Creative Healing: An Expressive Art Therapy Curriculum Designed to Decrease the Symptoms of Depression and Anxiety

Jennifer S. Price

This thesis is submitted in partial fulfillment of the Requirement for the degree of Master of Arts from Prescott College In Counseling and Psychology June 2009

Janet Lee O’Connor, Ed.S., LPC, LISAC Graduate Advisor

Del Worley, M.C., LPC, LISAC Second Reader

Laura Brinckerhoff, MA, LPC, LISAC Third Reader

UMI Number: 1464960

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Creative Healing 2

Copyright © 2009 by Jennifer S. Price All rights reserved.

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Creative Healing 3 Acknowledgements The life journeys of my education, work, and experiences have brought struggles, blessings, hardships, and rewards. These paths would have been left undiscovered and unconquered if it had not been for the following people in my life:

To my Mother – I could not have accomplished my dreams or been able to manage any of my hardships or struggles without you. There are no amount of words that can give you credit enough for all that you have done for me and brought to my life. I love you!

To my Children – The support and patience that I have received from you with the dinners left uncooked, the time not spent with you, and the messes left un-cleaned is immeasurable. I will forever be grateful for your unconditional love. You are my Sweethearts!

To my Eternal Love – Through all my sleepless nights, frustrations, tears, and stress – you have always been there, holding my hand, encouraging me to take one more step ahead. We made it Darling, and now our journey has

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Creative Healing 4 finally begun! Thank you for your incredible brilliance, it has added comfort, peace, and warmth to my life and soul forever.

“The power of the aesthetic, the beautiful, to quiet and to calm, to contain even ugly passions, is so profound as to be incalculable. Why else would we derive such joy from natural beauty or such pleasure from the arts? It seems that the nonverbal forms we treasure are so very valuable because they mirror, echo, and express the ineffable, unspeakable feelings we all carry within, from birth until death. And when we touch and shape materials in making art, we experience our impact on the world; indeed, we feel our very existence.”

- Judith Aron Rubin

“Crystal Ball” by John William Waterhouse 4

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Creative Healing: An Expressive Art Therapy Curriculum Designed to Decrease the Symptoms of Depression and Anxiety Table of Contents Chapter 1: Introduction • Which Techniques Work Best? • Author’s Hypothesis • General Background of the Study • Rationale for Study • Goal and Purpose of the Project • Theoretical Foundation • Overview of the Methodology • Delimitations of the Study

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Chapter 2: Literature Review Page 22 • Art Therapy and Expressive Arts • Distinction Between Art Therapy and Expressive Arts • Historical Overview of Art Therapy and Expressive Arts • Important Individuals • Differing Theoretical Approaches to Art Therapy and Expressive Arts • A Summary of Previous Research Results • Issues and Controversies • Specific Techniques and Medium Defined • Summary of Literature Review Chapter 3: Methodology • Design • Research • Data Collection • Participants • Data Analysis • Summary of Methodology

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Creative Healing 6 Chapter 4: Results Page 111 • A presentation of the Results • Arriving at Outcomes • Significance and Uniqueness about this study • Representation of Results • A Summary of the Results Chapter 5: Summary and Discussion • Reflection on Research and Results • Successes with this Project • Struggles with this Project • Areas for Future Research and Recommendations • Concluding Thoughts Appendices • Appendix A: • Appendix B: • Appendix C: • Appendix D: • Appendix E: Art Therapy

Questionnaire Informed Consent Benefits of Creative Therapy Definition of Key Terms Proposed 12-Week Curriculum

References

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“Far better is it to dare mighty things, to win glorious triumphs, even though checkered by failure… than to rank with those poor spirits who neither enjoy much nor suffer much, because they live in a gray twilight that knows not victory or defeat.” - Theodore Roosevelt

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Creative Healing 7 Chapter 1: Introduction “Part of the difficulty of giving an account of dreams is due to our having to translate these images to words. “I could draw it,” a dreamer often says to us, “but I don’t know how to say it.” – Sigmund Freud

Which Techniques Work Best? Expressive arts have been used as a way of communicating, celebrating, and healing since the human race began. Humans have used images and symbols throughout history in order to express themselves in a more meaningful and lasting manner that extends to a deeper level than the spoken languages. Expressive arts uses movement, dance, drawing, singing, weaving, and other forms of creativity to encourage people to express, communicate, and understand their emotions through the creative process. What is now considered to be ‘therapy,’ in the expressive arts, once used to be a part of daily life for others in the form of ritual and creativity. There are assumptions that, in our modern society, the absence of daily rituals and the loss of being able to freely express creativity or knowing how to do so, have helped to increase feelings and symptoms of isolation, stagnation, depression, and anxiety in an

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Creative Healing 8 individual’s life. “Since our earliest recorded history, art has served as a means of reparation, rehabilitation, and transformation and has been used to restore physical, psychological, and spiritual well-being” (Malchiodi, 2007, p. ix). It is therefore not surprising that treatment or ‘therapy’ by means of expressive arts can be an aid and accelerant to the process of healing and recovery, as well as creating or bringing back a sense of empowerment and balance to an individual in this day and age. Although it seems that expressive arts can, in general, help to decrease symptoms of mental illness, are there specific techniques of creative expression that best help to accelerate the process of healing and recovery better than others? Are there particular mediums that work more effectively when dealing with certain ailments, symptoms, or conditions of mental illness? This research was conducted to determine best practices in expressive art therapy when addressing depression and anxiety symptoms. Which techniques or mediums used in expressive art therapy best help to decrease symptoms of depression and anxiety?

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Creative Healing 9 Author’s Hypothesis It is this author’s belief and assumption that personcentered approaches to art therapy, integration of spiritual aspects, and unstructured versus structured approaches will be preferred to other approaches when addressing the amelioration of depression and anxiety symptoms.

General Background of the Study Symptoms of depression and anxiety affect millions of people either directly or indirectly every year. Approximately 6.8 million American adults, or about 3.1 percent of people age 18 and over, have GAD (Generalized Anxiety Disorder)in a given year. Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year (Kessler, Chiu, Demler, & Walters, 2005). That means that about 1 in every 10 adults directly suffer from symptoms of depression and anxiety each year. The numbers increase when we include those who are also indirectly affected by a family member, co-worker, friend, or loved one who has these symptoms.

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Creative Healing 10 In addressing the need to bring education, guidance, services, and support to those touched directly or indirectly by effects of depression and anxiety symptoms many organizations and movements, such as the National Institute of Mental Illness, the American Psychiatric Association, and the National Alliance on Mental Illness have begun and continue to provide public information about the scientific and researched based evidences of mental illness. In 2000, the Surgeon General, David Satcher, issued a report addressing this matter that compared ailments of mental illness to other types of medical issues. He stated, “Mental disorders are real illnesses that are as disabling and serious as cancer and heart disease in terms of premature death and lost productivity” (as cited in Martin, 2000, p. 23). Expressive arts used as a therapeutic tool, can be a cost effective way to address issues of depression and anxiety, as well as a more comfortable and acceptable form of therapy to those seeking assistance. Using creativity to begin the recovery or healing process, can also be a more natural way to create a willingness and acceptance to other modalities of therapy in a resistant individual. Expressive arts can also allow a more in depth opportunity for growth

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Creative Healing 11 in those actively involved in their treatment and recovery, as “art adapts to every conceivable problem and lends its transformative, insightful, and experienceheightening powers to people in need” (McNiff, 2004, p.5).

Rationale for Study Therapy through means of creativity can bring relief from depression and anxiety in ways that might not otherwise be possible with traditional forms of therapy or medication. There are those that believe that using a specific technique or medium in an artistic or creative setting can better aid in the goal of ameliorating these symptoms. The following research and documented professional opinions were gathered to determine best practice in expressive arts and creative therapy with the objective of decreasing symptoms of anxiety and depression. These results were then used to construct a 12-week creative arts curriculum that could be used in an individual or group setting that would specifically address the amelioration of anxiety and depression symptoms in the adult population. This study is such that any meaningful results would seem to be of value to practitioners.

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Creative Healing 12 The author and researcher of this project and thesis has a background in education, art, counseling and psychology. She facilitated an art therapy group weekly for a two year span from 2007 to 2009 at a guidance clinic serving the adult population. She also has experience developing educational curricula as she developed lesson plans on a weekly basis over a two year span between 2004 and 2006, who incorporated standards, goals, and outcomes. The author is also an artist whom incorporates creative arts into her daily life as a means to ameliorate symptoms of depression, fatigue, and stress/anxiety, and understands through self-experience the importance of creative healing.

Goal and Purpose of the Project Expressive and creative arts have been used in the therapy setting to address many forms of mental illness in the adult population. This project was conducted in order to create and develop a 12-week creative arts curriculum that would use best practice techniques to aid in the amelioration of depression and anxiety symptoms in the adult population.

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Creative Healing 13 Theoretical Foundation It is this author’s belief that there is no ‘one right’ way to approach any issue of mental illness, as there are as many different techniques and ways to use those techniques as there are people who can benefit from using them. However, there are some theories and techniques that have inspired this author in the developing of a creative art curriculum program that would specifically address the amelioration of depression and anxiety symptoms in the adult general mental health population. These approaches and theories include humanistic, analytic, cognitive- behavioral, and spiritual and are often used in a group setting. Abraham Maslow’s (1968) ‘self actualization’ theory and Carl R. Rogers’(1951) ‘client-centered’ approach greatly influenced this author in regards to the approach and delivery of creative arts and the atmosphere and setting in which the therapy would take place. These humanistic approaches also influenced how group members would be addressed and interact with one another. Corsini and Wedding (2005) define this approach: The central hypothesis of the person-centered approach is that individuals have within themselves vast

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Creative Healing 14 resources for self-understanding and for altering their self-concepts, behavior, and attitudes toward others. These resources will become operative in a definable, facilitative, psychological climate. Such a climate is created by a psychotherapist who is empathetic, caring, and genuine (p. 161). It is within this context and setting that individuals and group members can begin therapy, continue to progress, and to share with others in an atmosphere of safety, trust, encouragement, and non-judgment. Maslow’s (1968) ‘self-actualization’ theory states that once basic needs are met in an individuals life, he or she will inherently search for meaning, fulfillment, and growth to create a sense of self that defines them. Kurt Goldstein (1934/1959) expounded upon Maslow’s theory in stating that an individual must be understood in a holistic manner in order to address basic needs, and that in doing so, an individual will strive to actualize themselves. The analytical approaches in the theoretical foundation of this author’s project come from the work of Carl G. Jung (1957). Jung “advocated the use of movement, drama, and visual imagery in the technique he called ‘active imagination,’ which was a creative way of

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Creative Healing 15 amplifying ideas and feelings in therapy” (cited in Rubin, 1999, p. 161). Jung (1957) believed that using art as a way of creating and shaping our feelings, thoughts, and emotions we could bring these intangible things outside of ourselves to create a tangible object that could bring understanding of the feelings, thoughts, and emotions within us. This also addresses the importance of being able to express and explain the inexpressible and unexplainable things that are within us by a means other than the spoken or written language. Carl G. Jung (1964) also brought light to the concepts of universal symbolism, as he explored the meaning and background of similar images from different cultures. Jung (1964) would analyze and interpret these symbols to gain further insight into a person’s issues. Although the author of this thesis advocates the powerful meanings that can come through the creation of symbols and images, as Jung (1964) did, she takes a more humanistic approach when it comes to analyzing these images or having another person place meaning on a symbol or image other than its creator. Natalie Rogers (1993), the daughter of Carl R. Rogers, puts this thought into perspective when she stated:

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Creative Healing 16 The person-centered approach to symbols leaves room for educating ourselves as to the meanings of our symbols, but in the final analysis we are our own message-givers. Although our understanding of a particular piece of art is likely to change over time, its meaning for us still reflects our unconscious speaking to us (p. 76). Symbols and images in art, such as mandalas, can and have been used as a therapeutic tool for centuries. Jung (1957) did much of his own self-discovery work using symbols and images, including mandalas. This author uses this knowledge and information as a therapeutic tool, addressed with a humanistic approach. The cognitive and behavioral theories that this author relied on as a source for choosing particular techniques and activities included Howard Gardner’s (1983) ‘multiple intelligence theory,’ Aaron T. Beck’s (1963) (2003) work and study with depression and anxiety in regards to personality dimensions, Albert Ellis’ (2004) theory of Rational Emotive Behavior Therapy (REBT), and both Beck’s (1979) and Ellis’s (1962) contributions to cognitivebehavioral theories and techniques.

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Creative Healing 17 Howard Gardner’s (1983) theory of multiple intelligences suggests that each individual is unique in the way they gain information and learn. Gardner points out several different styles of learning which include linguistic, musical, logical/mathematical, spatial, bodilykinesthetic, personal, and added more recently naturalistic. This theory states that each person’s style or way of learning should be taken into account when considering someone’s overall progress, functioning level, needs, and overall intelligence. This educational model influenced this author with the belief and understanding that using particular methods, techniques, or medium could work best for different individuals based upon the way they might process information, their culture, and their history. Gardner (1983) puts it in these terms: Talk of specific analyzers, of computers, of production systems, or even modules no longer suffices once one encroaches upon this level of analysis. We must begin to think in terms of more encompassing categories – the individual’s experiences, his frames of reference, his means of sense making, his overall world view (p. 298).

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Creative Healing 18 Art therapy and the expressive arts approaches psychotherapy with this concept in mind, believing that using the individual’s creativity to bring progress to the therapeutic process in a more individualized and customized way can assist those who might be more inclined to learn and grow in an artistic environment. In Beck’s (1963) studies with depression he made clinical observations of depressed patients and investigated their treatment under traditional psychoanalysis. Corsini and Wedding (2005) state that “rather than finding retroflected anger in their thoughts and dreams, Beck observed a negative bias in their cognitive processing” (p. 243). Rubin (1999) explains that the therapeutic approach most commonly used in cognitive therapy is one in which the client is taught to identify their misconceptions and then taught new strategies and more adaptive views to replace the misconceptions. Rational Emotive Behavior Therapy, founded by Albert Ellis (2004), is a theory that rests on the assumption that most struggles people face are due to irrational and misconstrued beliefs about themselves and the world around them. “These include such notions as: they should be competent at everything and liked by everyone; life should

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Creative Healing 19 always be fair; quick solutions to problems should be available; and their lives should turn out a certain way” (cited in Morris & Maisto, 2005, p. 537). Both Ellis (2004) and Beck (2003) contributed to cognitive-behavioral therapies, which focus on educating clients about their faulty internal thinking as a way to come to an understanding that to change their thinking to a more adaptive and realistic view, could help to decrease their symptoms and problems. Lastly, this author also believes in the importance of bringing spirituality into the process of therapy, healing, and recovery. “Addressing issues regarding clients’ highest values, their underlying belief systems about where they belong in the universe and what they should do with their lives, offers a particularly useful framework for healing” (Corsini & Wedding, 2005, p. 423). Corey (2005) states that “spiritiual/relgious values have a major part to play in human life and struggles, which means that exploring these values has a great deal to do with providing solutions for clients’ struggles” (p. 467). Whether clients’ struggle with faulty thinking, behaviors that need to change, or they simply need validation and genuine non-judgmental listening, it seems that spirituality can play a part in

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Creative Healing 20 helping clients to grow, change, or even endure through their times of need and recovery. “For many clients in crisis, the spiritual domain offers solace, comfort, and is a major sustaining power that keeps them going when all else seems to fail” (Corey, 2005, p. 468).

Overview of the Methodology Research for this thesis included both qualitative and quantitative methods. This writer designed a brief questionnaire (Appendix B) that was given to art therapists and art therapy studio directors that produced both quantitative and qualitative information regarding techniques, media, and methods used in the art therapy setting. The literature review of this project, gathered further qualitative information about specific and differing therapeutic approaches used in the expressive arts. The research that was gathered was used to determine if there were or are any theories, techniques, methods, or media used in the creative arts setting that were or are perceived, noted, or believed to decrease depression and anxiety symptoms more so than others. The qualitative and quantitative results from this questionnaire and literature review will be discussed in a later chapter along with a

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Creative Healing 21 more in depth description of the methodology used in this project.

Delimitations of the Study In considering the delimitation of this research and project, one must note the small size of this sample. Participants of the questionnaire only had to be an art therapist, have conducted art therapy, or be or have been a director of an art therapy studio. Years of experience, background knowledge in expressive arts, or personal choices on theory were not addressed. The author’s previous experiences, would also need to be noted as being biased and subjective towards her views and philosophies of studio art therapy, however, the author used the organized literature review in an attempt to bring balance and validity to this research.

“In truth, the art process offers one of the few ways we human beings have found to utilize and to synthesize all of ourselves – body, mind, and spirit.” - Judith A. Rubin

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Creative Healing 22 Chapter 2: Literature Review “Art is basically a confession and is created largely from unconscious motives, the producer creating the world according to one’s own image” - Margaret Naumburg

Art Therapy and Expressive Arts The American Art Therapy Association (1996) defines art therapy as: A human service profession that utilizes art media, images, the creative process and patient client responses to the created products as reflections of an individual’s development, abilities, personality, interest, concerns and conflicts. Art therapy practice is based on a knowledge of human developmental and psychological theories which are implemented in the full spectrum of models of assessment and treatment including educational, psychodynamic, cognitive, transpersonal and other therapeutic means of reconciling emotional conflicts, fostering self awareness, developing social skills, managing behaviors, solving problems, reducing anxiety, aiding reality orientation and increasing self esteem (p. 79).

