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On Therapeutic Effects in Art Therapy
29th Dec 2011Posted in: Blog 1
On Therapeutic Effects in Art Therapy
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Back in the beginning, when i was doing my internship at a children's hospital in Montreal, the supervising psychiatrist invited me and my wife to his home for dinner. My internship under him had been somewhat tumultuous over a period of about 8 months because i felt insecure about my competence and particularly inferior in relation to his. I spent a lot of time in team meetings feeling anxious about saying something stupid. This pushed me to do more reading but still, i felt i could not catch up with the overwhelming amount of knowledge held by the psychiatrist, psychologist, social worker, occupational therapist or even the parents of our patients because surely, the parents knew more about their children than i ever could. Even though i was determined to increase my knowledge and understanding of clinical issues, an important part of me thought that an art therapist should never compare himself against a psychiatrist or any other professional because there is no other professional like an art therapist. We don't compare plumbers and ballet dancers do we?

At some point over dinner at the psychiatrist's house, i was asked by a woman - a hospital administrator, i believe - : "How does art therapy work?" My heart jumped into my throat and my words became muffled, chocking sounds swimming around a drowning question. Eventually, my wife saw me panicking and jumped in with her impressions about what a sustainable answer might sound like. This made things worse because it is inconceivably embarrassing to have your wife answer a question related to what you do for a living - what you have spent you life trying to understand.  I swore to myself at that point that i would not be in that situation again. To this day, my conclusion is that some part of art therapy's meaning will remain forever subjective, dynamic and hard to pin down verbally because art therapy is after all made up of one part "art" and art has always meant different things to different people.  No one can tell me with absolute certainty what art is and for that same reason, no one can give you an absolute definition of art therapy. However, not all hope is lost because we can still have  a very useful working or operational definition of art therapy. Something like this: Art therapy is the use of art and creative process to facilitate change. I like that working definition actually. It is short and sweet but it does not tell you everything you need to know about what art therapy is and what it does.

The truth is, i had never really felt the need to ask how art therapy works because i stumbled into this field as an artist first and a therapist second. I knew intrinsically that art was good for me. I knew that painting, music, dancing, acting and writing made me feel good and served some useful purpose even though i could not have told you what that was. Art therapy came to me naturally one day following a break up which turned my world upside down. I started painting. The original moment of my beginning to paint has always been a place i like to go back to in my mind.  After one painting, came another and another. With Art's help, i pulled myself out of a dark hole i had been stuck in. I should mention i was also seeing a psychotherapist at the time but it never occurred to me to conceive that the art and the psychotherapy could be part of the same healing process i was embarked in. I believed in art therapy before i even knew what it was. I had found Taoist Buddhism in much the same way, many years earlier. As a young teenager, i had been looking for a way to improve my outlook on life and make sense my experience of the big questions. To the surface floated ideas which I later discovered to be the ancient remnants of Buddhism. The examples of how i came to reflect on art therapy and Buddhism serve only to illustrate that sometimes we think and do things without knowing exactly why and sometimes the explanation for those things takes thousands of years to come into view. Art therapy and Buddhism were practices existing within thousands of individuals long before they emerged as the kinds of unified bodies of knowledge.

The fact that things can be hard to explain does not mean we stop trying to develop some kind of coherent understanding of what they are and when it comes to art therapy, i believe that people have a right to an answer to the dreaded questions: "what is it? and how does it work?". It is in the interest of every art therapist and in the interest of art therapy as a profession to have a standardized response to those questions. That being said, it may also be in our wider social interest that each art therapist should have his or her own slant on the "what is it?" question. Similarly, it seems to be in the interest of culture that each individual should make up his own mind about what art means. The what? and why? questions in just about any field including art therapy are so huge that it would honestly take a few hours to get to any meaningful depth. I mean, i could say that art heals but that only takes a second and does not tell you much. I could go a little deeper but then getting to understand how art therapy really works would  require some understanding of art history, some overview of the development of mental health care and the interrelationship between psychology, education and social work. In addition to all of that, one would need experiential knowledge of the concepts because all those hours of learning about theory would not even come close to conveying a complete portrait. You don't learn what riding a bike is by studying physics! What is art therapy? and How does it work? are questions like: what is a human being? or what is art? Maybe i should not feel so embarrassed when i can't come up with a short and clear answer to those questions. After all, art therapy will never be able to - nor should it wish to - divorce its meaning from the first part of its name: "art". Part of art will always remain socially constructed, part of it will reveal itself to science and part of it will remain for ever enigmatic, so the "art" part of art therapy will probably do all of those things as well. O.K, enough about answers and questions for now...

Here is a summarized list of things that art therapy does uniquely. By reading through the list you can get an idea about what art therapy is and how it works.

