Art Therapy and Psychology

A Step-by-Step Guide for Practitioners

Robert Gray

• Publisher: Routledge
• Year: 2019
• Print ISBN:
  9780815355908
• eBook ISBN:
  9781351129039
• Topic: Medicine
• Subtopic: Cognitive Behavioral Therapy (CBT)

Taking an interdisciplinary approach, Robert Gray offers a thorough and well-rounded clinical guide to exploring the depth of the unconscious through art in psychotherapy. He emphasises the clinical relevance of art therapy and critically highlights ideas around evidence-based practice and the link to cognitive behavioural therapy. Gray suggests specific ways of engaging with clients and their images, such as uncovering life scripts, changing neural pathways through Creative Mind Ordering, and addressing traumatic experiences through the Jungian Self- Box. He shows how artists and psychotherapists can make a transformational difference by combining 'art as therapy' and 'art in therapy' with a scientific approach and a spiritual awareness. He argues a clear framework that bridges the unmeasurable and spontaneous part of psychotherapy through art, along with the work with the unconscious and the clarity of a scientific method, can help facilitate long term change.

Art Therapy and Psychology is hands-on and rich with supportive study tools and numerous case studies with which the reader can relate. This book is essential reading for art therapists in training and in practice, psychologists and mental health professionals looking to establish or grow their expertise.

Chapter 1
Foundations

This book and you

A major part of this book is about you, about understanding yourself, and reflecting on the deeper meaning of your drawings, paintings and artworks that you are asked to produce from the methods described in the following pages. In my opinion, doing art within a specific framework is the best way for you to learn art therapy, so I have compiled my most tried and true methods, which I have used with clients for many years and which have worked successfully time and time again. You don’t need to be an artist to do this. The methods and techniques are designed to help you observe your thoughts and emotions as you draw or paint and to be non-judgmental of the process. As you progress through the book you will find it easier to ‘make space’. This means being in the moment and allowing things to happen and yourself to change. The methods help you to be more mindful or ‘awareful’ with all your thoughts, emotions, senses, body and spirit. At times you will notice if you are upset or angry as you draw, at other times you might find your spiritual side emerging, giving you greater insight into how you truly feel, as you uncover deeper levels of yourself in the artwork.

Art therapy helps us to explore who we are. There will be many instances when you will just notice what happens with your thoughts and feelings. Be aware and take notes when this happens, allow it to happen and reflect on it later. You might even choose to buy a personal journal to accompany the reading of this book. If a picture surprises you, irritates you or makes you upset, you have something to work with. This is a gift, a moment in time where your life can change for the better. You might want to talk to somebody about it, a friend, a partner or see an art therapist to help you with some of the issues that may come up for you.

In the process of art making one becomes engaged in the practice in such a way that observation skills become heightened. Each technique in the following chapters will involve you in this way, and as you take small steps into the journey of self-understanding, you will notice changes occurring on a deeper level, giving you greater insight, helping you be in the moment, as well as allowing you to be more perceptive of the life you want to lead, and more astute about the future you want to create.

Working with the unconscious mind

Freud’s iceberg in art therapy

The development of art therapy and its profound usefulness as a healing practice can be historically linked to Sigmund Freud, the founder of psychoanalysis. Even though Freud has been criticised for many of his assumptions and theories, especially about sexuality, he contributed significantly to a field of knowledge that unleashed groundbreaking insights into human behaviour during a very restrictive period in history. His lack of understanding of women, and his theories on castration anxiety, penis envy, hysteria and many other assumptions have been highly debated. Many of Freuds contemporaries were women, who built on or criticised his work, and this interest created a snowball effect of advancements in neurology and psychotherapy around the world. Two pioneers in the field of art therapy, and whose work is intrinsically linked to Freud, are Margaret Naumburg and Edith Kramer. Both used Freud’s understanding of the unconscious in their therapeutic art practice with patients (Tobin, 2015).

Even though Freud himself never used the image of an iceberg, it can be an extremely useful metaphor to help us understand the way he perceived and understood the relationship between our conscious and unconscious mind. The tip of the iceberg, above the water, represents the conscious mind while the bulk of mental content, in the unconscious, lies below the surface. What makes mental health issues so challenging is that, often, the content that prohibits optimal functioning is literally ‘out of sight, out of mind’ and liable to intrude upon consciousness without warning; without awareness of the culpable thoughts or beliefs. This is still valid 80 years after Freud. Have you ever wondered why you sometimes attract the same types of toxic people or run late for everything? Complicating matters further, the unconscious plays by different rules to those we assume to be true in conscious life. For instance, in the unconscious there is no time, which is why trauma can resurface as a relentless memory. In the presence of a trigger, the brain responds as though it is happening now – not 10 or 30 years ago. Since the unconscious mind is believed to be the ‘driver’ of what we really think, feel and do, this susceptibility means that gains made using talk-based methodologies in the here and now are often limited.

