Chapter 1
Introduction
Art therapists have a considerable understanding of art techniques and are proficient in using materials to facilitate non-verbal communication. Metaphors, symbols and the expressive use of art materials combine to create a rich language for self-expression and the opportunity for the translation of strong emotions into a pictorial expression which can be visceral in its intensity. Differences in scale or perspective, tone and colour, along with the use of metaphors, allow for a potentially sophisticated articulation of thoughts and feelings.
Symbolism is multi-faceted and able to contain manifold and contradictory meanings. Indeed, a veritable constellation of meanings can be generated at the meeting point of several symbols. The use of symbols enables the expression of moods and immaterial ideas or qualities, which would otherwise be hard to articulate.
Tacit embodied feelings can be sensed and explored through the manipulation of materials. The process of making art works is in itself potentially revelatory, triggering strong feelings and revealing previously unexpressed issues. The materials themselves, their very substance, can be evocative. It is a sensory process in which the movements of the body and the tactile sensation of the materials are evocative. Another embodied dimension of the art therapy process could include aspects of prosopopeia in which a part of oneself, or an imaginary or absent person, is represented as speaking or acting. There could be an inner dialogue stimulated by engagement with the art work, or it might be spoken. Moving around an object can uncover different dimensions, different potential dialogues.
The images produced can be enlightening and provoking in unpremeditated, startling ways. The revealing image unburdens complex representations. Furthermore, many works placed together can collectively create unforeseen narratives. The space in which they are experienced can also have an influence, as well as the relationship of the works to the maker and to the viewer in how they are seen, displayed or hidden from easy view. How the works are subsequently engaged with can generate significance. The art works, the space and the viewer can interact to create new meanings. The art work can become a powerful container; showing the piece to others is potentially transformational. The pictorial content may be immutable â it assails. Finally, the disposal of works can have strongly revitalising consequences.
Whilst art processes are at the core of art therapy, there are different conceptualisations of the process, based on varied theories. These theories are not inconsequential since they posit different views as to what a human being is. Consequently, there are different opinions about the role of the art therapist. How the use of art materials is advocated can vary, as well as the way the materials may be used and the language chosen to explain the engagement.
The aim of this book is to provide an introduction and give an overview of the main theoretical models of art therapy. Without âdumbing downâ the different approaches, the book will attempt to explain them in clear and concise English, avoiding jargon, and elucidating difficult terms and concepts as they arise.
Each chapter provides an analytical synopsis of one different approach. This book will be particularly aimed at trainee art therapists in the English-speaking world, who need when training to be able to demonstrate that they have a grasp of theory.
The idea of isolating theoretical perspectives seems an obvious one, but, surprisingly, an overview of theoretical approaches did not exist previously. It is therefore hoped that this small volume will be extremely popular, especially with trainees and with an international audience. The non-judgemental tone adopted is intended to ensure widespread adoption.
Terminology
This book uses art therapy as the generic term. It does not make the distinction, made by some North American colleagues, between art therapy and art psychotherapy, as there is no consistent dichotomy in the use of such terms in Europe and Australia, or in most historic writing on the subject. There is a glossary of terms included.
Contents: further details
In each of the following chapters the particular features of one method will be elucidated and the underlying theory explained.
Chapter 2. Cognitive behavioural art therapy
In cognitive behavioural therapy (CBT) there is a focus on distorted thought processes, which give rise to emotions and behaviours. The task of cognitive therapy is to identify patterns of understandings that are unfounded and regarded as inaccurate; these are challenged and more adaptive ways of thinking and behaving are formulated. Malchiodi describes CBT thus:
(2012, pp. 89â90)
In CBT there is a tradition of using mental images to envisage new emotional responses and ways of being. Art therapy can be instrumental in aiding these processes.
Negative thinking is identified, as well as triggers for such negative thinking. âAutomatic negative thoughtsâ or ânegative self-talkâ are identified with contexts and situations and are challenged (Corey 2009). Art is used in conjunction with this framework: for example, in exploring and reframing traumatic events. In CBT, clients are asked to imagine themselves thinking, behaving and feeling differently using mental images. Clients can make actual images of these imagined scenes (Malchiodi 2012, pp. 90â1).