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Creative Healing 23 “Art therapy, sometimes called creative arts therapy or expressive arts therapy, encourages people to express and understand emotions through artistic expression and through the creative process” (Ford-Martin, 2009, ¶ 1). The creative healing comes from the act of creating in itself, but can also come once a creation is complete. The creator can often reflect back on the process of creation as well as analyze the finished product, with both of these processes bringing one closer to internal insight. The insight gained can be used as the next step in understanding what the creator may need to explore as well as to communicate to the therapist things that the creator may not be able to verbalize. According to Malchiodi (2007), Art making is seen as an opportunity to express oneself imaginatively, authentically, and spontaneously, an experience that, over time, can lead to personal fulfillment, emotional reparation, and transformation. This view also holds that the creative process, in and of itself, can be a health-enhancing and growth-producing experience (p. 6). The terms expressive arts and creative healing best describe this process, as it is in the act of expressing or creating in an artistic manner with the objective of

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Creative Healing 24 healing that brings this therapeutic process to light. “Art experiences are directed at helping the patient find strength and self-worth through the discovery of one’s own artistic expression” (Robbins, 1987, p. 53). The therapist becomes the facilitator of this journey and is there to guide the creator in this process of self discovery and expression. The American Art Therapy Association (1996) explains that: Art therapists use the creative process and the issues that come up during art therapy to help their clients increase insight and judgment, cope better with stress, work through traumatic experiences, increase cognitive abilities, have better relationships with family and friends, and to just be able to enjoy the life-affirming pleasures of the creative experience. By helping their clients to discover what underlying thoughts and feelings are being communicated in the artwork and what it means to them, it is hoped that clients will not only gain insight and judgment, but perhaps develop a better understanding of themselves and the way they relate to the people around them (p. 79). It is important to note, that although there are forms of art therapy that are analyzed and interpreted without

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Creative Healing 25 the feedback of the client, it is seen as a more insightful and meaningful process when the client is involved in this important aspect of analysis. Solórzano (2009) states that: The role of the art therapist is not to interpret the art but use the art as a tool to therapeutically work through a problem or issue. Art therapy is a combination of art and therapy. Similar to verbal therapy, a therapist would never try to interpret what a client was thinking; instead using psychotherapy techniques, a process of verbal exchanges would take place. Art therapists work in the same manner with the advantage of having a visual image. They can observe the way the individual uses the material, interacts with a group, and will appropriately investigate the artwork with the individual. Art therapists are trained to process the art created. They may ask questions about the art or what the individual said in response to the art. The session becomes similar to verbal therapy, with the art being the method through which they may gather more information, have a permanent record and help the person get closer to the issue (¶ 4).

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Creative Healing 26 Those who would benefit from creative artistic expression need not be an artist or even artistically inclined. The only requirement to art therapy is to be open to the insight that can be gained from this process and be willing to create without judgment. The National Health Association (NHS) of England (2007) explains that: The purpose of Art Therapy is not essentially to teach art techniques or complete ‘projects’ which will impress the onlooker or produce ‘good art’ in the conventional sense. It is about giving the space, time and materials to discover your own individual creativity, and to experience being creative for its own sake, rather than necessarily having ‘goals’ or working toward a ‘finished’ product (¶ 1). Although there is the underlying objective to progress, recover, and heal – the expressive arts tries to reach these goals through more creative and natural means. Using art and creative expression to reach the places inside of us that need to be healed can be a more sensitive and non-abrasive approach to the therapy process. As Potash (2009) points out: Communicating with and through images is a natural source of expression for humans. Our earliest forms of communication, going back to cave paintings, are

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Creative Healing 27 through images. In addition, images are open to many interpretations and can provide us with new insights, perspectives, and directions. Such communication can provide us with a new and refreshing outlook or perspective (¶ 8). A strong belief and underlying assumption with art therapy and creative healing is that each person has inside of them that which can help them heal. The process of healing comes when a person can be guided in the journey of ‘remembering’ their creative nature and use it in ways to express themselves as well as to communicate unresolved issues that can be addressed and worked through with artistic expression and creativity. According to the Association Des Art Therapeutes De Quebec (2007): Some of the more important benefits offered by art therapy are: Through the making of art, art therapy strengthens creativity. This is important since the creative process, itself is fundamental to the attainment of all positive change, including personal growth, healing, insight and problem resolution. Similar to dreams, artistic works can be gateways to the unconscious, thus increasing the likelihood of revealing underlying issues, conflicts and concerns which can then be addressed in therapy. The created

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Creative Healing 28 artwork can serve as a powerful record of the artist-client’s therapeutic progress and may be particularly useful for review at pivotal points throughout treatment. Art therapy helps to foster integration, wholeness and coherence by encouraging the artist-client to communicate both verbally and visually, as well as to engage in a process that is physical, emotional and intellectual (¶ 5).

Distinction between Art Therapy and Expressive Arts Both art therapy and expressive arts both use artistic expression as a form of therapy. Distinctions have been made stating that art therapy relates to a more structured form of therapy that involves therapeutic analysis with clear and specific objectives, typically using mostly visual arts such as painting, drawing, sculpting, and other hands-on artistic methods while expressive arts address the other forms of art such as music, drama, dance, and other more expressive forms of art. In either distinction, however, the root of therapy is the creative expression or creative work that brings about the opportunity for change, growth, healing, and recovery. The International Expressive Arts Therapy Association (2008) states that “the expressive arts combine the visual

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Creative Healing 29 arts, movement, drama, music, writing and other creative processes to foster deep personal growth and community” (¶ 1). This author agrees with Bachelor (1997), who states that: Art is a powerful way to communicate. For thousands of years, it has influenced people, inspiring the imagination, telling stories, recording history and stirring emotions. Many people feel the need to express themselves, not just for enjoyment, but to identify and deal with pain. Art therapy is a very creative way to deal with stress, illness, physical, mental or emotional trauma, addiction, and other concerns (¶ 1). It matters not if it is called ‘art therapy’ or ‘expressive arts,’ the goal is the same - to aid in the progression of inner healing through creativity. Please refer to Appendix D for a more detailed definition of key terms.

Historical Overview of Art Therapy and Expressive Art Art and creativity have been used as a way to heal for as long as human beings have experienced struggles and suffering. Ford-Martin (2009) explains that:

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Creative Healing 30 Humans have expressed themselves with symbols throughout history. Masks, ritual pottery, costumes, other objects used in rituals, cave drawings, Egyptian hieroglyphics, and Celtic art and symbols are all visual records of self-expression and communication through art. Art has also been associated spiritual power, and artistic forms such as the Hindu and Buddhist mandala and Native American sand painting are considered powerful healing tools (¶ 2). There is no specific date or one specific creator of this magical, mystical, and mysterious form of healing, unless one wants to give credit to the creator of ALL. In speaking of the human race, however, it seems that art has simply always been an instinctive way to heal, express, and know. Should there be any credit given to a single individual, one would have to point the finger to each human being that has ever existed, as there is an artistic soul with the knowledge of creative healing in each of them. Now, of course, there is a time when people began to study the benefits of this form of healing and started to give it specific parameters, rules, and ideals. They began to teach and to expound on the concepts and meanings of this natural form of expression that was seen as having significant therapeutic value. This obviously was not the

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Creative Healing 31 beginning of creative healing, but one could say it was the beginning of art therapy. Allen (1995) states that “art therapy began as a loose collection of individuals from varied backgrounds who invented or discovered ways to use art in the service of others” (p. xv). Those like Freud (1958) and Jung (1957) began to use this therapeutic tool as they noticed that it could reach into the depths of the client’s unconscious in a way that other forms of current psychotherapy were unable to. “Freud recognized early that many of his patients’ communications were descriptions of visual images. In fact, at first he actively requested images, using a ‘concentration’ technique to evoke memories” (cited in Rubin, 2001, p. 15). Corsini and Wedding (2005) point out that: During his own self-analysis, Jung painted his dream and fantasy images; he perceived therapeutic value in doing this, in playing stones like a child, and later, in sculpting in stone and carving at his retreat in Bollingen. Jung encouraged his patients to do the same in their own analysis through painting, sculpting, and other form-giving methods that provided a feeling and image through which the contents of the unconscious could find expression (p. 119).

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Creative Healing 32 Connections were being discovered between not only the benefits from the experience of artistic creation, but in the types of projects created and the analysis and reflection on the expressive creations. Therapists and clients both could gain greater insight into the issues at hand and growth could begin in situations where clients had previously felt ‘stuck’ or were unable to express or open up to what needed to be addressed. The National Coalition of Creative Arts Therapies Associations (2009) explains that: Over one hundred years ago, a number of European writers described the spontaneous art done by patients in mental hospitals. This seemingly irrepressible urge to make art out of any available materials confirms the compelling power of artistic expression to reveal inner experience. It was because art making provided a means of expression for those who were often uncommunicative that art therapy came to be developed as one of the helping professions (¶ 1). Although art therapy began to develop simultaneously in different parts of the world, Rubin (1999) states that: Two remarkable women were primarily responsible for the planting, tending, budding and blossoming of the American art therapy garden. Both Margaret Naumburg

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Creative Healing 33 and Edith Kramer were sophisticated in their reading and understanding of analytic theory, child development, art, and education (p. 97). Margaret Naumburg (1987) is considered to be the mother of art therapy in the United States. She was “an educator and psychotherapist who started the Walden School in New York City, and wrote several books on art therapy and its applications with psychiatric patients in the 1940s and 1950s” (The National Coalition Of Creative Arts Therapies Associations, 2009, ¶ 3). “In the late nineteenth century, French psychiatrists Ambrose Tardieu and Paul-Max Simon both published studies on the similar characteristics of and symbolism in the artwork of the mentally ill” (cited in Ford-Martin, 2009, ¶ 3). Their work, which came to be known as milieu therapies, was some of the first of its type to use art therapy as a diagnostic tool in identifying specific types of mental illness. In later years, it would be the example of these tests that psychologists would use to create the drawing tests such as Draw-A-Man and Draw-A-Person test as well as other artistic and creative based personality tests. “The growing popularity of milieu therapies at psychiatric institutions in the twentieth century was an important

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Creative Healing 34 factor in the development of art therapy in the United States” (Ford-Martin, 2009, ¶ 4). The National Coalition of Creative Arts Therapies Associations (2009) goes on to report that “the first journal in the field was published in 1961 as the Bulletin of Art Therapy (now the American Journal of Art Therapy). The American Art Therapy Association (AATA), founded in 1969, is the national professional organization” (¶ 5). According to Thompson (2003), it is from these studies and the research conducted by these pioneers in art therapy that: The expressive arts have become an effective treatment for the developmentally, medically, educationally, socially, or psychologically impaired; and is practiced in mental health, rehabilitation, medical, educational, and forensic institutions. Art therapists work with individuals, couples, families, and groups and serve populations of all ages, races, and ethnic backgrounds (p. 120).

Important Individuals As mentioned earlier, it is hard to put an exact time or date on when art therapy began; and equally as difficult is giving credit to one specific individual for the

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Creative Healing 35 creation or beginning of art therapy. “In fact, as art therapy came to be better known, many individuals in different places appear to have given birth to remarkably similar ideas around the same time, often unknown to each other” (Rubin, 1999, p. 101). The following is a list of some of the influential individuals that have contributed to the field of art therapy in notable and inspiring ways. There are many others who are not listed here that have also significantly contributed to the field of art therapy, and it is only out of brevity and personal inspiration that others have not been listed, as it would be impossible to name each and every individual who has contributed to this vast field. Individuals are listed in alphabetical order.

Edward Adamson (1911–1996): Was considered a pioneer in the process of using art to treat mental illness. For three decades Mr. Adamson worked with patients at Netherne Hospital, a vast Victorian-era psychiatric hospital in Surrey. He was the founder and first chairman of the British Association of Art Therapists, and lectured on the subject in Europe and in the United States, where the field developed independently (Fountain, 1996, Section 2, p. 52).

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Creative Healing 36 “Adamson compiled a collection of sixty thousand paintings and objects by people with mental illness, which now constitute the Adamson Collection in England” (Malchiodi, 2007, p. 38).

Robert Ault (1936-2008): Ault was an artist that worked at the Menninger Clinic in the 1950s and 60s. “Don Jones and Robert Ault were instrumental in forming (in 1969) the American Art Therapy Association, a national organization of art therapists, making art therapy a recognized professional field” (Malchiodi, 2007, p. 38).

Aaron T. Beck: Beck is known as the father of cognitive therapy and inventor of a number of the widely used selfreport measures, including the Beck Depression Inventory (BDI), Beck Hopelessness Scale for Suicidal Ideation (BSS), and the Beck Anxiety Inventory (BAI) (“Aaron T. Beck”, 2009). He was a graduate of Brown University and Yale School of Medicine and was initially studying neurology before switching to psychiatry during his residency. He worked towards understanding the underlying reasons behind fear, depression, and anxiety by using his own experiences as well as his extensive research on these subjects. “Beck’s pioneering research established the efficacy of

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Creative Healing 37 cognitive therapy for depression. He has successfully applied cognitive therapy to depression, generalized anxiety and panic disorders, alcoholism and drug abuse, eating disorders, marital and relationship problems, and personality disorders” (Corey, 2005, p. 270).

Florence (Naumburg) Cane (1882–1952): Was an extraordinary art teacher and sister of Margaret Naumburg. She taught at the Walden School for many years where she “devised methods that included scribbling, movement, and sound to help children freely express themselves through art” (Malchiodi, 2007, p. 110).

Albert Ellis (1913-2007): An American psychologist who began his work as a writer and lay counselor, mostly being sought after for his advice on human sexuality. After realizing his calling in the field of psychology and practicing classical psychoanalysis for many years, he developed his own therapy that combined humanistic, philosophical, and behavioral therapy to form what is known as rational-emotive therapy, or REBT. Ellis is known as the grandfather of cognitive behavior therapy (Corey, 2005).

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Creative Healing 38 Viktor Frankl (1905-1997): “Was an Austrian neurologist and psychiatrist as well as a Holocaust survivor. Frankl was the founder of logotherapy, which is a form of Existential Analysis” ("Viktor Frankl," 2009). While Frankl and his family were imprisoned in the Nazi concentration camps between 1942 and 1945, his wife, children, parents, and brother died. Corey (2005) states that: Frankl received his Ph.D. in philosophy in 1949 and became an associate professor at the University of Vienna and later was a distinguished speaker at the United States International University in San Diego. Frankl’s works have been translated into more than 20 languages, and his ides continue to have a major impact on the development of existential therapy. Although Frankl had begun to develop an existential approach to clinical practice before his grim years in the Nazi death camps, his experiences there confirmed his views. Even in terrible situations, he believed, we could preserve a vestige of spiritual freedom and independence of mind (p. 129).

Sigmund Freud (1856 – 1939): “Austrian physician, neurologist, and founder of psychoanalysis, who created an entirely new approach to the understanding of human

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Creative Healing 39 personality” (“Sigmund Freud,” 2008). Art therapy is believed to be rooted in Freud’s concept of the subconscious and unconscious.

Adrian Hill (1895-1977): An artist who claimed coining the term “art therapy” in 1942 when he used his own creative expression in art to aid in his recovery while being hospitalized for tuberculosis. Cosentino (2008) explains that: While recovering from tuberculosis in a sanitarium, Hill felt that his own foray into art led to his emotional recovery. Introducing painting to his fellow patients, he found that they used artistic expression not only for enjoyment but also as a vehicle for expressing fears and emotions (¶ 6).

Mary Huntoon (1896–1970): “An artist who taught painting to psychiatric patients in 1935 at the Menninger Clinic in Topeka, Kansas. In 1946, at a veterans’ hospital, she created one of the first art therapy studios in the U.S.” (Rubin, 1999, p. 6). According to the University of Kansas Libraries – Kenneth Spencer Research Library (2005), Huntoon took part in many notable activities including:

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Creative Healing 40 Assuming the directorship of the Federal Art Project in Kansas (1934-1938), assisting in the establishment of the Department of Art, Physical Medicine and Rehabilitation at Winter Veterans Administration Hospital (1946-1959) and serving as director of Studio Gallery, Inc. (1961-1962) (¶ 3).

Don Jones: “An artist who, as a conscientious objector, had worked in a psychiatric hospital during WWII” (Rubin, 1999, p. 103). “In 1951, he went to the Menninger Clinic in Kansas where he developed an extensive expressive arts therapies program. He was American Art Therapy Association’s first Publications Chair and fourth President, 1975-1977” (Junge & Wadeson, 2006, p. viii). During his career he collected works from patients and himself that he compiled into the book: PRN in a Mental Hospital Community.

Carl G. Jung (1875–1961): “A Swiss psychiatrist, an influential thinker and founder of analytical psychology. Jung’s approach to psychology has been influential in the field of depth psychology and in countercultural movements across the globe. He emphasized understanding of the psyche

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Creative Healing 41 through exploring the worlds of dreams, art, mythology, religion and philosophy” ("Carl Jung," 2009, ¶ 1).

Emil Kraepelin (1856–1926): A European psychiatrist often referred to as the “Father of Psychiatry.” Kraepelin was a pioneer in the fields of neuropsychology, neuropsychiatry, and psychopharmacology. He is also credited with discovering schizophrenia and manic depression as well as being the co-discoverer of Alzheimer’s disease. As early as 1912, Kraepelin “observed that drawings by patients could be used as aids in understanding psychopathology” (Malchiodi, 2007, p. 25-26).

Edith Kramer: “An artist and teacher who defined her theory of Art as Therapy in her first book (1958). The theory was developed at Wiltwyck, a residential school for emotionally disturbed children near New Your City” (Rubin, 1999, p. 8). Kramer “proposed that the healing potential of art making stemmed from the ability of creative work to activate certain psychological processes” (as cited in Malchiodi, 2007, p. 36).

Hanna Yaxa Kwiatkowska (1910–1980): “Kwiatkowska, an art therapist who worked at the National Institute of Mental 41

Creative Healing 42 Health in the 1950s and 1960s, introduced art therapy into family therapy sessions” (Malchiodi, 2007, p. 37). “Although other art therapists were seeing families too, Kwiatkowska was the undisputed pioneer of Family Therapy and Evaluation through Art (Rubin, 1999, p. 170).

Myra Levick: Levick “established the creative arts therapy program at Hahnemann Hospital and Medical College in Philadelphia, the first graduate art therapy program in the country” (Junge & Wadeson, 2006, p. ix). Levick was also the first president of the American Art Therapy Association.

Bernard Levy (1924-1984): Levy was a professor of psychology and an artist. He co-founded the art therapy program at the George Washington University along with Elinor Ulman, and was also the program’s director. According to The George Washington University (2009), Dr. Levy made numerous contributions to art therapy literature, specifically in the areas of assessment and research.

Victor Lowenfeld (1903-1960): Lowenfeld was born in Austria, where he taught art in elementary school. While there, he also studied sculpture under Edward Steinberg who

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Creative Healing 43 required his students to blindfold themselves at times when they were working with clay, a technique that eventually led Lowenfeld to do work with the blind. He and his family later fled to England and eventually settled in the United States where he helped to define and develop the field of art education. “Though his field was psychology, Lowenfeld was directly responsible for establishing the art department at Hampton Institute in Virginia” (Efland, 2009, ¶ 4). He eventually became the chairman of art education at Pennsylvania State University.

