Art Therapy: Healing

Through Imagery

February 2014
 …as the imagination
is not a talent of
some men but is the
health of every man.
- Emerson
 What will these next
few
days be about…?
• Brief History of Art Therapy
• “Art IN therapy v.s. Art AS therapy”
• Art and the Brain
• “How does creativity affect the brain and how can
it help the traumatized clients you work with?”
• Art Applications
• “How can I take what this client is saying and
apply a creative intervention?”
• Art Interpretation
• “What do I see when I look at this work?”
• Case Studies
• “Let’s see this art therapy in action!”

AND…..
 What will these next
few
days be about…?

Most Importantly…

• Exploring your personal

creativity
“We can’t own something till we do it
ourselves”

Let’s get started!

Let’s Get Grounded

OMMMMMMMM
 Let’s Try

• Slowly remove a sheet of paper from you kit

• Let’s the colors choose you
• Begin drawing freely on the paper allowing
images to emerge naturally
• Reflect back on the time of meditation
– Where there images that presented themselves
– Memories
– Shapes
– Feelings
• Relax into the drawing and let it emerge
before you…
 Art Therapy: So what
is it?

• Art therapy uses art materials

combined with traditional
psychotherapeutic theories and
techniques with an understanding
of the psychological aspects of
the creative process, especially
the affective properties of the
different art materials….HUH?
Art Therapy: 2 Schools

• Art AS Therapy:
– The belief in the inherent healing power of the
creative process of art making. This view embraces
the idea that the process of making art is
therapeutic in and of itself
• Art IN Therapy:
– Art is a means of symbolic communication. Drawings,
paintings, and other art expressions are helpful in
communicating issues, emotions, and conflicts. The
art image becomes significant in enhancing verbal
exchange between the person and the therapist and
in achieving insight; resolving conflicts; solving
problems; and formulating new perceptions that in
turn lead to positive changes, growth, and healing.
 Art Therapy: Who
Started it?

• Art Therapy “greats” include:

• Margaret Naumberg
– The Mother of Art Therapy
• Edith Kramer
– Art “AS” Therapy
• Helen Landgarten
– Art “IN” Therapy
 Margaret Naumberg -
Dynamically Created
Art
• Founded the Walden School with an emphasis on spontaneous
creative expression OVER the more traditional, intellectual
approach.
• Fascinated by Freud’s dimensions of the unconscious and Jung’s
collective unconscious
– The Mandala!
• Believed in the release of the unconscious imagery as healing to
be understood and analyzed FIRST AND FOREMOST by the patient and
then the therapist.
• She believed that the unconscious was most directly tapped
through imagery and was one of the first therapists to view this
creative material as a primary agent, rather than an auxiliary
tool
• She concerned herself more with the actual image that with how
it was created. The art product played a vital role in
displaying conflict within the patient and it was for the
patient to interpret and assign meaning.
• She did not stress the importance of aesthetics. It was her
belief that virtually any image could provide meaning and
symbolic representations.
 Edith Kramer
Art “AS” Therapy
• Art AS therapy was the hallmark for Kramer’s theory. She
believed that powerful energy can be resurrected and
transformed through the process of art making and the use
of sublimation.
– What otherwise might be negative or primal energy
transferred or displaced fosters individuation and builds
the ego. There is a positive correlation between the quality
of the art making and the ego/super ego relationship.
• Kramer believed that it was very important for the
therapists to be well versed in therapy, art and
teaching. However, she did not feel as though the role of
the art therapist was to provide deep meaning of the
work. Instead she felt the pleasure and satisfaction
associated with the art process itself was supreme
• Kramer heavily emphasized the aesthetic nature of the
art. She believed that the maturation of the art was a
direct correlation to the completion of the sublimation
process.
 Helen Landgarten-
Art “IN” Therapy

• Landgarten believed that the roles of the art

therapist, was that of the primary therapist.
The therapist takes an active role as an agent
of change in the here-and-now by the use of
goal-oriented directives.
• She believed that the therapist’s role was to
educate the patients to record thoughts,
emotions and associations which relate to their
artwork and to encourage the clients to
understand the correlation between their
artwork and themselves.
• The therapist was also there to provide
insightful feedback, give clear directives
around the relevant issues, and act vigilantly
to understand the overt and covert messages in
the artwork and the art making process.
CREATIVE INTERMISSION
 Trace your hand

• Trace your hand using materials

in your kit.
• Cut out the hand decorate the
hand in whatever manner your
choose
• Place it on the large banner in
the room…

• We will come back to this…..

