may have been subject to kidnapping, natural disaster or a physical
illness involving hospitalisation. Trauma may also result for child victims of
verbal, emotional, sexual or physical abuse. Children can be witness to a natural
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disaster and other accidents or disasters. They can also experience vicarious
trauma after witnessing televised media images of these (Stern 2003) or after
inappropriate disclosures about former abuse from a disturbed parent.
Representational symbolic drawing of the experience of trauma allows an
imaginative synthesis for perceived and imagined possibilities. Instead of carrying
these images internally, they are externalised through art-making, which can help
children to express feelings of grief and loss, resolve feelings of confusion and
process strong emotions.
Art expression seems to be weH suited as a modality with children in trauma
as it is easier for them to use visual modes of communication before being able to
talk about trauma. This is especiaHy true for children who have been chronically
traumatised, as they are less able to freely express themselves. They require time to
adjust, to gain a sense of trust with the therapist and the therapeutic environment.
The therapist may fee 1 hampered by the short length of time available. However,
when working with children, the therapist needs to be able to go at the pace of
the child. This is weH documented in a British training video in which an art
therapy student is working with a child who is suffering from a brain tumour.
The trainee art therapist engages in a process of 'automatic drawing' for several
months (Rubin 2004). The therapist does not attempt to hurry the therapeutic
process, recognising that it is a gradual one, and does not direct the child's actions
or conversation in any manner. The child leads the way: the therapist foHows.
The therapist must be able to sit with processes that may not be making any
logical sense. Just because the referral asks the therapist to deal with a particular
issue, does not mean this is in the child's best interest. The therapist has to let
go of an agenda and be able to run with the child's emotional processes. This
can be reflected upon later, but at the time, the therapist needs to stay with the
processes of the child. This is unlikely to occur if the therapist is charged with
purposeful intent. The child has a fuHy-functioning right brain and the therapist
who can surrender to the child's innate expressive abilities can engage with the
child's creative processing. It is necessary to have a faith that it will be possible
to make sense ofwhat is going on later in supervision (see Chapters 15 and 16).
The therapist empowers the child to be confident, to trust the relationship, to cope
better and to continue integrating with the external world.
 Working as an art therapist with children 137

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 Chapter I I

Working as an art therapist

with offenders
Annette M. Caufter
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Documentation of the therapeutic use of art with offenders throughout the growth of
the art therapy profession was sparse unti1 Liebmarm'sArt Therapy with Offenders
in 1994 and Gussak and Virshup's Drawing Time: Art Therapy in Prisons and
Other Correctional Settings in 1997. These edited texts from either side of the
Atlantic present an expansive account of situations where art has been effective
in the treatment of prison inmates. Even prior to the establishment of art therapy,
it was observed that victims of incarceration had a natural desire to make art with
whatever materials were avai1ab1e (prinzhorn 1972; Cardinal 1972, 1979). This
natural urge to se1f-heal through engaging in the making of art is often counter-
productive when conducted in an institution designed to contro1 and contain. In this
respect, prisons are not unlike 10ng-term psychiatrie hospitals (Goffman 1968) and
'especial1y for those who fee1 deep1y unsure of their relation to themse1ves and to
other peop1e and are iso1ated from their surroundings, it [art therapy] can be a vital
means of self-expression and communication often succeeding where words fair
(Nowell-Hal1 1978: 39). However, the question arises how suitab1e is a form of
therapy that promotes se1f-expression and individuation, when it is operating in a
setting that desires compliance and promotes conformity and anonymity (Cou1ter
1986). Art therapists have to consider how to deliver a treatment programme that is
going to satisfy not only the authorities but also benefit the inmates. Delivering an
exciting self-expressive programme is not necessari1y beneficia1 if the incarcerated
individual begins to assert an independent attitude within the institution, chal1enging
authority and the system in which they reside. Goffman writes that 'any group of
persons. .. deve10p a 1ife of their own that becomes meaningful, reasonab1e, and
normal once you get dose to it' (Goffman 1968: 11). Art therapists who work in
prison settings adapt their skills and know1edge to an environment that is unique1y
its own and foreign to any outside infiuences. Change is not encouraged and good
behaviour is the measure of success.

Literature review
Gussak and Virshup discuss the economic demise and concems forthe dehumanising
of individuals p1aced in penal services (Gussak and Virshup 1997: xv-xx).
 140 Working as an art therapist with offenders

There is an increasing trend to mix people with mental illness with criminals.
Gussak and Virshup suggest that art therapy provides the opportunity for self-
reflection and insight to take place on a less conscious level, without the need for
this to be always addressed literally and consciously. They warn how 'unintended
disdosure of issues or insight can be quite threatening' (Gussak and Virshup 1997:
2) but that art offers a vehide of expression that does not have to be verbalised.
The inmate must return to the prison after the session. He is therefore not left
vulnerable: 'when a patient leaves a session ... he is going back to the general
prison population ... treatment should focus on helping the inmate/patient increase
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the understanding of self while allowing necessary defences and masks to remain
in tact' (Gussak and Virshup 1997: 2). After an art therapy session, the incarcerated
individual must return to a world about which the therapist has no comprehension.
Any institutionalised setting has its own culture and codes. As Gussak and Virshup
remind us (1997) and my experience demonstrates (Coulter 1986), an individual's
survival in asecure setting such as a prison or a psychiatrie institution is dependent
on their ability to conform with codes of anonymity, not individualisation through
creative activity. The work ofLaing and Boyle, while inspiring (Laing 1984; Boyle
1977), is more the exception than the rule (Gussak and Virshup 1997; Teasdale
1997; Liebmann 1994).

Working with anger and addiction

Offenders may often have addictive personalities; whether the addiction is to
alcohol, drugs, gambling, aggressive behaviour or crime itself, the repetition of
the compulsion to engage in behaviour that is deemed out-of-control by society
normalises life for that individual. A mechanism of denial is operating that makes
it difficult to accept there is a problem, so painful perceptions are denied. The
purpose of art therapy is to challenge these cognitive distortions and to support
the dient to better understand the mechanisms of self-deception that are operating
through the addiction.
Inmates are often dealing with extenuating problems connected to an offence -
marriage or family breakdown, drug dependency, alcoholism, gambling and
poverty. It is not the therapist's role to support and accept the prisoner's self-
deception and perpetuate mechanisms of denial. The addiction is usually
motivated by a need to escape painful feelings. The newly-qualified art therapist
can be easily over-zealous to engage with their dient, to understand and provide
a warm, caring and supportive relationship. This is not always in the inmate's
best interest. Through art, personal material can surface inadvertently. For dient
safety, it is not always in their best interest to encourage verbalisation (Gussak
and Virshup 1997). Working with offenders, the therapy is in the making of art,
the cathartic release ofpent-up emotion and the expression ofwhat is difficult to
verbalise; 'since an "angry" work of art is not generally regarded as threatening,
they [the inmates] can draw out their hostility and rage on paper, with little fear
of retribution' (Gussak and Virshup 1997: 2). As Liebmann points out, 'often the
 Working as an art therapist with offenders 141

actual offence is the tip of the iceberg and brings to light problems that have been
left unattended foryears' (Liebmann 1990: 134). Teasdale supports that while 'art
therapy is not solely able to help deal with anger ... it offers time for image-making
and discussion through which they may want to share ideas about the reasons why
thy have been so angry' (Teasdale 1997: 34). Offenders may genuinely want to
solve their problems and agree to join an art therapy group to address alcoholism,
gambling, anger management and other problem-focused groups.

A narrative approach with a solution focus

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There are different theoretical approaches to process the therapeutic engagement

with art materials. Liebmann has developed the narrative therapy approach of
creating a storyboard to examine the events leading up to the crime (Lieb mann
1990: 135; Liebmann 1994: 152-261). This approach is not dissimilar to Fisher's
idea of encouraging the client to make a narrative map of their plight (Fisher 2005).
Liebmann encourages the client to make a comic strip-sequenced disclosure of the
crime, allowing an expression from their point ofview regardless of evidence or
court findings. There are several ways this technique can be developed further to
assist a re-exarnination of the thinking in the distortion of the cognitive frame.
For example, the storyboard can be drawn from another perspective to examine
the incident from another's point of view who was maybe affected. The visual
recollection of retained images from the criminal event provides a greater
articulation of emotional memory.
The narrative approach can be collaboratively linked to a solution-focused
approach (Cade 1995) by incorporating a plan for action that has aresolution to
the problem (Coulter 2011). This resolution can be future focused - that destiny
post-incarceration is within their control. Cade suggests that the therapist helps
the client search for 'exceptions to the behaviours, ideas, feelings and interactions
that are associated' (Cade 1995: 1); in this case, to the recollection ofthe crime.
Through the creation of a personal narrative in Liebmann's storyboard, 'exceptions
are elicited, highlighted and explored in terms of how they came about and what
was different at that particular time' (Cade 1995: 1). Through the storyboard
examination of events, it may become clear that the influence of alcohol or the
farnily argument that precipitated the event are factors that indirectly contributed to
the event. As Cade suggests 'interventions build on what has worked or is currently
working for the client(s), even ifmarginally or occasionally' (Cade 1995: 1).
In the solution-focused approach there are three questions to help the inmate
considertheircircumstances differently: (i) the 'Miracle Question' (de Shazer 1994:
95), where the client imagines that overnight a miracle happens so that when they
awake in the morning, their situation is completely changed. They are asked to
describe how things are different in as much detail as possible, the therapist eliciting
questions about who in their circle of farnily and friends is affected by the change,
how are they affected and precisely what would be different. It is often easier for
the client to say what is no longer happening rather than what is happening. For
 142 Working as an art therapist with offenders

example, if it is an alcohol-related crime, they may hrunour the therapist by saying

they would no longer be drinking. It is more challenging if the therapist can respond
with something like, 'so ifyou are no longer drinking, what are you doing instead7'
- the therapist is implying for the client to describe what is the different activity
in which they are now engaged that has replaced their alcohol consumption. The
second technique in the solution-focused approach is (ii) to encourage the client to
provide numerical value to their circumstances through asking scaling questions.
For example, if 0 means not at all and 10 means as much as could possibly ever
be imagined, what number would describe their potential to implement change
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to their current circumstances. If they respond with 2, the next scaling question
encourages consideration of a future focus to improve this: 'So what would need
to happen for you to move from a 2 to a 37' The third question, (iii) is to highlight
the client's ability to cope with adversity up until now. The client shares their
resourcefulness and expertise, the client knows the solutions not the therapist. In
the solution-focused approach, imaginative questioning encourages the client to
describe practical solutions to their current dilemmas (Berg and Steiner 2003).
Another technique that is referred to as 'advocacy' in interactive drawing
therapy (Withers 2006, 2009) is where the therapist draws for the client. It is
important to only draw from the precise description the client presents and to not
embellish this with anything from the therapist's personal pathology, but in doing
an advocacy drawing for the client, the therapist can create the storyboard for
the client, as the sequence of events is told. Advocacy is mainly recommended
in situations where the client is reluctant to draw. In whatever way the image is
created, it has the potential to provide emotional distance from the event for the
inmate. As soon as possible, the picture is handed to the client to complete. Once
engaged with the page, the client starts to continue the drawing (Withers 2006).
Another technique developed by Liebmann for an alcohol group can also be
adapted to other art therapy applications with inmates. The page is divided into
four frames. Liebmann dictates the content of the first and last frame for the alcohol
group - drinking in the first and being arrested in the fourth. The group members are
then asked to fill in the blank frames in between to show how they got from the first
to the last (Liebmann 1990: 146). The same task can be applied for prison inmates
with a scene before the crime in the first frame, then the crime on the last frame and
then the inmate is asked to visually describe the events in between.
One last extension of the Liebmann storyboard technique is to impose a
narrative intervention of finding an alternate story, not dissimilar to thinking about
the Miracle Question (de Shazer 1994: 95) only in this alternate script, the focus
is on 'news of difference' (White and Epston 1990), which is not dissimilar to the
solution-focused notion of searching for exceptions (Cade 1995).
Art therapy offers opportunity for the inmate to examine painful feelings
from a distance. Wilson uses art to manage feelings of 'shame' in her work with
gambling addiction. There is a compulsion to commit the addictive behaviour
in order to keep painful feelings at a distance, and the notion of being addicted
or made out-of-control by the 'illness' of an addiction decreases the likelihood
 Working as an art therapist with offenders 143

of feelings of 'shame' (Wilson 2003). With the offender feeling powerless and
inadequate because of their addiction, the crime is justified. By engaging in the
creative process through an art activity, denial is addressed as 'shame' reducing,
and corrective work is begun. The art work production is an object that exists
externally to the client but that relates to their internal sense of self. Through
this creation of a bond between the internal/external worlds of the inmate, self-
expression is promoted. The art work is a permanent, concrete record ofthe client's
visual progress in therapy. It is easier to talk through the symbol or metaphor, and
a contemplative process is encouraged because the making of art is relaxing - an
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opportunity to engage in a process of soothing, energising mindfulness and to play

with imaginative possibilities. The creative process offers choices and solutions in
the recovery process that the crime or the addiction does not offer.
Wilson believes there are five main considerations when using art therapy with
people suffering addiction-related problems, which have paralieis in working
with offenders. These are: establishing safety and trust; understanding the nature
of the addictive illness; breaking through denial; surrende ring to recovery; and
understanding the origins of shame (Wilson 2003). Each of these interventions
will be examined, and examples given of practical therapeutic tasks.

Establishing safety and trust

The therapeutic aim here is to be able to risk self-disclosure. If trust and safety
are to be established, there is the fear of being judged out-of-control for people
addressing an addiction. Art provides an opportunity to develop a personal visual
language of unprocessed shame reduction where thoughts or feelings can be
transformed. 'If [the inmate] were to express anger verbally, those around him
would react adversely because they interpret anger as an assault. .. but... they
can draw out their hostility and rage on paper, with little fear of retribution'
(Gussak and Virshup 1997: 2). At this stage the client is learning self-resilience,
as mastering over what they choose to express relies on their ability to take risks
and to trust the therapeutic process.

• Introduce yourselfto the group (see pp. 66, 79-80).

• Draw the circumstances that brought you here (Liebmann 1990: 140-3).
• How do you feel about being here? (Wilson 2003: 285).
• Draw something about you that the group does not know (see p. 79).
• Draw a picture ofyour name (see pp. 79, 125).
• Draw whatever comes to mind (see pp. 57-8,79, 156-7).
• Make a collage that describes you (see pp. 80-1, 135, 157-9).

Understanding the nature of the addictive illness

To move on from being controlled by the addiction, the fact that a problem
exists must be acknowledged (Wilson 2003; Coulter 2011). In this process, the
 144 Working as an art therapist with offenders

dient is empowered to describe their experience through the personalised visual

descriptions of their experiences and to become more accountable for their
actiollS. As discussed above, sequencing events and considering the negative
consequences of their actiollS assists the developing sense of an accountability -
the addiction is named as an 'illness'.

• Draw your addiction (Wilson 2003: 285). If it could speak, what is it saying?
(Withers 2006: 2).
• Draw being 'under the infiuence' of your addiction or impulsive behaviour
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(Coulter 2011: 88-90, Wilson 2003: 285).

• Draw the events (or sequence of events) that happen after you have
succumbed to your addiction (Liebmann 1990: 137-43).
• Draw the feeling of 'being powerless' (Wilson 2003: 286).
• Draw other feelings related to your addiction.
• Draw the effects of your addiction on your family.
• Draw who I am/who I was/who I hope to be.
• Draw an outline ofyour house and fill in the internal and external effects of
your addiction on that horne (Wilson 2003: 291).
• Draw two pictures: one of yourself addicted, the other of yourself not addicted.

Breaking through denial

Art techniques as a therapeutic intervention are based on a non-verbal starting

point. It is therefore often a more effective way to break through defences that
mask shame and perpetuate denial. Through engaging with the creative process,
defence mechanisms such as intellectualisation, rationalisation and minimisation
(Moore 1983) are circumvented. A better understanding of what takes place is
fostered as the dient becomes more familiar with their issues.

• Draw the effect of the addiction on you, your family, the social systems that
exist outside you and your family (one or all of these).
• Self-box/bag - 'the outside represents what you let people see and the inside
is what you are afraid to let them see' (Wilson 2003: 287; see also pp. 80-1
of this book).
• Fantasy versus reality - what your addiction promises versus what you
really experience (Wilson 2003: 286-7).
• Illustrate three forms of denial you use (Wilson 2003: 287).
• Draw achecklist oftriggers (Wilson 2003: 288).
• Draw: who are you blaming?
• Draw a map ofyour addiction history and where this has led (Coulter 2007:
223).
• Draw when you are most vulnerable to your addiction - give it a context
(Wilson 2003: 288; Withers 2006).
• Draw tools of recovery that help you deal with triggers (Wilson 2003: 288).
 Working as an art therapist with offenders 145

Surrendering to recovery
At this stage of treatment, a shift in the operating belief system is required so
that the addiction loses its power. Wilson emphasises that at this stage, support
from the therapy peer group, the wider community, family and friends needs to
be harnessed (Wilson 2003). Depending on the circumstances, this support may
also include back-up from amentor. Wilson also refers to the need to structure a
belief system or to develop a relationship with a higher external power of their
choice, such as areturn to an earlier belief system - an acceptance of succumbing
to an addiction as part of being human assists shame-reduction. The support of a
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spiritual system from outside can be visualised as some distance away, but getting
closer as their recovery progresses. There are alternate tasks that suit the same
concept of a 'higher power' but less explicit, listed below:

o Draw your relationship to a 'higher power' (Wilson 2003: 290).

o Make a spiritual symbol - something to represent your new belief.
o Find and illustrate a symbol of strength.
o Draw a story aboutyourselftalking to a 'higherpower' (Wilson 2003: 290).
o Make a personal mandala that focuses on opposite parts of you.
o Draw a dOOf of opportunity and a dOOf of challenge.
o Draw your likes and dislikes.
o Draw what forgiveness looks like for you (Wilson 2003: 290).

Understanding the origins of shame

The final stage involves facing reality where the unspeakable is spoken. This
means often exploring family-of-origin issues as problems of addiction start to
connect to earlier childhood experiences. Alternatively, this may mean a need
for self-regulation from a traumatic memory or a breaking through from myths
and mIes that are contributing to entrenched patterns sustained over the years as
part of a need to control or a fear of change. This is a stage of self-realisation,
empowerment and self-affirmation.

o Draw a portrait of your family, including yourself (see pp. 156-7).

o Draw an outline of your body and fill the inside with positive affirmations
and images (Wilson 2003: 291). (This can also be used as a group task to
draw the physical effects of addiction; Wilson 2003: 286; Feen-Calligan
1999.)
o Together, build a map or a road to recovery (Wilson 2003: 291; Coulter
2007: 223).
o Create an image of your inner child part being attended to by your adult part
(Wilson2003: 291; Withers 2006: 1O-1l).
o Make a doll or puppet of your inner child and create a safe place (Wilson
2003: 291).
 146 Working as an art therapist with offenders

• Make a group tree and leaves representing things you are thankful for and
things you have lost.
• Make a mask - paint on the outside what people see and paint on the inside
what different feelings are coming up for you.

Training workshops on addiction

When conducting training on working with addiction for allied health professionals,
the following three workshops are effective experiential learning tasks. Visual
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diary work is part of any training workshop; in this example, the visual diary
instmction tasks are included to demonstrate how to incorporate opportunities for
privacy and self-care for workshop participants. Addiction work is confronting at
times and the art therapist has a responsibility to provide techniques about how to
self-process art work because they may only be with the training group for a short
amount of time.

Art task I: draw your addiction

Visual diary entry: journaling task
Draw something that is adebriefing from your addiction picture. This might
be something reflective about the process, how you are feeling after doing this
picture or thoughts that crossed your mind while doing the art task. Make any
relevant notes. Entries are private and only viewed by another if or when you
choose to share them.

Art task 2: family-of-origin

In any work on addiction, it is always useful to include something about the
client's family. It might be their family-of-origin and how their addiction relates
to their childhood experiences, or it might be their current family and how their
addiction is affecting important people in their life. This task is adapted from
the Kwiatkowska Family Art Evaluation Technique (Kwiatkowska 1978) but
executed in a different form of art media.

Instruction I
In plasticine, make a small abstract sculpture (approximately palm-size) to
describe your family and the relationships within your family. Represent each
family member considering colour, shape and any other principles of abstraction
that are relevant for you. A list of abstract art considerations appear on page 74
as basic art principles. This list helps clients and therapists consider abstract
concepts. The therapist can focus on a few or provide the whole list depending
on the capabilities of the client or group. If plasticine is a difficult media,
 Working as an art therapist with offenders 147

coloured paper can be used instead or one of the following tasks can be used as
an alternative.

Instruction 2
If Instmction I is too challenging, think ab out abstract adjectives that describe
each family member and try to convey those adjectives in colour, shape, size and
texture. For example, three adjectives to describe one family member might be
cheerful, active and reliable, and another might be irresponsible, mischievous and
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clever. Another family might have a member who is withdrawn, ambitious and
deceitful, or someone who is depressed, anxious and indecisive. See if you can
make a shape that combines three abstract descriptive qualities for each family
member through colour, form and texture, for example.
The art therapist can brainstorm these examples if there is time.

Instruction 3
A further extension to this task is to include a family mapping activity. This
can be done with the concept of a family genogram, or, in keeping with the
visual art therapy demonstration, in a spatial format (Coulter 2007: 223). The
small sculptures are placed in relationship to each other and a drawn or painted
environment on which to place the family members may also be included.

Create a map of your family by placing them in relationship to each other. You
may like to paint or draw on paper to add to this task. Consider the various
relationships and demonstrate by line, colour or orientation ofspace, to emphasise
the family system in which they are currently operating.

This task extension gives the abstract family portrait a context and provides
opportunity for a narrative sharing as the story of a family-of-origin unfolds in
small group discussions of three or four participants.

Instruction 4
A further extension to this task is to introduce a solution-focused task to consider
possible changes to the current description. This is only relevant for those who
would like some change to the map or context of their abstract family portrait.

lmagine that overnight, a miracle takes place and when you wake up the next
day, everything has changed for the better in your family portrait. Rearrange
your family sculpture into how it would be if a miracle happened. Alternatively,
in order to not be quite so prescriptive to the solution-focused model, this could
simply be Rearrange your family portrait into how you would like it to be.
 148 Working as an art therapist with offenders

After group discussion, another personal, visual diary entry is suggested to provide
opportunity to debrief from this task.

Art task 3: build 0 map to recovery

Visual mapping tasks provide an elevated or diagrammatic view of the concept of
a road to recovery, as an expansion of narrative storyboard construction. Visual
maps in family work can be an expansion on the diagrammatic genogram or house
plan (Coulter 2007: 223). They can also be a visual symbolic representation of
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a life journey (Lieb mann 2004: 212). White's use of charting to re-author
conversation maps provides a narrative approach (White 2007: 83-98) that can be
adapted to the processing of a more visual art therapy task.

Trauma through imprisonment

The harsh reality of attending court and consequent imprisonment can be
traumatic. Liebmann engages her probation clients in a narrative technique of
storyboard work to deal with traumatic memory, including recollection of the
crime (Lieb mann 1990: 135-7). Over time, memory fragments convert into a
coherent story, expressed through creating a comic strip account of the event,
frame by frame. By creating a visual ac count, the events become experienced
as past personal history that are no longer present. The subjective states of
consciousness are converted into a visual text of non-verbal communication of
traumatic memory image fragments. Through art therapy treatment all aspects of
the trauma experience and responses are explored. Through extemalised dialogues
between the person and their dissociated states, there is a cognitive examination of
the trauma. Images can evoke body memo ries and arousal of trauma flashbacks.
These dissociated self-states gain consciousness through concretised images.
As well as resolving dissociation, art therapy attends to a victim mythology.
Through the ritual of art, creativity and play, safety and trust are established
and asense of fear of the unknown and trauma damage is removed. There is
an interrelationship between imagery and resistances as issues for surviving a
dangerous world are addressed through the interaction of image and affect.
Alexithymia is a lacking of the words for emotions and is a manifestation of
a deficit in emotional cognition. The person is unaware of their feelings or does
not understand their significance, so they rarely talk about feelings or emotional
preferences. They have a manner of concrete operational function and rarely use
imagination to focus drives and motivations.
The essential feature ofpost-traumatic stress disorder (PTSD) is described by
the American Psychiatric Association as:

the development of characteristic symptoms following exposure to an

extreme traumatic stressor involving direct personal experience of a event
that involves actual or threatened death or serious injury, or other threat to
 Working as an art therapist with offenders 149

one 's physical integrity: or witnessing an event that involves death, injury, or
a threat to the physical integrity of another person.
(American Psychiatrie Association 2000: 424)

This can also involve the person learning about such an event happening to a dose
associate.
U sing art to process PTSD, concrete references to the trauma are transformed
into symbolic images. There is right hemisphere-processing on multiple levels.
Feeling experiences are essential to restmcturing thinking and behaviour. Art
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therapy provides an interaction between right- and left-brain operations. There is

a dose connection between imagery and emotion. Art is now being identified as
a vehide for treating trauma and connecting feelings with thought, and effective
management of emotion is enhanced (Coulter 2008).
Although art therapy offers victims of incarceration opportunity for self-
expression, the benefits of this work need to be carefully considered in terms of
the context in which the therapist is working. Enlightenment and self-realisation
are not always the most productive goals if the individual is residing in an
environment that discourages self-expression and self-assertion. There is no doubt
that art therapy assists inmates to deal with issues of addiction. The benefits of art
therapy in institutionalised settings help dients on a variety of levels as they come
to terms with their addiction(s), face their fears and unresolved childhood issues
and prepare for the retributions of change in their discovery of new strengths and
convictions.

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 Chapter 12

Art therapy with couples and

families
Annette M. Caufter
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The use of art in family work introduees an alternative way for all members to
eommunieate from a visual intervention, using a visuallanguage of metaphor and
image w hieh are easily understood by all family members and ean eut through
eomplex verbal diseourse. When family eommunieation has a visual starting
point, younger family members in partieular are able to understand and relate to
joint problem solving, ehallenge the system that is operating and develop a better
understanding of others' perspeetives. For some family members, it is easier
to say through an art task how they are affeeted by eurrent relationships. The
inclusion of art in family therapy helps bridge generational barriers as parents
and ehildren work together to clarify different pereeptions of the family issues. It
is important for art therapists to be able to adapt their skills to suit all members
of the family and to aeeommodate different thinking within family sub-systems,
sueh as the eouple relationship. The art therapist must maintain an unbiased
approaeh in order to see eaeh partner's perspeetive and to not ally themself with
only part of the family system, beeause one seems more reasonable than the
other.
Family and eouple eonsultation is a highly speeialised field within art therapy,
similar to intensive group work, but usually more toxie. Interaetional dynamies
are rieh, entrenehed and ehallenging. The foeus is on eurrent interaetion patterns
rather than gathering a eomprehensive family history. Communieation proeesses
and patterns of interaetion maintain the family system or eouple relationship
in astate of homeostasis. It is the aim of the therapist to implement a strategie
intervention, designed to dismpt this system. An art aetivity offers the reluetant
or resistant family member or partner a way to engage that has potential to
introduee fun and a sense of humour to the seriousness of therapy, as well as an
opportunity to express something through metaphor or symbol that is otherwise
diffieult to address.

Couples art therapy

Couples who seek therapy usually present a eomplex relationship history. If
their problems were easy to resolve, they would not be requiring therapy but
 152 Art therapy with couples and families

would have resolved their difficulties between themselves. There are entrenched
patterns of communication that have been established over the years, laced
with positions of misunderstanding and verbal impasses. Even if the couple
are in a new relationship, one or both parties will have previous relationship
experiences that may be impacting on their current new relationship. There is
also the therapist's potential personal story offailed relationships or relationship
difficulties that can impact on his or her response to a couple. Crago writes that
'the potential break-up of a committed adult relationship seems a matter of
emotional "life" or "death" ... their anxiety easily becomes Dur anxiety' (Crago
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2006: 54; original emphasis).

