Using Art Therapy with Diverse Populations

Crossing Cultures and Abilities

Sangeeta Prasad, Paula Howie, Jennie Kristel

• Publisher: Jessica Kingsley Publishers
• Year: 2013
• Print ISBN: 9781849059169
• eBook ISBN: 9780857006943
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Whether working in urban areas with high levels of cultural diversity, providing art therapy to 'unique' populations such as prisoners or asylums seekers, or introducing art therapy programs to parts of the world in which it is not yet established, it is essential that therapists understand the importance of practicing in a culturally sensitive manner. This comprehensive book considers how culture impacts the practice of art therapy in a variety of settings.

With contributions from experienced art therapists who have worked in diverse environments, this book attempts to understand and highlight the specific cultural, subcultural and ethnic influences that inform art therapy treatment. It addresses variable factors including setting, population, environment and ability, and how they influence art therapy approaches. It also considers how cultural differences can impact physical art making through choices of color, symbol and metaphor. Each chapter provides a framework showing how art therapy techniques have been used in order to successfully work with distinct populations. This book will provide practitioners with ideas for how to adapt art therapy training and approaches to suit the setting and meet the needs of a vast range of populations.

Full of informative case studies, this book will be invaluable reading for art therapists and students of art therapy.

Part I

Art Therapy and Culture

Chapter 1

Exploring Outside the Box

Art Therapy in Practice

Jennie Kristel

Using the arts as a form of personal expression is certainly not new. For centuries, all the arts have been explored by individuals to communicate with each other and other communities. Creating art has been an expressive way for people to understand the world around them. Using color, form, and symbols allows us to record history and give meaning to the world. To this day, this continues to be true. Art is around us, and integrated into the many parts of our lives, including our homes, our places of worship, our shops, and our landscapes. “It is widely acknowledged that the ability to communicate is an essential human characteristic” (Dalley 1984, p.xi). We paint, write, dance, and give voice to make sense of our world and what is going on within it.

While the idea of self-discovery through art is an old one, the concept of art therapy is relatively new. For years, artists of all kinds have been growing, learning, and expressing themselves through their respective media, but only in the last century or so have the arts as a potential tool for healing been taken more seriously.

Historical Perspective

Clinicians first began to consider the usefulness of the arts for healing in the 1860s. At that time, psychiatrists began experimenting with introducing the arts into “insane” asylums. MacGregor (1989) reflects on the intertwining of art and psychology going back centuries. Hans Prinzhorn, a German psychiatrist, documented artistic productions of those in insane asylums throughout Europe, culminating in The Artistry of the Mentally Ill, published in 1922 (Malchiodi 2012). His collection of art, known as the Prinzhorn Collection, is still shown in museums around the world and considered one of the earliest and largest collections of artwork by residents of the asylums. During his own illness, artist Adrian Hill used art as part of his healing while in a tuberculosis sanatorium. This experience obviously left a deep impression on him, as he later practiced as an art therapist and was instrumental in many ways in defining the term “art therapy” in Britain (Hogan 2001).

It is through the work of psychiatrists such as Prinzhorn and others, including Fritz Mohr (1874–1966), that people have begun to look at art created by the mentally ill, known as “Outsider Art” or “Art Brut” (ugly art), as poignant and valuable in its own right. It offers the viewer the opportunity to move from fear of the mentally ill to exploring art as a tool for healing and treatment. In the nineteenth century, Fritz Mohr began using art as an assessment tool. He first documented this in 1906 (Malchiodi 1998).

Sigmund Freud was not an art therapist, but his theories became the base for the evolution of what we now consider art therapy. “His theories of repression, projection, the unconscious and symbolism in dreams identified the importance of visual images to understanding mental illness” (Brooke 2006, p.4). Carl Jung brought his own theories of archetypes, symbolism, universal imagery, and the collective unconscious, as well as his own sense of artistry, to the field of psychotherapy. Jung saw the symbolic as present in everything we do and everywhere we go. He believed that through our understanding of these symbols we understand our internal worlds and ourselves as individuals and communities (Jung and Von Franz 1964).

Art therapy has been found to be deeply beneficial for soldiers returning from war and their families, helping them to deal with the traumas of combat, isolation, and reentry. Sangeeta Prasad (2008) states the need for art therapy in this situation: “Psychiatrists and artists recognized the deep connection between the mind, body and spirit as patients, soldiers, veterans, and prisoners were spontaneously creating art as a form of healing, expression and survival” (p.53).