Art Therapy and the
Brain
 Art Therapy and the
Brain-
Left v.s. Right

The Left Brain: The Right

Communicates Brain:
verbally, is Communicates in
analytical and images, is
critical, able symbolic and
only to tell us emotional, and
what we think can tell us
we feel. what we
actually feel.
Art Therapy and the
Brain - Not exactly
Left versus Right
 Brain-
Consider the Whole
Thing!
 Brain Integration

• So art is visual, imaginative and intuitive

(right) -
– Art AS THERAPY
• The ability to create a logical, orderly,
sequential narrative ABOUT the process is left
– Art IN Therapy

• Consider the importance of someone who is

either left or right dominant and how
important it could be to integrate the two
with-ART THERAPY!
 Brain-
Let’s do more that
just talk!
•Barbara Ganim, an art therapist based in
Rhode Island, USA, discusses that:
•When we talk about our emotions, we allow
our left brain to interpret them through a
linguistic, critical filter that is filled
with all sorts of baggage (e.g., cultural
expectations, limitations of words).
Conflict of ten persists because something
gets lost in this translation.
•Ganim expressed the in-effectiveness of
verbalizing emotions: "We try to talk it
 Art Therapy and the
Brain-
Art Therapy Can Help

•Emotional and mental unrest are the by-

products of this conflict between the heart
and the head, or the right and left brain.
•The goal of therapy, according to Ganim
(1999), is to synchronize these two aspects
of our personalities.
•Art therapy can prove superior to talk
therapy in accomplishing this goal, because
it allows us to experience rather than
verbalize our feelings.
 Art Therapy and the
Brain-
The Image is Proof

•In the sense that artistic expression

brings forth feelings from the depths of the
unconscious in the form of imagery, art
therapy is similar to free association and
dreaming.

•Not only does the creative process reach

further into the unconscious than
traditional talk therapy, it also records
progress the client can monitor in a way
that other therapies (e.g., art therapy) do
CREATIVE INTERMISSION
 What is in your heART?

•Remove a sheet of paper from

your kit
•Consider the shape, size and
state of your heart
•Draw a reflection of what lies
inside of you
•Consider feelings, dreams,
aspirations, wounds, pain, love
etc…
 Art Therapy, The Brain
and Trauma

•Studies of the brain help us to understand how

traumatic memories are stored. Recent research
conducted by Schiffer et al. (1995) measured
hemispheric activity of the brain in subjects with a
history of trauma while they thought about a neutral,
work-related memory and then an unpleasant early
memory.

•These responses were compared with a control group

(no known trauma) in which participants recalled a
neutral work related situation.

•The trauma group showed significant left-dominant

asymmetry during the neutral memory that shifted
 Brain-
More Research on
Trauma
•Other studies have shown that exposure to
violence or
trauma alters the developing brain by
altering neurodevelopmental
processes.

•Rauch et al. (1996) used PET scans to study

patients suffering from PTSD. When presented
with vivid accounts of their traumatic
experiences, these individuals showed
autonomic arousal; All at the same time,
there was a heightened activity in their
right amygdala and associated areas of the
 So What Does This All
Mean?

This suggests that since these experiences

are processed and
stored in a part of the brain that is
preverbal or nonverbal,
it makes sense to pay more attention to
nonverbal methods
of treatment…I.E.

ART THERAPY!
CREATIVE INTERMISSION
Let’s Explore Our LEFT
Brains!