Riley encourages the use of visual interventions in couples work because of
the introduction of an expanded view: 'to "see" is not possible with words alone'
(Riley 2003: 388). With a focus on visual mapping, the use of abstraction and
other techniques, the couple's verbal process is enhanced as they examine their
relationship in a different language, that of art (Coulter 2007: 215-19).
A basic principle from IDT (see pp. 82-3) that is effective when working with
a couple is that the art therapist manages the process while the couple manage the
content. If the therapist gets too caught up in the content, they feel drawn to take
sides or to problem-solve for one or other party. In couple work, if the therapist
has missed the point, it will surface again until the therapist addresses that issue.
It is also likely that the surface issue being presented is symbolic of a deeper,
less conscious problem or dynamic that is operating within the relationship.
In managing the process, the art therapist comments on the phenomenon of
repeated content and invites the couple to draw something about that repeated
point. They can draw the same task each session to reflect on their relationship
at that point (Coulter 2007; Riley 2003). By focusing on the couple's process,
the art therapist aims to visually assist the amplification of difference. The visual
concretisation of content means it is heard and seen by the other. Something that
has an unconscious emotional momentum becomes externalised, allowing the
couple to focus together on what is visually created, providing an opportunity to
understand the problem from the other's perspective, which has been translated
visually through symbol, metaphor or literal representation. The production of
an image has the potential to highlight reflections, change or progress in the
couple's relationship, and encourages the art therapist to listen to their own
thoughts and feelings as they sit with the couple's emotional dilemmas.
For some clients, especially the men in relationships, it is particularly effective
to provide a physical dimension to the therapeutic process. The notion of doing
something together that is seen as constructive, such as an art task, helps contribute
to an understanding of the system that is operating (Coulter 2007). Visual patterns
of current circular causality assist in the recognition of an alternate view of the
relationship difficulties. The aim of couple art therapy is to 'de-stabilize the cycle
of misinformation that has interrupted their ability to understand each other'
(Riley 2003: 389).
 Art therapy with couples and families 153

Family art therapy

The family art therapist focuses on the nature of the interactions between family
members rather than on the sequence of events that lead to the problem in the first
place. It is important to not regard the presenting problem as dysfunctional or a
sign of weakness, but more as a system of recursive patterns of communication
that maintain the interactional sequences (Bross and Benjamin 1982). Through
the content and process of various art tasks, the family art therapist works to
understand the family system that is operating and to also explore how this system
is maintained. The family is seen as a self-regulating organisation that seeks to
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maintain itself despite extemal pressures and internal events such as births, deaths
and developmental changes. Landgarten describes this process:

The system is examined through the way in which the family functions as a
unit while creating an art form together. The value of the art task is threefold:
The process as a diagnostic, interactional and rehearsal tool; the contents as
a means of portraying unconscious and conscious communication; and the
product as lasting evidence ofthe group's dynamics .... The invading device is
the art directive, which contains the appropriate media and is clinically sound.
(Landgarten 1987: 5; original emphasis)

Children or adolescents who are resistant to family interventionengage more easily

when a family art intervention is used to address a serious problem. Causality is a
circular process based on the cybernetic concept of feedback. No matter w here in the
family system an interaction begins, the same result will OCCUf. For example, where a
family member is the scapegoat, regardless of what or who precipitated the problem
or crisis, the operating dynamic is that this one person will be blamed, because that is
their role in the dysfunctional family system. This pattern is entrenched and circular.
The use of art as a systemic device is effective, dear and family indusive.
Art therapy offers areframe to take place in tangible form because by its very
nature, an art work can be 'framed'. Physical reframing in art therapy, by cropping,
transposing, destroying and repositioning, helps air family issues and facilitates
viewing from an altered perspective. As Riley (1994) reminds us, framing can
change a family's co-constmction of the extemal world:

To reframe ... means to change the conceptual and/or emotional setting or

viewpoint in relation to which a situation is experienced and to place it in
another frame which fits the 'facts' of the same concrete situation equally
weH or even better, and therefore changes its entire meaning. The mechanism
involved here is not immediately obvious, especially if we bear in mind
that there is change while the situation itself may remain quite unchanged
and, indeed, even unchangeable. What turns out to be changed as a result
of reframing is the meaning attributed to the situation, and therefore its
consequences, but not its concrete facts ....
(Watzlawick, Weakland and Fisch 1974: 95)
 154 Art therapy with couples and families

The metaphor of change to the physical frame can lead to a parallel metaphor of
change within the family system and joint reflection about how the dysfunctional
homeostasis is being maintained. Therapist and clients engage in non-threatening
communication through the symbolic quality of the metaphors/analogues. The
art therapist uses both visual and verbal metaphors. When an intervention is
presented through a metaphor, the client may not even realise the intervention has
been made (Haley 1976). When the metaphor is visual rather than verbal, it is easy
for all members of the family to grasp the new concept. The creation of tangible
family symbols or metaphors add a physical potency to the therapeutic process.
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The family images provide the content of therapy; the art therapist provides
processes by which those issues are addressed.
As well as systemic or strategie interventions, family art therapists can also
integrate solution-focused brief and narrative approaches. When working with
families, the art therapist is adapting to different personalities within the family
constellation. An integrative approach provides a variety of theoretical approaches
to be included to suit different personality types. For the logical structured thinker,
the solution-focused brief approach engages even the sceptical or reluctant family
member. A narrative approach allows opportunity for another perspective to be
heard that may not have been heard before (Riley 1993). This 'news of difference'
(White and Epston 1990: 61) can then be taken up by a solution-focused
intervention creating a systemic intervention (Coulter 2011). The art-based nature
of the activity is strategie in itself: art has a lot to offer the family in conflict.
For example, working in a women's refuge with mothers who are victims of
domestic violence might include the provision of family art therapy that includes
children and adolescents who are suffering vicarious trauma from their exposure
to family violence. There could be an adolescent member of the family who is
acting out a role model of violence to younger siblings or the adult parent. The
systemic goal is to dismpt the multi-generational pattern of domestic violence.
Through art, family members share their experience of domestic violence by the
perpetratorwho is now absent and the adolescentfamily memberwho is present. A
narrative art task interventionmightbe to 'draw what it's like to be inyourfamily'
or 'what would you like to change in your family?' What comes to light may be
that a younger child who is refusing to attend school is in fear that something
might happen to their parent if they leave horne. This becomes the narrative that
was previously unheard. Individual art therapy may be required where anger
management or separation issues are directly addressed in collaboration with
family therapy. In adult psychiatry, the client suffering mental illness may have
family members who require systemic treatment. Art therapy offers a way to
examine and reflect on the system and the operating dynamies.
When working as part of a farnily therapy team, an image can be drawn by the
team for the family to describe what has been discussed. Farnily members often
say they cannot remember the discussions, but that they can recall the image the
team drew and the metaphoric explanation. For example, a family member talking
about their struggles might use the metaphoric phrase 'it feels like we're paddling
 Art therapy with couples and families 155

upstream against the current and not getting anywhere'. The family therapy team
then draw a river and a boat being paddled upstream, and indude details such as the
two sides of the river in contrast and some emphasis of a strong current. In doing a
drawing, the team amplify a metaphor the family have raised in the content of the
session. When this image is shared with the family, the therapist shows the team-
generated image to the family by saying, 'the team behind the screen are wondering
ijit looks a bit like this?' Discussion ensues about why they are doing this, how they
got there and what direction are they going in, and obstades that are making their
journey more difficult. In advocacy, IDT also promotes that the therapist draws a
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picture to describe something the dient is talking about, the therapist is working as
an advocate for the dient's process (Withers 2006). Capturing a dient's metaphor in
the moment of a counselling session is a strategic intervention. The therapist is not
imposing any agenda other than the content introduced by the dient; what they are
doing is managing the process by slowing things down and encouraging the family
to examine what they' re talking about, and so the finer details of a verbal discussion
are explored. The family can change and correct the image or the therapist can hand
the image to the dient to explain or draw how it might be different.

The merits of a cognitive approach

While long-term art psychotherapy is an effective and satisfying way to work, it is
reliant on a public health system that is robust enough to financially support this and
does not fit for most parts ofthe world. An art therapist who has a psychoanalytic
orientation needs to be flexible and be able to consider the integration of a more
cognitive approach. Without this flexibility, their dient numbers are reduced and
limited to only the wealthy who are not reliant on state-funded services.

Designing an art therapy intervention

The real art of art therapy is the ability to be able to design an art intervention that
is relevant to the moment and may be entirely unique to the dient's therapeutic
process and situation.
The simplest way to design an art intervention is to follow the dient's content.
For example, if a dient is talking about feeling depressed and unmotivated,
that their life is on hold and they're not enjoying things any more, a potential
intervention might be to 'draw a feeling that is opposite to what you are feeling
right now'. While this is interesting and has merit in some strengths-based
situations, it is motivated by the therapist's need to dictate content and their
agenda to 'cheer the dient up', so the dient leaves the session brighter and
happier. A different intervention would be more prescriptive in terms of what the
dient originally spoke ab out, such as 'draw what feeling depressed looks like' or
'draw someone or something unmotivated'. The next statement, 'I feellike my
life has been put on hold', is metaphoric and so has a visual ambiance. If a dient
is talking in metaphors, the therapist's intervention should be to concretise the
 156 Art therapy with couples and families

metaphor, possibly providing a context where this is appropriate: 'draw something

or someone being put on hold', for example, or 'what does being "on hold" look
like?' In art therapy it can always be assumed that whatever a dient draws in some
way relates to them, regardless of the metaphor, diagram or symbolic content.
By suggesting 'something' is on hold, a cushion or safety buffer is set up around
the task so that the image produced is not necessarily to do with the dient. Even
though what they execute does relate to them, creating an emotional distance in
the wording ofthe task assists the reluctant dient (IDT Foundation Course, 2010).
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Family art therapy training for allied health

professionals
A visual intervention can be helpful ifhealth professionals find themselves 'stuck'
when dealing with entrenched patterns and circular processes of causality. There
are two family art assessment interventions that can easily be integrated into a
repertoire of skiHs. These are adapted from the work of US art therapy pioneers
Hanna Kwiatkowska and Helen Landgarten (Kwiatkowska 1978; Landgarten
1993).

Art task procedure

There are always two therapists for a family art evaluation. Asking an allied
health professional to be a co-therapist is an effective way to educate through
experientiallearning plus gain support from other members of the treatment team.
The art therapist leads the art task sequence and the other therapist observes family
interactions and their responses to the tasks. The co-therapist's role is similar to
that ofthe co-facilitator for group work (see Chapter 14).
Each family member has their own set of pastels with a full colour range
that indudes black and white, plus six sheets of paper numbered 1 to 6. Each
family member works in the same room but out of view of other family members.
To achieve this, Kwiatkowska recommends working at easels, so that family
members' distraction from the art task is minimised and they are able to focus
more easily on their own work. Family members can talk to each other about the
procedures as they unfold.
These six art tasks gradually increase in complexity and can be used as standalone
tasks as weH as part of the evaluation procedure (see pp. 57-8).

1 A 'free' picture: 'Draw whatever comes to mind' (see p. 57). This task is
designed to be open-ended and to aHow the person to draw wherever they
are at the beginning of a family session.
2 A picture of your family, whatever is family for you. If the dient asks who
to indude, the response is to draw it in whatever way they choose, and
within one family this could produce quite different pictures (Landgarten
1987).
 Art therapy with couples and families 157

3 An abstract family portrait, the same as the above but symbolic (see
pp. 127-8). This can be time-consuming but can be interesting, bringing up
highly-charged feelings.
4 A picture started with the help of a scribble (see pp. 56 and 79). This begins
with a physical warm-up exercise, loosening up before drawing a scribble
with eyes fully or partially closed. Once an image is discerned, lines, colour
and shape can be added to enhance the image.
5 A joint farnily scribble, as a group decision-making process. This task is
a group decision-making process for the family to complete together. It
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begins with the same physical warm-up as above. Following the scribble-
making production, the family members look at each other's work together
and share what they see. They then choose one scribble and complete a
joint family scribble pieture. This is usually a successful family group task,
though depending on the family dynarnics, it can be a stumbling block for
some families
6 A 'free' picture: 'Draw whatever comes to mind'. It is interesting to compare
this last free picture to the first free picture. Titling art work is significant
because of relevance to rest of the work.

Family portraits
Procedure 2 might be realistic family self-portraits (though stick figures are fine)
where placement on the page, or a picture of family members doing something
together becomes significant (Kwiatkowska 1978; Bums and Kaufman 1972).
Abstract family portraits can be quite significant, if the child can be assisted with
the concept of abstraction (Coulter 2007; Kwiatkowska 1978). The two 'free'
pietures at the beginning and end of the procedure are compared. lf the procedure
has intensified family dynamies, it is likely to be indicated in how the second
free pieture compares with the first. For example, if the first free pieture is a calm
horizontal landscape and the last free picture an empting vertical volcano or a
dragon spitting fire, it is likely to conclude that feelings have been heightened for
that family member.

Collage family assessment technique

A non-threatening task developed by Landgarten is useful for the client, family
member or even allied health professional who is reluctant to draw (Landgarten
1993). Using found images alongside collage materials is an alternative, effective
technique. Landgarten recommends two boxes of pre-cut images, one of people
and one of miscellaneous objects, so that clients are not distracted to read magazine
articles as they search for images. F or the first box, Landgarten suggests pictures of
people from different cultures, the majority of whom pertain to the clientlfamily's
culture; reality-oriented (only some to be stereotyped, glamorous images); male
and female figures; people of all ages and different facial expressions, movement
 158 Art therapy with couples and families

and static body positions; people from different economic conditions and walks
of life, and in different environments, alone, in dyads, groups or family settings
(Landgarten 1993).
The list of miscellaneous objects is not unlike a list of sand play objects and
includes clocks, trucks, cars, clothes, computers, dishes, furniture, tools, medicines,
houses, animals, bottles of liquor, fires, plumbing, food, jewellery, scenes from
nature, rubbish, demolished hornes, broken glass, guns, pills, and destroyed, broken,
fragile items. Additional materials include newsprint, coloured paper, glitter and
fabric scraps.
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Landgarten alerts the family art therapist to consider: how are pictures handled?
Were they tom, cut away or trimmed before they were pasted down? How was the
glue handled - messily, neatly, obsessively? Was placement of the found images
careful, haphazard or reasonable? What was the pictorial content? Did specific
themes appear or get repeated?

Assessment procedure I
Invite each family member to look through the images and pick out ones that
catch their attention, paste them onto the paper, then either write directly onto the
paper or tell anything that comes to mind about each picture.
Rationale: this introduces the assessment procedure. Few instructions make the
task easy to master and there are no boundaries on the number of pictures and a lot
of freedom for the selection process.

Assessment procedure 2
Invite each family member to pick out four to six pictures of people and paste
them onto paper, then write or tell what they imagine each person is thinking and
what he/she is saying.
Rationale: this reveals trust regarding themselves, someone else orthe therapist.
There is a specific number - how does each family member deal with limits being
set or an authority figure? It relates to congmencies or disparities about what
people think and say. There is sometimes a resemblance between the picture and
someone they know.

Assessment procedure 3
Invite each family member to pick out four to six pictures of either people and/or
miscellaneous items that stand for something good and something bad, paste them
down and write or tell what the picture means.
Rationale: this is purposely ambiguous regarding something good and
something bad.
Leeway is given in the choice of image selection. There is a choice between
people (more emotional content) or objects (distancing). Humorous pictures may
 Art therapy with couples and families 159

be avoiding feelings or may be a testing of the therapist. If this is the case, it would
be addressed later in the treatment phase.

Assessment procedure 4
Invite each family member to pick out only one picture of a person, paste it down
and write or tell what is happening to that person. Then ask, 'do you think the
situation will change?' If so, find a picture illustrating the change or tell what will
make it change.
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Rationale: evaluates a negative/positive outlook and reveals attitudes, ability

to cope, whether problem-solving is part oftheir lifestyle.

Landgarten has devised all four tasks (above) for free association and personal
projection. There is flexibility within each task to reflect individual personality,
with minimum constraints imposed by the family art therapist. These procedures
may appear simplistic, too prescriptive and cause discomfort for some art
therapists to consider. However, they are useful for allied health professionals,
and the techniques are effective and safe for most therapists.

Couple art therapy training for allied health

professionals
Again, safe, clear tasks provide a positive experience for both the art therapist
and allied health professionals. The line conversation (Coulter 2007: 218) is now
used in the context of a couple conversation. In a training workshop, there are two
participants to one piece of paper, preferably representing a couple. They may
even have a particular client in mind to possibly role-play in the line conversation.
Make the second line conversation a conflictual one; again, possibly role-play a
particular client with whom you are working or someone you know.

Joint scribble picture

Participants pair up in role as a couple - they can discuss a scenario or they can
be themselves.
Each person makes a scribble on the page. Together, view each scribble and
choose one to make a joint scribble picture. Enhance this shared image with colour,
and add details such as eyes, texture and any additional features or qualities.

Abstract description of a relationship

Make an abstract sculpture using plasticine or clay to describe the relationship.
(This can be a personal relationship, or a difficult client relationship with which
the worker is familiar.)
The Expressive Therapies Continuum can also be discussed (see Chapter 6).
 160 Art therapy with couples and families

For the therapist

These points are designed to quickly impart basic best practice guidelines for
couple and family therapists.

Establish guidelines before sharing

Issues of confidentiality and ownership of the art work must always be addressed
before art work produced in a therapeutic context is discussed and shared with
other family members or partners in relationship counselling. Such guidelines
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help to provide psychological safety.

• Listen to the language used: dients' word symbols not the therapist's
The fact that dient art work needs to be respected is always an important
point. Emphasising the significance of language as word symbols will
resonate for other family therapists because use of dient language is a core
understanding to best family therapy practice. Where this point expands is
the notion of words as another symbolic system in relationship to the art
work that is produced in the family or couple therapy session. Interactive
Drawing Therapy (IDT) is a drawing tool that focuses on the interaction of
words-image-behaviour (Withers 2006). For therapists who do not wish
to complete an art therapy qualification, further training in IDT provides a
basic methodology for best practice.
• Avoid assumptions
This point is areminder about how easy it is for the therapist to impose
themself onto the dient's art work. The same applies for other family
members imposing their view on another member's drawing.
• Do not talk while art -making is in progress: allow internal dialogue
This is another re minder of a basic art therapy principle. When working
with families, it is not always relevant or possible to impose this guideline
because family members are so familiar with each other and the multi-
generational aspect means younger members will want to interact with
parents and older siblings spontaneously and in order to deal with their
anxiety ab out an art task. At the same time, it is possible for children to
understand a time for art-making and a time for talking (see Chapter 10). It
is up to the art therapist's discretion how relevant it is to try to enforce this
guideline in a family consultation.
• Do not impose a 'therapist's agenda'
This point re-emphasises the idea offollowingthe family 's agenda ratherthan
something imposed on the family by the therapist. Art therapists are trained
to understand their own psychopathology and to avoid countertransference
when viewing and facilitating exploration of dient imagery. However,
because allied health professionals are not so schooled, this point helps
them to consider what might be infiuencing their involvement in the family
 Art therapy with couples and families 161

systemic dynamic. It is easy to be drawn into a toxic family operating system

but it is also easy to have an unexpected reaction and response to dient art
work. This point reminds the therapist to stay with the family process and to
remember not to impose themselves in the family interactional patterns in
response to personal wants and needs.
• Do not be satisfied with obvious responses
This is areminder that when the dient responds in an expected way, the
therapist may be satisfied and moves on to another aspect of the image
too quickly. It is important to double check predicted responses to ensure
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there is not something being missed. By consciously managing to hold a

moment in the processing of a drawing, the allied health professional is
more likely to not miss something significant in the content ofthe art work.
• Seek permission when handling art work
Art work is regarded as a physical extension ofthe maker. When processing
in the context of the family there is expected personal intrusion between
family members, but the facilitating therapist models a respectful regard
of the art work by bearing in mind boundaries around touching and group
displaying of work in family processing.
• Provide adequate workspace
Some techniques such as the family art evaluation (Kwiatkowska 1978)
require that the collaborative art works are completed in private view,
away from other family members to avoid contamination of individual
engagement with the art materials or task. Easels can assist this but are not
always easily induded in a family therapy space. Family therapy usually
takes place in a small group room or a larger than usual consulting room;
however, there is often limited space for other equipment. Alerting the
allied health professional to consideration of space helps planning and
preparation with limited physical resources.
• Document and store art work
This point is another reminder of the therapist's responsibilities.
Documenting art work (with name, date and title on the reverse) is crucial
to best practice. The family is unlikely to remember all that was shared
pertaining to the art work, and the therapist's record of what was stated
assists families to recall difficult moments in the session. The titling of art
work is especially important as this can often generate family metaphors
and symbols to which all family members can respond. Without good
documentation, successful moments in the couple or family sessions can
be lost.
• Try out tasks beforehand
To understand how a task is to be received and responded to, and to gain
familiarity with the dient's process, the allied health professional needs to
test out the intervention, w he re possible, on themself first. This is not always
possible if the intervention is a spontaneous, in-the-moment response to
a family situation during an art therapy session. However, where an art
 162 Art therapy with couples and families

task or an array of tasks is being considered in preparation for a couple or

family session, trialling these tasks beforehand is highly recommended.
Going through some ideas personally is always possible, but better still,
asking other staff to trial an intervention and provide feedback is equally
useful.

Clinical supervision and ethical practice

When sharing art therapy skills with other health professionals, the art therapist is
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also available to offer clinical supervision for the family or couple art consultation.
Alternatively, supervision can be provided by a family or couples therapist clinical
supervisor. Supervision helps monitor transference and countertransference in
relation to the use of art therapy interventions as they are designed and trialled. It
is educational for allied health professionals to leam that clinical supervision is
required for art therapy and that this is not just the provision of playful diversion
for couples and families. As they use art more frequently in their work, therapists
realise that art therapy directives can be a treatment intervention in itself or can
be used as an adjunct to verbal family therapy to address specific clinical issues
and needs as they arise.
Art crosses generational and gender barriers, bridging family members to co-
constmct a new family story. A solution-focused approach provides opportunity
for brief goal-directed art interventions for resistant families who may not attend
therapy for many sessions. Their experience is positive and productive, allowing
opportunity and motivation to return to therapy in the future.

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Landgarten, H.B. 1993. Magazine Photo Collage: a Multicultural Assessment and
Treatment Too!. New York: Bnmner MazeI, Ine.
Ri1ey, S. 1993. Illustrating the Fami1y Story: Art Therapy, a Lens for Viewing the Fami1y's
Reality. The Arts in Psychotherapy 20,253-64.
Ri1ey, S. 1994. Integrative Approaches to Family Art Therapy. Springfie1d, IL: Magnolia
Street Publishers.
Ri1ey, S. 2003. Art Therapy with Coup1es, in CA Malchiodi (ed.) Handbook of Art
Therapy. New York: Guilford Press, pp. 387-98.
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Watz1awiek, P, Weakland, J. andFiseh, R. 1974. Change: Principles ofProblem Formation

and Problem Resolution. New York: Norton.
White, M. andEpston, D. 1990. Narrative Means to Therapeutic Ends. NewYork: Norton.
Withers, R. 2006. Interaetive Drawing Therapy: Working with Therapeutie Imagery. New
Zealand Journal ofCounselling 26(4), 1-14.
 Chapter 13

Group work with adults

and the group-interactive
art therapy model
Susan Hogan
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Group art therapy

In Chapters 8 and 9 an overview of this approach was given, which will now
be elaborated in further detail. Earlier chapters have highlighted the fact that
there can be different styles or emphases within this model. At one end of the
interactive spectrum (or continuum) can be located approaches that focus much
more on explorations of transference reactions, or analyses of group interactions,
with an emphasis on talking about these. At the other end of the spectmm are
approaches which are more focused on the person as an individual in the group,
and in facilitating their relationship to their own art work, with minimal attention
to group dynamics (bringing the style of working doser to that which I have
described above as art therapy support groups). Some art therapists attempt to
position themselves pretty much in the middle of the interactive model of working
and attempt to work with aH elements. However, as has already been noted, some
choice about what aspects to focus on is unavoidable, as 'there is a wealth of
material which can sometimes seem overwhelming and thus difficult for the
group to process and make use of' (Skaife 1990: 237).
Groups can vary immensely and develop different personalities. Some groups
can be particularly confiict-ridden; others nurturing and highly sensitive to an
almost stifling degree; other groups can be vastly reticent, depending on the
personality make-up of its participants. Groups develop unique identities, which
thenchange overthe course oftheir life. I have beenmnning art therapy experiential
groups since 1990 and get fond of my groups: they are like an intimate friend who
is often cranky and hard work, but often generous and immeasurably brave too.
The analogy works quite weH and individuals in the group can experience the
group as an entity too, and 'project' emotions onto it.

Group-interactive theory
The distinctive aspect of the group-interactive model of art therapy today is that,
as the name suggests, it is interested in looking at how people interact in the group
with a view towards interpersonallearning:
 Group work with adults 165

Group interactive psychotherapy [from which interactive art therapy has

derived] focuses on the actions, reactions and characteristic patterns of
interaction which constrain people in their everyday lives and for which help
in modifying is sought in the group ... A fundamental of this approach is that
each person constructs an individual inner world which is continuously being
reconstructed through interactions with others and which determines that
person's view of himself and others and affects the expectations of others.
(Waller 1993: 22)
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It is immediately obvious that this is a rather particular way of conceptualising

what people are and how they are constituted in comparison with a more
traditionally psychoanalytic view, which insists that our personality traits,
or neuro ses, are developed early in childhood. Rather, this model of thought
provides a sharp contrast, proposing instead that we are continuously shaped and
re-shaped, and that, to some extent, our identities are in astate of continual flux
and re-construction. Philosophically, this is potentially at odds with orthodox
psychoanalytic models, though some interactive art therapists (including Waller)
try to incorporate some analytic features into their work, notably work with
'transference' and processes of 'projective identification' (members' feelings
about another person, or the group as a whole, not generated by their here-and-
now experience, but triggered by habitual reactions which are then stimulated).
Therefore, childhood experiences are not overlooked, but are not the main focus
ofthe group's attention.
A more behavioural understanding is also possible as:

In group therapy, the individual gradually realises how inner assumptions

may determine the patterns of interaction that develop. Exploration of
these patterns and willingness to modify them in the safety of the group
enables the person to try out new ways of relating in the 'outside world'.
Clearly, then, the model places the main source ofchange in the interaction
between group members and depends upon the participants learning from
each other.
(Waller 1993: 23; myemphasis)

This model has an emphasis on the capacity for change, and an idea that human
actions are not predetermined and that we have both choice and responsibility. It
also assumes that existentially we are looking for meaning in our lives (Ratigan
and Aveline 1988: 45). However, our habitual ways of being may not be very
evident to uso The anthropologist Pierre Bourdieu has highlighted this tendency
and called it habitus. This is an 'embodied history, internalised as a second nature
and so forgotten as history - is the active presence of the whole part' (Bourdieu
1990: 56). An important aspect of the group work is to increase personal self-
awareness of this habitus; this is done through active participation in group
processes:
 166 Group work with adults

Members do not simply talk about their difficulties in the group but actually
reveal them through their here-and-now behaviour. In this model, the 'here-
and-now' is where the therapy takes place and 'reporting' on past experiences
is discouraged. Disclosure does, however, take place: that is, revelation of
'secrets' or significant events from the past and present outside the group and
this may be important in understanding the behaviour of that individual in
the group.
(Waller 1993: 23; myemphasis)
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I' m not sure I' d use the word 'discourage " as there may be an inner compulsion
to reveal past traumas, and I think that doing this and being accepted by the group
is potentially curative. Traumatised individuals often hold the irrational belief
that they will be rejected, or that people will be repelled by them if they tell ...
Exorcising deeply internalised feelings of guiIt and shame is helpful. However,
as Waller points out above, the focus is more on the here-and-now of the group
and how the past informs the present. Participants are encouraged to gain a sense
of their influence upon events in the group. The aim is that group members will
move from unproductive ways ofbeing and relating to being able to take on more
responsibility for their lives, including their symptoms and difficulties (Ratigan
and Aveline 1988: 45). This is achieved by giving participants constant feedback
(hence the group work is analytical).

In art therapy the individualleams how his or her assumptions (conscious and
unconscious) deterrnine patterns of interaction and may have led to problems
in relating .... Taking responsibility for one's participation in the learning
experience of the group, having asense of one's influence on events, and
learning to give feedback are prerequisites.
(Waller 2003: 314)

To give a simple, and simplified, example, Jonathan (a pseudonym) had been

abused as a boy, but he had leamed to be tough, to defend himself and he had
been involved in physical assaults and knife crime. Now quite a large man, he
was verbally aggressive to other members of the group, engendering antagonistic
responses and then accusing the group as a whole of rejection (what revealed
itself to be a pattern of behaviour). However, it was possible to point out aspects
of his threatening talk and demeanour whenever it occurred, to make him more
aware ofthe fact that his own aggressive communication style was keeping other
people at a distance and preventing him gaining the intimacy with other group
members which he strongly craved; the group, though tempted, was not perrnitted
collectively to reject ('scapegoat') him. His aggressive manner acted also as a
catalyst for other group members to explore how they feIt about being threatened
and how they feIt about male violence, so added usefully to the overall group
process. As Waller puts it:
 Group work with adults 167

If we accept that patterns of behaviour are leamed and that it is possible to

unleam or relearn more effective or rewarding ways of being, then there is
much to be leamed from interpersonal interaction within the boundaries of a
group.
(Waller 1993: 25)

Enacted patterns of being are scmtinised. This can also take place on a more
conscious and self-conscious level in the group. Waller advances the following as
anexample:
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Participants are encouraged to explore irrational belief systems (i.e., if I don't

get married, pass an exam, get promotion by 30, then lama complete failure.
(Waller 2003: 314)

The model also attempts to respond to 'social, political, and economic realities
including discrimination and racism and how internalisation of these realities can
lead to feelings of despair and powerlessness' (Waller 2003: 314).
Waller (1993) endorses Bloch and Crouch (1985), who suggest that there
is an important therapeutic factor created through interaction, which they call
'interpersonallearning' or 'learning from interpersonal action'. Interactive groups
offer two important aspects, according to Yalom (1985: 77), which are that the
group functions as a 'social microcosm' and second, that it offers the opportunity
for a 'corrective emotional experience' . Waller (1993: 26) expands on this concept:

'Social microcosm' refers to a group process which resembles customary

everyday functioning, in which patients tend to behave in their usual
maladaptive way. It is by observing and drawing attention to these behaviour
patterns in the group that the therapist and other group members can have a
'corrective emotional experience', thus helping each other to change.

So, in other words, the group becomes a place where participants can learn
about patterns ofbehaviour which are causing them distress and result in disturbed
inter-personal relations. Group members may see these for the first time in a
revelatory way or perhaps dimly perceived aspects will come into focus. Increased
awareness perrnits the possibility of change, and changed ways of relating can
be rehearsed or 'tried out' in the group; as Waller emphasises, feedback from
the therapist and other participants, in addition to self-observation, enables an
expansion of self-awareness:

Feedback from members of the group and the therapist, illuminating

aspects of the self which have become obvious to others, but which are not
recognised by oneself, is essential. To be effective it must be well timed and
delivered with sensitivity. In this respect the therapist is an important role
model, demonstrating a positive clinical approach as opposed to a negative
 168 Group work with adults

and judgemental one, observing and commenting on behaviour and images

and their effects on the process ofthe group.
(Waller 2003: 314-15)

New ways ofbeing are taken outside ofthe group process by participants, who
can then 'report back' to the group on how aspects of their lives are changing.
Bloch and Crouch (1985: 78) suggest that an 'adaptive spiral' is developed. Waller
(1993: 35-7) identifies a number of interrelated features of group work, which
she suggests are generally regarded as 'curative features'. These are in summary:
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1 the giving and sharing of information;

2 what she calls 'the installation of hope' regarding the process of participation;
3 mutual aid;
4 the discovery that other participants have the same kind of anxieties, problems
or fears, and that the individual is not alone in having this problem (or there
may be someone who has overcome this particular issue and who can provide
inspiration);
5 the group can work as a reconstruction of the family, allowing potential family
dynamics to be recognised and worked out;
6 catharsis is an important aspect whereby a person admits to feelings and
thoughts (often ofwhich he is deeply ashamed) or re-experiences a traumatic
experience with the group, and then usually experiences a strong sense of
relief or even release; such intimate disclosures often precipitate similar
'confessions' from other participants, which, in turn, allows the group to
become more intimate. The containment of these feelings also makes the
group feel safer;
7 participants leam more about how they interact with others and get feedback
in relation to which they can try out different ways ofbeing;
8 the safety of the group as a place where deep feelings can be shared without
fear of reprisal allows group cohesiveness to develop;
9 through interpersonal learning, old ways of relating can be examined and
changed.

