Art Therapy

Although the idea of self-discovery through art is an old one, the concept of art therapy is relatively new. For years, artists of all kinds have been growing, learning and expressing themselves through their respective medias, but only until the last century and a half, have therapists turned to the arts as a potential tool for healing.

Who is Art Therapy for?
Art therapy is not just for people who are mentally ill, but rather for children, adolescence and adults who are struggling with personal issues or just in search of personal growth.

Art Therapy: Two Main Approaches
There are two basic ways in which an art therapist can approach the idea of art therapy. The first is to be process intensive. In this approach the art therapist, uses art as a means to help his/her patient(s) to discover something about him or herself. Art is used as a catharsis, an emotional journey to which self-actualization and discovery are the end result. Edith Kramer was the first person to champion this school of thought. Kramer emphasized the healing qualities of art making, and was concerned with artistic quality.

The second approach is not to be so concerned with the process of making the art, but with what the person is consciously or unconsciously expressing through their art. Margaret Naumburg believed that this was the best way to utilize art therapy. In this way, the art therapist uses art as a window into the subconscious of the patient, and from there can attempt to figure out the underlying problems that the patient may be suffering from. It can be risky to look into art too closely, but in the case of children, who may not have the words to express how they are feeling, it is very beneficial to use art as a mode of expression.

#1 Assessment
Assessment often comes at the beginning of art therapy, and usually happens during the first session that the therapist has with the client. Assessment is used by the therapist to find out what the client is going through, and to gain any other information that he or she may wish to find out about the client. It is important to be very up-front at this time with the client, being very clear that the session is not treatment oriented, but is for assessment purposes. Assessment at the beginning of therapy is an important first step because it is at this point that the therapist will decide if art therapy is a good option for the client or if it would be a waste of time.

#2 Treatment in the Beginning
The very first thing that needs to happen during the first session of treatment is for the therapist to establish a good rapport with the client. This rapport between the client and therapist is an important one because it allows for the development of trust in the relationship.

It is also essential in this first session for the art therapist to better grasp the framework from which the client is operating. This is also done in the assessment stage of the sessions.

After establishing a rapport with the client and getting a grasp on the client's vantage point, the art therapist can introduce art therapy to the client. This is done by giving back-round information about art therapy, and answering any questions that the client may have. At this point, the therapist may suggest doing some artwork.

This first piece of art that the client creates is a very important one because it sets the tone for the rest of the session. Because many people have art anxiety in these beginning sessions, it is important that the therapist makes the client feel as comfortable as possible. This could be done by saying to the client that they should not worry about artistic accomplishment, but rather self-expression. Another important aspect of this first artistic work is the reaction of the therapist to it.

After this first session, it is important for the art therapist to begin developing treatment goals, as well as to reflect on what initial reactions the therapist may have after the first meeting.

#3 Midphase of treatment
It is fairly hard to know when the treatment has moved from the beginning portion to the midphase, but there are a couple of key differences that do mark the midphase. First, trust between the client and therapist has been established, and the focuses of the sessions are more goal oriented. For this reason the midphase part of treatment is often thought of as the post honeymoon period. In the midphase of treatment the therapist establishes direction and boundaries, both personal and professional. Lastly, the midphase portion of treatment is generally believed to be when the major issues are treated.

There are many different techniques that are used in art therapy and knowing which one to use at what time is one of the art therapist's toughest jobs. Because each case is unique and each client is different, the art therapist must custom fit the art therapy for each individual client.

The following are some techniques that art therapists use and a brief description of what they are and what they are used for.

Techniques for Group and Individual Art therapy

Exploration Tasks
An exploration task can be quite liberating. The goal is to encourage the patient/client to let go of conscious thoughts and controls, and to have them express themselves as freely and spontaneously as possible. In this way, exploration tasks are very much akin to verbal free associations. Exploration tasks are generally used in the beginning sessions of art therapy.

Some examples of exploration tasks are :

Automatic drawing (also known as the Scribble Technique) -In automatic drawing, the patient/client is asked to relax and begin to make draw free lines or scribbles on paper. In some cases the patient/client will be instructed not to remove his or her pen from the paper until the exercise is over. Automatic drawing provides an excellent way for the patient/client to let down their guards and thus is a good starting point for therapy.
Free Drawing - In free drawing all the choices are up to the patient/client. All that the are patient/client is told is to express him or herself freely, and not to worry about planning the picture. This technique is useful because the images that the patient/client create are often mirrors into the person's present problems, strengths and weaknesses. Often at the end of free drawing, the patient/client is asked to share and explain what they drew about.
Drawing Completion - In the drawing completion technique, a patient/client is given one or more pieces of paper that already have a few lines or simple shapes on them. These shapes or lines act as a starting point for the art therapy artist, and they are to be incorporated into a larger picture. Because of the wide individual responses to the same stimuli, this is an excellent technique for a group discussion topic. Kinget developed this approach for therapeutic purposes.

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Rapport-Building
Rapport-building exercises are used in both individual and group art therapy settings. The basic idea behind rapport-building exercises is to reduce the amount of isolation that the patients/clients may feel while they are creating their art. This includes isolation from the other patients/clients in the group, and the distance they feel between themselves and the therapist.

Some examples of Rapport-Building are:

Conversational drawing - In conversational drawing, the group is broken up into pairs. The two people who are assigned to work together are seated across from one another. The only way of communication is with shapes, colours and lines. In this way, the pair is not only communicating, but sharing at the same time. This is a good way from patients to get to know one another a little better.
Painting Completion by the Group - In painting completion by the group, each member of the group is asked to name one thing, an object, feeling or event, and then depict it. From here, one or more of the group members begin adding to the collage, trying to improve upon what is already there. This technique better enables people to become aware of how it feels when they make something and have someone else "put upon you anything they want to." The patients/clients are encouraged to share what they are feeling about someone else adding to their work.
Painting with an Observer - In painting with an observer, one member of a pair tells the other one whatever comes to into his or her minds as he or she watches the other one paint. The painter can respond to what the other one is saying as he or she sees fit during their painting. This exercise promotes discussion of feelings of dependency and autonomy, as well as acceptance issues.

