Working document for trainee therapists who:

1.   Wish to integrate creative arts therapies into their practice and

2.  Apply creative practices to ensure self care of the therapist

Compiled by MBA (0410515637) for QUT Clinic Trainees

September, 2011

 

Welcome to this creative arts therapy  “collage” of ideas, practical suggestions and articles… I have gathered together material to give you a good background regarding the use of creative arts therapy in counseling.  Enjoy the ‘juice’ (and don’t get serious about formatting, I don’t!)

 

Here is an outline of what I have come to call

Constructionist Creative Arts Therapy.

What is constructionist creative arts therapy?

 

It is a “hybrid discipline indeed—my work is inherently both an Art and a Social Science (Landy, 1993)”.

 

The dominant paradigm in our society overvalues verbal discursive interactions (Talbott-Green 1989 in Hyland Moon, 2002) at the expense of sensual and intuitive was of empathic responding. Although the intentional cultivation of creativity is not overtly easy, it is essential to balance our rational intellect (Hyland Moon, 2002).  It is possible that our artistic awareness could be accomplished by living more fully and consciously in the small moments that make up the therapy session, by discovering the poetic possibilities in the everyday  (Hyland Moon, 2002; Hillman, 1991).

 

Moon (2004) talks about art therapy as

Being beyond words, meta-verbal.  I believe most people keep hold of images longer than they retain words and I am convinced life’s deeper moments and more meaningful experiences are sometimes nearly impossible to put into words. We are deluged with words…the sheer numbers of words have rendered them barren (p144).

 

Roger Lowe’s article Structured Methods and Striking Moments (2005) calls for a ‘more creative, improvisational and living style’ of constructionist therapy, and on observing Lowe in the therapy room, he is walking his talk.  Lowe demonstrates that the auditory-verbal modality can, with passionate dedication, be creative. Bird (2004), using her kinaesthetic (sensorial) channels, has devised an extremely creative way of communicating: she calls it relational language-making.  She became aware that although relational use of language is discussed often in counselling texts, it remains a ‘theoretical construct rather than a practice’ (Bird, 2004, 9).  My sense of her work is that she has done what Lowe suggests above and has made an art form of language.  Bird engages her imagination (she calls this process ‘working with the imaginative resource’ (Bird, 2004, 196) by listening with all the senses, engaging in non verbal languaging:

 

As I listen to the person, I can imagine, see, feel, anticipate a three dimensional possible representation of the two dimensional words. This three dimensional representation may include the therapeutic relationship itself. This possible representation is positioned beside the experiential language used by the person, together with the effect of living within this languaging of experience. With these resources I can generate a question where I experiment with a metaphoric representation of experience which I am guessing might be close to the person’s actual living experience’ (Bird, 2004, 197).’

 

That Bird does this in the therapy room shows us the possibilities we can create when we pass our therapeutic dialogue through our imagination.  If we embrace our therapeutic conversation as a form of art making, we can inspire and motivate our clients to co create new stories. 

 

Most people imagine that creativity is a gift of the selected few who make things out of ‘the void’ (McNiff, 2003).  This is in fact not the case.  Creativity is every person’s right. Everyone has the ability to create and I have yet to meet a person who has no creative skills.  It may not be painting but it may be gardening, or cooking or organising creatively…the list is long…right now, just have a conversation with your partner and see if you can help each other unpack some of your creative strengths.   Write down things that impact on you, either regarding the partners belief that they have a creative spirit, or that they have no creative bone in their body.  Share in group.

 

The majority of therapies including constructionist therapies seem to rely on the spoken language as the primary way to help the client change (Bird, 2004), and that spoken language is more often not “prose-flattened” (Brueggemann, 2003, in Piercy & Bensen, 2005).  Roger Lowe (2005) talks about the ineffective use of structured methods that often results in ‘dead conversations that do not engage or move the client.  My proposal is that if creative arts therapy, particularly improvisation and collage, could be incorporated more fully into the constructionist framework, we may have a richer more alive process. This enriched process would be reflected not only in verbal language which naturally takes into account rhythm, relative pitch, volume as well as content, but non-verbal language, including kinaesthetic modalities of movement, senses, pressure, duration, changes in direction and rotation, acceleration and stillness and visual modalities incorporating location in space, texture, line, size, colour, flat or three dimensional depiction and rhythm (Hale-Haniff, 1986). 

 

The counsellor therefore pays attention to not only the content of the client’s story, but the verbal and non-verbal process that accompanies their story telling (Satir, 1967, cited in Hale-Haniff, 1989).  The more information we access the more aware and connected we become to our client’s story.

 

The main principles that underlie the constructionist framework are:

 

1.      Language: language defines us.  It makes our world. It does not just map it (Lowe, 2004); the client can be helped to “literally talk themselves out of their troubles” (Miller, 1997, cited in Lowe, 2004).  The problem is the problem.

2.      Multiplicity: creating and co-creating stories: there are multiple stories or realities, not just he problem story; particular stories can take a more dominant stance.  The client constructs these stories, not simply uncovers them (Hoyt, 1998, cited in Lowe, 2004).  The therapist and client co-construct the new story together.

3.      Power balance: the client is the expert of himself or herself.  They have everything they need to elicit change and change is inevitable. The therapist takes the stance of curious participant with a beginner’s mind, a position of ‘not-knowing’ (Nichols, 2004, 292; Lett, 1999).

 

I will say up front: what I believe to be a crucial factor in wedding these two disciplines is the art of the spontaneous.  When this spontaneity is accompanied by a deep awareness, and substantial trust (Yalom, 1999) we can begin the work, with both client and counsellor agreeing to enter into the counselling relationship rather than just engaging in counselling techniques (Spinelli, 1994).  This requires improvisation on the part of the counsellor: to know the where, what, how and when of the session, to recognize the emergence of story and to facilitate the development of the alternative stories that are wanting to emerge.  With the ability to improvise comes aliveness and a sense of joint creativity. And we all have this ability to offer an intervention that is creative.

 

 

The scribble is possibly one of the most famous techniques of art therapy according to Ulman (1983).  However there is need for the line of the scribble to share the client’s own rhythm and emotion (Steinhardt, in Wadeson et al, 1989).

 

Winnicott (1971, in Wadeson et al, 1989, 349) used squiggles with children:

 

Some kind of impulsive line drawing and inviting the child whom I am interviewing to turn it into something, and then he makes a squiggle for me to turn into something in my turn (Winnicott in Wadeson et al, 349)

 

 

 

 

 

This exercise is called “Scribbling with your eyes closed”.   1.  Choose a colour that ‘feels right’. 2.  Begin with closed eyes, and scribble on your white sheet of paper. 18 X 24’, being aware of your body (are you relaxed? Do you want to be relaxed as you draw? 3.  Don’t worry if you go off the page. 4.  Just make a series of lines for about 50 seconds allowing the lines to flow, and shape themselves. 5.  When you have finished, open your eyes and look at the lines and shapes. See if you can pick out an image, a shape, a figure, an object…something that has meaning for you.  6.  You may want to change location in order to view your scribble to help you make out hidden images. 7.  You may want to move the paper around and upside down to find the hidden images. 8.  When you have found images draw around them with a dark pen.  9.  Start to add any details to that image so that it becomes clearer. 10.  Discuss with your partner.

 

 

Some questions and suggestions to use when inquiring

You may have some good questions to ask your partner, and you can use these too if you wish:

 

·       Take the time to really look at your drawing. ·       Describe it to your partner focusing on the questions that follow. ·       What stands out for you? ·       What do you really like? ·       What do you really dislike? ·       Move away from it then return. ·       Turn it upside down and all around. ·       What stands out for you now? ·       What do you see? ·       What can you say about this? ·       Can you say more about this? ·       Try to speak, move or sound from various positions in the drawing. ·       What is it like to be inside the image? ·       What else do you notice? ·       What are the feeling qualities of a particular line/shape/form/colour? ·       What do you think, feel and sense? ·       What is unexpected? Unusual? Seemingly unexpected? ·       Are you surprised by anything? ·       What emotions are present for you as you look at the image? ·       Where is the most energy in the image? ·       What do you think you know about this now? ·       . Where do you feel it in your body?

 

Another version of this Scribbling Exercise is swapping scribbles and finding images in your partner’s scribbles.

 

You could also try doing it with your non dominate hand, then when you add the image details you can swap over or stay with non dominant: up to you.

 

This is a great exercise to use with people who consider themselves as ‘non-artists’. 

 

It is important for the therapist not to interpret the scribble, rather move into reflective language, helping to develop the landscape of meaning emerging.

 

Your partner can write down some of the essence statements that you use to describe your drawing. It is important to record several, so the artist (or non-artist) can have an opportunity to choose and change the meaning.

 

If you are working with the client over a period of several months or even days, use the images together to discover any differences, similarities etc.  This may be useful to uncover alternative stories.

 

Here is a little extract:

 

“Would you tell me, please, which way I ought to go from here?

That depends a good deal on where you want to get to, said the Cheshire Cat.

I don’t much care where, said Alice

Then it doesn’t matter which way you go, said the Cat.

So long as I get somewhere, Alice added as an explanation.

Oh, you’re sure to do that, said the cat, if you only walk long enough”

(Lewis Carroll, 1954, 54).

 

 

The arts have a knack of being able to help us ‘walk long enough’ with each other. We do not try to find a definite goal, apart from having a relaxing and focused time.  The goal will reveal itself in its own time.  We create a depiction, we observe it and we gather meaning if it is appropriate. It may be just enough to depict.

 

Readings suggest that art making and watching theatre, dance, opera, listening to music, observing the visual arts and listening/reading literature, can

take an audience away from painful, depressing, grieving or humdrum       concerns, actions and feelings, and can enable reflexive thinking about the   self and personal and social situations (Duncan 2003; Kenyon 2003; Staricoff and Loppert 2003; in Bolton, 2008, 19).

 

MANDALAS

 (Malchiodi, 2007, 122):

http://www.metacafe.com/w/1083268/ for video about mandalas.

 

Circular forms in art are often called Mandalas, or “sacred circle”, or “maps of individual consciousness” or perhaps just circular drawings.  Jung felt that the mandala was a reflection of one’s inner situation at the time

I sketched every morning in a notebook a small circular drawing, a mandala, which seemed to correspond to my inner situation at the time…only gradually did I discover what the mandala really is: …the Self, the wholeness of the personality, which if all goes well is harmonious (Jung, 1965: 195-196).

Jung adopted the Sanskrit word mandala to describe these circle drawings (Fincher, 1991, 1).

 

It is not difficult to do this exercise with your clients.  The drawing of mandalas is spontaneous and it is untaught (Fincher, 1991, 20).  Some art therapists believe that the size of the paper is important (John Kellogg suggests 10.5X11”, being similar size to human head (Malchiodi, 2007, 128). However I would have a range of sizes for your client to choose for herself.

 

You may just want to relax by three deep inhalations.  Perhaps the PACE routine borrowed from Educational Kinesiology.

 

 

Mandala Exercise: 1.  On a sheet of paper draw a circle either freehand or trace a dinner plate. 2.  Choose colour to begin: you can use crayon, pastel, texta, pencil, watercolours, acrylic, gouache 3.  Use as little thought as possible.  4.  You might begin in the centre, or the outside. 5.  You may use any lines, colours and forms that you want. 6.  You may want to create a pattern or a picture; shapes and colours. 7.  You can go outside the circle or stay inside. 8.  When finished work out which way you want it to be and mark the top of the page. 9.  See if a title comes to mind. 10.  You may want to keep a Mandala Journal   (Malchiodi, 1997; Fincher, 1991).

 

This is an adaptation of the MIECAT Process, an experiential and creative arts therapy model. I have used Warren Lett’s research, ‘The Intersubjective Inquiry An Experiential Procedure’ as a guide to this process, and have refined and adapted the application to working with grieving clients:

1. Decide on what the issue is that you wish to work on in your relationship with the loved one.  This issue may be decided upon by talking and questioning.  It may emerge while ‘sitting and sticking’ (Brown Ash, 2004).  This is when the client and the counsellor sit and problem-free chat while sticking images torn from magazines. The client is instructed not to think too much about what they are doing with regards to the chosen images and the placement on the page. This keeps their ‘critic’ at bay. As the facilitator I am able to keep their attention on our conversation rather than the collage.
2. Creation of texts:  texts are created: they can be in the form of collage, drawings, paintings, movement, free writing.  The text is considered, and described in considerable detail, to show what is seen and what is in front of our eyes.  It is a factual description, not an interpretive one
3. The next step is to indwell the materials until key words, key images or gestures or tones emerge.
4. The client then constructs their own response (what is called intrasubjective response, a response from within) in one of the art modes (people choose visual, writing, movement, sound).  This is a way of depicting the experiencing of indwelling the first representation.  This is then shared. The therapist then creates an intersubjective response to the client based on what has gone before. This is a ‘deeply empathic-intuitive sense of what is at the heart of the materials’ (Lett, 1996). 
5. There is now a new step: the client depicts again, taking into consideration the intersubjective response, their own intrasubjective response, along with new material which may have emerged as a result of the former. 
6. The process continues until the energy is exhausted, or the search is completed.  All the creative texts are assembled as a way of integrating the process.

 

JOURNALLING/WRITING:

 

Here is an exercise from the Therapist’s Notebook: Addressing the Critical And Supportive Voices through Art Therapy, a chapter by Mary Forrest.  This is an exercise that helps broaden the client’s perspective, providing opportunity to discover multiple stories, other ways of seeing the world.

 

I have adapted this from Mary Forrest, page 18 in The Therapist’s Notebook:   ADDRESSING THE CRITICAL AND SUPPORTIVE SELVES   1.  Ask your client if she/he is comfortable participating in the activity (describe it). 2.  Have your art supplies ready: I usually have texta, pastel (both oil and soft pastel), watercolour paint, paper suitable for the medium. 3.  Begin the exercise by writing your name on a piece of paper. 4.  The turn the paper upside down and look at the shapes of the name upside down.  Discuss how different the name looks upside down. It looks like something else?  So begins the journey of looking at something through a different set of lens. 5.  Keep drawing based on the shapes they see. 6.  When finished, place it, with permission on the wall. 7.  Now give client two pieces of paper. One labelled ‘Critical Voice’ (or in conversation find out what words are appropriate) and one labelled  ‘Supportive Voice’ or whatever the client calls it. 8.  Contemplate the artwork that you have just put up on the wall and ask the client to write or talk what the critical voice would say about the work on the wall. Then ask the supportive voice to speak. 9.  Now give more paper. Ask client to write the word of a problem what they are struggling with, the theme they are dealing with in therapy. 10.  Turn it upside down. 11.  Draw from the shapes created from the words on the page (seeing the ‘negative space’ as opposed to the letters). 12.  Then make a critical voice list and a supportive voice list after viewing the artwork.  13.  Then have the conversation “which voice is stronger?” “Is there a way that the problem can be viewed ‘upside down’ in y our life?”  Etc.  You will know what questions to ask.

 

 

 

Following is an exercise that helps people feel that they belong, that they are noticed, and that they are valued.  It can be done in group, in families, or just between the therapist and the client.  When done in group there are more resources that can be accessed by the client.  However if done between client and counsellor it could be something that is added to week by week, with small cards that can be exchanged and assembled in the Box of Tenderness.

 

A BOX OF TENDERNESS   A writing exercise devised by Tara R. Gootee in The Therapist’s Notebook (p271).   Give a little box or container to participants. During session, decorate box with art materials (you can supply collage materials, paint, pastel etc. This may take a whole session. Next session, ask members of group to write down one thing that the other person does or says that they admire.  Also something they did that they appreciate. When everyone has completed the exercise, members can share their pieces of paper or write one succinct piece of writing to share. Clients keep their box of tenderness, and go to it when they need to.

 

As you can see, there are multiple games and activities that are suitable to be used in the therapy room, that require little in the way of supplies, but can make the world of difference to the client.

 

Here is another favourite one.  I have taken the liberty to adapt it or ‘dream it on’ for the clients we are focusing on tonight: those who are experiencing grief and loss. Jill Woodward (in The Therapists Notebook) wrote this intervention for children (her chapter is called “The Many Sides of Me: a storytelling intervention for children”), however I think it is also  \ appropriate as a tool of remembering and honouring a loved one.  I have called it “ I am, you are, we are”. You will have a better idea!

 

 

 

I am, you are, we are:

 

This is a picture and storybook that is made up of autobiographical stories based on real events or fantasies that the client dreams or wishes. 

1.     make a list together of possible chapter headings regarding the client and their relationships.  The counsellor can begin by suggesting things such as “the day we first met”, “the day I felt most loved”, “our home”, “a time we were happy”, “a fun day we had”, and then ask client to label the days that were perhaps not so good, eg. “a sad day”. Some clients may not wish to do this, and it is important to check out with the client if they want to do both the sad and happy. Follow their wishes.

2.     Client draws something that fits the chapter title.  To help client explore the title, you may ask questions such as “who, what, where, how, why sort of questions: what did you say; how did you look; where were you; who were you with; what happened right before this; how did you find the courage to do this?