There is both visual and verbal expression in interactive art therapy and, as I
have pointed out above, the focus can move from the art to an interaction, in a
back and forth manner. Maclagan has articulated that:

Art therapy represents a potentially dangerous encounter with the irrational

and the uncontainable. It also involves a shift of competence, from a verbal
domain that is to some extent an instrument of rationalisation and control,
to a non-verbal (or marginally verbal) area that is unfamiliar ... [addressing
itself] to those very areas of experience (dream, fantasy, imagination) that are
usually kept hidden behind veils of literal and anecdotal subject matter.
(1985: 7)
 Group work with adults 169

Whether or not we agree that art-making necessarily gives easier access to

'irrational' material, it is certainly non-verbal and non-linear and presents
a fundamentally different, but very rich, way of communicating to others and
with oneself. One aspect of art work which is importantly different from verbal
language, which was also highlighted earlier, is that art works can contain multiple
and confiicting discourses simultaneously, exemplifying irreconcilable ideas or
impulses. As Waller points out, image-making can be akin to 'free association' or
'dreaming into paper'. Skaife discusses what the art activity adds to the interactive
group work, allowing:
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. .. feelings to be expressed in an alternative way and metaphorical and

symbolic language to stay on in the group in a concrete form. As well as this,
feelings that are not easily expressed in words can be played with in their
symbolic form, for instance colour and shape, and thus worked on in a way
that can make them more accessible to language and thus to consciousness.
As in other art therapy settings group members are encouraged to use the art
materials to express themselves freely; this work is then looked at as both
belonging to the history of the individual and [potentially] as an expression
ofthe dynamic ofthe group.
(1990: 237)

The art work can become the focus of attention in group work, so that
conversations between participants may become indirect and via art works. Also,
the art work can become the focus for projected material and can be destroyed and
repaired. Members can show empathy towards each other by adopting a similar
pictorial style or particular symbols or motifs, and this has been called 'group
resonance' by Gerry McNeilly (1984); this is an idea (taken from physics and used
metaphorically) to describe the way images can seemingly infiuence each other
and 'resonate' or reverberate together. Certain themes can be held by the art and art
works can be brought out over and over again and reworked. This process could
take place over weeks or months. Making a picture can feelless threatening to some
people than having to talk in a group, and playful aspects of art making can come to
the fore. Many British people 'did art' at school, so there is sometimes a regressive
dimension to using art materials, especially in initial sessions. The actual physical
art object is in some sense arecord of what has taken place, but is also a future
stimulus for reflection and disclosure. Although the image is a disclosure in pictorial
form, the maker of the image may decide when to share content with the group,
so, depending on the nature of the image (which may be more or less pictorially
revealing), the pace of disclosure can be controlled by the participant; arguably,
this gives power to the art therapy participant in having control over when they
wish to make disclosures to the group. Group processes can be intensified through
the use of group painting, and group confiicts can be articulated and explored.
Finally, as noted in previous chapters, the pictorial stmggle itself (the mess made
or the effort in articulating a concept) can be tremendously revealing.
 170 Group work with adults

The shape of the group

Waller argues that some fundamental processes of an interactive group are
enhanced by the addition of art-making:

These include projection, mirroring, scapegoating, parataxie distortion, and

projective identification. Projection involves group members having feelings
and making assumptions about other members which are not based on their
here-and-now experience. For example, one member might experience
another as his critical mother and make assumptions about that person's
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feelings toward him. Mirroring entails a member having strong feelings

and emotions about another's behaviour, which is in fact an aspect of the
member's behaviour. Projection and mirroring are often accompanied by
splitting - by experiencing a group member, the facilitator, or the whole
group as all good or all bad. Scapegoating occurs when the group tries to
put all its difficulties onto one member and to get rid ofthem. The members'
tendency to distort their perceptions of others (parataxie distortions) provides
valuable material for the group to consider. An important and often disturbing
phenomenon is projective identification, which can result in one member
projecting his or her own (but actually disowned) attributes onto another
toward whom they may feel 'an uncanny attraction-repulsion' (Yalom 1985,
p.354). These attributes may be projected so strongly that the other person's
behaviour begins to change.
(Waller 2003: 315)

Regarding the latter, our emotional antenna may be finely tuned so that we
find ourselves reacting without being clear about why. Consequently, the long
experiential training group is an integral part of art therapy training. Arts therapists
work more or less with these elements, depending on their style.
Although Waller does not see the use of themes as in any way antithetical
to a group interactive approach (Waller 1993: 29), this chapter will concentrate
on non-directive approaches. It will identify two slightly different ways of
approaching a non-directive stance. As noted in Chapter 9, there are two main
models of working: one, which I will call 'regulatory' (or time-regulated) and
another, which is not regulated and is 'group-led' or 'open'. Both are non-
directive, insofar as the therapist is not offering themes or tasks. Both would be
scheduled at the same time each week. The length of the group would not alter.
In the 'time-regulated' model, the art therapist divides the time between talking
and art-making: a common stmcture would be a short period oftalking on arrival
in the group (generally how people fee 1 about being back in the group, a sharing
of any unresolved feelings about the previous session which fee 1 too pressing to
'keep' to the end, or clarification of something which the participant feels might
have been misunderstood), followed by between 20-60 minutes of art-making
(depending on the duration of the session, which is commonly two hours) and
 Group work with adults 171

the remainder of the session analysing the images made. There is often a minimal
break between the art -making and the final discussion part. With a group of two-
and-a-halfhours' duration, there is time for a short 'coffee' break. This is a secure
model (because participants have a definite time frame), but doesn't allow for
spontaneity of movement from talking to painting, and group members may have
to break off what they are doing in order to join the circle when it is time to talk
about the images, regardless ofwhether the majority fee 1 ready for this.
In contrast, working with the group-led ('open') non-directive interactive
model, the 'shape' of sessions can vary from the above model, though as Skaife
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and Huet (1998) observe:

... when we allow the group to develop their own culture for art-making
each session usually, though not always, follows a similar pattern. The group
usually starts with spontaneous verbal interaction, followed by art making,
followed by analysis and relating of the first two ... [a] pattern similar to that
discussed in groups where the therapist has set the stmcture.
(1998: 21)

And:

. .. our groups have tended to establish a culture for how long they spend
making art, which is usually something between twenty and forty minutes. At
times this is negotiated, but at other phases in the group's life there may be
a gradual stop, with one person beginning to clear up, thus giving a signal to
others who may or may not respond by also finishing.
(1998: 26-7)

We can see from the above quotation that groups tend to adopt a particular way of
working, though some groups may be more erratic than others.
Arguably, the group-led approach gives greater responsibility and power
to the group to direct itself; because I am involved in teaching advanced
group-work skills to art therapy trainees, this is the model I use as it is more
complex, challenging and potentially 'messy', with more intense and immediate
opportunities for learning. However, for therapeutic work with clients I favour
the more contained, and containing, time-regulated model. All of the issues I am
about to outline can arise in the time-regulated model too, but sometimes in a less
immediate way. They are more acutely feIt in the group-led or 'open' approach,
because these issues must be resolved; they are pressing and immediate.
In an earlier chapter, I suggested that there are productive therapeutic
opportunities generated by this group-led approach, in which tensions can arise
about how much time to spend talking and how much time to spend art-making,
and when that transition should occur. In negotiating this, group members illustrate
habitual ways ofbeing and behaving with regard to a variety of issues. Therapeutic
material can be generated from an exploration of conforrnity versus individuality
 172 Group work with adults

in the group process, including members' feelings about compromise; or, fears
of being alone and lonely can be explored. Desire for or fear of dependency,
including exploration and articulation of irrational fears about engulfment, or
rejection, are useful to consider.
Skaife (1990) elaborates the positive aspects which can emerge during this
process:

. .. the factors experienced in the process of making decisions as a group

become a means by which the group members can reflect on their own
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contribution to the decision-making process, thus developing a greater

understanding of their own particular means of negotiating social relations.
As well as this, issues particular to 'creative activity', such as the ability to
'let go', tolerate chaos, and so on, emerge frequently for discussion as the
responsibility for action is placed firrnly with group members.
(1990: 238)

Attitudes towards authority figures, and what should or should not be expected
of them, invariably arise. Feelings of disappointment (at not being 'told what
to do'), some of which may be transference and relate to significant others in
participants' lives, can be explored and expressed verbally and in art works.
Consequently, 'the group makes use of the tensions around the change in activity
to play out issues of power and authority' and this is something that can occur
throughout the life of the group (Skaife and Huet 1998: 25). Waller puts it thus
with reference to the opening of the group:

The first moments in a group when the members are trying to decide how to
proceed are often tense and the members want the therapist to tell them what
to do .... Individuals will quickly fall into habitual patterns: being the one to
suggest projects, withdrawing, moving away from the group into an isolated
corner, disagreeing with whatever is suggested, quietly or not so quietly
sabotaging the work, or being the peacemaker. All this is useful material for
the therapist to note for comment and to later reflect to the group.
(Waller 2003: 316)

Skaife and Huet (1998) note that it is the 'transition' from one activity to
another which is sometimes difficult:

We have observed that the 'push pull' dynamic between art therapy and group
interactive therapy is at its most intense at the times of transition between
phases. Breaking away from the group, the circle of chairs and from the
familiarity of words to the physicality of working with materials on one's
own is not easy. Finding the right time to stop making art may be artificial,
and finding a way to talk about art work can be difficult.. .. There may be a
long period of group time spent coming to some kind of consensus about
 Group work with adults 173

whether it is time to go and make art work. This can create an uncomfortable
tension for the art therapist, as during this time she has no clear role. Her
usual role as commentator on the group process would only serve to extend
the talking time, putting her vote, as it were, behind the verbal rather than the
change to art-making ...
(1998: 22--6)

Skaife and Huet also observe (1998: 27) what 1 have also observed myself, and
that is that there is a general desire on the part of participants to speak about what
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they are feeling. Participants often also want to receive acknowledgement from
others on their art work; occasionally this may simply be showing a work and saying,
'I don't feel able to talk about it yet', but much more frequently there is adesire
to explain the work and how it relates to their experience. Sensitive questioning or
comment making is also very much appreciated, and serves as a symbolic and real
acknowledgement of the work - it says, 'Yes, 1 really have understood this work,
and 1 can demonstrate this by my appropriate and valued remark'; it also says,
'Yes, 1 really have been attentive, and you really have been heard, and this remark
is evidence'. Not getting aresponse to a disclosure can feel very disconcerting.
We all respond slightly differently to anxiety caused by not knowing. Some of
our self-reflection in the group can be analysis of this discomfort. The group can
also explore moments of collective reticence. Sometimes silence is deemed as a
'respectful' response to a powerful disclosure, for example. However, the silence
may be misconstmed by the participant who has made the disclosure and is waiting
for aresponse as not caring, or as disengagement! (Here cultural differences can
come into play too and expectations and assumptions can be explored.)
Alternatively, empathy may be expressed more directly through another
participant offering a disclosure: 'Yes, that happened to me too' or 'I fee 1that too'
(though potentially that may move the group's focus away from the first speaker
and on to the next). On a different level, trainees must practise their facilitation
skills, so it is entirely appropriate that they practise responding to disclosures
made. Occasionally, participants will ostentatiously hide, or fold up, an art work,
which could draw attention to them because of adesire from group members to
make sure that person is okay, or out of curiosity, or even irritation at the lack of
exposure (the latter, especially if it's part of a pattern ofbehaviour of not showing).
All this exploration takes up time from the art-making process.
The facilitator's primary role in both modes of interactive group is to solicit
feedback from participants on group processes; to facilitate analysis of the
pictorial content of art work; to ensure safety, by maintaining and reinforcing the
group's boundaries; to intervene in extremis when the group gets 'stuck' (though
this is rarely necessary, as most groups can resolve their own issues); to ensure
participant safety by helping to facilitate acknowledgement of material which
might be overlooked or ignored to the detriment of a member or sub-group; and to
point out attempts at scapegoating, if not discerned and articulated during reflection
on group processes (ideally, the group, not the facilitator, can do this work). With
 174 Group work with adults

the more regulated of the two non-directive approaches, the facilitator also plays a
time-keeping role, rather than just flagging up the beginning and end of the group.
A mature group can ron itself with little intervention from the art therapist.
In this chapter I have outlined the basic theory underlying group-interactive art
therapy. I have examined the pros and cons of working with two slightly different,
fundamentally non-directive, group-work styles: 'time-regulated' and 'group-
led'. The chapter then moved on to look in more detail at how art work functions
in this model of working.
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Bibliography
Bloch, S. and Crouch, E. 1985. Therapeutic Factors in Group Psychotherapy. Oxford:
Oxford University Press.
Bourdieu, P. 1990. The Logic ofPractice. Cambridge: Polity Press.
Maclagan, D. 1985. Art Therapy in a Therapeutic Community. Inscape Journal of Art
Therapy 1, 7-8.
McNeilly, G. 1984. Directive and Non-directive Approaches in Art Therapy. Inscape:
Journal ofArt Therapy Winter, 7-12.
Ratigan, B. and Aveline, M. 1988. Interpersonal Group Therapy, in M. Averline and W.
Dryden (eds) Group Art Therapy in Britain. Milton Keynes: Open University Press,
pp. 43--64.
Skaife, S. 1990. SelfDeterrnination in Group Analytic Art Therapy. Group Analysis 23(3),
237--44.
Skaife, S. and Huet, V 1998. Art Psychotherapy Groups: Between Pictures and Words.
London: Routledge.
Waller, D. 1993. Group Interactive Art Therapy: its Use in Training and Treatment.
London: Routledge.
Waller, D. 2003. Group Art Therapy: an Interactive Approach, in CA Malchiodi (ed.)
Handbook ofArt Therapy. New York: Guilford Press, 313-24.
Yalom, I.D. 1995. The Theory and Practice ofGroup Psychotherapy. Fourth edition. New
York: Basic Books.
 Chapter 14

Art therapy and co-therapy

Annette M. Caufter
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An aspect of art therapy practice about which there is limited discussion is the
issue of co-facilitation of art therapy groups. Frequently constrained by limited
financial resources or the idea that the co-facilitator must be another art therapist,
art therapists may tend to mn groups on their own. However, in both ongoing
training groups and art therapy treatment groups, working in co-therapy is
advantageous to both the group and the art therapist, with an educative aspect
as weH as support for funding applications and in case-management discussions.
Furthermore, in most treatment situations, it is irresponsible to not work with a
co-therapist due to practical reasons, such as a group member needing to leave
the therapy space. Part of the co-therapist's role is also to be available to assist
with any extraordinary group situation. In such circumstances, the availability of
a co-therapist for best practice becomes imperative.

Contracting a co-therapist
In co-therapy situations, it is not only group members who have a group agreement.
Another group-related contract is that of the co-facilitator's commitment to the
group. Most responsible co-facilitators already understand that becoming the co-
therapist for an art therapy group is a commitment for a certain number of weeks,
but it is cmcial that the art therapist has a written contract of understanding with
their co-therapist that clearly states their agreement to participate, including the
commitment to a time frame.
Some groups have no set time frame because they function as part of an
ongoing treatment regime. In some residential treatment facilities, such as a
women's refuge or refugee detention centre, art therapy groups can be part ofthe
weekly programme to address ongoing trauma-related issues. To do this work
alone is irresponsible. Art therapy groups facilitate the expression of thoughts and
feelings where verbal or locallanguage may be limited. In these settings where
art therapy is part of the ongoing treatment regime, groups are open to whoever
is in residence at that time. Group membership varies as clients are admitted or
discharged from the facility, and the operation ofthe ongoing group becomes the
consistent factor, rather than the group membership. The two co-facilitators are
 176 Art therapy and co-therapy

part of this residential treatment consistency, and contracting the co-therapist's

involvement ensures that this is a clear understanding.
Contracting is better if it is in a written format. This does not have to be a
lengthy document but does outline the co-therapist's commitment. They must also
understand the likely impact oftheir absence from the group and the importance of
their role in 'holding' the group 'frame' (Schaverien 1989; BuH 1985; Vinogradov
and Yalom 1989).

Successful art co-therapy

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The most successful co-therapy situation is where the art co-therapists have a similar
training background or are grounded in a similar working model of art therapy
practice. Where co-therapists have an intuitive understanding of each other's art
psychotherapy interventions, the other's non-verbal communication is understood
and the co-therapists are able to complement each other's interventions. This is
supported by good supervision, preferably from a more experienced art therapist
or otherwise from an experienced group or family therapist, preferably someone
who has some psychodynamic training so that they can facilitate a productive
examination of any difficult dynamics that may arise between the two co-therapists.
In residential situations when a co-therapist has a greater knowledge of
the individuals and any interpersonal dynamics that are operating outside the
group, they are able to inform and complement the skiHs of the art therapist in
facilitating group work. FinaHy, mutual respect for each other's skills will also
assist successful co-therapy.

Co-therapy for treatment groups

Generally, one therapist is the primary group leader and the other is the co-facilitator.
U sually the more experienced therapist leads the group and in the case of an art
therapy group, it is the art therapist who is the primary group leader or facilitator.
It is advantageous for one therapist to focus on maintaining the stmcture and to
address inclusion issues as they arise. Inclusion issues include aspects that affect
the core structure and holding of group trust, such as group membership, group
contracting especially around such issues as confidentiality, time frames and group
boundary maintenance, as weH as violations. While one therapist works with what
is the conscious agenda of the group, the other therapist focuses on the group' s less
conscious processes. This is done by particularly attending to other group members
not in the line of focus of the group leader, w ho is dealing with a particular issue with
a particular group member or members. While the group are making art together or
individually, it is preferable that the co-therapists, as weH as the group members, do
not talk. Non-verbally and with discretion, they may draw the other's attention to
something of significance, but group participants' engagement with the art-making
processes should not be distracted or compromised - they are engaged in an internal
dialogue between themselves and the emerging art work.
 Art therapy and co-therapy 177

The presence of a co-therapist provides an opportunity to present an alternative

view in situations where group members are divided over an issue. Co-therapists
can work together to present different perspectives and model the resolution
of conflict, using phrases such as '1 can hear wh at you 're saying (the other
perspective can even be repeated back to demonstrate that it has been heard) but
my problem with this is ... ' and an alternate view can be presented. Co-therapists
can also role-play group members' thoughts (for example, 'I can understand why
Scott thinks Johnny should ... but he doesn't agree').
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Considering gender balance: male and female

co-therapists
Having a co-therapist who is the opposite gender to the art therapist provides
an opportunity to recreate the primary parental configuration. This allows group
members to project parental issues into the group situation, as well as observing
the role-modelling of a male and fe male working together collaboratively and
respectfully. There will be fantasies about the relationship between male and
female co-therapists, but this configuration can be highly effective and reassuring
for group members where parental issues are unresolved or difficult to access. For
example, in a male ward of a psychiatric hospital, two female art therapists worked
with two male charge nurses and so helped constellate a mother-and-father-
projected presence in the co-lead group facilitation. This continuity of gender
balance and co-facilitation provided a unique service, and might have been less
successful had there simply been two female art therapists, imposing something
onto the community from the outside. In addition, by involving co-therapists from
within the therapeutic community, group continuity was maintained.
Similarly, the impact of a fe male co-worker working with a well-established
men's group raised a variety of beneficial issues for everyone involved.
Observing this collaborative partners hip was significant for group members to
varying degrees, and the combination of male and female co-therapists working
in collaboration provided therapeutic gains, mobilising group material that might
otherwise not have been raised.

Agency collaboration in co-therapy

Another co-facilitation scenario is where two therapists decide to pool their
patients to form one larger group in their clients' best interest. The two agencies
involve two members of staff to work collaboratively to facilitate a group. This
can be a gender-balanced partnership or a same-sex partnership. For example, an
organisation that specialises in family dispute resolution forms a partners hip with
another organisation that provides mental health services to troubled adolescents.
A group for parents of those adolescents is then established to address behaviour
management issues and to provide support as members discover they are not the
only ones experiencing problems with their teenager.
 178 Art therapy and co-therapy

Another collaborative co-facilitated group is the example of a nurse therapist

working with new parents in a paediatric hospital, and collaborating with an art
therapist who specialises in couple work. The group examines issues that are
coming up as the couple prepare for the arrival of their firstborn child and for
their new role as co-parents. The use of art facilitates the expression of feelings,
particularly for young fathers within the group who may not have the same ability
as their partners to articulate the array of feelings coming up ab out their imminent
parenthood. The young mothers have had more contact with each other, meeting
throughout the pregnancy with various paediatric services, establishing supportive
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relationships, but the fathers-to-be are more isolated. Co-facilitating with a nurse
specialist provides the medical knowledge that is required to any questions group
members may have and the art becomes a way to express difficult emotions about
taking on fatherhood responsibilities and everything that this brings up. The
group becomes psycho-educational as affective and practical matters are aired
and addressed by the varying skills of the co-therapists.
In a youth refuge, an art therapy group is co-facilitated by one residential staff
member who better understands the dynamics of the group and the art therapist
who has the art specialist expertise. If one young person becomes emotionally
overwhelmed and leaves the room in a distressed state, the co-therapist can
accompany them to ensure their safety, calm any emotional turmoil and to
encourage their return to the group, which may require considerable internal
effort. Attending to them upon their immediate return is not recommended. In the
post-group peer debriefing session, the co-therapist can inform the art therapist
about issues that may have triggered the young person's inability to tolerate
remaining in the group room, and they can discuss the merit of follow-up in a
future group session.

The art therapist as a co-facilitator

If the art therapist is the co-facilitator of the group, their main role is to support
the group facilitator.
The group may not be an art therapy treatment group. The art therapist as co-
facilitator may be invited to provide adjunct therapeutic interventions on occasion
to facilitate the ongoing group process (Kerr 2008: 159). Such variables dictate
whether the art therapist is the co-facilitator or the group leader. Art therapy is a
usefultool as an intervention in its ownright at acertainpointwithin agroupprocess.
For example, in the ongoing men's group, co-facilitated by a psychotherapist and
an art therapist, the main modality is verbal psychotherapy. Art therapy is not used
every week, although the use of the visual diary at the beginning and sometimes
during or at the end of the group is increasingly encouraged. A visual diary entry
at the commencement of the group, for the first ten minutes, facilitates an inward
focus, a letting-go of outside world distraction and an entry into the therapy space.
Sometimes art is used to provide a creative intervention to clarify thinking during
the group where a particular issue is causing confused thoughts and feelings.
 Art therapy and co-therapy 179

Frequently, this is to address strong emotions whose source is unclear. The

group leader might initiate arequest to the art therapist, or the art therapist might
offer a suggested intervention or simply the space to do something reflective in
their diary about what just took place. For each group member the experience is
different, and engaging in an art task mobilises around a certain issue. At times
this helps dissipate verbal confrontation and facilitates constmctive use of volatile
emotions such as anger. For example, a guided interactive drawing therapy (IDT)
(Withers 2006) session ab out going on a journey facilitated powerful metaphors
on arecent men's retreat (Coulter 2012). Art therapy provides opportunity to
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express thoughts and feelings but is not the main modality of therapy - its use is
on occasion and as required by the group process.
Some art therapy groups may not have a 'group leader' as such, but simply
have two group facilitators of equal responsibility and involvement. In these
situations one facilitator may alert the group to a dynamic issue and the other
facilitator supports this observation and assists pursuing that particular issue,
theme or observation. An example might be that one group participant is cautious
to participate in a group discussion. There may be a number of reasons why their
participation is not forthcoming - the subject may have no relevance; the subject
may be very relevant and they do not want to expose their dilemma in relationship
to the discussion; or they may want to participate but simply have no idea how
to participate: the words just are not there. It is not the group facilitator's role to
do the hard work for this group participant, but it is their role to notice their non-
involvement and to consider what might be going on. One facilitator may notice
their non-participation and the other facilitator may link something they have said
previously to their current reticence. Working in co-therapy allows opportunity
for the therapists to interact within the group as they initiate and co-facilitate the
exploration of a group's themes, dynamic issues or observed group behaviours.

An allied health professional co-therapist

As mentioned in the various situations described above, the co-therapist for a
treatment group does not necessarily have to be a qualified art therapist to be
effective in an art therapy group. The co-therapist for an art therapy group can be a
nurse, a psychiatric registrar or psychologist intern, a social work or occupational
therapy student, psychotherapist or another allied health professional. Afamily art
therapy assessment procedure might also have a more senior clinician as the co-
facilitator, such as the child psychiatrist or family therapist team leader.
Having an allied health professional as the co-therapist is an opportunity to
educate staff about art therapy in clinical practice. Although this is experiential
art therapy education, the art therapist can provide preparatory reading material
for the co-therapist to read as apre-requisite before co-facilitating an art therapy
group. Allied health professionals usually have a commitment of interest and
enthusiasm to extend their skills repertoire. They are keen to gain knowledge
and do whatever is required for their co-therapy to be productive. For some co-
 180 Art therapy and co-therapy

therapists it is beneficial to know more about their role and potential expectations
from the art therapist group leader. The art therapist must decide whether or not
pre-group reading material advantages the allied health professional in their co-
therapy role. For some non-art therapist co-facilitators it is betterto first experience
an art therapy group, so that what they later read has an experiential context. In
the rare circumstance where more than one member of staff is interested to be the
co-therapist for an art therapy group, meeting with each allied health professional
individually and asking each the same set of questions to help make adecision
is advisable, although it is likely to be clear who is most suitable. Contracting a
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minimum limited number of group work sessions allows opportunity for other
staff to also participate later. Assistance to conduct ongoing group work facilitates
a better understanding about the effective benefit of art therapy, even as simply
'another approach', 'a tool' or 'a technique'.

The co-therapist's role in art therapy

treatment groups
One of the co-therapist's main tasks is to support the art therapist. Although
supporting the other therapist seems a simple role, this task is increasingly
complex as the co-therapists each become caught up in the group's dynamics. If
one therapist believes the other has not been supportive, this needs to be discussed
immediately after the group and if not resolved, taken to a joint supervision
session as soon as possible. It is important to address a perceived lack of support
immediately because if unchecked, this can damage the group potency. Group
participants unconsciously tune in to any cracks/chinks in the interpersonal
dynamics between the co-therapist group facilitators.
Being supportive means maintaining a number of responsibilities. Most
importantly, if one therapist is directing discussion and is focused in one direction,
the co-therapist is required to watch what is happening in another direction.
Seating positions of the co-therapists should never be side by side, but they should
be within easy range of the other's vision. Co-therapists develop non-verbal
communication skills as they get to know each other and this is most effective if
it is less obvious to the group participants. The co-facilitator may observe more
subtle interactions that take place in another part of the group, away from the
main focus of the group. It is not their role to highlight these observations but
they should note thell. It may be appropriate later during the group to mention an
observation but more importantly, it is to advise the other therapist of any subtle
dynamic that was observed in preparation for future group work. The co-therapist
can also assist with time-keeping issues. Part of the seating arrangement may
include discrete observation of a clock in the room, to which the co-therapist
attends. Frequently, something major will come up towards the end of the group
because this is a safer time to raise something complex, without having to deal
with it. If a contentious issue is raised, the co-therapist can remind the group of
the time constraints, intervening with a statement such as, 'I' d just like to remind
 Art therapy and co-therapy 181

the group that we have eight minutes left.' Going over time is counter-productive
to effective group time management, and the co-therapist helps keep such things
in check.
Another inclusion issue is group membership. The co-therapist assists with
pre-group interviewing to assess client suitability for art therapy group work. As
mentioned above, they might also be bringing a number of clients to the group
in circumstances such as a collaborative group work initiative of two services.
It is valuable to have both therapists present so that adecision, such as to not
accept a potential group member, is a joint decision made in consultation with
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the co-therapist. Pre-group interviews also provide an opportunity for group

members to meet both co-therapists prior to the commencement of the group.
This helps potential group members feel more at ease about joining the group.
This is not relevant if it is an ongoing open-ended group, for example in a
residential setting, but if the group is being conducted for a specific number of
sessions, it is useful to involve the co-therapist in preparatory logistics such as
pre-group interviewing.
Another role of the co-therapist is to assist with feedback to other staff
members. Depending on group circumstances, this is usually the role ofthe group
facilitator; however, in a residential setting, for example, feedback to the rest of
the team from the nurse co-therapist or the residential care worker contributes to
an understanding of a resident's post-group mood or behaviour. Joint feedback
can also occur if the co-therapists artend the same case management meetings
about clients. Where the co-therapists are presenting collaborative feedback to
other workers, they may be able to make the same point in different ways. One
approach might be slightly more acceptable than another. For example, ifthe co-
therapist is a psychiatric registrar, their opinion might gain more respect from
the medical members of the treatment team. It is sometimes more convincing
when two therapists share the same opinion. Back-up from the co-therapist when
explaining a client issue can assist a difficult treatment decision.
Co-therapists also assist where a client may need to leave the group therapy
space. Although the group guideline is always that participants try to remain in
the room for the duration of the group, there are exceptional circumstances where
this may not be possible. In the case of a young person, there is sometimes the
risk of an urge to self-harm or self-damage in light of a group interaction. Having
a co-therapist available to ensure no one is injured while absent from the group is
part ofthe group facilitator's duty of care. It is far better ifthe client can disclose
when self-destructive feelings arise without the need to leave the group therapy
space, but this is not always possible. Their abrupt walking out of the room, or
tearful fleeing is often provoked by astate of overwhelm that can be short-lived,
if they can have some quiet time - a few minutes away from the group. Where
a group is conducted with a high-risk group, the group dynamics can be quite
volatile particularly while group cohesiveness is being established. Leaving the
room might be part of a personal anger management protocol instigated by their
therapist, as part of a self-monitoring regime or it simply might be that something
 182 Art therapy and co-therapy

has been triggered and the person requires time out to compose themself.
Group members leaving the therapy session should be discouraged; however, in
exceptional circumstances the group co-therapist's presence can be of assistance.
If the dient is distressed, the co-therapist engages only minimally with the dient
outside the group. Their brief is to accompany the dient to ensure their safety
and to suggest their return to the group as soon as this is deemed appropriate or
possible.
The co-therapist also assists with setting up and deaning up of the group room
space. An art therapy group can be quite messy at times. Encouraging dients
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to assist with deaning up art materials is counter-productive where it distracts

from post-group self-reflection about personal issues that are the reason they
are attending the group in the first place. Clients often need time to stay with
group material and to not be distracted, so it is better that they leave the group
room to have time to self-reflect immediately after the group, unless the need
to tidy up is part of the treatment goal, such as the need to encourage a child to
be more responsible. Tidying up the therapy space post-group provides time for
the co-therapists to informally discuss their group work before formally making
notes together. The other option is to make notes first and tidy up art materials
afterwards.

Note keeping and documentation

Contributing to group work documentation is another role of the co-therapist.
Their input can be useful, particularly where they have been observing more
subtle group dynamics while the other therapist was focusing on and facilitating
a dominating group issue. The co-therapists can refer to their previous group
documentation and might jointly decide on a stmctured task or group directive
that might facilitate exploration of a particular group issue. Through joint note
making, co-facilitators offer each other opportunity to debrief from their group
facilitation. They can also take turns to lead the group. This might affect continuity
of a dosed group but works well for some open group situations because the co-
therapists learn about each other's way ofworking.

