Approaches to Art Therapy

Theory and Technique

Judith Aron Rubin, Judith Aron Rubin

• Editorial: Routledge
• Año: 2016
• ISBN:
  9781317505723
• Edición: 3
• Categoría: Psychology
• Categoría: Psychotherapy Counselling

The third edition of Approaches to Art Therapy brings together varied theoretical approaches and provides a variety of solutions to the challenge of translating theory to technique. In each chapter, the field's most eminent scholars provide a definition of and orientation to the specific theory or area of emphasis, showing its relevance to art therapy. The third edition includes many new chapters with material on a wide variety of topics including contemplative approaches, DBT, neuroscience, and mentalization while also retaining important and timeless contributions from the pioneers of art therapy. Clinical case examples and over 100 illustrations of patient artwork vividly demonstrate the techniques in practice. Approaches to Art Therapy, 3rd edition, is an essential resource in the assembly of any clinician's theoretical and technical toolbox, and in the formulation of each individual's own approach to art therapy.

PART I
Foundations

1
Art is the Therapy

Symbolizing

Laurie Wilson

Seeing

Mala Betensky

Introduction

Judith Rubin

The very foundation of art therapy is art itself. Without that basis, there would be no possibility of the discipline, nor any of the theoretical amalgams that comprise this text. The beginnings of the field were in the Art Studio, with artists offering an opportunity for creating to mental patients. As noted in the Introduction, the past several decades have seen a return to the Studio on the part of many who practice art therapy and train others.

Because art in therapy is so very powerful, however, it is really essential that those offering art to people who are in a state of vulnerability be prepared with considerable understanding about human psychology and the process of change over time. The bulk of the chapters in this book address different ways of understanding both human beings and the kinds of transformations for which we aim in art therapy.

Beginning, however, with art, there are a number of elements that are equally vital. Fundamental are two we often take for granted, but which are essential to the use of art in therapy, regardless of theoretical orientation. They have to do with what happens when people create art—symbolizing— as well as what happens when people perceive art—seeing. Both are ways of making and finding meaning through creative expression. Two chapters in earlier editions dealt beautifully with each of these topics, the first from a psychodynamic stance and the second from a humanistic one. While the theoretical basis is quite different, the clarity of thinking and writing in each brings the ideas to life.

The first chapter excerpted here was written by Laurie Wilson for the first edition and was titled “Symbolism and Art Therapy” (Wilson, 2001). As an art therapist and psychoanalyst, Wilson looked at the issue of symbolizing through an analytic lens informed by ego psychology, especially the work of David Beres (1965). Because she explained it so clearly, what follows are excerpts from her original chapter, part of the Psychodynamic Section.

On Symbolism

Laurie Wilson

The capacity to form and to use symbols distinguishes man from other species. “Instead of defining man as an animal rationale, we should define him as an animal symbolicum. By so doing we can designate his specific difference, and we can understand the new way to man—the way to civilization” (Cassirer, 1974, p. 26). Visual imagery—the quintessential stuff of symbolism—is the raw material of art therapy. I shall attempt to demonstrate that, by encouraging production of artwork, we are promoting the development of the capacity to symbolize, and that this capacity is linked to a number of critically important ego functions….

Pathology of the Symbolic Process

Dysfunction in symbol formation characterizes severe disabilities ranging from schizophrenia to aphasia. A brief look at some specific forms of pathology can help in understanding the value of making visual images in treating them. Beres (1965) notes three clinical areas in which pathology of the symbolic process may be seen: retarded ego development, schizophrenia, and organic brain disease. In all, “the essential element is a concurrent disturbance of the reality function of the ego” (p. 16).

Retarded Ego Development

In retarded ego development the child does not develop the capacity to distinguish the representative object from the real object—Linus’ blanket is mother. We see this clearly with the mentally retarded, whose crippling incapacity in this area (among others) interferes with the normal development of language, thought processes, and object relations.

Elena, a severely retarded, 22-year-old woman with an IQ of 20, had been living in institutions for 18 years (Cf. Wilson, 1977). Her records documented Elena’s prolonged fixation at the oral phase. She could not be weaned from a bottle until age five, and shortly thereafter developed a habit of collecting and chewing or swallowing bits of string and buttons. In adolescence Elena still collected such objects, but she no longer put them in her mouth. By age 22 she had abandoned this habit; instead she constantly carried, or wore around her neck on a chain, a ball-like clump of metal jingle bells. Elena herself wove the bells together with wire, and from time to time would increase or decrease the size of the cluster. If the bells were taken from her or she accidentally left them behind, she would cry inconsolably or angrily hit or overturn tables or chairs.

In addition to this fixation, Elena had a repertoire of gestures that included rubbing her hands together, stroking her cheeks, mouth, and nose, and holding and rubbing her breasts. Often she began to make these gestures when distressed, but her pained expression usually gave way to one of pleasure or comfort. Elena appeared to be attempting to comfort herself, with caresses that had in the past been given her by others.

When Elena began art therapy sessions, she was fixated on one image: a circle with a pattern of radial lines imposed on it. She repeated this pattern steadily in her artwork for a year and a half, covering sheet after sheet with numerous examples, almost always using red. Although she willingly varied the medium (using crayon, paint, or chalk), she would rarely alter the image or the color. She was also very clingy, needing constant reassurance and praise.

