100 95 75 HANDBOOK OF ART THERAPY Handbook of Art Therapy Edited by CATHY A. MALCHIODI T G P HE UILFORD RESS New York London © 2003 The Guilford Press A Divisionof Guilford Publications,Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved No part of this book may be reproduced, translated,stored in a retrieval system, or transmitted,in any form or by any means, electronic,mechanical, photocopying, microfilming,recording, or otherwise,without written permission from the Publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-PublicationData Handbook of art therapy / edited by Cathy A. Malchiodi. p. cm. Includes bibliographicalreferences and index. ISBN 1-57230-809-5 (alk. paper) 1. Arts—Therapeutic use—Handbooks, manuals, etc. I. Malchiodi, Cathy A. RC489.A7 H365 2003 615.8′5156—dc21 2002012812 About the Editor Cathy A. Malchiodi, ATR, LPAT, LPCC, is an art therapist, expressive art therapist, andclinical mental health counselor, as well as an internationally recognized author- ityonarttherapywithchildren,adults,andfamilies.SheisamemberoftheBoardof Directors of the American Art Therapy Association (AATA) and is the past editor of Art Therapy: Journal of the AATA. She has received numerous honors for her work, including recognition from the AATA, the Kennedy Center for the Arts, Very Special Arts, and the China Association for the Handicapped. An author of several books, including The Art Therapy Sourcebook, Understanding Children’s Drawings, and Breaking the Silence: Art Therapy with Children from Violent Homes, and editor of Medical Art Therapy with Children and Medical Art Therapy with Adults, she has written more than 60 articles and chapters and has given more than 160 presenta- tionsonarttherapythroughouttheUnitedStatesandabroad.Shecurrentlyservesas editor for Trauma and Loss: Research and Interventions, and is on the faculty of the National Institute for Trauma and Loss and the Graduate Program in Expressive Therapies at the University of Louisville. v Contributors Wae Soon Choi, PhD, K-ATR, Department of Rehabilitation, Taegu University, Taegu, Korea Marcia Sue Cohen-Liebman, MA, MCAT, ATR-BC, Drexel University, College of Nursing and Health Professions, Hahnemann Creative Arts in Therapy Program, Philadelphia, Pennsylvania Tracy Councill, MA, ATR-BC, Art Therapy Program, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC Carol Thayer Cox, MA, ATR, REAT, private practice, Washington, DC Robin L. Gabriels, PsyD, Department of Pediatrics, University of Colorado Health Sciences Center, and JFK Partners, Denver, Colorado Linda Gantt, PhD, ATR-BC, Trauma Recovery Institute, Morgantown, West Virginia Eliana Gil, PhD, Abused Children’s Treatment Services, Inova Kellar Center, Fairfax, Virginia Samuel T. Gladding, PhD, Department of Counselor Education, Wake Forest University, Winston-Salem, North Carolina Janice Hoshino, PhD, ATR-BC, LMFT, Center for Programs in Psychology, Antioch University–Seattle, Seattle, Washington Tomio Kakuyama, BA, Department of Rehabilitation, Kanagawa Prefectural Ashigara-kami Hospital, Kanagawa, Japan Frances F. Kaplan, MPS, DA, ATR-BC, Department of Art Therapy, Marylhurst University, Lake Oswego, Oregon Dong-Yeun Kim, PhD, K-ATR, Department of Rehabilitation, Taegu University, Taegu, Korea P. Gussie Klorer, PhD, ATR-BC, LCSW, LCPC, Department of Art and Design, Southern Illinois University, Edwardsville, Edwardsville, Illinois vii viii Contributors Marian Liebmann, MA, PGCE, CQSW, Inner City Mental Health Service, Bristol, United Kingdom Cathy A. Malchiodi, MA, ATR, LPAT, LPCC, Department of Expressive Therapies, University of Louisville, Louisville, Kentucky; National Institute for Trauma and Loss in Children, Detroit, Michigan Anne Mills, MA, ATR-BC, LPC, Art Therapy Program, The George Washington University, Washington, DC; private practice, Alexandria, Virginia Debbie W. Newsome PhD, Department of Counselor Education, Wake Forest University, Winston-Salem, North Carolina Joan Phillips, MA, MS, LMFT, LPC, ATR-BC, Department of Human Relations, University of Oklahoma, and private practice, Norman, Oklahoma Shirley Riley, MA, MFT, ATR-HLM, Department of Art Therapy, Marital and Family Therapy Graduate Program, Phillips Graduate Institute, Encino, California Aimee Loth Rozum, MA, ATR, Child and Adolescent Services, Hospice and Palliative Care of Cape Cod, Hyannis, Massachusetts Diane S. Safran, MS, LMFT, ATR-BC, Attention Deficit Disorders Institute, and Learning Strategies, Westport, Connecticut Rawley A. Silver, EdD, ATR, HLM, National Institute of Education Project, Sarasota, Florida Susan Spaniol, EdD, ATR-BC, LMHC, Expressive Therapies Division, Graduate School of Arts and Social Sciences, Lesley University, Cambridge, Massachusetts William Steele, MSW, PsyD, National Institute for Trauma and Loss in Children, Grosse Pointe Woods, Michigan Lenore Steinhardt, MA, ATR, Art Therapy Training Program, The Center for Training Creative Expressive