Art Psychotherapy E-Book

Harriet Wadeson

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 744

Veröffentlichungsjahr: 2010

Beschreibung

The long-awaited new edition of the landmark text defining art therapy

Art therapists use the creative process and the issues that surface during art therapy to help their clients increase insight and judgment, cope with stress, work through traumatic experiences, increase cognitive abilities, have better relationships with family and friends, and simply enjoy the life-affirming pleasures of the creative experience.

In this highly anticipated revision of the definitive text on art therapy, author and pioneer art therapist Dr. Harriet Wadeson examines the clinical considerations, education, history, and application of art therapy treatment programs for an array of presenting problems. Reflecting current DSM updates since the first edition's publication, the Second Edition has been completely updated, with nine new chapters on trauma, crisis, multicultural considerations, community art therapy, and more.

Illustrated with over 150 works of art from clients as well as the author's own personal artwork, and packaged with a companion CD-ROM, which includes more than 100 full-color versions of the illustrations in the book, Art Psychotherapy, Second Edition is a comprehensive guide to the theory and practice of art therapy. Written by one of the most established experts in the field, this book will be informative for practicing art therapists, other mental health practitioners looking to incorporate art therapy into their mental health practice, students in these disciplines, and those interested in entering the art therapy profession.

Note: CD-ROM/DVD and other supplementary materials are not included as part of eBook file.

Leseprobe

Table of Contents

Title Page

Copyright Page

Dedication

Foreword

Preface

Preface to the First Edition (Revised)

Acknowledgements

Acknowledgments to the First Edition

PART I - Principles and Application

CHAPTER 1 - Creative Process

NATURE OF THE CREATIVE EXPERIENCE: A PERSONAL ACCOUNT

CREATIVITY IN ART THERAPY

CHAPTER 2 - Advantages of Art Therapy

IMAGERY

DECREASED DEFENSES

OBJECTIFICATION

PERMANENCE

SPATIAL MATRIX

CREATIVE AND PHYSICAL ENERGY

SELF-ESTEEM ENHANCEMENT

CHAPTER 3 - Roots and Application of Art Therapy

APPLICATION OF ART THERAPY

PHYSICAL ENVIRONMENT

SESSION STRUCTURE

ART MEDIA AND PROCESSES

CHAPTER 4 - Institutional Influences

STAFF RELATIONS

ART THERAPIST AS ADVOCATE

AMERICAN ART THERAPY ASSOCIATION

ART THERAPY TRAINING

CHAPTER 5 - Therapeutic Relationship

GENERAL CONSIDERATIONS

PARTICULAR CONSIDERATIONS IN ART THERAPY

CHAPTER 6 - Multicultural Issues

AFRICAN-AMERICANS

IMMIGRANTS

SEXUAL ORIENTATION

PART II - Trauma

CHAPTER 7 - Posttraumatic Stress Disorder (PTSD)

TYPES OF TRAUMA

PSYCHOLOGICAL RESULTS

RECOVERY

ART THERAPY FOR TRAUMA

ART THERAPY WITH A VICTIM OF RAPE

A WAR VETERAN

CHAPTER 8 - Adult Survivors of Childhood Sexual Abuse

A MAN WHO WAS SEXUALLY ABUSED AS A CHILD

SCHIZOPHRENIA AND CHILDHOOD SEXUAL ABUSE

BORDERLINE PERSONALITY DISORDER

CHAPTER 9 - Crisis

INDIVIDUAL CRISIS ASSESSMENT

CRISIS INTERVENTION

COURSE OF TREATMENT

INDIVIDUAL CRISIS

COMMUNITY CRISIS

PART III - Mood Disorders

CHAPTER 10 - Depression

THERAPEUTIC RELATIONSHIP

CASE STUDY

CHARACTERISTICS OF ART EXPRESSION IN DEPRESSION

CHAPTER 11 - Bipolar Disorder

CASE STUDY

FURTHER EXAMPLES

THERAPEUTIC RELATIONSHIP

CHARACTERISTICS OF ART EXPRESSION IN BIPOLAR DISORDER

CHAPTER 12 - Suicide

THERAPEUTIC RELATIONSHIP

HOSPITALIZED PATIENTS

SUICIDE MESSAGES

ANGER

FEELINGS OF HARMFULNESS TO OTHERS

SELF-HATE

HOPELESSNESS

COMMUNICATION OR ISOLATION

SPIRAL SYMBOL

IMPORTANCE OF ART THERAPY

CASE EXAMPLE

PART IV - Schizophrenia

CHAPTER 13 - General Characteristics and Clinical Considerations in Schizophrenia

THERAPEUTIC RELATIONSHIP AND THE MEANING OF MEANING

CHAPTER 14 - Phenomenology of Schizophrenia Expressed in Art

SUBJECTIVE EXPERIENCE OF SCHIZOPHRENIA

HALLUCINATIONS AND DELUSIONS

PREVALENCE OF RECURRENT MOTIFS IN PSYCHOTIC DELUSIONS

CASE STUDY

CHAPTER 15 - Institutional Impact

IMPACT OF THE SECLUSION ROOM EXPERIENCE

TV: PROGRAMMING DELUSIONS

CHAPTER 16 - Art Expression and Recovery Style in Acute Schizophrenia

EXAMPLES

DISCUSSION

CHAPTER 17 - Comparison of Art Expression in Schizophrenia, Depression, and ...