Rollo May (1909-1994): May is considered to be one of the main advocates of humanistic and existential psychology and is credited with introducing existential psychology to the U.S. He came from an unpleasant childhood as well as two failed marriages and believed that “psychotherapy should be aimed at helping people discover the meaning of their lives and should be concerned with the problems of being rather than with the problem solving” (as cited in Corey, 2005, p. 130). While staying in a sanatorium for three years due to having tuberculosis and contemplating the possibility of his death, he began to read the writings of the philosopher Soren Kierkegaard, which influenced his theories on existentialism.

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Creative Healing 44 Shawn McNiff: McNiff is credited with being an influential leader in the movement towards integrating spirituality into art therapy. His “Art as Medicine: Creating a Therapy of the Imagination (1992) incorporated Hillman’s (1989) view of psychology as soulmaking and encouraged art therapists to consider models of shamanic healing and the use of art as religious ritual” (cited in Farrelly-Hansen, 2001, p. 23).

Charles (1862–1953), Karl (1893–1990), and William (1899– 1966) Menninger – “The Menninger Clinic, a world-famous psychiatric facility, was founded by Charles Menninger and his two sons, Karl and William, in 1925” (Malchiodi, 2007, p. 38). Ford-Martin (2009) goes on to state that: In the 1930s, Karl, William, and Charles Menninger introduced an art therapy program at their Kansasbased psychiatric hospital, the Menninger Clinic. The Menninger Clinic employed a number of artists in residence in the following years, and the facility was also considered a leader in the art therapy movement through the 1950s and 60s (¶ 6).

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Creative Healing 45 Margaret Naumburg (1890–1983): Naumburg is known as the mother of art therapy in the United States. “Margaret Naumburg was not a psychologist, but her work as an educator and as a therapist influenced twentieth century ideas about creativity and mental illness” (Milite, 2009, ¶ 1). She was the founder of the Walden School where teaching was done through creative expression and self-motivated learning. Naumburg was also the author of many works on psychology and art therapy. She believed “that the creative process could bring out unconscious desires and anxieties and help the person, therefore, to create the person they would like to become” (Naumburg, 1987, p. 9).

Frederick “Fritz” Perls (1893-1970): A neuropsychiatrist from Germany that, after seeking his own therapy for personal problems, began training in psychoanalysis himself. He served as a medic in the German Army during World War I, and after working with brain-damaged soldiers at the Goldstein Institute, he began to stress the importance of treating patients on a holistic level instead of treating only specific parts. Later he would move to the United States and ultimately challenge the theories of psychoanalysis and create his own theory in reaction to his experiences. Gestalt therapy was created by him, his wife, 45

Creative Healing 46 and a colleague, Paul Goodman. He and his wife gave seminars and workshops at the New York Institute for Gestalt Therapy, where his vivid and sometimes confrontational personality gave him a reputation of an innovator and pioneer in psychotherapy (Corey, 2005).

Marcel Reja (1873–1956): A French psychiatrist who wrote one of the first books to address the art of mental patients from an aesthetic rather than a clinical point of view. L’Art Chez les Fous – Art by the Mad), was published in Paris in 1907. “Paul Meunier, who wrote under the pseudonym, Marcel Reja, felt that the study of such work might yield an understanding of artistic creativity in general” (Beveridge, 2001, p. 595).

Janie Rhyne (1913–1995): An art therapist in the 1960s and 1970s, Rhyne “used art expression to help people achieve self-awareness and self-actualization” (Malchiodi, 2007, p. 37). “She is best known for Gestalt approaches to art therapy and refers to them as Gestalt art experiences” (Malchiodi, 2007, p. 225).

Carl Rogers (1902–1987): The pioneer for humanistic psychology and the founder of person-centered and/or

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Creative Healing 47 client-centered approach, Rogers expressed the importance of unconditional acceptance, genuineness, and empathy not only in his work and theories, but in the way he lived his life. Corey (2005) reports that: Rogers earned recognition around the world for originating and developing the humanistic movement in psychotherapy, pioneering in psychotherapy research, and influencing all fields related to the helping profession. Perhaps his greatest passion was directed toward the reduction of interracial tensions and the effort to achieve world peace, for which he was nominated for the Nobel Peace Prize (p. 163). “Carl’s research into the psychotherapeutic process revealed that when a client felt accepted and understood, healing occurred” (N. Rogers, 1993, p. 4).

Paul-Max Simon (1849-1923): “Simon has been referred to as the ‘father of art and psychiatry’ and was one of he first psychiatrists to establish a large collection of drawings and paintings by patients in insane asylums” (Malchiodi, 2007, p. 27). His work paved the way for the understanding of the connections between clients’ artwork and their diagnosis, and he is “credited with influencing the diagnostic uses of drawings” (Malchiodi, 2007, p. 27).

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Creative Healing 48 B. F. Skinner (1904-1990): A psychologist that began his career as a writer after receiving his B.A. in English literature. After discovering an interest in the writings of Watson and Pavlov, he left his struggling career and entered the psychology graduate program at Harvard. He would later return to Harvard, not as a student, but to join the psychology department, where he worked for the rest of his life (Van Wagner, 2009). “Skinner was a prominent spokesperson for behaviorism and can be considered the father of the behavioral approach to psychology” (Corey, 2005, p. 227). He was awarded the Citation for Outstanding Lifetime Contribution to Psychology in 1990.

Elinor Ulman (1910–1991): Ulman was an artist and educator. She co-founded the art therapy program at the George Washington University along with Bernard Levy. The George Washington University (2009) states that: Elinor Ulman was founder, editor, and publisher of The Bulletin of Art Therapy (now American Journal of Art Therapy), the first forum devoted exclusively to art therapy. She was also the primary editor of two of the

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Creative Healing 49 first books on art therapy published in the United States (¶ 1).

Differing Theoretical Approaches to Expressive Art and Art Therapy There have always been and still are different ideas about how the expressive arts should be applied to the therapeutic process. Rubin (1999) states that, “it would probably be accurate to say that there have always been as many different approaches as there are art therapists” (p. 157). Although each therapist has a unique way, specific methods, or preferred media to work with, more than likely there are leaves or branches in their choices and techniques that reach back to the tree trunk or roots to one or more of these basic theoretical approaches. Not all approaches are listed here, as mentioned above; there is a plethora of unique ways to approach the expressive arts. The author has listed below several of the basic and common approaches that seem to have an underlying theme from which most other approaches have been developed.

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Creative Healing 50 Psychoanalysis: Techniques and media used in psychoanalysis are used in ways to create a more concrete and visual experience for the client to aid in uncovering unconscious or repressed material. Artwork can be analyzed to aid in the discovery of inner desires that may be hard to verbalize. The art therapist will recognize and report verbal and nonverbal forms of transference and countertransference and address these issues to resolve hidden ideas and feelings. Through this process, insight can be gained into the client’s developmental level, their fears and fantasies, and the possible reasons why they are struggling with certain issues in their life (Rubin, 2001). An unstructured approach is typically what is used when working with clients under this theory, where the client freely produces art without specific instructions from the therapist. An example of a specific technique that is often used to help a client that has possible repressed feelings and is having a difficult time to express or understand these feelings, is the “scribble technique” created by Florence Cane (1983), which invites the client to start drawing by making a hand made scribble, and from that scribble to draw what they see in that scribble. This

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Creative Healing 51 technique is believed to help uncover unconscious and repressed material that can then be addressed and analyzed to develop an understanding into the client’s deep seeded issues, and therefore create resolve in the client’s struggles. The most influential person from this approach was Sigmund Freud (1958), an Austrian physician and neurologist, who created a system of psychology based on his discoveries and research on human personality. “Historically, art therapy’s roots were in the thendominant mode of understanding – psychoanalytical theory. It is the oldest and most elaborate among modern therapeutic approaches, and has influenced all the others” (Rubin, 1999, p. 158).

Analytical: Carl G. Jung (1957) was the founder of this theory. In using this approach in the expressive arts, clients are invited to express themselves with paper, pen, or brush with images from certain stages of development. Fears, fantasies, dreams, and other meanderings of the mind can then become concrete representations of the client’s intangible thoughts. The client and the therapist can then

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Creative Healing 52 search for meaning in the symbols that have been created. Connections are sought from the client’s images that have been created from their mind and thoughts and the reality of their current struggles, in hopes to aid in the ability to heal the present (Rubin, 2001). Several of Jung’s (1964) concepts include the concept of the psyche, the collective unconscious, the concept of complexes, and active imagination. According to Jung, the psyche is the sum of our thoughts and inner spirit combined, with which individuals view their perception of reality. The collective unconscious is the hidden parts of the psyche that is shared among all human beings, that typically manifests as common symbols, myths, or themes. Jung (1964) named these common inner themes archetypes, and stated that they were inherent inner patterns that existed within each individual. Through the concept of complexes, which are seen to be a mixture of one’s emotions, feelings, and memories, each individual creates a unique version of an archetype when their own personal unconscious interprets and makes meaning of the archetype they are currently experiencing (Corsini & Wedding, 2005). These concepts can each be put into play when a person creates an image drawing upon their psyche to address inner struggles. “A

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Creative Healing 53 relationship is encouraged between the image and its maker, by actively stimulating imaginative inquiry, and dialogue, the essence of ‘active imagination” (cited in Rubin, 2001, p. 83). An approach to the expressive arts using this technique could include the creation of a mandala, which uses an ancient healing symbol, that when created by the client could bring understanding and symbolic metaphors that would lead to further understanding of the client’s inner needs and therefore move towards personal growth and healing.

Person-Centered: The person-centered or client-centered approach believes that there are three necessary conditions for growth and healing to take place in a therapy setting. These are: empathetic listening, acceptance, and honesty. Empathetic listening is created when the therapist is fully in the moment with a client, giving their complete and full attention to and listening in a way that the client knows that he/she is being heard. Acceptance comes when there is no judgment coming from the therapist, when the client understands that he/she will receive acceptance

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Creative Healing 54 unconditionally no matter what he/she has done or what he/she needs to say, thus creating an opening for growth to move past the judging and rejection that he/she has or is placing upon him/herself. Honesty includes the genuine interaction between the client and the therapist where each is encouraged to be real, knowing that in this positive environment of complete and unconditional acceptance, it is safe to remove masks in order to reach and come to the place of true and deep healing and growth (Silverstone, 1997). This theory was formulated by Carl Rogers (1951), and was created only after many direct contacts between clients and other human beings in his life. “It is based on the therapist’s ‘unconditional positive regard’ for the patient, and the powerful effect of ‘empathy’ (feeling-into or feeling-with) as a way of fully responding to the person in pain” (Rubin, 1999, p. 162). Expressive art techniques used in a person-centered approach might include encouraging the client to reach into their inner self, by possibly creating a collage that expresses a fear or feeling they are having. The collage would be designed with their own style and uniqueness and the client would be responsible for determining and

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Creative Healing 55 describing what the images represented to him/her while the therapist would listen in an empathetic and genuine manner to what the client was expressing (Rubin, 2001).

Gestalt: Corsini and Wedding (2005) state that: Gestalt therapy was founded by Frederick “Fritz” Perls and collaborators Laura Perls and Paul Goodman. They synthesized various cultural and intellectual trends of the 1940s and 1950s into a new gestalt, one that provided a sophisticated clinical and theoretical alternative to the two other main theories of their day: behaviorism and classical psychoanalysis (p. 299). This approach is experiential in nature and integrates the functioning of body and mind. It is considered to also be “an existential-phenomenological approach based on the premise that individuals must be understood in the context of their ongoing relationship with the environment” (Corey, 2005, p. 192). Gestalt therapy focuses on the here-and-now in order to help clients become more genuine in their day-to-day lives. Face-to-face interactions are encouraged in order

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Creative Healing 56 for client’s to own their true feelings and to be real with others around them as a way to heal past hurts as well as to awaken to their true self that has been ignored or suppressed. The ultimate goal in Gestalt therapy is for the client to become aware of the personal responsibility of their own feelings, thoughts, and lives (Morris & Maisto, 2005). A creative art approach using a Gestalt technique could be encouraging the client to create a drawing as he/she listens or moves to the beat of a drum, responding to the rhythm and using it to bring up and express outwardly that which is within. It is through this mind and body creativity and using our senses that “we become aware, we perceive, we gain insight about the nature of the world and of our place in it, by contacting what’s ‘out there’ directly with our innate organismic perceptual system” (Rubin, 2001, p. 247) therefore, leading us to a sense of wholeness.

Existential: Corsini and Wedding (2005) report that: Existential psychotherapy is not a specific technical approach that presents a new set of rules for therapy.

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Creative Healing 57 It asks keep questions about the nature of the human being and the nature of anxiety, despair, grief, loneliness, isolation, and anomie. It also deals centrally with the questions of creativity and love (p. 269-270). This theory or thought is based in philosophy and expresses the importance of free will. It is in contrast to a pre-determined view of human nature found in psychoanalysis and behaviorism. Influential leaders and pioneers in this philosophical approach include Viktor Frankl (1969), Rollo May (1953), Irvin Yalom (1995), Bruce Moon (2001), and Clark Moustakas (1977). Corey (2005) states that: A basic existential premise is that we are not victims of circumstance, because to a large extent we are what we choose to be. A major aim of therapy is to encourage clients to reflect on life, to recognize their range of alternatives, and to decide among them, ultimately shaping their own lives (p. 131). In existential therapy, the expressive art approaches would use “methodologies that open channels of selfexpression and self-awareness, through artistic activities that enable people to explore their own hopes and visions

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Creative Healing 58 about how they want to live their lives” (Moon, 2001, p. 189). A therapist using this approach would encourage a client to create something in an open studio setting, where they could use the materials and media that appeal to them in that moment. During their creation, the client would be encouraged to step back from the process periodically to engage with the piece of work they are creating in order to ask it what it wants or how it feels, and to proceed creating from that point using the insight gained from the answered questions, continuing with this process until a piece of work ‘feels’ completed (Rubin, 2001).

Behavioral: Behavior therapy states that conflict and struggle within a human being comes from a learned response to the environment or situation in which that person is in. Depending on whether the individual or the therapist want that particular learned response to continue or be extinguished, the behavior can be rewarded and/or reinforced or ignored and/or punished. Rubin (2001) elaborates by stating that: This model of treatment is to first assess behavior, and then to alter it through procedures that modify

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Creative Healing 59 old behavior or that teach new behaviors (e.g., conditioning techniques, systematic desensitization, modeling, etc.). Desired changes are defined and demonstrated empirically, and are evaluated throughout treatment (p. 195). B.F. “Skinner was a prominent spokesperson for behaviorism and can be considered the father of the behavioral approach to psychology” (Corey, 2005, p. 227). Skinner rejected the idea of free will and although he acknowledged that personal thoughts and feelings existed, he refuted that they caused us to act in certain ways. Corey (2005) goes on to state that: Skinner maintained that too much attention had been given to internal states of mind and motives, which cannot be observed and changed directly, and that too little focus had been given to environmental factors that can be directly observed and changed (p. 227). Expressive art techniques that use a behavioral approach are often used more when working with emotionally disturbed, mentally retarded, highly anxious, or overly aggressive clients. With this approach, if the goal is to help a client interact in a more positive manner within a social setting, a therapist would create an environment of

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Creative Healing 60 success where the client could interact in a group activity and setting, where throughout the activity the client would be praised for good behavior or ignored or punished for bad behavior by the therapist, thus encouraging and reinforcing positive interaction and stopping or extinguishing negative interaction.

Cognitive: Rubin (1999) states that: Cognitive Therapies focus on habitual distorted thought processes which are thought to underlie maladaptive feelings and behaviors. The therapeutic approach is largely an educational one, in which the task is to identify the patterns of misperception or thought causing the persistence of symptoms. Patients are then taught new and more adaptive ways to think and to behave, using cognitive strategies (p. 165). Albert Ellis (2004) and Aaron T. Beck (2003) were both responsible for developing approaches that help clients to recognize and change negative thoughts and maladaptive behaviors in order to re-learn more adaptive and positive ways of thinking and acting. “This focus on learning new ways of thinking shares many similarities with behavior

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Creative Healing 61 therapy; in fact, many professionals consider themselves to be cognitive behavior therapists who combine both cognitive and behavior therapies” (Brewin, 1996, p. 33-57). In applying cognitive and/or cognitive-behavior approaches to the expressive arts, a technique called “rewriting the script” could be used to help a client rewrite the sequences of a traumatic event by incorporating a different outcome or different circumstances that would allow the image or the story to lose its negative power on the client as well as to empower them in the here-and-now. “The point of restructuring such images is not to deny what actually happened, but to reduce the ability of the image to disrupt daily functioning” (Corsini & Wedding, 2005, p. 259).

Spiritual: Rubin (1999) suggests that: In a technological world where human values seem to have been lost, the hunger for meaning has been intensified. One reflection of this longing is the popularity of spiritual approaches in mental health, as in the many kinds of treatment programs based upon

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Creative Healing 62 the “twelve-step” method of overcoming addiction (p. 169). Moon (2004) elaborates on this subject by stating that: People are not simply cognitive/behavioral/affective automatons. The spirit of a person is not something that is constructed from the body alone. The personality doesn’t own the soul. The body and the personality are there to support the willful, purposive aspect of the self (p. vi). People have begun to openly talk about spirituality and religion, whether from an absence in their life, from misconceptions that have led to a distancing from this subject, or from an inner need to discover something beyond them, something to fill the void that has been ignored for too long. “Even though art therapists operate from a number of different perspectives, one that cuts across all of our theoretical differences is that of the human spirit, which is so essential to our creative capacity” (Rubin, 1999, p. 170). Writers such as Moon (2004) and McNiff (2004) have expounded upon this approach in describing theories and techniques, such as “Soul Loss” and “Images as Angels.” McNiff (2004) stats that: I have consistently discovered that the core process of healing through art involves the cultivation and

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Creative Healing 63 release of the creative spirit. If we can liberate the creative process in our lives, it will always find the way to whatever needs attention and transformation (p. 5). Using a spiritual approach in the expressive arts, McNiff (2004) describes a technique he calls “Images as Angels” where he encourages clients to refer to their creations as an angel instead of a piece, work, drawing, or picture. In this process he believes that the client can imagine their work or “angel” as messenger or representation of something their spiritual self is trying to relay to them in order to become more open and receptive in responding to or dialoging with their creation and creative spirit.

