During the Forensic Art Therapy Focus Group at the American Art Therapy Association annual conference this past July, I had the good fortune to meet Cindy Chen, a clinical program therapist/art therapist at a forensic setting. She had first interned in this facility, later obtaining a position there, specifically to work for the facility's Sex Offenders Treatment Program. Currently pursuing a second master's degree in Marriage and Family Therapy, Ms. Chen was forthcoming about the challenges she faces as an art therapist for this very difficult population. I was very excited that Ms. Chen was willing to write a post for this blog. In it, she focuses on the benefits of using art to identify treatment barriers, build therapeutic alliances and establish emotional resiliency. In addition, she describes the way in which she used the art to manage the very real issue of her own counter-transference. While you, dear reader, may feel that this a great deal to fit into a mere thousand words—and it is—you will soon discover that she does so with great aplomb and success.

Art Therapy with Sex Offenders: Exposing the Fragile Self

by Cindy Chen, MEd, AT

Cindy Chen, used with permission.
Source: Cindy Chen, used with permission.

Ten minutes before facilitating my first art therapy group at the Sex Offender Treatment Program in a high security facility, the program psychologist called me in to say that a client in the group reported having sexual fantasies of raping me. She asked me how I was feeling and if I needed any support. I did not know how to respond. I knew I was feeling scared, disgusted, and nervous, but what did those feelings mean? Was I now a target of a sex offense? And should I be running the other way? I informed my co-facilitators, came up with a new game plan for the group, and then put my feelings aside. It was my introduction to a very difficult population.

The program serves those who committed harmful sexual crimes, to reduce their chance of recidivism. Many have extensive criminal histories, chemical dependence, poor sexual boundaries, and various mental illnesses. Due to the civil commitment process and the challenging nature of sex offender treatment, many distrust the system.

I was trained as a K-12 art teacher and clinical art therapist; however, I did not have any experience working in forensic settings. Besides giving art directives, facilitating clients to trust their art making process, providing a language for clients to talk about their work, and sharing my clinical observations, I did not think I had more to offer. My co-facilitators knew the clients' behavioral patterns and were able to directly address their treatment targets. Although I put on my most professional attire, asked the most skillful questions I can think of, and designed my art therapy “activities” using clinical terminologies I learned on the spot; as well, I began to think that art was just another recreational tool. What was art therapy offering that I was not seeing?

This soon became clear.

Cindy Chen, used with permission.
Source: Cindy Chen, used with permission.

When someone manipulates materials and draws meaning from what was created, a part of that person is externalized and captures great emotional content that little words can express. When revealed through the artwork, it becomes the third person in a therapeutic relationship. This understanding became key to tackling some of the resistance typical in this type of forensic setting.

Cindy Chen, used with permission.
Source: Cindy Chen, used with permission.

Corey: “Stuck” in treatment

Six months into working at the program, I received a referral by a primary therapist to provide art therapy for Corey, who, it was believed, had little regard for rules and was “stuck” in his treatment. The first two sessions consisted of the client reviewing all the major events of his life from his personal victimizations and neglect, his crimes, to his relationships with other peers on the unit. Although I believed he was open to therapy, a sense of uneasiness settled in. I was unable to pinpoint my discomfort until we drew our first picture together.

The directive was to create a picture together without any verbal exchanges. He started with a line on his side of the page, I responded by drawing a similar line on my side of the page. This action repeated back and forth until he started a series of scribbles that consumed the entire the page. When we finished, we put the picture up and shared our observations of the drawing. The client noted that the picture seemed chaotic. His description mirrored my experience during the first two sessions. I indicated that although we started off on our sides of the page, his scribbles loomed across the entire page. After looking at the picture, he reflected that he tended to create chaos in his relationships through stealing, acting out sexually, and lying, to distract others from how he truly feels inside. This self-disclosure became the foundation of our work together and a way to address his depression and shame around his sexuality. His artwork shined light on our barriers and strengthened our therapeutic alliance. 

Keith: A fragile self view

Later, I began to see Keith, who is considered a sexual exhibitionist. Although he was committed to his treatment, his fragile view of himself often became a hindrance. When asked to explore the underlying dynamics of his offense pattern, he often retaliated with verbal aggression and blamed others for “triggering” him. This emotional pattern seemed to be manifested in his voyeuristic behaviors, but he was not ready to see and accept the part of him that was capable of offending. While he verbally downplayed having a “perpetrator side”, his artwork said otherwise.

During a group art therapy session, he drew a picture of a large shark in water facing a road full of buildings. [Unforutnately, this image is no longer available]. When he finished, he stared at his picture and quietly waited for other group members. He pointed at an empty space next to the buildings and informed his group members that it was the parking lot where he exposed himself to his victims. The shark owned the entire parking lot and it waited for any women to walk by before he struck. He spoke with regret. The artwork revealed a part of him he adamantly denied. I believe that the act of creating the picture offered him the space and emotional safety to see that part of him, and to make a decision on what to do about it. In this case, he chose to uncover that part of him and begin his work of addressing his maladaptive schemas and coping responses.

My own self, my own work

Cindy Chen, used with permission.
Source: Cindy Chen, used with permission.

Working as a female therapist in a program that serves primarily male clients, I am made aware of my own sexuality. It's a part of treatment for clients to disclose their sexual attractions, sexual fantasies, and their sexual offending history. And while it is good for clients to develop a level of transparency around their sexuality, it was distressing for me to process their stories and the transferences they projected onto me. I made art throughout my internship, supervision, groups, and individual sessions. My artwork captured my fears, insecurities, my counter-transferences, and they also reflected my coping system. It's fair to say that my artwork drove me to look at my blindspots, forced me to address my own issues, and facilitated me to become a more effective therapist.

Cindy Chen, used with permission.
Source: Cindy Chen, used with permission.

A month into my internship, I made a mandala drawing of a person sitting on the other side of a confession booth. I remember spending a great deal of time creating and designing the screen that separated the supposed priest and the penitents. I have never been inside a confession booth nor am I a priest, but the drawing mirrored my difficulties connecting with my clients and my desire to emotionally disconnect from my clients. The drawing allowed me to ask questions, seek support, and to manage my counter-transferences. All the feelings I chose to ignore were expressed through the pieces of art; fear, anxiety, confusion, anger, at times a fragmented identity, and depression. It was not easy to work in a forensic setting, but through my own artwork, I was able to navigate through those moments, brainstorm self-care ideas, and be more empathic and directive in working with my clients.

About the Author

David Gussak, Ph.D.

David Gussak, PhD, ATR-BC, is a professor and chair-person for the Florida State University Department of Art Education, and a clinical coordinator of its Graduate Art Therapy Program.

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