Therapists, Continuing Education, Kibbutzim College of Educa- tion, Tel Aviv, Israel; Rakefet Children’s Therapy Center, Ramat Hasharon, Israel Carmello Tabone, MA, ATR, Chestnut Ridge Hospital, Morgantown, West Virginia Masahiro Tanaka, MA, Department of Psychological Counseling, Mejiro University, Tokyo, Japan Madoka Takada Urhausen, MA, ATR, Intercommunity Child Guidance Center, Whittier, California Randy M. Vick, MS, ATR-BC, LCPC, Department of Art Therapy, School of the Art Institute of Chicago, Chicago, Illinois Judith Wald, MS, ATR-BC, Department of Therapeutic Activities, New York Presbyterian Hospital, White Plains, New York; College of New Rochelle, Graduate Division of Art and Communication Studies, New Rochelle, New York Diane Waller, MA (RCA), ATC, DIP. Group Psych, DPhil, SRAsT, Unit of Psychother- apeutic Studies, Goldsmiths College, University of London, London, United Kingdom Marie Wilson, MA, CSAT, CSAC, ATR-BC, LPC, Art Therapy Programs, Caldwell College, Caldwell, New Jersey Preface Artis a powerfultoolin communication. Itis nowwidely acknowledged thatart ex- pression is a way to visually communicate thoughts and feelings that are too painful toputintowords.Creativeactivityhasalsobeenusedinpsychotherapyandcounsel- ingnotonlybecauseitservesanotherlanguagebutalsobecauseofitsinherentability to help people of all ages explore emotions and beliefs, reduce stress, resolve prob- lems and conflicts, and enhance their sense of well-being. The countless individuals I have been privileged to work with over the last 20 years have repeatedly demonstrated to me how art expression is effective as both a form of therapy and a method of nonverbal communication. On the jacket of this volume, there is an image by one of these individuals, Eduardo, a remarkable man whosestrugglewithmentalillnesswashelpedthrougharttherapyalongwithpsychi- atricinterventions.Nowinhisearly 30s,hehadbeenstrugglingwithdepressionand mood swings since adolescence, and was looking for answers about his condition and seeking professional help. Even though he lived more than 2,000 miles away, Eduardosentmealetterofintroductionandalargeenvelopewithsomeofhisdraw- ings and paintings. He had been carefully saving his artwork for many years, and it was easy to see just how much creative expression meant to him. He neatly titled eachonasmallpieceofnotepapermeticulouslyclippedtotheupper-left-handcorner of each artwork. Forthenextmonth,wecommunicatedthroughe-mailsandletters,andIlearned moreaboutEduardo’smental illness, hislife history,andlack ofsuccessinobtaining effective treatment. On good days, he wrote articulately, describing his frustration about his depression and “his problems with thinking.” On other occasions his let- tersweredisorganizedandillogical,reminiscentofathoughtdisorder,andseemedto bearesultofmanicfeelingsandimpulses.ToensurethatEduardoreceivedappropri- ate treatment, and since sufficient medical care was not available where Eduardo lived, I made arrangements for his treatment at a local neuropsychiatric hospital. Fortunately, Eduardo was willing to relocate and was able to enter one of the hospital’s inpatient programs to receive an evaluation. ix x Preface Eduardo was diagnosed with bipolar disorder, which accounted for his mood swings,fromlethargytomaniaanddaysofinsomnia.Psychiatrictreatmentincluded finding the correct drug combination to control his mood swings and individual and group therapy to increase the psychosocial skills that he had suffered as a result of years of emotional disturbance. I was able to work with Eduardo on an individual basis during his inpatient program and later as an outpatient for many months. I helped him to continue his creative expression during his psychiatric treatment and kepttheneuropsychiatricteaminformedaboutthecontentandscopeofhisartwork. Ashisarttherapistandclinical mental healthcounselor,Iwasintriguedbytherange of colors, patterns, and subjects in his images and impressed by his creative abilities, especially because he was not a trained artist. Many of his drawings and paintings were quite playful and almost childlike abstract designs (see Figure 1) while others werehauntingrepresentationsoftheeffectsofmentalillnesssuchashisrecurrentin- somniaandmania (seeFigure2).Some haddetailed storiesaboutfancifulcharacters and animals like whales that could speak or fly or had other extraordinary powers (see Figure 3; see also book jacket). Eduardo’s experiences illustrate the value of art expression as part of psycho- therapy and counseling, and his case validates the benefits of visual communication. Like many individuals, his drawings and paintings served as a record of his mood swings, giving his helping professionals a clear “picture” of how he was feeling, pre- and posttreatment. His artwork also gave him a way to express what words could not during moments when his thoughts became disorganized and inarticulate. Most FIGURE 1.Untitled design in oil pastel by Eduardo.