Use of art in group co-facilitation

A general principle of art therapy co-facilitation is that the co-therapists do
not produce art work. Their role is to observe the art-making processes and to
provide technical assistance ifrequired. However, there are exceptions to this. For
example, co-therapists making art can help settle children into a group. Working
with a co-therapist in a dassroom setting, Prokofiev would allow the teacher 'to
join in the art activity if she wished but. .. I would be an "engaged observer" with
responsibility for the professional mnning of the group' (Prokofiev 1998: 63).
Such decisions need to be carefully considered and always with the best interest
of the group participants in mind.
 Art therapy and co-therapy 183

Wbile co-therapists do not usually make art during the group, they can use art as
part of their post-group debriefing and joint reflecting. The use of images to recall
thoughts and feelings of the co-therapy experience assists note making of group work
- a form of visual documentation of the group process. Tbis might be diagranunatic
to record weekly seating variations, with arrows to indicate directions of conflict or
to represent focused scenarios or alliances within the group or geometric force-field
clusters operating as part of the group dynamics. Visual documentation might also
provide opportunity for co-therapists to express their impressions or experiences as
group facilitators - tbis could be by literal, symbolic or metaphoric representation. If
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the group is newly formed, or is a short training course, visual documentation might
include quick portraits or caricatures of group members to assist facilitator's visual
memory of participants. Co-therapists can include art making as a regular part of
their group work documentation to process their interpersonal relationsbip as co-
therapists in the context of conducting group work together. Such use of art therapy
processes can enhance co-therapists' understanding of each other and contribute
to self-Iearning and the therapists' personal growth in the context of experiential
clinical work. Peer debriefing through an art task also supports best co-therapy
practice. Co-therapist tasks might include:

1 Draw how we each fee I after today's group.

2 Draw a good moment and a not so good moment from today.
3 Regarding a particular group interaction that took place today - from your
impression draw how tbis affected the group.
4 Draw how tbis incident affected you or uso
5 Draw how we see our co-therapy relationsbip at the moment.
6 Draw how our relationsbip has changed.
7 How could our co-therapy relationsbip improve? Represent tbis in some
way.
8 How does your co-therapist impact on your ability to facilitate the group? Is
tbis positive or not so positive? Is there a way to represent tbis symbolically?

Any of these suggestions could be discussed in supervision or as part of co-

therapy peer supervision.

Art therapy students as co-therapists

In agencies that might be considering employing an art therapist, an art therapy
student might work there on a clinical placement or intemsbip. There are three
possible ways to expose other staff to the effectiveness of art therapy in situations
where an art therapist trainee is available for co-therapy:

1 The trainee art therapist runs a group with another member of the team
as their co-therapist. The student has support and help from the training
institution, and also the opportunity to develop group work skills wbile on
 184 Art therapy and co-therapy

clinical placement. The other staff member can use this as an opportunity to
observe the student's group work skills and provide written feedback to the
training programme.
2 The trainee art therapist is co-therapist for an ongoing group that is
conducted at an agency and provides spontaneous art task interventions as
required by the other co-therapist group leader. This other staff member
is likely to be part of the permanent team and provides feedback to others
about the benefits of recmiting an art therapist.
3 If the agency can provide digital media equipment and the group members
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sign consent forms agreeing to be recorded, the trainee art therapist can
document the art therapy group. This can be played back with their clinical
supervisor as a training resource.

Agencies are often keen to consider establishing an art therapy position but
do not know enough about this to go ahead with funding applications. A student
art therapist can help promote and educate allied health professionals about the
therapeutic benefits of incOlporating art therapy into their agency's treatment regime.

Interviewing for a co-facilitator

Art therapists are interviewed for both short- and long-term art therapy groups.
An advertisement indicates that a co-therapist is required and art therapists with
reasonable credentials are considered. The following questions are used to assist
the selection of an art therapy group co-facilitator.

What is your experience of art therapy groups?

It is preferable that co-facilitators have some group work experience and have
completed a group work component as part of their training programme, though
in some countries it is a compulsory component of regulated training.

Have you any previous experience working in co-therapy?

It is not necessary to have worked in co-therapy previously, although it is an
advantage if the two art therapists work in the same approach. However, if one co-
therapist is less experienced than the other, there is opportunity to develop group
work skills while working as a co-therapist.

What is your understanding of co-therapy for an art

therapy group?
Does the applicant place importance on supporting the other group facilitator or
do they see their role as one of co-Ieadership? It is often a misunderstanding that
co-facilitators co-lead. The best co-facilitation is where the two therapists can take
 Art therapy and co-therapy 185

on group leadership when required, can concede to another's leadership and can
back up a group work intervention, even if they disagree at the time. This basic
understanding of group co-facilitation is core to successful art therapy group work.

How do you feelabout working with another art therapist?

This question may not be relevant if the co-therapist being interviewed is not an
art therapist: it is to explore how one art therapist regards working with a peer
professional. There may be one art therapist who has more group work experience
but the other therapist may have an understanding of the client group or knows
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specific group members. This combination is usually successful because each

offers the group something unique - there is no competition or potential for group
ownership issues to emerge.

What would you do if you thought the co-therapist had

affected an unfortunate outcome in the group dynamic?
This is not an uncommon group dynamic event and it helps to know the potential
group facilitator's opinion on this point. The co-therapist hopefully knows to wait
until the group has ended and brings the matter up in the facilitator's debriefing
session. If they are unable to agree, the matter can be taken to supervision. When
working together over a long period of time, there are paralleis to being in a
relationship together, not dissimilar to being like a married couple. This is a good
concept to keep in mind and there may be paralleis to other relationships in the
life of the therapist.

What would you do if you became aware the group was

engaged in splitting the group facilitators?
It is better to have a co-therapist who expects this is part of the group process.
The mechanism of splitting co-facilitators is a drawback to co-therapy but if the
therapists understand this mechanism and can handle this dynamic when it occurs,
it is a learning situation for both group participants and facilitators.

Are you prepared to attend supervision with the co-therapist?

If the co-therapist does not appreciate supervision as part of best group work
practice then there is a problem, as supervision is important to sort out between
what is group material and what is the co-facilitators' personal business intmding
into their co-therapy relationship.

Can you commit to the term of the group life?

A responsible therapist understands the therapeutic contract is a commitment for
the life of the group or the term of the group members' contract to each other.
 186 Art therapy and co-therapy

Do you have personal support systems in place?

Although supervision is provided, when personal material comes up for therapists
it is helpful to be able to discuss material sometimes with partners, family or close
colleagues/friends. It is unlikely a co-therapist does not have personal support
systems in place, but it is still an important question to ask rather than to make an
assumption. A scenario could be that the therapist is socially isolated and might
want to co-facilitate a group because they are lonely.
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Do you have any questions?

It is important for potential co-therapists to ask their own questions. They need
to know ab out the stmcture of the course or therapy group and more about the
context of the co-facilitated group component of the training or the expectations
for therapy provision.
It is strongly recommended that art therapists consider working in co-therapy
where possible, as the advantages of co-therapy with either another art therapist or
a supportive allied health professional far outweigh any disadvantages.

Bibliography
BuH, AS. 1985. The Psychotherapeutic Frame. Australian and New Zealand Journal of
Psychiatry 19, 172-5.
Coulter, A 2012. The Use of IDT on a Men's Retreat. Unpublished presentation for
InSightIDT Conference, New Zealand.
Kerr, C. 2008. Experiential Family Therapy and Art Therapy, in C. Kerr (ed.) Family Art
Therapy: Foundations ofTheory and Practice. New York: Routledge, pp. 151-66.
Prokofiev, F. 1998. Adapting the Art Therapy Group for Children, in S. Skaife and V Huet
(eds) Art Psychotherapy Groups: Between Pictures and Words. London: Routledge, pp.
44--68.
Schaverien, J. 1989. The Pieture within the Frame, in A Gilroy and T. DaHey (eds)
Pictures at an Exhibition: Selected Essays on Art and Art Therapy. London: Tavistockl
Routedge, pp. 147-55.
Vinogradov, S. and Yalom, ID. 1989. A Concise Guide to Group Psychotherapy.
Washington, DC: American Psychiatrie Press.
Withers, R. 2006. Interactive Drawing Therapy: Working with Therapeutic Imagery. New
Zealand Journal ofCounselling 26(4), 1-14.
 Chapter 15

Starti ng su pervision
vulnerability in supervision
Aspects of hopelessness,
inadequacy and anxiety in the initial
stages of a supe rvi sory re I atio ns hip
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Susan Hogan

This chapter will focus on some important aspects of good and bad practice in
the very preliminary stages of supervision groups. It will draw on notes from
two psychodynamic student-led post-graduate art therapy supervision groups
conducted on-site in an art therapy training institution (not the one in which I
currently work, incidentaHy). The chapter will make reference to the chaHenges,
fears and doubts expressed by trainee art therapists in their initial weeks, as weH
as their successes. It documents their evolving understanding of art therapy
processes in this very first phase of supervisory work.
Art therapy training is complex. Students undergo experiential group-
interactive art therapy sessions in which they make art work and talk about it.
This group work can often become very intense. They receive supervision from
a placement supervisor where they are placed for their dinical work experience
component. They also attend a university-based supervision group with their
peers, in which their placement work is further scmtinised. Furthermore, they are
required to undergo personal therapy throughout their training. Generally, this
latter requirement is the responsibility of the student who enters into a private
arrangement with a registered practitioner. Where things 'fit' - whether best
into group work or personal therapy, or supervision - is not always immediately
obvious.

The role of supervision

In any kind of supervision arrangement, a dear contract is always advisable. In
training institutions this should already be in place, but for those supervising other
professionals, part of the first session can be used to darify the parameters of the
work.
The main focuses of university supervision is the supervisee's ongoing
presentation of their dient work, with a view to improving the service to the dient,
and a learning experience for the student, leading to enhanced dinical competence.
Their casework presentations comprise adescription of what they are doing, an
 188 Starting supervision

elaboration of the interventions made and a justification of these. There should be

an elucidation of the process undelWay. 1 don't mean a 'justification' in a defensive
way, but a reflection on their own emotional and intellectual responses, which led
them to make a particular intervention. There is a self-critical component here
- was the intervention too hasty? Was it too clumsy? Was it too dogmatic, not
leaving room for other forms of interpretation? Was my own emotional discomfort
at that moment having an impact on my decision-making? Necessarily, an analysis
of emotional responses to the content of art therapy sessions is an element of the
important process of critical self-reflection on the part ofthe supervisee.
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There are different models of working, but 1 favour a psychodynamic model

in which students feel increasingly able to share personal responses to their
therapeutic work. Like Edwards (1997), 1 don't fee I it is appropriate to bracket off
emotions and tell students to 'take them to personal therapy'.
At the outset, the group will help in alleviating anxiety about the placement
and prospective clients, and, as will be outlined, aspects of the supervisory
relationship can be scrutinised. Assumptions and fears can be aired, and students
leam to articulate potentially embarrassing or painful questions.
Clearly, the supervisee must feel very safe in the supervisory relationship in
order to be able to open out their professional practice for scrutiny in this manner,
so establishing a climate of trust and safety, with clearly defined boundaries in
terms of confidentiality, is essential.
As Malchiodi and Riley (1996: 60) point out, part ofthis process involves the
experienced professional (or trainee) looking at their attitudes and prejudices as
part of the process of analysing their clinical work. Again, being willing to be a
little vulnerable in the supervisee role is essential to get the most from supervision.
The therapist (or trainee) must be willing to reveal aspects of themselves which
they may worry another might find distasteful.
More straightfolWardly, supervision is the place where trainees (or indeed
professional art therapists) should be able to say, 'I think 1 made amistake', and
then to go on to analyse what was happening in the group or at that moment with
an individual which caused that error to occur. Not letting egotism get in the way
allows the useful exploration to take place. Clearly, the supervisor has a great
responsibility to respond to disclosures with the same level of sensitivity and tact
that they would with clients' disclosures in the therapy room.
With openness comes the realisation that there is an opportunity for reparation
too, and it is liberating for trainees to realise that they can return to something they
fee I they missed in a therapeutic session; in a literal way, Tve been reflecting on
what X said to Y ... ' and thus something important (or bungled) can be revisited.
Mollon (1989: 113) points out that:

Trainees inevitably suffer injuries to their self-esteem and self-image when

finding they are floundering; the capacity to withstand these narcissistic
blows, perhaps with the aid of supervision, is a crucial factor in whether or
not the trainee can leam to practice effective psychotherapy.
 Starting supervision 189

The supervisor can draw on their own emotions, as weH as inteHect and theory,
in order to make responses which will help the supervisee's reflective processes:
'that makes me feel. .. ' -type responses can often be helpful.
If a 'group interactive' approach is being used in the therapeutic work being
undertaken, the supervisee can elaborate on the group's dynamics and solicit their
supervisor's reactions. Getting a 'second opinion' in this way is useful, especially
when the group processes involved are very complex. Or, the supervisor, or
another group member, may simply 'read' the situation differently and notice
something the trainee or supervisee may have missed.
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There are advantages to supervision taking place in a group setting, because

participants can leam from each other. It is cost effective and as Case and DaHey
(2006: 208) point out, 'There is less likelihood of supervisor and supervisee sharing
blind spots or of an authoritarian/dependence relationship being established'.
Edwards (1993: 33) notes some common strategies employed by students
in supervision in order to help them contain anxiety. These include flattering
the supervisor (be nice to me because I am nice to you); attempting to redefine
the relationship as a social relationship in order to evade a potentially negative
evaluation; or indulging in extreme self-criticism aimed at eliciting sympathy and
minimising the opportunity for the supervisee 's work to be critically examined by
others, including the supervisor.
To feel a little fearful and vulnerable in supervision, especially as a trainee,
is entirely reasonable. I have argued that it is essential for supervisees to be
willing to be emotionally open with their supervisors in order to use supervision
effectively. Inviting supervisees to articulate their fears and fantasies may be part
of the process of supervision. This chapter will now elaborate further on this topic.
This account provides an exceHent resource for would-be art therapy
supervisors. It also gives the trainee art therapist a useful insight into what they
are likely to encounter in the outset of their clinical placement, which forms an
important part of their art therapy training. I hope that in seeing the struggle and
the anxiety inherent in the opening stages of the supervision groups, trainee art
therapists will gain confidence and prospective supervisors will have a better
idea of what to expect. Of course, the precise content of sessions will vary, and
this is a 'taster' rather than a definitive summary; furthermore, groups vary in
what they bring, but the anxiety and uncertainty will be a feature. For prospective
supervisors the account will give an insight into the issues that arose in the first
few weeks of supervision. Students' apprehensions were to the fore.
Some of what we are dealing with is imagined, as the supervision in art therapy
training commences before students are actuaHy in their work placements; various
'what if' scenarios can be articulated.

Supervision tools and structured note taking

There are various guides for helping students to reflect on their clinical work,
which range from very simple to very complex. Some supervisors may wish to
 190 Starting supervision

Describe
What happened?

Action Feelings
What would you do next time? What were you thinkingffeeling?
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Evaluation
Conclusion
What was good/bad
What else could you have done?
about the experience?

~al~;,
What sense can you make of it?
Figure /5./ The Reflective eyde (used by permission of Gibbs 1988)

nm through several of these at the outset of supervision to enable students to pick

a model they wish to work with. Other supervisors may provide a supervision
sheet with a standardised format which students are expected to use to help them
stmcture their thoughts ab out the dinical work. When the student starts dinical
work, these standardised supervision sheets are completed prior to supervision
by students and brought in with them as a reference. I increasingly fee 1 that such
stmctures are helpful for students, so long as it is made dear that students should
try to think beyond whatever format they have been given, rather than allowing it
to restrict their thinking.
Complex tools may not be introduced at the outset, but rather later on when
they will be more relevant, perhaps a few weeks into the supervision group's life.
The Reflective Cyde may be a good starting point (see Figure 15.1).

The role of the art work in supervision

Art can be used to help the analysis in supervision. For example, when using
plasticine or day, it might be useful to make representations of all the members
in an interactive group and to then place them in relation to one another to help
the analysis. How group members are represented can be illuminating and how
they are positioned in relation to each other can be explored very easily using a
 Starting supervision 191

medium such as plasticine. The figures made can be moved around, which can
also be helpful when exploring what has happened in a session. U sing a malleable
medium such as plasticine can even allow the figures to be modified as they
change their position, so for example, a rather brittle and spiky -looking 'creature'
might undergo a metamOlphosis when placed next to a representation of someone
whom they feel is particularly supportive. This is in addition to dients' art work
being brought in and analysed.
Students, in the initial sessions of a supervision group, may be asked to
complete brief art works to depict their mood, or to be used in dient-therapist
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role-play sessions. There are different ways of doing this, but dientltherapistl
observer can work very well as an educational technique. Students work together
in groups ofthree, taking turns in the different roles ofbeing the 'dient' (talking
about the brief art workjust made), being the 'therapist' (who practises facilitating
the 'dient') and the ob server (who will give feedback to the therapist apropos of
their demeanour, how they asked questions and what they missed in the image).
The ob server will be asked to comment at the end of the role-play session on
the demeanour of the therapists, which could indude the body language of the
protagonists: for example, 'you asked really sensitive questions, but you had your
arms crossed and you were leaning back in a rather defensive posture' , or, 'you
kept biting your lower lip and you looked rather stern'. A student concentrating
on what the dient is saying may not think about what their po sture may be
communicating.
The ob server can also comment on the types of interventions made by the
'therapist' : 'are you aware that you interrupted your "dient" twice?' The language
used may be scmtinised: 'you made a statement of fact about X rather than asking
an open question'. The tone of a question or the pace of questions may be of
relevance. Perhaps the 'therapist' rather over-interrogated the 'dient'. Whether
content was missed can be noted ('you didn't comment on the sea at all') and so
forth. This is extremely useful training to help build trainees' confidence prior to
them starting work with real dients.
Later on, students may also (with their dients' and on-site supervisors'
permission) bring in examples of their dients' work for discussion in the group.
The art works can help aid the student's memory, so they can point to a bit of the
picture and reiterate what had been said about it. However, having the art works
in the session is more than a mere aide-memoire as the group members and the
supervisor will ask apposite questions: 'did you ask the dient where that bird is
flying?' for example. Then the student can admit, 'no; actually, I didn't think of
that'. Consequently, their analytic skills can be strengthened in this process. Many
compositional elements can be considered, such as the relative scale of objects and
how they are juxtaposed. Metaphors and analogies may have been overlooked.
Missed opportunities for detailed scmtiny can be considered. Of course, this is
always done in relation to thinking about the dient's manner. It may be appropriate
not to ask too many potentially intrusive questions, depending on the dient's mood.
So this is a two-tier analysis of what might have been appropriate at the time, as
 192 Starting supervision

well as a process of learning to interrogate images in further depth. Just because

many art therapy trainees have an arts-based background (all present a portfolio at
application, regardless of the subject of their first degree, at least in the UK), this
sort of analysis of images is not something that all trainees can do without practice.
I want to distinguish between analysis and interpretation here, as we are honing
the student's analytic skills, not encouraging them to offer interpretations of the
art work to their clients (though it is reasonable, and inevitable, to formulate
ideas about the art which then help form open questions which do not foreclose
meanings); multiple meanings contained within one symbol and tantalising
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ambiguity is part ofwhat may be represented. As many art therapists have pointed
out, art works can contain multiple meanings that may be quite contradictory
(Malchiodi 2006: 12) and it is hard for trainees to understand that not knowing
may be the most appropriate response to a particular work.
As noted, the type of language used by the trainee can be thought about. 'You
might have asked a more open question at that point' might be possible feedback.
New art therapy trainees need to think ab out not foreclosing meanings by being
too unequivocal. Other things the trainee might have said can be envisaged.
Focusing techniques can be explored, such as, 'if you imagine yourself in this
purple space, what does it feellike?' or 'what does this animal fee I?'
The actual construction of the piece can be thought about. How was it made?
What has been covered up or obliterated? How was this acknowledged or explored
in the session?
The use of the therapeutic space as a whole can also be thought about. How did
the client or clients position themselves in relation to the trainee whilst making
their work? Did they sit in a corner with their back towards the trainee or were
they performative? (I had one client spend an entire session sculpting my face
in a portrait, before, when it was her 'turn' in the group to speak, pulverising
the sculpted head in front of the group, releasing angry feelings about someone
I reminded her of. This was a strong example of a 'transference reaction' to
the therapist.) How the image is modified, displayed or destroyed is always an
important element to be considered.

The on-site supervision and university-based

supervision interface
University supervision groups have the general purpose of assisting students
with their learning whilst they are out on placement. Some students start off their
clinical placements in an observation role prior to the allocation of clients, so they
will sit-in on sessions and watch without taking on the role of therapist; others
act as an 'assistant' to the practising art therapist from the outset, prior to being
allocated their own clients. This will depend on the nature of the client group,
the model of art therapy being used, as well as the preference of the supervisor.
If possible, aperiod of observation can be extremely helpful in building the
student's confidence.
 Starting supervision 193

During art therapy training, supervision is provided in the placement setting

by a registered art therapist or another professional who has an understanding of,
and an interest in, art therapy. As weH as this on-site supervision (or 'mentorship'
as it is sometimes called), students attend a weekly art therapy supervision group
in the university setting, usually facilitated by a registered art therapist. In the
latter group, students are encouraged to air their concerns about and reactions to
their placement setting and their elients. Sometimes the relationship between the
student and the on-site supervisor can become strained:
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Art therapists can experience problems if the supervisor is unfamiliar with

working with images. Either party in the relationship can feel mystified,
devalued or defensive about her own or the other' s approach. It is helpful if these
difficulties are resolved within the 'here and now' ofthe supervision relationship.
(Case and Dalley 2006: 208)

This may be easier said than done, depending on how defensive the relevant
parties are. Sometimes, there can be a personality elash or tensions about what
are appropriate 'boundaries' in terms of the confidentiality of the group work.
Sometimes, an on-site supervisor will agree one thing and do another. OccasionaHy,
a placement supervisor will sabotage their student's work. Problems ab out the on-
site supervisory relationship can be brought to the university supervision group
and discussed. The university supervisor may give the student opportunities to
resolve matters before intervening. A strategy may be formulated within the group
and the student would then 'report back' on the ongoing situation.
It can be useful for the university supervisor (or placement visitor if this is not
the same person) to hold separate meetings with the student and the supervisor
on placement visits and to hear the different (and possibly confiicting) 'stories'
of each and to look for areas of disparity, which can indicate where there are
confiicting expectations or misunderstandings. Then a joint meeting can be
convened where these confiicts are highlighted to the parties by the university
supervisor. These problems tend not to surface immediately and are unlikely to
arise in the opening weeks of a new supervision group.
The placements available to trainee art therapists in this setting are wide ranging
and inelude working in established art therapy departments. A wide spread of
community-based placements are available with a variety of elient groups. Some
very interesting work is also being carried out in pre-operative and post-operative
care using art therapy, in hospital settings and by voluntary organisations.

Contracts and formal assessment

The practical task of negotiating placement contracts with on-site supervisors may
or may not be conducted by the same member of staff facilitating the university-
based supervision group, but in either case the contacts established for student
placement work can be brought in to the supervision sessions in the initial stages
 194 Starting supervision

and scmtinised, so that all aspects ofthe contact are understood. Students must be
confident that they understand the paperwork. Doing this practical work can also
help to allay students' fears about the unknown; on the other hand, the assessments
do look daunting at first sight. Standards of practice for UK-based art therapists
are available from the Health Professions Council (HPC), and all courses tailor
their assessments to meet these standards of proficiency. These may be subject
to change in the future, so rather than reproduce them here I refer readers to
the Health and Care Professions Council website which has the 'Standards of
Proficiency' for art therapists listed.
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Many institutions divide the assessment up into various chunks. To give an

example from my own institution, one might be entitled 'personal skills' which
could look at the student's ability to respond to feedback, their capacity for
critical self reflection and whether they are dependable or not. Their professional
demeanour is assessed also, along with their capacity to work under pressure.
Because assessment is quite difficult, the criteria for assessment have been
carefully described to try to make the process easier for supelVisors and students.
So to take the example of the student's ability to think about their work and respond
to constmctive criticism, there are various columns in the placement assessment
document which try to describe what is meant: 'the student is unable to self-reflect in
an open and honest way and respond to constmctive criticism appropriately without
significant guidance' in the far left-hand column, which would be a very poor 'score'
(and a fail), moving to, 'the student can sometimes self-reflect in an open and honest
way, and can respond to constmctive criticism appropriately with guidance' (which
we also have as unsatisfactory - fail, because only being able to do this 'sometimes'
would not render them fit to practise), followed by, 'the student can self-reflect in
an open and honest way; and respond to constmctive criticism appropriately with
guidance' (a pass), and so forth, through to 'the student is excellent in his or her
ability to self-reflect in an open and honest way; and can respond to constmctive
criticism appropriately' (which is anA). All ofthe HPC Standards ofProficiency are
'benchmarked' in this way to assist in the assessment of clinical work.
A discussion about all aspects of the assessment is important as students need to
be aware precisely how they will be assessed, and to be as clear as possible about
what will be expected of them. Obviously, thinking about the assessment can
raise the students' anxiety levels, so it may be worth starting with some other less
daunting tasks before scmtinising the assessments. Looking at ethical regulation
documents and discussing them, undertaking some simple role-play exercises, as
previously mentioned, and discussing the role of supelVision itself can be better
things to do at the outset ofthe supelVision group (though the timing ofthis must
be determined by when students are timetabled to do clinical work, as clearly it
would be inappropriate to allow clinical work to commence before the assessment
procedures had been properly scmtinised).
Another important aspect of early supelVision is in discussing different models
of analysis and tools for note taking. However, in the initial weeks of a supelVision
group it can be helpful to allow time for some open discussion.
 Starting supervision 195

Issues which arose in initial student-Ied sessions

Drawing on transcripts, I shall now highlight some of the issues and concerns that
arose at the outset of the supervision groups. As the sessions were student led,
issues were discussed as they emerged in a fairly ad hoc manner.

Anxiety
Anxiety about the prospect of starting a clinical placement was at the forefront
of students' minds at the beginning of the supervision group. Issues around their
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capacity to explain themselves arose along with anxiety about how they would
cope starting an art therapy session.
Giving oneself time to settle into the placement and discover its ethos,
philosophy and working practices were considered to be important. Students
expressed their sense of pressure in having to get started. It was thought they
would be better able to do this having first got a grasp of how the organisation
functioned.
In some placement settings students would not have a specified group to work
with but would have to recruit clients by advertising their services within the
organisation, by word of mouth, or by other means, including the production of
posters and brochures. We agreed that advertisements could be brought into the
group for comment and discussion. Using language in the advertisement which
we ourselves would not find alienating was thought to be a good strategy, rather
than phrasing ads along the lines of: 'Have you got a problem?' or 'Depressed?
Try Art Therapy! '
Supervision can respond to concerns directly as they arise. For example, in
this situation a ten-minute role-play on 'introducing yourself and the concept of
art therapy' to each member of the group in turn could help turn anxiety into self-
confidence.

Moral issues and <therapeutic boundaries'

A considerable amount of discussion focused on the importance of explaining
what art therapy is to clients before engaging in any work with them and not
foisting art therapy onto clients under the guise of an art class or other creative
activity. The British Association of Art Therapists' guidelines on ethics and
professional conduct were read by the group and discussed. The code of ethics
is clear that at the start of treatment a clear contact between the client, or the
client's representative, and the art therapist will be agreed with respect to the
boundaries of the therapeutic relationship, and different types of contract were
discussed.
What constituted 'therapeutic boundaries' came under scmtiny as some
students were placed within a therapeutic community and other settings where
clients and staff engage in a range of activities together, such as socialising and
 196 Starting supervision

eating together. I suggested that in such a setting one would not discuss the
content of art therapy sessions in any other context than the art therapy session.
One anxiety that was expressed was what would happen if a dient raised an issue
from the art therapy session outside of the session? The supelVision group feIt
that it might be possible to gently suggest that the issue raised be taken up in the
next art therapy group. The idea that one could be straightforward was advised.
A response such as, 'Well, that's an art therapy issue so we can follow up on it in
the next session' was promoted. The importance of containment in group work
was discussed. The added complexity of working in a therapeutic community
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setting was acknowledged. The relationship between trainee art therapist and
dient is obviously much more straightforward if they only meet in the context of
the ongoing art therapy group work.
Bumping into dients on the street was also discussed. In a large city, this was
relatively unlikely to happen, but it was feIt that a polite 'hello' without further
conversation would be the best response. It could be counter-productive to 'blank'
a dient. A colleague of mine, who works in a very small community where she is
known as the local therapist and where she frequently bumps into her dients all
over the place, asks them in the first session ifthey would like her to acknowledge
them or not outside of sessions.

Photographing the work

Whether or not to ask to photo graph work at the outset of therapy was discussed
in the group. Since art therapy students have to produce an illustrated case study
on one of their dients during both years of the two-year training, this was thought
to be an important issue. I feIt that it was reasonable for them to explain their
trainee status and the requirements of the course at the outset though this might
fee I quite awkward. Offering a simple permission slip for the dient to sign was
recommended (ethical protocols suggest that this should contain a paragraph
about the dient's right to withdraw the permission and that the dient should retain
a copy). Asking to photograph work after sessions had started could resuIt in a
refusal from the dient and disappointment for the trainee art therapist. However,
asking fairly early on in sessions to photograph work rather then at the outset was
thought a viable alternative, as it should be possible to keep very detailed notes
on several dients for the first few weeks before selecting whom to write the case
study on. This has the advantage that it gives students time to select a case they
find particularly interesting to write ab out.

Writing up case notes

It was suggested that an hour between sessions should be set aside for the task.
As trainees, it is useful for students to record as much detail as possible about the
sessions so that they are forced to reflect on the work, and it can then be analysed
in depth in the supelVision group.
 Starting supervision 197

Other paperwork
Therapeutic work with clients should not commence until institutional permissions
are in place. Most training institutions have now developed a set of protocols
(standardised forms and procedures) to enable students and on-site supervisors to
expedite permissions, and these are all completed and signed off before students
start any clinical work. Obviously, if not scmtinised elsewhere, initial supervision
sessions for student trainees can involve looking at such paperwork.
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Location
The location of art therapy sessions is always a recurring issue as not all art
therapists work from adesignated art therapy studio space. One student was due
to see clients in a playroom and feIt this was potentially confusing for the children
who associated the room with a certain type of activity.

