Anna, age 12 Anna entered treatment with chronic anxiety and depression resulting from five major cardiac surgeries due to a heart defect, sexual abuse by a family member, lack of friendships, stomach aches and difficulty coping with her feelings about these problems.
Through combined art therapy and psychotherapy, Anna has made progress with peer relationships and using relaxation and stress management techniques to cope with recent heart procedures and contact with the family member. Her depression and anxiety are much more manageable.
Anna had been in therapy about two years when I asked her to create a collage as a way to determine the level of resolution she had reached related to the abuse and her medical condition, both of which have been traumatic experiences for her.
Anna represented herself by drawing a large head and small body centered on the paper surrounded by pictures and words she cut out from magazines. She glued all the "good" things that represent herself on the right side of the head and all of the "bad" things on the left side.
Drawing a large head and small body indicated that Anna did not feel very grounded or stable. The pictures and words surrounding her were suggestive of feeling overwhelmed and not knowing when the stressors would end. The notion that she is floating expresses her surreal experiences of abuse and heart surgeries that are difficult to make sense of at her developmental age. Dividing herself into "good" and "bad" sides suggests she is having difficulty accepting that both sides exist and are part of her identity.
The information and insights gathered from this art directive could not have been identified through traditional talk therapy only because Anna did not have the conscious awareness that this division within herself existed. Her art helped us understand where her sense of being emotionally overwhelmed was coming from. It also gave us direction for treatment in terms of needing to continue work on the trauma issues, coping with a chronic health condition and on accepting the parts of herself she doesn't want. As these issues are addressed, it is anticipated her anxiety and depression will continue to diminish.
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Caroline, age 15 Caroline entered treatment with symptoms of anxiety and depression. She had difficulty making friends at a new school, did not want to go to school, didn't feel she fit in because of her heritage, had low self-esteem due to confusion about her ethnic identity and was quite lonely.
Caroline was asked to create a self portrait and was offered pencil, colored pencils, oil pastels, crayons, markers and paints. I asked her to create a portrait in order to work on the identity issues that were contributing to her poor sense of self, loneliness and peer problems. Self portraits can allow people to express what they believe and feel about themselves on a deeper emotional level, separate from the physical identity that is visible in the mirror.
Caroline chose to draw with pencil and sketched with gentle, sweeping repetitions, using muted lines that have movement and intention. The way she went about her portrait showed she has a desire for control and stability in her life. As we talked about her portrait, we learned that how she thinks about herself and the feelings she experiences were at odds, leading to confusion about herself and about friends.
I asked her to write a poem about her portrait and this is what she created:
Oh mirror, mirror won't you tell me why I feel this way, I look at that girl in the mirror and laugh, She's become everything that I'd hoped I'd never be, Lord knows, it's a blessing that she's wise beyond her years, But while she paints a picture for the world to see, She longs for someone like her, to carry her away, In the darkness she holds on tight, To the fleeting light of the stars, Wondering where, asking why, All she can do is hide, Her wisdom is bound with curses, Distant is she who sees all their petty dreams, Everyday she seems to lose a bit of herself, No one will listen, She is a voice unheard I'm broken, and missing my pieces, Won't you come with me, take a journey, To the recesses of my mind, She'll say she is strong, But I know that she's hurting, And we've almost given up on our self.
The poem reflects the cognitive connection she has to her portrait. The process of correlating expression of feelings through creating art work with the imaginative thoughts explored through the freedom of poetry blend into a representation of body, mind and spirit.
When discussing how her poem reflects her portrait, we found that the serenity in the image she created may suggest she needs to nurture rather than reject herself. Caroline recognized that the veil represented the need to take time to discover her heritage and to be gentle instead of judgmental toward herself. She expressed that even though she was struggling with her identity, her art and poem helped her realize that she needed to be patient with herself and allow for her identity to emerge as she continued to grow as a person.
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Tina, age 38
Tina had been in treatment with Dr. Lees for depression and bulimia when she started remembering incidents of physical, emotional and sexual abuse. Tina was having difficulty working through these memories, so Dr. Lees referred her for art therapy in order to explore her trauma issues in a less threatening therapeutic manner.
Tina had been working with both Dr. Lees and I for about two years. The following series of three paintings were done over this time and show the progress she made in her ability to address her trauma issues. Tina worked on many other art directives in between the paintings shown here.
Tina was asked to keep an art therapy journal as a daily tool for exploring thoughts and feelings through the use of art and creative expressions, not words. She brought the journal to each session and we would look through it to determine whether any of her art suggested the need for further exploration. In one of her journal entries she created a drawing of a large, wooden door. Doors can represent secrets or things that are hidden, so we chose to explore this image further.
I first had her paint a life sized door so she could visualize that the door existed and that she had the ability to go through the door, when ready, to discover what was beyond it. She realized the door kept her from fear of the unknown as there was a keyhole but no key to open the door. Finding a key to open the door was the focus of art directives during other sessions. I had her use paint because the fluidity, blending and movement helps express deep emotions and can help bring forth things forgotten due to the connection most of us have to using paints in childhood.
The first painting is of the large wooden door. The colors are dark, chaotic and solid which depicts a sense of blocking, heaviness and lack of clarity. The door has a vine growing around the perimeter which can indicate life and a sense of natural healing. The sun represents a sense of hope and was described by Tina as her sign of security and spirit.
The second painting of the door created about eight months later shows the colors on the door to have more clarity and organization with less darkness. The vine continues to grow and flourish in the warmth of the sun which has doubled in size and breaks through the center with force and conviction.
After many months, Tina was able to create a key that would open the door. In the third painting the door was opened. Darkness is revealed upon passing through the door but light beams on the other side, bringing forth hope and Tina's readiness to face the core of the trauma she had been too afraid to face. She was then able to make ongoing progress toward resolution of the trauma issues in individual therapy with Dr. Lees.
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While psychotherapy can measure progress through changes in symptoms, coping ability and overall functioning, art therapy can provide more tangible and visual proof of progress, especially with issues like trauma that are deep rooted in the psyche and less objectively measurable.
Many thanks to our patients for allowing us the use of their art and life experiences to help educate and inform others.
Anna entered treatment with chronic anxiety and depression resulting from five major cardiac surgeries due to a heart defect, sexual abuse by a family member, lack of friendships, stomach aches and difficulty coping with her feelings about these problems.
Caroline entered treatment with symptoms of anxiety and depression. She had difficulty making friends at a new school, did not want to go to school, didn't feel she fit in because of her heritage, had low self-esteem due to confusion about her ethnic identity and was quite lonely.
The second painting of the door created about eight months later shows the colors on the door to have more clarity and organization with less darkness. The vine continues to grow and flourish in the warmth of the sun which has doubled in size and breaks through the center with force and conviction.
After many months, Tina was able to create a key that would open the door. In the third painting the door was opened. Darkness is revealed upon passing through the door but light beams on the other side, bringing forth hope and Tina's readiness to face the core of the trauma she had been too afraid to face. She was then able to make ongoing progress toward resolution of the trauma issues in individual therapy with Dr. Lees.
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