Systemic: Systemic approaches include family and group therapy and are based upon the theories of group dynamics, cybernetics or systems theory. Group dynamics describe the personality that each member brings to the group. This personality is typically the same one they demonstrate in their own family and outside life from the group. The group dynamics also consist of the differing interactions that 63

Creative Healing 64 each member has with other group members or the group as a whole, which again, reflect upon how they lead their own life and conduct other outside relationships with others. Cybernetics and systems theory have been used as synonyms to refer to the study of the structure of a regulated system, such as a group or a family, to find meaning and understanding of given or perceived roles and functions of each individual and the group or family as a whole and how these functions are communicated ("Systems theory," 2009). Hanna Yaxa Kwiatkowska (1978), who is considered to be the “undisputed pioneer of Family Therapy and Evaluation through Art” (Rubin, 1999, p. 170), and others such as Alfred Adler (1929), Murray Bowen (1978), Virginia Satir (1972), and Irvin D. Yalom (1995) have offered great insight and contributed widely used theories in the systemic approach to psychotherapy. Morris and Maisto (2005) state that: Family therapists believe that it is a mistake to treat a client in a vacuum, making no attempt to meet the person’s parents, spouse, and children, for if one person in the family is having problems, it is often a signal that the entire family needs assistance. The primary goals of family therapy are improving family communication, encouraging family members to become

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Creative Healing 65 more empathetic, getting members to share responsibilities, and reducing intrafamily conflict (p. 539). Group therapy is also seen as beneficial to the individual by placing them in a structure or system that allows for the possibility of interaction with others in an effort to create insight to the individual’s behaviors. A group also “offers a client social support, a feeling that he or she is not the only person in the world with emotional problems” (Morris & Maisto, 2005, p. 539). Using this approach in the expressive arts, a therapist might encourage each member of the family or group to draw an image or representation of their greatest struggle at this time in their life. Group and family members would then be encouraged to share their images with each other in order to create empathy among family members, as well as to create a sense of commonality and connection between group members.

Reality: Corey (2005) defines reality theory through the therapist’s point of view in stating that:

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Creative Healing 66 Reality therapists believe the underlying problem of most clients is the same: They are either involved in a present unsatisfying relationship or lack what could even be called a relationship. Many of the problems of clients are caused by their inability to connect, to get close to others, or to have a satisfying or successful relationship with at least one of the significant people in their lives. The therapist guides clients toward a satisfying relationship and teaches them to behave in more effective ways than they are presently behaving. The more clients are able to connect with people, the greater chance they have to experience happiness (p. 316). William Glasser (1967), an American psychiatrist, is credited with developing reality therapy which explains “that all any of us can control is our present lives” (Corey, 2005, p. 315). In applying reality therapy to techniques of expressive arts, a therapist might ask the client to write or draw about a positive experience they have had or wish to have with another individual in their life. Depending upon what the client produces, the therapist can then encourage the client to understand and recognize what has

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Creative Healing 67 worked in past relationships in order to create future positive relationships with others. The therapist can also encourage the client to create an image or a list explaining how they will foster a personal and satisfying relationship that they want to experience; all the while focusing on the here-and-now and on what the client can do or change to create or re-create positive and satisfying relationships with others.

A Summary of Previous Research Results The National Coalition of Creative Arts Therapies Associations (2009) reports that: Research in art therapy has included studying the influence of depression on the content of drawings, the use of art to assess cognitive skills, the correlation of psychiatric diagnosis and formal variables in art, and the effect of art therapy interventions as measured by single-case designs (¶ 8). Rubin (1999) explains in further detail that: Most early studies in art therapy were done by people who worked in settings where a lot of research was going on, like Hanna Kiwatkowska and Harriet Wadeson

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Creative Healing 68 at NIMH, or myself at PCGC. Some were done by those trained in other disciplines to conduct objective investigations, like psychologists Bernard Levy, Mala Betensky, and Janie Rhyne; and art educators Rawley Silver, Donald Uhlin, and Frances Anderson (p. 307). Although there have been many studies on the effectiveness of art therapy, this author has chosen to focus on the specific research results that would pertain to the developing of an expressive arts curriculum designed to ameliorate the symptoms of depression and anxiety in the adult population. The following studies come from a comprehensive search done by this author to discover particular techniques, methods, or media used in expressive arts that directly effect symptoms of depression and/or anxiety in the adult population. These studies are listed in sequential order according to the date the study or research was conducted starting with the earliest dates and ending with the most recent study or research results.

Case Study 1 - Mandalas and Anxiety: This study, conducted in 2005, examined the effectiveness of different types of art activities in the reduction of anxiety. After undergoing a brief anxiety-induction, 84

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Creative Healing 69 undergraduate students were randomly assigned to color a mandala, to color a plaid form, or to color a blank piece of paper. Results demonstrated that anxiety levels declined approximately the same for the mandala-and-plaid-coloring groups and that both of these groups experienced more reduction in anxiety than did the unstructured-coloring group. These findings suggest that structured coloring of a reasonably complex geometric pattern may induce a meditative state that benefits individuals suffering from anxiety (Curry & Kasser, 2005, p. 81-85).

Case Study 2 - Painting, Depression and Anxiety: Sixty cancer patients on chemotherapy were included in a 2007 study to determine whether depression and anxiety symptoms improved after an art therapy intervention of painting with water-based paints. Patients completed the Hospital Anxiety and Depression Scale (HADS) at a baseline level and then at the beginning of each subsequent session. Only patients completing at least four sessions of the art therapy were evaluated in the intervention group. Data was gathered at the end of the fourth group with 19 patients being evaluated. Patients were encouraged to express their feelings with the colors and movement of the paint on paper. Patients could choose the time they participated in

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Creative Healing 70 this activity (ranging from ten minutes to more than one hour). After an evaluation of the results 58% of the patients in the intervention group improved their depression level, and anxiety levels that were scored in the normal range at baseline testing remained the same (Bar-Sela, Atid, Danos, Gabay, & Epelbaum, 2007, p. 980984).

Case Study 3 - Music, Depression and Anxiety: Choi, Lee, and Lim (2008) conducted a pilot study to test whether group music therapy is effective for improving depression, anxiety, and relationships in psychiatric patients. Twenty six patients were non-randomly allocated to either a music intervention group or a routine care group. The music intervention group received 60 minutes of music intervention for 15 sessions (1 or 2 times weekly). The outcomes were measured with Beck's Depression Inventory, the State and Trait Anxiety Inventory, and the Relationship Change Scale. After 15 sessions, the music intervention group showed significant improvements in depression, anxiety, and relationships compared with the control group. These findings suggest that music can improve depression, anxiety, and relationships in psychiatric patients.

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Creative Healing 71 Case Study 4 - Doll Making and Depression: In a study conducted on the effects of art psychotherapy intervention on the levels of depression amongst black women living with HIV Field and Kruger (2008) reported a reduction of depression symptoms in their experimental group after an all day art therapy session making dolls as compared to a control group that watched entertainment videos. The Beck Depression Inventory – II (BDI-II) was used before and after the experiment, and following the intervention, the levels of depression among the participants in the experimental group had decreased significantly (Field & Kruger, 2008).

Issues and Controversies One of the ongoing issues in art therapy is the lack of evidenced based research. Although many studies provide results that art therapy is indeed an aid in ameliorating many mental health symptoms as well as health issues, there is a lack of quantitative evidence. Rubin (1999) states that: Demonstrating the effectiveness of art therapy through tightly constructed research designs, however, has not been easy to do. This problem has plagued all clinical 71

Creative Healing 72 outcome studies because of the huge number of critical, uncontrollable, and perhaps unquantifiable variables involved in measuring change in human beings. It has been argued that well-designed investigations, which would unequivocally demonstrate art therapy’s ability to positively affect its recipients, are desperately needed in order to get those in power to pay its providers for their services (p. 306). Agell (1997) further explains that: Art therapy research practiced in the United States has been, for the most part, poorly designed, consisting mostly of anecdotes and case studies. Many published articles by art therapists that claim to be research have not made serious attempts at empirical control. A case study should be more than a narration that demonstrates an optimistic outcome. If it is truly to be of value, it should provide a gateway to research (p.46). Other ongoing art therapy issues include provocative images, confidentiality, and proper training.

Provocative

images that are created during an individual therapy session or group settings could include pornographic or

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Creative Healing 73 violent images that are disturbing. Haeseler (1987) believes that although some images may be disturbing, it is important to address these images in order to gain insight into the meaning and symbolism behind such depictions. The therapist, artist, or group members might explore the intent of the artist and then seek an alternative way to express the image in a less disturbing manner. Confidentiality is an important issue with art therapy, especially if the client’s work will be displayed or shared in any manner. In the American Art Therapy Association’s Ethical Standards of Art Therapists (1995) it states: “Art Therapists shall respect and protect confidential information obtained from patients in conversation and/or through artistic expression” (p. 1). However, there are still certain circumstances in which the therapist has an obligation to break this confidentiality when the client or other individuals may be in a harmful circumstance. With any forms of display, the decision must be carefully weighed as to the goal of the display and any implications or effects that such a display would hold for the client. Proper training in art therapy and expressive art techniques is also an ongoing issue that has become

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Creative Healing 74 extremely important in the field of art therapy and expressive arts. It is imperative that those who use artistic techniques, creative therapy, and other forms of expressive arts be trained by proper institutes and professionals. When using art therapy with a client, it is fairly easy to get into deep issues in a more rapid way, as opposed to talk therapy. Therapists that choose to use these techniques and methods need to be fully prepared to handle and deal with the breakthroughs and the raw and emotional material that could be produced and brought out by the client using these forms of therapy.

Specific Techniques and Medium Defined The following techniques and media described below can be used in individual and group settings as well as in structured and un-structured environments. By no means is this an exhaustive list of every technique or media that is or has been used in art therapy.

Creative Art Medium “An artistic medium is the substance or material the artistic work is made from, and may also refer to the technique used. For example, paint is the media used in painting, paper is a media used in drawing” ("Art," 2009).

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Creative Healing 75 The supplies used in art therapy are limited only by the artist's (and/or therapist's) imagination. Some of the materials often used include paper, canvas, poster board, assorted paints, inks, markers, pencils, charcoals, chalks, fabrics, string, adhesives, clay, wood, glazes, wire, bendable metals, and natural items (like shells, leaves, etc.). Providing artists with a variety of materials in assorted colors and textures can enhance their interest in the process and may result in a richer, more diverse exploration of their emotions in the resulting artwork. Such appropriate tools as scissors, brushes, erasers, easels, supply trays, glue guns, smocks or aprons, and cleaning materials are also essential. Art materials and techniques should match the age and ability of the client ("Art therapy: Preparations," 2009). There are many other types of media used in creative art as well, such as: magazine clippings, photographs, stamps, glitter, and boxes to name a few. Each type of media has its unique place in the art therapy setting and can be used to enhance meaning and describe emotions based upon its texture or color. Malchiodi (2007) states:

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Creative Healing 76 Art therapists sometimes design art-making activities for their clients based on the characteristics of certain materials. For instance, some media are more fluid (for example, water colors, tempera or acrylic paints, or chalk pastels). These materials are easier to manipulate but harder to control because they are watery (such as paints) or powdery (such as chalk pastels). Some media, in contrast, are considered to be more resistive (for example, pencils, felt-tip markers, and cut-paper collage). These materials permit you to be more precise and detailed, and they are easier to control (p. 84). Regardless of the medium chosen, it is important that the artist feel comfortable and safe in the environment of creation. Age and ability need to be considered in the appropriateness for each media, and clients should be allowed enough time to work through a creative session. When there are plenty of materials and media to choose from, enough time for the client to express themselves creatively, and the client feels comfortable and safe that is when the healing process can begin as well as

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Creative Healing 77 continue in a productive and conducive manner for recovery, connections, and in depth soul searching.

Creative Art Techniques There are as many techniques in art therapy and the expressive arts as there are media to use in these techniques. When you combine the materials and media used in differing ways with each technique there are a multitude of variations that can also be included. Listed below are several techniques used in art therapy and the expressive arts. Again, this is by no means an exhaustive list, as creative art can come in many forms. Techniques are listed alphabetically.

Body Movement/Dance Some type or form of dance exists in almost every culture. It is a way to celebrate, a way to exercise, and it is a way to express oneself without words. “Dance/Movement Therapy is the psychotherapeutic use of movement as the process which furthers the emotional, social, cognitive, and physical integration of the individual” (American Dance Therapy Association, 2009). Physical movement can help to alleviate pain, it can

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Creative Healing 78 increase blood flow, and it can help to decrease both physical and mental ailments. The use of dance or movement has the power to increase awareness physically and mentally. Dancing or body movement can be incorporated into other techniques as well and can enhance or help to get the ‘creative juices’ flowing. An example of movement used in the expressive art setting could be listening to the beat of a drum or another instrument and moving one’s body spontaneously to the rhythm that resonates within the self. A person could respond with physical movement or dance that can release emotions and pent up energy as well as using the movements to produce an image on paper with paint while using expressive body movements to create brush strokes onto a canvas.

Collage Malchiodi (2007) explains that: Collage involves adhering papers, found objects, or other materials onto a flat surface, such as heavy paper, cardboard, or wood. Common materials for collage include newspapers, magazine pictures, tissue paper, fabric, and string, as well as found materials,

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Creative Healing 79 such as grasses, tree bark, shells, twigs, and other natural objects. Collage is a popular modality for art therapy because it appeals to people who are intimidated by drawing or painting (p. 91-92). There are specific programs that have been designed around this technique, such as Soul Collage ®, created by Seena Frost (2003). In this collage activity Frost explains that: You make your own deck of cards – each collage card representing one aspect of your personality or Soul. Use the collage cards intuitively to answer life’s questions and participate in self-discovery. Joyfully deepen your understanding of the relationships between your personality parts, you and your family/community/world, and you and your dreams, symbols, and Spirit (¶ 2).

Doll/Puppet Making Doll or puppet making can be used in the expressive art setting to facilitate healing and growth in many areas such as the healing of past trauma, to develop an understanding and value of family and/or self, and to gain insight and set goals for the future and self care. A

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Creative Healing 80 variety of materials and medium can be used to create the dolls that will also add symbolic and spiritual meaning to each creation. Pinkola (2003) states that: For centuries humans have felt that dolls emanate both holiness and manna – an awesome and compelling prescience which acts upon a person, changing them spiritually. Dolls are believed to be infused with life by their makers. They are used as makers of authority and talismans to remind one of one’s own power (p. 88-89). Doll or puppet making can be used to more easily aid the discussion of inner feelings of fear or trauma that can be brought out while using the created self representation as a puppet or storyteller. Doll or puppet making can also address the need for inner self care and nurturing, as well as to help the client in creating a sense of self worth and empowerment.

Drama Therapy/Psychodrama Drama therapy or psychodrama can be used in an individual or group setting. Clients can act out or reenact particular scenes from their lives or experiences that they struggle with in a safe environment to either deal with

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Creative Healing 81 past issues that have not been resolved or to aid in giving them confidence in future circumstances that they might experience.

Using drama as a technique, gives the

client a chance to experiment with alternatives and to create new scenarios as well as become confident in their interaction with others. Emunah (1997) explains that: In a sense, the client is both clothed in colorful costumes, offering an array of new possibilities, and also bared as she or he unravels and reveals core issues. In the context of a therapeutic relationship, the raw material of the client's imagination and real life is creatively concretized and gradually transformed. The therapist's artistry in interweaving the essential elements of drama therapy and psychodrama helps the client to become an artist empowered to express and master the raw material and to generate new sources for renewal (p. 108).

Drawing Drawing can be used in a variety of settings and is one of the more simple techniques that can be used with most individuals. Pencils, markers, crayons, chalk and other forms of media can be used with this technique 81

Creative Healing 82 depending on the client’s preference or the therapist’s goals in the session. Buchalter (2004) states that: Drawing allows the client to express problems, feelings, fears, wishes and concerns in a nonthreatening manner. Unconscious material, which was previously hidden from exploration, is often depicted in many of the drawings. The artwork enables the individual to communicate symbolically as well as verbally. It affords the client a wealth of symbolism and images which he or she may relate to and learn from. Images serve as vehicles, which facilitate communication, growth, and insight (p. 26). There are many specific assessments that incorporate some type of drawing including art assessments such as the Draw-A-Person (D-A-P) or House-Tree-Person (H-T-P), created by Goodenough (1926) and Buck (1948) as a way to assess intelligence and/or personality through drawings. There are many specific creative techniques that use drawing as the tool for therapy. One of these examples is the Rosebush Fantasy. The Rosebush Fantasy technique involves the creation of an image of a rosebush produced by the client which represents themselves. The therapist can ask the client

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Creative Healing 83 what color the rosebush is, what environment it lives in, whether it is flourishing, if it has thorns, where is it located, or what is the weather and other environmental factors surrounding it. Stevens (1971) created the Rosebush Identification Fantasy as a way for adults to reconnect with unpleasant aspects of their experience that they have alienated from their awareness and that are creating distress for them. By imagining themselves as a rosebush, participants project disowned aspects of themselves onto the rosebush and then can re-identify with, or "re-own," these aspects by identifying with the experiences of the rosebush. Having more complete access to their entire experience and self-image allows participants to experience less confusion and less distress (cited in Ray, Perkins, & Oden, 2004, p. 277-282).

Dreamwork Dreamwork is a technique used to study one’s dreams – both sleeping ones and day dreams. The belief is that by analyzing or finding meaning and metaphor in our dreams, we can learn about what our sub-conscious is trying to convey 83

Creative Healing 84 to us or teach us. Drawing images from a dream can help to put meaning to life struggles and can help the client to find symbols and relationships in their waking reality. Sharing dreams with others such as a therapist or other group members can also invite other perspective or insight although in general, it is only the dreamer that can ultimately interpret any dream. Dushman and Sutherland (1997) state that: Dreams reflect the creative potential of the dreamer and thus help us understand that we are responsible for the meaning we give to life events. We can attribute more than one meaning to a dream, or we can change the meaning of the dream over time. If we carry the message of the dream with us, we can give new meaning to it based on what is going on in our lives at the moment. Dreams hold the potential to understanding ourselves and the conflicts we create in waking life (p. 461). An example of using dreamwork in an expressive art setting would be to keep a dream journal and use it as a means for choosing artistic subject and material to create. A client could use symbols or pictures from a dream to create a sculpture, painting, or drawing as a way to bring

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Creative Healing 85 or find meaning to something that has come from within them. This physical representation of a symbol or picture from a dream could give the client a more in depth way to look at things and give opportunity for further growth and investigation on areas of need in the client’s life.

