Healing from Clinical Trauma Using Creative Mindfulness Techniques

A Workbook of Tools and Applications

Corinna M. Costello, Beth Ann Short

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000442052
• Edition: 1
• Topic: Psychology
• Subtopic: Post-Traumatic Stress Disorder (PTSD)
• Index: Psychology

This workbook offers diverse strengths-based tools to incorporate the Creative Mindfulness Technique (CMT) into clinical practice. It provides an essential understanding of the ethical scope of practice, ensuring that clinicians consider the depth of their own training in the implementation of the CMT art directives.

Chapters explore aspects such as attachment and art therapy, multicultural considerations when using art with clients, mindfulness, the eight dimensions of wellness, and the application of CMT techniques with clients affected by PTSD, anxiety, and low self-esteem. The creative activities, mindfulness approaches, and arts-based exercises provided support the healing process of clients in ways that are accessible, practical, and easy to execute. Examples of activities include guided imageries with art-making, art journaling directives, and mixed media prompts. Through these exercises, clients will learn to draw upon their strengths and feel empowered in their daily lives.

People with PTSD/clinical trauma, stress, addiction, and anxiety, and clinicians and mental health practitioners working with them will find this book to be an essential tool. Readers may also be interested in Creative Mindfulness Techniques for Clinical Trauma Work: Insights and Applications for Mental Health Practitioners, which can be used on its own or as a companion to this book.

Part I

The Evolution of the Creative Mindfulness Technique

1 Art and the Process

DOI: 10.4324/9781003036777-1

What interests us about other people’s art? It is common to consider the artist’s motivations when looking at a piece of art. Museums and galleries worldwide exhibit art for the public to view and contemplate. How is their art different from the art created in an art therapy session? Some isn’t, but some is and comes from a product driven approach utilizing the formal elements of art looking to create balance and symmetry in an art form. In art school students attend critiques where art is thoroughly examined by the instructor and peers in the class. Critiques are learning opportunities for students exploring the art product in relation to media technique, however the process is not always deeply considered. In art therapy the product may be experienced like an iceberg, what lies beneath represents a vast array of experiences, truths, feelings, thoughts, and intentions. The process is not limited to art therapy in the creation a piece of art. For instance, consider artists like Egon Shiele or Frida Kahlo. They were artists who created pieces of art in response to their life experiences and self-concept. Humans are still fascinated by their work. Many artists do channel the process having no formal training, they have been labeled outsider artists (Cardinal, 1972). The term comes from writer and historian Roger Cardinal who described an outsider artist as one who has no formal training and lives outside of the confines of the art world (Cardinal, 1972). While human creativity continues to evolve outside of traditional art, some in the art world continue to look the other way from outsider art not valuing the process that is often an undercurrent in art-making. Art therapy embraces the process.

Typically art made in an art therapy session is not put on display, and is considered confidential in content, as important as the client’s words in session. In open studios the lines of confidentiality become less rigid, dependent on the agreement between the client and art therapist. Releases must be signed for art to be hung for display or used in educational situations. Open studio projects like the Artist/Humankind: Location/Earth (AH:LE) provide platforms for stories to reach others feeling alone and marginalized. This project aims to provide anyone “the opportunity to share their own life experiences using a creative outlet and find community in the process” (Short, n. d.). The goals of the project inclusive to anyone who comes into contact to view the art as well as the participants (Short, n. d.):

• Participants will experience increased ability to use creativity in self-care, as well as in problem solving while gaining insight into past, present and future life choices through this process.
• Participants will explore self-perception and personal role identity formation exploring and engaging with others in the core group finding normalcy in their experience relating to the role of the session, while translating their own experience in their unique art voice.
• Participants will examine the concept of roles in life that guide our behaviors, rights and obligations through the social experience in social status, social community and expectations of others.

Participants were not required to have any experience using art materials. The ongoing project currently has completed three versions of the project including the Caregiver Summit, the Gender Summit (Figure 1.1), and the Survivor Summit. Each session consists of a period of group art- making over a period of time and then an exhibition. The Gender Summit went on to travel to multiple locations providing educational talks about the experience including a panel discussion of select participants at one conference. In each of the sessions project participants were not individual therapy clients, signing releases prior to starting the process. All art pieces remained the artists’ property once the session ended.

Figure 1.1 Art from the AH:LE Gender Summit.

Art provides a limitless container for humankind to communicate about needs, desires, events and experiences. Humans have been creating art for over 40,000 years. What motivates the creation or the urge to observe art? Could it be as simple as finding a familiar thought, feeling, intention, or experience? To not be alone in this life? Art therapy provides opportunities for clients to use the process as an additional voice in treatment. Traditional counseling does not work for everyone. Not all clients are able or open to sitting and talking. Art therapy becomes an engaging vehicle or transitional object in the therapeutic process (Robbins, 1998). The art process and exploring materials has been fundamental for some clients to challenge existing patterns (Pénzes et al., 2014). Arthur Robbins implicates object relations art therapy as his version of art therapy pulling from psychoanalytic theory whereas the art process becomes the object where a person’s “libidinal energy is invested” (p. 131). Robbins compares the art therapy process to that of a transitional object to a child. As a child emotes, plays, imagines, practices, socializes, and projects onto that transitional object, the object in turn is an accepting non-judgmental vessel. The art therapy process is also that, a safe malleable container, or object of attachment. The process provides room for clients to explore struggles around separation, individuation, dependence, independence, and intimacy thus providing opportunities to repair developmental deficiencies from early childhood relationships (Robbins, 2016). “Art can contain, organize, and mirror internal object relations and the interplay between therapist, client, and the art product” (Robbins, 2012, p. 70).