Over the course of two years, Elena gradually progressed, in both her art expression and general behavior, from an infantile dependency to greater maturity. The key to helping was understanding the psychological meaning of her art. By partially satisfying some of her needs, both artistic and personal, and by leading her toward small, but appropriate changes in these two areas, Elena was gradually able to become more flexible and independent, eventually travelling unassisted to the art room.

Her graphic vocabulary also expanded to include concentric circles, images of bodies, squares, and ultimately a rich combination of circles, triangles, squares, and hybrid shapes that she used to draw full figures, clothing, and ornaments. She was able to modify her radial schema, and to include it in different configurations as eyes (Fig. 1.1) and breast.

As I realized that Elena’s perseverative radial schema stood equally for breast, mother, and bell, I understood the clump of jingle bells to be her transitional object. I now see the desperate attachment to her bells as a failure of the symbolic function, since at the start of treatment the bells stood for her as a substitute, not a symbolic object. Elena then developed—through art therapy—a capacity for symbolization, whereby the function of the transitional object shifted from substitute (standing as equal) to symbol (standing as representation) for the original object—mother.

The persistent making of visual images in art therapy sessions actually seemed to spur the development of her ability to symbolize. As long as the clump of bells and the radial schema functioned as a substitute for mother, they were experienced as essential, and could not be given up or altered. When Elena finally developed the capacity to symbolize and thereby evoke the absent mother, she was freed to function more flexibly, her security consisting now of symbolic rather than concrete reminders of an absent object. Thus, she was able to leave her bells behind in her room, and to come to sessions unaccompanied either by this transitional object or an actual attendant. We also saw her replace the bells with a pocketbook—another symbolic transformation of the original substitute object….

Figure 1.1

Organic Brain Disease

Partial or total loss of the ability to articulate ideas through brain damage is known as aphasia. David, a 65-year-old man, was seen in art therapy for three months by Irene Rosner, an art therapist who specializes in work with the physically ill and disabled. He had suffered a stroke, causing paralysis on the right side of his body and an inability to speak intelligibly. Retired for three years from his position as a social security examiner, he had maintained a private business in accounting. His wife was disabled with cerebral palsy, as was one of their five children. The family seemed to be supportive and nurturing.

When first admitted to the hospital, David was extremely lethargic. His yes/no responses (head movement) were unreliable, and he was exhausted by any attempts at communication. The psychologist reported that David was only sporadically alert, but when alert did respond to visual stimuli by nodding. Although he seemed to understand some of what was said to him, his attention span was very limited. He emitted a repetitive, grating cry and was demanding.

The treatment plan included daily physical and occupational therapy, speech therapy two or three days a week, and art therapy every other day. Initially art therapy sessions lasted 20 minutes and were increased to between 45 minutes and an hour as he was able to concentrate longer.

David’s first drawings in art therapy were similar to a child’s early scribbles. Although his marks looked as if they had been placed randomly on the paper, his drawing process reflected a struggle to gain motor control. The paralysis of his right side meant that David had to use his left hand—not his dominant hand—which had been weakened by a bout with polio in childhood. Nevertheless, he was focused and attentive while he drew. Although incomprehensible to an observer, his drawings seemed to have specific meaning for him. So his art therapist focused on attempting to help him to achieve more recognizable forms.

David’s progress in art paralleled the development of drawing in young children. In time, his perseverative vocalization decreased, and he slowly regained the ability to say some words; he then reached the stage of naming his scribbles, although they were still unrecognizable. Like a young child, the name David supplied for a given drawing might shift with the associational current. Thus, at one moment he called an early scribble “ice chips” and at another “fish.” At this time the psychologist reported that David was more alert and attentive, was communicating his needs with nonverbal cues, and was responding well to directions.

The next stage in David’s development marked an advance in two areas. He began to make recognizable forms, to name them appropriately, and was able to place his marks on the paper in a way that indicated his awareness of the entire page. We can easily pick out the tree in Fig. 1.2, titled by David “Fish, Tree, and Amoeba.” In contrast to his earlier efforts, David’s work now gave evidence of planning and deliberation. He created numerous intentional enclosures: circles of various sizes, elongated triangles, and irregular shapes. Because of the shakiness of his hand, the shapes were barely discernible amid the scribbled lines on the same page, as with young children’s drawings.

Figure 1.2

Nevertheless, on close inspection, forms become apparent in David’s drawings from this period—in one a face schema, a crude circular shape with two eyes. Soon after, when asked to draw a person, David combined his face schema with body parts to create Fig. 1.3.

As he drew, the human figure took on a personal meaning. He began to cry and in response to gentle questioning, said, “My wife—she’s short and fat and ugly and wonderful.” David had been responding without signs of emotion; now he began to register personal involvement. His reaction, stimulated by his own art, seemed a pivotal event in his psychological recovery. He went on to produce better integrated pictures and to invest them with personal meaning, as well as to make further strides in speech and movement.

In view of all of his therapies, it is impossible to say to what extent his work in art precipitated or merely coincided with a longer attention span, more coherent speech, and appropriate affect. But this moving sequence of events suggests that, just as the development of visual images by young children promotes their capacity to engage in symbolic processes, so brain-damaged adults may be helped to recover symbolic functioning in all areas, including language, throug...