Art Therapy With Families In Crisis

Overcoming Resistance Through Nonverbal Expression

Debra Greenspoon Linesch

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780876306383
• eBook ISBN: 9781134853939
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This volume describes art therapy interventions for particularly dysfunctional families and explains the connections between the process of creating art and the curative process in meeting these families' needs. The first chapter examines distressed family systems, and psychotherapy in relation to the uses of art therapy. Subsequent chapters present a crisis intervention model for family art therapy and demonstrate the applications of this model with single-parent families, families affcetd by alcoholism or sexual abuse, and families of political refugees and disaster victims. More than 70 samples of the art produced by these families are reproduced and analyzed.

—SECTION II—

SEARCHING
FOR
ANSWERS

—2—

A Crisis Intervention Model for Family Art Therapy

Julie Belnick

The extraordinary versatility of art therapy has allowed for its application in a wide range of therapeutic settings with vastly differing populations. The intrinsic qualities of this modality, such as its ability both to provide structure and to promote free expression, can be drawn upon to meet the varied needs of clients and treatment approaches.

In my work with families in crisis at the Benjamin Rush Center (BRC) in Los Angeles, I recognized what appeared to be a theoretical connection between art therapy and the fundamental concerns of the BRC family crisis intervention model. It was striking to observe how art therapy seemed to enhance the attainment of specific objectives involving cognition and problem-solving, the ventilation of affect, and work with family systems.

Spurred to investigate this dynamic in greater depth, I found that although art therapy had been shown to be a valuable component of various crisis intervention strategies, little had been published about its use in family crises. The few reported cases involved work with one family or at most two families, each following a different treatment format. This inconsistency made it difficult to assess the value of art therapy in facilitating family crisis resolution.

Since the BRC crisis intervention model comprises a clearly defined sequence of steps, one could achieve consistency in evaluating the use of art therapy by following the progress of several families through the treatment process. I proceeded to investigate how art therapy could promote family crisis resolution by facilitating the essential steps of the BRC model.

History of Crisis Intervention

As the stressors in contemporary urban life continue to increase, so do the conditions for crises of all kinds. Families are being faced with dilemmas that overtax their usual coping strategies and thus push them into a state of crisis. It took some time for the mental health field to recognize the unique needs of people in crisis. Once they were recognized, the urgency for developing specialized treatment was realized as well. Lindemann’s (1944) seminal study on bereavement was instrumental in bringing about this awareness. As a result of his work, a state of crisis was redefined as a normal response to overwhelming loss. Furthermore, it was noted that people would achieve crisis resolution, adaptively or maladaptively, within four to six weeks of the crisis precipitant.

It followed that ready access to mental health services, as well as a brief treatment approach, was essential to effective intervention. Traditional psychoanalytic treatment was costly, time-consuming, and ill-suited to the specific demands of crisis intervention. Additionally, psychoanalysis was particularly inaccessible to groups of lower socioeconomic status, whereas crisis intervention invited realistic participation of all segments of the community. This awareness, along with the recognition of crisis intervention as an effective treatment modality, culminated in the passage of the Community Mental Health Centers Act of 1963, which established emergency services as one of five primary programs.

Until the 1960s, crisis intervention programs were aimed primarily at treating individuals. With the establishment of family therapy as a treatment modality, programs were developed specifically for families in crisis—where the basic tenets of crisis intervention were found to be equally applicable. For example, the crisis intervention model developed and implemented at BRC began as a model for individuals and grew to encompass work with families.

Crisis Theory and the Equilibrium Model

The theoretical core of the equilibrium model of crisis intervention (the foundation of the BRC approach) is based on the idea that a state of crisis is a normal response to overwhelming loss, resulting in an individual’s (or family’s) being thrown into psychological disequilibrium. The extent of loss is based on the subjective perception of an event as a threat to needs, safety, or meaningful existence. Loss of self-esteem, of sexual-role mastery, or of nurturing can be major crisis precipitants (Strickler & La Sor, 1970).

Family crises parallel individual crises in that a family is propelled into a crisis state when habitual coping is inadequate to maintain the family’s equilibrium. Consider the basic premise of family therapy, which states that the family constitutes a system wherein all parts affect the whole. It follows that a family can be thrown into a state of disequilibrium in response to loss affecting one or more members.

The equilibrium model of crisis intervention seeks to return a person (or family) to the precrisis equilibrium—or better. The basic premise that psychic equilibrium will be restored within six weeks lends theoretical structure to the intervention process in that there is a definite time limit on the length of treatment (up to six visits) and precise steps to follow in the intervention process. This supports the necessity for an active stance to be taken by the intervenor. The client is continually directed toward his or her personal coping resources; any dependency on the therapist is discouraged.

Steps in the Intervention Process

Family crisis intervention at BRC is an extension and elaboration of individual crisis intervention techniques, which are examined in the following discussion.

The essential first step in crisis intervention is to assess whether or not the consultee can be treated safely on an outpatient basis. The next task is to identify the precipitating event, which helps differentiate crisis issues from long-term pathology. Often, the consultee is not conscious of exactly what provoked his or her distress. It is helpful to explore the “last contact” (the last interpersonal contact prior to seeking help) because it is almost invariably related symbolically to the core of the crisis. Working backwards chronologically, one can incorporate events leading up to the “last contact” into a time-line, which can facilitate understanding the interrelationship of these events. One can often ascertain how a family has coped in the interim between the crisis precipitant and the decision to finally ask for professional assistance. When the precipitating event has been identified (usually it has occurred a month or less before treatment is sought), one must then uncover the meaning of the event in terms of the threat that it poses to vital psychological needs. It is also important to explore the coping mechanisms usually employed in response to similar threats and the new conditions that have rendered them ineffective.