UNIPOLAR DEPRESSIVE PATIENTS

BIPOLAR MANIC-DEPRESSIVE PATIENTS

SCHIZOPHRENIC PATIENTS

ORGANIZATION

AGE-MATCHED GROUPS

DISCUSSION

PART V - Physical Conditions

CHAPTER 18 - Medical Conditions

A MASTECTOMY GROUP

PHYSICALLY ILL CHILDREN

ART AS THERAPY FOR PARKINSON’S DISEASE

DEATH AND DYING

CHAPTER 19 - Substance Abuse

EVALUATIONS OF ALCOHOLIC FAMILIES

PART VI - Structuring Art Therapy

CHAPTER 20 - Short-Term Hospitalization and Aftercare

AFTERCARE

SHELTERS

CHAPTER 21 - Group Art Therapy

STRUCTURE

TIME

SHARED IMAGES

ROLE OF THE ART THERAPIST IN THE GROUP

EXAMPLES FROM ART THERAPY GROUPS

HOSPITALIZED ADOLESCENT GROUPS

PRIVATE PRACTICE GROUPS OF WELL-FUNCTIONING ADULTS

CHAPTER 22 - Family Art Therapy

THERAPEUTIC RELATIONSHIP

COUPLES ART THERAPY

COUPLES ART TECHNIQUES IN BIPOLAR RESEARCH

MULTIFAMILY ART THERAPY

CHAPTER 23 - Drawing Dreams

EXAMPLES

CHAPTER 24 - Combining Expressive Therapies

STRUCTURE

MOVEMENT TO MUSIC

RELAXATION

MURAL MAKING

DRAMATIC EXPRESSION

FANTASY

RESULTS

CHAPTER 25 - Community Art Therapy

HOMELESS WOMEN’S SOCIAL ACTION PROTEST

THE HOCKEY/ART ALLIANCE

THREE CROWNS IN A FOUNTAIN

CHAPTER 26 - Research

OVERVIEW OF TYPES OF RESEARCH

EXAMPLES

RESEARCH ETHICS

PROBLEMS INTRINSIC TO ART THERAPY RESEARCH

APPLYING METHODOLOGIC RIGOR

COMMENT

FUTURE RESEARCH

Epilogue

CHAPTER 27 - Art For Professional Self-Processing

POST-SESSION RESPONSE ART

RACIAL PREJUDICE

SEXUAL ABUSE

BURNING OUT BURNOUT

CROSSING THE BORDER

ILL AND DYING CHILDREN

CAREGIVERS GROUP

MY OWN ART

DEATH

THE DARK SIDE

Concluding Remarks

Appendix

References

Author Index

Subject Index

About the CD-ROM

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Library of Congress Cataloging-in-Publication Data:

Wadeson, Harriet, 1931-

p. cm.

Includes bibliographical references and index.

ISBN 978-0-470-41700-3 (cloth : alk. paper)

1. Art therapy. I. Title.

[DNLM: 1. Art Therapy. WM 450.5.A8 W121a 2010]

RC489.A7W32 2010

616.89’1656—dc22

2009050968

To my children, Lisa, Eric, and Keith, with appreciation for the creative challenges, enrichment, joy, and love they have brought to my life.

Foreword to the First Edition

The concepts and the practices of art psychotherapy have evolved both within and outside the sphere of psychotherapy. In the 1940s, under the pioneering leadership of Margaret Naumburg, the initial framework was psychoanalytic. By studying clinical cases in detail, with artistic expression as the springboard for the patient’s associations and the therapist’s interpretations, Naumburg established an invaluable tradition that continues as one component of present-day art psychotherapy.

Other psychoanalytically oriented pioneers, such as Edith Kramer, gave greater emphasis to the healing potentialities of the psychological processes activated in the creative act. Still others, such as Hanna Yaxa Kwiatkowska, began some 50 years ago to expand the scope of art psychotherapy into the interpersonal field of families.

At about that time, innovations suddenly proliferated not only with fresh concepts and methods, but also with newly defined professional roles for art therapists in private practice and in a great array of clinical settings and academic and research institutions. It was my good fortune to be in a position in the Intramural Program of the National Institute of Mental Health (NIMH), where I could readily be aware of these exciting developments, especially in Washington and Philadelphia, and to facilitate, more explicitly, the creative work of Hanna Kwiatkowska and Harriet Wadeson at NIMH.

Over the subsequent years, Harriet Wadeson has continued to add to her clinical, research, and artistic experience. On the one hand, she has published numerous research papers in leading psychiatric journals; on the other hand, she has thoroughly familiarized herself with developments in existential psychology and the Human Potential Movement, using not only graphic arts but also other modalities of expressive therapies.

This book, then, has become a personalized statement arising from her highly diversified professional background. She shows how this personal philosophy can be successfully adapted for use with a variety of people, ranging from those with major and minor psychiatric symptoms to those who wish to enhance their growth in dealing with the problems of living.

As an ingredient of the professionalization of art psychotherapy, Harriet Wadeson discusses forthrightly many of the special problems that art therapists, especially when working in institutional settings, have had while establishing their status and identity. Earlier, art therapists often worked as psychodiagnosticians, and their therapy was defined as adjunctive to the primary therapy of someone else. Wadeson asserts that “art therapists should be psychotherapists plus,” that is, psychotherapists who are qualified to work alone or in a team of colleagues and who also are trained in the theory and practice of art therapy, have technical expertise in art, and are experienced in using art for self-expression. Surely, this professional identity is a far cry from “messing around” and “killing time” with art materials in activities programs. In my view, psychiatrists and psychologists even today have failed to understand how much they can learn from skilled art psychotherapists. Interdisciplinary acknowledgment clearly needs to be reciprocal; the gains then are mutual.

I must also express a personal hope—recognized in this volume—that a sophisticated approach to art psychotherapy will not neglect those deeply impaired individuals whose creactivity becomes manifest through developing simple but often surprising and personally meaningful “artistic” skills. Also, certain patients can benefit from art therapy that begins stepwise, helping patients to extend their attention span, develop the ability to integrate parts into a whole, improve their motor control, and gain better ability to focus or perceive. Such approaches are quite compatible with a comprehensive approach that also has been enriched by the incorporation of a humanistic tradition concerned with helping all persons, including “normal” clients, to improve authenticity, individuality, and self-actualization. In varying degrees, all approaches to art therapy require a transfer from the realm of materials to the realms of individual creative processes and interpersonal relationships.

Harriet Wadeson’s many years as an art therapist have engendered thoughtful and quite detailed guidelines here for dealing with a multiplicity of patients and situations. She devotes an entire chapter or more to each of the following: mania, depression, suicide, schizophrenia, alcoholism, families, and hospitalized and “normal” groups. A most important chapter explains the hypothesis that the recovery style of schizophrenics (either “integrating” or “sealing-over”) can be determined and assessed by the quality of the patient’s pictorial expression. These findings are documented by collaborative research that suggests the patient’s recovery style can be elucidated by the quality and expressiveness of his or her pictorial representation. The recovery style can then be a determining factor in planning the best type of treatment by all the staff and in deciding whether drug therapy or other approaches are indicated.