Expression of Inner Feelings
These techniques are designed to help the patient/client get in touch with inner feelings, desires and fantasies and to make visual representations of them. This is done in the hopes that the patient will become increasingly aware of him or herself. The therapist will then attempt to help the patient/client deal with these feelings, and move in a direction toward a solution.

An example of expression of inner feelings technique is called "three wishes".

Three Wishes - In the three wishes technique, the patient or client is asked to paint or portray three or more wishes. Responses tend to be of desires for things, personal security and so on. Responses to this exercise reflect maturity level, degree of egocentricity and so on. Discussion that follows this exercise focuses on the strength of the wish and whether or not these goals/wishes are attainable.

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Self Perception
The self perception technique is aimed at moving a client toward a more complete awareness of personal needs and body image.

Some examples of this technique are as follows:

Immediate States -Here the patient/client selects one or more of statements "I am", "I feel", "I have", or "I do" to paint about.
Self-Portraits -Self-portraits can vary from being realistic, done with or without a mirror to abstract. A variation of this technique is to give a time limit to the painter, such as one minute. In this way, the artist is forced to quickly decide what important feature about themselves they wish to draw.
Draw Yourself as an Animal - Here the patient/client is asked to draw themselves as any kind of animal, or as the animal that they see themselves as most similar to. This is a good group building technique because the discussions are usually funny as well as revealing.

Interpersonal Relations
The interpersonal relations technique is designed to make the patient/client more aware of others, and how others may perceive him or her.

Some examples of this technique are as follows:

Portraits of Groups Members - Here group members are asked to depict each other. This exercise helps groups members to more fully clarify their feelings toward each other.
Group Mural - Here the group works cooperatively on a large project. The choice in subject matter and materials may be left up to the group or predetermined by the therapist. This exercise promotes cooperation, group unity, fitting in individually to a larger whole and self-expression in a larger group setting.

Source: http://www.vickyb.demon.co.uk/group.html

The Individual's Place in the World
This technique is designed to help the patient/client to see where he or she fits into the world, and hopefully accept and deal with this realization.

Some examples of this technique are as follows:

House-Tree-Person Here the patient/client is asked to depict a house, tree and a person in one picture. The patient/client is faced with the task of how to relate the human figure to the other two common environmental features.
Collage and Assemblage -Here the patient/client is allowed to create a personal world out of any materials that he or she may desire. The therapist may predetermine themes, or the patient/client may work until themes begin to appear by themselves.

It is important to keep in mind that although there are many techniques available to the art therapist and all of them are valid, no one technique should dominate. This is because the techniques discussed here are only loose guidelines that the art therapist should take into consideration. More important than these guidelines are that the approaches that the art therapist chooses to take are well designed and thought out to meet the specific demands and needs of the individual or group.

#4 Termination
The termination of art therapy is initiated abruptly and clearly. Either the art therapist or the client can initiate the termination of the art therapy. Termination is generally decided upon when the therapist or the client realizes that the therapy is finite.

Termination is a very important part of the therapy process. The way in which therapy is brought to a close is crucial to the outcome of the treatment. If termination is handled incorrectly, the client or patient may regress as the end of therapy approaches.

The therapist should prepare the patient well in advance. This can be done by bringing up the issue of termination, focusing on its importance and discussing and interpreting feelings and behaviors due to the pending ending of the sessions. This is a difficult tightrope for the therapist to walk because focusing on the end often brings to mind other separations that client may have suffered.

When nearing the end of the therapy, the client and therapist should begin re-looking at the art that the client has created throughout the sessions and talking about the progress that the client has made. It is also a good idea to use art in these last few sessions to help express feeling about the termination of the therapy sessions. The therapist often will join the client on these works of art.

The termination of the art therapy brings up a very practical question as well, what should be done with the art that the client created during the course of the sessions? This is a tricky question, but ultimately it is one that should be answered by the client. They could keep the art as a form of remembrance to the journey they went through, or give it to the therapist to show the importance of the therapeutic bond that they reached. These are of course not the only two options that the client has, but two of the most common ones.

Some important things to remember about art therapy
Art therapy is not just a stepping stone to a verbal exchange, and should not be treated in this way. The art therapist should be very careful of over or under reliance on the verbal amplifications of the art by the client or patient.

There are some ways to get away from becoming too verbally oriented in art therapy. One way involves a group therapy activity in which the members of the group each create a piece of art, and then share it with the rest of the group. However, rather than explain what it means to the rest of the group when it is finished, they should focus on exploring and telling about the part of the art that they find the most interesting or exciting or puzzling. The other members of the group also talk about what the find interesting in the piece. From here the client again creates a piece of art, this time focusing on what they found interesting in their previous work. The process is repeated until the client feels that they have a finished piece of art that they are happy about. This process is a valuable one because it allows the artist a departure from traditional, intellectual expressiveness toward a more purely emotional response.

According to the American Art Therapy Association, Inc.'s professional definition of Art Therapy, Art Therapy is a human service profession that utilizes art media, images, the creative art process and patient/client responses to the created products as reflections of an individual's development, abilities, personality, interests, concerns and conflicts. I hope that you see that defining art therapy is a daunting task because it is an evolving science, and one which we just recently started using. Just because it may be hard to come up with a definition that fully encompasses what art therapy is doesn't mean that it is any less beneficial as a form of therapy.