The consultant condenses the information gleaned thus far into a crisis formulation that is conveyed to the consultee in order to clarify the crisis dynamics. The intent is to provide the consultee with a cognitive grasp of his or her experience, thus opening the way for adaptive coping to emerge. The development of new coping then becomes a primary focus of treatment. Emotional aspects are addressed throughout the crisis intervention, as the consultant assists the consultee in identifying and expressing underlying feelings. Anticipatory planning review of gains makes up the last phase of intervention.

When one is working with families, the sequential steps of crisis intervention are consistent with those just described. However, they increase in complexity as the practitioner necessarily develops ideas on both individual and family levels.

Art Therapy and Crisis Intervention

Art therapy is uniquely suited to promoting basic goals of crisis intervention involving cognition and problem-solving, ventilation of affect, and work with family systems.

Cognition and Problem-Solving

Attaining cognitive understanding of crisis dynamics is seen as a vital step toward regaining psychic equilibrium. Art therapy provides an individual the opportunity to step back and evaluate the meaning of his or her subjective art expressions. This promotes a person’s ability to symbolize, to think, and to think about thinking—processes that are emphasized in cognitive therapy.

Another basic premise of cognitive therapy is the idea that perception is an active process and that each person’s view of the world is unique. It follows that a person, although free to choose between alternatives in the environment, is limited by his or her perception. The art experience can facilitate a person’s process of choice (or problem-solving) by providing a safe context in which to discover and test out various options.

Visual representation offers a means to express multiple layers or meaning in a condensed format. This aspect of the art experience is strikingly helpful in crisis intervention, where it is essential to uncover the meaning of events. It provides an avenue of exploration that is in marked contrast with verbal representation, which is organized serially in terms of cause and effect.

Cognition and problem-solving are also enhanced by behavioral characteristics of the art experience. The art activity demands problem-solving choices in that the client must weigh alternatives, criticize, and follow through on decisions. Additionally, the graphic product is durable, allowing a client to review and respond to what has been expressed, whereas mental images can fade and evade reevaluation.

Ventilation of Affect

Various theorists and practitioners have addressed the potent capability of art therapy to heighten the subjective experience of affect. Horowitz (1971) notes that the visual modality can help bypass defense mechanisms (such as intellectualization and suppression) that can block affect. Wadeson (1980) reports that art objects can allow people the necessary psychic distance from which to recognize the existence of feelings. From that point, individuals can begin to own and integrate these affects as part of themselves. Additionally, the physical experience of manipulating media (such as squeezing or pounding plasticene),; can provide a cathartic release of feelings.

Work with Family Systems

Art therapy can be utilized to illuminate family systems, another vital component of family crisis intervention. A family system can be examined by observation of the family working as a unit on a joint art project: “The value of the art task is threefold: the process as a diagnostic, interactional, and rehearsal tool; the contents as a means of portraying unconscious and conscious communication; and the product as lasting evidence of the group’s dynamics” (Landgarten, 1987, p. 5).

It follows that one can also use the art process as a structural intervention by directing the family to work on art tasks in subgroups. For example, in a mother + child + father triad in which the child is triangulated, the parents may be asked to work together while the child remains free to work on his or her own.

Family Art Therapy Crisis Intervention Model

Art interventions were designed to promote the sequential goals of the BRC treatment model, which are delineated as follows: (1) cognitive understanding of crisis dynamics; (2) identification and expression of crisis-related affect; (3) exploration of previous coping mechanisms and facilitation of adaptive coping through problem-solving; (4) anticipatory planning; (5) summary of gains made during the intervention process.

It is interesting to note that an art intervention directed toward one goal may well provide access to other goals. The process of creating the artwork, the content of the artwork, and the interchange stimulated by the art activity are all vital aspects of the interventions.

Art Interventions

Cognitive Understanding of Crisis Dynamics

Assisting people to explore the events culminating in their request for professional help can lead to clarification of crisis dynamics. One might ask members of a family to draw these events and to include what happened the day and the hour before they contacted the clinic. It can be particularly illuminating to have people draw or choose magazine images about the “last contact” (the last interpersonal contact prior to asking for help), since this interaction almost always contains a key to uncovering crisis dynamics. Comparing perceptions of the family before and after the crisis precipitant can provide striking access to underlying crisis dynamics. This can be done with two-dimensional media (e.g., draw your family before and after) or with three-dimensional media such as plasticene, which can facilitate reenactment. For example, one might ask family members to create plasticene images of themselves in order to stage before and after family scenes.

Identification and Expression of Crisis-Related Affect

The metaphorical aspects of magazine collage images often uncover levels of feeling that people are not consciously aware of. Therefore, it can be very useful to ask family members to choose pictures that describe how they feel about the crisis.

Another...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Introduction
• SECTION I. ASKING THE QUESTIONS
• SECTION II. SEARCHING FOR ANSWERS
• SECTION III. FORMULATING ANSWERS
• Index