The book as a whole makes it clear that Dr. Wadeson especially enjoys working with the “integrators,” those persons who want to explore the meaning of disturbing experience to the totality of their lives. At the same time that this work delineates many details of technique and the examination of research hypotheses, Dr. Wadeson effectively models for the reader her interest in the therapist’s use of self. She shares with us some of her life experiences, dreams, art productions, and even a poem or two. The chapter on research concludes with a statement that gives a clear picture of the author’s professional goals: “It is my hope that the creativity that is the essence of the profession will be applied to new means of exploration of the human condition through the fertile expressiveness art therapists are trained to perceive.”

Harriet Wadeson has waged a successful struggle to make a synthesis that does justice both to her personal viewpoint and to her profession. Grounded in artistic and psychodynamic traditions, she has absorbed and integrated diverse innovations with families and groups without surrendering her interest in personal meaning. She has worked in-depth with psychotic inpatients as well as with dissatisfied “normals.” Perhaps the most distinctive emphasis in her approach—and in my view the most difficult but most therapeutically valuable—is her concern with a creative therapeutic alliance. Within a framework of participant observation, in the reciprocal processes between therapist and client, lie the most powerful opportunities for personal growth and therapeutic change. Wadeson addresses both the potentialities and the pitfalls for client and therapist alike in such knotty issues as the extent of self-disclosure by the therapist. In art psychotherapy as in verbal therapies, the complexity of countertransference problems requires self-awareness. Further, she points out that as a therapist in a creative alliance, she does not abandon her own philosophy but is “receptive to the client’s finding her own way” and thus enables the client to “experiment with new ways of being.”

Lyman C. Wynne Professor and former Chairman, Director of the Division of Family Programs, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York

Preface

The many significant changes in the art therapy profession since the first edition of this book was published reflect the massive changes in our world in the span of the last 30 years. Throughout these three decades, I have been gratified and appreciative that Art Psychotherapy has continued to be used, despite the arrival on the scene of many other excellent art therapy texts compared to the sparse resources available in the field at the time of this book’s initial publication. I am told that it is unusual for a book of this sort to remain in print for so long. Throughout the years, strangers have approached me at art therapy conferences to tell me that this book was the reason they entered the art therapy profession, which of course has been immensely affirming to hear.

In noting modifications necessary for this second edition, of special significance is the change in the perspective on psychopathology in the last decades. Trauma-related conditions were not classified in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association until 1980, the year the first edition of this book was published. The relationship between trauma and its emotional sequellae is now recognized in the diagnosis of posttraumatic stress disorder (PTSD), which may result from various tragedies, such as rape, childhood abuse, war, terrorism, and natural disasters. Attachment disorder also may result from early trauma. Therefore, a whole new section of this book is devoted to trauma.

Other changes in mental health services include shorter hospitalizations resulting from current medical insurance practices. These shorter stays have increased the importance of aftercare services, many of which utilize art therapy as the core of their programming. There is also added awareness of the importance of multicultural competency on the part of therapists in our increasingly multicultural society. Art therapists are now going out into the community to work, more so than they did several decades ago. All of these developments are reflected in this book.

Added also are illustrations of art therapists creating artwork to process their own professional issues, particularly in work with those clients who raise strong emotional reactions in the therapist. Just as art can be an expressive vehicle for insight for those in art therapy treatment, it can also serve art therapists well in helping them to understand what is transpiring in the therapy, especially in regard to their relationships with clients.

Specifically, the new chapters are all of those in Part II: Trauma, as well as Chapter 6, Multicultural Issues; Chapter 18, Medical Problems; Chapter 20, Short-Term Hospitalization and Aftercare; Chapter 25, Community Art Therapy; and Chapter 27, Art for Professional Self-Processing. In addition to this new material, most of the text of the previous edition has been retained and updated.

Like the first edition, this second edition is descriptive in nature, supplying many case examples to illustrate the psychodynamics of the clients and patients, how art-making can promote their therapy, and how art therapists work with various clienteles under different circumstances. As was the case in the first edition, the focus of the second edition is largely on work with adults, although there are several examples of work with children and adolescents to make specific points. The reason for this focus, as in the previous edition, is that a greater abundance of material has been published on art therapy with children than with adults.

Although I have been fortunate over my many years in art therapy to see a vast number of clients in various treatment milieus, the field has expanded beyond the experience of any one art therapist. In order to cover art therapy with populations with whom I have not worked, I have included treatment examples from generous colleagues, many of them my former students.

As mentioned in the Preface to the first edition, the book covers many years of my professional experience, which now spans almost five decades. Some of the changes in my own perspective and ways of working since publication of the first edition are reflected in the newer case material. I believe there are some changes in the writing style as well. In recent years, I have been writing novels, so perhaps the added case vignettes have a bit of a story quality to them.

In my many years of training art therapy students, I have operated under the assumption that basic principles come alive in illustrations of specific case examples. Therefore, the bulk of this book introduces many of the individuals with whom I have worked, along with their art expressions. I have tried to protect their confidentiality by changing their names and identifying details. I have included names of colleagues and students, however, in order to give them credit for their work. Because case histories usually are not nice, neat illustrations, even in summary, I have taken some liberties in omission and simplification in order to make the points I am trying to show. In a few cases, I have combined the stories of more than one client.

My sessions at the National Institutes of Health (NIH) were tape-recorded, so the conversations are accurate. Those from other sessions are reproduced from my detailed post-session notes and more recent work from my memory, which may not be totally accurate. Nevertheless, I believe it has served me well in recalling the gist of what was said. The artwork, of course, has provided an unchanging documentation of therapeutic course. In some cases, clients wrote comments about their artwork, which are quoted directly.

Although I have used the first edition of this book repeatedly in my teaching, I had not approached it with an eye toward what I wanted to update, change, or eliminate until now. In doing so, studying its tenets and its examples, I was introduced to my former self. Reading many of its passages, I realized I would write them differently today, not necessarily better, but from a changed perspective. I discovered the former me to be more of a romantic and more philosophical than my now more practical self. I found that I rather liked reading that younger me, so I have left much of it as originally written.