Guided Imagery Myrick and Myrick (1993) state that: In guided imagery, a person is led through a thinking process by a leader who provides stimulus words or sounds that serve as catalysts. Participants create mental pictures or reflect on a series of imagined events. Some have called the process a guided fantasy. Others refer to it as a structured daydream or image. The leader's words and comments guide participants through a personal experience. All the images or mental pictures are self-generated by whoever is listening to the stimulus words or sounds. Although individuals vary in their ability to produce mental images and to feel comfortable with imagery, these are skills that can be improved through teaching and practice (p. 62).

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Creative Healing 86 This technique can be used to help reduce stress and to create a sense of relaxation. Guided imagery can be used by clients at times of extreme anxiety in order to bring back a sense of calmness or grounding. This technique can also help to invoke vivid imagery that can be used in other creative activities such as painting, drawing, or sculpture.

Life Mapping Life mapping is the technique of creating a visual and/or written representation of past, present, and future goals, struggles, and dreams. In essence it is exactly like choosing to travel to a far away destination (the future) and setting out to get there in the most effective and efficient route. Metaphorically speaking there could be landmarks, detours, dead ends, or dream vacation spots, etc. In creating a life map, one can look back to the past to see where “wrong turns” have been made or look to the future as to which routes would take you to your destination in the shortest amount of traveling time. Life mapping can be simple with a horizontal line drawing with explanations at different marks along the line, or it can be as intricate as creating alternate routes, deciding what

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Creative Healing 87 necessities will need to be “packed” in order to ensure a more comfortable and safe trip. Basically this technique invites the client to vision and create goals and objectives by using experience from the past as well as plans for the future in order to accomplish the dreams and aspirations that one is seeking in life. An example of a life map is a road drawing. Road drawings can be used as a metaphor for the client’s life story and can be drawn to represent the past, present, and future. This technique can also be used as a tool to gauge what level or stage of emotion the client may be at, which can lead to further discussion of past trauma that needs healing or possible issues the client is facing. Hanes (1995) explains that: Road drawings have the potential to reflect the client's origins, the history of his or her life process, and intent for the future--even in just a single drawing. This theme provides an opportunity for clients to literally draw their "road of life." Additionally, the periodic upgrade of the road lends itself to the therapeutic process: Potholes can be repaired, alternate paths built, and warning signs erected to prepare for future events that may occur. Only the client can ultimately understand the full

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Creative Healing 88 significance of his or her own road drawing; thus, premature interpretations can easily impede the natural unfolding of this deeper meaning (p. 19).

Journaling Journaling can come in many forms as well such as an image journal with sketches or paper images collected from magazines. They can include brief words or phrases of inspiration or feelings, they can be a daily recording of your thoughts, or they can be wordless. “Emotional hurts, physical suffering, and even constructive growth can all be approached and understood through the routine use of a journal” (Soneff, 2008, p. 6). Rogers (1993) states that “many people keep a diary or journal to allow for personal and spiritual development. Through creating images and writing, we become aware of our feelings and our patterns of behavior. Out of this comes self-understanding and empowerment” (p. 35-36). Soneff (2008) goes on to say that: Peace, calm, and resolve are often found in the sweet, quiet moments garnered for introspective journaling. Simply structuring an environment that fosters real and honest reflection (a private, undisturbed space and time) helps breed tranquility. Furthermore, that 88

Creative Healing 89 tranquility will be compounded by the rhythmic qualities of simply creating. Brushing paint in backand-forth strokes, dipping a calligraphic pen in an inkwell, punching out shapes, and peeling off stickers all supply a tactile distraction in which the hands are busy and the mind is free. In this precise place of mental liberation, and out of this realm of inaudible expression, a healing balm is concocted from your own artistic well and applied, not just to paper but to your soul (p. 8).

Mandalas A mandala is a sacred circle that has come to represent many things such as: wholeness, nature, spirituality, journey, time, community, and universe. Creating one can be a way to release anxiety or stress and can bring meaning and symbolism to one’s creativity. Gauding (2005) reports that: Coloring or creating intricate designs demands mental focus and concentration – similar to the concentration you can develop during meditation. This focus naturally causes you to suspend your mental chatter; and quieting your inner dialogue creates an interval 89

Creative Healing 90 of calm during which you can develop awareness of your thought patterns (p. 21). Clients can design a mandala from scratch or they can color in pre-designed mandalas. Choice of color and images can be used as a therapeutic tool to determine a client’s inner feelings.

Mask Making Mask-making is an exciting and powerful adventure that finds its roots in the initiation ceremonies of indigenous cultures (Andrews, 1992). Snyder (1997) states that: Having clients make their masks is a journey along their own personal path toward spiritual evolution, especially if done immediately after the counselor provides guided imagery that sets the stage for this to happen. Mask-making involves clients discovering who they are on the deepest levels. To make a mask requires clients to know the difference between their persona (or false self) and who they are at their core. The mask becomes a bridge between the physical world of everyday life and the spiritual world that encompasses the healing dimensions of reality (p. 74).

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Creative Healing 91 Murals Murals are typically used in a group setting to allow and encourage socialization and group participation by each member. Buchalter (2004) adds that: Designing murals increases socialization and cohesiveness within the group. Problem-solving skills are enhanced and self-esteem among group members is raised. The mural images may be drawn, painted, or glued on. Each client gets a chance to draw, for instance, his or her idea, and then speak about his or her drawing. The art is explored both in terms of the individual’s self-expression and his or her contribution to the overall picture. Murals provide patients with a non-threatening method of expressing themselves and socializing with others (p. 16-17).

Music “Music therapy techniques can involve making music, listening to music, writing songs, and talking about lyrics. Some of its applications are to help the patient articulate difficult emotions or to aid in relaxation”

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Creative Healing 92 (Schimelpfening, 2008). Kemper and Danhauer (2005) explain that: Music plays a central role in all human cultures. It has direct and indirect effects on physiology and clinical symptoms. Carefully selected music can reduce stress, enhance a sense of comfort and relaxation, offer distraction from pain, and enhance clinical performance (p. 282-288). Getting clients involved in music making is also a technique that can be applied to a group setting that will allow for group participation and positive socialization as well as a sense of pride in creating something together that could not be done individually. Music therapy can be used in an active role, where the client participates in singing, playing an instrument, or even dancing or moving to music. Music can also be used with clients in an inactive role, where the client is at rest or involved in another project and simply listens or relaxes to the music being played.

Painting Painting, like drawing, lends itself to many variations. Water colors, acrylics, and oils can be used and/or mixed with other media such as crayons or pastels to 92

Creative Healing 93 create other interesting effects. Buchalter (2004) states that: Paint allows the client a spontaneous, free-flowing method of portraying thoughts and feelings. It is less structured than pencil, crayons or pastel, and gives the client the opportunity to mix colors and to experiment artistically. The client can be messy if he or she chooses to do so; it is acceptable in this creative environment (p. 75). There are also unique programs that have been created using painting techniques, such as Touch Drawing ®, created by Deborah Koff-Chapin (2009). Koff-Chapin explains that:

Touch Drawing is a simple yet profound process where the fingers take the place of pen or brush. Paper is placed over a freshly painted surface. Wherever it is touched, an imprint is made on the back side. Impulses from within take form on paper through the movement of the fingertips on the page. A multitude of drawings can be created in one session, each a stepping stone to the next; guiding progressively deeper into the self. Through this direct drawing process, even the least confident artist can experience interior images coming alive on the page. The hands become organic

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Creative Healing 94 extensions of the soul, moving freely in response to the sensations of the moment. In a medium as immediate and transparent as Touch Drawing, previously unused channels of expression are opened, enabling uncensored feelings to flow forth. The act of creating with these feelings provides more than cathartic release: it unleashes vibrant healing forces which guide the psyche toward wholeness. Touch Drawing is a practice of creative, psychological and spiritual integration (¶ 1).

Photography McNiff (2004) states that: Photography can help us become more aware of our environments. The camera has a unique ability to hold moments of perception and thus to help us see endless possibilities for perceptual awareness within the movement of time (p. 57). Whether one works with a collection of photographs in a scrapbooking or photo album manner, or one takes photographs with which to create things; photography can be a technique that helps one to reflect on symbols and images

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Creative Healing 95 around us, as well as concepts of time, both past and present. McNiff (2004) goes on to explain that: When we look deeply at things, we get outside ourselves and become immersed in the object of contemplation. This meditation brings new and vital energy into our lives. We stop running from one thing to another and become completely present to the process of reflection (p. 57). Like the famous saying states: “A picture is worth a thousand words” - photography can allow us to chronicle and document our journey in a way that words simply cannot compare to. In Photo Therapy clients are encouraged to use family snapshots and other pictures from the past to present their life story. Weiser (2001) reports that: A lot can be learned as they talk about what their snapshots are about emotionally, in addition to what they are of visually. In reviewing their personal and family snapshots, or hearing the feedback of others' responses to these images, clients often learn things about themselves that they were not conscious of when they first acquired or took the photographs. Things that are later obviously visible were perhaps only

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Creative Healing 96 potentially "there" at the original moment of "timefreezing" (p. 10).

Ritual/Ceremony Ritual or ceremony in therapy or technique can be used to describe the process or act of turning an action or creation into a type of outward sacredness. Malchiodi (2007) explains that: Healing rituals frequently involve support and the presence of a group or community of individuals and often involve imagery as part of the experience. For example, the Navajo people create elaborate sand paintings for specific healing purposes and, as part of the process, family and friends gather to witness and participate in the event. Visual objects and images are often used by groups to honor, commemorate, or make closure with a death or memorable experience (p. 193). Rituals and ceremony can take place in an individual, group, or community setting and can be created for a variety of reasons. Rituals generally are used to create a deeper and connected meaning to the practice that is being

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Creative Healing 97 done or the creation that is being created. Another example of a ritual or ceremony is the labyrinth, an intricate symbol that can be represented on a small or large scale which can symbolize the path of life, journey, or particular goal or struggle that a client is working with at that moment.

“When a client creates a ritual as an

expression of his or her spiritual faith, the client creates metaphorical symbols that are concrete manifestations of the client’s personal power and of the therapeutic goals of psychological healing” (Cole, 2003, p. 184).

Sand Tray Therapy Although sand therapy is typically used with children, there are ways that this technique can be used with adults. Carrell (2001) explains how she uses sand therapy with adults in creating a family genogram, while explaining to the client the following: It encourages you to express an extremely important part of your life in a way that is quite different from writing about it or talking about it. Rather than working from your logical, linear thought processes, you can work from a different, perhaps more creative 97

Creative Healing 98 process of expression. In expressing this material from your past in a different way, you may learn something new about you or your family (p. 19). Clients can use figurines such as cartoon characters, dolls, fairy tale characters, animals or birds, action superheroes, fictional characters, and religious characters to represent members of their family. The therapist and the client can gain insight into the client’s family structure, struggles, and other issues that may not have been discovered in typical talk therapy.

Sculpture The technique of sculpture can be used with a wide variety of materials such as clay, ceramics, wood, paper Mache, wire, and even food. Buchalter (2004) explains that: Engaging in sculpture design allows clients to see things three-dimensionally. Observing a form in all of its aspects – front, back, sides, top and bottom – encourages individuals to broaden the way they view life; to see situations from more than one vantage point. Abstract thinking is focused upon; this gives the client the ability to explore his or her problems

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Creative Healing 99 from many perspectives. He/She learns that life has gray areas; everything is not black and white. Sculptures, mobiles, and dioramas give the individual the opportunity to mod, shape, build and manipulate his or her environment (p. 97). With sculpting media such as clay clients can relieve stress, anxiety, anger, fear, frustration, and other feelings that are kept pent up inside by manipulating or pounding the clay into shapes or forms. “Because clay is a tactile material, it engages the senses – sight, touch, sound, and smell” (Malchiodi, 2007, p. 103). Buchalter (2004) goes on to say that: Working with clay gives the client the opportunity to “get dirty,” to freely express himself/herself. Feelings may be expressed in a variety of ways. The client becomes the master of the clay; he or she is in control of it (p. 104).

Writing/Poetry Creative writing or poetry uses words as a way to express thoughts and feelings with words in a way that can be easier than speaking those words. Putting our thoughts

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Creative Healing100 and feelings on paper can help clients to remember ideas, reflect on emotions, and to create a sense of ownership to thoughts and feelings expressed. Writing and poetry can help to free and open up stagnant or stuck thoughts as well as to bring voice to words or issues that have remained unspoken. In her book, The Artist’s Way, Julia Cameron (1992) uses what she calls “Morning Pages” as a tool for creativity, reflection, and motivation. She encourages a free-form of writing with no structure, no rules, and no expectations. Whatever comes to your mind or doesn’t, is written down by hand in three pages each morning. These pages can be a discussion with oneself, they can be a wish list, and they can even be written complaints. The purpose is just to write to get out the thoughts that are within oneself onto paper, and therefore ultimately into action. Cameron (1992) states that: Morning pages map our own interior. Without them, our dreams may remain terra incognita. Using them, the light of insight is coupled with power for expansive change. It is very difficult to complain about a situation morning after morning, month after month, without being moved to constructive action. The pages lead us out of despair and into undreamed solutions (p. 30).

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Creative Healing101 Creative writing and poetry can help clients to express feelings of joy, sorrow, happiness, or regret and help them to celebrate, remember, plan, honor, or simply acknowledge life. Poetry and creative writing allows for sharing with a sense of understanding when another reader can connect to the emotions that are being presented by the writer. The writer can also read and re-read their own work in order to reflect and move forward with gained insight and understanding of their emotions and struggles.

Summary of Literature Review In my search to find specific techniques, theories, and medium in the creative arts that addressed ameliorating the symptoms of depression and anxiety, I discovered that the amount of research designed to give solid empirical evidence of any specific technique or practice to reduce these symptoms was lacking. There were many case studies that gave evidence to the beneficial outcomes of artistic creativity regarding these symptoms, however, these studies were directed towards the general goal of proving that expressive arts or art therapy in general aided in the amelioration of symptoms, other than one specific technique or medium being tested for this validation. Although specific techniques and medium were used in each case

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Creative Healing102 study, the studies were not designed to prove the benefits of these particular approaches or the materials used in them, but rather to prove the use of any artistic creativity as a form of healing and symptom amelioration. Thus my literature review validated more of the fact that techniques in art therapy, expressive arts, and other forms of creative expression can be used for tools in reaching therapeutic goals, or they can be therapy in a stand alone environment. There are different theories, different ways to apply or approach the theories, and even different ways to view the work created during therapy. Although there are a myriad of techniques and applications in the creative process and just as many unique therapists to apply these approaches, all seem to agree on one thing, that the use of expressive arts in a creative and comfortable environment has many therapeutic benefits. Not only can the creative process with its unlimited forms of applications and approaches promote healing and ameliorate symptoms of depression and anxiety, it can provide opportunities for the client to open up in ways that are not possible through traditional forms of verbal therapy. Creativity and expressive art helps to get in touch with one’s deepest thoughts and feelings from both the

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Creative Healing103 conscious and the subconscious. Dreamer (2005) shares her concept of why the act of creating can be so healing when she stated: We create as a way to be with what is hard and beautiful and unexpected without closing our hearts or pretending something else is true, as a way of easing the suffering that comes when we fight with or try to hang on to what is. And as we create we make it all – the sorrow and the joy, the failed efforts and the places of ease – count. Our stories and images and sounds create, explicate, or point to a deeper meaning that helps us receive, celebrate, and be fed by beauty and bear what is hard (p. 14). Although specific results regarding particular techniques or medium being used to decrease depression and anxiety in an art therapy setting were not discovered, there were ideas gleaned from these studies that did use particular techniques and media that evidenced the general use of art therapy in decreasing these symptoms. Therefore, although further studies may need to be conducted with this particular goal in mind, it is also an optimistic discovery that most forms of creative expression will aid in the

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Creative Healing104 decreasing of these specific symptoms. The Association Des Art-Therapeutes Du Quebec (2007) sums it by stating: When making art in a supportive environment, individuals are helped to engage in an experience which can be absorbing and enjoyable. Creative activity can help to lower stress and intrusive negative thinking, as well as increase confidence, concentration and positive feelings. This learning transfers readily to other areas of life (Section 2, ¶ 2).

“Sorceress” by John William Waterhouse

“The most important of life's battles is the one we fight daily in the silent chambers of the soul.” - David O. McKay 104

Creative Healing105 Chapter 3: Methodology “It is sometimes the most fragile things that have the power to endure and become sources of strength.” – May Sarton

Design This project was designed to gather information regarding which best practices used in the expressive arts specifically address the amelioration of depression and anxiety symptoms. An extensive literature review was conducted as well as a brief questionnaire that would be distributed to past and current art therapists in order to review case studies, quantitative data, qualitative data, and professional opinion in order to gather relevant and reliable information regarding this subject.

This

information was then used to develop a 12-week art therapy curriculum (see Appendix E) directed towards reducing the specific symptoms of depression and anxiety in the adult population within an individual or group setting.

Research As a qualitative study, the research and results reported in this thesis address both qualitative and

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Creative Healing106 quantitative perspectives of the amelioration of depression and anxiety in the adult population. The research for the literature review and the art therapy survey were conducted over a year’s period between May 2008 and May 2009. During the literature review, relevant and reliable books were studied, professional journals were searched, videos were viewed, and case studies were examined in order to gain a vast array of information regarding the topic of art therapy, anxiety, and depression. The literature review was conducted to gather information from previous similar research designs that reported both qualitative and quantitative material regarding decreased symptoms of depression and anxiety in an art therapy or creative healing setting within the adult population. Research was examined for the use of specific techniques which resulted in the decrease of these particular symptoms. A brief questionnaire (Appendix A) was also developed and distributed to current and previous art therapy counselors and directors to address the question of which techniques and medium they have used in an expressive art setting that helped to ameliorate depression and anxiety

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Creative Healing107 symptoms in the adult population. This qualitative and experiential data was then analyzed in order to gain insight regarding the specific techniques and media used by these therapists in an art therapy setting that they believed decreased symptoms of depression and anxiety. Results from the literature review and the questionnaire were then used to create a 12-week expressive art curriculum specifically designed to target and decrease symptoms of anxiety and depression in the adult population.