Take the dominant psychotherapeutic framework, cognitive behaviour therapy (CBT). The focus of CBT is on observable behaviour and conscious cognitions/thoughts. Treatment focuses on changing dysfunctional assumptions, expectations and interpretations of events as well as negative self-talk into positive, healthy thinking (Hofmann, 2012). In the iceberg context, it works only at the ‘tip’, with thoughts and behaviours that can be consciously accessed.

Example: Client with the belief “I’m not a good mother.”

Parent programs that use CBT may install an opposing, more adaptive or helpful thought (“I’m a good mother”), but might fail to address the underlying childhood issues and related beliefs that lie in her unconscious. If her worldview is built upon the experience of being told that she was no good at anything by a critical parent in her early childhood, her belief that she is a good mother will at best be superficial, fragile and susceptible to rupture with any suggestion that favours her not-good-enough belief.

Freud, Jung and others have observed and written, that imagery can be used to encourage a person’s unconscious to rise into their consciousness. In psychoanalysis, the unconscious is described as “the part of the mind which you are not aware of but which affects behaviour and emotions” (Waite & Hawker, 2009, p. 762). Art can often bypass vulnerability and defence mechanisms inherent to verbal communication, making visible an image in one’s inner world (Swan-Foster, 2016). By making the unconscious conscious, art therapy can enable fundamental ‘shifts’ that, in turn, alter conscious thoughts, feelings and behaviours for the better.

Emotions and the unconscious

Most practitioners have a basic understanding of how emotions affect the brain, a person’s ability and function. Emotions like anger and grief, can play havoc with our lives, and can be detrimental to our well-being. Many of us are aware of how emotions that overwhelm us can cause us to lose focus on what we are doing. We may be unable to think of others, but only of ourselves, or on the emotion that is taking charge. Not being able to process highly charged emotions in ourselves can lead to long-term problems, even depression and anxiety. Frequently, traumatic experiences from early childhood are triggers for things we feel in our adult life. Even with the best of parenting and support we can still suffer intensely from an early age, which, in turn, will create many different negative feelings around grief and loss. These stored emotions, experiences or trauma stay in the body and in the unconscious, and, if unreleased, can make a person either overwhelmed with emotion, angry or numb, or any number of residual feelings can occur. This is often why depressed clients don’t know why they are depressed. Depression can have a history of buried emotions. A great deal has been written about the need for talking about one’s emotions in order to heal, however sometimes clients, especially depressed clients, aren’t able to target what is causing them distress. It can be confusing, so they aren’t able to discuss their deep feelings or problems, as they are not even consciously aware of them.

Art therapy works to uncover unconscious feelings, grief and trauma, ‘stuck feelings’ in the body and mind. I find it helps clients to access the hidden aspects of themselves, allowing them to understand their emotional condition. Art therapy can give a release to their experience, by allowing the emotion to surface, be acknowledged and be re-integrated. Once the unconscious becomes conscious and the deep-seated feelings become unstuck, a client is much more capable of talking about their problems, feelings and thoughts. So it is helpful to use a combination of art therapy for the unconscious work, together with a talking therapy like CBT, for consciously understanding ourselves.

Cognitive behaviour therapy (CBT) and psychoanalysis

The difference between the two

The intellectual forebears of cognitive-behavioural therapies are found in the empirical-positivist tradition of American academic psychology rather than in the European philosophical attitudes that influenced Freud and many other psychodynamic therapists.

(McWilliams, 2011)

Cognitive behavioural therapy, developed from cognitive therapy by the American psychologist Albert Ellis and psychiatrist Aaron Beck, and behavioural therapy (developed mainly by American academics including Watson, Wolpe, Meichenbaum, Skinner and Bandura to name a few), has similar goals to psychoanalysis. This approach can help clients overcome difficulties, change their behaviour, and move forward in their lives. Many of the CBT treatments have clearly demonstrated their effectiveness in reducing symptoms; however, these are best suited to clients who are in need of short-term therapy, 15 to 20 weeks. CBT is best suited for clients whose problems stem from more immediate issues, and where inaccurate thinking can be changed or modified in order to affect behaviour. McWilliams (2011) contended that some clients also prefer a more focused and directed treatment, complete with homework assignments.

Psychoanalysis and psychodynamic therapies are more contemplative processes that can take many years; the goal is to uncover the underlying unconscious schemata. Unlike CBT, it involves an emphasis on childhood and past experiences, on exploration of the unconscious, and on wishes, dreams, and fantasies (McWilliams, 2011).

CBT is similar to psychoanalysis in that there is an exploration of patterns in the patient’s actions, thoughts, feelings, experiences and relationships (object relations). However, psychodynamic therapies differ in that they focus more on expression of emotion and the role of emotion in the client’s life. The patient’s efforts to avoid certain topics (i.e. resistance) is also examined, as the fear of change is often a strong unconscious motive. In psychoanalysis there is also an emphasis on the therapeutic relationship (transference and working alliance) (McWilliams, 2011).