In studying the content of my former writing, I was also returned to long-ago clinical experience, much of it very different from my more recent work. From my present perspective, I am impressed with the array of experience I have had: working with nonmedicated people diagnosed as schizophrenic, those who had attempted suicide, ongoing groups of insight-oriented creative women, some of whom were art therapists, the experience group in which I could experiment with various expressive modalities to enliven regressed and withdrawn people who were psychotically depressed, and many more. I have been privileged to view the hallucinations and delusions that were the idiosyncratic inner experience of those whose realities were vastly different from the common shared experience of most of us. For all of these opportunities that expanded my own awareness, I am immensely grateful.

The balance of my career shifted midway from a predominance of clinical work and research to education. The six books I have published are products of this second half of my career. Educating others, both face-to-face and through my writings, is another kind of challenge, but like the clinical work and research, it has provoked reflection and a synthesizing of ideas as well, many of which are distilled in this book.

I hope that in its second incarnation, Art Psychotherapy will continue to inspire and inform those who work in the exciting, creative field of art therapy, as well as those who are interested in doing so.

HARRIET WADESON Chicago, IllinoisSeptember 2009

Preface to the First Edition (Revised)

Art psychotherapy begins with an expressed image, and so shall this book begin. I have selected as an introduction to this field a drawing by Craig, a young man diagnosed as having paranoid schizophrenia, because his images are eloquent. By expressing himself in them, he probably averted further decompensation. Through his pictures he divulged his “secrets” to me, overcoming his fears and building trust by sharing his images. Figure P.1 is his picture of the Mother of the Universe, with Craig as the tiny person sitting in her hand. The many experiences of a deep involvement with people through their images, such as my journey into Craig’s inner world (described more fully later), pushed this book into being.

Figure P.1Mother of the Universe, a delusion by Craig, diagnosed as having paranoid schizophrenia. He believed he was the keeper of Mother Nature’s secrets.

I discovered art therapy at the National Institutes of Health (NIH) almost by chance, at a time when budgeting was generous and I could find employment there as an art therapist despite a lack of experience and training. In this rarefied atmosphere, I felt I was witnessing (and later participating in) the leading edge of psychiatric research. I entered art therapy when it was all but unknown and ripe for pioneering. As a result, I have been fortunate in having the opportunity to innovate and to have my work published in journals that are read throughout the world.

The surge of the Human Potential Movement, with its valuation of creativity and direct experience, found me in the right place at the right time and opened opportunities for me beyond the psychiatric world to which I had been introduced at NIH. Subsequently, the increasing professionalization of art therapy has led to challenging opportunities for the training of students and for developing my thinking about what constitutes high-quality training for art therapists.

Obviously this book is not, nor is it intended to be, the last word on art psychotherapy. The profession is young and energetic, with much growth still to come. But this book is intended to provide philosophy, principles, practice, abundant variety of case material, and research. It is written from a highly personal perspective. It is clear to me that the therapist is a large part of the process, and to have written a book devoid of my personal beliefs and reactions would have made it an empty shell. I have tried to make my biases explicit.

Basically, I would describe my approach as humanistic, existential, and phenomenological. I see psychotherapy as primarily an educational process to help people with problems in living rather than as a treatment for a disease. The educational process is not the traditional cognitive model, but rather an affectually oriented facilitation of emotional growth. I make no pretense of speaking for the entire profession; rather, I am expressing my view and experience of it.

The title, Art Psychotherapy, reflects my way of practicing art therapy. The field is a broad one, with much variety among the approaches of different practitioners. Some place emphasis on the art, some on the therapy, and many on both. Some art therapists consider themselves psychotherapists using art expression as a therapeutic modality. Their work is art psychotherapy, and they are comfortable with both primary therapeutic responsibility and working as part of a treatment team. Art psychotherapists distinguish themselves from others with less training and experience who work in an adjunctive capacity only.

The first part of the book furnishes a foundation: philosophy, history, application, training. These discussions inform the case material that follows in succeeding sections. It is possible to proceed directly to the case material in any order desired; that is, the book can be approached in its totality as a text or be used as a reference for specific information. To develop each chapter so that it can stand alone, a small amount of repetition has been necessary. The basic approach is described in the first section, then illustrated in the following sections that form the major portion of the book.

Despite the aim of this work to be a comprehensive book, there are some deliberate omissions. Because the focus of the book is emotional disturbance, organic brain syndromes are not included. There is minimal material about work with children. Many art therapy books published to date have dealt exclusively with children. In contrast, there is presently less material published in book form on art psychotherapy with adults. Because my experience has been primarily in this realm, and because need for information in this area is so much greater, I have not tried to overextend myself into art therapy for children.

Another significant omission is the use of art expression for diagnosis. Art therapy diagnostic instruments are not yet sufficiently reliable for generalized use.

Related to this decision is the whole issue of psychiatric labeling. I struggled with this one for some time. When art expression (or any other form of data) is used to gain a fuller understanding of the client or patient, a diagnostic term can be a useful sort of shorthand. On the other hand, when a diagnostic label is used as a means of classification—without an attempt to comprehend the individual’s uniqueness—then the shorthand becomes a shortcut, circumventing the more demanding process of dealing with the individual humanly. There are other abuses perpetrated through psychiatric classification, such as stigmatization and facilitation of distancing between therapist and patient, with each of them viewing the former as “well” and the latter as “sick.” These are crucial issues in the field of psychotherapy.

Despite the problems surrounding diagnosis, and my own personal distaste for applying a diagnostic label, I have divided the case material into chapters according to diagnostic categories. There are two reasons for this. First, as stated earlier, I believe that to some extent these classifications are valid. Second, and perhaps more important, students and mental health professionals need to understand these categories as they form the framework of our present understanding of those undergoing psychotherapy. As used here, however, I hope it is clear that diagnosis is never implemented to pigeonhole, but rather as a means of organizing the material presented to differentiate the kinds of problems the art therapist encounters with various populations.