3.     Themes will emerge that can be explored.

4.     Publish!!!!

GUIDED IMAGERY:

1. using images (a thousand words) can encourage communication around grief and loss.  Images such as Kath Killwitz (accessed from the web)
2. Reflect on the images below. Let yourself enter the image.
3. What are you thinking, feeling, hearing, sensing, smelling…
4.  

Some examples from Sandra Bertman’s article Visual Art for Professional Development in Bolton’s Dying, Bereavement and the Healing Arts (2008):

 

My mother died two months after my brother. My brother tom had been cremated but not buried because the group was frozen.  I asked the funeral guy if my brother could be tucked into the coffin with my mother. Then she could take him back to earth with her (anonymous, Bertman, in Bolton, 2008, 53)

 

I waited so long for you to come to me. You arrived, but it was too quick, without warning, my heart is heavy and everything is so black.  I want to caress and hold you; I hope that you’ll come back. Still I can’t see you. Who are you? How can I fix this (my wife and I had a miscarriage 14 years ago. Social worker. M  (Bertman, in Bolton 2008, 53)

 

Nobody ever told me this is what a father would be all about. The wood I hold has made me wonder. The child I hold has made me whole. I bury my wholeness with my child never again to be a father (Clergy, in Bertman, in Bolton, 2008, 53).

 

 

A VISUALISATION: ADAPTED FROM JEAN HOUSTON WORKSHOP, ASHLANDS, 2005   Gently close your eyes.  Focus on your breathing. Notice it coming in, turning around and leaving the body.  Notice what you notice. Allow your right arm to get heavier and heavier. You will enter your mountain of potential, your mountain of dreaming, your mountain of desire.    As you ascend the mountain, you are aware that your body is made up of a trillion set of cells, and each cell is vibrating. As you breathe in blue and golden light, your cells glow a soft pink.  In each cell you place a tiny little brain, and a tiny little heart.  This will allow you to disengage your intellect for a while and trust that your body, with its trillion brains and trillion hearts, can do the job.    Your whole body is now feeling and thinking at a cellular level as you ascend your mountain.    You can hear across the valley, and because you have a trillion sets of cells working, you can hear far more clearly than ever before.  You can hear beyond the mountains, you can see beyond the horizon, you can feel the pulse of the earth beneath your feet.  You can see, hear, and feel beyond anything you have seen, heard and felt before.  You reach the top of the mountain, your mountain, and you look down and see a plaque. And on that plaque is written a message just for you possibly written by your future self.  You read it, and then you realize that there is a set of moving stairs that go into the mountain.  These moving stairs beckon you, and you step aboard.  As the stairs take you into the centre of the mountain, you witness many rooms and you can glimpse inside these rooms.  These rooms are the rooms of your dreams. …. read what is written on the top of the door…allow yourself to journey right through the mountain, passed the many rooms of loved ones, of opportunity and experience.  Go back and choose one or two to enter…which ones attract you the most…inside these rooms you meet your wise and resilient self, and perhaps the wise self of someone you love, and she/he has a message and a gift to give you (you may have a question to ask your wise self, or your wise self may have something to tell you).   You accept the gift; remember the words, and then leave, walking backwards out of the space, through the door, up the moving stairs to the top of the mountain. Before you leave you may want to enter another couple of rooms, go to the rooms that had the most energy around them.  On your return to the outside, you look at the plaque and the message may, or may not, have changed.  You then return to the bottom of the mountain, with your gift and your words. You then depict this experience on paper, in your journal, and through chatting together.

 

 

This is an exercise to connect with your future successful self, the mindful and resilient one. We can learn a lot from her/him and she/he can give us some guidance.

 

 

A conversation with you: creative arts therapy processes that you can adjust and use

 

As you read this document, please know that these are just ideas, and I am hoping that you will have the courage and the joy to ‘dream them on’. I have gathered these ideas from others, dreamed some of them on, and I will have a list of references at the end.

 

EXPLORATION:

Sometimes young people are quite nervous about coming to see you; they may have seen many therapists in the past, or may never have seen a therapist. One young person who has seen many therapists said, when I asked her what she would like to see in a therapist, that it is important to find ways to communicate not just with words, and that the therapist needs to be  ‘tender’ towards the young person. When she said that word ‘tender’ I felt my temperature change. Here was this beautiful young woman who suffers constantly with fears of harming herself, and she has told me that what she needed was ‘tenderness’.  She also said how arts therapy would have been a wonderful thing for her to do when she was younger (she was also doing right now with me as we shared our stories), because then she would not feel foolish just sitting there.  “The therapists go straight for the issue’, she said, rather than developing the relationship.

 

So here, on the advice of a beautiful young woman, are some activities that do not go directly to the ‘issue’ but rather relax the client, and help build the therapeutic alliance.  I suggest both you and your client engage in these games: they will not only wake your client up, they will bring a degree of spontaneity and creativity into your role as therapist.    This is also what we do in solution-focused therapies: this, I am thinking, could be seen as ‘problem free talk’ but with young folk it may go longer than you think!

 

(Smith, Keri, 2008)

How to be an explorer of the world

USA: A Perigee Book

 

1.     “You are an explorer”, says Keri Smith, and “your mission is to document and observe the world around you as if you’ve never seen it before. Take notes. Collect things you find on your travels. Document your findings. Notice patterns. Copy. Trace. Focus on one thing at a time. Record what you are drawn to” (11).

 

 

2.     “Exploration #1 is” continues Keri “right where you are sitting.  Write ten things about where you are sitting right now that you hadn’t noticed when you sat down. Use your senses. Do it quickly. Do not censor. Okay” she concludes, “begin (29).

 

 

3.     “The artist is never bored.  She [or he] looks at everything and stores it all up.  She rejects nothing; she is completely uncritical.  When a problem confronts her she goes through all the stuff she has collected, sorts out what seems to be helpful in this situation and relates it in a new way, making a new solution. She prepares for leaps by taking in EVERYTHING (Corita Kent in Keri Smith, 2008, 38).

 

 

 

 

 

 

 

4.     World of Colour: have a collection of paint chips from the hardware store.  Ask young person what colours they respond to (43).

 

 

5.     Case of Very Small Things: “collect objects that you do not understand or have meaning for. Create a miniature museum and collect only very small things.  Store them in a mint tin or small box”, says Keri, “for example found things, or bits of string, or chalk, or buttons or coins.

 

6.     World of Magic 

Imagine that everything is magical.  Find some objects that could have a potential magical quality. Create a story about its magical qualities. 

 

Eg. MAGIC PINECONE when planted, this magic pinecone grows into a tree that causes everyone who sits under it to fall asleep and have vivid dreams (Smith, 2008, 93)

 

7.     Official License to Create my Own Reality

 

OFFICIAL LICENSE TO CREATE MY OWN REALITY   NAME:……………………………………………………… ADDRESS:…………………………………………………. Affix photo here   Experimenting since…………………….

 

Cut out and carry it with you!!!! (Smith, 2008, 92)

 

Get Creative With Collages

 

Collages are another easy art therapy idea to implement. If for some reason you’re not familiar with collages or you need a quick refresher on some different types of collages, here is a little explanation as to what they are.

The term collage originates from the French word coller, which means, “to glue.” The collage is a form of the visual arts and is created by gathering many different pieces or chunks of things. After you’ve gathered a variety of pieces you can then assemble the pieces into one, collective piece of art. This usually achieved by placing the individual pieces and gluing them onto a canvas or piece of paper, for instance, essentially creating a unique piece of artwork.

Some examples of things you can include in a collage:

·       Pictures or photographs

·       Bits of newspaper

·       Ribbons and/or bows

·       Other pieces of paper – can be different colors for example

·       Pictures or images from magazines

·       Pieces of other artwork

·       Old clothing or fabric

·       Comics

·       Food labels

·       And many more!

There are endless ways to create a collage. You can pretty much create a collage from anything. You’re only limited by your imagination and, well, I guess the availability of the pieces you need.

Collages of a certain type can include the following:

Paper collage – One of the more basic forms of collage. Various pieces of paper gathered and put together to create a unique collage strictly from paper products.

Photomontage – whether done by hand or with the help of a computer, a photomontage is a collage of pictures or photos.

Painting collage – Gluing pieces to a canvas and then painting over and/or around those pieces on the canvas, thus creating an original and unique painting.

Collage & architecture – Less about the technique, more about the concept of infusing different ideas into architectural design…probably not as much use in an art therapy sense as some of the others.

Wood collage – Create from pieces of wood, whether it be from scraps, old furniture, crates, barrels, house parts, driftwood, branches, sticks, bark, etc.

Digital collage – Using a computer to gather the visual pieces and put them together.

As you can see, one of the great things about collage as an art therapy idea is there’s really no barrier to begin. The ideas and activities for creating this type of art are only limited by your imagination.

 

Solution-Focused Play Therapy Note Taking

Client: ____________________________________

Date: ______________

1.     What brings you here today?

2.     What could we talk about that would make you happier?

3. If things were better, what would you be doing?

4.     If a miracle happened tonight and you woke up tomorrow and your problem was solved, what would be the first sign that the miracle has occurred?

5. What would you be doing differently?

6. What else would be different after the miracle?

7.     Who would notice the change in you?

8. What would they notice?

9. How would they respond to you?

10.   How would you then respond to them?

 

(Repeat entire sequence three or four times).

·       When has this miracle already happened, even a little?

·       How were you able to make this happen?

 

(Remember the “wow’s” and “ how’s”.)

1 2 3 4 5 6 7 8 9 10

·       On a scale of “1” to “10,” with “1” being the worst and “10” being the best, where would you rate yourself today?

·       How did you get to a “#” day [Insert the number from the scale here]?

·       When you move one number higher, what will you see yourself doing?

·       Is there anything else we need to discuss?

 

EBSCO Publishing Green Initiatives

 

 

SOME REFERENCES:

Something I found on the net for you to access whenever you want to:

1.     

Art Therapy

Read more: http://www.arttherapyblog.com/art-therapy-activities/future-self-portrait/#more-93#ixzz0ue2cEt00

Below is a copy and paste from the website above:

 

“Future Self Portrait” Art Therapy Activity

 

Here’s a quick activity that you can try: Imagine yourself tomorrow, a week from now, a month from now, a year from now, 10 years from now, or any other future date of your choice. Imagine how you would like to be. Imagine yourself somewhere you’ve never been. Imagine yourself in any way you like, some time in the future.

Now create a self-portrait that reflects how you see yourself in the future. For this exercise, let’s go with a drawing or painting. If you don’t have those materials readily available, then use anything you do have readily available…maybe it’s a collage from magazines or other materials. The idea is to create something relatively quickly (within hours or a day). Feel free to create more than one future self-portrait. You could create one for each day of the week or one for each month of the year, or one for each of your favorite holidays. Place the date on your finished future self-portrait.

What you have now is something you can put on your fridge, wall, mirror, etc. as a reminder of how you want to be in the future. Use this as a way to jump-start your path to becoming who you want to be in the future.

 

Read more: http://www.arttherapyblog.com/art-therapy-ideas/get-creative-with-collages/#more-14#ixzz0ue3X6OBa

2.   Art therapy exercises: inspirational and practical ideas to stimulate the imagination

By Liesl Silverstone (2009) 

London: Jessica Kingsley Publishers.

This is online so go to qut.edu.au and it will be there for you any time. Here are some examples from Silvertone (2009):

 

MAGIC CARPET

 

YOU ARE SITTING IN THIS ROOM ON A SMALL CARPET

Now you notice that the carpet with you on it is rising slowly floating towards the open window

You are floating out of the window

Rising

Up

Up

You are flying over the rooftops

Gently flying

 

Now you notice that the carpet with you on it is slowly descending down down

Now you have landed

You look around

What do you see?

And now

Gently

Open your eyes

You are back in the room

 

Draw your experience in whatever way is right for you

You have five minutes…

 

 This is a great resource, online. Worth a read, as it sits somewhere between evidence based principles and creative arts principles:

3.     Hinz, Lisa, 2009 Expressive Therapies Continuum, Routledge: New York

This book is in the library as an ebook. You can download it onto your computer.

Here are a couple of ideas from this book:

Kinesthetic work in the clinic: asking a client to move, to gesture, to create something with clay or paint, mediums that have some sort of resistance (eg. Clay needs to be manipulated; paint can be thick and piled on the brush).

Kinesthetic  experiences  embrace some sort of rhythm, movement, and a release of energy (Hinz, 2009).

 

·      Using clay: pounding; release of tension; meditative

·      Tearing paper: release of tension; helps relaxation

·      Moving paint: cathartic; energetic; relaxing

 

 

4.   One excellent resource  is Integrating the Expressive Arts into Counseling Practice: Theory-Based Interventions Suzanne Degges-White PhD LMHC LPC NCC (Editor), Nancy L. Davis PhD LPC LSC (Editor), 2010

Here are some extracts:

BIBLIOTHERAPY

Clients identify with characters in books, movies etc.

Structured family drawing technique: (Mary Amanda Graham and Dale-Elizabeth Pehrsson, in Degges-White & Davis 2010)

 

DRAWING FAMILY

·      Draw a picture representing a family activity, either real or imaginary: provides some sort of distancing, allowing the client to talk about their family safely and with new insight, with encouragement and support from the counsellor.

·      Now do speech bubbles or say what the family members would be saying in the activity.

·      What would each person be thinking about and not saying?

·      Draw a heart shaped bubble and ask what each person would be feeling

·      And finally what would each person in the picture  be going to do next

·      Is there anything you want to erase or add to the picture that may be important?

 

USING DOLLS HOUSE IN PLAYROOM

·      Create your family in dolls house.

·      “a typical day”

·      tell me about this scene. What is going on in the house right now

·      if the family were to sing a song together what would it be? Or

·      if the family were to watch a TV show what would it be?

 

LIFE MAP ACCORDION BOOK BY KATRINA COOK  (Degges-White & Davis 2010)help client create a concertina book (see model)

·      develop collages, maps, etc. in the book of memory.

 

COLLAGE:

You can have a theme or not. The theme emerges anyway. Sometimes people feel a little lost without a theme and sometimes they like the freedom.

      Questions to ask:

·      when I look at your picture I see:

§  colours

§  images

§  words

§  when I look at your collage I think about

§  this comes to mind

§  those colours represent to me…what about you

 

DRAWING A SOLUTION

·      draw a picture of what is troubling you

·      what you want to change: this establishes goal

·      have client describe the image

·      draw a picture if there was a miracle and it was a perfect day and the problem had disappeared.

·      Look for exceptions; when was this not happening?  Draw that picture.

·      Draw a picture of what your number on the scale LOOKS like. Eg. On a scale of 1-10, and 1 being the worst day, and 10 being the perfect miracle picture or perfect day, where are you right now?

 

NEW CHAPTER PAMPHLET STITCH BOOK BY KATRINA COOK

 

·      If you had a book title that represented the miracle question what would it be? Write it in your stitch book

·      What story does this book tell us?

·      How does this chapter end?

 

DISCOVERING SOLUTIONS IN THE SAND BY CHARLES E. MYERS

 

·      Place hands in sand; notice how it feels; how it moves;

·      Say to the client: “think about the (presenting issue). What does it look like in your life and what feelings does it bring up?”  Now select some images and symbols that can represent what we are working with. Place it as it is right now in the left hand part of the sandtray.

·      Allow the client to work silently if they wish. Hold the space.

·      Then process the depiction by asking strength based questions such as:

o   Describe what you see?

o   What do you notice?

o   What attracts your attention?

o   What don’t you like

o   What do you want to change

o   Is there anything you need to add?

·      Now, on the right hand side of the sand tray, depict your miracle.  In six months the problem no longer exists.  How will your world be different?

·      Once the second half is complete, talk about what has changed, what is different, how do you know that the problem has gone; how can others tell that the problem has gone;

·      Then ask client: what can you do to get form the left half of the tray to the right half? What is in your power to change?

·      Take a photo.

 

5.     Here is an article that may be of interest

Melina Roberts.  (2006). "I want to play and sing my story": home-based songwriting for bereaved children and adolescents. The Australian Journal of Music Therapy, 17, 18-34.  Retrieved July 24, 2010, from ProQuest Psychology Journals. (Document ID: 1393979841).

6.     Here are some more articles that you will want to read: remember they are NOT through a constructionist lens but you can do that for yourself as you read them:

 

A Conversational Model of art therapy

Nicolette Eisdell. Psychology and Psychotherapy. Leicester: Mar 2005. Vol. 78 Part 1. pg. 1, 19

 

Abstract (Summary)

This paper illustrates a ‘Conversational Model’ of art therapy. The Conversational Model was jointly created by Robert Hobson and Russell Meares. It is a developmental theory unique in its clinical application. The focus of the paper is two sessions that altered the course of therapy. In these sessions, variations on Donald Winnicott’s "squiggle-game" and Hobson’s "party game" were used to engage an isolative, reluctant incarcerated patient. The interventions illustrate the basic tenets of the Conversational Model. The theoretical process–from disruption to repair–is visually recorded in the artwork. The central argument of the paper is that interactive art therapy interventions can be effective, when used appropriately. By engaging the patient in a ‘visual’ conversation, he/she may develop an emotional vocabulary, a prerequisite for a psychotherapeutic conversation. The paper begins with a brief historical overview of the interface between art and psychoanalysis, the context out of which ‘art therapy’–a distinct body of theory–evolved. Theory interweaves with clinical material in a narrative style. What I say and do in therapy is aimed at promoting understanding: a ‘conversation’, a meeting between two experiencing subjects (an I and a Thou), here and now, in such a way that learning can be effective in other relationships. If, as I believe, psychotherapy is a matter of promoting a personal dialogue, then we need to know how to receive, express, and share feeling: how to learn a language of the heart in its ‘minute particulars’.