Attachment and Art Therapy

Ruptured childhood attachments appear to be underlying in many diagnoses, especially those that are trauma based. Secure attachment not only allows an infant the ability to begin to individually regulate their emotions, but it also is vital in the development of the brain (Malchiodi, 2012a). A child with secure attachment is more resilient in facing adversity. Resilience has been defined as an individual’s ability to understand, anticipate, and then cope with a traumatic event, which may be by threat or stress (Agaibi & Wilson, 2005). Attachment can be connected to both psychological and physiological experiences. Many sensory memories stored in the limbic system may be accessed through art therapy and can be crucial in working through struggles. The art therapy process has been perceived to contribute successful completion of treatment goals. The process is known to reduce anxiety around treatment as well as expedite the formation of the therapeutic relationship. Art therapy has also been proven to increase memory recovery and details surrounding experiences (Malchiodi, 2012a).

Siegel outlined four components of attachment that individuals who have secure attachment experience, they are being seen, feeling safe, receiving soothing, and feeling secure (Siegel, 2010). Secure attachment is one of four types of attachment that individuals experience; the others are avoidant, ambivalent, and disorganized attachment (Siegel, 2010). Some individuals may be likely to experience a combination of these considering there may be multiple caregivers in their childhood. Caregivers may include biological parents, but may also include stepparents, partners of parents, grandparents, aunts, uncles, older siblings, and cousins. Individuals who experience secure attachment have felt consistently secure, seen and soothed in their needs and experience of life as they develop from infancy. Seigel notes that a child who experiences avoidant attachment has a caregiver who is indifferent to them and does not respond to their needs (Siegel, 2010). In ambivalent attachment, parents are inconsistent sometimes engaged and available while other times tuned out (Siegel, 2010). Disorganized attachment seems to add to an individual’s trauma narrative more than the others due to the caregiver’s extreme lack of attunement creating a frightening environment often filled with chaos that develops into degraded representations that can elicit strong emotional reactions perpetuating a vehement cycle involving both the body and the mind (Siegel, 2010; van der Kolk, 2014). Attachment work in mental health treatment can provide individuals who have experienced one or more of the insecure forms of attachment an opportunity to make sense of both their inner and external worlds.

Art therapy treatment can provide an opportunity to address these broken attachments. As formerly mentioned engaging the process is akin to the concept of a transitional object. The art therapist provides materials in a safe space and becomes a part of the play of recreating opportunities to address these broken attachments. When epistemic experiences happen consistently there is more success in attachment work. Springham & Huet propose an alignment with art therapy and the bio-psychosocial model noting the creation and development of art pieces as second-order representations (2018). These works transform into a mechanism that impacts the attachment system, however, the therapist must embrace their role as an attachment provider. As previously mentioned, an art therapist has the specialized training, which supports the client’s trust in the process. Providing a safe space creates an environment where clients feel more readily able to trust and more prepared to make disclosures in relation to the process. The trained art therapist knows the importance of being concise in comments focusing more on the client’s responses to the process and artwork (Springham & Huet, 2018).

Art therapists utilize art directives in their work with clients. An art therapy directive is a thematic prompt and chosen specifically for each client, as each client has unique intersections that makeup who they are. This treatment planner includes examples of directives that will require sensitive consideration prior to implementation. Art therapy is not a formula. While there are many formal methods of assessment, each individual brings with them their experiences, strengths, and struggles. Art therapy formal training, supervision, and consultation provide a structure for art therapist’s evolving professional identities fostering growth resulting in a seasoned professional with an intricate understanding of clinical art therapy and its application to each unique individual they encounter. Through the use of art directives clients take creative risks within the safe structure of the session while making art and also discussing the process. It should be stressed that art directives may impact individuals differently. The process includes multiple factors like the client’s overall effect, how they may be emoting throughout the session from beginning to end. It includes the client’s behavior, which includes how they interact with media. The process involves the client’s cognitive functioning, including problem-solving in using media or in immediate conversation. Additionally, the process includes social or familial undertones that may surface throughout the session in conversation or in the art. To be clear, art therapists do not analyze their client’s art. They talk with their clients and ask clarifying questions to support the process.

The process is not a scripted curriculum for use in a similar fashion with each client. This therapeutic process becomes conformable and accommodating to each client’s needs.

Annette Shore considers the art therapy process as one that involves tolerance providing the client an honored witness in the process that brings about “strengthening and renewing one’s sense of meaning” (2006, p. 189). The creative risks clients take in the process, in turn, serve as stepping stones of choice that contribute to building resiliency. This practice impacts the client to be more readily able to confront and address trauma or other struggles impacting daily functioning. Some art directives may be more approachable earlier in treatment, while others may be better utilized after the therapeutic alliance is established.

The Expressive Therapies Continuum

The Expressive Therapies Continuum (ETC), developed by Sandra Kagin and Vija Lusebrink, is an assessment tool used in art therapy treatment that is focused on an individual’s creative functioning (Lusebrink, 1990, 2010; Hinz, 2020). This tool, in theory, is based on human development and information processing and focuses on conceptualizing an individual’s creative functioning. Snir and Regev (2013) describes the ETC as a “systemic approach to understand the relationship between client and materials” (p. 94). It is based on exploring the artist’s purpose for creating a piece, the medium chosen, the synergy of the artist’s approach to the chosen medium, and the narrative or imagery within the art product (Malchiodi, 2012b).

An art therapist utilizes the ETC to determine which mediums and art directives are appropriate for each client and also provides clinicians with information about how a client’s brain processes imagery within their sensory-motor development, cognition, and psychosocial behavior (Lusebrink, 1990, 2010; Malchiodi 2012b; Hinz, 2020). The ETC is divided into levels including (1) the kinesthetic/sensory level, (2) the perceptual/affective level, (3) t...