Friday, October 31, 2014

Art Therapy Group Directives in Short-term Residential Treatment

I ran an open art therapy group for teens who were in a short-term residential placement. This group was co-ed and met twice a week for an hour and 15 minutes.
Below are some of the directives I used with the short-term groups. I share these directives with art therapists: if you are not trained in art therapy, please only consider trying these directives with an art therapist co-facilitator or supervisor.

 In the short-term facility anything that could possibly be used to cut or grate or hurt oneself was banned, so my supplies were limited to very basic ones: markers, paints, oil pastels, and dry pastels. The plain and colored pencils had to be accounted for at the end of group. No scissors without supervision, erasers taken off the end of pencils, etc.
With these factors in mind I worked more thematically than process-oriented. This group was open and the group members varied every session, so only projects that could be completed in an hour were possible.

1. What brought you here? Draw an image that represents some of the internal and/or external factors that led to your placement. Only share as much as you feel comfortable and feel free to represent those factors artistically, using abstraction and metaphor.

2. Who are you? Draw or paint an image of who you are outside of the factors that led to your placement. You are so much more than your symptoms: share other aspects of yourself with the group through your art.

3. What keeps you going? Make an image of what/where/who gives you strength. You are alive in spite of everything that has happened to you: how? Represent the strengths you have as well as the strength given to you by others.

4. Where does your power come from? Make an image of the power you carry inside. Optional: represent that power as an animal.

5. New ways of coping. Draw an image that will remind you of the new, healthy ways of coping that you have learned here. If drawing these are too difficult, write a fun, colorful list that you will want to keep.

6. What do you want to leave behind? Draw an image of what you would like to leave here when you return home: the behaviors, the feelings, the beliefs about yourself and the world. Optional: draw first an image of a container, and then draw inside of that container everything you want to leave behind.

As I write these, I realize that these directives could be used as writing prompts for non-art therapy groups or for a creative writing/poetry group.
In my next post I will share directives I used for a long-term, closed art therapy group with a DBT theme.

Wednesday, October 29, 2014

A detour to residential work

I just returned to New Mexico after a 1.5 year stint in Western Massachusetts. During my time there I worked in two residential facilities for children and teens: one short-term and one long-term. I had worked para-professionally in residential facilities with adults prior to earning my Masters in Art Therapy/Counseling. But working with kids whose issues were of such intensity that they had to be removed from their homes was a new experience.
The children who spend time in residential treatment in Massachusetts have usually stepped down from acute hospitalization at one of the many mental health facilities in the state or a state nearby. For the state or insurance to pay the often $100,000/year bill that is residential treatment, the child has to exhibit some ongoing symptoms that are life-threatening: self-harming behavior, abusive or threatening behavior, suicidal ideation, or homicidal ideation. Most often these children experience suicidal ideation and/or self-harming behavior. Most often these children have suffered trauma.
So having written about these kiddos in terms of their symptoms, I want to write about their soulfulness, power, humanity, and creativity. These children are the survivors: they have endured horrific traumas, genetic legacies of mental illness, soul-crushing disappointments and betrayals. They are still alive even when some of them don't want to be. When their voices are heard, they are loud and fraught with all the intensity of youth and the world-wariness of adulthood mixed still, somehow, with innocence.
I don't want to romanticize their situations. In my short time working residential, I drove countless times to hospitals to meet with kids who weren't able to be safe even in a residential program. I confronted children about committing sexual abuse. I ran through the dark winter woods in rural Massachusetts trying to catch a runaway girl. I soothed staff who found a teenager trying to hang themselves in a closet. I would sometimes leave work and think, "These parents eat their young." And yet most of these kids were able to paint, draw, or collage in sessions, creating images of huge power and significance for themselves. They had the courage to share parts of themselves with me, even though I was often therapist number 38 in their short lives. They shared with each other and gave each other strength to continue trying.
Their art was incredible, and I wish I was able to share it here. As an art therapist who also actively makes art, I appreciate its value emotionally and artistically. I know I was often assigned the more artistically inclined clients, so I probably saw more skilled artists than is average in the client population. Even so, I hope some of the kids I worked with are able to pursue careers in the arts. I am routing for each of them to survive their childhood and adolescence and share their gifts with the world.



Saturday, November 17, 2012

Coiling


This is an image of my experience with anger.

Holding the Raw

We as art therapists hold intense content and raw affect as it manifests in our clients' words, postures, movements, actions, and art. When a client or a group is processing something particularly painful, it can touch into our own vulnerable places and elicit a strong and sometimes unexpected response from us as therapists or group facilitators.

I was recently directing a small team of art therapists to lead group art processes for teenage girls in conflict. At times I was facilitating the art directives myself, and at other times I was supporting and coaching my team in facilitation. Throughout this process I was present, participating, and absorbing the anger of the group in a way that I don't normally experience. I have a history of absorbing the grief of groups, and I am comfortable with this: anger, on the other hand, is a trickier animal for me. I found myself wriggling with the intensity and unpredictability of carrying raw anger. It is hotter, faster; it is an outward force, requiring movement. Carrying it so fully challenged fundamental judgments around anger that I was indoctrinated with throughout my childhood and which were reinforced by society. I judged myself a lot at first, then laughed at myself and admired myself for carrying the anger. In holding it and being moved by it, I found myself coming to a greater understanding of anger. I found it can be a friend  when all feels hopeless. Anger can disprove helplessness in the face of injustice. Anger can be like jet fuel when I've been running on puddle water. Anger is not war.

These teenage girls we were guiding have experienced violence and injustice at a level that I can only imagine - genocide, terrorism, extreme loss facilitated by each other's relatives. Of course their anger is palpable. And if that anger can be transformed into a friend and into fuel to resolve a decades-long conflict, then what can they not accomplish?

It is our job to metabolize the raw affect of our clients and resolve it somewhat in ourselves: if we cannot do this, how can we guide others to do the same. The challenge is in the process, in our courage and willingness to step into the fire with our clients.

Tuesday, April 3, 2012

Back Again: Vulnerability

After many intense months, I finally have the time to rest and reflect.
Work. Refugee youth are one of the most vulnerable client populations a therapist can work with. This has become more evident to me in the past three months than it has ever been in my five years working with this group.
In the past three months I have:
-Supported four young clients in gaining out of home placements.
-Listened to stories of immense cruelty that have occurred in this country, at this time.
- Supported the language interpreters themselves as they reacted with outrage to the story content.
-Got to know the local authorities pretty well.
-Struggled to find a place in my ever-widening worldview for these stories.

How do we as therapists and caring people process the terrible situations that our clients report to us, particularly when they are still occurring?

I have stumbled my way through this quandary as if I had never done so before. All of my usual coping strategies have been only minimally helpful: supervision, rest, art, mindfulness, time with partner and friends, etc. This time around I found I literally needed regular bodywork, a vacation without phone or email at all, and ultimately to leave one of my work environments that was not taking threats to my personal safety seriously.
I have  incredibly high tolerance for difficult content in client stories; even so, when the worst stories I've ever heard intersect with a greater community that is not able to insure the safety of my very vulnerable clients and myself, I meet my limits. We all have different limits, and most of us won't know what those limits are until we hit them.
I'm sure I'll have more to share as I metabolize this experience further and come to greater understanding. For now, I feel it is important to share this process midway - to reflect with honesty the raw impact this work can have on us as human beings. It's tough and brutal and incredibly moving. I feel simultaneously heartbroken and richer for what I've experienced.