Do not disturb
Staff members intermpt sessions for various reasons. These include practical
reasons, because the room is where certain things are stored, or in a well-meaning
but dismptive way, because they want to know how the art therapist is getting on.
Establishing confidential boundaries in some institutions, in terms of ensuring
sessions are not intermpted, can fee I quite difficult. Other dismptions to art therapy
sessions can be from other clients. Some students resolved to work with staff
teams to emphasise the importance of confidentiality and creating a 'safe space' in
which strong emotions could be expressed within theirplacement settings. Giving
a talk or mnning a workshop for staff was discussed. Others decided to put up 'do
not disturb' notices while they were working!

Has the client got 0 problem?

A number of issues were raised in this session around a student's ambivalent
feelings about seeing clients as 'other'. One group member expressed her desire
to work with clients as though they were entirely 'normal' human beings, this
prompted by a positive desire to treat clients with respect, to engender and
promote their sense of self-respect in the process. However, she worried that her
stance might lead her to overlooking genuine difficulties. This led to an interesting
philosophical discussion ab out the nature of normaley. I then asked the group to
reflect about how they might feel if they were to work with someone who was
very identified with their psychiatric diagnosis, or to imagine they were working
with a prisoner whom they feIt was genuinely evil!
The group then focused on one student's experience of being told that her
prospective client was considered to be a 'problem client' before she had even met
her. This raised expectations and anxieties before art therapy had even begun as
 198 Starting supervision

weH as fear of failure since the student was being given a 'difficult' case. Whether
students working with prisoners should know what crimes they had committed
was raised. Art therapy students said that initially, at least, they would rather not
know since this could colour their perceptions of and subsequent relationship with
the client.

What can art therapy offer and does it work?

One student attended a case conference in a psychiatric institution at which a
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number of different professionals were gathered. The client in question seemed to

have intractable problems and was seemingly unable to be cured. This made the
student wonder what good he could do and trepidation was feIt at the prospect of
starting art therapy sessions.
How to explain art therapy in a non-condescending manner was raised as part
of this question. What kind of language should be used to explain w hat art therapy
can offer to self-referring clients? Will certain kinds of language alienate certain
people? We discussed using language that was natural for us to use, since if the
client didn't like the way we expressed ourselves, they might not like working with
uso On the topic ofprofessional demeanour, we talked about being 'ourselves' in
the art therapy session, and the importance of not putting on a pretence or using
language that we wouldn't normally use.

Confidentiality
Problems of confidentiality were again raised. For example, working as an
art therapist in a prison setting, would there be other people in the art therapy
room? What would happen to the art work? Would it end up on the govemor's
desk? Would a prison psychiatrist get to see it? Institutional norms vary. On-site
supervisors need to make students aware of the code of ethics in place in each
institution prior to them starting work with clients.
Sometimes confidentiality was problematic. Not wanting to disclose certain
information to a supervisor was an issue for one student. The student said, 'He
knows the men so weH that I might as weH name the person under discussion, as
he knows who I'm referring to'. The student was able to explore his fears that if
the supervisor knew who he was referring to, then the supervisor might make a
remark about a disclosure made in art therapy in another setting; it was suggested
that the trainee explore these fears with the supervisor directly and that the limits
of confidentiality of the supervision agreement be re-stated. Clearly, being able
to talk about individuals openly with the supervisor in the on-site supervision
sessions would be advantageous to the student's learning as the supervisor had a
lot of insight about the individuals concemed. The issue here was one of a lack
oftrust.
Another student was uncertain about the ethical problem of getting agreement
from a woman with senile dementia who forgot who her art therapist was in-
 Starting supervision 199

between sessions. Extra confusion was caused by the location of the sessions,
which were in a kitchen area. Again, the institutional supervisor should be able
to advise the student what permissions are required prior to therapy conuuencing
(which may be from the next ofkin). There mayaiso be larger questions about the
appropriateness of the referral.
The importance of setting out a clear contract at the outset was emphasised
as important in terms of making it apparent to clients who will have access to
their art work and how art therapy will be conducted. Obtaining clarity about
supervision, and other arrangements, which might involve the student disclosing
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information about therapeutic work, needs to be negotiated and agreed and then
articulated to potential art therapy clients.
Clients should be aware of whom information disclosed in a session will
be shared with. The limits of confidentiality should be clear to both therapist
and client at the outset of therapy. Setting the boundaries might require some
research or negotiation on the part of students who may need to find out from
their placement supervisor what norms apply within the institution. For example,
some institutions have inter-disciplinary case meetings at which they would want
to view art therapy work and discuss the therapy in progress. The university's
supervisor can always be brought in to negotiate on their behalf, if necessary, if
institutional norms are such that art therapy would be untenable.

Setting the pace

Anxiety about how to set the pace of an art therapy group was expressed. How
does the art therapist infiuence the pace ofthe group? What about the 'chemistry'
of different people in a group? How much should be exposed by clients and, if
exposed, acknowledged and dealt with? How does the art therapist deal with the
client's resistance to the idea of the art therapy? Students fantasised sentiments
such as a client saying, 'she is trying to get into my head' or, 'art therapy is
for nutters, isn't it?' These are quite difficult questions to answer, since groups
vary tremendously. Certainly, acknowledging disclosures made was considered
important, though clients themselves need to become aware of the meaning of
what they have made. Sensitivity is required on the part of the therapist to give
clients time to assimilate what they have done and this might mean holding back
for some time until an invitation is extended to them directly from the client, or
the client somehow indicates that she or he is ready to speak. These subtleties of
practice are daunting for the new trainee and can be explored in supervision in a
succession of 'what if' -type scenarios.
Settings vary tremendously. Some students were based in therapeutic
community-style settings in which a lot of trust had already been established
and clients already knew each other. In such settings the art therapy had 'taken
off' very fast with disclosures of a very personal nature being made from the
outset. This raised anxiety for some students about whether they would be able to
'handle' the pace ofthe work, and cope with the strong emotions being expressed.
 200 Starting supervision

Almost the opposite occurred for some students with very different elient
groups such as people with physical illnesses or prisoners, as it was possible,
or had already occurred, that elients from an art therapy group had left or been
removed. In the prison settings, in particular, it was possible that a prisoner would
be moved or given an appointment with another person or placed on a work duty,
which would prevent him or her attending the art therapy session. These problems
were not confined to prison settings though.
Students expressed a concern about a prisoner 'opening up' and then not being
supported in an ongoing marmer because they had been scheduled elsewhere.
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These experiences also provoked frustration in students when their elients simply
failed to turn up, no one in the institution having bothered to inform the trainee.
It was feIt important to note the missing person's absence in group work. In one
institution a elient had been withdrawn from the art therapy group (which he
loved) as a punishment for disruptive behaviour.

Trust
Are you believed in or are you working with a elient group who has been promised
much and delivered little? Clients' expectations are elearly relevant in terms of
how art therapy has been 'sold' to them.
The usefulness of communicating ab out the art therapy sessions with other
members of staff was noted. For example, one student said that her conversations
with a head teacher about a child's background had given her vital information
necessary for understanding the content of the child's pictures. Again, good and
open working relations with the on-site placement supervisor cannot be overstated
in their usefulness.
Establishing trust is pivotal to the success of therapy work.

Us and them
A elash of cultures was evident in some placement settings with an 'us and
them' attitude firmly entrenched in one particular prison setting. Professional
territorialism was noted in several settings, with one art therapy trainee getting a
very cool reception from the on-site elinical psychologist. Whilst promoting good
relationships with other professionals, giving presentations to raise awareness of
art therapy practice and attending multi-disciplinary case-assessment meetings
are part of the grist of an art therapy placement, it is often very daunting for the
new trainee, especially if some of their reception is frosty.

Boundaries and having others in the room

The benefits of being placed with an experienced art therapist were noted. One
student who feIt great anxiety found he gained a lot of reassurance from working
alongside a therapist.
 Starting supervision 20 I

The presence of a clinical nurse, in a room of particularly challenging

psychiatric patients, was described by another student as a help in allaying her
anxiety. We discussed the pros and cons of inviting the nurse or support worker
to paint andjoin in the group discussion. It had been decided that in this case she
would simply sit as unobtrusively as possible in the corner.
We discussed how a silent ob server could have an impact on group dynamics.
On one occasion, I had worked with a deaf women who had a sign-Ianguage
translator and I recounted how his behaviour had begun to have an impact on
group dynamics - how he sat, his gestures, whether or not he glanced at his watch
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(clearly waiting for the break or the end). Secondly, fantasies began to develop
around what he might be thinking about in the group.
Another reaction to fear of failure or a sense of personal danger was a sense of
relief expressed that an art therapist or other professional was to sit-in on sessions.
In prisons, a prison warder was often on call outside of the room. All art therapy
students were advised that they should not work in an isolated situation, though
sometimes this would occur by chance. One student who had formally worked
as a care worker recounted how in the psychiatric hospital she had worked there
were many locations on the wards that had panic buttons, but that when they
were pressed by staff, help had not always been forthcoming. Safety precautions
should be articulated in placement contacts and signed by both on-site supervisors
and their trainees, but they are not always honoured and unfortunately sometimes
placements have to be withdrawn.

Being put at risk by 0 lax on-site supervisor

A number of factors can potentially have an impact on the ability of students to
fulfil their contracts with clients. In one prison session a 'lock-in' was used to
enable prison officers to get together for a meeting. The art therapy student on
placement at the prison elected to be locked in with her art therapy group and then
experienced anxiety when one of the prisoners left the art room and wandered
off in the department. This left the trainee feeling very 'responsible', yet she feIt
unwilling to 'interfere'. Clearly, without her placement supervisor on-hand, the
student had been put in an untenable position.

What do art therapists do?

Some students faced overt or subtle misunderstanding ab out their role from
staff at their placement institutions. For example, some students were extended
invitations to give lessons in art techniques. Others sensed an expectation that
beautiful objects were to be produced. Another student was handed a book about
model building (a strong hint that this is what was considered to be appropriate
with her male client). Rehearsing how to describe art therapy can be part of the
preparation for trainees.
 202 Starting supervision

The absent supervisor

One student noted that though she had established a regular appointment time with
her supervisor that he was often absent, busy on the wards, leaving her feeling
very unsafe, very unsupported and alone. (Supervisors sign a contract offering a
certain amount of supervision time to their trainees, so this would be a matter the
university would pursue on a formal level; however, it is also useful for the trainees
to be able to share their feelings about unsatisfactory supervisory relationships.)
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Contracts and <ground ru/es'

Students working with dismptive children feIt that a clear contract with them was
imperative to determine what behaviour was not acceptable in the art therapy
room. Drafts of contracts were brought into the supervision session for discussion
and included items such as, 'the client and the therapist agree not to be mde to one
another' or 'the client and the therapist agree not to hurt one another'.

The ug/y client

Students can find it useful to fantasise about what kind ofpeople they may or may
not be able to work with. Feeling unsafe is a recurring theme of early supervision
work. The physical appearance of a client could make a trainee fee I unsafe. It was
also feIt that knowing a client's background could set up anxiety. This ranged
from working with a small child renowned for biting, to working with a formerly
violent prisoner. The advantages and disadvantages ofknowing the client's history
was debated, with a number of students deciding that they would rather not know
about their client's past at the outset of therapy; rather that they would rather
commence the relationship in the 'here and now'.

Storage
The disposal and storage of art work is an important issue that needs to be resolved
at the outset of therapy. For example, if a group of clients makes a large group
work, what will happen to it? Ifthere simply is no storage available and the work
needs to be dismantled at the end of the session, clients will have feelings about
this. This is more than merely a practical question. Some outpatient departments
give clients a choice to store work or take it horne at the end of sessions. Making
sure clients understand what is on offer in terms of disposal and storage is always
a point that needs to be clarified.

Ending sessions
Even early on, students start to think about how to end art therapy. So even though
this chapter is looking at the outset of supervision, this issue is likely to come up.
 Starting supervision 203

Issues around loss can crop up near the end of groups, so betrayals, bereavements
and feelings about mortality can become group themes towards the close of groups.

Summary and conclusion

As noted, students feIt the need to bring drafts of client contracts and advertising
into the sessions for discussion in the initial stages. They also rehearsed describing
what an art therapist iso Standard client contacts can be included in placement
handbooks which students can modify, as necessary, to make the whole process
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easier. Placement contacts can be considered, and codes of professional practice

and ethics assimilated.
In this chapter, I have suggested that it is essential that supelVisees, be they
professional practitioners or trainees, fee 1able to share theirfeelings of vulnerability
with their supelVisors in order to benefit fuHy from the supelVision process.
Many fears and fantasies can be expressed and explored prior to trainees
commencing their clinical hours. Giving clear permission to students to feel able
to express their vulnerability is profoundly important in order for them to leam
to use supelVision effectively; appearing professional, though important in their
placement settings, is not the point when it comes to participating in supelVision.
As I noted at the outset of this chapter, supelVision is where students must be
able to share their sense that they may have made amistake in clinical work.
SupelVisees may need to deal with their feelings of humiliation, embarrassment
or shame in order to make such disclosures, but when sensitively handled by their
supelVisor these disclosures are transformed into positive learning experiences.
Becoming a safe practitioner means being able to use supelVision effectively.
In the initial stages of supelVision for art therapy trainees, it is helpful for them
to be able to openly express their doubts and fears. Students newly out on training
placements, as demonstrated, experience a wide range of issues and concems. Not
all trainees have the luxmy of a placement in a weH-established art therapy selVice,
or they may be working peripatetically, so negotiation about selVice provision,
promotion of the art therapy selVice and establishing therapeutic boundaries are
an important part of the learning experience.
At the outset of the supelVision group, familiarising students with rules
for professional conduct and codes of ethical behaviour, looking at placement
documentation, informing students as to how their clinical work will be assessed,
rehearsing how to explain and define art therapy, sharing leaflets and promotional
material as weH as conducting client-therapist role-play exercises, are all useful
constructive activities, which help to counteract the students' initial feelings of
despondency, frustration and apprehension. Later, when the supelVision process is
more advanced, the work of the supelVision group can become more concentrated
on therapeutic interactions and intelVentions, but at the outset, as illustrated, a
lot of time can be spent usefuHy addressing trainees' feelings of hopelessness,
inadequacy and anxiety about prospective clinical work and clients, which also
acts as a rehearsal for how to use the supelVision group.
 204 Starting supervision

Bibliography
Carrigan, J. 1993. Ethica1 Considerations in a Supervisory Relationship. Art Therapy:
Joumal of the American Art Therapy Association 10, 130-5.
Case, C. and Dalley, T. 2006. The Handbook of Art Therapy. Second edition. London:
Routledge.
Edwards, D. 1993. Learning About Feelings: the Ro1e of Supervision in Art Therapy
Training. The Arts in Psychotherapy 20,213-22.
Edwards, D. 1997. Supervision Today: the Psychoana1ytic Legacy, in G. Shipton (ed.)
Supervision of Psychotherapy and Counselling. Buckingham: Open University Press,
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pp. 11-23.
Fish, D. (ed.) 1998. Tuming Teaching into Leaming. London: West London Press.
Gibbs, G. 1988. Leaming by Doing: a Guide to Teaching and Leaming Methods. Oxford:
Oxford Further Education Unit, Oxford Polytechnie.
Gilroy,A. 2006. Art Therapy, Research and Evidence-based Practice. London: Sage.
Hawkins, P. and Shohet, R. 1992. Supervision in the Helping Professions. Buckingham:
Open University Press.
Hogan, S. (ed.) 1997. FeministApproaches toArt Therapy. London: Routledge.
Ishiyama, F.r. 1988. A Model ofVisua1 Case Processing Using Metaphors and Drawings.
Counsellor Education and Supervision 28, 153-6l.
Ma1chiodi, C. 2006. Art Therapy Source Book. New York: McGraw-Hill.
Ma1chiodi, C.A. and Ri1ey, S. 1996. Supervision and Related Issues: a Handbook for
Professionals. Chicago, IL: Magnolia Street Publishers.
Mollon, P. 1989. Anxiety, Supervision and aSpace for Thinking: some Narcissistic Peri1s
for Clinica1 Psycho1ogists in Leaming Psychotherapy. British Joumal of Medical
Psychology 62, 113-22.
Schaverien, J. 2007. Supervision of Art Psychotherapy: a Theoretical and Practical
Handbook. London: Routledge.
Smith, H., Hogan, S., Newell-Wa1ker, U. and Stein, N. 2008. Art Therapy Clinical
Placement One: Assessment Form. Derby: University ofDerby.
Wi1son, L., Ri1ey, S. and Wadeson, H. 1984. Art Therapy Supervision. Art Therapy:
Joumal of the American Art Therapy Association 1(3), 100-5.
 Chapter 16

Models of supervision and

personal therapy
Annette M. Caufter
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Introduction
A newly qualified art therapist enjoys the availability of peer supervision and
psychotherapy supervision. There is a culture of support and experiential
learning which also includes the provision of on-site clinical supervision for art
therapist trainees on clinical placement. However, when working in more remote
locations there may be quite a different understanding about clinical supervision
arrangements and requirements. Motivated by an awareness of professional
isolation, the art therapist's request for supervision may elicit unexpected
employer responses such as, 'Why, don't you know what you' re doing?' indicating
a different understanding about supervision requirements. This response is a
reminder that the concept of clinical supervision is relatively recent and cautions
against making assumptions about supervision availability when setting up a new
art therapy service in a different country. There is also the risk that the employer
may be motivated by economic convenience and cost cutting, wanting the clinical
supervisor to be appointed from the local community - suitability and quality
become of secondary importance. The supervisor must have more expertise than
the supervisee but what does an art therapist do when their employer determines
that they see a supervisor with less experience or less expertise?

Defining supervision
As Hogan has already described in the previous chapter, art therapy supervision
gives an opportunity to scmtinise ongoing clinical work, to ensure safe practice and
to enhance the level of clinical practice. Pedder's metaphoric description of a good
supervisor's relationship with their supervisees in the learning experience is that:

they are not empty vessels into whom we POUf from a jug; not inert lumps
of clay to be fashioned after OUf own image. We are facilitators, gardeners,
accepting the plants that spring up in OUf gardens and doing what we can by
pmning.
(Pedder 1986: 2)
 206 Models of supervision and personal therapy

This idea is of the supervisor's role being one of working with what the
supervisee brings, rather than imposing themselves onto the supervisee's skill
set; the supervisee has a large part to play. This view fits with Carroll's position
that supervisees are active in determining supervision to meet their requirements.
Carrolllists the rights and responsibilities of supervisees. Rights include those to
'see your supervisor's report on you with opportunity to comment on content';
to 'give clear and focused feedback to your supervisor'; and to 'appeal decisions
made in supervision with which you have problems' (Carroll and Gilbert 2006: v).
Responsibilities include 'preparing for supervision' ; 'being aware of other stake
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holders in the supervisory arrangements' (for example, clients and their farnilies,
taxpayers and organisations); and 'being aware of cultural, religious, racial, age,
gender and sexual orientation differences between you and others' .

Finding a supervisor
It is the supervisee's responsibility to find a suitable supervisor, someone from
whom they willleam more, extend their skills, with whom they will be able to
reflect with about their work and with whom there is a rapport of potential trust,
honesty and mutual respect. If the employer is insisting on a supervisor who is
deemed by the supervisee as inappropriate, it is the supervisee's responsibility to
educate the employer about their professional needs and requirements. The most
obvious way to do this is to quote professional standards of practice, arguing
that in order to complete professional registration requirements, an art therapy
supervisor with considerably more experience is recommended.
However, in circumstances where the job title is not adesignated 'art therapist'
position, it is not always viable to argue for an art therapy supervisor. Art therapists
may be employed under such job titles as 'counsellor', 'clinical coordinator',
'team leader' or 'family counsellor', for example. In these circumstances, the
employer may argue that the position in which the art therapist is employed is
not adesignated 'art therapist' position and therefore does not require an art
therapy supervisor. In this situation, the art therapist has several options: as part
of educating their employer, the art therapist may decide to deliver a talk about
the specialist nature of their work (see Chapter 5); where post-training registration
requirements demand art therapy supervision, the art therapist may choose to pay
for their supervision privately (either in conjunction with supervision provided
by the employer or not); or the art therapist may choose to write a paper on the
merits of clinical supervision, arguing for the need to travel for supervision. In
a rural or remote location, this may entail negotiating time to travel and arguing
the need to attend supervision in the city because local expertise is inadequate.
When working in a clinical role that stretches beyond the role of 'art therapist'
it is sometimes necessary to find a supervisor who can provide expertise that
stretches between the parameters of cognitive goal setting and the unpacking of
unconscious material; clinical supervision is most effective when it caters for all
contingencies the workplace demands.
 Models of supervision and personal therapy 207

Supervising allied health professionals

Experienced art therapists are available to supervise allied health professionals,
in particular those who have chosen to use art as part of their casework. An art
therapy supervisor provides expertise in the use of image-making processes as
part of therapy and as occasional therapeutic intervention.
While on clinical placement or intemships, art therapist supervisees are
often called upon to educate their allied health professional supervisor about
art therapy. They mayaiso be asked to present to the rest of the agency in the
form of an introductory talk, a case presentation or about their training course
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(see Chapter 5). Talking intimately to their on-site supervisor is quite different
to presenting to a larger audience or clinical team. Art therapy can enhance the
supervision relationship regardless of whether the supervisor is an art therapist or
an allied health professional (Durkin et al. 1989).

Supervision contract
The supervisee has a right to negotiate the terms and conditions of the supervisory
arrangement. A written agreement of understanding makes provision for this right,
as well as clarifies from the outset 'what is not negotiable in the contract' (Carroll
and Gilbert 2006: 27). According to Carroll, there are four types of supervision
contracts:

1 Two-way contracts between the supervisor and the supervisee that

include time and space to bring work to reflect upon.
2 Three-way contracts include the organisation that is employing the
supervisor and to whom the supervisor may be also reporting. Being
clear here on limits of confidentiality and boundaries of the supervisory
relations hip becomes important.
3 The business contract is the administrative aspects of the arrangement.
4 The psychological contract defines the expectations of both the
supervisee and supervisor.
(Carroll and Gilbert 2006: 27-8)

One contract could incorporate different aspects of these four types of contracts,
which are not mutually exclusive.

Art therapy tasks in supervision

From the outset, art therapy tasks can be used to enhance the supervisory relationship.
When negotiating the supervision contract, the supervisee may not understand and
be fearful that in signing something this might be held against them later. They may
also have ambivalent feelings about the intention or purpose of a contract. Prior to
concretising the supervision contract agreement, art can be used to explore fears,
 208 Models of supervision and personal therapy

ambivalent feelings and to visually conceptualise the desired leaming relationsbip.

A task such as 'draw an effective supervision contract' helps the supervisee to
visually describe what they regard as important in the supervisory relationsbip.
Art can be used to establish group supervision cohesiveness. Art tasks could
include drawing 'how I see the pUIpose of tbis group'; 'what do the supervisor/
other supervisee group members expect of me?'; 'feeling safe in tbis group'; 'how
I would like tbis group stmctured'; or 'my understanding of how this group is
to operate' . Such tasks help group members negotiate their needs and wants at
the commencement of group supervision. Art therapy can be used to facilitate
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processes of getting to know each other, determine group supervision goals,

explore hopes, expectations and ambivalences, as weH as how the group is to
operate and be stmctured.
Based on the experiential learning cycle of activity, reflection, learning and
application (Kolb 1984), there are a number of experiential art tasks that facilitate
the supervisee's leaming process. These are more likely be used in a one-on-one,
face-to-face supervisee-supervisor relationsbip but could be adapted to a group
supervision setting.

1 In the first stage ofKolb's leaming cycle, the supervisor and the supervisee
exarnine how the supervisee does their work, with an art task such as 'draw
how you do your work' or 'draw yourself doing your work'. Where the
supervisee is an art therapist or an allied health professional who is leaming
to use art more effectively with clients, the task describing the activity of
therapy or counseHing can be more specific, such as 'draw how you use art
with clients' or 'draw yourself using art in yourwork' . It is up to the supervisee
to determine how they approach such a task, but suggestions are that it could
be diagranunatic, literal or symbolic. For some, a diagram is a much easier
way to describe what they do than a more descriptive, complex image.
2 In the reflection stage, art tasks could include 'draw something that reflects
on an aspect ofwhat you do with clients' or 'tbink about what we have been
discussing today and draw about your relationsbip with tbis clientlgroup'.
A reflective art task is about developing the ability to step back from the
intensity of the clinical work or to focus on a particular aspect or incident
in the content of a session. The use of art at tbis learning stage provides
opportunity to examine therapy content and processes from a reflective
distance. Supervisors use art-making to facilitate this reflective process.
Creating a concrete image, sometbing that represents whatever is being
reflected upon, gazing at that image, then receiving back from that image,
is not unlike phenomenological perceiving (Betensky 1995: 17-20). The
art work aHows what is less conscious in the therapist-client relationsbip
to emerge. It also provides opportunity for countertransference issues that
were not previously clearly evident to also emerge. The use of art -making at
this stage ofthe supervision leaming cycle enhances the supervisee's ability
to step back from the case and see it from a more objective place.
 Models of supervision and personal therapy 209

3 What the supervisee sees or becomes aware of w hile in reflection becomes

core material for the third stage: leaming. Art tasks can concretise what
has been leamt; for example, 'based on your reflective drawing, what have
you leamt in this session? Is it possible to visually describe what you now
know? Draw what this session has taught you' or 'draw some wise advice
for yourself' (Withers 2006). This task is based on what the supervisee
has leamt in the process of reflecting from the session through creating
an image. The supervisor attends to the supervisee's learning process and
notes their ability to grasp self-awareness, heed advice and gain knowledge
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of themselves and their relationship with a client, group or family while

self-reflecting on process and content (Carroll 1996). The art task can
also examine their relationship with the supervisor: 'draw something to
represent what you have leamt in this supervision session' or 'how do you
fee 1 in relation to me after today's supervision session?'
4 The application stage challenges the supervisee to consider how they are
going to apply what they have leamt in the earlier stages to their work. An
art task reflective of this could be 'draw how you intend to integrate what
you have leamt' or 'draw yourself in relationship with this client or with
me (i.e. your supervisor) with this new information'. The intention is to
integrate what has become conscious, or changes in self-awareness, in the
process of reflection and leaming stages.

Working in professional isolation

Chapter 5 explored the challenge of finding oneself located far from any other art
therapists and possibly any other counsellors or psychotherapists. Particularly in
countries where distances are great, art therapists are often working in complete
professional isolation, orthey may be part ofa relief team in an area of natural disaster
or conflict, risking exposure to vicarious trauma without adequate supervision. In
such circumstances, it is important to have a flexible attitude to supervision and to
think creatively about what other options are available, such as peer supervision
and self-supervision. For some professional associations, however, neither of these
options may count towards supervised hours credentialling requirements. This is
unfortunate, because supervision with other allied health professionals who are
also part of an isolated community offers art therapists in sole-worker positions
a viable alternative that is arguably effective and well considered. From a more
global perspective, a future view of art therapy as a fully integrated profession
might allow consideration ofboth peer supervision and self-supervision as offering
a credentialing option over more traditional methods.

Peer supervision
Art therapists can offer each other support through shared group supervision. Peer
supervision is effective in situations where income does not stretch to include
 210 Models of supervision and personal therapy

clinical supervision, such as when a newly-qualified art therapist is unable to find

immediate employment, but has an opportunity to provide minimal therapy.
In peer supervision, 'each participant becomes co-supervisor and supervisee
at different times' (Carroll and Gilbert 2006: 11). Participants might also include
non-art therapists (Laine 2007). When working in professional isolation, the art
therapist can be part of a peer-support group made up of professionals from the
local community, such as nurses, doctors, clergy and teachers (Crago and Crago
2002: 83). Crago and Crago suggest that instead of asking, 'is this person my
professional equal?' the therapist should consider, 'would this person be able
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to give and take, in an atmosphere of mutual respect and safety?' (Crago and
Crago 2002: 83). For professionally isolated art therapists, community-based peer
supervision provides an opportunity to educate and promote art therapy through a
group of professionals who have significant roles in the community, even though
'this supervision may end up coming from right outside the network of similarly
trained and credentialed professionals with whom most ofus identify' (Crago and
Crago 2002: 83).
It is important to ensure that the type of supervised hours, including peer
supervision, are recognised as meeting supervision requirements by most
associations. Where this includes therapists trained in quite different or quite
specific models, such as aSteiner or transpersonal orientation, a cognitive-
behavioural bias or a psychoanalytic psychodynamic approach, there is a wealth of
peer educational opportunity, exposure to new theoretical models and challenging,
thought-provoking discussion. For peer supervision to be beneficial, formal
professional roles need to be replaced by mutual respect, an openness towards a
sharing of self-disclosure and an honest self-expression in one's responses. The
goal is to establish trust and safety over time.
Hawken and Worrall (2002) suggest a reciprocal mentoring model of peer
supervision (Hawken and Worrall2002: 43-53) in small groups ofnot more than
two or three where each participant is both supervisee and supervisor at different
times. Responsibility is to the collegial relationship and there is no hierarchical
line-management accountability. A reciprocal learning relationship is fostered,
based on 'mutuality and equality' that 'recognises wisdom, skills and knowledge
of each person' who gives as well as receives, and 'these partnerships have
exponential potential as they proliferate throughout organisations' (Hawken and
Worrall2002: 43-53).
Peer supervision allows opportunities for the integration of knowledge from
other fields such as the acceptance of art therapy by allied health services and the
relationship 'provides reliable and candid personal feedback, emotional support,
career strategizing, and on-going confirmation of each individual's competence and
potential' (Kram and Isobella 1985: 121-4). An optional structure is a reciprocal
mentoring arrangement which allows freedom to choose a supervisee partner. The
purpose is to engage in a non-hierarchical, non-evaluative relations hip where there
is an equal commitrnent to time and process. A contracted formal relationship of
reciprocity and mutuality is established where trust, honesty and transparency
 Models of supervision and personal therapy 21 I

are promoted through stmctured sessions, where reflective learning takes place.
Hawken and Worrall (2002) describe meeting fortnightly and rotating both the
venue and who starts. They have a break in the middle of a three-hour session
where they change roles from supervisor to supervisee. Their contract includes
boundaries regarding confidentiality and they are intentional about not identifying
clients or organisations. There is no managerial accountability - tmst and honesty
have encouraged a deep and close relationship to evolve over time. They are able
to challenge each other safely and respectfully: 'we leave supervision feeling
heard, understood and with a much clearer perspective on our professionallives ...
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we give what we would like to receive' (Hawken and Worra1l2002: 50).