This paper illustrates a ‘Conversational Model’ of art therapy. The Conversational Model was jointly created by Robert Hobson and Russell Meares. It is a developmental theory unique in its clinical application. The focus of the paper is two sessions that altered the course of therapy. In these sessions, variations on Donald Winnicott’s "squiggle-game" and Hobson’s "party game" were used to engage an isolative, reluctant incarcerated patient. The interventions illustrate the basic tenets of the Conversational Model. The theoretical process - from disruption to repair - is visually recorded in the artwork. The central argument of the paper is that interactive art therapy interventions can be effective, when used appropriately. By engaging the patient in a ‘visual’ conversation, he/she may develop an emotional vocabulary, a prerequisite for a psychotherapeutic conversation. The paper begins with a brief historical overview of the interface between art and psychoanalysis, the context out of which ‘art therapy’ - a distinct body of theory - evolved. Theory interweaves with clinical material in a narrative style.

 

 

What I say and do in therapy is aimed at promoting understanding: a ‘conversation’, a meeting between two experiencing subjects (an I and a Thou), here and now, in such a way that learning can be effective in other relationships. If, as I believe, psychotherapy is a matter of promoting a personal dialogue, then we need to know how to receive, express, and share feeling: how to learn a language of the heart in its ‘minute particulars’.

Robert F. Hobson, Forms of Feeling (1985, pxiii.)

This paper illustrates the ‘minute particulars’ of a ‘Conversational Model’ of art therapy that was used to engage an isolative, reluctant, incarcerated patient charged with a capital offence. The playful nature of the ‘visual’ conversations triggered poignant ‘verbal’ conversations. This enabled the patient to reflect on his disturbed early life which had led to destructive behaviour. Now he can begin to imagine an alternative future. The Conversational Model was jointly created by Australian psychiatrist Russell Meares and his mentor, British psychiatrist and Jungian analyst Robert Hobson. The model provided the theory to understand the patient. It is a developmental theory unique in its clinical application.

The focus of this paper is two sessions that altered the course of therapy. The interventions illustrate the basic tenets of the Conversational Model. As therapist and patient began to engage in interactive visual games, symbols of alienation and persecution - at first predominant - faded. Rapport quickly developed, facilitating the beginnings of a self-reflective capacity. This resonated through the imagery.

To understand the journey it is important also to understand the historical context. Art therapy emerged from a synthesis of art and psychoanalysis. This drew on the vastly different creative energy of both, but its unique genius derived from working on their complementary nature. It was out of this intellectual construct that the concept of using art as a therapeutic tool - that is, art therapy - emerged.

Art and psychoanalysis: A brief overview

From the earliest days of psychoanalysis, the making of art was viewed according to the analyst’s theoretical stance. This is illustrated in the attitudes of the two giants of psychoanalysis - Sigmund Freud and Carl Jung. While the former was ambivalent, the latter was unequivocal. There is abundant literature on the connection between art and psychoanalysis, but I will limit my focus to those psychoanalytic theories of art and the artist1 directly related to the theory and practice of art therapy outlined in this paper.

Freud’s ambivalence is reflected in his view of the artist as ‘not far removed from neurosis’. In Freud’s view he/she is Oppressed by excessively powerful instinctual needs’ and ‘turns away from reality and transfers all his interest, and his libido too, to the wishful constructions of his life of phantasy, whence the path might lead to neurosis’. Freud described conflicting constitutional factors: ‘a strong capacity for sublimation and a certain degree of laxity in the repressions’. But, in the same paragraph, Freud also wrote: ‘there is, in fact, a path that leads back from phantasy to reality - the path, that is, of art’ (Freud, 1973 p. 423). The psychology of the ‘true artist’, he believed, was a convoluted journey from neurosis to ultimate fulfilment. The latter equated to ‘honour, power and the love of women’ (p. 424).

Recognizing the centrality of images in dream interpretation, Freud still did not incorporate art-making into his classical technique. This was despite the following observation, much quoted by art therapists (Dalley, 1984; Rubin, 1987):

We experience it (a dream) predominantly in visual images; feelings may be present too, and thoughts interwoven in it as well; the other senses may also experience something, but nonetheless it is predominantly a question of images. Part of the difficulty of giving an account of dreams is due to our having to translate these images into words. ‘I could draw it’, a dreamer often says to us, ‘but I don’t know how to say it’ (Freud, 1973, p. 118).

Freud’s colleague and contemporary, Carl Jung (1964, 1966, 1967), was the forerunner of art therapy. He viewed art-making as a means of expressing the sacred and mysterious - an important element in the ‘individuation’ process. Jung used art in his own self-analysis and encouraged his patients to express themselves ‘by means of brush, pencil or pen’, between sessions (1966, p. 48). Here Jung preempts the art therapy movement:

It is not a question of art at all - or rather, it should not be a question of art - but of something more and other than mere art, namely the living effect upon the patient himself (1966, p. 48).

Extending the application of Freudian theory, Anna Freud and Melanie Klein (1959) incorporated art-making into their respective psychoanalytic techniques, to overcome a lack of free association, in their work with children.

Taking this journey further, one of the pioneers of art therapy, Margaret Naumburg, regarded art as ’symbolic speech’. A Freudian analyst, Naumburg published her findings on the therapeutic and diagnostic value of art-making in the treatment of neuroses (Naumburg, 1947) and psychoses (Naumburg, 1950). She paved the way to the central thesis of this paper - that symbolic ‘visual’ communication is for some patients less problematic than, and can facilitate the later development of, ‘verbal’ speech:

Objectified picturization acts then as an immediate symbolic communication which overcomes the difficulties inherent in verbal speech (Naumburg, 1958 p. 512).

Developing a strategy on the use of art as symbolic speech, British analyst Donald Winnicott (1971) converted a pre-existing drawing game into a ‘technique’ to engage his young patients at the start of therapy. He named it ‘the squiggle-game’, describing it as ‘a game with no rules’ (1974, p. 141). The focus is on engaging his patient, rather than the creation of a product for interpretation:

In this squiggle game I make some kind of an impulsive line-drawing and invite the child whom I am interviewing to turn it into something, and then he makes a squiggle for me to turn into something in my turn (1974, p. 19).

Winnicott expands upon the theoretical aspects of the game:

The squiggle game is simply one way of getting into contact with a child … An artificial link is made between the squiggle game and the psychotherapeutic consultation, and this arises out of the fact that from the drawings of the child and of the child and myself one can find one way of making the case come alive (1971, p. 3).

Robert Hobson (1985) also adapted a pre-existing game, a ‘party game’, to psychotherapy. In work that has particular relevance to this paper, Hobson used this ‘technique’ to engage a withdrawn adolescent called ‘Stephen’. Using a shared lead pencil and an old envelope, he invited the boy to play, the instructions being simply that ’someone draws a line and then someone else goes on with the picture. . . Let’s play together and see what comes out of it’ (p. 10). He viewed the technique as ‘an invitation to explore the unknown, an adventure which calls for courage’ (p. 11).

Hobson refers to it as ‘imaginative activity" as distinct from Jung’s ‘active imagination’.3 The latter, Hobson (1985) denned as ‘a kind of colloquy, or dialogue, with the personalized fantasy images… an inner conversation with personal ’selves’ (p. 102), a solitary activity. In contrast, ‘imaginative activity proceeded within a relationship - a verbal and non-verbal dialogue’ (Hobson, 1985 p. 102). As exemplified by both Hobson’s ‘party game’ and Winnicott’s ’squiggle game’, both analysts specifically utilized these techniques in their initial interviews with difficult-to-engage adolescent patients.

The Conversational Model

The Conversational Model is one of the best-validated of all currently employed psychotherapies. An abbreviated version of the model has been manualized as ‘psychodynamic-interpersonal’ (PI) psychotherapy (Shapiro & Firth, 1985; Shapiro & Startup, 1990). PI has proved to be effective in depression (Shapiro et al., 1994; Shapiro & Firth, 1987; Shapiro, Rees, & Barkham, 1995), in certain psychosomatic disorders (Guthrie, Creed, Dawson, & Tomenson, 1991), and to be cost-effective in treating repeated users of clinic services (Guthrie et al., 1999). A brief form of PI is useful in reducing repeated episodes of self-harm (Guthrie et al., 2001). The conversational model also produces beneficial effects and is cost-effective in the treatment of personality disorders (Hall, Caleo, Stevenson, & Meares, 2001; Meares, Stevenson, & Comerford, 1999; Stevenson & Meares, 1992, 1999).

At the heart of the Conversational Model is the idea that ‘I can only find myself in and between me and my fellows in a human conversation’ (Hobson, 1985, p. 135). To an outsider this may seem like an Ordinary’ conversation, but it is a ’special kind of conversation’ (p. 199) in which the therapeutic focus is on the mutual creation or discovery of a ‘language of the heart’. Hobson explains that ‘in an intimate personal conversation we are sharing A feeling language’ (p. 49, italics added).

Elaborating upon the idea of a ‘feeling’ language, Russell Meares (1998) identifies two kinds of conversation. One is connected to a particular use of words which becomes a ‘linguistic marker of ’self’ (p. 875). This conversation has a non-linear form an aimless, meandering quality in which shifts and jumps occur according to associations and analogy. Importantly, it is characterized by a feeling of well-being or pleasure, a sense of ‘aliveness’ and an attitude of intimacy. Attention is focused on an inner world of personal meaning, which is connected to the world of symbolic play, the world of metaphor. Meares (1995) calls this the ‘narrative of self’4 (p. 541).

In contrast, the ‘linear’ language - connected to the traumatic memory system - is characterized by anxiety, a lack of vitality, a sense of disconnectedness from self and other, and a diminished capacity to play or use metaphor. Attention is directed outward, towards the external world. Events are reported chronologically, sequentially, devoid of personal meaning (Meares, 1998).

Developmental theory

Meares (2000) has further developed the model, providing a theory that supports the development of a non-linear ‘feeling language’. Extrapolating from empirical studies, he proposes that soon after birth, mother and infant become involved in ‘a protoconversation’, a ‘form of conversational play, out of which will emerge the ’selfhood’ of her child’ (p. 15). Meares suggests that it is ‘the resonance between the ‘conversing’ partners’ which has ‘a transformational effect’ (p. 17). Developmentally, it is this initial proto-conversation within the dyadic intersubjectivity of mother and baby, that makes ’symbolic play’ possible (Meares, 2000, p. 138).

Meares (1993) focused extensively on the establishment of a therapeutic ‘play space’5 in which the sense of self can be generated, on the fragility of that play space, and on how and what may disrupt it. During symbolic play, the child transforms the objects in his environment into symbols of his own imagination - i.e. the leaf becomes a boat - whilst all the time chattering to himself in an inner-directed conversation, totally absorbed, seemingly oblivious to the presence of the care giver. It is through this process that the child begins to sense an ‘inner world’, a sense of selfhood. For the adult patient the process is similar. It is this symbolic play which is the precursor of the adult state of self-reflection or contemplation. But when a developmental disruption has occurred, as illustrated in the following clinical illustration, the therapist’s task is to foster the emergence of the non-linear ‘narrative of self’. Meares (2000) elaborates:

In essence, the therapist’s goal is to participate in the creation of a feeling of ‘aliveness’ in an individual whose sense of ordinary living is one of ‘deadness’ (p. 125).

This is a fitting introduction to the patient, who was in such a state of ‘deadness’6 when he first entered therapy.

Clinical illustration

Alex was an isolative, 25-year-old incarcerated psychotic patient convicted of murder. He approached me requesting individual, rather than group, sessions. Alex made it clear he would not talk about his feelings, his past, his family or his offence, but he would draw.

Initial sessions were characterized by stilted disjunctive dialogue and long periods of silence. Note the linear quality of the image (Fig. 1), the faceless disembodied stickfigure pinned to the cross. Alex’s suffering was palpable. My attempts to explore the artwork were met with monosyllabic responses and heavy sighs.

Disjunction and repair

Central to the Conversational Model is the concept of disruption and repair. Meares (1993) recognized that therapy generally begins in a state of disjunction. Thus the therapist’s task is to make a connection in a manner that resonates with the patient’s inner world (Meares, 2000, p. 124).

I clearly needed to connect with Alex. Aware that I am part of what may appear to Alex as an abusive autocratic system - a prison hospital - I mused aloud about how painful our therapy sessions must feel for him. And with regret stated Ι must seem like a torturer!’7 For the first time Alex smiled and began to explain that if he didn’t attend he was afraid he might never be discharged. What a terrible bind! Aligning myself with him I said, ‘well, if you have to be here, you may as well enjoy it! How about we play some drawing games together?’ Alex beamed. The idea that one could ‘enjoy’ therapy and ‘play games’, was new and appealing. It seemed we had finally connected and the process of repair had begun.

 

It was Donald Winnicott (1974) who first acknowledged the importance of ‘play’ in an ‘adult’ psychotherapeutic context, in relation to a sense of self:

It is in playing and only in playing that the individual child or adult is able to be creative and to use the whole personality, and it is only in being creative that the individual discovers the self (p. 63).

Squiggle with a twist

Next session I suggested we play Winnicott’s (1971) ’squiggle-game’. However, when played with a range of art materials rather than a lead pencil - as in Winnicott’s original version - the game took on a whole new dimension.

Choosing a pale blue crayon I made a scribble and invited Alex to ‘make something out of it’. Alex drew a distressed face and without prompting related it to recent frightening ‘paranoid’ thoughts - abusive ‘foul-mouthed voices’ in place of the usual comforting voice of his ‘forgiving loving’ God.

 

Reflecting on the formal qualities of Alex’s artwork, I note a sense of distortion and fragmentation, with disparate parts precariously linked together. The image could well symbolize Alex’s battle to hold together a fragmented self.

On the same sheet of paper, choosing green crayon Alex made a scribble. My intention was clear, I would respond to his image. After completing my drawing, instantly recognizing that the images related to one another, Alex said, ’she’s sad about him feeling so bad’. Undeniably, a visual conversation had begun. Judging by the image that followed, Alex experienced my pictorial response as empathy.

My turn to draw the scribble. Choosing blue crayon, on a new sheet of paper I drew a shape. Alex responded. Using yellow crayon he drew an oval shape, eyes and a mouth showing teeth - at this point he’d left out the ears, nose, eyebrows and hair. ‘It’s a smiling face’, he said, before drawing a mauve coloured scribble for me to complete. With the same crayon, I completed my drawing in response to his.  Delighted by his shift in mood I had ‘amplified’ his expression.

Amplification, a basic tenet within the conversational model, was originally a Jungian concept. It is beyond the scope of this paper to elaborate on this concept, but Hobson (1971) provided a detailed analysis of the genesis of Jung’s complex theory of amplification, before later reinterpreting the concept in terms of the Conversational Model:

 

A single work. . . has many facets… It cannot be translated into unequivocal discursive language; but it can be extended, expanded, or amplified (Hobson, 1985, p. 54).

Implicit within the Conversational Model is the ‘amplification’ of positive affect, based on the premise that positive affects - knocked out during repeated childhood traumas - are reactivated during the therapeutic process. Being the benchmark of a sense of self, positive affects are highly prized. Similar is the Self Psychological concept of ‘mirroring’, which relates to the patient’s need to have their archaic grandiosity reflected back through the ‘gleam in the mother’s eye’ (Kohut, 1966, p. 252). However, Hobson (1985) differentiates between the two, explaining that ‘in responding, I am amplifying, not merely reflecting’ (p. 23). For Hobson the difference resided in the added ‘inflection’ provided by the therapist.

Explaining that he wanted to make his drawing ‘more real. . . like yours’ Alex went back to ‘finish’ his own, using an expanded colour range - ears and nose in deep red, hair in green and eyebrows in brown. Finally, I reached over and drew half a blue rectangular border enclosing his half of the page. Using the same blue crayon, he completed the blue border, mirroring my marks. The border acted as a frame to ‘contain’ the images, whilst drawing attention to the feelings - further ‘amplifying’ them.

For the art therapist, translation from the ‘visual’ to the ‘verbal’ may or may not occur. Either way the joint focus is on the artwork in which is embedded a metaphor, created within the dyadic intersubjectivity of therapist and patient. The artwork symbolizes the ‘triadic’10 intersubjective dimension of the therapeutic relationship (Meares, 1998). Analogous is Meares’ concept of the ‘metaphoric screen’ upon which the patient projects associative thoughts - like a movie in the making - to be gazed upon by both patient and therapist. The therapist’s task is to stay within the metaphor, remarking upon the artwork/movie, rather than the patient/co-observer (Meares, 1983, p. 76).

Hobson’s ‘party game’ reinvented

In the following session I invited Alex to draw a picture ‘together’ - taking it in turns to draw something, or anything, using whatever colours we liked. Hobson (1985) described a variation of this technique.