Art Therapy:

1) utilizes the strengths of creativity and resiliency which clients already possess. Creativity and resiliency are nearly synonymous in art therapy in that both are manifestations of the will to thrive. Resiliency is the innate response to difficulty. It is the inherited and learned ability to rebound from hardships. Creativity is what we use to build houses, cure diseases, make children and art, invent technology, solve problems, develop language and imagine music. Art therapy finds that creativity and resiliency are natural partners which have been part of humanity since the beginning. Art has  always been the most universal way of manifesting and communicating resiliency and creativity. It is something any child does without even the slightest bit of learning to do. By mobilizing those forces through art, clients are empowered towards solutions of their own making. I call this feature of art therapy: Mobilization of creative potential.

 

2) allows therapist and client to have a chronological record of the course and evolution of therapy. This unique feature of art therapy is particularly useful for reviewing past activity and agenda setting for the future. Viewing all work in succession allows both therapist and client to share simultaneous but unique perspectives on the entire therapeutic process. Client and therapist can use this "bird's eye view" to return to previous images and uncover new meaning through evolved perspectives. The therapist can evaluate pre and post mental status in relation to concurrent images and this can contribute to a richer understanding of any transformations in clients' cognitive schemes or worldview.  The "view all" option allows the therapist to observe whether changes in a participants functioning or mental status correlate with observable manifestations in the creative process-product. The view all option also allows not only for the placing of a single piece of client work in the context of all all client work but allows for the placing of clients' entire body of work in the context of art history. On this last point, consider that you have thousands of years of art history in the form of critiques, discussions, analyses of documented movements and artist biographies to help contextualize the work of each client. It is like being able to place one's creative work in the context of all work universally. Ideally, an art therapist has studied various cultures and artistic expression throughout time within those cultures. I call this feature of art therapy: "The View All option"

3) allows for the objectification of latent feelings or emotions which are hard to express verbally. bypasses ordinary psychological defenses which are operational through semantic and syntactic language processes.   We sometimes hear the saying: "the body never lies" and this is the principle behind the galvanic skin response measurements in lie detectors. Though lie detectors are not a reliable predictor of lying behaviour, they do seem to reliably detect stress responses in relation to psychological stimuli. The idea is that you can defend yourself and protect your vulnerabilities with verbal language but that your body betrays you in subtle ways when you do because you have a conscience. In keeping with psychodynamic theory, that conscience manifests itself in spite of our best attempts to conceal it. Police officers are trained in the art of detecting and reading incongruous body language. When one is making art, the right brain regions involved are not as well equipped for the verbal type of defensive activity known as denial, or concealment. The right brain literally does not know what the left is doing when one is making art. Art therapists sometimes say that art short circuits defense mechanisms and that people will tend to portray core issues in their art one way or another. It is very hard me to make a painting by anyone other than me, but i can very easily lie and pretend i am someone else verbally. An astute art therapist knows when to be directive with a specific kind of art activity and when to sit back and follow client's lead.Here we are talking about taking abstract or loosely defined feelings and making them more accessible.  This is sometimes referred to as objectification because when subliminal states are projected into an art object, they transition from subjective to objective states.  Some art therapists encourage clients to talk about mental states like depression in an objective form by reffering to "the depression" rather than talk about it in the personal, subjective form using the first person, ie. "my depression". I believe it was Albert Ellis, the father of rational emotive therapy who said that "the person is not the problem, the problem is the problem". This feature reminds me of a funny thing that used to happen when i was a kid. I would stub my toe or trip on something as children often do and my father would encourage me to get mad at the table or the chair i had stumbled into. I would sometimes yell at it or kick it and say: bad chair! It made me feel a whole lot better, in addition to giving me a good laugh. In art therapy,  I call this feature: "objectification"

 

4) allows therapist and client to address the relatively non-threatening image rather than the core issue directly. This feature is closely related to number 3 above, in that it is enabled by objectification. Objectification is valuable on its own, but it is made possible because the creative process and the product in art therapy circumvent  ordinary unconscious defenses. We sometimes hear that the body does not lie and that to see if someone is telling the truth, you should look in their eyes or their hands. Without being conscious of it, we rely heavily on body language to tell us what is going on with someone else. Lie detectors which use the galvanic skin response are essentially measuring physiological changes in skin conductance in response to psychological stimuli. Though lie detectors are not reliable or admissible in court, they do provide interesting clues as to how the body responds to stress in spite of subjects sometimes contradictory verbal output. The idea that the body and the rational mind are sometimes playing on two separate fields is held to be true in art therapy and this principle assumption is at the root of justification for why image work and creative process are valuable in therapy. We sometimes hear in art therapy that art short circuits ordinary ego defenses. These ego defenses often operate within linguistic paradigms. Lies are told with words and the hard work of a rational mind.  Spontaneous artistic creation is less rational, less predictable and this reduces the potential for defensive behaviour to obstruct it. Of course, on can always intellectualize the image afterwards but the image speaks for itself and it is worth at least a thousand words. I call this feature of art therapy: "Circumvention" because creative process circumvents unconscious defenses.