The material in this book spans many years of work, so there are certain variations in approach as my professional activities evolved and developed over time. For example, my early work was focused much more on the patient than on our relationship, and the case material reported from my early years in art therapy reflects that focus. The rough chronology of the work is as follows: I began working with adolescents; then successively with depressive and bipolar patients, families, and schizophrenic patients; and lastly with private practice clients and substance abusers. (Naturally, there was some overlap.) My research interests and approaches also changed over the years and, although not detailed in this book, to the extent that they are introduced, a fair amount of variety may be seen.

Selection of the illustrations was based on applicability, presentational qualities, intrinsic interest, and photographic reproducibility. The choice was sometimes difficult, because there were often many excellent examples to illustrate a particular point. In a few instances, pictures have not been supplied, because the available examples did not reproduce well or required too lengthy an explanation.

Finally, I hope that this work conveys some of my own gratification from the creative opportunities afforded me in the young and exciting profession of art therapy. Because the field is a dynamic one, this book is intended to be thought-provoking rather than conclusive.

HARRIET WADESON Houston, TexasSeptember 1979

Acknowledgments

My initial gratitude goes to my John Wiley Editor, Isabel Pratt, for her persuasiveness in encouraging me to respond to her request to write a second edition of Art Psychotherapy and for her interest and support of this project. Thanks also to Kara Borbely, John Wiley Senior Editorial Assistant, for her work on the final manuscript.

I’d like to acknowledge art therapists Nancy Slater, Janice Hoshino, Suzanne Lovell, Heidi Bardot, and Elizabeth Mott for reviewing the first edition of the book and advising the publisher that a second edition would be valuable and for recommendations of added subject matter. Thanks to my Portia group of women artists, writers, and scholars, to whom I read portions of the new material, for their interest and comments, and to Neena Schwartz in particular for her support.

Finally, I want to give extra-special appreciation to my assistant, current art therapy student Anthony LaBrosse, who I believe will be a future president of the American Art Therapy Association. Tony requested to help me with this project and was unstinting in his resourcefulness and hard work, often suggesting references and related material to include, even though it meant more work for him. When we first began this enterprise, he asked me to write a list of his responsibilities. Number eight was “Keep Harriet in good cheer.” He moved this goal to the number-one position and fulfilled that responsibility above and beyond the call of duty.

Acknowledgments to the First Edition

I wish to express my appreciation first to Lyman Wynne, MD, PhD, for his support and inspiration throughout my art therapy career. Lyman gave me my first art therapy job, has provided me with challenging professional opportunities since, and has enthusiastically supported art therapy from its early days when it was an unrecognized therapeutic modality. Lyman’s work and being have been a source of inspiration to me throughout our years of personal friendship and professional association. I am grateful, as well, for his careful reading of this manuscript and his valuable suggestions.

Next I would like to acknowledge Hanna Yaxa Kwiatkowska, my first art therapy mentor, who, in a sense, gave me a profession that has provided me with abundant gratification and challenging opportunities. Similarly, I would like to thank William Bunney, MD, and Will Carpenter, MD, for their support and supervision of my work at NIH. Both provided me with learning and opportunity for research through art therapy.

To Roy Fairfield, PhD, Richard Gillespie, PhD, Joyce Cohen, PhD, Marcia Hart, MA, ATR, and Nancy White, MA, go my thanks for reading this manuscript and offering some excellent suggestions. I am particularly indebted to Roy for responding to some of the case material in poetry, a beautiful way of letting me know he understood what I was trying to say.

I give my thanks to my mother, Sophie Weisman, who typed many rough drafts as a labor of love, to Al Jankowitz and Frank Riley for assistance in duplication, and to Rose Allinder for proofing and indexing.

Finally, my most profound gratitude is for the clients, patients, and students who are the life of this book.

H.W.

PART I

Principles and Application

CHAPTER 1

Creative Process

Life. Meaning. Creativity. Art. In the largest sense, they are all one. In presenting Art Psychotherapy, the appropriate place to begin is in these larger realms that form the context for my profession. So I begin with meaning in life. Much of human striving, beyond mere survival needs, appears to me to be directed toward the creation of meaning in life. Creation of meaning, not discovery of meaning. Although an object or a process may have intrinsic characteristics, we determine its importance to us in the way we structure and integrate experience. For example, an intrinsic attribute of fire is its heat. The meaning we give it may be destructive force, weapon, necessity for warmth, useful tool, gift of the gods, magic power, and so forth.

An important part of the acculturation and socialization process in human development is the learning of shared meaning. Some beliefs are widely shared in our culture, such as a germ theory of disease. Others are prevalent but less universal, such as concepts of a divine being. And others may be particular to a small subculture, such as belief in reincarnation. It is evident that each of these examples has wide implications for how people choose to live their lives.

The issue of belief and meaning is a complex one and much more subtle than these obvious examples illustrate. The evolution of a culture’s myths reflects humankind’s ongoing search for meaning and the importance of these myths in directing the individual lives within the culture.

The meaning of meaning is central to art and psychotherapy. To limit ourselves for the moment to the graphic arts, the art products are visual productions related to other visual perceptions. Visual perceptions themselves are nothing more than shapes of color we integrate into visually meaningful experiences. Optical illusions demonstrate the tricks that can be played on our integrating ability. This ability is so significant that we can even have visual experiences without use of our visual perceptors. We can close our eyes and see with the mind’s eye, and see involuntarily in our dreams.

The image that is produced in graphic art is created to be seen. It does not duplicate the natural world, although it may bear a strong resemblance to objects in it. The artist has created an illusion, a separate reality, a personal vision that through transformation into an art object may be shared with others. The compelling nature of this communication gives art its power.

Much has been written about what distinguishes great art from other comparable expressions that don’t achieve greatness. I won’t attempt to hazard the complexities of the field of aesthetics, but a few points appear obvious to me. Art that is considered great must communicate at a significant level of meaning. Expressions in art that are purely idiosyncratic do not achieve this end. Secondly, it seems to me that art that comes to be considered great does not merely reflect the status of the times, but in some way advances consciousness in the human view of the universe. Present meaning becomes transcended, and new forms emerge.