Alex began, drawing a large mauve circle  in the middle of the page. No words were spoken. I saw the circle as an egg. Choosing green crayon - the patients wear green tracksuits - I drew a person curled up in it, a kind of embryo. Again using mauve crayon, Alex drew both the water and a huge wave. Now, it seemed, the embryo was threatened by the wave. I drew two flesh-coloured hands coming from outside the picture, symbolic of my rescue fantasy. ‘ ‘ In response - using black crayon - Alex drew a thick crack on the egg near the hands. Next a thought flashed through me - Ι need some grounding’ - so I drew the grass, a solid base. Alex then drew the shark - another threat, I thought, this time from below. In response, I drew a fishing rod with the hook in the shark’s mouth. Alex took the bait, drawing a man, albeit a stick-figure, smiling, holding the rod. I drew a woman beside him, sharing his delight. Finally, he drew two clouds which I associated with lowered mood. In response I drew the sun, for me a hopeful symbol. He put his crayon down, saying ‘it’s finished’.

So what did the picture mean to him? Without hesitation he said it was a picture of himself ‘being saved by God’. I note his positive interpretation, indicative of his sense of feeling valued by an idealized other. As Meares says:

The child who feels good, attaches meaning to this feeling and to this valuation, so that people who are part of him or her, share this goodness and are idealised. On the other hand, experiences which are essentially traumatic involve a negative valuation. The traumatised child senses himself or herself as bad, even though the trauma was not his or her fault. The other people who are part of the experience are also bad, persecutory, and so on (Meares, 2000 p. 68).

 

Clearly, I was being idealized here, but I chose not to interpret the transference. A ‘traditional’ transference interpretation links together a current incident in the patient’s life, the therapeutic relationship, and the patient’s developmental history (casement, 1985). Although several analysts have warned against ‘premature’ transference interpretations (casement, 1985; Winnicott, 1974), few have questioned their ultimate therapeutic value. Meares (2000) however, actively discourages transference interpretation:

More recent studies, which involve taped recordings, produce, in the main, opposite results. The studies, comprehensively reviewed by Henry et al. (1994), tend to show that transference interpretation correlates negatively with outcomes. One of the better known of the studies cited came from Piper et al. (1991). These and other findings cannot be ignored. Yet the management of transference phenomena … is central to the therapeutic process (p. 164).

Meares recommends that the therapist use the transference to monitor the patient’s subjective experience of the therapeutic dyad,12 and their own countertransference, rather than as a tool to promote ‘insight’ in the patient. For, by passively accepting the therapist’s ‘expert’ knowledge, the compliant patient forfeits any possible sense of agency, diminishing, rather than strengthening a sense of self (Hobson, 1985; Meares, 2000).

This serious but playful visual conversation allowed a joint yet separate exploration into the inner worlds of therapist and patient - as Hobson noted - bringing pleasure to both. Rather than a ‘collusive avoidance of anxiety’ (Hobson, 1971, p. 100), Hobson argues that such interactive therapeutic interventions exemplify the sharing of a ’symbolical attitude’ (Hobson, 1985, p. 10). Hobson defined this important term as ‘an openness to receive what is novel, a counteraction to the more usual tendency to confirm our assumptions and presuppositions’ (p. 142). Moreover, although a purposeless13 activity in that one didn’t know where one would end up, the Hobson’s ‘party game’ seemed to serve the purpose of engaging a patient who, for one reason or other, had not been able to speak.

American art therapist Mildred Lachman-Chapin (1979, 1983, 1987) proposed a Self Psychological approach to art therapy. She devised a controversial ‘interactive technique’ which differs significantly from the Winnicottian and Hobsonian drawing games outlined in this paper. Essentially, art therapist and patient engage concurrently in separate artworks, neither looking at the other’s artwork in progress:

When we have both finished, the patient shows me what he has done and we talk about what it means to him, what ideas it stimulates, how he feels about it. Then I tell him what responses his artwork evokes in me. Next I show the patient what I have done and ask him to respond to it. Finally, I talk about my work. (1983, p. 14).

Critics question the therapist’s motives, suggesting that it may be the therapist’s anxiety or exhibitionism which led him/her to create artwork along with the patient. It is considered unlikely that the therapist can be attentive to the patient if immersed in his/her own inner world. According to Meares, however, the effectiveness of any intervention - controversial or otherwise - can only be judged by what follows (Meares, 2001).

The family

Alex took another sheet and quietly began to draw. A child-like picture of his family emerged. There’s Dad, his sister and himself. Mum is absent. He began to speak of his childhood dream to live with his father. Finally he began to tell his story.

When Alex was 10 months old his parents separated. His father took Alex’s sister, who was 18 months older, back to Eastern Europe to live with her grandparents. Alex was left with his mother. He did not see his father again until he was 5 years old, and his sister until he was 10, when she returned to live with her father. At 12, Alex began using alcohol. At 15, Alex’s mother moved back to Eastern Europe, leaving no forwarding address. Alex tried, but failed, to look after himself, ending up in squats and on the streets. He began to drink heavily and abuse drugs. A short stint of living with his father ended disastrously. After an intense argument about leaving empty beer cans lying around, Alex was ‘kicked out’; his father’s last words being ‘and don’t come back’. Once more rejected and abandoned, Alex headed back to the streets, enraged.

With interest I noted that the large black ‘Dad’ stick-figure had no ears, and wondered aloud if it was something about Alex ‘not being heard’. He didn’t comment but drew on the ears in blue, the colour used to represent himself. Then, oscillating between the past and the future, memories began to flow. He recalls being quietly tearful while Dad was driving him home to Mum, wanting to stay with Dad but too afraid to ask. A huge sun fills the right hand side of the image. ‘When I’m released we’ll be together’ he says, future hopes reactivated. On the left, a house is drawn. Commenting ‘there’s smoke coming out the chimney’, I speculate that there’s a sense of ‘warmth’ there. He tells me how he would ‘muck around’ with Dad. I note that the house has an attic, ‘a place to put things’ says Alex. In this way the stories began to flow. The form of conversational language associated with the ’sense of self had began to emerge and an attitude of intimacy was developing (Meares, 2000).

The family revisited

Some months later Alex again drew the family. This time Mum is included. His (future) dog - previously identified with qualities of faithfulness, protection and playfulness - is beside him. Note the detail in this pencil drawing, particularly the ears, the smiling mouths and the hands. This is the ‘happy family’ that eluded him.

His was a deprived childhood. Mum worked long hours. No room of his own, he slept on a camp bed in the living room. A witness to violence perpetrated by various male callers left Alex feeling powerless and ashamed that he couldn’t protect his mother. Mum ‘beat’ him for such misdemeanours as finding his sandwiches in ‘the toy box’. Alex blames himself; he was ‘bad’ and deserved to be punished.

From a stylistic perspective, Alex explained that he liked the drawing in pencil because he ‘can change things. . .and make it right’. I note that it looks faint, easily ‘rubbed out’. He’s drawn himself as extremely muscular, yet he tells me how ’skinny’ he was at 15. He felt depressed, couldn’t eat. He recalls saying goodbye to his mother at the airport. Overcome with grief and panic, Alex wept, but was told to stop. He felt ashamed.

In this drawing he’s sixteen, which is interesting because this is a year after his mother left. His fantasy is clear. He wished his parents had stayed together, been a ‘real’ family. He’s convinced he wouldn’t be in this predicament today, wouldn’t have been living on the streets, wouldn’t have turned to drink, drugs and crime.

At 18, a drunk, drugged, angry and violent Alex, with a friend, without provocation, beat-up and ultimately murdered a vagrant, before setting him alight. Mystified, Alex recollects his ‘co-accused’ having told him that, as he hit the man, with every blow, he shouted ‘Mum. . . Mum. . . ‘ Alex recalls it like a nightmare, hazy, menacing, unreal, but with intense shame. Meares’ (1993) explains such acts of violence, where the victim becomes the victimizer, in terms of his theory of ‘reversals’. During a trauma the precarious self and traumatizer are fused. At times of intense anxiety, an unassimilated traumatic state is triggered, knocking out any sense of self. With no ’sense of self’ left, it is as though ‘the other comes to inhabit the victim’, resulting in a ’switch’ or reversal (Meares, 2000, p. 87).

More recently, Alex didn’t draw at all. He began to speak of the ‘near disasters’ suffered in childhood, corresponding to the various scars on his head and body. The conversation crescendos when, during various sporting activities, he has been able to make a ‘come-back’, ‘winning against all odds’. Through this metaphor he was able to acknowledge how far he’s come since the start of therapy 7 months earlier, when he ‘couldn’t talk’. While pointing to the circular space above and between us I commented ‘it’s almost as if you’ve done the drawing up here today, rather than down there’ pointing to the blank paper. He smiled, realising that he’d ‘talked the whole session’! No longer dependent upon the artwork to facilitate expression of ‘the third zone’ (Meares, 2000), the process was becoming internalized.

Conclusion

The Conversational Model provides a sound theoretical basis from which to understand and explore the patient’s inner world. Alex entered therapy with a disrupted sense of self, characterized by an impoverished ability to play. Trapped in a linear world, exemplified by his image of the disembodied faceless figure nailed to the cross, Alex struggled to overcome a sense of disconnectedness from himself and others. His rigid religious beliefs, although an attempt to find inner peace, further isolated him, creating an unbreachable schism between the saintly and despised aspects of himself. Through our joint participation in the modified Winnicottian and Hobsonian games, an atmosphere of connectedness developed between us, allowing symbolic play to begin.

Through the process of therapy, Alex was beginning to develop a self-reflective capacity and an emotional vocabulary; first visual, then verbally articulated. His repertoire of responses expanded, he could now both draw and talk. The images, reviewed over the course of therapy, provided ample opportunities for further expansion, elaboration and clarification. There was a chance to note repeated themes, recognize differences and similarities, whilst appreciating over time the subtle but noticeable shifts in style, content, colour and tone.

Clearly, this approach was successful with this patient, and may be successful with others. However, such interactive interventions have been discouraged from the general practice of psychoanalytic art therapy - particularly in Britain - despite precedents set by Winnicott and Hobson. It is important that any ‘technique’ be used with caution, with sound clinical judgment in accord with the therapist’s training and expertise, and with each patient’s specific developmental needs in mind. Some patients are clearly able to engage both visually and verbally without such a directive approach. Some may in fact find such interventions extraneous, or worse, intrusive or childish and thus insulting. However, in this particular case, Alex may have been deprived of the opportunity for a positive therapeutic experience without the art therapy ‘conversations’. The journey undertaken suggests that, with some patients, working interactively with visual imagery may facilitate the development of a therapeutic relationship in which words can at last be spoken. This process could mean the difference between a patient becoming a member of the community, or remaining a threat to it.

[Footnote]

1 Due to space constraints, important historical works exploring psychoanalytic theories of art and creativity have been omitted, e.g. Ernst Kris’s (/952) Psychoanalytic explorations in art; Marion Milner’s (1957) On not being able to paint; Otto Rank’s (1932) Art and artist: Creative urge and personality development; Hanna Segol’s (19911 Dream, phantasy and art.

2 The following publications provide an overview of an therapy theory and practice: ‘An as therapy: An introduction to the use of art as a therapeutic technique’, edited by Tessa Da/ley (1984); The handbook of art therapy by Caroline case and Tessa Do/ley (/992); Images of art therapy: New developments in theory and practice by Tessa Da//ey, Caroline case, joy Shevarien, Felicity Weir, Diana Halliday, Patricia Nowell Hall and Diane Waller (/987); Development and diversity: New applications in art therapy, edited by Doug Sandle (1998); and Approaches to art therapy: Theory and technique, edited by Judith Rubin (1987).

3 Marie-Louise von Franz (1964) described active imagination as ‘a certain way of meditating imaginatively, by which one may deliberately enter into contact with the unconscious and make a conscious connection with psychic phenomena’. But, unlike with ‘guided imagery’, ‘the meditator remains completely devoid of any conscious goal or program. Thus the meditation becomes the solitary experiment of a free individual, which is the reverse of a guided attempt to master the unconscious’ (pp. 206-207).

4 Meares (2000) devoted a chapter to a definition of self, extrapolating from the writings of William James, James Baldwin and Pierre Janet

5 There are strong parallels between Meares’ ‘play space’ and Winnicott’s ‘playground’ - a ‘potential space’ - a space where play between mother and baby starts. And later, the space between therapist and patient, in which the artwork - synonymous with Winnicott’s notion of the ‘transitional object’ - is created. However, a comparison of Winnicott’s theories with those of Hobson and Meores would be well beyond the scope of this paper.

6 Other analyts spoke of ‘aliveness’ and ‘deadness’: Winnicott (1971) interpreted a ’squiggle’ os a picture of ‘a coming alive ‘inside’, following a phase of deadness ‘inside" (p. 109); regarding a lack of mirroring, Kohut (1976) wrote ‘his craving to fill an inner void, to obtain a sense of aliveness, therefore became intense’ (p. 809); and Thomas Ogden (1997) monitored his own sense of aliveness/deadness during ‘reverie’ to understand the analysand’s unconscious communications.

7 Meores and Hobson (1977) elaborate on ways a therapist can damage a patient Certain interventions can leave the patient feeling attacked and persecuted. The therapist may evade his/her pan in a two-person psychology by inferring that all the patient’s responses to the therapist are ‘transference’, denying the therapist’s responsibility for empathie failures/the countertransference.

8 Thomas Ogden (1997) and his colleague Bryce Boyer f / 997) used the phrase a ‘verbal ’squiggle game" to describe how their own internal dialogue informs their analytic work. Ogden interprets his periods of reverie’ within the session as intersubjectively co-constructed, and subsequently interprets the analysand’s material in accord with this ‘reverie’. Boyer believes that, through ‘projective identification … the analyst learns from the patient what the /otter cannot think consciously’ (pp. 64-65). The Ogden/Boyer ’squiggle game’differs from Winnicott’s (1971) version, which primarily aimed to facilitate the patient’s free-associations, interpretations rarely being given.

9 Unintentionally I drew the mouth as a pink heart - on its side - perhaps relating to my intention to respond with soothing comments.

10 Ogden’s (/994) ‘analytic third’ is analogous to Means’ ‘third element’ (1993, p. 33), ‘third term’ and ‘third zone’ (2000, (p. 138).

11 In relation to such counter-transference, Stuart Per/man (1999) concluded that ‘a common dynamic for therapists involves a search to repair the deprivations and traumas of their own lives by curing patients, who are seen as representing the therapists’ needy child parts’ (p. 60). In reality. Per/man recognized, it is the patient who has to make the changes. The best we can do is to remain open, point the way, and give encouragement

12 Similar is Patrick casement’s ‘interactional viewpoint to listening’. casement attempts to gauge the impact of his therapeutic interventions from the patient’s responses - as distinct from the more autonomous intrapsychic material which arises- as well as the patients effects upon him in terms of counter-transference (/985, p. 59).

13 Winnicott(l974) recognized the importance of relaxation’ as a precursor to a sense of non-purposive being’ in contrast to ‘purposive activity’. In the former state, free-association becomes possible (p. 64).

 

 

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Received 29 March 2002; revised version received 14 February 2004

 

 

[Author Affiliation]

Nicolette Eisdell*

University of Western Sydney, Australia and New Zealand Association of Psychotherapists, Sydney, Australia

 

7.   Here is another one:

 

A creative writing program to enhance self-esteem and self-efficacy in adolescents

Genevieve E Chandler. Journal of Child and Adolescent Psychiatric Nursing. Philadelphia: Apr-Jun 1999. Vol. 12, Iss. 2; pg. 70, 9 pgs

 

This study suggests that a writing intervention focused on building self-in-relation self-esteem and the four aspects of self-efficacy resulted in increased sense of well-being.

PURPOSE. To describe the rationale, content, and results of a group creative writing program to increase adolescent self-esteem and self-efficacy.

METHODs. Subjects were low-income, at-risk minority youth (N = 11). Free writing in response to specific exercises, sharing their own stories in their own language, and responding to their peers were used daily for 2 weeks as part of the high school English class. The program was oriented toward health rather than problems, with the content created by the adolescents.

 

FINDINGS. The opportunity to tell their own story, in their own language in a safe, structured setting with positive feedback led to higher self-efficacy and self-esteem.

 

CONCLUSIONS. This study suggests that a writing intervention focused on building self-in-relation selfesteem and the four aspects of self-efficacy resulted in increased sense of well-being. Key words: Adolescents, self-efficacy, self-esteem, writing

 

 

One of the primary goals of transition from childhood to adulthood is to develop a positive sense of self. Miller (1991) maintained that a person’s self-concept is the single most important factor that affects behavior. Meisenholder (1985) acknowledged that self-esteem and self-efficacy are key components in the restoration and maintenance of health. In 1992, Hardin, Carbaugh, Weinrich, Pesut, and Carbaugh reported that one of the most important stressors for teens was threat to self. The authors concluded that because adolescents identified negative coping strategies that were life-threatening, there is a vital need to develop interventions that reinforce adolescents’ healthy coping and a solid sense of self. It is critical to provide the next generation with knowledge and skills that will facilitate internal strength and resilience.