Supervision and the internet

Peer supervision can also be through an internet hook-up such as Skype. A reproduced
image to be discussed and any prepared notes can be sent in advance to an art therapy
peer group. This group may even be made up of art therapists from outside the local
area or country to include overseas members. This is not the same as face-to-face
contact, but is a compromised alternative where no other option is available. McNiff
mentions 'distance art therapy' practice as a future direction for art therapists to
consider, including clinical supervision and digital storage of art therapy records
and images (McNiff 2000: 98). The discussion of images in supervision by distance
requires that both the client's art work and the supervisee's preparatory art work
(see below) is sent in advance to the supervisor. On Skype, images can be held up to
indicate a certain aspect or to point to something in particular. A phenomenological
viewing and description can help with this logistic (Betensky 1995).

Stages of supervision
In one view of the supervisory relationship, the supervisee moves from unconscious
incompetence, to conscious incompetence, to conscious competence, to unconscious
competence (Robinson 1974). Anotherway to describe this is as moving from relying
on your own internal critic, to the 'intemalised' supervisor, to developing your own
'intemal supervisor' (Carroll and Gilbert 2006: 45-7). The 'internal supervisor'
is able to integrate what has been learnt in supervision with individual style and
clinical experience. The supervisee is able to effectively assess their own work and
to trust their practice in a more instinctive, intuitive way that does not necessarily
follow known mIes and systems. 'Unconscious competence' means that skills and
knowledge have been fully integrated and the therapist conducts their practice with
an inner confidence, knowing what to say and do without any conscious thought.

Visual diaries in supervision

Visual diaries provide a means to personally debrief from client work and offer
an alternative to the more traditional means available to supervisees' presentation
 212 Models of supervision and personal therapy

of material: verbal reports, process notes, session verbatim accounts, audio taping
or filming, role-play and dient evaluation feedback. Visual diaries can also be
used to present aspects of verbal and physical communication between dient
and art therapist, the supervisee's perspective of what might be going on in the
dient's mind or what is going on in their own mind - a personal perspective on the
transference and countertransference relationship, to be shared with the supervisor.
Completion of a quick, spontaneous image after a difficult session provides
cognitive relief and an opportunity to express feelings of counter-transference
that are difficult to access and to immediately verbalise. The therapist sometimes
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experiences a personal issue that is triggered by a session, or an unclear emotional

response comes up in reaction to dient work. Sometimes the therapist is aware and
insightful of what personal issue has surfaced for them, but they may be unaware or
uncertain. Art provides an opportunity to self-reflect which is especially valuable
when dinical supervision is not immediately available. In circumstances where
supervision is monthly or fortnightly, visual diary work offers an alternative way
to prepare for the next dinical supervision session, with both spontaneous diary
entries as weH as journaHing tasks that explore the therapist's responses to dient
issues (see pp. 83-5).
When planning ajournaHing task, the therapist's intention might be to explore
counter-transference material that they are aware has emerged. Through this
documentation, the supervisee assists the supervisor in addressing things that are
continuing to emerge in relation to their case material, but which are remaining
unclear for the supervisee. This visual diary work provides an alternate way
for the supervisee to engage in advanced casework preparation and processing
involvement before supervision takes place. It allows for 'reflective distancing',
described by Kagin and Lusebrink (1978: 172) thus: 'reflective distancing is an
integrative experience where body sensations take on perceptual organisation and
are then given meaning ... [and] a cognitive distance between the art experience
and the individual's reflection on that experience'. Visual diary work can also
be a warm-up to facilitating a self-supervision session as a way of processing a
difficult session when supervision is not immediately available.

Se If-su pe rvi s i on
Regular dinical supervision is a requirement ideaHy built into the art therapist's
weekly work for best practice (Case and DaHey 2006: 203). Self-supervision is
where the art therapist has a discussion with themself regarding an interaction
with a dient, family or group. The therapist presents the problem as they would
to a dinical supervisor, then asks questions and explores aspects as if they are the
dinical supervisor. By setting this time aside for self-examination, an opportunity
for daily debriefing is provided. Self-supervision is also an interim measure if
supervision is not available because of cost or geographical isolation. Through
the making of art work, the art therapist is able to provide self-reflection and
transference examination. The notion of self-debriefing through art aHows time
 Models of supervision and personal therapy 213

to consider difficulties in clinical work before going horne to family, friends or

social situations. This provides a 'stop-gap' measure until supervision can take
place. Sometimes an issue will resolve itself through this process and sometimes
the preparatory work that has taken place must be taken to supervision. There
should always be an arrangement that the supervisor can be contacted between
sessions, if necessary, for emergency!crisis cases that cannot wait until the next
supervision session to be discussed and resolved. This is likely to be a discussion
over the phone, and again such crisis contact with the supervisor can be enhanced
by self-supervision preparation.
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Documentation
As in all counselling and psychotherapy practices, art therapy files can be
subpoenaed. A case note account that comments weekly on the 'black blob'
(as a euphemism for the client's anger!character in their art work) requires
complex, possibly subjective, explanation. Art therapists are at risk of cross-
examination about the intent of such documentation and its wider meaning or
'interpretation'. It is far better to write in the official case file that the client is
'working through issues of anger' and quote the client's verbatim statement
about the art work directly into the case notes, if the therapist believes this to be
relevant and important. Subjectivity is hearsay in legal proceedings: it is strongly
recommended to only state facts in case notes. Case notes and anything written
down is a legal document. For example, someone becomes angry in a session.
Rather than writing, 'he became aggressive', it is better to state 'he came to the
counter and said to the secretary, "where's the bloody counsellor?''' and to record
that the secretary responded in a calming tone with 'please take a seat and someone
will be with you shortly' and that he then responded, 'no fucking way. I want to
see that bloody counsellor right now'. Saying the client was 'aggressive' is a
subjective statement: it is an opinion only. Documenting actual facts, and what the
client said during a critical incident, preferably verified by a witness, leaves it up
to the magistrate to deterrnine whether or not the client was aggressive.
It is always good to document art therapy work and a more detailed explanation
might be attached to the back of the art work. This allows direct material from the
client's perspective to be recorded as part ofthe post-session documentation. The
art therapist's official case files are best written with minimised language that only
states facts. Because of the sheer size of art work, client art work is often stored
away from the case file but some art therapists maintain client art work records on
file as digital images. The art therapist must always consider the viability of art
therapy documentation in the event of a client file being subpoenaed.
Some clients might also maintain their own explanatory account of their work
in a specific exercise book or visual diary, depending on their ability to work with
insightful processes. Visual diary processing between sessions is also useful for
most clients. Between sessions the client is encouraged to record dreams, events and
feeling states as they arise. In this way, the client is supported and empowered to
 214 Models of supervision and personal therapy

continue their own personal therapy process. This is also preparing dients for post-
therapy after termination when the dient has greater autonomy and is more self-
reliant. The visual diary provides opportunity to self-reflect on issues away from
the art therapist. Diary entries are private - there is no expectation these images
must be brought to the next session. The use of the visual diary between sessions
provides a private space that maintains the dient (Coulter 2008). An ongoing visual
diary at the beginning and end of each session can be used by the dient as part
of a self-monitoring of the treatment experience. There should be an initial intake
form in which basic dient information is recorded. Several art therapy and other
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publications provide examples for intake information (Malchiodi and Riley 1996;
Edwards 2004) and these can be adapted to suit specific workplace situations.
Every art therapy session requires entry into the general dient case notes file
- in most countries, this is a legal requirement. The art therapist must determine
how much to write but usually briefer notes are preferred: five to eight hand-
written lines are adequate. Other staff read the case notes, so lengthy ac counts are
not appreciated - staff want to know the dient attended art therapy and that it went
well, or that a particular issue came up and was dealt with, or that the dient has
concems or plans regarding something.

Personal therapy, suicide risk and supervision

It is always good to experience therapy from the position of being a dient. All
therapists benefit from engaging in personal therapy. This is not only to experience
being a dient, but also the more the therapist knows about themself, the less likely
personal material is going to contaminate the relationship with dients or the
dient's transference onto the therapist. It is important for the dinical supervisor to
be dear about the boundary between what is material for supervision and what is
personal material arising within the supervisory process. Although the supervisor
is not there to provide personal therapy to the supervisee, the overlap and parallel
processes that may be taking place during supervision and in relation to a dient's
processing may need to be addressed as part ofthe supervision session (Case and
Dalley 2006: 205). The better understanding the therapist has about their own
psychopathology, the more effective their casework is likely to be.
On British art therapy training programmes, personal therapy is mandatory,
undertaken independently from the training programme via an independent
practitioner; this is in addition to the supervision provided by the university setting
which Hogan describes in Chapter 15. When dealing with a form of therapy that
is stimulating unconscious processes, there is a risk that the therapist or dinical
supervisor cannot always know of or understand the irrational thought processes
that may be taking place in the mind ofthe supervisee (Yorke 2005). Likewise, the
importance of being dear ab out the supervisee 's responsibilities in supervision,
especially their education in emotional competence in relation to issues such as
suicidal threats, can be enhanced through what one leams in personal therapy
(Carroll and Gilbert 2006: 95-100).
 Models of supervision and personal therapy 215

Personal therapy is encouraged both during training and as a practitioner,

because it benefits both the therapist and the client. The therapist is more aware
of their own psychopathology and what personal issues may be triggered by
transference and projection from the client. The therapist's competency is
enhanced if they are self-aware and possess self-knowledge as a result of several
years of personal therapy. They have developed humility and respect for the
client's process because of their own 'client' experience.
The supervisee has areas of responsibility in organising, monitoring and
managing their supervision and this chapter has outlined some options to consider
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when resources for supervision are inadequate or unavailable. Effective practice

includes the designing of forms for the documentation of work for supervision as
weH as clinical practice. Standardised forms are used for the gathering of referral
information, consent to be taken in supervision, including art work, exchange of
information, and discussion ofboth session content and processing client art work
with an art therapy supervisor.

Bibliography
Betensky, M. 1995. What Do You See? Phenomenology of Therapeutic Art Expression.
London: Jessica Kingsley Publishers.
Carroll, M. 1996. Counselling Supervision: Theory, Skills and Practice. London: Cassell.
Carroll, M. and Gilbert, MC. 2006. On Being a Supervisee: Creating Leaming
Partnerships. Kew, Australia: PsychOz Publications.
Case, C. and Dalley, T. 2006. The Handbook of Art Therapy. Second edition. London:
Routledge.
Coulter, A. 2008. 'Came Back - Didn't Come Horne': Returning from a War Zone, in
M Liebmann (ed.) Art Therapy and Anger. London: Jessica Kingsley Publishers, pp.
238-56.
Crago, H. and Crago, M. 2002. But You Can't Get Decent Supervision in the Country! In
M. McMahon and W. Patton (eds) Supervision in the Helping Professions: a Practical
Approach. French's Forest, NSW: Pearson, pp. 79-90.
Durkin, J., Perach, D., Ramseyer, J. and Sontag, E. 1989. A Model for Art Therapy
Supervision Enhanced through Art Making and Journal Writing, in H. Wadeson, J.
Durkin and D. Perach (eds) Advances in Art Therapy. NewYork: Wiley, pp. 390--43l.
Edwards, D. 2004. Art Therapy. London: Sage Publications.
Hawken, D. and Worrall, J. 2002. Reciprocal Mentoring Supervision: Partners in Leaming:
a Personal Perspective, in M. McMahon and W. Patton (eds) Supervision in the Helping
Professions: a Practical Approach. French's Forest, NSW: Pearson, pp. 43-54.
Kagin, S.L. and Lusebrink, VB. 1978. The Expressive Therapies Continuum. Art
Psychotherapy 5,171-80.
Kolb, D. 1984. Experiential Leaming. Englewood Cliffs, NJ: Prentice Hall.
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Career Development. Academy ofManagement JoumaI28(l), 10 1-32.
Laine, R. 2007. Image Consultation, in J. Schaverien and C. Case (eds) Supervision of
Art Psychotherapy: a Theoretical and Practical Handbook. London: Routledge, pp.
119-37.
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Malchiodi, C.A. and Riley, S. 1996. Supervision and Related Issues: a Handbook for
Professionals. Chicago, IL: Magnolia Street Publishers.
McNiff, S. 2000. Computers as Virtual Studios, in CA Malchiodi (ed.) Art Therapy and
Computer Technology: a Virtual Studio of Possibilities. London: Jessica Kingsley
Publishers, pp. 86-99.
Pedder, J. 1986. Refiections on the Theory and Practice of Supervision. Psychoanalytic
Psychotherapy 2(1), 1-12.
Robinson, W.L. 1974. Conscious Competence: the Mark of the Competent Instructor.
Personnel Journal 53, 538-9.
Withers, R. 2006. Interactive Drawing Therapy: Working with Therapeutic Imagery. New
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Zealand Journal ofCounselling 26(4), 1-14.

Yorke, V 2005. Bion's 'Vertex' as a Supervisory Object, in C. Drive and E. Martin (eds)
Supervision and the Analytic Attitude. London: Whurr, pp. 34-49.
 Chapter 17

International perspectives
Annette M.Coulter
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This chapter is written with the reader in mind who has migrated overseas, set
up art therapy training or anational association in a new country, or had to work
in unsupported professional isolation. These 'outsider' art therapists work on the
fringes ofthe known art therapy world. For the reader who has not worked outside
Britain or North America, the content of this chapter is likely not to resonate and
might be difficult to grasp.
For the purpose of this chapter, the reader has to consider the possibility that
the current international community of art therapy is very broadly polarised into
two 'camps' that are biased towards either side of the Atlantic. Although this
gap is lessening, the purpose here is to define this positioning so that it is better
understood in terms of a global view of current art therapy perspectives. These
camps encompass a North American/Canadian as opposed to a British/European
position, which will be referred to as 'US' versus 'UK' perspectives respectively.
Both offer rich and contrastingly unique information, practical structures and
theoretical challenges (Hagood 1993, 1994).
The professional development of art therapy is infiuenced by differing cultural,
political and educational systems that affect training, mental health services
and professional governance. As more countries establish art therapy, this
'transatlantic' divide is increasingly examined and appreciated (Betensky 1971;
Coulter-Smith 1983, 1989a; Woddis 1986; Campanelli and Kaplan 1996; Gilroy
and Skaife 1997; Gilroy and Hanna 1998; Gilroy 1998; Coulter 1999, 2006a,
2006b; Slater 1999; Rosal 2007; Hurlbut 2011; Potash 2011; Wadeson 2002;
Potash, Bardot and Ho 2012; Kalmanowitz, Potash and Chan 2012). Achieving
an international perspective requires an understanding of the dichotomies and
discrepancies between these two polarities. This chapter considers strengths and
differences that are currently contributing towards a future global community of
art therapy and acknowledges the ever-increasing need to integrate these 'camps'
of art therapy difference (Coulter 2006a). 'Healing the split' is the job of the art
therapist (Nowell-Hall1987).
 218 International perspectives

Conflicting origins of art therapy

Both UK and US art therapy claim early art therapy history, and it is clear that
at a similar time a parallel growth of the profession was occurring. When both
countries were in post-war circumstances, the rehabilitative use of art on either
side of the Atlantic was documented (Hogan 2001). The term 'art therapy' was
first coined by UK art educator Adrian Hill (Hill 1945) and in the US Margaret
Naumburg was practising progressive education, calling her work with art a form
of 'symbolic speech' (Naumberg 1958). Rubin's historie research of art therapy
video footage includes an exploration of recent international growth and the
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historical contributions made by many art therapists and others over time (Rubin
2004).
Some would say that Jung was the first 'art therapist' because he was the first
therapist to document the use ofvisual art in the consulting room while examining
transference, and infiuenced early art therapy development in the UK. However,
claims about the therapeutic arts pre-date any ofthese developments (Hogan 200 1).
From a global perspective, confiicting claims about the origins of art therapy
practice or who should be regarded as the first 'art therapist', or where the more
substantial knowledge base is located, does not help 'heal the split' between the US
and UK 'camps' of art therapy difference. Bias is coloured by where one trained,
from whom and what infiuences or prominent personalities impact on a specific
training progranuue or country.

Polarised 'camps' of art therapy

Generally, art therapy in the US has a psychological emphasis, whereas in the
UK there is a psychodynamic emphasis, 'the richness of the object-relations
approaches and in-depth work on transference and countertransference ... leaves
me feeling envious that my American training did not focus more deeply on these
aspects of art therapy' (Hagood 1994: 56). In the UK, art therapy is regulated by
the Health Professions Council (HPC), a semi-independent body set up in 2001
that ensures both training and professional standards are maintained, whereas
in the US, the American Art Therapy Association (AATA) and the Art Therapy
Credentials Board (ATCB) regulate accreditation and certification. Clearly, the
situation in the US is more complex than that of the UK.
One significant difference between the US and UK training standards is that
US trainees are required to gain competence in the area of art therapy assessment.
They also acquire skills in statistical reasoning including familiarity with the
concepts of reliability and validity, and must be familiar with aselection of
assessment tools, instruments and procedures used in evaluation and appraisal
(Betts 2012). Furthermore, this training is linked to the formulation, administration
and documentation of specialist treatment goals, as weH as psychiatrie diagnoses.
The use of the Diagnostic and Statistical Manual (American Psychiatrie
Association 2013), theories of psychopathology and abasie knowledge of
 International perspectives 219

psychopharmacological medications are also required. Arguably, such knowledge

is useful for the development of art therapy, possibly contributing, along with
successful marketing and promotion, to US acceptance of the profession. Art
assessment techniques are delivered as part of programmes packaging for private
health schemes that have funding constraints and usually a limited number of
sessions. To validate service delivery, US art therapists also invest heavily in
researching effectiveness.
For the US art therapist, delivering visual art assessment tasks is the preferred
procedure when the agency stmcture allows provision for this before treatment
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commences. UK art therapists tend to steer away from structured assessment

regimes preferring to see what the client does with the art materials, placing
as much value on a client's resistance to engage in this process. Sitting with
unconscious processes and attempting to understand resistance and transference
is part of the essential work in UK art therapy. On assessment, UK art therapist
Edwards writes:

[the client] will usually be invited for an initial assessment appointment. ..

to establish whether or not art therapy is the most suitable form of therapy
and to arrive at a shared understanding of the problems the client wishes to
address.
(Edwards 2004: 74)

To emphasise this point, a generalisation is that a UK art therapist might be

viewed more as an 'art psychotherapist' with an interest in psychodynamic theory,
whereas US art therapists are more grounded in a spectmm of psychological
perspectives.
Although both work with unconscious processes, US art therapy works more
towards a client's conscious realisation whereas UK art therapy provides the
client opportunity to be immersed in unconscious processes. For UK art therapy
the client's conscious understanding is not the goal whereas in the US, art therapy
results are at times measured and analysed and time constraints are imposed in
order for treatment to continue. To varying degrees, both work towards a conscious
integration of issues but this becomes more important for US art therapists if
treatment funding is to continue. Both orientations have merit - both 'camps'
have produced speciality and excellence. In the US there is a training pre-requisite
of at least four courses in psychology as well as at least five studio courses in
visual art, whereas in the UK visual art is still the preferred requirement, although
other first degrees are also accepted. Both countries require pre-course practical
experience in a relevant work setting, but how rigorously this is enforced requires
further research. This inconsistency in what is a 'sound basis' for art therapy was
raised by Levick (1989: 59) and 'in researching such (inconsistent) perceptions
of art therapy in Korea, Park and Hong (2010) found that the profession could
gain more credibility if, among other factors, it had a unified curriculum' (Potash,
Bardot and Ho 2012: 144).
 220 International perspectives

Training
Arguably, US training has more emphasis on cultural and social diversity than
its UK counterpart. Furthermore, a more social emphasis is taken in the US
in educating trainees for possible roles in social justice, advocacy and confiict
resolution work. In the UK these areas are often taken up by artists working in the
arts and health movement rather than by art therapists. Thus an area of creative
and interesting practice is sometimes lost to art therapists in the UK, because of
an overtly narrow psychodynamic clinical focus.
Personal therapy during training is mandatory in the UK, demonstrating the trend
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towards the profession being that of 'art psychotherapy', where opportunity is built
in to address less conscious material that may emerge. It is a further requirement that
participation in non-directive psychodynamic training groups is an essential part of
training accreditation. These groups focus on exposing the trainee art therapist to
processing and developing an awareness of less conscious material (Waller 1993;
Rosal2007). In the US, personal therapy is strongly recommended but not enforced;
the understanding and use of assessment techniques is essential and participation in
non-directive psychodynamic groups is largely unheard of, although understanding
more directive group art therapy dynamic experiences are included. When US-
trained art therapist Maralynn Hagood was exploring the status of UK art therapy
research (Hagood 1990), her suggestion was for a 'transatlantic dialogue' between
US and UK art therapy in order to learn from each other and to expand the repertoire
of theoretical models used in each country (Hagood 1993).
At present, UK and US training standards infiuence international professional
promotion, regardless of local culture, and different education and health systems.
For countries outside the established 'camps' of UK and US difference, there is
an ever-increasing need for a more generalised, flexible international art therapy
training guideline document.
Currently, in the absence of an agreed position for the global education of art
therapists, training pioneers are faced with three options:

1 To adopt either a US or UK training model, so that approval and support is

gained from at least one 'camp', which may be better than disapproval from
both 'parent' nations (Coulter 2006a). For example, Taiwanese art therapy
foHowed US standards (Lu 2006), whereas Singaporean standards began
with a British accreditation process (Coulter 2006b).
2 To ignore US and UK training standards and develop a training model
that is unique to the local culture, health care system and educational
establishments, possibly adapting this within another more established
therapy or counseHing training programme so that the term 'art therapy'
is obscured or over-ridden. In Australia, for example, other professions
such as psychology and occupational therapy, as weH as private training
progranunes, include or claim to offer training and supervision in 'art
therapy' within another course title.
 International perspectives 221

3 To compromise a training model to encompass the best of both US and

UK training standards, so that overseas recognition is hard to achieve -
there is no approval from either art therapy 'parent' nation. For example,
Australia originally attempted this (Calomeris, Hogan and Coulter 1992),
but the compromised qualification was not easily recognised outside
Australia (Coulter 2006a). For example, in a compromised training model,
group work training may be both a directive and non-directive approach,
offering a phase of directive work, followed by a non-directive experience.
Arguably, offering both gives maximum skills to the trainee to be confident
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in both techniques. Increasingly, such difference is being appreciated

on some training programmes in both the UK and US (Rosal 2007). An
enlightened position might be to define a more integrative 'transatlantic'
theoretical framework for new training programmes (Hagood 1993, 1994),
'a challenge to the global education of art therapists is to define standards to
determine minimally expected content areas of know ledge ... there is a need
to create a curriculum that. .. is culturally applicable and relevant' (Potash,
Bardot and Ho 2012: 144).

Standards and policies from overseas do not transfer easily to the political and
social systems of another country. The integration of the transatlantic 'camps' is
being further researched 'in order to ensure world-wide sustainable art therapy
training programs, we will need to find the careful balance between globalisation
of standards and the unique value of local traditions' (Potash, Bardot and Ho
2012: 149). Emerging global trends increasingly integrate art therapy into new
cultural perspectives that make provision for cultural flexibility (Hurlbut 2011)
and it may be that an international training model will eventually be established
to provide a departure point from which other countries can develop more flexible
and culturally sensitive programmes; 'a truly international standard cannot simply
be a Western one imposed on the rest of the world, but rather one that has input
from many different cultures' (Potash, Bardot and Ho 2012: 149).
Until the 1990s, UK training standard requirement was a one-year post-
graduate diploma, whereas US standards demanded a two-year Master's
degree. The first training programme established in Australia in 1989 followed
UK training standards, but the national association then made adecision to
adopt the Master's degree training level requirement of the US (Harvey 1991).
Other countries - Israel, South Africa, Japan, Singapore, Taiwan - have made a
similar decision and more recently the UK postgraduate diploma in art therapy
qualification was replaced by a Master's degree following debate about whether
the basic qualification should remain a diploma, with an MA being a professional
development undertaken after aperiod of clinical practice, leading to an advanced
practitioner status.
UK and US art therapy training, standards and theoretical philosophies and
practices are influencing the establishment of art therapy training programmes in
Asia. Taiwan and Singapore have established training programmes modelled on
 222 International perspectives

US and UK training standards respectively and there is increasing interest from

other countries such as India, Thailand, Cambodia, mainland China, Malaysia,
Indonesia and Hong Kong.
If there is no art therapy training already established in the art therapist's country
of origin, then this is less problematic. However, if a course is later established
that confiicts with the training standards of the local art therapists, there can be
challenges for which one is unprepared. For example, in SouthAfrica, UK-trained
art therapists were marginalised because the govermnent chose to only recognise
art therapists with a US Master's degree.
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The international dysfunctional family of art therapy

As mentioned above, currently, polarisation of art therapy continues either side of
the Atlantic and inherent professional differences and theoretical divisions remain
largely unaddressed. Although there are elements of individual professional
respect, and ever-increasing opportunities for dialogue (Rosal 2007; Coulter
2006b; Spring 2007; Burt 2011; Gilroy, Tipple and Brown 2012; Potash, Bardot
and Ho 2012), each 'camp' understandably regards itself as the seat of art
therapy excellence and both are equally justified to hold this view historically,
professionally, academically and culturally. On either side of the Atlantic art
therapy is a respected profession that is well established and both 'camps' have
produced specialist art therapists of excellence.
The analogy is of two parents who are aware of each other but whose
communication could be more prevalent and effective. Historically each 'camp'
has justified its existence, fought for professional recognition and until quite
recently, tended to deny the existence or accepted the merit of the other. Neither
'parent' knows much of the other and neither takes much responsibility for
the 'off-spring' they have created. They were never married yet bore children
whom neither parent wishes to claim. These 'children' are other countries - for
example, Taiwan, Australia, New Zealand, Israel, South Africa, Japan, Korea,
Singapore, India, Thailand - that continue to try to establish art therapy, some
more successfully than others, and which have adesire for communication and
a cross-fertilisation of ideas. However, they are destined purely by geographic
location to be related to but not part of US or UK 'camps'. Art therapists who
find themselves working in isolated locations look to established professional
organisations, current literature and prominent colleagues for support and
validation of their work. Their situation demands examples from which to draw
in establishing educational programmes, national associations, employment, pay
scales and networking contacts within their own country. It may also require
consultation in setting up seminars, engaging speakers or trainers to come from
overseas or supportive documentation to gain licensing or certification.
In Australia, transatlantic differences affected all aspects of establishing a
professional association: the drafting of a Constitution; membership criteria;
registration and training standards; and eventually ethical guidelines and standards
 International perspectives 223

of practice. The founding committee, a combination of UK and US art therapists

(Coulter 2006a) had to be considerate and respectful, harnessing the challenge
of negotiation and compromise in its decision-making processes (Coulter-Smith
and Cowie 1988; Coulter-Smith 1989a). The only way forward was to embrace
difference - to be open and flexible to learn more about the other, despite initial
entrenched positioning (Coulter 2006a).
Being in a position that demands compromise, flexibility and consideration of
opposing models and standards, the pioneering art therapist risks marginalisation
from transatlantic 'camps' because the revised position integrates and values the
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best of both. It is a compromise that is unappreciated. Transatlantic differences

remain unresolved and despite increasing awareness and attempts to integrate
polarities, the window is small in terms of a generally compromised and divided
international community of art therapy.

International developments
The establishment of INGAT (The International Networking Group of Art
Therapists) was originally proposed to provide a forum for international
communication amongst geographically isolated art therapists (Coulter-Smith
1989b) who were interested in a global exchange that promoted and encouraged
art therapy growth and development (Coulter-Smith and Stoll1989). In the spirit
of international promotion of art therapy, the Australian art therapy association
convened the first international conference in 1989 (Hogan 1989a). During this
conference, an international educators' forum took place at which both US and
UK art therapists contributed and challenged the Australian training guidelines
(Coulter 2006a). This early Australian experience was later echoed by Hagood's
suggestionfor a 'transatlantic dialogue' (Hagood 1993) and continues as a current
discourse (Potash, Bardot and Ho 2012) despite genuine attempts to reconcile
differences (Spring 2007; Gilroy, Tipple and Brown 2012; Kalmanowitz, Potash
and Chan 2012).
Those who appreciate the pioneering aspects of art therapy development outside
the US and UK have documented their research (Betensky 1971; Woddis 1986;
Hogan 1989b; Campanelli and Kaplan 1996; Gilroy and Hanna 1998; Edwards
2004; Westwood 2012; Potash, Bardot and Ho 2012). However, consultation with
local art therapists does not always take place for such research. In instances
where local art therapists are not consulted, the history of art therapy can become
biased, misinformed and written from fleeting impressions by transatlantic 'camp'
representatives. This attitude is arguably parochial. It does not enhance a better
understanding of the global challenges that pioneering the profession requires
- dealing with limited resources, cultural diversity and addressing controversial
political, economic issues and dilemmas. Pioneers of art therapy are often
working alone, but need to accurately record their experiences rather than rely on
outside impressionistic accounts. Although caught up in an isolated professional
challenge, these art therapists are part of an unfolding existential narrative that
 224 International perspectives

is often hard to identify, understand or appreciate. In time, this becomes the

professional art therapy history of a country.
The original pUIpose ofINGATas an international supportforisolatedarttherapists
was never realised. In fact the predominant activity of INGAT has been mainly for
US art therapists to travel sharing their skills and knowledge. In most instances
supporting isolated art therapists and establishing forums for communication and
exchange has been arguably secondary to personal self-promotion.