The relation of meaning to psychotherapy is both obvious and subtle. Troubled people who seek psychotherapy are obviously not giving their lives the meaning they want. They’ re depressed, unhappy with themselves, confused, angry, or disappointed. Others are sent into treatment because someone is unhappy with them. They may not ascribe to the consensual meaning endorsed by the culture, as illustrated by some of the schizophrenic patients described in this book. (One of these people believed he could control the weather; several were visited by the devil.) When the behavior predicated on such beliefs is threatening to others, these people are likely to be incarcerated. For example, a woman was hospitalized by her husband because she kept jumping out of their moving car to obey God’s commandments to her. Thomas Szasz (1970) has written eloquently of society’s measures for dealing with deviancy through institutionalization in mental hospitals.

The more subtle issues of meaning emerge in the actual therapeutic work. Many values and doctrines of meaning are conveyed in the institution’s and therapists’ reaction to their clientele. These aspects of meaning are discussed further in Chapters 4 and 5.

Creativity is not the same as art. Not everyone is capable of becoming a great artist. But all people are creative, no matter how limited. Frank Barron (1968a) writes:

Because we are capable of reflecting upon ourselves, we are committed, willy-nilly, to an artistic enterprise in the creation of our own personality.

Consciously and unconsciously, we use the multifarious influences that have played upon our lives to create meaning, to make choices, to fashion our behavior. Throughout our lives, we are engaged in an ongoing creative enterprise, in the broadest sense.

The field of the art therapist is one in which clients use the particular creative medium of art expression to advance the larger creativity of making their own lives meaningful. Reciprocally, art therapists create meaning in their own lives through their particular expertise in encouraging and relating to the meaning others create in their art expressions.

NATURE OF THE CREATIVE EXPERIENCE: A PERSONAL ACCOUNT

Creativity is difficult to discuss. No one seems to know exactly what it is or why some people are more creative, imaginative, or original than others. Several psychoanalytic theorists have written on the subject (Kris, 1952; Weissman, 1967; Arieti, 1976, to name a few). Barron (1968b) has conducted studies on it, and Koestler (1964) has described the process. I will not struggle through the maze of whys and wherefores but will instead say a few words about my own creative experience.

Many of my most deeply satisfying moments have been spent in the act of creative expression. For me this experience is an important part of my life. For others it has been even more—the mainspring of their existence. What makes personal artistic endeavors so compelling?

I believe my early relationship to art was an important influence and that the direction of my professional life has been a logical consequence of my childhood and adolescence. My mother used to boast: “Harriet painted before it was stylish, before everyone was doing it.” Art expression has been an important outlet for as long as I can remember. I used to make up stories and tell them through a series of pictures before I could write. Artistic expression was reinforced further by the acclaim of classmates and teachers as well as the many uses I found for this expression.

For example, when my brother and I believed our mother had instigated a campaign of discipline and, to us, harshness, I hung posters around the house depicting her as a gestapo agent. I remember as a small child spending hours in our attic looking over prints of the paintings of old masters. What musings they prompted, I don’t remember. Even today, there are pictures at the National Gallery of Art that I view fondly as old friends—friends from whom I have grown away but who have a special place in my affection because of our history together.

I never considered art as a career, however. For one thing, I didn’t think I was good enough. But perhaps even more significant, at the time of career choosing and most of the time since, I very much wanted involvement with others. For me art expression is a solitary experience. At times I have found it a necessary one in the development and exploration of my own individual relationship to myself and my world, but it is a journey into myself rather than an engagement with others.

I don’t believe I can articulate how an amorphous mass of clay in my hands comes to take the form of a mother and child lying together in a way that says much to me about myself as both mother and child, as well as pleasing me aesthetically in relationships of shapes, mass, space, texture, and material. The message is one of image—beyond and before words. Usually I give myself over to the material and am surprised at what emerges. The element of surprise is certainly one of the delights. Sometimes, however, nothing much happens and the result is disappointing.

A significant question for me is what is it that makes the creative experience so satisfying? I believe that it is a particular sort of paradox. On the one hand, there is a getting out of oneself, the sort of transcendence Koestler discusses in The Act of Creation (1964), a feeling of touching and being part of a more universal experience than the unique conditions of one’s own life. For me, there is illumination and possible alleviation of pain in this sort of occurrence. On the other hand, the stuff of which the creation is made is deeply personal, often putting one more profoundly in touch with oneself. It is here that understanding is achieved, and integration is probably the result of the interface of the personal and the universal. Finally, there is the pleasure. I as creator can look at my creation and admire it, and realize that I am looking at myself.

I do not believe that the process is a magic one, but rather a flowering of germanating images and techniques. In this sense, each work of art takes a lifetime to produce.

CREATIVITY IN ART THERAPY

Therapy conceived as an art form is created in the same manner. Each therapeutic intervention (like each brush stroke), each therapeutic case (like each work of art) is the result of the therapist’s (artist’s) training and experience. Both artist and therapist develop their sensibility so that their efforts flow from the heightened awareness of long discipline and reflection.

What is the place of creativity in the client’s experience in art therapy? Some art therapists believe that the quality of the art product indicates the degree of sublimation achieved (Kramer, 1971). Followers of this school of thought propose that the synthesizing effect of the creative force produces art therapy’s beneficial effect. I do not hold with this belief. Although I have worked with many people who achieved clarity and direction seemingly unconsciously and almost mysteriously through their art expression, I have worked with many others whose art expression was minimal or undeveloped, who achieved important insights and changes in themselves through reflecting on their images. In either case, creativity is involved, but not necessarily only the narrow artistic sublimation Kramer suggests.

The client’s creativity, as well as the therapist’s, encompasses the entire art psychotherapeutic process. Such is the case in any form of therapy. In art therapy, however, the medium of expression is an art form, thereby encouraging a more focused creativity than otherwise. Because expression in visual imagery encourages production of fantasy material (as discussed in the next chapter), some of the deeper layers of consciousness are stimulated, bringing to bear on the creative processes richer resources than may be ordinarily available.

Finally, the art-making process can be meditative or cathartic, soothing or playful. It can be an absorbing time out of time that transports the art-maker out of everyday life into the realm of the creative process, and in the end provides a satisfying product.