To date, the majority of interventions with adolescents have been problem focused and administered through verbal techniques such as lectures and discussion, with the content determined by adults. This author designed a nursing intervention, Writing for Resilience to Increase Self-Esteem (WRITE), that was oriented toward health rather than problems, using material that came from the adolescents themselves, with the goal of enhancing selfesteem and self-efficacy.

Literature Review

Sorrell (1994) documented that traditionally, research on composition has focused on the written product. In the 1960s, however, the focus shifted to the writing process. Observations have shown that in this process there is a complex interplay between thinking and writing in which initial ideas are reworked into new meanings and unformed thoughts are given form and clarity (Sorrell). Writing then enhances thinking and has value as part of the learning process. Emig (1983) observed that writing slows down thinking, transforming the passive thinker into one who is actively, physically engaged with the creative process. Fulwiler (1987) noted that writing facilitates the thinking process, thus allowing the writer to think something through completely. Brown and Stephens (1995) support the notion that writing is a valuable vehicle for reflecting on one’s thoughts, feelings, and reactions. They contend that authentic writing is the merger of thought and feeling; when students have both cognitive and affective responses to subject matter, they construct important connections. This construction of meaning is personally transformative, growth producing, and essential to the learning process (Brown & Stephens). Atwell (1987) observed that writing can provide a neutral way to solve problems, capture feelings and inner experience, exercise power and freedom, and know one’s own voice. Pipher (1994) argued that "knowing one’s own voice" (p. 5) is a critical part of the process of learning who one is. Writing thoughts and feelings can strengthen one’s voice and sense of self.

There are three categories of writing: transactional, expressive, and poetic. Transactional writing is the typical language of science-factual, impersonal-and the main mode used in most school curricula. Expressive writing is the written form of everyday speech, the language of the personal narrative, the mode in which new ideas are tentatively explored and from which more specialized writing can be developed. Poetic writing evokes feeling. A piece of expressive writing that recollects a significant past experience often emerges as poetic writing in a story or poem.

The personal poetic narrative is an ideal mode for reflection. It is a fundamental way to search for meaning, value, and truth, all of which become clearer when set in written form (Nicolini, 1994; Sorrell, 1994). Exploring and defining the self and its relationship with others, becoming aware of structuring one’s thinking processes, and recognizing how the past has influenced and will continue to affect one’s life are the benefits of writing the personal, poetic, narrative (Nicolini).

The poet James Baldwin (1991) wrote of his childhood, "Growing up in a certain kind of poverty is growing up in a certain kind of silence. . . in the silence one cannot name the sensations, fears, injustices and simple facts of daily life because no one corroborates it. Reality becomes unreal because no one experiences it but you" (p. 38). When Baldwin read the work of another black author, he commented, "When circumstances are made real by another testimony, it becomes possible to envision change" (p. 38).

According to Nicolini (1994), "the writer is on a search for himself. If he finds himself, he will find an audience, because all of us have a common core" (p. 60). Onuwami, a storyteller, felt that bringing stories out into the public realm is transformative and healing, reminding people of their commonality and creating community. Santiago-Welch (1995) believed that sharing one’s self through creative writing and receiving positive criticism are therapeutic. The writing process gives power to the writer in a community of people coming together for the purpose of writing, to be heard and affirmed. Writing is a tool that can bring people to a place where they feel empowered. Writing can give access to one’s own self, knowledge, experience, imagination, and voice. Most theorists agree that writing has great potential to contribute to the mental, emotional, and social development of the writer (Nicolini; Sorrell,1994).

Nicolini (1994) observed: "Teachers can’t inject selfesteem, can’t inject a self-concept serum . . . but through success in writing students’ sense of self-esteem improves naturally" (p. 61). Based on these theoretical notions, the WRITE program was designed to help students use creative writing to know the self and know others, with the goal to increase self-esteem and self-efficacy. Baker (1996) suggested that the process of reflective learning leads to an increased sense of self-awareness and self-esteem and a change in conceptual perspective. Experts recognize that language alone does not lead to reflective, abstract thought. From their study of knowledge development, Belenky, Clinchy, Goldberger, and Tarule (1986) concluded that "in order for reflection to occur, oral and written forms of language must pass back and forth between persons who both speak and listen or read and write-sharing, expanding and reflecting on each other’s experience" (p. 26). The authors suggest such interchanges lead to ways of knowing that enable individuals to enter into the social and intellectual life of their community. Without these interchanges, people remain isolated from others and, even more important, without tools for symbolizing, representing, and sharing their experiences, individuals remain isolated from themselves. Vygotsky (1962), an expert in linguistics, explained that exterior dialogues are a necessary precursor to inner speech and an awareness of one’s own thought processes. Linesch (1988) described the writing process as a way to communicate personal experience, engage in social participation, and explore and experiment with identity. In the traditional school curriculum, there is little opportunity for students to focus on the development of self.

Methods

Purpose

The purpose of the WRITE intervention was to introduce creative writing as an opportunity for adolescents to tell their own story in their own words and to be respectfully heard and responded to without criticism. The goal was to provide a positive behavioral alternative for anger, stress, substance abuse, and violence.

Conceptual Framework

The conceptual framework underlying the design of the program incorporated the self-in-relation construct of self-esteem (Jordan, Kaplan, Miller, Stiver, & Surrey, 1991) and Bandura’s (1977) theory of self-efficacy Self-in-relation theory suggests that individuals develop a distinct identity and sense of their own capabilities in relation to others. The self-in-relation construct is a shift from traditional theories of self-esteem, which stress separation and autonomy rather than connection and relationship. In self-in-relation theory, self-esteem is described as the intimate connection between the growth and development of the individual self and the interactional development of self and others.

Self-esteem, then, is an evaluation of self (Rosenberg, 1965) and cumulative feelings about the self (Coopersmith, 1967) that evolve in the context of relationships. In the creative writing program, the development of supportive relationships through positive feedback and sharing written work among students and facilitators provided a relational context in which to develop connections to others to compare self-concept, values, and goals.

Bandura (1977) defined self-efficacy as evaluative feelings about one’s ability to carry out a behavior to a successful outcome. Perceived self-efficacy determines the initiation of a particular coping behavior as well as the persistence of that coping behavior in the face of obstacles. Self-efficacy is based on four sources of information: performance accomplishments, vicarious experience, verbal persuasion, and emotional arousal. Personal mastery of particular experiences that results in a sense of accomplishment is the most influential aspect of determining self-efficacy

A sense of self-efficacy gained from performance accomplishments tends to generalize to other situations in which performance may have been stunted by preoccupation with personal inadequacies. Self-efficacy is generated through vicarious experience, defined as seeing others perform threatening activities without adverse consequences. Negative emotional arousal, such as fear of the impending situation, can inhibit successful performance. Fear-provoking thoughts about ineptitude can be diminished when individuals are persuaded verbally that they have the capabilities to master a task and are provided with the knowledge through modeling and skills development (Bandura, 1977). The WRITE program created the opportunity for performance accomplishment through writing, vicarious experience by hearing others read their writing, and verbal persuasion from both peers and facilitators.

When the program was introduced at the English department faculty meeting at an urban New England vocational high school of 1,600 students, several teachers volunteered to participate. Participation was based on the ability to match the schedules of the high school students and graduate student facilitators. Subjects

The setting had a high-risk population of minority adolescents. The school has the largest percentage of lowincome children (51%) in the city, with the student body mix being Hispanic (41%), African American (35%), and white (24%). Participants in this pilot program were boys (3) and girls (8) in an 11th grade English class.

The Intervention

The WRITE program uses the creative, narrative, poetic writing method developed by Sneider (1993) in which individuals write in a group with the purpose of "developing their voice." This creative writing method has been used for more than 10 years with a variety of populations, including low-income women, English as a second language students, adolescents, bereaved parents, and professional writing groups. Sneider comments on the low-income women’s group: "All have gained confidence, are working together and acting as role models for their children in the struggle against poverty" (personal communication, November 10,1995). The author, who served as the faculty facilitator of the WRITE program, is certified as a group facilitator by the Amherst Writers and Artists Institute. The co-intervenors participated in 8 hours of training to implement the program.

WRITE was introduced to the high school students by the faculty facilitator as a creative writing workshop, with the goal being to "tell their own story in their own language." The students were assured the workshop was not concerned with technical writing, punctuation, or spelling. Following a brief description of creative writing, students were asked to "free write" by putting their pen to the paper and writing for 10 minutes, whatever came to mind in response to an exercise. The exercises (Table 1) used topics ranging from objects placed on a table (e.g., a clock, toy car, rosary beads, hammer) to lines of poetry read aloud. Following the written part of the exercise, students and facilitators were asked to read their writing aloud. After each person read, class members provided positive feedback by commenting on what they liked and what they remembered. Table 2 outlines the specific steps to the writing/reading process.

Analysis

To assess students’ response to the program, mid and end evaluations were conducted in the form of a paper in which the students were asked to write for 1 minute to the question, "What is this experience like for you?" (Angelo & Cross, 1993). The evaluations were anonymous to encourage students to write both positive and negative reactions. Table 3 summarizes the student’s midpoint and final evaluations.

Results

The content written in response to the exercise fell into three categories: memories, affect, and ideas.

Memory

In the memory category, students generally wrote about happier, simpler times of the past, such as going to the beach, a trip to their home country, or special family moments. For example, in response to the stimulus object, "Draw a map of a remembered place," one participant drew a map of a labor room and wrote, "When I think about the birth of my brother, I will never forget that moment. It was very funny to me, my mom was very noisy," and she went on to describe a scene of her mother telling her father it was time to go to the hospital and her father going crazy, jumping in the car and leaving the writer and her mother on the front steps. Another participant drew a map of a beach and began his story with "sea shells remind me of my family’s last trip to Puerto Rico," and ending with "life in Vieques (Puerto Rico) is very simple."

Affect

In the affect category, participants tapped into a whole range of feelings, from sadness to disappointment to delight. In response to the statement, "Write about something in your childhood that you don’t have now," a participant started with, "Something I had in my childhood and I don’t have now is a father. . . me, I love and hate him at the same time and that’s because when I was 11 years old he walked out on my mother, sister, and I." The participant ended with, "I wish everything could go back to around when my sister was born, everything seemed so perfect then."

Ideas

Writings in the creative idea category were poems, short stories, and commentaries that came from the heart. One student started her poem with, "Words can hurt, words can wound, words can break a heart in two, when we speak before we think."

Facilitators’ Response

Throughout the 2-week period, there was one consistent facilitator, with a different graduate student co-facilitator every session. The overall responses of the cofacilitators were very positive. After our first meeting, the co-facilitator wrote, "At first the students were not impressed, but as the session progressed they were relaxed, liked what they were doing, and were feeling good. By the end, the students were all buzzing with curiosity and excitement about the next day’s exercise. Something good is definitely happening here." In response to the second session, a co-facilitator wrote, "I think it’s good to have something unstructured like this. I think most of their classes are probably very structured. I wonder how much they are encouraged to use their imaginations, to be creative and, most of all, have fun with it?" Following the third session, another facilitator commented, "The group as a whole was quite a bit more interactive than I expected. I was, frankly, surprised to see that all of the students engaged themselves in reading in front of their peer group. This experience made me realize how this alternative method of instruction would enable these adolescents to feel more in control of their life. It afforded them the opportunity to reflect on what had and is happening to them." The fourth facilitator observed, "Most of the kids gave each other positive feedback. They laugh at each other a little but it seems all in good humor, and no one seems offended.

 

In the second week of the program, facilitator responses included not only a reaction to the individual writings but also several observations of the collective experience of the group: "Writing came easily, (students) were very eager and excited about sharing. I was impressed with the sensitivity to each other’s writing and feelings of closeness that came through when commenting on their peers." After the second day, the facilitator had a similar response: "Overall, I thought they did great! They seemed very enthusiastic and anxious to read; I was amazed how quickly they responded with their input. They appeared to be such a tight group and seemed to enjoy each other." The writing was affecting not only the individual, but also the group dynamics of the class. Group cohesion had increased markedly.

"I have read articles about adolescents who think they will never live until they are 20, so they live dangerously because they feel they are going to die early anyway. Reading about it is one thing, but listening to an adolescent say this is more shocking," was the observation of another facilitator. A facilitator on the following day observed, "I was struck by the responsibilities these adolescents have. One 16-year-old worried about her baby’s father taking him away, while another wrote about paying regular household bills." The eighth facilitator related her knowledge of the literature to the experience: "I was startled that very young people had a fear of death. It was interesting to hear both boys and girls list embarrassment as something they were afraid of. Additionally, each sex spoke of their fears equally, which goes contrary to the assumption that boys would not talk about feelings or admit them." All the facilitators recognized that the literature suggested there would be a gender difference in level of participation as well as the content of the writings. Throughout the program, however, there was no discernible gender difference in writing or responding. Following the final session, the facilitator wrote, "It felt like it went too fast, it was over before it got started. I wanted to spend more time with the kids, get to know them. It was neat to hear a little snippet of their lives: being sad, proud, uncomfortable, excited."

The co-facilitators’ responses indicated that over the 2-week period, the group interaction went from students being withdrawn and reticent to participate to a cohesive group that responded enthusiastically to each exercise while competing to read and respond to their peers.

Teacher Evaluation

Initially, it was not anticipated that the teacher would be present in the room during the intervention; however, she chose to work quietly at her desk for the 40-minute sessions. An unexpected benefit was her daily verbal support and the final written evaluation. Before the intervention she reported that attendance in class was very erratic. In fact, the day the program was initiated only 25% of the class was present, with additional students attending every day, so by the last week there was 100% attendance. After the final session, she commented:

It was good for them, they came to understand themselves. These kids have a plethora of problems in their personal life and no one to talk to. They want to talk, writing gives them the opportunity. . when they write about their personal life, they begin to reflect, they look back and gain an understanding of themselves. . . it brings back stuff from the past that you might not remember . . . it helps to free write to get thoughts down . . . it relieves frustration.

When asked if there was anything that surprised her, she said, "I was amazed that there was no resistance at all… The kids looked forward to it every day, they enjoyed it a lot…. One girl, who never talked before, told another teacher that she loved this class!"

Discussion

The purpose of this program was to pilot a creative writing intervention program designed to enhance selfesteem and self-efficacy. A basic assumption of the interventions was that to maintain or enhance health, adolescents need to develop a strong sense of self through selfknowledge and the ability to express themselves. The goal of the intervention was to facilitate self-knowledge through relating to others in a structured safe environment with positive feedback that would increase selfesteem and self-efficacy. Through their writing and responding, participants combined cognitive and affective responses to construct important connections between themselves and others.

Sironkik (1983) recognized that most schools provide meager opportunities for dialogue. Verbal interchanges tend to be teacher initiated and dominated, constrained, and unilateral. The WRITE program provided an opportunity for student-initiated voice and reflection. Baker (1996) described reflection as a process of thinking and exploring an issue of concern, which is triggered by an experience. In this case, the students’ concerns were triggered by the introductory exercises, followed by a 10-minute "free write." When the students read aloud, they heard their thought process describing their values, priorities, and preferences expressed in their own voice. Voice in writing implies words that capture the sound of the individual on the page. When people learn to use their real voice, it leads to growth and empowerment in using words and relating to others as well as self. The student and teacher evaluations supported Atwell’s (1987) claim that writing helps solve problems, capture feelings, and know one’s own voice.

Conclusions

Through the writing process, students increased their writing efficacy. The four sources of self-efficacy-performance accomplishment, vicarious experience, verbal persuasion, and emotional arousalwere part of the intervention. The students experienced performance accomplishment once they engaged in the exercise, voluntarily read aloud, and received interested, positive responses. Several students learned to trust the process through vicarious experience. For example, the majority of students were not in the first session when the project was explained; however, as absent members joined and observed their colleagues immediately responding to the exercise in writing and voluntarily reading their work, the late-arriving students participated enthusiastically. The feedback method was designed to provide positive verbal persuasion. As indicated in the evaluations, through mastering the skills of free writing and having their stories "heard" through reading out loud and responded to with genuine positive feedback, the students’ potential negative emotional response was diminished.

Both adolescence and poverty have the potential to maintain a silence. The sharing of writing through reading aloud and receiving positive feedback provided the students with a different way of knowing each other, a new way of interacting. They heard each other’s stories. Most adolescents, especially those at risk, believe they are alone in experiencing their pain, confusion, and angst. Nicolini (1994) wrote, "How comforting then to discover they are not alone, that they and their classmates have a pool of shared experiences" (p. 60). In support of the self-in-relation concept of self-esteem, which emphasizes the centrality of connecting to others as a way to enhance selfesteem, students reported an increased sense of wellbeing from hearing about the lived experience of their peers.

The WRITE intervention holds much promise in enhancing adolescents’ self-esteem and self-efficacy. This project laid the groundwork for a study with an increased sample size, which will obtain additional qualitative data as well as quantitative pre and post measures of self-esteem and self-efficacy

Acknowledgments. The author expresses her appreciation to the research team: Gail Blanchard, BSN, Sheila Christianson, BSN, Christina Clark, BSN, Wende Graves, BSN, Margaret Howarth, BSN, Evelyn Johnson, BSN, Anna Lea Kantor, BSN, Lynda Fountain, BSN, Kristin McCarthy, BSN, Sharon Shumway, BSN, Kiki Tipton, BSN, and Kathleen White, MSN.