• Take out a pencil and begin to scribble with

your non-dominant hand…
• Scribble as freely as you can just allowing your
left brain to turn off and your right brain to
turn on
• Let the pencil move freely over the paper. Keep
the pen on the paper at all times.
• Now exchange your paper with your neighbor and
see if you can identify an image amidst the
scribble.
• Take a different color pencil or marker and
begin to pull out and accent that image…
• What did you see?
What do you see?
What do you see?
What do you see?
 So How Does it Work?

• Using skills in evaluation

and psychotherapy, art
therapists choose materials
and interventions appropriate
to their clients’ needs and
design sessions to achieve
therapeutic goals and
objectives.
 Art Material Continuum

For Instance: For Instance:

OCD, Low Frustration Schizophrenia,
disengagement, trust
Tolerance, Fears,
issues, building the
Family Enmeshment,
therapeutic
Personality Disorders
relationship, poor

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boundaries, need for
control
structure

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Pen red
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sti

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1 2 3 4 5 6 7 8 9 10

Least Most
 Advantages of Art
Therapy

• Imagery
• Decreased Defenses
• Objectification
• Permanence
– Transitional object
• Spatial Matrix
• Creative and Physical Energy
 Giving the Art
Directive
• Look for openings in the conversation to
move to art exploration
– E.x.
• Therapist: “So tell me how you’re a feeling today”
• Client: “ Good”
• Therapist: “Can you elaborate on that feeling at all?”
• Client: “Well I recently passed my exams”
• Therapist: “Wow. I imagine that is a good feeling.
Would you be open to showing me what that feeling looks
likes to you?”
• Consider appropriate medium for the client
• Consider their state of openness to art and
the art making process
 “But I am not an
artist!”

• “I don’t know how to draw”

• “I only know how to draw stick figures”
• “I am not an artist”
• “My drawing won’t look like anything”
• Remember that it’s important to remind clients
that this type of art is not about the
“quality” of art.
• There are no “rights” or “wrongs” in this type
of expression. In fact, sometimes the tiniest
mark can contain the most valuable
information.
• Explore the fear of making mistakes
Process, Mannerisms &
Perception
• When observing someone creating art in a
therapeutic setting, consider that the actual
creation can provide clues to their state of
being just as much as the actual product.
• Consider:
– Process
– Materials
– Hesitations
– Pressure applied
– Lack of images
– Color
– Line quality
– Space
 Individual Art
Evaluation
In addition, let’s consider these
topics as well:

• Figures
• Doing and Undoing
• Looking intently
• Talking about artwork
• Decoding Symbolic Messages
Cultural Aspects to
Consider
• Family structure
• Roles
– Familial
– Societal
• Traditions/Superstitons
• Secrets/Acceptable levels of disclosure
• Socio-Ecomonic Status
• Lesbian/Gay
• Elderly
• Handicapped/Terminally ill
Talking About v.s.
Talking With
• Jung’s “active imagination”
• Allowing the images to speak to the client
versus “taking about the images”
• Taking on the role of listener rather than
“explainer”
• The Renaissance therapies of imagination
suggest that we might be better off changing
images, objects, stories and conversations
than attempting to “fix” the organism that
houses them
• People might need help and coaching into this
style because of it’s unusual and thought of
as “out of character” or “childish” to speak
to images
CREATIVE INTERMISSION
Paintings have stories
to tell…

• Refer back to the drawing that

you did at the beginning of the
day
• Ask questions of the work like:
– “What message do you have for me?”
– “How are you feeling?”
– “What are you here to tell me?”
• TRUST your first instincts and
write them down
 Steps In Processing
the Art
1) Allow for the client to explain the art
2) Questions should be reserved for any
unexplained objects and clarification
3) Follow the clients lead in what seems to be
important to them to pursue
4) Offer “hunches”
5) Link images and themes to previous drawings
and discussions
6) Once client is complete with their
explanation, use of probing questions and
encouragement into fantasy can be helpful
7) Continue to encourage self exploration
 Techniques

• Loosening Up Techniques for

“stuck” Clients
– Draw with your eyes closed
– Non-dominant hand
– Meditation
– Scribble
 Techniques Cont.