CHAPTER 2

Advantages of Art Therapy

Why art therapy? What does it have to offer? If I am giving a presentation to familiarize mental health professionals with art therapy, I usually conduct an experiential session so that they can discover the power of art therapy for themselves. I try to explain that art therapy is a “doing” sort of therapy and that to try to describe it is like trying to explain the flavor of chocolate to someone who has never tasted it. Because needs and perspectives differ, those experiencing art therapy for the first time may not all discover the same things.

Despite the limitations inherent in presenting art therapy in the abstract, art expression contributes some unique advantages to the psychotherapy process that may be helpful in reflecting on the illustrative material in this book.

IMAGERY

We think in images. We thought in images before we had words. We could recognize mother before we could say “mama.” No doubt other senses played a part too, such as touch and smell, but it is evident that in the second half of the first year of life, babies come to recognize their mothers by sight. Although some of us develop to become more visually oriented than others (e.g., those with photographic memories are an extreme), in all of us much of our preverbal thinking took the form of images. Primary process is the psychoanalytic term used to denote primitive, id-related experience. It would seem logical that much of this experience laid down early in life (primary) has a significant image component. We can say, therefore, that imagery probably plays a large part in early personality formation, the core experiences that influence subsequent layers of personality development. (Such a scheme of personality building in which each developmental stage is strongly influenced by its predecessors is found in many theories, but perhaps is most explicit in the concepts of Erikson [1950].)

In addition to imagery forming a base of experience in personality development, it is also recognized as a primary component of unconscious phenomena. In writing about dreams, which he considered to be the “royal road” to the unconscious, Freud (1963, p. 90) stated:

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

In art therapy the image of a dream, fantasy, or experience is depicted in image form rather than having to be translated into words, as in purely verbal therapy. Irvin Yalom makes the point well:

First there is the barrier between image and language. Mind thinks in images but, to communicate with another, must transform image into thought and then thought into language. That march, from image to thought to language, is treacherous. Casualties occur: the rich, fleecy texture of image, its extraordinary plasticity and flexibility, its private nostalgic hues—all are lost when image is crammed into language. (1989, p. 180)

Jungians have encouraged their clients to produce pictures of their dreams, and in many cases, the interpretations of the pictures serve as the prime modality of a Jungian analysis. (An example is the work of Perry [1976].) Words may be used to elaborate and associate to the art expression, but the essential message is conveyed in image form.

In addition to the reflection of images, the art medium often stimulates the production of images, tapping into primary process material and enhancing the creative process, both narrowly in an artistic sense and broadly in the creation of solutions in living.

DECREASED DEFENSES

This attribute is closely related to the importance of imagery, discussed previously. Because verbalization is our primary mode of communication, we are more adept at manipulating it and more facile in saying what we want to say and refraining from saying what we don’t want to say than we are through other communicative modes. Art is a less customary communicative vehicle for most people and therefore less amenable to control. Unexpected things may burst forth in a picture or sculpture, sometimes totally contrary to the intentions of its creator. This is one of the most exciting potentialities in art therapy. Unexpected recognitions often form the leading edge of insight, learning, and growth.

A common misconception about art therapy is that artistic ability is necessary for self-exploration through art expression. On the contrary, an artist may be less prone to accidental “slips of the brush” because of a high degree of ability in manipulating the materials. Occasionally I have worked with such people, but I have also conducted therapy with several art therapists who were both skillful artistically and sophisticated psychologically, yet who were sufficiently open to self-examination to relax their controls and let their pictures speak to them.

OBJECTIFICATION

In addition to work in images, another unique attribute of art therapy is the production of a tangible product. There are many implications to this aspect of the therapy, some of which are discussed in Chapter 5. A particular advantage of there being a tangible object produced is that it is often easier for a resistant patient to relate to the picture than to the self. For example, a hospitalized depressed man initially spoke of the angry expression on the face in his picture. He hadn’t intended it to look that way and didn’t understand why it had come out like that, because he did not feel angry himself, he said. Eventually he came to identify with the figure in his picture and to recognize his own anger.

In this way the art expression can form a bridge. I call this process objectification, because feelings or ideas are at first externalized in an object (picture or sculpture). The art object allows the individual, while separating from the feelings, to recognize their existence. If all goes well, the feelings become owned and integrated as a part of the self. Often this happens within one session. For particularly resistant people, it may take longer. For example, an agitated, depressed elderly man denied for many months that his pictures had any relationship to his feelings. He had been a draftsman and was adept at depicting tranquil scenes. Eventually he drew a large smoldering volcano and recognized that it represented himself.

PERMANENCE

Unique to art therapy is the permanence of the object produced. The advantage here is that the picture or sculpture is not subject to the distortions of memory. It remains the same and can be recalled intact months or years after its creation. I have found that reviewing the art productions with clients is extremely beneficial. Sometimes new insights develop. Particularly helpful is noticing emerging patterns that may not be apparent when the work is viewed singly. There have been times when clients have forgotten a piece of work, but seeing it recalls the feelings that were present at its creation. In this way it is possible for both therapist and client to derive a sense of the ongoing development that occurs in the therapeutic process. Such awareness can be very encouraging to a client, who thereby comes to recognize his or her own progress. Although it might seem likely that therapeutic progress would be self-evident, it is striking how easily people tend to forget how things were and how they felt. A series of pictures can provide ample documentation of the significant issues and their affectual components.

Permanence of the tangible object provides other advantages besides therapeutic ones. This very personal record created by the patient is a potent source of research data (Chapter 26). It also furnishes a vivid and dramatic statement from the patient that can be shared with others. (Naturally, the pictures express confidential material and are not shown and discussed outside of staff meetings except for professional presentations, when the patient’s identity is disguised.) At staff meetings I have found that although material was presented about the patient by other staff members—psychiatrist, social worker, nurse, occupational therapist—describing history, symptoms, family, and treatment process, frequently the pictures I have brought captured the attention of the meeting in the discussion period. They are a direct statement by the patient rather than information that has been filtered by others. They are often evocative, stimulating an emotional reaction from the onlookers beyond just intellectual processing.