Moreover, many with a psychodynamic sensibility could not work within a manualised CBT framework; it is too left-brained for many therapists and clients (McWilliams, 2011). There is often a need to help the client achieve balance in their life through therapy. Where clients might be too logical, too linear or unable to be spontaneous, it is important to stimulate right-brain thinking, whereby clients can be more open emotionally, less linear, and more wholistic (Carnevale, 2015).

On a final note: What I personally love about working with images and the unconscious is that “accidents can happen”, as Case and Dalley (2014, p. 114) put it so discerningly. Working with a CBT approach can quickly achieve a directed and practical outcome. A great adjunct to art therapy. Within an art therapy approach however, you want to allow for ‘accidents’, chaos, confusion and contradictions. often, it is exactly these moments when ‘accidents’ happen that can be eye-opening for our clients. When something totally unexpected comes up this can make a huge difference.

In the following chapters we will examine how both approaches, and a variety of others, can coexist harmoniously for better client outcomes.

Exploring the official timeline of art therapy and psychology

• Early 1900s: Freud and Jung lead the way with the ‘power’ of the unconscious.
• 1930s: ‘Art as therapy’ is used in mental health institutions.
• 1940s: ‘Art in therapy’ (some authors call it ‘art psychotherapy’) began when psychiatrists, psychologists and art therapists started using drawings and paintings as a way to replace verbal communication, to prompt discussion, explore transference (of feelings from client to analyst), and countertransference (from analyst to client), and to tap into the unconscious material of their clients.
• 1950s: Behavioural therapy developed in opposition to psychoanalysis and the work with the unconscious. After the horrors of World War II, psychoanalysis, with its strong focus on the life instinct, which includes sexual instincts ‘Eros’, and the death instinct, destruction and death wish ‘Thanatos’ as core impulses, lost popularity, possibly out of a need for something more tangible, dependable, measurable and reliable. This was a crucial moment in history, where many psychologists moved away from working with the unconscious and art therapy. I believe the world was traumatised by this event and when people are affected by trauma, they like to be pragmatic and rational. They don’t want to delve too deeply. Even if they reflect on the past, they want to focus on practical solutions in the present and concentrate on the future.
• 1960s: Cognitive therapy has been developed to deal with the shortcomings of behaviour therapy. It helped to identify thinking and how it affected us, i.e. sometimes people tend to do the right thing, but their thinking is not in it, which can cause them stress etc. You might be nice to your boss, but think otherwise and grumble.
• 1960s: Humanistic therapy is a third force (Maslow, 1968; Moon, 2016), opposing the determinism of dehumanising psychoanalysis and behaviour therapy. There is a strong belief that we are capable of healing ourselves, and the role of the therapist is ‘just’ to enable that. I personally see this approach as the baseline for all good therapy. We start here and then use different approaches in a decisive way. Consequently, we don’t need to have all the answers and can be respectful and supportive towards the inner wisdom of our clients.
• 1970s: Behaviour therapy and cognitive therapy got ‘married’ and formed a powerful union, a paradigm of evidence-based practice for decades to come, continuing up to today.
• Today: Throughout all those years, art therapy has not disappeared, but has become more widely accepted and many psychologists who struggle with using CBT alone show an increased interest in working ‘again’ with the unconscious including art therapy.

Two types of art therapy

Of course, we can theoretically divide art therapy in many different ways, but over the last few decades this model has worked well for me, in a very practical way.

Despite its informal longevity, reaching back to the primitive cave paintings, art therapy only really emerged as a therapeutic paradigm in the 1930s and 1940s. A British artist, educator and the author of Art Versus Illness, Adrian Hill appears to be the first person who used the term ‘art therapy’ to link art making to the therapeutic process (Edwards, 2004). Hill (1948) believed that the practice of art could turn society away from war, by encouraging appreciation of artistic creativity. Around the same time, Edith Kramer (1971) introduced the idea of ‘art as therapy’, eschewing verbal interpretation in psychoanalysis for the therapeutic scope of the creative process.

In sync with the psychoanalytic practice of her days, and different to Kramer’s focus on the art as therapy process, Margaret Naumburg’s art psychotherapy had a strong focus on ‘art in therapy’ /art psychotherapy, where unconscious material was uncovered through the analysis of the artwork (Ulman & Dachinger, 1975). She believed that the drawn images represent inner images of the client and can facilitate and lead into discourse or substitute it while being in therapy (Naumburg, 1953). Thes...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• Introduction
• 1 Foundations
• 2 Positive art therapy
• 3 Representational images, projective drawings and the House-Tree-Person (HTP) task
• 4 Life Script: Create an alternative script
• 5 Goals: Overcome obstacles
• 6 Abstract art and the self-picture mind map
• 7 Self-Box: Become authentic and integrate traumatic memories
• 8 Creative Mind Ordering (CMO): Change neural pathways
• 9 Advancing art therapy and cognitive behaviour therapy (CBT)
• 10 Group art therapy
• Pseudonyms
• Acknowledgments
• Index