Art therapy in Asia

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Recent natural disasters have fuelled an interest in art therapy and trauma.
Relief agencies engaged in servicing victims of natural disasters are becoming
increasingly aware of the benefit of art in post-trauma recovery (Malchiodi 2006;
Bovornkitti and Garcia 2006; St Thomas and Johnson 2007; Alfonso and Byers
2012). This growing awareness has infiuenced educational institutions in the
planning of art therapy training. U ntil recently the only available option for Asian
students wishing to pursue an art therapy career was to train overseas. During
the 1980s and 1990s, the majority of Asian students studied in the US and more
recently there is growing interest in Australian programmes. In Hong Kong there
has been a UK infiuence (Potash 2011) with short introductory training courses
being conducted for many years at Hong Kong University, fuelling interest from
allied health, educational and other rehabilitative agencies. There is also an active
professional art therapy association.
The first art therapy MA in Asia was launched in Taiwan in 2005 (Lu 2006)
and the first in south-east Asia in Singapore in 2006 (Coulter 2006b). Both
programmes participated in the integration of a Western art therapy -training model
into an Eastern context - Taiwan was a US-based programme and Singapore was
a UK-accredited programme. Singapore is a multi-cultural society with students
from bothAsian and European backgrounds, who have a broad range of religious,
social, clinical, cultural and spiritual beliefs and backgrounds. Innovative teaching
strategies helped integrate Western ideas and notions into an Eastern context. For
example, based on UK training requirements, the Singaporean integration of
Western notions of object-relations and attachment theory into a local medical
context that favoured directive cognitive techniques was challenging. The
introduction of an infant observation and seminar, even though not a standard part
of UK art therapy training, was an effective way to teach this Western concept
in a culturally sensitive way. Students participated in this weekly observational
practicum visiting a young child, for one hour each week, and observing the
child's relationship to significant and insignificant objects and people. The child's
role within the family determines their emerging cultural identity and this could
be related to and discussed in a weekly seminar discussion group. Although this
course content was later revised when US course content was introduced, the
training programme continues to be a rich blend ofUK and US theory and clinical
application, in an Asian context.
 International perspectives 225

Although Taiwanese pioneering art therapists adapted their US standards and

their US training experience to the local cultural context (Lu 2006), in Singapore,
Western progranuue leaders were less familiar with the local culture and medical
and clinical contexts (Coulter 2006b), disadvantaging the adaptation of UK and
US theory and practice. In both situations, despite local and overseas input, the
'transatlantic split' of polarised art therapy origins is maintained and the unspoken
discourse is perpetuated.
If art therapy is to be effectively practised globally, the profession must be
able to accommodate Eastern thinking and cultural values that offer art therapy
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a rich and varied contribution to Asian clinical practice (Coulter 2006b). After
all, it was Jung's tour of Asia that strongly infiuenced his later writings and
theories. For example, Jung's notion of opposites making up the whole, such as
the masculine versus feminine, or introversion versus extroversion, come directly
from the Asian concepts such as Yin and Yang (Jung 1964: 290) as well as the
therapeutic adaptation of the concept of 'mandala' from Eastern philosophy (Jung
1964: 213-l7). We live in a time when Western appreciation ofEastern culture
is gaining increasing respect, understanding and interest. There is a rise in the
appreciation of Asian health practices such as acupuncture, massage, yoga and
herbai remedies. Asian culture offers the field of art therapy a rich wealth of
ideas and concepts that are likely to challenge Western theoretical models in the
future. McNiff inspires consideration for a worldwide perspective of art therapy
as he poses such questions as 'how do art therapists trained in North America,
Europe and Australia operate in Korea, China and Japan where it is conuuon to
suppress personal emotions which are fundamental to the art therapy experience?'
(McNiff 2012: 15). Kalmanowitz, Potash and Chan highlight Eastern concern for
the whole versus the Western concern for the individual: 'Eastern traditions point
to holistic health by reminding us that separation is contrived and that all aspects
of life infiuence each other' (Kalmanowitz, Potash and Chan 2012: 40). Current
established UK and US art therapy 'camps' need to listen, consider and sometimes
accept alternate views that differ and challenge their culture. The task is not to
impose a Western profession into an Asian context, but to adapt and integrate
the complexity of art therapy theory into a society that has ancient complex
philosophies and traditions of its own that are equally important: 'Western health
is largely ... focused on specifics without attention to the whole ... educators will
need to honor the dominant health beliefs in the country' (Potash, Bardot and
Ho 2012: 147). Eastern societies have values and beliefs that require respect and
integration (Kalmanowitz, Potash and Chan 2012).

An international perspective for art therapy

US and UK art therapists have mbbed shoulders over the years. Gilroy and Skaife
(1997) feIt 'the networking of two imperialist countries, ourselves and the US, in
different parts of the world with only scant acknowledgement from each of the work
of the other' was significant, and that 'the nature of art therapy practice in America
 226 International perspectives

was profoundly different, so much so it was hardly recognisable as the same

profession in Britain' (Gilroy and Skaife 1997: 58). Rosal also encapsulates current
theoretical and practical differences in her objective account about differences
between UK and US art therapy group work (Rosal 2007). Hurlbut has recently
reviewed and sununarised the activities of the international networking group of art
therapists (Hurlbut 20 11) and Potash, Bardot and Ho ask the still pertinent questions:
in parts of the world where there are no national associations or the ones that exist
have not developed such standards, what course topics should be offered? Should
we be beholden to standards set by associations beyond our borders? How do we
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integrate local cultural values? (Potash 2011; Potash, Bardot and Ho 2012: 144).
Art therapists from both sides of the Atlantic have appreciatively written
about their discovery and exposure to 'new' or 'different' perspectives of the
other (Hagood 1993; Betensky 1971; Woddis 1986, Coulter 2006a), but the fact
that generations of art therapists continue to stmggle to sustain a global stance
highlights a sense of unclear definition of purpose. When there is aglobai disaster,
art therapy is often there to assist, but this is usually a US-infiuenced model. As
noted above, US training has a more social and cultural emphasis and is extrovert,
marketable and more portable than UK art therapy. You are less likely to find a
UK art therapist practising in a makeshift tent beside an earthquake disaster zone
or a landslide-devastated area, because UK art therapy requires a secure space, a
frame of safety. However, UK art therapists may miss opportunities because of an
unwillingness or inability to compromise a less flexible position.
Much UK art therapy requires a considerable length of time to focus on the
relationship, transferential issues and all that comes with the in-depth work that
unconscious processing demands. US art therapy is robust, energetic and resilient.
It can adapt to different cultural situations more readily and therefore has greater
accessibility to a broader audience as it is packaged for portability, expediency and
effectiveness, w hereas UK art therapy is not packaged and has a focus on unconscious
processing and is therefore by its very nature, less flexible. Both 'camps' can leam
something from the other (Hagood 1993; Rosal2007; Coulter 2006a).
Where art therapists live outside the UK or US 'camps', there is a motivation
for greater international discourse, 'given that the currently available standards
are from the West, educators will need to reconsider ... as art therapy takes shape
across borders' (Potash, Bardot andHo 2012: 149). US academics are pursuingthe
location of student art therapy internships and post-training projects overseas, but
UK art therapy follows Health Professions Council (HPC) training requirements
and is not so flexible. Art therapy would benefit greatly if broader international
standards could be deterrnined that considered registration, training and standards
of clinical practice.

International registration
Currently there is no international mechanism in place to recognise an art
therapy qualification globally. To gain professional registration is to be clinically
 International perspectives 227

endorsed as an art therapist practitioner, but not all countries recognise art therapy
nor do they have designated 'art therapist' positions or a clinical registration
process. Depending on where the art therapist trained, clinical registration can
require undertaking further supervised hours. Some countries provide statutOlY
registration for approved training programmes, such as the ANZATA in Australia
and New Zealand, the HPC in the UK and the ATCB in the USo Eligibility for
UK registration is automatic, once one completes a state-endorsed training
programme, but this credentialled qualification is only valid if the art therapist
remains in Britain. Once the UK-trained art therapist resides outside Britain,
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their professional endorsement is no longer valid: they '... will not be on the
HPC Register and therefore the membership category open to [them] is Associate
International' (Huet 2010). In order to describe themselves as a 'registered art
therapist', overseas students need to complete art therapy training where their
clinical registration remains valid after they return to their homeland, migrate
overseas or relocate to a professionally isolated part of the world. At present, US
training offers more flexibility for this option but ATR registration is not automatic.
On completion of training from an AATA approved programme, 1,000 supervised
post-training hours are required (approximately 100 hours of clinical supervision
is required; with one-half or 50 hours of supervision with an American registered
art therapist, an ATR).
Variance depends on the relocation, but qualifications are scrutinised and
may not be considered of equivalent value to existing standards in a new
country. Even if there is a registration process in place, an overseas art therapy
qualification may not be immediately recognised as relevant to that country.
Endorsement of an international art therapy registration/credentialling that
appreciates current variations, yet accepts difference, would mean art therapists
could relocate between countries without the risk of their qualification being
declared invalid. Such a system would provide greater opportunities for
cross-cultural research and fertilisation for non-competitive collaboration on
international projects. For example, both UK- and US-registered practitioners
were originally eligible for automatic registered endorsement in Australia
that accommodated overseas-trained practitioners to relocate. At the recent
Coalition of Art Therapy Educators meeting in 2011 in Washington DC, the
American Art Therapy Credentials Board (ATCB) announced the consideration
of an international credentialling system. It is expected that culturally isolated
art therapists will welcome this decision. As geographic barriers are crossed,
aglobai view of the profession is enhanced, promoting a greater appreciation
of cultural diversity and a better understanding of differing views that begin to
integrate and enrich future growth of the profession.
Outside the UK and US, there is an increasing cross-fertilisation of ideas
taking place (Coulter-Smith and Rosal1985; Gilroy and Harma 1998; Sedgewick
1991; Jones 1991; Hagood 1993; Lu 2006; Coulter 2006b; Kalmanowitz, Potash
and Chan 2012). There is a growing interest, exchange of ideas and increasing
acceptance of difference within the UK and US art therapy literature. Recent
 228 International perspectives

development welcomes an increase of collaborative art therapy texts as US and

UK authors have exposure to the other's viewpoint (Rubin 2001; Malchiodi
2003; Hogan 2003). International pressure demands global dialogue, respectful
acceptance and worldly consideration (Coulter-Smith 1989b; Hagood 1994;
Rosa12007; Potash 2011; Hurlbut 2011).
A more mutual dialogue is starting to take place (Spring 2007; Burt 2011;
Gilroy, Tipple and Brown 2012; Potash, Bardot and Ho 2012). Consistent with
their openness to new ideas from an extroverted and flexible position, US art
therapists are keen to initiate and support a 'transatlantic' exchange. In 1999, the
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British Association renamed its journal the International Journal of Art Therapy,
conveying an awareness ofthe need for a broader international dialogue.
International debate is increasingly taking place via the cyberspace revolution.
Globally enlightened art therapists are making international connections, locating
supelVision support and debating issues through discussion forums and Internet
alliances such as Art Therapy Without Borders, Linkedin and Facebook. It is
through such initiatives that an integration of disparate concepts can begin to occur.
The potential is there to expand and be innovative even in areas of specialisation,
'by learning from art therapy pro grams around the world, understanding the
challenges to designing new programs and developing the profession, we can
enhance the overall quality of art therapy education, which will ultimately benefit
clients and professionals in every country' (Potash, Bardot and Ho 2012: 149-50).

Conclusion
Transatlantic polarities have determined our art therapy origins; however, it is
the global art therapy community that will determine the future of our profession.
International art therapy perspectives require ongoing flexibility, the ability to be
open and respectful of a broad range of models and sensitive to an ever-increasing
multi-cultural awareness, especially to eschew reductive interpretation that is not
culturally sensitive.
Despite a narrowing ofthe 'gap' through enhanced dialogue between US and
UK art therapy 'camps', the family of art therapy nevertheless remains arguably
somewhat dysfunctional. Other countries, the 'children' and 'adolescents' of
art therapy, wait for initiatives of repair and reconciliation to originate from
the 'parent nations' of art therapy; however, this is perhaps an unrealistic and
unreasonable expectation. Although UK and US art therapy 'parent nations'
are related, the integration of an expanded repertoire of knowledge and mutual
respect from these entrenched 'camps' of difference is questionable. Hagood's
vision of a 'transatlantic dialogue' is inspiring but is it realistic? Perhaps it is time
for countries outside the UK and US to initiate discourse and work towards a more
unified international art therapy community. Any support towards favouring one
art therapy 'camp' will perpetuate division in theory and practice.
Academic origins provide a secure base from which asense of pUIpose is
maintained and strengthened, but it is the challenges art therapists face when
 International perspectives 229

working in isolation, away from professional supports, that is going to bring art
therapy into the twenty-first century. The vision of an international community of
art therapy that is able to respect difference, acknowledge and cater for cultural
diversity and has the potential to inspire a more integrated global future for the
profession should be our goal.

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 Chapter 18

A critical glossary of key

terms informing art therapy
Susan Hogan
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amplification A technique derived from Carl G. Jung in which the mood-tone

or symbolic content of a picture is entered into in an imaginative way. For
example, the therapist might ask (looking at a picture of a boat at sea) how it
feels in the boat, or where the boat is going or whether the boat has a voice.
Originally, the term referred to the symbolic quality of dreams:

Compared to free association, amplification is a more narrowly defined,

more controlled and more focussed type of association where one attempts
to search for analogies that would expand the symbol in question.
(Laine 2011: 129)

Irene Champemowne, an early pioneer of art therapy in Britain, for

example, talked about 'dreaming the dream onwards on paper' (Hogan 2001:
240) and advocated 'entering into the language' of her clients' art works. She
wrote, 'it is possible to accept the material in the state ofthe subject [the same
mood-tone] at the moment, and discuss it from the experimental point of view,
rather than from the intellectual interpretation of the symbols used' (1949,
cited Hogan 2001: 271). This is a useful elicitation technique.
analogy 'An agreement, likeness, or correspondence between relations of things
to one another; a partial similarity in particular circumstances on which a
comparison may be based' (Macquarie Dictionary 1981: 103); for example, the
analogy between a heart and a piston pump. It's an 'illustration of an idea by
means of a more familiar idea that is similar or parallel to it in some significant
features, and thus said to be analogous to it. Analogies are often presented in
the form of an extended simile' (Baldick 2001: 12).
biological determinism This is the idea that shared behavioural norms, and the
social and economic differences between groups (primarily races, classes and
sexes), arise from inherited inbom distinctions. Certain sets of social relations
have existed and evolutionary theory was (and is) used to justify them. In
the nineteenth century, the application of evolutionary theories was simply a
matter of analogy. Equated through supposed likeness were women, criminals,
children, beggars, the Irish and the insane - all ofwhom were lacking in social
 Key terms informing art therapy 233

power and were likened to 'primitives' or 'savages'. Biological determinism

has changed shape over time, but is still evident in psychiatrie discourses,
especially in relation to gender 'norms'.
countertransference (Read 'projection' first) The therapist's projection to the
client, which is a potentially distorting aspect of treatment. The term is also
used to mean 'the analyst's emotional attitude towards the patient, including his
response to specific items ofthe patient's behaviour' (a reflection upon which
may be therapeutically useful in illuminating the therapist's understanding of
the client) (Rycroft 1968: 25).
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discourse Debate, or communication of thoughts in words, the term has a

specific meaning within cultural theory. This is Foucault's idea of discursive
practice, which is a highly organised and regulated set of practices and
statements that serve to create and maintain definitions, say of 'madness' or
'femininity'. This has a history and a set of mIes w hich distinguishes it from
other discourses establishing both links and differences. In other words, the
term has been used to denote any coherent body of statements that produces
a self-confirming account of reality by defining an object of attention and
generating concepts with which to analyse it (e.g. medical discourse, legal
discourse, aesthetic discourse). The specific discourse in which a statement is
made will govem the kinds of connections that can be made between ideas,
and will involve certain assumptions about the kind of persons(s) addressed'
(Baldick 2001: 68-9).
The literary theorist Catherine Belsey defines 'discourse' eloquently thus:

A discourse is a domain of language-use, a particular way of talking (and

writing and thinking). A discourse involves certain shared assumptions
which appear in the formulations that characterise it. The discourse of
common sense is quite distinct, for instance, from the discourse of modem
physics, and some ofthe formulations ofthe one may be expected to conflict
with the formulations of the other. Ideology is inscribed in discourse
in the sense that it is literally written or spoken in it; it is not aseparate
element which exists independently in some free-floating realm of 'ideas'
and is subsequently embodied in words, but a way of thinking, speaking,
experiencing.
(Belsey 1980: 5; original emphasis)

We can see in this definition that here 'discourse' is embodied in ways

of experiencing and that as a particular 'domain of language-use' (thinking,
talking and experiencing) it resembles a paradigm, and moves beyond the
small 'd' discourse 'language-in-use' concept that the theorist Gee describes
(1999: 7).
displacement A psychoanalytic idea used to describe the 'process by which
energy (cathexis) is transferred from one mental image to another. .. for
instance in dreams one image can symbolise another' (Rycroft 1968: 35).
 234 Key terms informing art therapy

embodied image Arguably, any image which carries with it a strong mood-tone is
an embodied image; art can become imbued with another person's feelings in a
tangible manner, or at least what appears to be a tangible manner. As the writer
Tolstoy put it:

Art is a human activity consisting in this, that one man consciously, by means
of external signs, hands on to others feelings he has lived through, and that
others are infected by these feelings and also experience them.
(cited Harris 1996: 2; my emphasis)
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Joy Schaverien (2011) suggests that, 'no other mode of expression can
be substituted for it', and that 'in the process of its creation, feeling becomes
"live" in the present' (2011: 80). In Chapter 8 I discussed how we feel other
people's emotions; sometimes we can even feel engulfed by them. However,
the intended meaning of the painter does not necessarily hold a privileged
position, so art therapists must always be circumspect about whether they really
are experiencing what was intended, and seek clarification from the person who
created the art work. This is because we bring our own experience and 'habitus'
(our embodied way ofbeing) to the experience ofviewing an art. Art objects in
general are inherently open to multiple meanings and interpretations. Context
too is important in how we see art works (Hogan 1997).
empathy 'This is the ability to identify [with] and thereby understand another
person's feelings or difficulties' (Wood 2011: 81). Art therapists would wish to
demonstrate an empathetic response to the art works produced in sessions.
feminist This is a much maligned and misused term. Feminism is the principle
of advocating the social, political and other rights of women as equal to those
of men. Feminism is necessarily interested in the question of equality (Hogan
2011). In academic writing, feminism refers to a mode of analysis that seeks to
examine the function of sex in societal relations. This mode of analysis sees the
construction of sex (or writers may use the term 'gender') as historically and
geographically situated and subject to change. In terms of feminist art therapy,
this is primarily an enhanced awareness of women's issues and misogynist
discourses (particularly negative psychiatrie discourses about women's inherent
inbom 'instability'). Sometimes, when using directive art therapy, it is possible
to introduce exercises that can help participants reflect on their sex and sexual
orientation. For example, I offer a workshop in which I ask men and women to
bring in two images from any source (newspapers, art books, magazines, etc.),
of a man if they are a man, and of a woman if they are a woman, or if they regard
themselves as gay, lesbian or transgender, they may reflect that in their choice
of images. I ask them to bring in one image they like and another that makes
them feel uncomfortable. These images form the basis ofthe session, and it is an
opportunity to look at how women, 'gay' people and men are represented, and
to explore how participants feel about these images which surround us in our
daily lives.
 Key terms informing art therapy 235

Some art therapists work with women-only groups to readily allow women to
explore unique aspects of their experience, such as pregnancy and childbirth
(Hogan 2003, 2008, 20 12a), or collective trauma such as breast cancer or rape
(Malchiodi 1997), or the experience of ageing (Hogan and Warren 2012).
However, maintaining a feminist awareness is, arguably, an important aspect
of good practice in general and should form an integral part of training.
(Hogan 2011b: 87).

group resonance Members can show empathy towards each other by adopting
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a similar pictorial style or particular symbols or motifs, though this may be

done quite unconsciously, and has been called 'group resonance' by Gerry
McNeilly and others (1984, 2005). This is an idea (taken from physics and
used metaphorically) to describe the way images can seemingly influence each
other and 'resonate' or reverberate together. Certain themes can be held in the
art works and they can be brought out over and over again and reworked. This
process could take place over weeks or months. Richardson (2011) explains
that 'resonance makes the group more than the sum of its parts, rather like the
moment when the individual voices in a choir lend to a spine-tingling complex
chord' (2011: 202).
hegemony Has been used to mean political prominence. In cultural theory, from
the work of Gramsci, it is often used to mean what is taken for granted as
'common sense' or it refers to unquestioned assumptions. It is also used to
refer to the dominant ideology. Taking the example of the concept of taste,
Douglas writes:

Taste is always going to be harnessed to the struggle for hegemony in a

particular community... although good taste claims to rest on universal
principles, it is always challengeable; the challenge comes from those who
wish to subvert the established order.
(Douglas 1994: 29; myemphasis)

This introduces the idea of a plurality of hegemonies linked to different

'community' interests, which is more sophisticated than suggesting one
overarching oppressive hegemony.
icon According to semiology, an icon involves actual resemblance between the
signifier and the signified; for example, a portrait signifies the person depicted
less by arbitrary convention than by resemblance (Culler 1981); however, the
resemblance could be analogous.
iconography 'The branch of knowledge concemed with pictorial or sculptural
representations' or 'symbolical representation' (Macquarie Dictionary 1981: 865).
ideology Hadjinicolaou writes of ideology that:

the very fimction of ideology... is to hide the contradictions in life by

fabricating an illusory system of ideas which shapes people's views and gives
 236 Key terms informing art therapy

them a perspective on their experience of life ... this system ... extends to
myths, taste, style, fashion, and the 'whoie way oflife' of a particular society.
(1978: 10)

In this example, ideology represents a false consciousness, a lack of

awareness of ideas conditioning one's experience and actions. The term has
also been used to describe a system of ideas appropriate to a specific social
group such as 'bourgeois ideology' (Williams 1983: 157).
introjeetion A psychoanalytic concept that forms part of the idea of transference
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(hence its inclusion).

It describes the process by which the functions of an external object are

taken over by its mental representation, by which the relationship with an
object 'out there' is replaced by one with an imagined object 'inside'. The
resulting mental structure is variously called an introject, an introjected
object, or an internal object.
(Rycroft 1968: 77; original emphasis).

metaphor 'The figure of speech in which a name or descriptive term in transferred

to some object to which it is not properly applicable' (Shorter Oxford English
Dictionary 1973: 1315) or the 'comparison of one thing to anotherwithout the
use of like or as' (dictionary.com). Henzell claims that for a metaphor to have
real power, it must be concerned with more than simple tmth or analogy: 'the
comparison affected by it must scandalise current perceptions and so doingjolt
them into a new frame ofreference' (HenzellI984: 23). He defines a metaphor
as 'the illumination of one realm of related facts, associations, history, and
orderings in terms of another. This is accomplished by the interaction of at
least two conceptions of different things in one symbol which refers to them
both' (HenzellI984: 22). A simple example would be the idiomatic expression,
'to lay one's cards on the table' to denote frankness. Metaphors are used
abundantly and eloquently in art therapy, as well as in literature: 'the road
was a ribbon of moonlight' is a literary example (dictionary.com). The use of
metaphor to produce new combinations of ideas is important in art therapy,
where multiple metaphors can interlink to produce multifarious meanings.
motif 'A recurring subject or theme ... a distinctive figure in a design' (Macquarie
Dictionary 1981: 1118).
parataxie distortion This concept derives from the work of Harry Stack
Sullivan and refers to a tendency to distort the perceptions we have of others.
These distortions are the result of relating to another person, 'not on the basis
of the real attributes of the other, but wholly or chiefly on the basis of the
person we see in our fantasy' (Molnos 1998). Parataxic distortions result from
the individual's propensity to shape their responses in relation to previous
experiences; this may also serve as a defense against anxiety. It is a broader
concept to that of 'transference'. See also 'habitus'.
 Key terms informing art therapy 237

projection Literally 'throwing in front of oneself' - hence its use in psychiatry

and psychoanalysis to mean 'viewing a mental image as objective reality'. In
psychoanalytic theory there are two further meanings. The first is 'a general
misinterpretation of mental activity as events occurring to one as in dreams
and hallucinations'. The other 'involves a process in which wishes or impulses
or other aspects of the self are imagined to be located elsewhere in an object
external to oneself' (Rycroft 1968: 125). Projection is often linked with
reversal, in that the emotion or wish feIt is denied, but asserted to belong to
someone else.
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reification A tendency to convert abstract concepts into entities. This tendency

is applied to a complex and multi-faceted set of human capabilities. The
'shorthand' for these intelligences is then reified. Alternatively, sophisticated
ideas ab out human interaction can be 'reificated' in the design ofbuildings. For
example, a ranked lecture theatre with a built-in lectern is a physical design
that illustrates assumptions about the transmission of knowledge.
representation In cultural theory, images and texts are not viewed simply as
'mirrors' which reflect reality. Rather, representations are seen as conventions
and codes which articulate practices and forms that condition OUf experience.
resonance (see group resonance)
scapegoat transference (see also transference) Joy Schaverien describes the
concept of transference, that is, the idea of the magical transferability of attributes
and states, as the main pivot of psychoanalytical theory. Schaverien argues that
the biblical scapegoat may be seen as representing a 'ritualised transference' -
the goat having become a talisman, in that it is magically invested with the power
ofthe sins (1987: 74-5). When the goat is killed his sins are absolved. A similar
process takes place in art therapy when there is a transference of attributes and
states to an object which, subsequently empowered, becomes a talisman. Once an
object is experienced as a talisman, any act of resolution in relation to it becomes
significant and might be seen as an act of 'disposal' (1987: 75).
Schaverien points out that 'scapegoating' can OCCUf in groups, that a person
is punished or ostracised for something which is not their own fault; for
example:

for exhibiting or expressing behavioUfs which those doing the rejecting

might fear, or need to display themselves. The group fantasy may be that
once this individual is removed, everyone else will relate harmoniously.
The bad is all invested in one person.
(1987: 80)

However, if recognition of transference can take place prior to 'disposal' ,

then Schaverien argues that disposal can be positive rather than negative.
Making an art work can enable 'acknowledgement' to take place, since the art
work has undeniably been made by the dient - though such acknowledgement
may be fleeting (1987: 86).
 238 Key terms informing art therapy

Schaverien describes the destruction of the art object as a potentially

'meaningful act [which] offers a genuine opportunity to enact the scapegoating
process in full. Keeping the art object is also a meaningful act which offers the
solution of a different type of disposal'. The dient, she argues, 'has dominion
over the picture or art object, in a way that would never be possible with a
person' (1987: 87).
sign In a sign, the relationship between the signifier and the signified is arbitrary
and conventional; for example, a red cross (usually on a white background)
denotes a first aid kit in the UK.
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simile The explicit comparison of two unlike things; for example, 'she was like
a rose'.
surrealist The word 'surrealistic' has acquired an idiomatic popular meaning,
replacing the rather 1970s 'zany' in conversation. It can refer to iconodastic
images: images that jolt us out of our usual lazy sensibilities. Examples of
iconic surrealistic images are perhaps Meret Oppenheim's fur-covered cup,
saucer and spoon, Salvador Dali's melting docks or Rene Magritte's 'Ceci
n'est pas une pipe' C'This is not a pipe') or one ofhis floating bowler hats. The
surrealist artistic movement dates from the 1920s; artists sought to apply the
idea of 'free association' from psychoanalysis to art, harnessing thought 'freed
from logic and reason' (Breton 1924, cited Hogan 2001: 94). First a technique
called 'automatic writing' was developed and then these ideas were applied to
images. Surrealism was a contributing influence to the development of modem
art therapy (Hogan 2001).
symbol 'A material object representing something immaterial; an emblem, token
or sign... Something that expresses, through suggestion, an idea or mood
which would otherwise remain inexpressible or incomprehensible; the meeting
point ofmany analogies' (Macquarie Dictionary 1981: 1720). 'Something that
stands for, represents, or denotes something else (not by exact resemblance,
but by vague suggestion, or by some accidental or conventional relation); esp.
a material object representing or taken to represent something immaterial or
abstract'; e.g. a wedding ring can be a symbol of marriage (Shorter Oxford
English Dictionary 1973: 2220).
In psychoanalytic theory, symbolism is seen as arising out of an interpsychic
conflict between the repressing tendencies [of the unconscious mind] and the
repressed: 'only what is repressed is symbolised; only what is repressed needs
to be symbolised ... ' (Rycroft 1968: 162). Furthermore, the object or activity
symbolised is theorised as 'always one of basic, instinctual, or biological
interest' (1968: 163). Therefore, the word 'symbolic' is used in a particular
way by psychoanalytically-orientated writers.
It is not necessary to get bogged-down in the fundamentally reductive
psychoanalytical theory of symbolism here. However, symbolic representation
is immensely important in all forms of art therapy (notjust psychoanalytically-
oriented work), as feeling states and ideas which would be difficult or
impossible to articulate verbally can be depicted in symbols and metaphors.
 Key terms informing art therapy 239

Symbols are often 'mysteriously indeterminate' with many possible meanings,

or multiple meanings. Baldick speaks of literary symbols, but his point applies
equaHy to images when he suggests that it is:

usually too simple to say that a literary symbol 'stands for' some idea as
if it were just a convenient substitute for a fixed meaning; it is usually a
substantial image in its own right around which further significances may
gather according to differing interpretations.
(Baldick 2001: 252)
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Thus symbols offer a rich and complex mode of communication.

transference The 'process by which a patient displaces onto his analyst [or
art therapist] feelings, ideas, etc., which derive from previous figures in his
life' via a process called displacement. In this process the client relates to the
therapist as if the therapist 'was a former object in his life'. In psychoanalysis
these are called object-representations [the mental representation of an object]
acquired by earlier introjections' (Rycroft 1968: 168). Or put more simply,
clients 'tend to re-experience emotional reactions which were originally
directed towards members of their own farnilies [or significant others]... in
relationship to their doctor' (Tredgold and Woolf 1975: 22). These feelings are
projected onto the therapist, and to the image. Broadly, the term can be used to
describe the client's emotional attitude towards their therapist (Rycroft 1968:
168). In art therapy the client's demeanour towards their art work is of cmcial
importance, as weH as their feelings ab out their therapist. However, seeing
all aspects of the therapeutic relationship in terms of shifting transference is
potentially reductive in my view.
unconscious Being unconscious is not realising the existence or occurrence of
something, being 'temporarily insensible' (Shorter Oxford English Dictionary
1973: 2406). In psychoanalytical theory, unconscious processes refer to
psychic material, which is only rarely accessible to awareness and which
is repressed or pre-conscious (the latter may arise into consciousness more
easily). It is believed that such psychic material can have a profound infiuence
upon behaviour: 'when used loosely, the unconscious is a metaphorical, almost
anthropomorphic concept, an entity infiuencing the SELF unbeknownst to
itself' (Rycroft 1968: 173). In the 1920s Freud renamed the conscious mind
the 'ego' and the unconscious mind the 'id' (a potentially useful distinction),
the id being associated with 'instinctual' energy and the gratification of basic
needs, the 'ego' being the more cultivated, civilised and socialised aspect of the
psyche. Rycroft discusses why the use of the term unconscious is potentially
problematic:

First it can be and is used to obliterate a number of other distinctions, e.g.