References

 

 

Angelo, T.A., & Cross, K.P. (1993). Classroom assessment techniques: A handbook for college teachers (pp. 148-153). San Francisco: JosseyBass.

Atwell, N. (1987). In the middle: Writing, reading and learning with adolescents. Portsmouth, NH: Boynton/Cook.

Baker, C. (1996). Reflective learning: A teaching strategy for critical thinking. Journal of Nursing Education, 35(1),19-22.

 

 

Baldwin, J. (1991). Sometimes a person needs a story more than food to stay alive. In M. Krysl (Ed.), Curriculum revolution: Community building and activism (pp. 29-40). New York: National League for Nursing Press.

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review 84,191-213. Belenky, M., Clinchy B., Goldberger, N., & Tarule, J. (1986). Women’s ways of knowing. New York: Basic Books.

Brown, J.E., & Stephens, E.C. (1995). Writing as transformation: A new paradigm for content writing. The Clearing House, 69(1),14-16. Coopersmith, S. (1967). Antecedents of self-esteem. San Francisco: Freeman.

 

 

Emig, J.A. (1983). Writing as a mode of learning. College Composition and Communication, 28, 122-133

Fulwiler, T. (1987). Teaching with writing. Upper Montclair, NJ: Boynton/Cook.

 

 

Hardin, S., Carbaugh, L., Weinrich, S., Pesut, D., & Carbaugh, C. (1992). Stressors and coping in adolescents exposed to Hurricane Hugo. Issues in Mental Health Nursing, 13, 105-119.

Jordan, J., Kaplan, A., Miller, J.B., Stiver, I., & Surrey, J. (1991). Women’s growth in connection. New York: Guilford Press. Linesch, D.G. (1988). Adolescent art therapy. New York: Brunner/Mazel.

 

 

Meisenholder, J.B. (1985). Self-esteem: A closer look at clinical intervention. International Journal of Nursing Studies, 22,127-135. Miller, J.B. (1991). The development of women’s sense of self. In J. Jordan, A. Kaplan, J.B. Miller, I. Stiver, & J. Surrey (Eds.), Women’s growth in connection (pp. 11-26). New York: Guilford Press.

 

 

Nicolini, M. (1994). Stories can save us: A defense of narrative writing. English Journal, 2, 56-61.

Pipher, M. (1994). Reviving Ophelia. New York Ballantine Books. Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.

Santiago-Welch, E. (1995). In J. Melrose (Ed.), Righting wrongs by writing. Amherst Bulletin, 27(44),1-3.

Sironkik, K. (1983). What you see is what you get: Consistency, persistency, and mediocrity in classrooms. Harvard Education Reviews, 53, 16-31.

 

 

Sneider, P (1993). Writer as artist. Los Angeles: Lowell House. Sorrell, J.M. (1994). Writing as inquiry in qualitative nursing research: Elaborating the web of meaning. In PL. Chinn (Ed.), Advances in methods of inquiry for nursing (pp. 1-12). Frederick, MD: Aspen.

 

 

Vygotsky, L.S. (1962). Thought and language. Cambridge: MA: MIT Press.

Author contact: gec@nursing. mass.edu, with a copy to the Editor: Poster@uta.edu

 

 

[Author Affiliation]

Genevieve E. Chandler, PhD, RN, is Associate Professor and Director, Center for Nursing Advancement, University of Massachusetts, Amherst, MA.

References

Blamer, A., & Blamer, A. (1988a). The art of play: An adult’s

guide to reclaiming imagination and spontaneity. New York:

Human Sciences Press.

Blatner, A. (1988b). Foundations of psychodrama: History, the-

ory, & practice. New York: Springer.

Bonny, H. L., & Savary L. (1990). Music and your mind: Lis-

tening with a new consciousness (2nd ed.). Barrytown, NY:

Station Hill Press.

Frank, J. (1961). Persuasion and healing. Baltimore, MD: Johns

Hopkins Press.

Moreno, J. L. (1945). Scientific foundations of group psycho-

therapy. Sociometry, 8(3), 315-322.

Moreno, J. L. (1946). Psychodrama (Vol. 1). Beacon, NY: Bea-

con House.

Rogers, C. R. (1946). The necessary and sufficient conditions of

therapeutic personality change. Journal of Consulting Psy-

chology, 21. 95-103.

Sheikh, A. A. (1983). Imagery: Current theory, research and

application. New York: Baywood.

Shoor, J. (1983). Psychotherapy through imngery (2nd ed.). New

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Yalom, I. (1985). The theory and practice of group psychother-

apy (3rd ed.). New York: Basic Books.

 

8.      And another: Renee Emunah is well known in the creative arts community:

 

PERSPECTIVE

EXPRESSION AND EXPANSION IN ADOLESCENCE: THE SIGNIFICANCE OF

CREATIVE ARTS THERAPY

RENEE EMUNAH, MA, RDT*

The Arts in Psychotherapy, Vol. 17, pp. 101-107. 0 Pergamon Press plc, 1990. Printed in the U.S.A.

 

 

Most people steer away from them. They are considered hostile, moody, narcissistic, withdrawn, aggressive, rebellious, and unpredictable; indeed Anna Freud (1958) considered all adolescents to be “normal psychotics.” Therapists seem to be either particularly reluctant or particularly drawn to working with them; both responses intimate a high level of countertransference. When I ask my students which pop- ulation they are thinking of working with during their second-year internship, the reply is all too often either, “I don’t know, but definitely not with adolescents’ ’ , or “I don’t know about the setting, but definitely with adolescents. ”

Why the emotional charge? Adolescence is a revolutionary period, given the profound physical/ sexual, psychological, and cognitive changes that mark this transitional stage of life. The intensity of emotional responses to the challenges of adolescence remains deeply embedded in our memory; most people can recall the sensations and anxiety of their

teenage years with uncanny precision. Although it is hoped the major developmental tasks facing the adolescent are mastered by the close of adolescence, the fact that so many tensions need to be handled concurrently and that, as a result, psychic energy is

bound in defensive operations to avert trauma or disintegration (Blos, 1962), the resolution at the end of this life stage often contains some gaps. As therapists, the reasons for our gravitation toward or resistance to work with adolescents may be the same: the strong recall of our own adolescence promotes empathy and identification, and the gaps in our own resolution are spotlighted when we are confronted by adolescents in treatment. We are drawn to go back to-or we want to steer away from-the unresolved. If the countertransference evoked in work with adolescents along with the challenge of their often high level of resistance to treatment can be effectively handled, there are rewards in store for both client and therapist. The adolescents’ state of crisis is described by Erik Erikson as “. . a turning point, a crucial period of increased vulnerability and heightened po- tential” (1968, p. 96). Like most crises and transi- tions, there is pain but also tremendous opportunity for growth. This particular life transition, acknowl- edged by early and nontechnological cultures via their

most intense rituals, is a time not only of revolution but of transformation. Just beyond the adolescent resistance lies a readiness. And the changes made at this point have repercussions for the rest of one’s life. But there is a special component to therapy with adolescents that makes it particularly relevant and fertile working ground for the creative arts therapist. It was during their own adolescence that many cre- ative arts therapists began their involvement with an art modality. (This is not surprising, as the crisis of adolescence ignited the creative fuel of many peo- ple-some of whom were to later become artists, others whose artistic pursuit was limited to this period. Many laypeople comprehend the notion of

creative arts therapy when they recall the creativity in their adolescence (comments as “when I was in high school, I was in a rock band, and it saved my life” are not uncommon). In the autobiographical sketches written by applicants to the Drama Therapy Program that I direct, the vast majority state that serious engagement in theatre began in high school. Further-

more, this engagement is almost always linked to the evolution of essential components of personal growth and emotional health. The discovery of a creative outlet in adolescence resulted, for most creative arts therapists, in a love for and skill at an art form, and, even more importantly, a deep understanding of the relationship between creativity and healing.

 

This paper begins by examining what I call adolescent explosion and its relationship to creative expression. It continues by proposing that the significant healing properties of the arts during adolescence lie not only in the outlet for expression they provide, but in the way they enable containment, and in the way that, given skillful intervention by the creative

arts therapist, they lead to expansion. I have identified these four concepts: (a) explosion, (b) expression, (c) containment, and (d) expansion, as central to the understanding of creative arts therapy with adolescents .

Explosion

The intensity and complexity of the multitude of changes in adolescence create an upheaval. Physical growth and sexual maturation necessitate the development of a new concept of body image. Thinking and reasoning capacities increase qualitatively (Piaget, 1952), allowing abstract and ethical concepts to be manipulated by thoughts alone. The adolescent is

faced with existential dilemmas, paradoxes, and moral choices, which generally must be resolved by late adolescence. Ties to infantile object relations are loosened and modified. In the shift of allegiance from the parent as the primary love object to the peer group

and to the self, the adolescent undergoes a tremendous sense of inner emptiness, sadness, loss, and impoverished ego-functioning. The increased independence, though exciting, requires increased responsibility and personal decision-making, which the

adolescent is often not ready to assume. In the struggle to form a cohesive sense of identity, the adolescent is obsessed with the need for affirmation by his or her peers. Adolescence is described by G. Stanley Hall (1916), the psychologist of early adolescence, as a period of Sturm and Drang, “storm and stress. ’ ’ Erikson (1968) too uses the phrase “storm of puberty,” explaining that this is not only a period that demands coming to terms with new challenges, but a time of crisis in which drives and unresolved conflicts from earlier stages reemerge. Given the tensions on all levels-physical, sexual, mental, emotional, so- cial, psychological-it is no surprise that adolescents are on the brink of explosion. Indeed, many adolescents do resort to acting-out behavior including criminal activity, or to substance abuse, severe withdrawal, and even suicide. Or the explosion may take the form of seemingly sudden angry outbursts, destruction of property, running away from home, making threats, retreating from social or familial interaction. Although their need to express and communicate their internal world is great, they have not yet acquired the capacity to verbally articulate what they think and feel, in the sense of having a meta-level of awareness, in which one can reflect, with some perspective and distance, on one’s thoughts and feelings. A form of expression is des- perately needed, one which matches the intensity and complexity of their experience, is direct but nonthreatening, is constructive and acceptable. The creative arts provide this means of expressing the inner explosiveness of adolescence.

Expression

There is a heightened creativity during adolescence, which Blos links to the “intensified psychological closeness to internal processes in conjunction with a distance from outer objects” (1962, p. 125). The chaos and emotionality experienced in adolescence, combined with the fact that aesthetic sensibility, as one type of conceptual thinking, develops at this time (Speigel, 1958) makes it a fertile creative period. The decline of this unusual artistic activity at the close of adolescence, claims Blos, is an indication that it is indeed a function of the adolescent process. Although all the creative arts assist in accomplishing what Blos describes as “the urgent tasks of internal transformations’ ’ ( 1962, p. 125)) particular adolescent tasks may best be addressed via particular art modalities. The narcissistic regression in the service of mourning the loss of childhood (p103)and the parent image, which is considered a necessary and positive stage in ego development, involves with- drawal from the outer world. Blos refers to the standstills in adolescent development as “holding actions” that consolidate and assimilate inner changes and gains before they become manifest on the outside, and explains that the withdrawal facilitates the “internal mastery” that is a critical adolescent task. This stage of mourning and withdrawal can perhaps best be addressed by the more internal, or solitary arts of poetry and painting. The more “external” challenges, as peer socialization, may best be served by the more external and generally collaborative arts of music and drama. Dance may be at an intermediary level on the internal-external continuum. (These distinctions are admittedly simplistic; all the arts can be engaged in on an individual or collective basis, and all possess multidimensional andcomplex characteristics, a discussion of which is beyond the scope of this paper. The intention here is solely to point to a few of the ways adolescent struggles can be expressed via particular arts modalities.)

 

The radical changes in body image and awareness, and the transient feelings of depersonalization this engenders (Erikson, 1968; A. Freud, 1958), may best be explored via movement and dance. The conflicting psychological tensions and tumultuous emotional states can perhaps most easily be reflected musically, especially as music is an art form that adolescents naturally gravitate toward. The struggle for an identity, along with the task of both

shedding and integrating past childhood roles and experimenting with future roles can be addressed by drama. In addition, the adolescent’s impulse toward acting-out can be channeled via acting (Blatner, 1973). The self-observing ego is engaged in drama, which facilitates a sense of mastery and internal control (Emunah, 1983). Adolescents need a laboratory setting in which to explore real life with safety and distance. Drama, the closest art form to daily life, can provide such a laboratory. Given that to a large extent adolescent art is born out of a need and impulse to express inner turmoil, it is not surprising that adolescent creations are generally undisguisedly autobiographic (Blos, 1962). Thus, the degree of distance between self and product is minimal. Although teachers of the arts have a critical role to play in encouraging and assisting adolescents in creative pursuits, they understandably address the product only, ignoring the self that lies just beneath the surface of the product, often exposed and vulnerable. The clues and cries contained in the product

remain unexamined. Given the personal relationship the young person has to his or her art piece, work with a creative arts therapist seems particularly appropriate. The arts therapist, who both apprehends the product as a work of art and acknowledges the expression of the self it encompasses, can serve as witness and guide to the adolescent. (For the adolescent who has not naturally discovered a creative means of self-expression, the arts therapist can offer-in a nonthreatening way-such an outlet. The heightened creativity in adolescence proclaimed by Blos may be better understood as a heightened potentiality for creativity, sometimes needing elicitation.) Further, the arts therapist realizes that though expression in itself is healthful, it is only a first step. The interventions of a skilled creative arts therapist can

help the young person progress from the mode of expression to that of expansion, as will be explained later in this paper.

Although creative expression serves critical needs in adolescence, it is not my intention to view creativity solely as functional, or to subscribe solely to the psychoanalytic perspective that it is a form of sublimation, representing conflict and ungratified wishes. At the same time that the arts provide a means of expressing the pain of this life passage, they also engage the adolescent’s strengths, idealism, and healthful inner resources. Arieti (1976), considering motivation as only one component of creativity, refers to the longing in adolescence that activates creativity. Rollo May, in The Courage to Create, states that “the creative process must be explored not as a product of sickness, but as representing the highest degree of

emotional health, as the expression of normal people in the act of actualizing themselves” (1975, p. 40).

Containment

The adolescent achieves a sense of emotional release and catharsis via creative expression, but equally important is the attainment of a sense of mastery over emotion, which is a primary psychic task of adolescence (Blos, 1962). In creative arts therapy, the balance and interplay between expression and containment are central. The creative process, with its engagement of both primary and secondary processes, is an integrative one; the unconscious and irrational is synthesized with a rational structuring and organization. There is

a parallel between this combination of primary and secondary processes (which Arieti calls “tertiary process”) (p104) and the adolescent’s attempt to regain internal equilibrium. The reawakening of libidinal forces in adolescence disrupts the previously attained balance between id and ego; as Anna Freud (1936) articulated, “a relatively strong id confronts a rela-

tively weak ego. ” This disruption is further aggravated by the superego’s newly internalized moral standards and rejection of external controls and famil- ial influences. Creative art activity enables the adolescent to discover and utilize structuring mechanisms that arise from within the self, rather than being enforced from the outside. The adolescent takes hold of inner feelings, impulses, and turmoil-that which usually cannot be articulated, let alone contained- and through his or her own resources gives this inner material aesthetic shape and form. The process of creation thereby strengthens the adolescent ego.

 

Through the artistic product, what is internal is externalized. Spiegel (1958) refers to transference of the self onto an object (the artistic product) as a means of establishing a “balance between narcissistic and object cathexes, ” a balance that Blos (1962) asserts is

essential for a constancy of reality perception and self stability. The product, reflecting the achievement back to the self, also contributes to the adolescent’s sense of mastery and self-esteem. This is especially significant for adolescents who did not receive secure, empathic parental care in their early years, particularly in infancy when their need for admiration was not responded to and “mirrored” (Kohut, 1986). The artistic product, in conjunction with the therapist’s regard for it and for the self it reflects, offers some compensation and reparation for these narcissistic deficits. The client’s feeling of pride and accomplish- ment is heightened when the product is made public via a performance, exhibit, or publication. Video can serve as an intermediate between an emphasis on process and product. A final dramatic, musical, or dance piece, for example, can be prepared for video; the video is then played back for the client/s (or for an outside audience), providing the rewarding experience of completion and achievement, while circumventing the pressures and potential drawbacks of a

live performance. The practice and skill-building in arts activity help the adolescent exercise control and experience mastery. One of the mechanisms utilized by the ego in

adolescence to master conflictual tension is repetition. “Simply by repeating an action, thought, emotion, or affect the adolescent can establish a familiarity with and a tolerance of them. This method is especially effective if the dosage of the quantitatively and qualitatively new drive discharge is regulated and kept within tolerable limits” (Blos, 1962, p. 181).

This is different from repetition compulsion, in which actions are repeated, unconsciously, in an attempt to replay overwhelming experiences from the past, with

some control over the outcome.