• Generalized Subjects for Pictures

– Present Feelings
– Specific Feelings (anger, joy, sadness, contentment,
love, hate, envy, excitement, fear, anxiety etc…)
– A Wish
– A Secret
– A Fantasy
– Past Present Future
– Self Portrait
– Idealized Self
– A Significant Event or Situation
– An Important Relationship
– Shadow
CREATIVE INTERMISSION
 Portraits

• Choose a partner
• Face them knee to knee
• Draw a picture of your partner and share when
you are completed
• Now blindfold yourself and use your mind’s eye
to draw your partner
• Notice how it feels to take away the sense of
“seeing”
• How critical are you of yourself when you can
see versus when you cannot?
• What is it like to see others interpretation
of your self?
Assessment Chart for
Art and Play in
Preschoolers
 Art Expression
Comparison (*Wadeson)
 Group and Family
Exercises
– Self Introduction
– Mural
– Feelings about a common experience
– Gift
– Picture of the group
– Joint Scribble
– Pass Around the picture
– Family Portrait
– Ideal Family
– Partners Exchange Portraits
CREATIVE INTERMISSION
 Give a Gift

•Identify a group member to give a

“gift” to
•Something that you would like to
offer them
•Explain your intention to your
recipient when you present the
“gift”
•Practice receiving and listening to
their intention and interpretation
of the art
 Identified Patient- Karen
V. (14)

• Karen is a 14 year old, 9th grade, mainstream Hispanic girl.

• Karen lives in Los Angeles with her mother, Eugenia (45) who
was born in Mexico.

• IP’s parents are divorced and she has one sister, Laura (18),
and two half siblings, Janice (24) and brother Roy (26).
These siblings live in San Diego.

• IP’s parents are divorced and her father lives in Los Angeles
with his new girlfriend and her children. Father has one son
(18mos.) by his new girlfriend.

• IP’s parents divorced in 2004 due to multiple incidents of

domestic violence which were witnessed by the client.

• Father has received a restraining order and is not able to

visit the client’s home.He is also facing criminal charges
and is currently embroiled in court trials.

• IP was also the victim of domestic violence between her and

her sister, Laura. This was reported by a previous clinician.
 Presenting Problems

• Anger
• Challenges with identity and
personal growth
• Self Concept/Identity Formation
• Anxiety (Mild/Acute)
• Insomnia (Mild/Acute)
• Decreased appetite (Acute)
• Panic attacks (Acute)
 Axis Diagnosis