Art Therapy Today

We are surrounded by art whether we know or think about it. As we walk down a street or through a park we experience art made by both nature and humans. We often connect through artistic mediums—dancing, playing music, or painting. In many countries, the world of the museum has been deeply important as a way of preserving and keeping history through art. For centuries, women have collected in sacred circles to sew, knit, and create. As they gather, they talk about their lives, their families, and the world at large. These circles were often the history keepers.

The arts can transform our lives: they can tell challenging and dark truths, resolve conflict, bring communities together, and express what is often inexpressible in words. We also know that art therapy can be used to promote positive social change and social justice. Art therapy aims to heal individuals and groups and promote positive social change. For many, it is in fact a form of coping with their world, a way to understand the chaos of their minds and of the world around them.

As exemplified here, the expressive arts therapies use visual arts and other modalities like writing, music, drama, and dance to help people of all ages and backgrounds to express themselves in ways that might not be possible with other forms of therapy. Based on the idea that the arts communicate unconscious and even archetypal material, and that images and symbols carry meaning that can transform experience, art therapy involves not only the creation of art but also the reflection and discovery of its meaning. The art-based therapies also allow unconscious material to arise when verbalizing issues is too difficult. Art therapy is typically practiced with individuals, groups, and families and is often very effective with individuals who are limited verbally or speak a different language. Many different kinds of populations benefit from the art therapy process. For example, Kate, a woman in her early 40s, came to art therapy to explore longstanding issues related to childhood sexual and emotional abuse. Kate continues to experience secondary traumatic symptoms related to abuse that she experienced between the ages of 8 and 16.

A person who finds writing an accessible way of communicating, she began keeping a journal and bringing it to therapy with her. She is used to shouldering tremendous responsibility, both in her family and at work, often at her own expense. Kate often found it difficult to say “no” when asked to do things and frequently felt that her family expected her to carry the emotional load within the family system. Through specific art assessments and techniques, Kate found and created a safe place, observed her relationships, using a creative genogram assessment, and used visual art and psychodrama to channel the negative feelings that she still had toward her abuser.

In one session, to help release these feelings, Kate threw wet clay at a target on the wall. Each time she threw the clay, she made statements to the wall, which repesented her abuser, about her feelings toward him. At first, it was challenging for her to put words to what she felt and instead made wordless sounds that described her feelings. She felt this was an easier way to express herself and, in the end, was able to find the right words she wanted to say to him. She stopped the exercise when she felt a shift within herself signaling that she was done and had no more to say to him. Afterward, she took the clay off the wall and shaped it into a new form, signifying a new inner relationship for herself, releasing and excluding the lingering effects of the abuse. Through a process of physically expressing her need and desire for release, she was able to explore her anger and rage at her abuser. In addition, she integrated important aspects of her verbal and nonverbal brain and released the deep emotions that remained a part of her body memory.

Along with painting and other expressive arts media, Kate also explored and got clarity about her own needs—her need for self-expression and for finding personal balance between family and work. In discovering this balance, she was able to understand the links between her experiences of being abused and the resulting feeling of being overly responsible and driven. By externalizing her feelings through a creative process, she was able to increase her self-esteem and let go of her need to be responsible for everyone.

Hannah, 29, a young woman on the autism spectrum (PDD-NOS), came to the art studio to work on improving and increasing her social skills. Hannah was aware that she had trouble moderating her emotions, especially at work, and was hoping to change this. When she arrived, she was not comfortable using art materials. With guidance from the therapist she hesitantly drew with pencils and sometimes pastels. Her lines were rigid and straight in a very linear formation. She also kept a journal where she wrote down positive exchanges with people. While working on her issues of low self-esteem, Hannah’s lines became more fluid and less rigid. She began to paint using tempera. In doing this, her lines became more abstract. At the same time, she reported less conflict at work and at home.

Christine is a 12-year-old adopted child living in the United States, originally from Korea. Referred by her school for acting-out behavior, she arrived with her mother very quiet and unwilling to engage. In the first session, she complained of being bored and not caring about what people thought of her. She refused to look at me or her mother and instead stared at the design on the rug where we were sitting. She appeared defensive about her behavior.

In her first session she was asked to do a genogram in order for me to understand her relationships. In her genogram she listed her mother, father, brother (also adopted), and her birth parents whom she had no contact with and had never met. Through art assessments that included psychological testing such as the House–Tree–Person (Buck 1948) and Kinetic Family Drawing, and art therapy assessments such as the PPAT (Person Picking an Apple from a Tree; Gantt in Malchiodi 2012) and the Family Art Evaluation as developed by Kwiatkowska (Kwiatkowska 1978), among others, we looked at how she experienced herself, her attachments, her family life, and the coping and resiliency skills that she felt she had at the time. She was able to explore through a variety of expressive modalities, including psychodrama, keeping a journal, and art, her relationships and her attachments to these relationships. By using the expressive arts, she ultimately was able to understand more of herself, relax rather than being defensive, creatively restructure her primary relationships in a different way, and make needed changes both at school and at home.