 

Drama therapy is particularly relevant in this regard. In drama therapy, where actions are practiced in a safe setting and within the make-believe context, one is exempt from real-life consequences. The acting is conscious, and therefore not only more “controllable,” but more accessible to insight. The structure, pace, and “dos- age” of the dramatic processes, monitored by the therapist, facilitate a progressive development of tolerance, along with a gradual exercising of internal control. Adolescents will often use this aspect of drama therapy to gain exposure to, and feel more in charge of, anxiety-producing situations, or to confront impulsive, self-defeating behavior. Given the close resemblance between drama and real-life, the rehearsal taking place within the dramatic context can readily be transferred to actual situations. The fact that the enactments occur in “real” time and space, by the self, in front of one or many witnesses (unlike fantasy or visualization), facilitates ownership and integration of the experience. The fact that the enactments can be frozen, rewound, replayed, dissected, or developed fosters the sense of distance and control. Self-observation, usually so difficult to achieve while one is engaged in an experience, is here almost unavoidable. The heightened degree of awareness lays the groundwork for behavioral change. The adolescent feels more in control, more able to assume responsibility, and more conscious of the ramifica- tions of his or her actions. In sum, the cathartic expression of the inner explosiveness in adolescence is balanced by containment of emotion, along with a sense of self-mastery and the development of internal control. But there is a third critical component to creative arts therapy with

adolescents-that of expansion.

 

Expansion

One of the significant cognitive developments in

adolescence is the ability to think beyond the present,

to envision possibilities for the future (Inhelder &

Piaget, 1958). In imagining the future, one also

achieves perspective on the present, and thereby

strengthens the capacity to tolerate and cope with

current difficulties. In the creative arts therapies, this

adolescent development is capitalized on: the adoles-

cent’s visions are externalized and concretized via the

artwork, and the therapist uses the creative process to

broaden and expand the client’s range of possibilities.

In art or poetry therapy the client may depict his or her

dreams on paper; in music therapy the client’s hopes

are sung or played; in dance therapy these aspirations

are physicalized. In all cases the therapist assists the

client in the exploration of new terrain.

In drama therapy, the adolescent experiments with

future roles, changing identities, and new experi-

ences. Scenes can easily take place in future time.

Here the adolescent not only envisions future possi-

bilities and future selves, but embodies these. The

embodiment makes the dream for the future seem a

little more attainable. We are, according to Maslow,

both actuality and potentiality; “we both discover and

uncover ourselves and also decide on what we shall

be” (1968, p. 13). The conscious direction and

enactment of scenes helps bridge some of the gap

between fantasy and possible reality. At a time in

which adolescents typically feel trapped and helpless,

the experience of being not only passive audience but

playwrights and directors of their lives is significant.

Actual predicaments that the adolescent currently

faces can also be replayed via acting. The make-

believe context provides the freedom and permission

within which alternative responses and coping mech-

anisms can be discovered and practiced. Adolescents

are afforded an opportunity both to become more

conscious of their roles, behaviors, and feelings and

to experience via the enactment what may lie just

beyond their realm in real life. Active facilitation

and intervention on the part of the creative arts

therapist is generally needed to help the adolescent

expand ways of perceiving and coping with the

present. In drama therapy, this therapeutic interven-

tion often takes the form of theatrical directions. A

scene may be frozen, discussed, then played with

many different endings. Perspective is also achieved

through playing the role of others in one’s life.

“Whether through the use of time, space or role, the

drama therapist attempts to expand the adolescent’s

perspectives, present options and facilitate the exam-

ination of situations from a variety of angles” (Emu-

nah, 1985). Insight and behavioral change are brought

together through dramatic activity.

Arieti (1976) talks about imagery as a means of

removing oneself from reality in order to find an

alternative, even if it is only hypothetical. The ado-

lescent has just reached a point in life at which she or

he can do this. The imagery in the painting, dance,

poem, or musical piece allows for the transcendence

of the actual. Here, in the world of art, one can get

past the usual confinements, be they internally or

externally induced confinements. Longings and hopes

manifested typically in daydreams are communicated

and given tangible form through the artwork. Ideal-

ism, an important component of adolescent develop-

ment, which unfortunately is often crushed under the

pressures of conformity and acculturation, can be

expressed through the creative act.

The creative process, involving navigation be-

tween inner fantasy and outer reality, can result in the

discovery of previously undetected creative solutions

to problems (Robbins, 1980). Under the guidance of

the skilled creative arts therapist, the adolescent

expands his or her views and perceptions, actions,

and dreams.

From Expression to Expansion

This paper has identified and examined what I

consider to be four key concepts in creative arts

therapy with adolescents: explosion, expression, con-

tainment, and expansion. Although the first step in

work with adolescents generally entails dealing with

their resistance to treatment (which I have written

about elsewhere) (Emunah, 1985)) once involved,

their inner experience of explosion can be extemal-

ized and channeled via creative expression. The

cathartic expression is balanced by a sense of contain-

ment. Expression can thus be viewed as the median

point between explosion and containment, enabling

the move from one to the other. Expression provides

the much needed release; without this, any attempt to

move from explosion to containment would be one of

suppression. And containment can be viewed as the

median point between expression and expansion. The

containment implies a consolidation, in which the

gains brought about by the process of creative expres-

sion are integrated. The containment promotes a sense

of self-mastery and thereby safety, which paves the

way for further expression to take place. At this point,

the consolidation is again balanced, this time by an

enlargement in scope; the client is now ready for

expansion. She or he is emotionally engrossed in the

process, yet maintains some distance; from this van-

tage point, the self is observed and new insights are

derived. Anchored with containment, expression evolves

into expansion. And once in the mode of expansion,

possibilities are multiplied.

Although active facilitation on the part of the

therapist is needed throughout, interventions are gen-

erally most critical at this point of expansion, as the

client is invited to open new doors. Some of these

interventions are made under the auspices of artistic

direction. A respectfulness for the client’s creative

process is maintained throughout. A premature em-

phasis on interpretation of artistic symbolism can

constrict expression, which would ultimately also

limit the potential for containment and expansion.

Most importantly, the creative process should serve to

enliven, and not pathologize, the client.

With a group of adolescents undergoing short-term

psychiatric hospitalization, I initiated the creation of

a rock video. First, I asked them to bring to the

session tapes of songs that spoke to issues we had

been discussing and dramatizing- hopelessness, lone-

liness, rage. The songs they chose were personal and

dear to them; they knew the words and melodies by

heart, and clearly felt the songwriters had expressed,

for them, some of their own pain. With the aim of

helping the clients “take on” the expression rather

than be recipients only, the next step entailed lip-

syncing the songs. Here they expressed with their

bodies and faces what they had previously only

passively listened to. Brad, an aggressive fifteen-

year-old boy with severe behavioral problems, si-

lently belted out his song of rage, and his passion

increased with each rehearsal. Debra, a withdrawn

and depressed fourteen-year-old, did a song of quiet

despair. We practiced these two selected pieces,

adding movements and gestures, in an attempt to

articulate all the diverse feelings and moods within

the songs. While Brad and Debra lipsynced as lead

singers, other group members became, via panto-

mime, the band-with impressive precision. Still

others danced.

Using both visualization and active group discussion,

we devised the background sets to the performances.

Several clients painted a fiery red mural that the

video camera could focus on as the backdrop to the

song of rage. The backdrop for the song of despair

was a large blackboard on which clients jotted,

graffiti-style, significant words and short poems.

Next, we collaboratively brainstormed images that

would symbolically convey the feelings of the songs.

These would be interspersed on the video with shots

of the singer and band. Favorite posters, photo-

graphs, or props were brought in. Shots were taken

of these, or of live images the clients came up with,

as a flying bird, a fence, a person praying by

candlelight.

I explained to the clients that aside from the interjec-

tion of images, we could have excerpts of the lead

singer or other characters in different contexts or

engaged in diverse interactions while the music

continued in the background. I suggested that, for

Brad’s song, we show scenes that precipitated his

rage. The group decided on and dramatized family

scenes in which Brad’s father physically and emo-

tionally abuses him. With my directions, the next

scene revealed Brad internalizing the abuse, turning

his father’s perception of him as a worthless hateful

kid inward. Using diverse theatrical devices, we

experimented with ways Brad might separate himself

from the father’s abuse and begin to view himself in

a new way. In the final scene, Brad is seen being

easily provoked by another boy and about to physi-

cally strike. At that point, the scene is frozen, and

several people play his inner thoughts. Once his

emotions and motives are examined, he is able to

react in a new way. He shrugs off the boy’s provo-

cation and walks away.

The group decided that the song of despair would

begin with a shot of Debra gazing out a window.

After several shots of images and of her singing with

the band (backed by the chalked graffiti poetry), I

suggested that we show Debra asleep, dreaming of a

better day. The group collectively created and en-

acted the dream. After watching a rehearsal of the

dream enactment on video, group members were

moved to write their own song about their hopes.

Some wrote the words and others composed the

music, and for this last number there was no lipsync-

ing. They all sang together.

Three weeks later the video was completed and

shown to other clients and staff at the youth center.

This example demonstrates the facilitation of ex-

pression, via the lipsyncing, pantomime, dance, paint-

ing, and poetry. The dramatic lipsyncing contained

passion and intensity, but the creation of images

enabled clients to explore the feelings in their full

depth and complexity. Rather than being steered away

from the feelings, they were encouraged to stay with

the feelings; the elaboration of images prolonged this

process, which resulted not only in a clear acknowl-

edgment, but in an embracing of their feelings of rage

and despair. The brainstorming and decision-making

about the images and all aspects of the production

facilitated containment. By devising ways to cre-

atively and concisely depict rage and despair, these

feelings were more easily handled and mastered. The

(107) rendering and arranging of images gave the clients a

sense of power and control-that is, they contained

the feelings rather than being overwhelmed by them.

Although the first part of the process entailed devel-

oping the nuances of the feelings via the different art

forms, this part of the process required editing and

structuring sequences. Giving shape to the final piece

paralleled giving shape to their internal worlds, which

were often chaotic and confused. The dramatizations

concretized some of the feelings, situating them in

actual life circumstances. They promoted insight into

the feelings and led to expansion by presenting new

options. These options included changes in self-

perception, behavior,and visions for the future. The

collaboration involved in this project developed social

skills and provided an experience in trust, reciprocity,

and intimacy that most of these teenagers never had

experienced in their families. The final video product

reflected to them their achievement, and allowed

them to receive praise from others for all they had

communicated and accomplished.

Aside from illustrating the movement from expres-

sion to expansion, the above example seems appro-

priate given its inclusion of all the arts. Although as a

drama therapist, the processes used with my clients

are obviously drama/theatre, there are occasions,

particularly in work with adolescents, in which the

incorporation of other art forms seems entirely natu-

ral, if not inescapable. At these times, the other

modalities are seen as supporting and amplifying the

dramatic process, from both creative and clinical

standpoints.

The heightened intensity and creativity in adoles-

cence makes work with this notoriously challenging

age group particularly relevant to-and potentially

rewarding for-the creative arts therapist. This is one

population we have all been! Looking back at our own

artistic experience in adolescence fosters our empathy

for adolescents and our sensitivity to the therapeutic

potency of our art form. I can still recall the poems

and dramas that burst out of me in my adolescent

years, poetry about pain and longing, dramatizations

expressing unrealized parts of myself. Although I will

never forget the relationships with the teachers who

encouraged me-for through my art they saw not only

bits of who I was but who I might become-I am also

keenly aware of the limitations inherent in these

relationships. As arts teachers, they supported the

first part of the process discussed in this paper:

expression. They did not have the context nor the

tools to facilitate what we as arts therapists can-that

is, the progression from adolescent expression to

adolescent expansion, while ensuring containment as

an anchor. This progression addresses the particular

struggles of adolescence, at the same time engaging

the new and emerging capacities in adolescence. The

explosiveness inherent in this most difficult and

memorable life stage is given expression and a sense

of inner expansiveness is developed, paving the way

for the adolescent’s successful entrance into adult-

hood.

References

Arieti, S. (1976). Creativity: The magic synthesis. New York:

Basic Books.

Blatner, A. (1973). Acting-In. New York Springer.

Blos, P. (1962). On adolescence: A psychoanalytic interpretation.

New York The Free Press.

Emunah, R. (1983). Drama therapy with adult psychiatric patients.

The Arts in Psychotherapy, 10, 77-84.

Emunah, R. (1985). Drama therapy and adolescent resistance. The

Arts in Psychotherapy, 12, 71-79.

Erikson, E. (1968). Identiry, youth and crisis. New York: Norton.

Freud, A. (1936). The ego and the mechanisms of defense. New

York: International Universities Press.

Freud, A. (1958). Adolescence. Psychoanalytic Study of the Child,

13, 255-278.

Hall, G. S.(1916). Adolescence. New York: Appleton.

Welder, B., & Piaget, J. (1958). The growrh of logical thinking.

New York: Basic Books.

Kohut, H. (1986). Forms and transformations of narcissism. In A.

Morrison (Ed.), Essential papers in narcissism. New York:

New York University Press.

Maslow, A. (1968). Toward a psychology of being. New York:

Van Nostrand.

May, R. (1975). The courage to create. New York: Norton.

Piaget, J. (1952). The origins of intelligence in children. New

York: International Universities Press.

Robbins, A. (1980). Expressive therapy: A creative arts approach

to depth-oriented treatment. New York: Human Science Press.

Spiegel, L. A. (1958). Comments on the psychoanalytic psychol-

adolescence. Psychoanalytic Study of the Child, 13,Folder Languages

Menu With Su

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9.   Integrating Play Therapy Techniques Into Solution-Focused Brief Therapy

By: Donald R. Nims

Western Kentucky University

Biographical Information for Authors: Donald R. Nims, EdD, RPT/S, LMFT, LPCC, is a professor in the Department of Counseling and Student Affairs at Western Kentucky University.

The solution-building approach was pioneered with the work of Steve de Shazer (1985, 1988, 1991, 1994). In solution-focused brief therapy (SFBT), the client is seen as competent and in charge, able to visualize desired changes and build on the positive aspects of what the client is already doing (DeJong & Berg, 1998). Trebing (2000) described two reasons why a solution-focused approach was relevant: “There are so many children to reach and so few child therapists to go around… because children’s character structure is more flexible, their personalities are more resilient, and their outlook is more positive” (p. 144). Shapiro (1994) observed that the goal of short-term therapy is to enable children to use their internal resources for growth and development within their own environment.

SFBT is relevant for working with children whose cognitive ability is sufficient to comprehend and appreciate the concepts integral to the solution-focused process. In a study by DeJong and Berg (1998), it was reported that 78% of children 12 years old and younger and 89% of children 13–18 years of age made progress toward achieving their goals through this process. DeJong and Berg (2002) described success with children as young as 5 years old when making language adjustments for the children’s developmental age. Considering the cognitive requirements for this model, the solution-focused approach is probably not appropriate for children younger than kindergarten age.

Berg and Steiner (2003) noted that the children’s nonverbal, playful, and creative habits support successful therapy based on the SFBT model. Selekman (2005) presented a model that combined the best elements of modified traditional play and art therapy techniques with a solution-oriented approach when working with children. In a study by Perkins (2006) of clients receiving treatment in an urban child and adolescent mental health clinic over 14 months, the therapeutic success with children when using a solution-focused approach was statistically significant. She affirmed that the high satisfaction level among children and parents using this approach was “not surprising given its emphasis on early treatment, encouragement and increasing the sense of hopefulness in the client” (Perkins, 2006, p. 223). Corcoran and Stephenson (2000) found a significant improvement between pretest and posttest scores on the Conners’ Parent Rating Scale and positive improvements on the Feelings, Attitudes, and Behavior Scale for Children when using the solution-focused approach. Working with adolescents using the SFBT approach, Paylo (2005) found that this process empowered families to find solutions in the future while drawing on their own expertise and strengths to promote the desired change.

In SFBT, the therapist uses a variety of techniques to help the client experience positive behaviors or solutions that establish the groundwork for new thinking. The structure of SFBT has several important elements that are designed to elicit positive behaviors. (Refer to the Appendix for a list of the steps in the solution-focused process that are described in this model.) SFBT calls for creating hypothetical goals that include desired behaviors as a way to help clients see what is possible for them (Sklare, 2005). These goals need to be concrete and focused on the positive expression of a behavior rather than the absence of a negative behavior and on some specific behavior that the client has a desire to experience.

Establishing and articulating goals is important because this provides the foundation for the entire solution-focused process. According to Sklare (2005), identification of a clear goal is the best predictor of effective counseling outcomes. Problems with succeeding steps in the process are usually traced to an ill-defined goal. A child’s goal might be the desire for parents to come back together after a divorce. The therapist has to redirect the child by asking the child what has happened since the divorce and eliciting how the divorce has affected the child. Then the therapist turns the child’s answer into a positive behavioral goal. “If you weren’t so sad, what would you be doing differently?”

In SFBT, the miracle question is used to help the child visualize a picture of reaching these goals. The child is asked to imagine that while sleeping a miracle takes place and the problem that he or she is experiencing has disappeared. The therapist asks relationship questions to help clarify what the miracle looks like, what is different, and what others would notice that would indicate that a miracle has occurred. Children often wish for a miracle that is impossible to obtain, such as the return of a loved one who has died. Although it is important to affirm and validate the child’s wish, the miracle question is related to the goal of what the child would be doing differently when he or she is feeling better or less sad. Relationship questions help the child to express how other people might respond to these positive changes in behavior. The purpose is to affirm the child’s visualization of these new behaviors.