• Diagnosis:
• Axis I: 309.81 Post Traumatic Stress
Disorder - Acute
• Axis II V71.09 None
• Axis III: None Noted
• Axis IV:
• Problems with primary support group, social
environment, housing Problems, economic Problems,
access to health care services
• AXIS V: Global Assessment of Functioning Scale
Score: 60
 Treatment Plan - Early
Problem(s) Goal(s) Art Intervention(s)
• Poor self • Build therapeutic
awareness alliance and safe • Fairytale creation.
holding environment Have the client
• Negative • Obtain information create a fairytale
expression of about client's around her current
sense of being disorganized situation to help
(i.e. anger, boundaries, her redefine
fear, sadness) coalitions, roles, symptoms and use
empathy, and level fantasy
• Blocks in of conflict to alternatives.
personal determine why
growth violence, anger and • Have client draw
rage have become a about personal
• Challenged by vehicle for goals to encourage
defining emotional growth
concept expression
• Explore and • Use collage to
identify conflict create self
patterns in portrait
relationships
• Identify client’s
competencies and
strengths
 Treatment Plan - Middle
Problem(s) Goal(s) Art Intervention(s)
• Problems • Continue to increase self
expressing awareness of one's • Create a box to fill
emotions immediate existence and decorate as a
congruently (i.e. interpersonal and means of self
• (i.e. – intrapersonal issues) expression and
placater) • Continue to encourage identity formation.
expression of Subsequently give the
• Defining unacknowledged feelings box a context to help
her role in regarding childhood role play identity in
the family abuse and relationship a situation.
and as an with father to address
individual reported trauma symptoms • Have client create a
• Encourage expression self portrait of both
• Anger, of feelings related to her internal and
resentment abuse, particularly more external landscape.
vulnerable feelings Encourage client to
• Identity • Encourage expression explore ideas around
formation of ideas around identity individuation and
(i.e.- cultural and growth through the use
gender) and blockages in of this artefact.
personal growth
 Treatment Plan - Late
Problem(s) Goal(s) Art Intervention(s)
• Continued • Highlight • Review all art
struggles accomplishment of created during the
with goals treatment to
identity validate progress
and • Emphasize personal and growth
Individuatio growth and progress
n on developmental • Revisit symbolic
tasks (i.e.- identity family drawing to
• Continued formation) see how boundaries,
need for roles and
continued • Foster a simultaneous relational patterns
growth sense of togetherness have grown and
and healthy shifted
• Continued separation from her
need to mother • Create a “feelings
validate board” to identify
experienc • Emphasize genuineness members of client’s
e, through true self family and how she
feelings expression feels about each
and one
emotions • Encourage continued
Directive: Decorate your
folder
Directive: What it feels
like when mom does not
tell you the truth
Directive: What does the
anger feel like?
Directive: Family
Portrait –
1st Attempt
Directive: Family
Portrait-
2nd Attempt
Directive: Self
Portrait
 Directive: What does
feeling overwhelmed look
like?
Directive: Who is
Karen?
Directive: Discarded
Collage
Directive: What does the
wound look like now?
Directive: First Aid Kit
for the wound
CREATIVE INTERMISSION
 Let’s give it a try!

I need 2 willing volunteers!

• One person act as the client and one person act as therapist
• If you are the client, pull in the essence of a client that
you are currently working with and experience the session
from their point of view
• If you are the therapist, try and move from talking about
the feelings, problems, issues etc to an art/non-verbal
exercise
 Identified Patient- Erin.
(15)

• African female who has been referred to

receive 9 intensive individual art therapy
sessions.
• Client’s parents are both deceased.
• She reports having 4 siblings. These siblings
live at home with their caretaker.
• Client is attending boarding school in
northern Kenya
• This is her first time away from home
• Clients parents both died around the age of
11. Client reports that father passed away
first and then her mother.
• School reports that mother died of a
menningitis. It is not known the reason for
father’s death.
 Presenting Problems

• Selective Mutism (Acute)

• Isolation
• PTSD due to parental deaths
• Possible neglect
• Low Self Esteem (Chronic)
 Axis Diagnosis

• Axis I: 309.81 Post Traumatic Stress Disorder -Acute

• Axis II V71.09 None

• Axis III: Refer for medical check-up
• Axis IV:
– Problems with primary support group Specify Death of
both parents
– Problems related to the social environment Specify
Living with caretaker
– Educational Problems Specify Struggle to receive
education due to financial
– Housing Problems Specify Currently living at
school
– Economic Problems Specify No stable financial support
– Problems with access to health care services Specify
Limited access

• AXIS V: Global Assessment of Functioning Scale Score:

 Treatment Goals

• Build therapeutic alliance and safe

environment
• Encourage identification and expression of
feelings and thoughts relating to client’s
fears and anxieties
• Facilitate the art making process as a
means of sublimation for the anxiety and
stress that she may be experiencing
• Build ego strength
• Creation of coping mechanisms to help
manage varying symptoms like anxiety fear
and anger, depression, grief and loss.
 Treatment Plan

• Individual art therapy for her to:

– Explore the reality of certain situations that she is
experiencing and the externalizing of painful memories
so as to understand it as separate from herself.
• Given this client’s initial assessment future directives
should be geared towards:
– Normalizing her experience, encouraging positive coping
skills for the future and providing an environment that
is safe; something that this client desperately needs.
• This therapist would also recommend processing the grief
and loss associated with the death of her parents.
• The therapist would also recommend introducing directives
to meet treatment goals in no specific order but rather
relevant to her current affective state to provide some
level of cohesion and thread from one session to the next.
Directive: “Marker
Talk” - Detail
Directive: Self Symbol
Directive: Tracing Hand
Directive: Making “Joy”
3-D
Directive: Draw life
at home
Directive: Mandala
 Individual Art Analysis