This model will be elaborated in further detail, from initial goal setting through to termination of treatment. The views of some of the principal exponents of these ideas, such as Roth (2001) and Rosal (2001), will be presented. This model is more developed in North America and Canada than in the UK, and with pressure for evidence-based practice and shorter-term interventions, this model is likely to be further developed and adopted in Britain. Included in this chapter will be a section on solution-focused brief art therapy (SFBT).
The solution-focused technique will be elaborated on. Although philosophically located within a constructivist framework, this is essentially a behavioural technique in which the individual identifies aspects of her or his life she or he wishes to change. The therapist assists by asking questions that help the beneficiary to clarify possible solutions and the means of achieving them. The technique focuses on what the individual desires to achieve; it is a method that attempts to utilise the strengths and capacities of the individual. Identifying such strengths might entail some analysis of previous situations or events in which the recipient successfully generated a solution. However, generally, it is future-focused and âgoal-orientatedâ.
âScaling questionsâ are frequently employed, allowing individuals to analyse aspects of their lives on a scale of 0 to 10, where 10 equals the achievement of all targets and zero is the worst possible scenario. The person undergoing SFBT is asked to identify his or her current position and the point at which there might be adequate fulfilment. Within this structure it is possible to define ultimate objectives (Iveson 2002). This approach is also particularly associated with the âmiracle questionâ, which is explained below.
Mindfulness as a technique is being used by CBT arts-based practitioners in conjunction with other CBT methods, but these will be discussed in a separate chapter.
Chapter 3. Psychoanalytic art therapy
In this chapter, the distinctive features of psychoanalytic art therapy will be explored and applied to practical work. Psychoanalytic theory will be explained in further detail in a comprehensible manner. This is one of the areas in which students often struggle, as the theory is particularly complex, but it can be articulated clearly without reductionism.
Psychodynamic therapy has arisen out of psychoanalysis, and sees inter-psychic conflicts as a form of stress which can result in psychological disturbance. It is an approach which is interested in the fundamental psychological forces governing human behaviour. These forces are seen as resulting in human action in a way that is not always obvious to the individual. The underlying forces are seen as being in a state of fluctuation (hence âdynamicâ).
The personality (or psyche) of the individual is seen as being comprised of three main elements which are in a state of constant tension. The super-ego is the moral part of the self which responds to the demands of civilisation and includes such ideas as conscience, discipline, self-restraint and self-sacrifice.
The ego is viewed as the conscious, rational part of the mind that negotiates with the other parts of the psyche and is seen as attempting to create a compromise between conflicting impulses. If the ego has good strength then it will succeed in maintaining balance; if the ego is weak, the personality may become unbalanced and consequently too ruled by either the super-ego or the id. The ego is seen as having various âmechanismsâ at its disposal to maintain this balance, which will be elaborated on. For example, ârepressionâ is explained as the egoâs attempts to thrust painful memories deep down into the unconscious mind so that they are effectively forgotten (though they may be rekindled later and cause problems). Another important mechanism is that of âprojectionâ, in which thoughts are attributed to someone or something else. Freud saw a number of mechanisms at play to do with flows of psychic instinctual energy and conflicting internal forces.
The third part of the mind is called the id. The id is the primitive part of the self. Instinctual behaviours and basic needs are viewed as arising from the id. The id is seen as demanding immediate satisfaction and pleasure; it is interested in the gratification of needs, and is not interested in morality, and is therefore in conflict with the super-ego.
Developmentally, the id is seen as infantile and as developing in early childhood; the ego then develops, and then lastly the super-ego. These theoretical constructs allow for a mobile or âdynamicâ view of the mind and have been immensely influential. These ideas permeate twentieth-century thought and culture, though the technicalities of psychoanalytic theory are not always well understood.
Other psychodynamic approaches have evolved from psychoanalysis. In psychodynamic art psychotherapy, clients become increasingly aware of the dynamic conflicts and tensions that are being revealed as symptoms or stress in their lives; whilst this approach has evolved from psychoanalysis, psychodynamic therapy is not necessarily explicitly Freudian and may not use all the conceptual apparatus Freud postulated to explain how the ego functions. The term âpsychodynamicâ is used for explanatory schemas and methods interested in interrogating dynamic emotional processes.
Psychodynamic principles are evident in several models of modern art therapy, as will be elucidated: as Malchiodi explains, âmost contemporary practitioners do not take a strictly psychoanalytic, analytic or object-relations approach to art therapy, elements of these philosophies are present in many contemporary art therapy approaches to treatmentâ (2012, pp. 72â3).