Another important element in SFBT is the idea of an exception. Exceptions are past occasions when the child has experienced a “little bit” of the miracle. It is important to explore at least two or three exceptions to subtly remind the child that past success can be repeated in the present and into the future.

The SFBT technique of scaling is an attempt to objectively demonstrate the achievement of goals to provide clients with a measure of their success. The child is asked to rate success on a scale of 1 to 10, with 1 meaning “no success” and 10 meaning “complete success” in achieving one’s goal. The therapist affirms the response and asks why the number is what it is and why it is not any lower. Again, this process subtly challenges the child to view life in more positive terms.

The final step in SFBT is to reinforce the child’s efforts to this point, remind the child of any past success, and look for ways to move up to the next higher number on his or her scale. The therapist prepares a “solution message” to give to the child to take as a reminder of the session and provide opportunity for growth. This message is important as a visual representation of the SFBT process and becomes the basis for the next session.

This article presents a framework for integrating the expressive play therapy techniques of art, sandtray, and puppets into the SFBT model. Three case studies that describe the integration of expressive play therapy techniques into the SFBT model are included.

GOAL SETTING

The first and most important step in the SFBT process is establishing clear and concrete goals that fit the individual needs of the child or adolescent. The child’s goals are simply stated as getting along better with a peer, doing homework, or feeling better about being with a stepparent. The goal must be concrete, positive in nature, and clearly behavioral. The important thing is that the child wants this goal to happen. The therapist and child work together to set goals and to find ways to achieve them (Haley, 2000).

It is crucial that goals be relevant, meaningful, and specific to the child’s situation. The more concrete, behavioral, and measurable the goal, the more potential there is for making progress toward solutions (DeJong & Berg, 2002). For example, a child who has a history of abuse may have feelings of guilt and worthlessness. The goal becomes specific things the child would be doing that would be a sign that life is better and more hopeful. A child with a disability might wish to cope more effectively. The goal then is what the child might be doing that would be evidence of coping more effectively. If a child is angry, the goal is what the child would be doing differently if the anger were not present. An adolescent wanting to be respected is asked what would be a sign to an observer of being respected. Other questions asked in this important stage are “What brings you here today?” “What has to happen so you won’t have to come and see me anymore?” “What would you like to be doing that would be a sign that things for you were better?” “If there was something we could work on together that would help you feel different, what would that be?” “If you were not ______, what would you be doing instead?” Expressive play therapy techniques are an important aid in establishing these goals.

My technique of the “wows and hows” uses statements that begin with the words wow and how. They are designed to affirm children’s positive conclusions about their lives in spite of what has happened to them—the “wow”—and of asking them how they knew their behavior was the right thing to do under these circumstances—the “how.” This helps them to discover their own capabilities and feel encouraged to use these skills in the future. Examples of this technique are “Wow, you were able to control your anger that time and stay calm. I wonder how you knew to do that?” “Wow, you did your homework that day. I wonder how you did that? There have been so many times you didn’t do your homework. What was different that time?”

Using Art

The use of art-based therapy is a valid therapeutic modality (Kossak, 2006) and is beneficial when working with children (Malchiodi, 2005). Art is an excellent tool for helping children make a picture of what is going on in their lives right now and what they would be doing that would indicate that things were better. The therapist begins the session by saying, “Draw a picture of what you would like to talk about.” “Draw a picture of what is going on right now.” “Draw a picture of something you would like to change.”

Ten-year-old Marty was having a problem with anger. He had recently had an incident at the tennis court where he got very angry at a call against him; subsequently, he slammed his racket on the ground and got into an argument with his coach. Marty’s inability to control his emotions was jeopardizing his play. He first drew a picture of his anger that he described as a lightning bolt. He then drew a picture of being calm; he described it as a slow-moving river. Marty was asked what he would be doing differently on the tennis court if he were calm. Behaving calmly became the goal for the session. In goal setting, it is important to help the child have a clear picture of the goal that includes as many details as possible. If the child can visualize the goal, it becomes more probable that the goal can be reached.

Using the Sandtray

When using the sandtray, it is important to permit the child to first make a sandtray of a world. This activity helps with rapport and immediately engages the child in the process. Therapist and child then work toward setting a goal for the session. The therapist instructs the child, “Using the miniatures, make a sandtray of your world right now.” “How would you like to make this world a little bit better?” “Make a sandtray of what you would like to be different in your world.” “Now, show me in the sandtray what you would be doing differently in this world.” This new behavior becomes the goal.

Jamie is 9 years old. He was referred because of issues at home. When asked what would be better for him at home, he talked about having a clean room. He used the sandtray to show what a clean room would look like. He included what he would be doing if his room was clean. Being able to do this activity became the goal for the session.

Using Puppets

Puppets are one of the most useful tools in working with children because they are naturally attractive and fun; they lend themselves to a variety of theoretical approaches of play therapy (Reynolds & Stanley, 2001). Behavior and learning problems that require counseling are often the result of underlying issues that involve changes in the home or school locations, divorce, loss, major illness, or abuse (Thompson, Rudolph, & Henderson, 2004). Prior awareness of these issues enables the counselor to be an active participant in the puppet play. Many young children struggle to discuss their difficulties. At the same time, these same children find it easier to act out what they cannot verbalize. Puppets serve to help those children express what they have difficulty verbalizing. This is especially helpful in the first step of goal setting in the SFBT process. Puppets facilitate role playing in therapy sessions and are particularly effective with elementary-age children; the child practices new skills with the counselor and receives ongoing feedback regarding progress (Knell, 1994).

Eight-year-old Mary was referred by her teacher to a children’s therapist because she was acting withdrawn in school. Her mother reported that she was increasingly uncooperative and aggressive at home. The therapist was aware that her parents were divorced. Mary was given a hand puppet made of two pieces of neutral-colored material stitched together (Blackwell, 1997). She was asked to use markers to draw a face on her puppet that represented how she was feeling at that time. She drew a sad face. Talking to the therapist through her puppet, Mary indicated that she was sad because she and her mother had to move into a new house. The therapist asked Mary’s puppet what she would be doing if she was no longer sad. Mary described doing fun things with her mother like going to the park as they used to do before her mother was divorced and had to work more. Mary talked about how she would act differently when doing these fun things. These new behaviors became the goal for the session.

THE MIRACLE QUESTION

The miracle question helps children transition to experiencing what life would be like if the problem that brought them to therapy were magically solved. This step is not intended to minimize the multiple and complicated problems that children can experience. The child has identified a goal; the miracle question helps the child to visualize how life would be different if the goal was achieved “even a little.” The therapist engages the child:

If a miracle happened tonight while you were asleep and you woke up tomorrow and the problem that brought you here today was solved by magic, what would be the first small thing you would notice that told you this miracle has happened?

 

Relationship questions help to clarify and expand the miracle. “What would you be doing differently now that the miracle has taken place?” “How would your mother or teacher respond differently to you?” “Picture yourself next week, next month; how will you recognize the signs that a miracle has indeed taken place, that things are different, even better?” It is important to provide as much detail as possible to the miracle. Again, the more one can visualize what these positive feelings and new behaviors look like, the more likely it is that the change can take place. Berg (2005) observed the importance of experiencing the state of the miracle as well as the usefulness of the relationship questions.

Using Art

To facilitate the miracle question, the therapist states, “Let’s draw a picture of your miracle. It can be a big miracle or a little miracle; it’s up to you.” “Draw a picture of what would be a miracle for you; even if only a little bit.” Marty drew a picture of himself playing tennis in what he described as a “tough match.” He drew the scoreboard and the two players. The score had him behind, but the picture showed what he described as himself calmly playing the game. They talked about what his coach would do differently because Marty was playing more under control.

Using the Sandtray

Jamie made a sandtray of his miracle. His miracle was the clean room with all his toys where he wanted them. Because his room was clean, he could spend the day playing. His mother would compliment him on his clean room. He liked it when his mother gave him compliments. The miniatures he used in the miracle sandtray were less dark and scary and spread out in the tray rather than constricted as they were in the goal-related sandtray.

Using Puppets

Puppets are used to play out the miracle; the therapist uses a magician puppet who waves a magic wand to make the miracle happen. Puppets are also used to act out examples of when some of the miracle is achieved. The wizard puppet asked Mary the miracle question of her going to sleep, waking in the morning, and discovering her sadness has disappeared. The wizard puppet waved a magic wand to make the miracle happen. When Mary wakes up, she is at home with her mom and she is happy. The wizard puppet asks her what she would be doing differently that showed she was happy. Mary said she would wake up and be thinking about the fun things she was going to do that day like going to the park or the mall or playing with her friends. When asked the relationship question about what her mother would notice that would indicate that something was different, Mary said she would smile at her mother when she came in to wake her up. When asked how her mother would respond to this, Mary answered that her mother would smile back and give her a hug, and they would go down together to the kitchen for breakfast. Mary and her mother would eat breakfast and make their plans for the day. Mary would then get dressed and make her bed without being asked. She would even clean her room. She smiled and said her mother would really be surprised.

EXCEPTIONS

Exceptions, the third step in the SFBT process, are little pieces of the miracle or times in the past that the problem that brought the child to therapy did not occur. It is also used to describe past occasions when the child experienced some of the goal. As clients recall the instances in their lives when the problem did not exist, they discover the details of how they avoided the problem, which provides a road map for solutions, success, and empowerment (Sklare, 2005). Children very often do not know how to appreciate the success they have had in the past. Individuals tend to minimize or dismiss the importance of their perceptions where a measure of success was achieved (DeJong & Berg, 2002). Whatever the goal is, they will give someone else the credit. “My mother made me.” “The teacher told me I had to do it.” An effective response is to remind them that they do not always do what their mother or teacher says. “What was different about those times?” With this positive self-awareness, the child begins to identify and access an internal locus of control and thus begins to take responsibility for his or her own behavior in the future.

Using Art

“Let’s draw a picture of a time when you had a little piece of the miracle.” Again, Marty was asked to draw pictures of times when he was calm. The therapist suggested that Marty remember similar occasions when he did not get angry and processed with him what was different. The therapist asked Marty how he managed to remain calm on those occasions. He was then challenged to plan what additional behaviors he could use in the future when he felt angry to help him remain calm. Marty was able to see that he does have control over his emotions.

Using the Sandtray

“Let’s use the sandtray to show me a time when you had just a little bit of the miracle.” Jamie made a sandtray to show how his world was when things were going well at home. The therapist then asked him to make a sandtray of his world at school. The therapist knew that sometimes Jamie felt pressured to do well at home and at school. The sandtray gave Jamie the opportunity to experience times when he felt happy and good about himself.

Using Puppets

The therapist provided Mary with the opportunity to identify exceptions or instances of success in having some of her miracle occur. Mary described how happy she was when her mother took her to the park before her parents got divorced. She remembered that afterward when her mother asked her to help with the laundry she did so willingly and even cleaned up her own room. The therapist made a point to compliment her and asked how she knew to clean her room without being asked. She said it made her happy when her mother was happy. The therapist affirmed her response.

SCALING

As part of scaling, clients are shown a strip of paper with 10 faces with numbers from 1 to 10. This is a pictorial technique I adapted to elicit levels of feeling in children. The faces range from one that looks extremely angry to one that looks extremely happy. This exercise is a visual representation of the scaling question “On a scale of 1 to 10 with 1 being the worst and 10 the best where were you on the day the miracle occurred?” Scaling is an activity that sets the tone for the client’s new learning process that is active, spontaneous, relaxed, participatory, and fun (Zalter & Fiske, 2005). Once the child has identified a number on the scale, the therapist might ask, “Wow! How is it a [the number identified on the scale] and not a [one number lower]?” “Wow, how did you know that was better?” “Now, what do you have to do to get to a [one number higher]?”

Using Art

Marty drew a picture of himself at a 6 on his scale. The therapist used the “wows and hows” questions to process his picture. Marty was then asked to draw a picture of a 7. Marty and the therapist talked about what was different and what new skills Marty used to move higher on his scale. The therapist and Marty noted any obstacles to the scaling improvement. The client can then draw a picture of any potential obstacles and possible solutions.

Using the Sandtray

Jamie circled the number 7. He used the sandtray to describe what a 7 looked like. Jamie and the therapist discussed what made it this number and what Jamie would be doing differently at the higher number on the scale.

Using Puppets

Mary’s puppet was asked to take a marker and circle the face on the scaling sheet that represented her estimate of where she was on the scale related to achieving her miracle. She circled the face at number 7. Using behavioral examples, Mary’s puppet was asked to explain the reason for her rating. She said that she would be cleaning her room without being asked. Using her puppet, Mary described what she would be doing at the next level up and what her mother would be doing. She responded that she would be doing her homework with her mother and then her mother would read her favorite story with her before she went to bed.

SOLUTION MESSAGE

The solution message is the final step in the SFBT process. This is a concrete written summary of the session that the child can take home as a visual representation of the child’s efforts toward finding a solution. This message is written in the child’s presence with the child’s participation. The solution message has three parts: the credits, the bridge, and the solution task. The credits are a series of compliments and affirmations about the child and the efforts the child has expressed in participating in the play therapy session. The child is given credit for taking part in the process; being vulnerable in sharing what is happening in his or her life; and for achieving past success as expressed in the exceptions. The therapist provides a written list of all these positive attributes for the child. The bridge is the connection between the credits and the solution task. The therapist indicates in the bridge the commitment and willingness of the child to work on the goal. The solution task is simply asking the child to aim for the next number on the scale. The solution task can also be to pick a “miracle day” and remember what is different about that day. The child is asked to report on the task in the next session.

Using Art

The therapist wrote out on construction paper the elements of the solution message for Marty. This message noted Marty’s courage in sharing about his anger and his creativity in talking about things he could do to remain calm when playing tennis and at other times.

I appreciate your talking with me today. You are a fine young man who is trying to play tennis and be calm and relaxed even when you might miss a point or even lose the match. This takes a lot of courage and confidence in your self. Therefore, because you are courageous and committed to staying calm, I want you to aim for an 8 on your scale. Perhaps at your next match you might say to yourself that today will be an 8 day, no matter what.

Listed were the illustrations of when Marty had previously experienced some of this calm. Marty and the therapist each drew a picture of what that match might look like. Marty was asked to remember what happens and report at the next session.

 

Using the Sandtray

The therapist also wrote a message for Jamie that included the same three parts and the same goal to move up one number on his scale. Then the therapist said, “Let’s make a sandtray together of what we did today. Now, let’s make a sandtray of what a miracle day might look like.” Jamie was asked to remember what happened during the next week so he could make a report at the next session. On a piece of construction paper, the therapist listed Jamie’s attributes: that he was cooperative, quick thinking, and willing to play in the sandtray and talk about his goal. The therapist asked Jamie to draw a picture of a target. The therapist drew an 8½ on the target and said, “Aim for it and we’ll talk about it next time.”

Using Puppets

Mary’s puppet was praised and encouraged for talking about her feelings about her mother and for her willingness to role-play her miracle with the puppets. The therapist’s puppet complimented Mary for her success in achieving some of her miracle as indicated by the exceptions. This was particularly the case in how she cleaned her room without being asked and how important it was to Mary that her mother be happy, too. Mary’s task was to pay attention to her feelings and notice the things she does at home and at school that will help her move up one number on her scale of happy faces. Together, the therapist and Mary wrote out her solution message. This message included Mary’s attributes of being cooperative, helpful to her mother, and a desire to do well in school. The message also affirmed Mary for knowing that cleaning her room helped her mother. The therapist wrote a big 8 at the bottom of the piece of construction paper and asked Mary to notice when she was having a day like that. They would talk about it at the next session.

FOLLOW-UP SESSIONS

Subsequent sessions begin with remembering the goal as stated previously. The key is to ascertain what is different or better for the child since the last session. Relationship questions that describe who noticed this change help to provide detail as to what is different or better for the child. Scaling is used to establish a baseline of progress and what needs to happen to move to the next highest number on the scale. The miracle question is repeated if the therapist determines this step will be helpful. Using art enables the child to draw what is better or different. The sandtray is used for the same purpose. Puppets enable the child and therapist to role-play what has happened since the last session and what the child can do to move up the scale. As described earlier, a solution message is given to the child that establishes the groundwork for the next session.

CONCLUSION

SFBT is relevant for working with young children. Expressive play therapy techniques are effective in facilitating this process. Adjustments need to be made according to the child’s developmental level. Relationship questions for the miracle need to be basic to help children visualize what they would be doing, saying, or feeling when the miracle occurs. Exceptions are a difficult concept to explain to young children, who remain focused in the present. Through consultation with significant others, the therapist is made aware of previous times when the child experienced some of his or her miracle and then acts out these incidents with the puppets as a way of modeling this concept. Special effort is made to use the child’s cognitive level and language in helping describe what the miracle might look like. It is important that the behavioral goals the child chooses be understood clearly and measurable so that a degree of success is achieved. Solution-focused play therapy note taking (see the Appendix) is an outline for the therapist to use in the solution-focused session.

REFERENCES

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Zalter, B., & Fiske, H. (2005). Scaling in action. Journal of Family Psychotherapy, 16, 107–109.

 

 

 

 

I hope this document is useful, and I will continue to build on it depending on our needs,

Many thanks for being a splendid team!

 

Margi