Contemporary Art Therapy with Adolescents. Shirley Riley
on-going
This text will not focus on assessment protocols, they are useful and may be researched by the reader if they have the need to evaluate the client (Buck, 1948; Burns and Kaufman, 1970; DiLeo, 1973; Kellogg, 1970; Malchiodi, 1990; Oster and Gould, 1987; Silver, 1989). The assessment that I prefer is an on-going comparison of the artwork that the client offers from session to session. The individual symbolic meaning narrated by the adolescent, enriches and personalizes the evaluation. Adolescents are suspicious of pre-planned drawing ‘tests’. They are unwilling to be analyzed and will go to extremes to avoid exposure. I would much prefer to involve the teenagers in their own appraisal processes than to try and fit their art into a preconceived schema. It is not too difficult to judge the onset of trauma, when images change from organized to disorganized structure. However, knowledge of the assessments available in art therapy and projective tests used by psychologists, is recommended. There are patterns that dominant in many cases, and can be useful triggers to alert the therapist. The danger, in my opinion, is to have the formula interfere with the ability of the therapist to look at each client art piece as unique. I believe that we each invent our reality, and if I impose my reality or an assessment device on the client’s reality, then I am interfering with therapy.
Perspectives and history
When I think back almost two decades ago on the adolescent boys and girls that I worked with in an outpatient clinic in southern California, I believe that the problems were less intense. There were fathers in jail, poverty, drugs, gangs, and sexual promiscuity, but the drive-by shootings, threat of HIV-AIDs, and the surge of minority ethnic conflicts were much less violent. The greatest change that I observe is the high percentage of adolescents who are suffering from pre-natal substance abuse and subsequent neglectful parental care. These learning disabled, hyperactive children make up a large percentage of the clinical cases, particularly at ages eleven through thirteen. Because these early adolescents do not have responsible parents (in most cases) they suffer from shifting placements and dubious foster care. This is a tremendous challenge for the clinician who is dedicated to helping this age group.
Some of the art therapy activities, discussed in the following chapters, are helpful in keeping the teen focused and provides a vehicle for expressing their frustration and depression. If the art therapist chooses to share his/her skills and educate other professionals in the use of art, s/he has offered a unique service. I do not feel that art therapy is threatened when other mental health workers employ graphic images in therapy. Training in art therapy is specialized and goes beyond the occasional use of artwork to engage an adolescent. There is a difference, and it does not need defending. I hope the examples I have provided will clarify that difference and encourage therapists involved in providing adolescent treatment.
An overview of the following chapters
It may appear rather unorthodox to suggest to readers that they turn to the Appendix before becoming engaged with the main body of the text. I recommend this to those not familiar with social constructionist/ narrative thoughts about conducting therapy. In addition, it is helpful to recognize that these theories are altered when utilized in conjunction with imagery and the incorporation of art making. They are further modified by the person who integrates these belief systems into their own method/construction of approaching therapy; in this case the author of this text. Therefore, I suggest that in order to understand the basic philosophical stance that is taken throughout this narrative of adolescent treatment, it is best to read the last chapter first!
Chapter 1 takes the reader into the specialized environment and attitudes that surround the art of creating a therapeutic relationship with an adolescent. The more recent thoughts about development, and the impact that bears on treatment with this age group are reviewed. A variety of therapeutic issues and how the theories are integrated into expressive therapy are discussed. The importance of seeing the adolescent in the context of their living conditions and past and present traumas is emphasized. Some of the important issues in adolescent treatment, such as confidentiality, power and control, non-pathologizing belief system, and the impact of gender concerns are introduced in this first chapter.
The second chapter focuses on adolescent group treatment. Group is the therapy that is most commonly offered to teenagers; in part because they prefer to be with their peers, and in part because it is financially productive for the agency. The progression of a group from its inception through forming a cohesive whole, is discussed. Art therapy tasks that further group process are developed. Examples of successful and unsuccessful group interventions are offered, as well as the clinical rationale for the outcome. How to set up a group as well as keeping it vital, is also examined. The art therapy tasks that are described in this chapter on group can also be utilized in individual work if the therapy requires it.
Chapter 3 examines the rising prevalence of depressed, acting-out adolescents. The rationale that depression is the major, underlying cause for adolescent malfunctioning is discussed. Many illustrations help the reader to learn how the adolescent displays his or her depression in the art, even when they are unable to verbalize the pain within. Why the act of externalizing depression is helpful to the teen, and how to encourage this activity through art expressions, is a major focus of Chapter 3. Suicide, self-mutilation, and deliberate risk taking is also looked at.
Chapter 4 offers a unique opportunity to enter into a dialogue between the author and two art therapists practicing with a similar adolescent population but in different settings. The discussion illuminates how the context, the environment, and the agency expectations, color the therapy offered the teenager. Each methodology succeeds, but the approach differs radically. With Aimee Loth we learn how she integrates a time-limited frame into the therapeutic scheme and satisfies the goals of therapy. Her art therapy interventions are inventive and synchronized with a narrative philosophy of treatment. Many of her clients are labeled ‘severely emotionally disturbed’ and are served in a public school which specializes in keeping these teenagers from dropping out of school. Roberta Lengua conducts her art therapy in a residential setting, with adolescents who have been placed for a variety of reasons. Many are depressed, display conduct disorders, and come from dysfunctional homes. Her art therapy department offers an opportunity for these disturbed youngsters to find a haven in the art. She is not required to limit her treatment to a time frame, and this modifies the art therapy approach.
The outcome of evaluating these two dialogues offers the reader an opportunity to appreciate that where the therapy is offered, the context and process of the therapy, decides whether it will be art psychotherapy or art as creative therapy. The arguments pro and con concerning these two ways of offering art therapy are put to rest by the clear demonstration that a good therapist is led by the needs of the client, not by an ideological belief system.
Chapter 5 uses the chaos theory as the departure point to explore how the onset of adolescence disrupts the family system. Families, introduced to the chaos theory of change, can benefit from the knowledge that adolescent discontinuous growth patterns are not unusual, are in fact helpful. Education can normalize the impact of the adolescent developmental phase. The variety of ‘families’ that qualify for this nomenclature is taken into consideration, with a focus on the single parent family. Several case examples help the reader imagine how the art is essential in the process of illustrating the differing views that family members have of the ‘problem’.
Chapter 6 reviews the major ways that therapists get tangled up in the adolescent clients’ world. Many of our own unresolved difficulties stem from this period of our life, and the adolescent client is a master at stimulating these dormant stressors. Personal challenges that the author has struggled with are referred to, as well as the conflicts that other therapists have shared about their entanglements. This chapter will resonate with any therapist who has to deal with the teenagers of today’s society.