That âpsychoanalyticâ and âpsychodynamicâ are used synonymously by some writers adds to the general confusion. Nevertheless, there are art therapists whose practice is clearly located within the psychoanalytical tradition and who subscribe to the psychoanalytical view of symbolism, so this will be articulated. As this is also the theoretical basis for subsequent theoretical developments and challenges, these ideas are significant and need to be properly understood.
âObject-relationsâ theory is a development of psychoanalytic ideas and is explored. In this model of thought, the internal representations acquired in childhood are seen as playing out later in life through relationships. There is usually a particular emphasis on exploring how such representations are projected outwards, particularly to the art therapist; hence, the main focus of therapy becomes the exploration of this transference relationship.
Chapter 4. Analytical (Jungian) art therapy
This chapter will explore art therapy derived from analytical psychology. The term âanalyticâ will refer to analytical psychology. Important art therapy techniques that stem from analytic psychology, such as âamplificationâ, will be explained.
There has been a tendency among some British art therapists to refer to psychoanalytic art therapy as âanalyticalâ. Analytical psychology is properly âJungianâ, deriving from the work of Carl Gustav Jung, and is a distinctive departure from psychoanalysis, especially in respect to its attitude towards images.
In analytic art therapy, pictorial symbolism, emerging from the unconscious, acts as a âcompensationâ or complement to the conscious psyche, potentially bringing into focus aspects of the person not to the fore. Jung felt that good health was best achieved by giving voice to the unconscious aspects of the self and that the less conscious aspects of a personâs total nature could appear in dreams or art work. Symbolism is seen as a bridge between the conscious and unconscious realms. The production of images is seen as assisting in creating equilibrium and as playing a regulatory role upon consciousness.
As well as the theoretical underpinnings of the analytic approach, studio-focused analytic art therapy techniques will also be explored. This way of providing art therapy is focused on the aesthetic dimensions of the production of art works and the relationship of the subject to her or his work. Thus, analytical studio work has an emphasis on non-verbal aspects of art making. Believing the psyche to be a self-regulating system that is capable of balancing and adjusting itself as necessary, art therapy is thought to be efficacious without verbal analysis. Indeed, art is regarded as therapy.
Chapter 5. Gestalt art therapy
Gestalt theory is a branch of humanistic psychology which has a particular emphasis on working in the present. Gestalt art therapy has also integrated some psychodynamic aspects into its practice.
Using images as an adjunct to verbal psychotherapy is a technique employed by some art therapists. Gestalt art therapy is essentially a verbal psychotherapy that employs drama therapy methods into which image making is then incorporated. It employs a focused use of imagery that is often rather directive.
The art work in the Gestalt approach is usually a brief sketch rather than an involved piece. The art work is usually made at the same time as speaking, or is used to stimulate discourse. Part of the process is an opportunity to look at how the present is affected by the past. As John Birtchnell puts it: âTalking to the picture, particularly in the here and now, is the most powerful device I knowâ (1998, p. 149).
This chapter will explore ideas from psychodrama and verbal psychotherapy that have been incorporated into this distinctive mode of art therapy. Itâs theory and practice will be illuminated. The views of its principal exponents will be explicated.
Chapter 6. Person-centred art therapy
The person-centred art therapy model will be explained, and delineated in terms of its similarities and differences. This model of working and its underlying theory will be elucidated, with reference to the work of Carl Rogers (1902â87) in particular. The humanistic roots of the model will be described, along with the key features of Rogerian art therapy.
Humanism is interested in an individualâs subjective conscious perception and understanding of the world. It does not look for âunconsciousâ motivations. It has been described as a âthird wayâ: an alternative to both behaviourism and psychoanalytic (and psychodynamic) orientations.
The ânon-directiveâ, or âperson-centredâ, approach assumes that the client has the resources to deal with her or his problem, if given the opportunity, in the context of an authentic, empathetic relationship, and to be aware of his or her own feelings and desires. This authentic relationship is described as being âcongruentâ. Being non-directive is thought to give power to the client to deal with what she or he considers important, and to set the pace, and is a distinctive feature of this approach. Clients are seen as having âdeep strengthsâ which can be released and freed in a permis...