voluntary and involuntary, unwitting and deliberate, unself-conscious and
self-aware. Secondly, it can be used to create states of sceptical confusion;
 240 Key terms informing art therapy

if a person [patient] accepts the general proposition that he may have

unconscious motives, he may then find himself unable to disagree with
some particular statement made about himself, since the fact that it does
not correspond to anything of which he is aware does not preclude the
possibility that it correctly states something of which he is unaware. As a
result he may formally agree to propositions (interpretations) without in fact
assenting or subscribing to them.
(1968: 173; myemphasis)
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As discussed in the main text, it is potentially problematic for art therapists

to offer interpretations for precisely these reasons: that the therapist's view may
be hard to resist, especially if unconscious motivations are invoked. Rycroft
also discusses the potential problem that a client may 'entertain an indefinite
number of hypotheses about their unconscious motives without having any
idea how to decide which ofthem are true' (1968). It makes much more sense,
I'd maintain, for any interpretation of an art work to be undertaken by the art-
therapy participant, as thoughts and feelings reach his or her awareness. The
other, very serious, reason for avoiding focusing on 'unconscious' motivations
for clients' behaviour is, as Rycroft suggests above, that it is simply too emde,
and can distract from the more helpful task of enabling clients to explore their
psychological motivations and complexities. Anyway, it is not my intention
to try to re-convert the psychoanalytically inclined here, so much as to point
out the conceptual pitfalls implicated with the use of this term. Making
assumptions ab out what might be unconscious in art or dis course is potentially
problematic as has been discussed in the main text. In Chapter 13 I discuss
the contribution of Pierre Bourdieu, who has highlighted another way to think
about what we 'unconsciously' bring with us, and called this habitus. This is an
'embodied history, intemalised as a second nature and so forgotten as history
- is the active presence ofthe whole part' (Bourdieu 1990: 56). It conjures up
our habitual ways of being that are not necessarily in our conscious minds, or
even in our consciousness. With an increasing emphasis on embodiment in art
therapy, Bourdieu's ideas may be useful to uso

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Be1sey, C. 1980. Critical Practice. London: Routledge.
Culler, J. 1983. On Deconstruction: Theory and Criticism. London: Routledge and Kegan Paul.
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Gee, J.p. 1999. An Introduction to Discourse Analysis: Theory and Method. London:
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Hadjinico1aou, N. 1978. Art History and Class Struggle. London: P1uto.
Harris, R. 1996. Signs, Language and Communication. London: Routledge.
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Henzell, J. 1984. Art, Psychotherapy and Symbol Systems, in T. Dalley (ed.) Art As
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Hogan, S. 2008. Angry Mothers, in M. Liebmann (ed. )Art Therapy and Anger. London and
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Hogan, S. 20lla. Feminist Art Therapy, in C. Wood (ed.) Navigating Art Therapy: a
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Richardson, L. 2011. Resonance, in C. Wood (ed.) Navigating Art Therapy: a Therapist's
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Schaverien, J. 1987. The Scapegoat and the Talisman: Transference in Art Therapy, in
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Dictionary.com (n.d.) http://dictionary.reference.comlbrowse/metaphor (accessed 23111111).
Momos, A. 1998. A Psychotherapist's Harvest. http://www.net.klte.hu!~keresofilpsyth/a-to­
z-entries/parataxic_distortions.htm1 (accessed 23111111).
 Index
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AATA (AmericanArt Therapy art materials: assessment 55-7;

Association) 10-11,218,227 collage 74, 80, 157-8,219;
abstraction, use of72, 128, 146-7, communication, in 100-1;
152; coup1es relationship 159; with 'contaminated' 68, 70; definition,
families 157; mood 34; princip1es art therapy 9-10; do the thinking,
for74 let 84; expression, and 40-1, 45,
abuse 136, 166; see also domestic 99,101,124,134; evaluation 59;
violence, image, sexual, trauma group painting 37; importance
activities see art tasks of70, 139; keep tidy 68;
Adamson, E. 97 manipu1ating 27, 30, 38; practice,
addiction: alcohol142-3; anger and in 19, 60, 68, 71,111-2,141,161;
140-1; denia1 ofl44; group 143-8; printmaking 18-19; scu1pture 18,
understanding of 143--4,146; see 38,40-1; suggested 12,17-18,
also art tasks, intervention, mental 40,56,72,74,158; time bound 17;
health training, in 27, 33-7, 39, 46, 67,
ado1escents 114, 132-3, 135-6, 154, 73,76; training kits 73--4; working
177-8, 181; see also child, fami1y, without 79; see also collage, ETC,
solution-focused evaluation, photo, scu1pture, tidy
advertising, promotion 52, 195,203; up, visua1 diary
for a co-therapist 184-5; see also art psychotherapy 9, 10, 219-20; see
funding also group
advocacy drawing see IDT arts in: education 21; hea1th 10,22,220
a1exithymia 148 art space see space
allied hea1th professionals 3; education art tasks: addiction 143-8; ado1escents,
of64, 146, 160; considering with 135; assessment 55-8; collage
materials 70; co-therapist with 131; coup1es, with 159; endings
179-80; forming partnerships 61 50-1; ETC 72-3; experientia1 79-
ana1ysing: se1f as student/client 29, 46; 81, 146-8; families, with 156-9;
skills 192 group, with children 124-32; group
'ana1ytic' art therapy 22, 78, 93; see introductions 34-5,46,58,80, 125;
also art therapy,jouma1ing se1f-box 80-1,144; se1f-focused
anger: and art 143; cathartic release 125, 145--6; in supervision 208-9;
33,41,87,140-1,143; management themes 47-8, 124-32; titling work
181; vio1ence 166; see also trauma 157; try out beforehand 161; see
ANZATA (Australian and New Zea1and also 'free' picture, narrative,
Arts Therapy Association) 11-12, solution-focused, endings
227 art therapist(s): co-therapy, in 180;
artistic merit 69 establishing sharing 160-2; outsider
 Index 243

217; see also documentation, Cade, B. 141-2

guide1ines CAMHS (Chi1d andAdo1escent Mental
art therapy: ana1ytic 93-5, 106; 'camps' Health Services) 22
217-18,220-3,225-6,228; Campanelli, M. and Kaplan, F. 52
children of 222, 228; with children Carroll, M. 206-7,209-10,214
5; definition of 9-11; dysfunctiona1 Case, C. 116
family of222-3, 228; gestalt 75, Case, C. and Dalley, T. 107, 122, 132,
91, 106; global view 217; history 189,193,212
of 20-1,218,223; integrating case notes 196,213; see also
perspectives 221, 228; international documentation
community of217, 228; owning the catharsis see anger
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name 61; 'parentnations' of222, causality 153, 156

228; pioneering 223; polarisation certification see registration
222; practitioner 3; presentations 61; change 167; see also solution focused
se1f-image 125; training standards Chebaro,M.115-16
218,220; va1ues of87; see also child: art therapy with 5; deve10pment
job titles, international, space, . 134-5; establishing trust 132-3;
.
supervlsee, supervisIon, supervIsor group work 122-32; observation in
Art Therapy Without Borders 228 training 224; see also education
art works see documenting Chipp, H.B. 20-1
Asian (art therapy) 220, 222, 224-5; classroom: setting 116, 123-4, 182;
training standards 220, 224-5; see schoo1 art 169, refusal125, 154,
also Potash, Singaporean, Taiwanese se1f-box, as 81
assessment: administering 55-7; classroom setting: co-therapy 182;
collage in 157-9; designing 57-8; research 124
interpreting 78; procedures 124; client: relationship with the page 83;
purpose of55; UK vs US 218, 219; speak/language 78; support (visual)
see also referra1 84
association: membership 61; national 61 clinica1 p1acementlpracticum see
ATCB (Art Therapy Credentia1s Board) placement
218,227 clinica1 team see team work
ATR (Art Therapist Registered) 227 Coalition of Art Therapy Educators 227
Australian (art therapy) 220-3; cognitive/symbolic 71-2, 134, 155; see
predjudice 119; progranmles 224 aisoETC
automatic drawing 136 collage: ado1escents, with 135;
assessment 158-9; chi1dren, with
BAAT (British Association of Art 131; coup1es/families 157-9;
Therapists) 9,11,21,195,228 materials 74; photo 135
Betensky, M. 74-5,78,211 communication: co-facilitation 176,
Birtchnell,J. 91-3, 106 178; consu1tant 85; exercises 34, 36,
Blake, P. 132, 134 143-6; families, visual with 151;
Bloch, S. and Crouch, E. 167-8 non-verbal134, 180; team building
body image see image 86
body 1anguage 37; see also conferences
.
see profi1ing
.
communication non-verbal conSCIOUS see unconsclOUS
boundaries see ethics, groups, space, confidentiality: of art work 14, 34, 193,
workshops 198-9; group 67; limits of 55,59,
Bourdieu, P. 165 199,211; trust 132-3,200; see also
brain: ado1escent 135; chi1d 122, 136; documenting
emotional122; hemispheres 149, continuum, art therapy 89-91, 100-3
and trauma 136 contract: with clients 199,202;
breath, use of 42 corporate sector 85; co-therapist,
British see UK with a 175-6; placement 193;
 244 Index

supervision 187,202,207; with 182; during training 30, 35, 55,

supervisors 202 78; 1egalities of55, 58,161,196,
corporate, art therapy 85 213-14; naming 78; reports 59; se1f-
co-therapy: agency collaboration 177-8; refiection 80; supervision, for 206;
art 6-7; art tasks 183; contracting visual183, 213-14; see also case
175-6; fami1y art evaluation 156; notes, endings, ethics, exhibiting,
gender balance 177; interview journa1ing, photographing, reports
for 184-6; ro1e 180-2; see also Dokter, D. 115-16
documenting domestic vio1ence 41,113,125--6,136,
Coulter,A. 58, 83,122,128-30,133, 154
139-40,147,149,152,159,214,217, dream: day dream 128; diary 84;
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223-4; men's retreat 179 images 128-9; interna1 world 81

Coulter-Smith, A. 223 dress code 60
counselling/counsellor: 10-11; coup1e drugs see medication
and fami1y 22, 160; documentation, DSM-5 123,148-9,218
case 213; rooms 60; school123; Dubowski, J. 41, 134
session 83,155,61; title,job 54, 77, duty ofcare 33, 181
82-3,206; training 37,220; see also
art therapist( s), profiling Eastern; hea1th 225; infiuences 8,
coup1es: co-facilitator ro1e 185; families, 224-5;
and 6,151-2; sub-system 151; see education: absence of220; art 123; co-
also fami1y, training, working in pairs therapist 179; see also training
Crago, H. and Crago, M. 210,152 Edwards, D. 188-9,219
creative process 11, 81; with chi1dren Edwards, M. 99
124; stages of81-2 emp10yment: collaborative team 59;
credentia1s see professional, registration extending p1acementlpracticum
cu1ture: adaptation to 52; elash 200; 53; finding 53-4; see also job(s),
diversity 119; fiexibility of 221; professional
institutiona1 140; and interpretation endings: documentation 213-4 fami1y
112-19; issues 3,112-14 evaluation 157; farewells 131-2;
cystic fibrosis 127 gift-giving 50-1, 132; of sessions
45,181-2,202-3; structured 50-1,
Dalley, T. et al. 78-9 116; training workshop 38, 75
DDS (The Diagnostic Drawing Series) environment see space
56-7 equipment see art materials
debriefing: co-therapy 183; group 182; ETC (the Expressive Therapies
visual diary 146, 148,211 Continuum) 66, 68, 70-3;
definition: of arte s) therapy 2, 9-11; abstraction 159; see also cognitive/
presentations 65, 77 symbolic, kinaesthetic/sensory,
dehumanising see institutiona1 settings perceptual/affective
denia1, breaking through 144 ethics: art work display 59; BAAT
detention centres see refugees 195; behaviour 203; boundaries
deve10pmenta1 see chi1d 195; code of61, 67,195,198,203;
diagnosis, misunderstanding about 9, 12, guide1ines 160-2; ownership 59;
55,65, 123, 197; see also tests photographing work 196;
directive, and non-directive approach responsibility 59; supervision 194
32-3,55-8, 110, 170-1; group ending evaluation: art materials, of 59; elient
50-1,131-2 se1f 59; fami1y art 156-7; workshop
dissociation 148 75
documenting: art work 14, 66-8, exhibiting art work 12, 19, 59, 111; see
83-5,161; case notes 196,214; also documenting, photographing
elient statements 55; consent, written experientia11eaming 2, 26-8, 38, 65
59, 197; co-therapist ro1e with Expressionism 21
 Index 245

Facebook 228 boundaries 19,34,67,75,196;

family: agenda 160; art evaluation 146- chi1dren's 124-32; curative features
7,156-7; art therapy 11-12,69,74, 168; debriefing 182; diverse 5;
79,81,153-5; assessment 157-9, empathy in 173; feedback 181;
179; breakdown 22, 140; clients 59, 'frame' 153, 176; 'ground mIes'
209; co-construct 153,162; cu1ture, 34; guidelines, training 66-8,78-9;
and 224; dynamics, generational intensive 151; interactive model
barriers 151; dysfunctiona1 system 6,30,32,95-7,164-9,167; -led
153-4,161,222,228;effectof approach 171; men's 178; painting
addiction on 141,144-5; extended 37-8,169; pre-interviewing 181;
work 59; group dynamics 168; prob1em-focused 57-8,141,197;
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genogram, visual147; ofinmates processing, visua185; resonance

141; 10ss 132; mapping 147-8; 169,235; safety 98; scu1pture
-of-origin 135,145-7; picture 38-40,146-7; seating 19, 180;
assessment 57, 127-8; portrait 57, si1ence 173; size 44; student 1ed
72,128,145,147,157; schoo1,and 49-50; themes 124-32, 131;
124; scu1pture 57,146-7,152-3, transference 165, 172; UK vs US
159; system 133, 144, 147, 151, work 226; work with 6, 13; see also
153-4, 161; therapist's 94, 186; art tasks, child, directive, endings,
therapy team 61,154-5,176-7,206; guide1ines, image, 1anguage,
vio1ence 154, see also ado1escent, mandala, offenders, space, training,
art tasks, Cade, causality, coup1es, visua1 diaries, working in pairs,
Kwiatkowska, metaphor, narrative workshops
story board, professional titling guided: drawing 179; fantasy 29,41-3,
fantasy see guided fantasy 86; interna1 world 81
fathers-to-be 178 guide1ines: group 66-8; with familie si
feelings 58 coup1es, before sharing 160-1;
feminist approaches 101,112,235 processing 69-70, 78-9; training 61,
fo1ders 14 70,223; supervision 195; see also
'free' picture 79: assessment 55-6, standards
57-8,124-5; association 159, 169; Gussak, D. and Virshup, E. 139-40,
communication 66; with families 143
156-7
fun 40, 151, 162, 169 'habitus' 165
funding: chi1dren's groups 123-4; lIagood,1J.217-18,220-1,223
cost cutting 205; generation of 53; lIauser, A. 20-1
insurance 60; limitation 58, 72; lIawken, D. and Worrall, J. 210-11
private hea1th 60; state 60,155; hea1th: care 7, funding 60; insurance
support for 175; see also hea1th 7; practice 225; systems 220, 222;
future focus see solution focused work 22; see also arts in, funding,
mental
gamb1ing see addiction lIill, A. 20,218
gestalt model see art therapy lIogan,S. 12,20-2,97,99,108,111,
Gi1roy, A. and Skaife, S. 225-6 113,116,205,218
global: challenges 220, 223; cultura1 lIong Kong (art therapy) 65, 116, 222,
trends 221, 225; disaster 226; future 224
61-2,209,217,229; variances HPC (lIea1th Professions Counci1) 194,
62; view 217-18; 226-8; see also 218,226-7
international
Goffman, E. 139 IDT (Interactive Drawing Therapy):
group: addiction 143-8: agreement advocacy drawing 142, 155;
66-70,83,97; 'ana1ytica1' processes coup1es, with 152; definition 82-3,
22,29; art psychotherapy 220; 160; guided 179; metaphor 156;
 246 Index

method 83,152,156; use ofwords 228; discussion 26,34,45,

160; see also Withers 77, 112; consensus about 112;
image: abuse 117; affect, and 72, 98, misunderstanding 9,21,36,44,
107, 133;approaches to 78, 100, 65,78, 107-8, 192; selective
157; assessment of 9-10, 19,55-7; questioning 26; skills 36-7;
body 32,40-1,45-7,74, 111, 145; workshop training 35-7,45,48,65
'-eide' 112; diagrammatic 106,208; 102,105-7; supervision, in 188,
dialogue with, narrative 10, 12, 192; see also assessment, image
91-2; emotional distance 142, 156, intervention: addiction groups, for
208; group training, in 29-30,34, 143-8; creative 178; designing an
36-8,44-7,95-8,168-9,171,191-2, 155-6; group group 79,111,141,
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207-9; imagery 29, 47,82,149; 143,174,176,178,184-5,188,

literal36, 72,152; memory 134, 141, 203; sculpture 38--41; refiecting on
148; metaphor 151; pre-cut, found experience 39; solution-focused
131,135,157-8; portrait 58,80; 141; strategie 151, 155; systemic
revealing 47-8,84, 110; role ofthe 153--4; team, family 154-5; using
5,28; scribble 56, 66, 159; self 37, metaphor 155-6; see also familyl
46-8,58,66,80,125,145-6,188; couple
storage 12,211; televised, trauma introductory: professional training
136; words, and 83-5, 160, see also 32-3; refiective practice 28-31
art materials, collage, documenting, isolation: professional 52, 61, 205,
family therapy team, interpretation, 209-10,222--4,229
metaphor, photo, trauma
incarceration see offenders James, R. 112
individuation: vs conformity 139 job(s): description, negotiating 54;
information sharing 9 title, another 85, 206; see also
INGAT (International Networking Group employment, professional
ofArt Therapists) 8, 223--4, 226 journaling: analytic 38-9; refiecting
institutional settings: benefits of art in 39; visuaI84-5, 146
149; culture in 140, 198; effect on Jung,C.G.21,99,105,218,225
groups 31; organisational systems
139; see also residential settings Kahnanowitz, D. et al. 225
insurance: health 58; professional kinaesthetic/sensory 71-3,169; see
indemnity 60 aisoETC
interactive art therapy 95-6, 109; see Kolb, D.: learning cycle 208-9
also group interactive model Kramer, E. 55-6, 123--4, 133
internal dialogue 10,67-8,75, 160, 176 Kramer Art Evaluation 55-6
international: community 223, 229; Kwiatkowska, H. Y 127-8,146,
development 223--4; discourse 223, 156-7
226; educators 223--4; journal of art Kwiatkowska Family Art Evaluation
therapy 89, 228; perspective 61-2, 146, 156-7
217-18,222,225-6; polarities 217,
223,228; registration 226-7; training Lala, A. 114-15
standard 221; see also art therapy Landgarten, H. B. 74,131,135,153,
'camps', Asian, Australian, global, 157-9
isolation, job(s), New Zealand, language: body 37, 106; bypassing 79;
professional, Singaporean, Taiwanese, internal 67; of maker 70; metaphor
UK,US for task 155-6; promotional 85;
InternetILinkedinlSkype 211, 228; see questions 36, 39,48-9; symbolic
also Facebook 134, 169; trainee, ofl92; visual
interpretation: abuse, and 107~8, 75,81,151; words as symbols 160;
135; assessment, in 55, 78, 112; writing words, IDT 83,160; see
cultural aspect to 109, 116, 119, also documentation
 Index 247

Levick, M. F. 135 new service, art therapy: establishing

Liebmann, M. 97, 125, 131, 139,140- 54; provision of 53-60; supervision
2,144,148; see also narrative 205; see also emp1oyment, jobs
storyboard New Zea1and (art therapy) 11,25,
line conversation, with coup1es 159 82-3,222,227
locus of contro1 124 Nightinga1e, F. 20
Lofgren,D.117-19 NorthAmerica see US
Lowenfe1d, V. 123, 134-5
Lusebrink, V. B. 70-3,212; see also observation 48, 167, 192,201; see also
ETC,MDV,RD training, teaching
offenders 5,139-40,197-8,201; group
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McNeilly, G. 169,235; see also group, work with 143-8; incarceration 149
therapeutic community
McNiff,S. 109,114,116,119,211,225 peer: debriefing182-3; supervision
mandala 145; centre point 127; hands, 183,209-10
in group 131; phi1osophy, Eastem pena1 services see institutiona1 settings
225 Pemose, R. 21
mapping 58, 125, 141, 144-5, 147-8, perception: arousing effect 72; creative
152 process 82; distortion of 36; past
marketing and promotion see profiling 134; se1f 37,46; unique 45
materials see art materials perceptua1/affective 71-2; see also
MDV (Media Dimension Variables) 73 ETC
medica1 settings 54, 59 personal: disclosure 30; liability
medication 54, 219 60; therapy 7,187-8,214-15;
meditation 42 mandatory or recommended 220
men(s): group 97,177-9,198; physica1 person-centred art therapy 98
dimension of art 71-3, 152; on phenomeno1ogica1, approach/model:
retreat 179 contemp1ating art work 74-5; in
mental: health 7,10-11,22,77,111, supervision 208, 211; see also
177; illness 122-3, inprison 140 Betensky, M.
mentor 85,145; in supervision 193, photographing: art work 41, 67, 196;
210 digital, consent 184; image 74,131,
mess see tidying up 135; see also collage, documenting,
metaphor 3, 5,12,21,28,35-6,39,41, ethics, exhibiting
47,86-7,95,99,105,125,143, pioneering art therapy 52, 62, 64;
151-2,154-6,169,179,183,191, isolation 223-4
205; family 161; as intervention p1acements/practicums: anxiety about
155-6; for se1f 130,134,154-5; see 195; expectations 201; extended
also image, scu1pture emp10yment 54; supervised 33,
Miracle Question, The 141-2, 147; see 189,193,201; vulnerability 188,
also solution focused 203; see also emp1oyment, jobs
Modood, T. 116-17 p1ay: 'alive' 134; art and 134; creative
motherhood 100, 178 process of 82; not a diversion 162
post-structuralist 96
narrative: approach 141,154; art task Potash, J. S. et. al. 221,225-6
80,154; and solution focused 141, practicums see placements
162; story board 141-2, 148, 162; presentations see profiling
see also image, White and Epston printmaking see art materials
national association: establishing 61 prisoners see offenders
native American 115,117-19 private: hea1th schemes 219; practice
natural disasters: and art therapy 224, 60; space, visual diary 83, 85,214
226 problem, the see group, solution-
neuroscience 122 focused
 248 Index

processing see guide1ines safety: of art work 14; client 58, 98,
professional: association 61, 209, 217-18, 143,181-2; trainee 201-2, see
221-2,224,226; bui1ding respect 54, also group, space
59; code of ethics 61, 67, 195,203; sca1ing questions 142
deve10pment delivery 64-5; dia10gue Schaverien,J. 14,18,67,93-4,107,
228; titling 54, 61, 85, 206, 219; see 116
also dress code, ethics, insurance, schoo1(s): refusal154; see also
isolation, jobs, supervision classroom
profi1ing: portability 226; practitioner, scribb1es: assessment, in 56;
endorsed 226-7; promotiona1 deve1opmental135; experientia1
packaging 85; se1f as a practitioner 52; presentation, for 79; family and
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the profession 52, 61, 64, 79; see also jointfami1y 157; in training 30,
advertising 159
projection 34, 36, 87, 98, 165, 170 scu1pture: group 38-40; materials 18;
promotion see profi1ing p1asticine/clay figures 191
psychoana1ytic see 'ana1ytic' se1f: box 80-1,144; children 125;
-conscious 28, 43, 167; harm 127,
qualifications 227; Master's degree 33, 181; realisation 149; referral198;
221-2; promoting previous 54 refiection in practice 28, 110, 188;
questions36,39,48-9, 105-6, 131, 192; -supervision 84, 183,209,211-13;
sca1ing 142; solution-focused 142; into see also image, metaphor
statements 70; supervision 198; see sexual: abuse 41,97,130,136;
also Miracle Question transference 60
shame 143, 145--6, 166
RD (refiective distance) 73, 212 de Shazer, S, 58,141-2; see also
recording see documenting Miracle Question
referral: case suitability 54; direct 54, si1ence see group
215; forms 59; see also assessment, Singaporean (art therapy) 220, 224
documenting, se1f-referra1 Skaife, S. and Huet, V 95,98-9,
refiection in: experientia139; intercultura1 171-3
5; 1earning 38-9,48,194; practice Skaife, S. 97-100, 109, 113, 164,
28-30; supervision 212; see also 169,172
journa1ing, se1f, visua1 diary, working solution-focused: ado1escents 133;
mparrs art task 130-1, 141-3; assessment
Refiective eycle, The 190 58; with families 162; looking at
refiective diary see jouma1ing, visua1 change 147; andnarrative 141
diary space: for art therapy 13-17;
refugees and migrants 115, 175 boundaries 19, 195; defining
registration: supervision requirements for 2,197; as environment 2, 15;
206,209; internationa1226-7 establishing safety 58, 133, 173,
rehabilitation contexts 22 197,226; fami1y work 161;
relationship see therapeutic 1eaving the 181; managing/
report: assessment 58; disclosure 166, ownership of 13-14; as part of
168; mandatory 59; proforma 59; contracting 19; safe 19, 58,145,
supervision, in 193,206-7; verbal 197; sharing 18-19; see also
212; see also documenting private space, storage
residentia1 setting 181 spiritua120, 81,145,224
Ri1ey, S. 4, 152-3, 188 spontaneous gesture drawings 84
risk: supervisee 214; -taking 72 standards: compromise 221-3;
Rogerian, person-centred 98 cu1tura1 context 8; establishing
ro1e p1ay: use of 48 guide1ines 61; establishing new
Rosa1, M. 124,226 61, 221-2, 227; international,
Rubin,J.A. 15-18,133,136,218 need 226; Master's degree 221; of
 Index 249

practice 61,226; pre-requisites 219; tidying up 18,68,182

ofproficiency 194; training, approva1 time frarnes 19,34-5,37,44,46,75,96,
of 220; US vs UK 218220,222,225; 111,170-1,175,178,180-1
see also education, registration time1ine 117
storage 14, 161,202; see also 'too1 kit' see art materials
documenting, image trainee 1,28-30,53,188-92,196-7;
strategic see intervention see also art psychotherapy, personal,
studio approach 17, 97, 111-12 superVlsee
subpoena 213 training: baby!child observation 108,
supervisee: anxiety 195, 199,200,203; 224; coup1es art therapy 159-62;
on placement 188, 200-2; rights and establishing 52; groups, experientia1
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responsibilities of 206, 215; see also 32,65,100,146-8; ob server in

confidentiality, trainee 35; and personal therapy 215;
supervision: of allied hea1th psychodynamic 220; students as
professionals 162, 207; art tasks in co-therapists 183-4; tasks 34-51,
207-9; assessment 194; boundary 79-81; UK vs US 220-2; see also art
of214; co-facilitation, for 182-3, materials, guide1ines, introductory,
185; contract 201, 207; counter- teaching, working in pairs, workshops
transference 162,212; for credentia1s 'transatlantic': 'camps' 221, 223;
209; diary, visua184, 211-12; dress dia10gue, exchange 220, 223, 228;
code 60; hours 210, 227; internet divide 217, 222-3; framework 221;
211; on-site 192,200; stages of 211; 'split' 225; see also art therapy
transference 165; university-based 'carnps', international
187,192-3; see also contracts, transference see group, supervision
new serVIce, peer supervIsIon, transitiona1 object 82
placements, 'reflective distancing', trans1ating: accessing know1edge 61;
report, se1f-supervision, supervisee, working with 201
tranee trauma: chi1dhood 125, 136; disclosure
supervisor: clinica1 188, 162,205; of 166; flashbacks 148; imprisonment
'internal' 211; on-site 192-3, 198, 148,175; memory 116, 145, 149;
200-2; relationship with 107 natural disaster 136,209,224,226;
symbolisation 82 PTSD 148-9; vicarious 136, 154;
symbolism 20, 36, 82, 117 see also domestic violence, sexual
systems see institutiona1 settings abuse
treatment, residentia1 175-6
Taiwanese (art therapy) 220, 224-5 triangular configuration 10
talks 64, 77, 206; professional trust, establishing with: children 132-3;
deve10pment 64; see also defining importance of200; offenders 143;
art therapy, profi1ing revealing 158; therapist's 136
tasks see art tasks
teaching: art therapy 3; experientia12, UK: 'art psychotherapist' 219; art
66; introductory 3, 36, 66-70; use of therapy assessment 78, 219; art
observer 35, 48,191; strategies 4 therapy models 4,8-9,89,136,169;
team work: bui1ding 64, 85-7; clinica1 diversity 114; dominant discourse
77; collaborative 59,178,181; see 52; healthcare 7; journa1228; safe
also corporate art therapy, co-therapy space 226; standards 220-1; training
Teasda1e, C. 141 requirement 192, 194, 214, 224;
techniques see art tasks unconscious 220, 226; see also HPC,
termination see endings BAAT, international
tests, diagnostic 116 Uhnan,E. 56
therapeutic: community 195-6, 199; UhnanAssessment, The 56
relationship 133 unconscious!conscious 21, 47,55,67,69,
therapist's agenda 70,83, 160 79,87,95,124,128,133,140,148,
 250 Index

152-3,161,176,219; 'collective' well-being 11

82; creative process, in 81-2; Western ideas: integration of, ideas
group 180; integration 83-5,219; 8,113-14,221,224-6
processing 84-5, 116, 166, 169, 176, White, M. and Epston, D. 142, 154;
219; supervision, in 107,206,209, see also narrative approach
211,214; team-building, in 86, see Wilson, M. 142-5
also se1f-conscious Winnicott, D. W. 82
US: art therapy assessment 218-19; Winnicott Scribb1e Technique 79;
diagnostic tests 116; global disaster see also scribb1es
226; dominant discourse 52; group Withers, R. 82-3, 133, 142, 144-5,
work 226; standards 220-1; training 155,160,179,209; see also IDT
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224-5; see alsoAATA,ATCB,ATR, Withymead 21, 99

international women 22,48,80,100,113-15,
154,175
van Gogh, Vincent 21 working in pairs/coup1es: in groups
verbal psychotherapy: art adjunct 90-3 34-7; training 68-9
visual diary: debriefing 146, 148; workshops: boundaries 75;
deeper se1f-ana1ysis 28; group experientia1 content 66,79;
guide1ine 67-8; men's group 178-9; introductory 34-7, 65; owning
refiective 28; spontaneous 59; use the name 61; personal therapy,
of83-5; see also jouma1ing, private not for 75; purpose 36; student
space, supervisIon 1ed 49-50; training, on addiction
vitality of affect 81 146; see also groups, profi1ing,
training
Waller, D. 6, 13, 30, 32,44, 95-6,
165-9 Ya10m,I. D. 19,96,167,170
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