SPATIAL MATRIX

Verbalization is linear communication. First we say one thing, then another. Art expression need not obey the rules of language: grammar, syntax, or logic. It is spatial in nature. There is no time element. In art, relationships occur in space. Sometimes this form of expression more nearly duplicates experience. If I were to tell you about my family, I would tell you about my mother, then about my father, then about their relationship to each other, then about my brother and his relationship to each of them, then about each one’s relationship to me. Obviously, I experience all of this at once. And in a picture I can portray it all at once. I can show closeness and distance, bonds and divisions, similarities and differences, feelings, particular attributes, context of family life, and so forth.

CREATIVE AND PHYSICAL ENERGY

For years I taught an evening art therapy course attended mostly by professionals. They had worked all day and were tired when they came to class. It was primarily an experiential course, but often there was discussion at the beginning. I was struck time and again by how sleepy we all were until we began the artwork. Then everyone seemed to wake up, and the discussion following the picture-making was much livelier than the initial interchange.

There seems to be an enlivening quality to be found in engaging in art expression. I have noticed a comparable phenomenon in ongoing art therapy groups. In the discussion following the drawing period, group members are often more open, revealing, and receptive than in initial discussion, even though the former may have been quite intense and probing.

I don’t know how to explain this observation, but I have experienced the change in energy level in myself as well, as I have become activated in art activity. It may be simply a matter of physical movement, but I doubt it, because often the physical activity is not that much greater than talking. I am more inclined to believe that it is a release of creative energy and a more direct participation in experience than in talking, especially “talking about.” At times the creative activity takes on the character of play, and art therapy becomes more like fun than like work. Even when being playful, however, I take the art therapy seriously.

SELF-ESTEEM ENHANCEMENT

For many patients and clients, the possibility of making art is an opportunity to develop a new side of themselves. Especially for those who are less skillful verbally, the pleasure they may derive from expressing themselves in visual form can be not only satisfying in and of itself, but it can also enhance a sense of mastery and self-esteem. In some settings clients may also receive the added admiration from others. One Chicago aftercare facility has an annual art show and sale of the artwork of its clientele that is very impressive. I vividly recall visiting an art show of one of my student intern’s clients at a facility for developmentally delayed individuals, who showed me their paintings with great pride.

CHAPTER 3

Roots and Application of Art Therapy

The roots of the art therapy profession reach back to prehistoric eras, when our remote predecessors expressed their relationship to their world in cave drawings and sought the meaning of existence in imagery. The beginnings of thought itself probably began with the process of symbolization (Greek syn“together” and ballein“to throw”). Thus meaning became established by the “throwing together” of the known and the unknown. The concrete image could stand for the unknown, the mysterious, the ineffable. For example, in 2500 B.C., a crude Greek stone carving with protuberances to indicate breasts served as a fertility goddess (Jung, 1964, p. 107).

Art therapy today has grown out of the current psychiatric movement, with particular indebtedness to Freud and Jung, both of whom placed great significance on symbolization. Freud developed the concept of an unconscious, expressed particularly vividly in the symbolic imagery of dreams. Jung postulated a universal unconscious, with common symbols appearing among different cultures through various epochs. As a result, Jungians have been especially interested in the art of many cultures.

Art of “insane asylum” inmates had been of interest in the past, particularly in regard to its sometimes bizarre qualities. It became a focus of attention in the Heidelberg Collection, formed by Hans Prinzhorn (1972) in 1922 from art gathered from many of Europe’s insane asylums.

The use of art expression as a therapeutic modality did not come into its own until the 1940s, through the pioneering efforts of Margaret Naumburg (1966). Relying heavily on psychoanalytic theory and practice, she encouraged clients to draw spontaneously and to free associate to their pictures. She entered the world of therapy through her contacts with psychoanalysts whose children were students at the progressive school she directed. She was followed in the 1950s by Edith Kramer (1971), who worked extensively with children. Her approach was different from Naumburg’s, in that she emphasized the integrative and healing properties of the creative process, which does not require verbal reflection. This differentiation of emphasis continued in a polarity in the profession, with one extreme placing the emphasis on the art and the other on the therapy. In the former, the creative process of the client is stressed; in the latter, the art forms the basis for insight.

From its early psychoanalytic beginnings, the profession has branched out and diverged into existentialistic directions that hold the individual responsible and accountable, in contrast with the more deterministic forces proposed by psychoanalytic theory. The Human Potential Movement has had a strong influence, as has the resurgence of Jungian psychology. As a result, the present state of the art encompasses many frameworks and approaches.

In the 1960s, art therapy became a recognized profession. Two events were significant in its development at that time: the creation of the American Journal of Art Therapy (published initially as The Bulletin of Art Therapy in 1962) and the establishment of the American Art Therapy Association (AATA). Though composed of only a handful of members initially, the AATA has grown rapidly. Its annual meetings, beginning in 1970, are highly professional, and the organization has taken steps toward accrediting art therapy training programs and lobbying for the development of the profession.

For more thorough histories of the profession, see Junge and Asawa, A History of Art Therapy in the United States (1994), and Junge and Wadeson, Architects of Art Therapy (2006).

APPLICATION OF ART THERAPY

The term art therapy is a huge umbrella, covering the use of art expression for many purposes in a great variety of settings. There are art therapists in private practice whose work with clients is insight-oriented on a long-term basis. Art therapy may be used for clarification purposes in a short-term crisis intervention center. Elderly residents in nursing homes may use art therapy as a life review, which is so important for those who are nearing the end of their lives. Drug and alcohol addiction centers use art therapy to help addicts examine their lives. Art therapy is being used increasingly with physically and mentally handicapped people as well.

Art therapy is probably used most extensively in hospital psychiatric wards and psychiatric outpatient settings, where patients may be seen individually or in groups. In the latter, the shared art expression becomes an important vehicle of communication (Sinrod, 1964). Patients may also participate in family art therapy, which was developed by Kwiatkowska (1962, 1967a, b) at the Clinical Center of the National Institute of Mental Health. In a family art therapy session, family members draw their perceptions of the family and make joint pictures to explore family dynamics. Individual and family art therapy procedures are used for diagnostic and evaluative purposes as well as for treatment.

Art therapy is important in the programs of many kinds of social service agencies as well, such as community centers, shelters for the homeless and for victims of domestic violence, aftercare programs for the chronically mentally ill, penal institutions, and others.