There are two ways to approach art within the therapeutic context. The first is art in therapy, a means to gain psychological insight, and the second is art as therapy, the process of art making.

In art in therapy, Margaret Naumburg, who promoted art therapy from a psychoanalytical perspective in the United States, suggested this was the best way to utilize art therapy. The therapist works to guide the client to explore what her/ his unconscious is revealing through her/his artwork. The focus then is on the symbolism of the art and exploring the meaning. In this case, the art making is specifically to understand unconscious material—the act of art making is then secondary to the overall process.

In art as therapy, the act of creating art is the focus. That is, the activity itself is the primary vehicle to understanding unconscious material, so it is very process based. In this form of therapy we pay careful attention to what the person is consciously or unconsciously expressing through their art and how they are using the materials to make that expression. There may or may not be a verbal exchange, then, within this model.

Edith Kramer focused on using art therapy as healing for children. Her use of art in schools is psychologically based—she very much believed that the act of creating art was therapy in itself. When teachers focus on the artistic quality of the student’s work, the act of creation as well as a child’s self-esteem is raised as he/ she is supported in feeling competent.

It is this type of art as therapy that lends itself well to use in education as a form of expression. Utilizing art therapy with children to explore and assist in self-expression, both in nonclinical settings such as schools and after-school programs and in clinical settings such as hospitals and mental health facilities, is becoming more known and accepted. Art therapy can also be utilized in places like a psychotherapy office, a classroom, or a designated art therapy studio, where the focus is on the creation of the art itself. Whether with individuals, families, or groups, or in larger community settings, art has the power to heal and to profoundly impact one’s life. In addition, whether it is clinically based or not, art supports clients in being able to communicate their confusing emotions as well as their interludes of calm; it may also help some individuals to forget symptoms of an illness (Prasad 2008).

Art therapy as a field has grown in the last 50 years. There are multiple undergraduate and graduate programs in art therapy in Canada, Britain, and the United States and ethical guidelines specific to the use of art therapy. The American Art Therapy Association (AATA), the British Association of Art Therapy (BAAT), ANZATA of Australia, and YAHA in Israel offer ways for people to network, develop collaborative projects, and create ethical guidelines. Art therapy assessment tools have been created, some of which have been incorporated into the larger field of mental health in the United States. Guidelines about using these assessments are clearly demarcated in the mental health profession as well as the AATA art therapy ethical guidelines.

Recently, art therapy has been widely recognized for its healing power in coping with traumatic disasters such as the tsunami of 2008 in Southeast Asia or the earthquake in Japan in 2011.

While art therapy began from a Western psychological basis (Malchiodi 2012), it is now being used in countries around the world. For instance, the use of expressive arts as therapy has been growing in Asia and reflects the strong cultural, artistic, and ethnic roots of each country in which it is practiced. Other forms of therapy exist in many of these countries with ethical guidelines of their own that respond to the societal, religious, and individual needs of that country. Because of this, there is a need for continuing education consistent with the cultural needs of each country, as well as an understanding of the ways of Eastern philosophy and spiritual practices to inform clinical practice.

Arts-based therapists are by their very nature multifaceted and encourage others to “think outside the box.” Many art therapists look to dreams, creativity studies, and other explorations to help clients access their creativity. In her research of art therapy and myth making, Paula Howie observes (Wilson et al. 2003, p.208):

In the short history of art therapy, our “cultural” incompatibility between the artist and therapist ...

Table of contents

• Cover Page
• Title Page
• Copyright
• Contents
• Foreword Mercedes B. ter Maat, President, American Art Therapy Association, and Gaelynn Bordonaro, Graduate Art Therapy Program, Emporia State University
• Acknowledgments
• Preface
• Introduction
• Part I: Art Therapy and Culture
• Part II: The Culturally Sensitive Art Therapist
• Part III: The Practice of Culturally Based Art Therapy in Educational Settings
• Part IV: Understanding the Cultural Implications of Using Art Therapy in Hospital and Rehabilitation Settings
• Part V: Cultural Perspectives: Using Art Therapy in Outpatient Treatment Settings
• Part VI: Cultural Influences In Community-Based Art Therapy
• Part VII: Cultural Implications for Practicing Art Therapy with Unique Populations
• Appendices
• The Contributors
• Subject Index
• Author Index