Data Collection Data collection for the literature study was comprised of case studies from published literature including educational books and professional journals. Data collections for the questionnaires were distributed in the form of a survey that this author created (Appendix A) to gather experiential knowledge and professional opinion. Participants of the questionnaire completed consent forms and the survey and then mailed or faxed the completed forms to this author. The questionnaire included 20 multiple choice questions and 2 essay questions about specific techniques and media used in the art therapy setting that

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Creative Healing108 were believed to decrease anxiety and depression symptoms in the adult population through the means of art therapy.

Participants This author originally received feedback from 15 past and previous art therapists across the United States that were willing to participate in this brief questionnaire. Participants were both randomly selected from an internet search as well as purposefully selected from this author’s knowledge of their previous work through direct interaction with them during the two year period of teaching an art therapy group at a community mental health clinic during the period between 2007 and 2009. Seven of the original fifteen willing participants completed the survey and returned it to this writer in the three-month time frame allotted for this particular portion of research. Participants were not compensated in any manner for their time or their knowledge. They were asked to spend no more than one half hour of their time to complete this survey. Each participant signed a consent form stating that they understood that their experiential knowledge and opinions would be used in this study in order to create an art

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Creative Healing109 therapy curriculum designed to ameliorate the symptoms of depression and anxiety. Completed questionnaires were mailed or faxed to this author.

Data Analysis During the literature study, data were analyzed after case studies were gathered regarding art therapy, depression, and anxiety. This author then only used the case studies in which specific art therapy techniques and media were used with patients that led to a decrease in either depression, anxiety, or both depression and anxiety symptoms. A summary of these particular case studies are reported in the literature review and also displayed in a list form (Figures 1-4) in the final results. The raw data for the 20 structured questions in the survey are reported in percentages and displayed in a bar graph form (Figure 5). The 2 unstructured questions in the survey are reported in a narrative list form (Figure 6). A narrative summary is given for each graphical representation as well. Raw data from the literature review and the questionnaire were analyzed to determine which specific techniques or medium were used in previous case studies

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Creative Healing110 that decreased symptoms of anxiety and/or depression as well as which techniques and medium choices scored highest or were mentioned more amongst the art therapists’ questionnaires. Techniques and medium that were reported more often in the case studies and the questionnaires were then incorporated into a 12-week art therapy curriculum (Appendix E) geared towards decreasing the symptoms of depression and anxiety in the adult population.

Summary of Methodology This chapter has explained the methods used by this author in the qualitative and quantitative research and study to gather and present information regarding which best practice techniques and use of medium in an art therapy setting have aided in the decreased measure of depression and anxiety in the adult population. The next chapter will present the results obtained by using these methods.

“And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom.” - Anais Nin

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Creative Healing111 Chapter 4: Results “It is in the knowledge of the genuine conditions of our lives that we must draw our strength to live and our reasons for living.” – Simone De Beauvoir

A Presentation of the Results As stated in Chapter 1, the purpose of this study was to gather information about which techniques or medium used in the art therapy or expressive art therapy setting have been viewed or reported to decrease the symptoms of depression and anxiety in the adult population. This information was then used to create a 12-week art therapy curriculum (Appendix E) designed to specifically address the symptoms of depression and anxiety in an effort to ameliorate these symptoms through the means of creative art. This chapter displays the results of the case studies in list form (Figures 1-4), the results from the questionnaire questions 1-20 in graph form (Figure 5), and questionnaire questions 21-22 in list form (Figure 6).

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Creative Healing112 Arriving at Outcomes Outcomes were reached by using available and gathered raw data from previous case studies that fit the criteria of this research and by gathering and organizing the bits of data from each questionnaire which was then represented in lists and a graph displaying the data gathered.

Significance and Uniqueness about this Study Although there have been case studies that report the overall effectiveness of art therapy or expressive arts in decreasing the symptoms of depression and anxiety in the adult population, this author did not find other studies that specifically addressed the question of which specific techniques or medium were used in the art therapy setting that would target the amelioration of these particular symptoms. Thus, information gathered from this study addresses the amelioration of depression and anxiety symptoms in an art therapy setting in a way that is unique to other similar studies in this field. Similar studies have reported similar results, but only with the information that art therapy or expressive arts in general have been used to decrease the symptoms of depression and anxiety. Whereas this study discusses the specific techniques and medium used in the art therapy or

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Creative Healing113 expressive art process and setting to determine whether there may be best practices or preferred techniques or medium used to reach the goal of decreased depression and anxiety symptoms.

Representation of Results Case Study Results The case studies that were listed in Chapter 2 resulted from an extensive search regarding which forms of art therapy techniques or medium have been used in a therapeutic setting to decrease symptoms of anxiety and depression. The following lists display the data gathered from four case studies where creative arts were used in a therapeutic setting with the adult population resulting in a decrease of anxiety, depression, or anxiety and depression symptoms.

CASE STUDY 1: Mandalas and Depression Techniques:

Medium:

Coloring Drawing Mandalas

Paper Crayons Markers Printed Mandalas

Figure 1

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Creative Healing114 CASE STUDY 2: Painting, Depression and Anxiety Techniques:

Medium:

Painting Body Movement

Water-based Paints Paper Paintbrushes

Figure 2

CASE STUDY 3: Music, Depression and Anxiety Techniques:

Medium:

Music Body Movement

Music

Figure 3

CASE STUDY 4: Doll Making and Depression Techniques:

Medium:

Doll Making

Scissors Glue Paper Yarn Markers Fabric Buttons

Figure 4

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Creative Healing115 Questionnaire Results: Questions 1-20 The following graph (Figure 5) and lists (Figure 6 and 7) show which specific techniques and medium have been used by other current and past art therapists or art studio directors in an effort to decrease symptoms of depression and anxiety in the adult population. These results were gathered from the bits of data from the questionnaires that 7 art therapists or art studio directors completed. Each technique or medium was also rated by the therapist or director as to its effectiveness on decreasing symptoms of depression and/or anxiety. The following bar graph represents the gathered data from questions 1-20 of the questionnaire.

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0

1

2

3

4

5

6

0

2

Ceremony/Ritual

2

3 3

0

Drawing

4

0

0

3

Dreamwork

0

4

3

0 0

2

0

Life Mapping

2

3

2

1

1

Mask Making

3

Techniques and Medium Used

Guided Imagery

4

Questionnaire Results

4

0

Painting

3

0

1

0

Poetry

5

1

0

3

0

The Artist's Way

0

3

Has Definitely, Always Decreased Symptoms Has Sometimes Decreased Symptoms Has Rarely, Never Decreased Symptoms Has Not Used This Technique or Medium

Soul Collage

1

3

4

Creative Healing116

Figure 5

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N u m ber of Particip an ts

Creative Healing117 Questionnaire Results: Questions 21-22 The following are lists of techniques and medium from the data gathered from questions 21 and 22 of the questionnaire. Art therapists and art studio directors were asked to list any additional techniques or medium they use in an art therapy setting with the adult population in order to decrease symptoms of depression and/or anxiety. Techniques and medium are listed in alphabetical order.

Techniques

(Figure 6)

• Body Movement/Dance • Book Making • Collage • Crayon Resist • DBT Mindfulness (integrated with art therapy) • Doll/Puppet Making • Journaling • Labyrinth • Mandalas • Murals • Music • Origami • Printmaking

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Creative Healing118 • Psychodrama • Sand Tray • Sculpture • Weaving

Medium

(Figure 7)

• Animal Spirit Totem Cards • Clay • Mandalas • Music • Soft Pastels

A Summary of the Results The results gathered from this research indicate that there are several techniques used in the expressive art setting that have aided in the amelioration of depression and anxiety. The medium used in the case studies appear not to be directly connected to the results, however, the questionnaires give specific examples of medium that have been used to decrease depression and anxiety symptoms. A more detailed and in depth summary of the findings from this research will be presented in the next chapter.

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Creative Healing119 Chapter 5: Summary and Discussion “Your vision will become clear only when you look into your heart. Who looks outside, dreams. Who looks inside, awakens.” – Carl Jung

Reflection on Research and Results This study was designed in an attempt to discover which best practices and/or proven and preferred techniques or medium used in an art therapy setting with the adult population lead to an amelioration of symptoms of depression and/or anxiety. The findings of this research was then used to create an art therapy curriculum (see Appendix E) specifically aimed towards decreasing the symptoms of anxiety and/or depression. Raw data was gathered in this research through a literature study/review, research on previous case studies, and a questionnaire developed and distributed by this author to previous and current art therapists and art directors in the United States. The gathered data was analyzed and placed into visual representations including graphs and lists (See Figures 1-7) presenting the results from the author’s findings regarding which techniques or medium work best in an art therapy setting to decrease symptoms of depression and/or anxiety.

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Creative Healing120 During the research process of this study, the author noted that case studies and literature that dealt with art or expressive art therapy which used any specific techniques or medium simply dealt with the fact that the therapy in general, or the creativity in general was the vehicle for decreasing symptoms of depression and anxiety and success or improvement was not necessarily connected to specific techniques or medium. The questionnaire (Appendix A) that was developed, specifically asks about techniques or medium in regards to decreased symptoms of anxiety and/or depression, however, 61% of the questions answered (see Figure 5) stated that the specific techniques or medium used only seemed to decrease these symptoms “sometimes.” There were a total of eight out of the ten techniques or medium included in the survey that received responses from the participants of “always” decreasing symptoms of anxiety and/or depression. These eight techniques and medium were: Ceremony/Ritual, Drawing, Guided Imagery, Life Mapping, Mask Making, Painting, Poetry, and Soul Collage. It should be noted, however, that only the categories of “Guided Imagery” and “Painting” received more responses in the “always” section over the other choices available. Also worth noting is the

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Creative Healing121 fact that there was only one response of “never” for any of the listed techniques or medium. This can be understood, however, by the likelihood of the art therapists or art directors using the techniques or medium listed in therapy or programs because they already had a belief or understanding that these particular techniques or medium were or have been effective tools in this setting. According to the findings of this research, this author believes that, due to the subjectivity of the questionnaire and the non-specific data gathered from the literature and case studies, that no conclusive or definite answers were reached in this study. However, the author does believe that the subjective answers, non-specific data from the literature and case studies, as well as other suggestions and beliefs from the questionnaire participants were informative enough, albeit subjectively and nonspecific, to create a well-rounded and well-defined art therapy curriculum that targets the amelioration of depression and/or anxiety symptoms. As the outcome of this research project was to develop a 12-week art therapy curriculum (see Appendix E) with the findings from the research and study, this author believes that success was met with the completion of the curriculum.

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Creative Healing122 Successes with this Project As mentioned above, success was met in this project with the development of a 12-week art therapy curriculum (see Appendix E) designed to specifically decrease the symptoms of depression and/or anxiety in the adult population. The author was able to create the curriculum with the gathered information and data from the literature review, case study results, and the questionnaire data. Data and information from each section of the research was incorporated in the final 12-week art therapy curriculum. This author believes that use of this developed curriculum in the art therapy setting would prove to show a decrease in symptoms of anxiety and/or depression within the adult population. Therefore, although conclusive answers were not reached as to which specific techniques or medium would or have decreased symptoms of depression and anxiety in an art therapy setting, the developed curriculum incorporates several of the previous positive results in such a way that an improvement of symptoms in general would likely occur should this curriculum be used in an art therapy setting with the adult population.

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Creative Healing123 Struggles with this Project The difficulties met with the research conducted in this project were many. Literature and case studies seemed to focus on general outcomes of effectiveness not connected to specific techniques or medium. So, although specific techniques were used in each case study, the results presented did not define that the positive results were due to the use of a specific technique or medium more so than the general use of art therapy and creative projects in general. Where the questionnaires did address the specific nature of the decrease in depression and/or anxiety with the use of particular techniques or medium, the survey was subjective in nature and was also limited to a small sample size. From the 15 participants who were willing to participate in the initial process of this research, only 7 completed the survey in time to be used in the research results. In summary of the struggles that this author met with during the research, the limitations would include: the small sample size, the subjectivity of the data collection instrument with regards to the questionnaire, participant activity, and no other found similar research on the specific nature of this study to refer to or rely on.

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Creative Healing124 Areas for Future Research and Recommendations Due to the original question of this research, “Which art therapy or expressive art techniques or medium work best at decreasing symptoms of depression and/or anxiety,” not being conclusively or definitely answered in an empirical fashion; this author believes that further study and research directed towards this specific information is justified and called for. During the process of this research the author also pondered on the use of specific colors in regards to medium being used in an art therapy setting such as paint, crayons, markers, pencils, etc. in a connection to decreased levels of anxiety or depression. There have been previous case studies that have used the information about which colors the client uses in an art therapy setting being connected to their diagnosis, however, this author believes that further study and research could be directed to which colors, when being used in an art therapy setting with the adult population, could better lend to the amelioration of depression and/or anxiety symptoms.

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Creative Healing125 Concluding Thoughts Does it really matter which technique or medium is used in an art therapy setting for healing, recovery, and a decrease in symptoms to occur? There are those that state “definitely, always,” and those that have responded, “yes, sometimes.” Who is right? Can definite answers be concluded from this research question, or is it all a matter of subjectivity? This author believes that it is important for therapists to be aware of best practice techniques being used in any setting, but most of all, it is a subjective matter to be addressed once the client or group members and the therapist have met, made connections, and from there discovered, learned, and understood what the client(s) needed based upon their unique and individual circumstances. Rubin (2001) states that: As for the single best “technique” in art therapy, I think family art therapy pioneer Hanna Kwiatkowska said it best. My strong conviction is that “the only technique of art therapy is the technique of relating to a patient through art” (p. 347). Rubin (2001) goes on to say that: There are very good reasons for having more than one way to look at the infinitely complex phenomena of

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Creative Healing126 people and their art. Simply put, the more extensive any art therapist’s understanding of different approaches, the more clinical lenses she has with which to see (p. 350). The important thing is to be aware of and have knowledge of the techniques and medium that are available so that a client can have the best opportunity to heal, recover, and decrease symptoms from the information that is known and available. It is this author’s concluding belief that there may be some specific techniques or medium that work best at decreasing symptoms of depression and anxiety in the adult population, but that these things are only the tools in which to create the foundation for creative healing to occur. This author believes that the best practice to be applied to the expressive art or art therapy setting in an effort to decrease symptoms of anxiety and depression would be to incorporate creative healing activities into the client’s daily or weekly life. Whether that is through the use of the developed 12-week art therapy curriculum that was created during this research, or any other form of creative activity in the client’s life, it is the daily/weekly creative activities that will ultimately lead

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Creative Healing127 to positive therapeutic benefits (see Appendix C) as well as the amelioration and significant decrease of anxiety and/or depression symptoms of the client.

“Ophelia” by John William Waterhouse

“In every block of marble I see a statue; See it as plainly as though it stood before me, Shaped and perfect in attitude and action. I have only to hew away the rough walls Which imprison the lovely apparition To reveal it to other eyes, as mine already see it.” - Michelangelo

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Creative Healing128 Appendix A: Questionnaire

Questionnaire 1. Do you use or have you used the program Soul Collage ® in your therapy?

Yes ________

No _______

2. If you use or have used Soul Collage ® in your therapy, do you find the process to ameliorate symptoms of depression and/or anxiety? A. B. C.

Definitely, Always _______ Yes, Sometimes __________ Rarely, Never ____________

3. Do you use or have you used the program The Artist’s Way ® in your therapy?

Yes _______

No _______

4. If you use or have used The Artist’s Way ® in your therapy, do you find the process to ameliorate symptoms of depression and/or anxiety? A. B. C.

Definitely, Always _______ Yes, Sometimes _________ Rarely, Never ___________

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Creative Healing129 5. Do you use or have you used painting in your therapy?

Yes ________

No _______

6. If you use or have used painting in your therapy, do you find the process to ameliorate symptoms of depression and/or anxiety? A. B. C.

Definitely, Always _______ Yes, Sometimes _________ Rarely, Never ___________

7. Do you use or have you used drawing in your therapy?

Yes ________

No _______

8. If you use or have used drawing in your therapy, do you find the process to ameliorate symptoms of depression and/or anxiety? A. B. C.

Definitely, Always _______ Yes, Sometimes _________ Rarely, Never ___________

9. Do you use or have you used Life Mapping in your therapy?

Yes ________

No _______ 129

Creative Healing130 10. If you use or have used Life Mapping in your therapy, do you find the process to ameliorate symptoms of depression and/or anxiety? A. B. C.

Definitely, Always _______ Yes, Sometimes _________ Rarely, Never ___________

11. Do you use or have you used Dreamwork in your therapy?

Yes ________

No _______

12. If you use or have used Dreamwork in your therapy, do you find the process to ameliorate symptoms of depression and/or anxiety? A. B. C.

Definitely, Always _______ Yes, Sometimes _________ Rarely, Never ___________

13. Do you use or have you used Guided Imagery in your therapy?

Yes ________

No _______

14. If you use or have used Guided Imagery in your therapy, do you find the process to ameliorate symptoms of depression and/or anxiety? A. B. C.

Definitely, Always _______ Yes, Sometimes _________ Rarely, Never ___________ 130

Creative Healing131 15. Do you use or have you used Ceremony/Ritual in your therapy?

Yes ________

No _______

16. If you use or have used Ceremony/Ritual in your therapy, do you find the process to ameliorate symptoms of depression and/or anxiety? A. B. C.

Definitely, Always _______ Yes, Sometimes _________ Rarely, Never ___________

17. Do you use or have you used Mask Making in your therapy?

Yes ________

No _______

18. If you use or have used Mask Making in your therapy, do you find the process to ameliorate symptoms of depression and/or anxiety? A. B. C.

Definitely, Always _______ Yes, Sometimes _________ Rarely, Never ___________

19. Do you use or have you used Poetry in your therapy?

Yes ________

No _______

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Creative Healing132 20. If you use or have used Poetry in your therapy, do you find the process to ameliorate symptoms of depression and/or anxiety? A. B. C.

Definitely, Always _______ Yes, Sometimes _________ Rarely, Never ___________

21. Are there any other specific expressive art therapy programs or techniques that you have found to be effective in ameliorating symptoms of depression and/or anxiety with your clients?

