Winnicott and child client

Winnecott and child client

Recently, I happened upon a review of book whose title implied it would teach the reader a number of art therapy “techniques” with a specific population. The reviewer was not an art therapist, but an allied health professional who made a spot-on assessment of the book’s contents. She noted that it was essentially a set of “recipes” for art-based activities grouped under various headings such as emotion, materials, and subject matter. According to this reviewer, techniques were provided without any in-depth conceptualization for application or considerations for individual needs, cultural impact or more importantly, evidence of effectiveness.

These types of art therapy books (and often play therapy books) delight publishers and booksellers because they are sought after by mental health professionals. Publishers are not the only ones in the activity book game; there are many organizations and agencies selling high-priced workbooks and manuals purporting activities that will ameliorate posttraumatic stress, support resiliency, reduce the incidence of bullying, eliminate depression, or any number of “problems du jour” in children and adults. Students and new professionals in particular seek out these publications because they may doubt their own creative skill set as therapists. Counselors, social workers, and other practitioners with no formal courses in art therapy or play therapy theory also lap up this material, enthusiastic about having some specific art or play-based directives to fill client sessions and apply a little “creativity in counseling.” Despite their good intentions, more often than not these professionals have little understanding of art materials, play-based props or conceptual frameworks to really apply these techniques beyond that of diversionary activities.

But it’s not just books that are contributing to this growing problem; there is a proliferation of online sites that offer searchable “catablogs” of art therapy activities. And of course there is Pinterest, that enticing and addicting image-based social medium where many are compelled to accumulate as many links to art and play activities like anxiety-ridden squirrels scurrying to bury the most walnuts for a long winter. And each year I cringe when a well-known art therapy graduate program hosts an “art therapy intervention day” to exchange recipes for activities. Why do I cringe? For same reason I flinch when I get weekly emails from another art therapist or mental health professional who wants me to spell out an “intervention” for them to use with an abused child, a person with autism, a Veteran with posttraumatic stress symptoms, or a couple struggling with challenges in their relationship. These continual requests say to me that the ability to respond creatively to the individual in treatment is disappearing or, at the very least, is not being communicated in graduate education. They underscore that art therapy is at risk of becoming dissociated from its roots in psychotherapy and concepts that contribute to sound clinical thinking and decision-making. I also wonder if practitioners have misplaced their own powers of empathy, forgetting that only an authentic and accurate understanding the client’s experience can help to determine what interventions may be most useful and effective.

In writing this piece, I was reminded of what I call the “improvisational wisdom” of art therapist and marriage and family therapist Shirley Riley. Riley’s interventions with clients of all ages were rooted in conceptual frameworks associated with narrative, solution-focused, strategic and systemic therapies; they were also client-tailored and based on the situation at hand, not a workbook or standard set of activities. Here is a brief example [summarized from Integrated Approaches to Family Art Therapy]:

Cindy and Larry identified their problem as a couple as one of ‘age.’ Cindy was six years older than her husband; she had been six years older than Larry throughout their seven-year marriage, the birth of their son, the blossoming of Larry’s career, and her decision to be a stay-at-home mother. Larry tried hard to get older faster, but it never worked and the challenge of age difference remained.

Riley empathized with the couple’s worldview of reality and inevitability in terms of age difference. She then asked them to return the following week with copies of their birth certificates. The couple complied with the recommendation and at the next session, Riley gave them a single sheet of colored paper, two scissors and glue. Riley then asked them to cut apart their birth certificates and create a collage made of the two documents. Cindy and Larry began their collaborative work slowly, but soon started to work together to create a collage inclusive of pieces from both certificates. This process continued until the original documents were unrecognizable and a new image was created. They decided to make a gold seal together and placed it at the bottom of collage with the session date. In brief, Riley helped the couple to reinvent and literally “reframe” their relationship [she asked them to take the collage home, frame it and place it in a prominent place for awhile]. The intervention helped them to move on from their age dilemma, a problem that initially served as a way to avoid other issues, and begin the process of addressing other challenges in their relationship.

The family art therapy writings of Shirley Riley underscore the value of responding to clients’ needs in the moment, rather than using a pre-defined protocol to address presenting problems. Today we also have “brain-wise therapists” like Bonnie Badenoch and neurodevelopmental models from practitioners such as play therapist Rick Gaskill to provide conceptualizations that can guide the application of creative interventions in treatment. Being able to respond in the moment with a creative art-based or play-based intervention is undoubtedly a skill that evolves over time, with practice, and with good supervision and mentorship. I don’t fault students and new professionals for seeking out ideas and activities to support their first steps toward becoming mental health practitioners. But it’s important that this does not become the dominant story for art therapy. Ultimately, this dependence on directives and activities will relegate art therapy to being defined as an activity-based intervention at best. Art therapy and its close relatives expressive arts therapy and play therapy are better than that and have infinitely more potential to transform and repair our clients. An effective and authentic intervention only emerges when we resist the “recipe,” use our creativity, apply best practices and simply pay attention to what our clients need.

Be well,

Cathy A. Malchiodi, PhD, LPAT, LPCC, ATR-BC

©2012 Cathy Malchiodi

Reference: Riley, S., & Malchiodi, C. (2004). Integrated approaches to family art therapy. Chicago: Magnolia Street Publishers.

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