5) allows for painful memories to be re-experienced in a novel and less invasive way. This is somewhat akin to the concept of systematic desensitization held within a cognitive behavioural approach to treatment of phobias. While post traumatic stress and reactions to sexual abuse are exacerbated by the inability to express and integrate the experience, art therapy allows for a gentle, non threatening method of transforming and re-encoding it as in a novel experience.  From here, it can be re-integrated to consciousness with new meaning. Thus,  some experience previously believed to be fixed is rendered open to change. The creative process has helped us to turn a frown upside down! It is held by me personally as an art therapist that creative process is the means by which we surmount difficult memories. We express those memories in the process of objectification then re-absorb them in a more digestible form.  Thus, ideas and experiences which become crystallized as semi permanent or life defining moments can be re-viewed, re-negotiated and new meanings can begin to emerge with more adaptive outcomes for participants. I call this feature of art therapy work: "re-integration".

6) allows participants to engage in what many in the field of neuroaesthetics, including Ramachandran and Zeki find to be neurologically pleasurable art making activity. I call this feature: "Pleasure"

7) helps develop artistic skill and technique. This can have a positive effect  on self efficacy and self confidence for participants who have a goal of increasing their artistic abilities while in therapy. Many therapists feel that the objective of developing artistic skill has no place in the context of art therapy but i disagree here because i find that it is possible for art therapy work to include both parts of it's name, being both art and therapy. Greater mastery in art can only help clients in the long run.  Many therapists seem to think that a focus on artistic technique and skill muddies the waters of art therapy. It does add a parallel process in therapy and this increases the potential for challenges and conflicts to be faced but it does not in my view undermine the potential for good art therapy practice.   It is possible to maintain a dual focus on artistic objectives while also staying true to the therapeutic needs of clients.  So long as the development of skill is a warranted objective in the course of therapy with a particular client, i don't see the problem.  Naturally, the development of skill is not an objective for all clients but it is a valuable target from many. If skill development in art therapy is one of a clients' stated goals then i fail to see why so many art therapists object to considering it in the process of agenda setting. I call this  feature of art therapy: "Appeal to Multiple Intelligences" because art therapy can simultaneously function on verbal-linguistic, interpersonal, intrapersonal, body-kinesthetic, musical, visual spacial, logical mathematical, naturalist and existential levels.

 

8) allows more direct access to sensory memories. A large amount of experience (maybe even all experience) is at least partially encoded as sensory memory. Visual spatial, acoustic, olfactory and tactile memory all play a part in procedural memory for how to do things which involve the body, such as like ride a bike, find your way to a friends house, re-create a food recipe or a dance step.   To be sure, any emotional state we can speak of, has to exist in the body first before we can call it happy, sad or mad. Mad is pupil dilation, increased heart rate and blood pressure, dryness of mouth and contracted muscles first, before it is something we can talk about. Sad is decreased heart rate, slouched body posture, low blood pressure and teary eyes before we can name it. Happy is serotonin-endorphin release, lightness of posture and contracted smile. We laugh at jokes long before we can explain why and we react with anger in the same way based on a few simple non verbal cues such as body language and vocal intonation.That is why they are called feelings : because we feel them.  Emotional memories tend to be encoded with greater long term potential because they have semantic and and physiological weight for us. They are memorable because they are sensory rather than just semantic.  This is why we remember a spanking. Post traumatic stress disorder is characterized by the encoding of traumatic experience into body memory, thus making the trauma reaction particularly difficult to extinguish with traditional talk therapy.  A biofeedback method such as art therapy can be particularly helpful in treating ptsd because it employs the same sensory modalities and neural pathways during the creative process as those which were employed for the encoding of the initial traumatic experience. In doing this, the various art modalities may be directly accessing the neural networks of sensory memory involved in ptsd. Visual art modalities may be particularly well suited to treatment of post traumatic stress because ptsd reactions usually have strong visual precursors. This means that people suffering from ptsd often face frequent re-exposure to image based memories of a traumatic nature and an art therapy modality which is visually based may have an advantage in re-wiring or transforming the neural networks involved.  As most memory has a visual component to it, visually based art therapy may have an advantage over other modalities in general. I call this feature of art therapy: "Ease of Access to Sensory Memory".

 

9) is naturally regressive, specifically because art making involves the body in an activity which most adults remember from from childhood. I call this feature: "Natural Regression "

 

It should be said here that this is by no means an exhaustive list of what art therapy is and does. This list is a compilation of the features of art therapy which appear most natural to me as an art therapist but colleagues working in different ways would have a lot to contribute here. My hope is that some professional art therapists can give provide some feedback on these 8 features by replying at the bottom of this post. It should also be said that these features are commonly held within the college of like-minded professionals who call themselves art therapists but that i typically venture out in my posts to a world of where conjecture is not only possible but desirable. My posts are not literature reviews, nor research reports in the classical sense but they are  artistic renderings of the phenomenon within my experience. As with all experience, there is some objective reality and some element of subjective fiction. This is not a mistake or an oversight, it is how the exercise of writing helps me to get clarity on art therapy theory and practice. To put it another way, sometimes i am talking about what i know and sometimes i am talking about what i think i could know. In either case, your input has always been valuable to me and i hope to continue receiving it.

 

 
 

One Response

  1. Nick says:

    Great likeness!

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