22. Are there any other specific expressive art therapy media that you use and have found to be effective in ameliorating symptoms of depression and/or anxiety with your clients?

“One ship sails east and one sails west By the self-same wind that blows; Tis the set of the sail and not the gale That determines the way it goes. Like the ships of the sea are the ways of fate As we voyage along through life; Tis the set of the soul that determines the goal And not the calm or the strife.” - Ella Wheeler Wilcox

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Creative Healing133 Appendix B: Informed Consent

Informed Consent Creative Healing: An Expressive Art Therapy Curriculum Designed to Decrease the Symptoms of Depression and Anxiety You are being invited to take part in a research study. The information in this form is provided to help you decide whether or not to take part. Study personnel will be available to answer your questions and provide additional information. If you decide to take part in the study, you will be asked to sign this consent form. A copy of this form will be given to you. What is the purpose of this research study? The purpose of the research study is to gain an overview of current expressive art therapy programs and techniques being used in an expressive art therapy studio setting with an adult population. This research will also help to define which expressive art therapy programs and techniques the therapists/participants believe to be effective. The information gained in this project will help to create a proposed expressive art therapy curriculum designed to ameliorate the symptoms of depression and/or anxiety in the adult population within an art therapy setting. Why are you being asked to participate? You are being invited to participate because you are a therapist or someone who has previously used or is currently using an expressive art therapy program or technique in your practice or work with an adult population. If you agree to participate, your participation will involve one interview and/or survey about the specific expressive art therapy programs or techniques you use with your adult client population and your perceived effectiveness of each specific program or technique that you use in an expressive art therapy setting with your adult clients. Your participation time will take no more than one half hour and will be conducted at a time that is convenient to you. How many people will be asked to participate in this study? Approximately 15 to 25 other art therapists or art therapy directors will be asked to participate in this research. How long will I be in this study? This project will take approximately two to three months to be completed. Participants will be asked to spend no more than one half hour of their time for interviews or surveys. Participant’s Initials _______

Page 1 of 3

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Creative Healing134 Are there any risks to me? The things that you will be doing have little to no risk to yourself or other participants. Although we have tried to avoid risks, you may feel that some questions we ask will be stressful or upsetting. If this occurs you can stop participating immediately. Are there any benefits to me? You will not receive any benefit from taking part in this study. Will there be any costs to me? Aside from your time, there are no costs for taking part in this study. Will I be paid to participate in the study? There will be no compensation for this study. Will video or audio recordings be made of me during the study? No. Will the information that is obtained from me be kept confidential? The only persons who will know that you participated in this study will be the research team members: Janet Lee O’Connor, Del Worley, and Laura Brinckerhoff. Your records will be confidential. You or your facility will not be identified in any reports or publications resulting from the study. It is possible that representatives of the Federal Government or some other Human Subjects Protection Program that supports the research study will want to come to Prescott College to review your information. If that occurs, a copy of the information maybe provided to them but your name will be removed before the information is released. May I change my mind about participating? Your participation in this study is voluntary. You may decide to not begin or to stop the study at any time. Your refusing to participate will have no effect on your evaluation. You can discontinue your participation with no effect on your evaluation. Also any new information discovered about the research will be provided to you. This information could affect your willingness to continue your participation.

Participant’s Initials _______

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Creative Healing135 Whom can I contact for additional information? You can obtain further information about the research or voice concerns or complaints about the research by calling the principal investigator, Jennifer Price, at 928-899-7078. If you have questions concerning your rights as a research participant, have general questions, concerns or complaints or would like to give input about the research and can’t reach the researcher, or want to talk to someone other than the researcher, you may call the Human Subjects Committee Chairperson for this study, Janet Lee O’Connor, at 520-909-8585. If you would like to contact the Human Subjects Committee Chairperson by e-mail, please use the following e-mail address: [email protected] By signing this form, I affirm that I have read the information contained in the form, that the study has been explained to me, that my questions have been answered and that I agree to take part in this study. I do not give up any of my legal rights by signing this form.

________________________________________ Name (Printed) ___________________________________________________ Participant’s Signature Date Signed Statement by person obtaining consent I certify that I have explained the research study to the person who has agreed to participate, and that he or she has been informed of the purpose, the procedures, the possible risks and potential benefits associated with participation of this study. Any questions raised have been answered to the participant’s satisfaction. _________________________________________ Name of study personnel ___________________________________________________ Study personnel Signature Date Signed

Participant’s Initials _______

Page 3 of 3

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Creative Healing136 Appendix C: Benefits of Creative Therapy •

Empowerment: Using art therapy as a tool to overcome or address struggles or emotions that are overwhelming, one can regain a sense of control in their life.

•

Personal Fulfillment: Creativity can bring a sense of fulfillment and confidence by producing a piece of artwork as well as by the simple process of creating.

•

Relaxation and Stress Reduction: In the act of creating, one can remain in the moment, through the act of creation. A sense of calm and peace can come by using particular colors, body movement, and music.

•

Self Discovery and Insight: Creative therapy provides the opportunity for self discovery through visual and tactile means of self expression. This can enable clients to work through and address issues of anger, grief and loss, trauma and abuse, depression, and anxiety when they might not have been able to verbalize a need for healing in these areas. It can also give a client insight into their emotions, feelings, and thoughts that they had not been able to understand previously.

•

Symptom Relief: Creativity can promote a sense of calm and peace while reducing levels of anxiety, it can boost levels of serotonin, and decrease depression levels, and

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Creative Healing137 it can be used as a coping method or distraction when dealing with physical pain. Creativity is also been shown to boost overall levels of the immune system, and to aid in the physical and psychological healing of a patient.

“Skywatcher” by Susan Seddon Boulet

“God answers sharp and sudden on some prayers, and thrusts the thing we have prayed for in our face, a gauntlet with a gift in it.” - Elizabeth Barrett Browning

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Creative Healing138 Appendix D: Definition of Key Terms Adult Population – The term adult or adult population in this study refers to those who are of the age 18 and older.

Art Therapy - Art Therapy is when any form of artistic expression, be it dance, music, poetry, drawing, paining, sculpting, etc., is used as a tool or means to aid in the therapeutic, recovery, and/or healing process. (In this thesis, Art Therapy is used interchangeably with the terms Creative Art, Creative Healing, Expressive Art, and Creative Therapy).

Creative Art - Creative Art is defined as a creative activity that produces something that is different than the materials that simply were used in its creation. (In this thesis, Creative Art is used interchangeably with the terms Art Therapy, Expressive Art, Creative Healing and Creative Therapy).

Creative Healing – The term Creative Healing is used when there is an amount of growth, a catharsis, or any other form of positive insight produced by the act of doing something creative. (In this thesis, Creative Healing is

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Creative Healing139 used interchangeably with the terms Art Therapy, Expressive Art, Creative Therapy, and Creative Art).

Creative Therapy -

Creative Therapy is viewed as the

techniques or tools used in therapy that are considered to be creative by nature, typically referring to nontraditional forms of therapy as well as non-speaking forms of therapy. (In this thesis, Creative Therapy is used interchangeably with the terms Art Therapy, Expressive Art, Creative Healing and Creative Art).

Healing - The term Healing in this text refers to growth, insight, and other forms of mental recovery, not necessarily curative in nature, but being more related to becoming mentally stable and balanced.

Spirituality - refers to the sacred knowledge, traditions, feelings, and all other aspects of what an individual would define as their religion, their way of knowing, and their inner nature.

“Every man has in himself a continent of undiscovered character. Happy is he who acts as the Columbus to his own soul.” – Sir J. Stephen 139

Creative Healing140 Appendix E: Proposed 12-week Art Therapy Curriculum

Creative Healing: An Art Therapy Curriculum (This 12-week curriculum is designed to take place once a week for an hour and a half each week) Week 1: Introductions – What’s In A Name? - Group rules, expectations, goals, objectives, and curriculum will be discussed, defined, and created. Mindfulness will be explained and a short mindfulness activity will be introduced. Meanings and representations of names will be discussed. Group members or client will create a collage that represents their name and/or an expression of themselves that they will use to introduce themselves to the group and/or therapist. Goal: o To explore the need to be known and understood by others and to create a sense of ease and comfort within a new setting. Rationale: o Once group members can make a connection to others, anxiety symptoms should decrease. Being able to voice feelings of need and express themselves in a way to show others who they are may also ameliorate some symptoms of depression and anxiety. Activities: o Facilitator will discuss group agenda, goals, and objectives. (5 minutes) o Brief introductions will be made and facilitator and group members or client will discuss meanings in a name and ways we want ourselves to be viewed or represented to and by others. (15 minutes) o Facilitator and group members or client will create group or session rules. (15 minutes) o Facilitator will explain the concept of mindfulness and introduce the mindfulness activity – Square Breathing (inhaling to a count of 4, holding to a count of 4, exhaling to a count of 4, holding to a count of 4, and then repeating this process 4 times). (10 minutes) o Group members or client will create a name or picture collage that represents them and will then use the finished creation to introduce themselves to the other group members or therapist by describing and explaining the images and symbols they have chosen to represent themselves. (45 minutes)

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Creative Healing141 Materials: o Magazines (for clippings), glue sticks, 8X10 card stock (in a variety of colors), scissors, markers, paint, and pencils. Assessment: o Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their name collage. Room to Grow: o Facilitator will encourage group members or client to find out more behind the meaning of their name to share with the group or facilitator next week.

Week 2: Black & White - Positive and Negative Talk and Thoughts – Group members or client will check in. Name meanings will be briefly discussed again. A mindfulness activity will be conducted. A discussion about negative self talk and thought patterns as well as positive talk and thought patterns will be conducted. Facilitator will talk about automatic thoughts and what can be done to change negative thoughts into positive ones. Group members or client will create a black and white drawing or painting depicting or representing a thought or feeling that has prevailed in their mind during the last week. Creations will then be shared and explained.

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Goal: To explore the concept of the thoughts that client’s carry in their minds on a daily basis, to recognize automatic thoughts and self-talk, and to understand the concept of thinking in black and white extremes. Rationale: Learning how to see things in gray colors instead of rigid black and white vision can help to alleviate symptoms of anxiety. It can also aid in maintaining healthy relationships, which can ameliorate symptoms of depression and anxiety. Activities: Check in and briefly discuss name meanings from last week. (10 minutes) Mindfulness activity – Black and white thinking (extreme thinking and thoughts will be discussed such as concepts of never and always. Group members or client will be encouraged to make a list of three things in their life that they deal with in black or white extremes as well as an alternative or new way of dealing with those issues in their life. (15 minutes)

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Creative Healing142 o Facilitator will lead a discussion about positive and negative self-talk and thoughts as well as automatic thoughts. Group members or client will create a list of ideas to help recognize and counteract or stop negative self-talk or automatic thoughts. (15 minutes) o Group members or client will create a black and white image using only black and white paper, makers, paint, or crayons. The image, painting, or drawing will represent a thought or feeling (negative or positive) that has been in their mind during the last week. Group members or client will then share and explain their creation to the other group members or the therapist. (50 minutes) Materials: o 8X10 card stock (in black and white), scissors, markers (black), crayons (white and black), paint (black and white), chalk (white), charcoal, and pencils (black and white). Assessment: o Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their name black and white image, painting, or drawing. Room to Grow: o Facilitator will encourage group members or client to notice and recognize when they have negative self-talk or automatic thoughts during the next week and to use some of the ideas that the group created to stop or counteract the negative thoughts or self-talk.

Week 3: Personal Needs – Creating a Needs Altar – Group members or client will check in and discuss successes or struggles with self-talk and automatic thoughts during the last week. Facilitator will lead a discussion about personal needs and group members or client will create a needs list based on physical, spiritual, and emotional aspects. Discussion will stress the importance of recognizing one’s owns needs and keeping those as a priority in daily life. Group members will create a 3-Dimensional Needs Alter with objects, drawings, or paintings to represent or symbolize their needs spiritually, mentally, and physically. Altars will be shared and explained. Goal: o To explore individual needs on a spiritual, mental, and physical level. To understand that meeting these needs are an important aspect to a healthy mind, body, and spirit. To create a 3-Dimensional representation of these needs in order to view these needs from every different aspect and angle. 142

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Creative Healing143 Rationale: When one can recognize the need to address self-care emotionally, physically, and mentally; they can help to be an active participant in their recovery. Being aware of and taking action of these needs can help to decrease symptoms of depression and anxiety. Activities: Check in and a brief discussion of self-talk and automatic thoughts successes and struggles from last week. (5 minutes) Mindfulness activity – Self soothing techniques (discuss ways to self soothe using the five senses). (10 minutes) Facilitator will lead a discussion about personal needs and group members or client will create a needs list based on physical, spiritual, and emotional aspects. Discussion will stress the importance of meeting these needs on all levels to maintain health in mind, body, and spirit. (15 minutes) Group members or client will create a 3-Dimensional Needs Altar to represent their spiritual, physical, and emotional needs. Group members or client will share and explain their creations. (1 hour) Materials: Shoe boxes, magazines (for clippings), glue sticks, hot glue, buttons, pipe cleaners, beads, yarn, ribbon, trinkets and findings, 8X10 card stock (in a variety of colors), scissors, markers, paint, crayons, glitter, and pencils. Assessment: Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their 3-Dimensional Needs Altar. Room to Grow: Facilitator will encourage group members or client to put their altar in a place where they can see it on a daily basis to remind them to work towards meeting their needs spiritually, mentally, and physically.

Week 4: Acceptance – Behind the Masks – Group will check in and briefly discuss the successes or struggles in remembering to use last week’s created altars as a symbol of addressing personal needs. Discuss the meaning behind wearing a mask or not being able to present oneself in a genuine manner. Facilitator will lead a discussion about the difficulties and reasons behind wearing a mask and group members or client will discuss and create a list about ways they can learn to accept themselves and others for what they or others are. Discussion will also lead into times that group members or the client have been 143

Creative Healing144 judged by or have judged others before really being understood or understanding the real person behind the mask. Suggestions for alternatives to making judgments on ourselves and others will also be addressed. Group members or client will create a mask with images, words, and decorations placed on the outside and inside representing what we show to others and the world and what we keep hidden behind our masks. Masks will be shared and explained.

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Goal: To explore the meaning of wearing a mask. To develop an understanding of why we and others create a façade at times when facing others and the world. To address the importance of genuine acceptance of self and others. Rationale: Learning concepts of validation, radical acceptance, and non-judgment can decrease symptoms of depression and anxiety. Learning how to live, feel, and view the world in a less critical way can bring relaxation and relief from stress and anxiety. Activities: Check in and a brief discussion of personal needs successes and struggles from last week. (10 minutes) Mindfulness activity – Validation (learn about non-judgmental stance, radical acceptance, and how to view things within yourself and others by only using facts). (1o minutes) Facilitator will lead a discussion in acceptance of self and others and group members or client will help to explore, list, and discuss ways in which they can learn to be genuine and real with themselves and others in an unconditional manner. (10 minutes) Group members or client will create a mask by decorating it on the outside and inside with symbols and objects representing that which is shown to the outside world and that which is kept behind the mask. Group members will share and explain their mask. (1 hour) Materials: Paper masks, feathers, hot glue, beads, magazines (for clippings), scissors, buttons, pipe cleaners, yarn, ribbon, trinkets and findings, scissors, markers, paint, crayons, glitter, and pencils. Assessment: Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their mask. Room to Grow: Facilitator will encourage group members or client to hang or put their mask in a place where they can see it through the coming week in order to be reminded about self acceptance as well as accepting others by using non-judgment and validation techniques. 144

Creative Healing145 Week 5: Sharing Your Gifts and Talents – “Treasure Within” Box: Group members or client will check in and discuss struggles and successes from last week’s Room for Growth. Mindfulness activity will focus on the gifts and treasures that others see in you. Facilitator will lead group or client in a discussion about gifts and talents that we have and group members or clients will discuss and list ways in which their talents and gifts can be explored and developed in order to share them with others as well as to experience the joy in themselves by expressing them. Discussion will also address some of the reasons why we might hide or neglect our talents and gifts. Group embers will create an origami box and decorate both the inside and outside with trinkets, glitter, and other treasures that represent their gifts and talents. Creations will be shared and explained and the box will become a symbol to remind them to develop and share their talents and gifts. Goal: o To explore the importance of honoring, developing, and sharing your gifts and talents. To understand that by sharing our gifts with others that we also bring joy to ourselves. Rationale: o By learning and understanding that others see gifts and treasures within us may encourage us to develop our gifts and talents. By feeling confident with the gifts and treasures within us that can be shared with others to bring joy to others as well as ourselves can help to alleviate symptoms of depression and anxiety. Activities: o Check in and a brief discussion of living less critically and hiding behind our masks successes and struggles from last week. (10 minutes) o Mindfulness activity – Treasures and gifts (each person will take a piece of paper and write their name on the top. Papers will be passed to the left until each member of the group has listed a gift, talent, or treasure that they have recognized in the individual listed on the sheet. Papers will be kept by each client to remind them of what others see in them as a motivation to develop and share their gifts with others). (15 minutes) o Facilitator will lead group members or client in a discussion about developing, honoring, and cultivating gifts and talents. Group members will participate in a discussion in ways which they can develop and share their gifts and talents with the world. (15 minutes) 145

Creative Healing146 o Group members or client will create an origami paper box with directions from the facilitator. The “Treasure Within” boxes will then be decorated, inside and out, with symbols and representations of the gifts, talents, and treasures that they have within themselves and ones that they share with others. (50 minutes) Materials: o 12X12 card stock (in a variety of colors and patterns), scissors, hot glue, glue sticks, beads, magazines (for clippings), buttons, ribbon, trinkets and findings, silk flowers, markers, paint, crayons, glitter, and pencils. Assessment: o Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their “Treasure Within” box. Room to Grow: o Facilitator will encourage group members or client to put their treasure box in a place where they can see it through the coming week in order to be reminded about developing their gifts and talents. They will be encouraged to review the list of treasures, gifts, and talents that others see in them as well for encouragement and inspiration to work towards cultivating and growing their gifts.