• Let’s take a look at

some work done in
individual art therapy
sessions
 Directive: Found
Objects to Represent
Aspects of Self
Directive: Self Symbol
Directive: What does
“Angry” look like?
Directive: Past,
Present Future
Directive: Personal
Emotions
Directive: True Self
v.s. Mask
Directive: Free
Drawing
Directive: What Does
Pain Look Like?
Directive: Sandtray
Directive: Draw your
heart
Directive: Collage
 Directive: Create a
safe space for “Little
Man”
Directive: Mood
Thermometer
Directive: Photocopied
Images
Directive: Where do
you feel colors?
Directive: What does
Anger Look Like?
 Group and Family Art
Analysis

• Let’s take a look at

some work done in group
and family sessions
 Directive:
Mediation/Mandala
 Directive:
Mediation/Mandala
 Directive:
Mediation/Mandala
 Directive:
Mediation/Mandala
 Directive:
Mediation/Mandala
 Directive:
Mediation/Mandala
CREATIVE INTERMISSION
 Create your own Mandala

• Using the paper in your

kit, draw a large circle on
the paper
•Fill the space with images,
shapes, colors and visual
expressions that represent
Directive: “Royal”
Strengths
Directive: Non-Verbal
Family Drawing
Directive: Verbal
Family Drawing
Directive: Non-Verbal
Family Drawing
 The Termination Process

• Allow time (6-8 weeks) prior to termination

to begin talking about completion
– “What has been your experience with
goodbyes?”
– “How do handle “goodbyes”?
• Use the art for a “Corrective Experience”
• Consider an art review of the work done in
session
• Consider an art “exchange” between therapist
and client
– Transitional Object
 Therapist Self
Care/Exploration

• Personal Therapy
• Art journaling after each session
• Art reflections about the process
• Bodywork (Massage, Energy work)
• Meditation
• Create boundaries both verbally and
energetically
• Remember that you cannot help
others till you help your self!
 Salamat

“Wherever you go, go

with all of your
heART”….
- Confucius
 Suggested Reading

Books
• Jung, Carl (1978) Man and His Symbols. London: Picador.
• Jung, C. G. (1997) Jung on Active Imagination. London: Routledge.
• Kramer, E. (1971). Art as therapy with children. Schoken books, NY.
• Landgarten, H (1981) Clinical Art Therapy: A Comprehensive Guide. Brunner/Mazel
• McNiff, ShaunArt as medicine, 1994
• Malchiodi, Cathy (1998) Understanding Children's Drawings. London:Jessica
Kingsley Publishers.
• Malchiodi, Cathy (1998) The Art Therapy Sourcebook. Lincolnwood, ILL:Lowell
House.
• Naumberg, M. (1973). An introduction to art therapy. Teachers college press, NY.
• Rubin, J. A. (1997) Child Art Therapy: Understanding and Helping ChildrenGrow
Through Art. London: John Wiley & Sons.
• Wadeson, H. (1980). Art Psychotherapy. John Wiley & Sons, NY.
Journals
• Art Therapy, Journal of the American Art Therapy Association.
• The American Journal of Art Therapy (AJAT).
• The Arts in Psychotherapy
Websites
• American Art Therapy Association : http://www.arttherapy.org/
• Global ARTery: http://www.globalartery.org
 Copyright

NOTE:

• The material contained in this presentation is property

of Global ARTery. The unwritten permission and consent of
use of this material is strictly prohibited by US law and
will be prosecuted to the full extent.
• If you have any comment, questions or concerns, please
feel free to contact
Global ARTery directly:

Global ARTery
Lindsay Hurtt, LMFT, ATR
President/Founder
[email protected]
www.globalartery.org