Week 6: Road Blocks – Life Map – Group will check in and discuss struggles and successes regarding last week’s Room to Grow. Mindfulness activity will be a guided imagery depicting a beautiful path or road that is being traveled. Facilitator will lead a discussion about struggles from our past, road blocks, and other detours we have taken on our journey of life and progression. Group members or client will discuss, list, and explore ideas to create plans and a map for a safer and easier journey. Group members or client will create a road map drawing or painting with depictions and representations of plans, goals, possible detours, destination plans, and other travel plans that will metaphorically represent their life journey and path. Road/Life maps will be shared and explained. Goal: o To explore the metaphor and symbolism of a road as life’s path or journey. To understand that plans can be made in life, as if one were embarking on a trip or journey. To prepare plans in advance for road blocks or detours that could be

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Creative Healing147 encountered in order to resolve from being stopped at the dead ends or traffic jams of life. Rationale: By looking at life as a map, journey, or road, one can place experiences along the path representing the past, present, and future. One can also use the road map as a plan to prepare for things in the future as well as making changes to things that have not worked or slowed us down in the past. Having a visual representation of this plan can bring comfort from having set plans and goals for things we might face in the future, which could help to alleviate fears, worries, and anxiety symptoms. Making plans for the future in spite of regret from the past, with anticipation for positive change can also ameliorate symptoms of depression. Activities: Check in and a brief discussion of successes and struggles in regards to cultivating, developing, and sharing your gifts and talents from last week. (10 minutes) Mindfulness activity – Guided imagery (Facilitator will conduct a guided imagery session about a beautiful path or road that the group members or client is following – noticing the landscape, the texture of the road, and what they see in the distance). (15 minutes) Facilitator will lead group members or client in a discussion about the metaphorical symbols of a road map that can be applied to life’s journey. Group members or client will participate in creating a list of suggestions of ways in which a safer and easier road to travel can be created, including plans for alternative routes and detours. (15 minutes) Group members or client will create a painting or drawing depicting a Road/Life map with destinations, travel plans, possible detours, plans for alternative routes, and other metaphoric and symbolic representations of their life journey. Road/Life maps will be shared and explained. (50 minutes) Materials: Sketch paper (portrait size), paint, paint brushes, markers, crayons, chalk, pastels, and pencils. Assessment: Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their Road/Life map. Room to Grow: Facilitator will encourage group members or client to put the image of their Road/Life map in a place where they can see it through the coming week in order to be reminded about the ability to make advance plans as well as changes to their life journey in order to create safer and easier travels on a consistent basis.

Week 7: Struggles and Growth – Butterfly Wings – Group members or client will check in and briefly discuss struggles and successes about plans, goals, and changes in life maps to create a safer and easier route from last

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Creative Healing148 week. Mindfulness activity will include a guided imagery session about being a butterfly in a cocoon. Facilitator will lead a discussion about how we can view our struggles from the past and present as opportunities for growth. Group members or client will explore and define struggles they have faced in life and attach a positive outcome or growth that has come with each struggle. Group members will then create a pre-printed butterfly diagram listing their past and present struggles on the left side of the butterfly wings and opportunity and growth that has been developed and created out of each struggle on the right side of the butterfly wing. Butterfly diagram will then be decorated or colored and shared and explained to other group members or therapist.

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Goal: To discover the benefit and opportunities that comes with struggle. To learn to look at difficult circumstances with a more positive attitude by understanding that meaning can be found in our trials. Rationale: By learning to view life’s struggles as an opportunity and recognizing that growth will gifts come from our trials, it can bring new perspective to pain and suffering, which might help to decrease symptoms of depression and anxiety. Activities: Check in and a brief discussion of successes and struggles in regards to last week’s Room for Growth assignment of learning to create a more safe and easy road map for life’s journey. (10 minutes) Mindfulness activity – Guided imagery (Facilitator will conduct a guided imagery session describing being in a cocoon and the struggle of the butterfly to break out of the confined space, understanding in the end that the struggle was needed in order to bring flight. (15 minutes) Facilitator will lead group members or client in a discussion about the need for challenge, trials, and struggles in life if there is to be growth and learning. Group members or client will explore past and present struggles and find the positive meaning and lessons in growth and opportunity that have come from each struggle. (15 minutes) Group members or client will then create a butterfly diagram displaying struggles on the left wing and growth and opportunity that have come from each struggle on the right wing. Group members or client will then decorate, share, and explain their butterfly creation. (50 minutes) Materials: Pre-printed butterfly diagram, pencils, crayons, markers, glue, glitter, scissors, and 8X10 colored card stock for mounting. 148

Creative Healing149 Assessment: o Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their struggles and growth butterfly wings diagram. Room to Grow: o Facilitator will encourage group members or client to put their butterfly diagram in a place where they can see it through the coming week in order to be reminded of the need for struggles and trials as well as remembering to notice the chance for opportunity and growth that come with each struggle instead of only focusing on the struggle at hand. Week 8: Empowerment – Creating a Wellness Toolbox - Group members or client will check in and briefly talk about successes and struggles from last week’s struggle and growth butterfly diagram. Mindfulness activity will introduce a visual of a toolbox with tools and group members or client will discuss what each different tool can be used for or is needed for. Facilitator will then lead group members or client in a discussion about creating a Wellness toolbox in order to fix, repair, or build things in their life that will help them to stay well physically and mentally. Group members or client will help to create a list of coping skills or techniques that they have used in the pas, are using now, or want to start using in order to help manage their symptoms. Group members will then create a small wooden toolbox that is decorated inside and out with symbols and representations of skills and techniques that can be used as tools in fixing and repairing issues, relationships, triggers, and other daily life issues. Toolboxes will then be shared and explained. Goal: o To explore and list skills and techniques that can be used as tools in every day life to manage and decrease symptoms. To use this list on a daily basis in an active manner in order to be responsible for your own wellness and recovery. To empower the client to become a responsible participant in their treatment and recovery.

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Creative Healing150 Rationale: By listing and learning about coping skills that can be used to decrease symptoms and to crate a physical representation of what can be used, one can actively participate in their treatment, recovery, and overall wellness. By being an active participant in your wellbeing and recovery, one can more easily ameliorate symptoms of depression and anxiety as well as feel empowered to work towards objectives and goals in treatment and recovery. Activities: Check in and a brief discussion of successes and struggles in regards to last week’s Room for Growth assignment of learning to see struggles and trials as an opportunity for positive growth. (10 minutes) Mindfulness activity – Tool box visual aid (Facilitator will bring out a toolbox with tools and group members or client will explain what the toolbox and tools are used for). (10 minutes) Facilitator will lead group members or client in a discussion about creating a wellness toolbox that can be filled with coping skills and techniques that can help to keep themselves well, as well as fixing and repairing things that have been damaged. Group members or client will participate in creating a list of coping skills that have been used, they are using, or they want to start using. (15 minutes) Group members or client will then create a small wooden toolbox with symbols and objects that represent coping skills and techniques that they can apply to their daily life in order to keep themselves well. Toolboxes will be decorated, shared, and explained. (55 minutes) Materials: Small wooden tool-box kits, hammer, nails, toolbox and tools (for visual aid), hot glue, paint, glitter, markers, magazines (for clippings), glue sticks, buttons, scissors, and trinkets and findings. Assessment: Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their wellness toolbox. Room to Grow: Facilitator will encourage group members or client to put their wellness toolbox in a place where they can see it through the coming week in order to be reminded to use as well as add to the choices and ideas of coping skills and techniques that they can use on a daily basis to empower themselves and be an active participant in their treatment and recovery. Facilitator will encourage group members or client to list on paper some of those skills to keep in their toolbox.

Week 9: Balance – Mandalas – Group members or client will check in and briefly discuss Room for Growth from last week including successes and struggles in using their Wellness toolbox. Mindfulness activity will include

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Creative Healing151 learning about mandalas and looking at several created and natural mandalas. Facilitator will lead group members or client in a discussion about maintaining balance in their life, to include moments of mediation and peaceful activities to promote calm and relaxation. Group members will then color preprinted intricate mandalas. Group members or client will be encouraged not to talk during this activity and to listen to the soft background music and clear the mind of excess worry or thoughts and to simply focus on coloring the mandala. Group members or client will also be encouraged to possibly contemplate on a positive small phrase or word to think about while they are creating their mandala. Mandalas will be shared with group and explained, and group members or client can share their positive thought or word that they have attached to this creation. Goal: o To learn how to use meditation or mandalas as way to create calmness and peace. To learn about clearing the mind of excessive worry or thoughts by possibly using a positive mantra, small phrase, or word in order to clear the mind and focus on the moment or what is at hand without thinking of other things. Rationale: o By learning how to clear the mind or focus on the moment in an activity of listening to music or coloring a mandala, one can learn to distract the mind and emotions in the moment to bring peace and relaxation even in times of anxiety or panic. This can aid in the reduction of anxiety symptoms. Activities: o Check in and a brief discussion of successes and struggles in regards to last week’s Room for Growth in continuing to use their wellness toolbox. (10 minutes) o Mindfulness activity – Mandalas (Facilitator will introduce and explain the concept, history, and use of the mandala. Group members or client will be encouraged to mindfully meditate on images of created or natural mandalas). (15 minutes) o Facilitator will lead group members or client in a discussion about maintaining balance in their life through mediation and relaxation techniques such as coloring a mandala or creating other opportunities for quiet, peace, and relaxation in their life. (10 minutes) o Group members or client will then color a pre-printed mandala while remaining quiet and either quieting their mind by listening to the background music or focusing on a positive phrase or word to help clear their mind of excessive worry 151

Creative Healing152 or thought. Client(s) will be encouraged to stay in the moment and focus on coloring the mandala. Mandalas will be shared and explained and group members can share the thought or word that they have attached to this creation. (55 minutes) Materials: o Pre-printed mandalas, music, images of mandalas, pencils, crayons, and markers. Assessment: o Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their mindfulness mandala. Room to Grow: o Facilitator will encourage group members or client to put their mindfulness mandala in a place where they can see it through the coming week in order to be reminded to create moments and opportunities in their day for relaxation, peace, or calmness in order to reduce symptoms of stress and anxiety. Week 10: Emotions and Feelings – Riding the Wave Mural – Group members or client will check and briefly discuss struggles and successes with creating moments and opportunities of mindfulness meditation or relaxation in their life. Mindfulness activity will include listening to a CD with sounds of ocean waves as group members or client move or sway their arms or body with the visualization of the ebb and flow from the ocean. Group members will be encouraged to apply the feeling of ocean waves ebbing and flowing to the surges of emotions that they experience at times in their life as a way to understand and experience that these anxious and sometimes terrifying feelings will eventually pass and subside. Group members or client will then participate in creating a paper mural of an ocean scene with calming colors of blues and greens using sweeping motions of their body, arms, and hands to paint waves and to feel the movement of the ebb and flow in their creation. Group members or client will also be encouraged to share their experiences in creating the ocean mural. Group members or client can then either decide to take a piece of the finished paper mural home or to hang the full paper mural in the art room. 152

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Creative Healing153 Goal: To understand that emotions and feelings that are strong and overwhelming do subside just as an ocean tide ebbs and flows. To use movement and sound as a way to release tension and stress in order to reduce anxiety. To create a visual and physical image and feeling of the oceans ebb and flow while connecting that to feelings and thoughts of extreme and emotion coming and going. Rationale: By learning that emotions and feelings that are overwhelming will not last forever can reduce symptoms of anxiety and fear. When one can remember that these emotions and feelings can come and go, attitudes of desperation can be dispelled and a feeling of knowing and understanding that things will not remain negatively for long can bring comfort in times of extreme emotions. Activities: Check in and a brief discussion of successes and struggles in being able to create moments of relaxation and rest in daily life. (10 minutes) Mindfulness activity – Music and body movement (Facilitator will play a CD with ocean sounds and ask group members or client to close their eyes and move their arms or body to the sound of the ebb and flow of the ocean tide). (10 minutes) Facilitator will lead group members or client in a discussion about having extreme emotions or thoughts that become overwhelming at times which can create high anxiety and panic attacks. Group members will be encouraged to visualize their emotions ebbing and flowing like the ocean waves and to understand the concept that their extreme thoughts of despair or worry will also recede in time. (10 minutes) Group members or client will create a paper mural of an ocean scene using the calming colors of blue and green. Client(s) will be encouraged to use arm or body movement when creating images of the waves in order to feel and visualize the ebb and flow of the waves as well as contemplating an understanding that their extreme emotions can also ebb and flow in this manner. Group members or client will then explain or share their experience in the creation of the ocean mural. (1 hour) Materials: Roll of mural paper, paint (blues and greens), paintbrushes, tacks for mural, and ocean music. Assessment: Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their experience while making the paper ocean mural. Room to Grow: Facilitator will encourage group members or client to reflect upon and visualize the ocean waves ebbing and flowing during the times that they feel extreme emotions throughout the week in order to help calm fears and anxiety with the knowing that these feelings and emotions will subside. Group members or client will be encouraged to listen to the sounds of the ocean if it helps them to remember this activity when they are experiencing symptoms of anxiety or fear.

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Creative Healing154 Week 11: Celebrating Your Uniqueness – Doll/Puppet Making – Group members will check in and briefly discuss successes or failures regarding reducing anxiety or fear with the visualization of the ocean. Mindfulness activity will include each group member or client in creating a list of unique facts, characteristics, and ideas about themselves that they value or find odd about them. A bag of pine cones will also be handed out and each group member or client will choose a pine cone. Pine cone will be studied for two minutes and placed back in the bag with the other pine cones and mixed up. Group members or client will then need to pick out the pine cone they had from remembering the little unique things that made their pine cone different from the others. Facilitator will lead a discussion about celebrating our uniqueness with others and learning to value in ourselves and others those things that might be looked upon as odd or scrupulous. Group members will create a Doll or Puppet using a variety of materials to represent them. Group members will be encouraged to be innovative in their creation as and unique with ideas while they make a doll or puppet that represents their uniqueness. Dolls/Puppets will be shared and explained. Goal: o To discover and celebrate the unique things within us and about us, whether they are wonderful or odd things. To explore the importance of celebrating our own individuality and uniqueness instead of comparing ourselves to others. To appreciate the uniqueness (good and bad) in others, in an understanding the benefits of diversity and differences. Rationale: o By learning that our own uniqueness, including odd things, can be celebrated for the reason that these things make us an individual and different from others with a sense of specialness can help to decrease symptoms of depression or shame. Learning to appreciate the differences in each individual can also aid with creating more healthy relationships.

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Creative Healing155 Activities: Check in and a brief discussion of successes and struggles in regards to the ebb and flow of our emotions. (10 minutes) Mindfulness activity – List of Unique things about us and Pine Cone study (Group members or client will create a list of the unique facts, experiences, and ideas about them. Facilitator will pass around a bag of pine cones for each person to pick and study one. Pine cones will be gathered and placed back in the bag. Group members or client will then try to find the pine cone they previously had by remembering the unique details of the pine cone they had. (15 minutes) Facilitator will lead group members or client in a discussion about celebrating the unique and odd things about ourselves and others. (1o minutes) Group members or client will then create a doll or puppet representing themselves and all the unique things about them. Group members or client will be encouraged to be innovative and unique in their design as they represent those things about themselves. Dolls/Puppets will then be shared and explained. (55 minutes) Materials: Yarn, ribbon, sticks, paper, buttons, fabric, hot glue, pipe cleaners, scissors, beads, trinkets, thread, needles, and other findings. Assessment: Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their unique doll or puppet. Room to Grow: Facilitator will encourage group members or client to put their doll or puppet in a place where they can see it through the coming week in order to be reminded of celebrating the uniqueness that makes them an individual as well as seeing that difference in others as a positive part of life and diversity.

Week 12: Maintenance – Continuing to Heal Creatively – Group members or client will check in and briefly discuss the struggles and successes in celebrating their and others uniqueness. Mindfulness activity will include a discussion and introduction to using wise mind – the integration of reason and emotion with equal balance. Facilitator will then lead a discussion in maintaining wise mind and keeping a healthy life style physically, mentally, and spiritually by using the creative arts as a way to remember, invigorate, inspire, and maintain wellness in their daily life. Group members or client will then

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Creative Healing156 participate in creating a list of creative projects and ideas that will allow them to continue with hope and insight as well as continuing to create responsibility for their own healing and recovery. Group members or client will then decorate the covers and inside of a spiral notebook in the process of making a “Creativity Journal,” where they will list these ideas and will commit to using this journal as a way to record, create, and share their continuing journey of creative healing. Group members or client will share their completed creativity journal and will list three things that they plan to continue doing in their daily life to maintain progress and growth.

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Goal: To discuss the importance of maintaining a healthy lifestyle mentally, physically, and spiritually with the aid of creativity. To make a commitment to the continuation of self-care, creativity, and responsibility for their own recovery and wellness. Rationale: By continuing to use the power of creativity in their life, clients can be an active participant in their healing and recovery. By creating a journal to list ideas for creative healing and to use it as a record of how healing occurs will help to keep a visual reminder for the client(s) to continue towards wellness in their life. The continuation of creative activities as well as keeping a record of these experiences could help to decrease the symptoms of depression and anxiety. Activities: Check in and a brief discussion of successes and struggles in regards to last week’s Room for Growth assignment of celebrating the uniqueness of ourselves and others. (10 minutes) Mindfulness activity – Wise mind (Facilitator will introduce and explain the benefits of balancing our emotional and rational mind in an effort to produce a wise mind). (10 minutes) Facilitator will lead group members or client in a discussion about continuing with the process of creative healing. Group members or client will assist in creating a list of ideas that they could use to continue their journey of healing and recovery. (15 minutes) Group members or client will then create a “Creativity Journal” where they will list the ideas that were developed. They will decorate the journals cover and inside by drawing, painting, or collage. Journals will be shared and explained. Group members or client will then share three things that they will commit to doing in

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Creative Healing157 order to continue with their creative healing process, healing, and recovery. (55 minutes) Materials: o Spiral notebooks, hot glue, glue sticks, markers, paint, paintbrushes, scissors, crayons, pencils, magazines (for clippings), glitter, and 8X10 colored card stock for mounting. Assessment: o Group members or client will be assessed according to participation level and interaction as well as the detail, time, and effort they put forth in creating and explaining their creativity journal. Room to Grow: o Facilitator will encourage group members to continue on their journey of creative healing. They will be encouraged to use the techniques and skills learned in group as well as to explore and find other ways to creatively heal on their own in an empowering effort to be in control and responsible for their own healing and recovery with the aid of creativity.

“Flaming June” by Lord Leighton

“The soul would have no rainbow if the eyes had no tears.” - Native American Proverb 157

Creative Healing158 References

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Kalachakra Mind Mandala

“Create your passion and then passionately create!” – Jennifer Price

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