Sunday, March 29, 2015

Art Therapy Group Directives: a DBT group in long-term residential treatment

I ran a DBT-informed art therapy group for preteens and teens who were in a long-term residential and/or school placement. This group was closed, co-ed, largely white but not entirely, and met twice a week for an hour.
This residential/school program is based on the DBT model: Dialectical Behavior Therapy. In brief, DBT is a model of treatment focused on validation, mindfulness, and skills practice. Treatment is based on the belief that clients are trying their best but lack basic skills to effectively manage their emotions and relationships. It also incorporates self-awareness and accountability on the part of therapist that we are all fallible and can use practice in the skill areas of DBT.
For more information on DBT check out these links:
http://behavioraltech.org/resources/whatisdbt.cfm
http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/About_Treatments_and_Supports/Dialectical_Behavior_Therapy_(DBT).htm

Below are some of the art therapy directives I used with that group.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. I have organized the directives under the four areas of skills practice as they are taught in individual and group treatment. Some of these directives are not created by me, I just used them in this particular setting for skills use/ DBT therapy purposes. I will put a * by those I developed myself.

Mindfulness: 
a. Scribble Drawings. Play some music (fast or slow depending on your read of the group's need) and ask participants to scribble on a medium-large sheet of paper for 1-2 minutes. Then ask participants to look for images within the scribble and accentuate these with markers or colored pencils. Support members in checking in with themselves during this process, staying mindful of their feelings and thoughts. 
b. *Thought Tracking. Have participants sit in silence for 5-10 minutes with paper and pencils. Ask them to track their thoughts and feelings and depict them on the paper through words or images as they come. Tell participants: Notice judgments you may have about your thoughts and feelings as they come up. Track those judgments as well, maybe with + or - symbols or with the colored pencil you use or with your own creative symbols. 

Distress Tolerance:
a. Watercolor Pools. Provide each participant with a medium-large sheet of watercolor paper taped down to the table, a jar of water, and watercolor paints and brushes. Ask participants to pour water onto paper. Ask members to go against their tendency, pouring a lot of water if they only want a little or pouring a small amount if they want a lot. Then have them dip their brushes in watercolor paint (tubes work better than dry sets for this) and dip the paint-coated brushes into the water. Tell participants: Notice the colors expand and drift and mingle in unexpected ways as you add more paint. Track feelings of distress and practice skills if lack of control of the colors troubles you. If you only have a small pool of water and a lot of space to paint with more control on your paper, track feelings of distress for having to stay in control of your medium. 

Emotion Regulation:
a. *Skills Dice. Using small wooden blocks, depict with an images (painted or drawn in permanent materials) and a key word or two the skills you use to regulate yourself. Example: deep breathing or exercising. Put a skill on each of the 6 sides. Coat in acrylic gloss to seal. Tell participants: If you can't fill the dice, ask for help figuring out your skills - you have more than you think! Take your dice with you to remind you of what you can do when you are beginning to get (or are already) stressed out.

Interpersonal Effectiveness:
a. *Collaborative Paintings. (Also great for distress tolerance) Using small canvases and permanent paints, have participants take turns putting marks/images on a canvas and then passing the canvas to their left so that others can add to it. Leave room for others to paint as well. Tell participants: Track your feelings and use your skills to cope as you watch the evolution of your original image. Use your interpersonal effectiveness skills as you add to other images, considering that others may feel similarly to you about their original paintings. Also use your interpersonal skills as you consider and may want to respond to what others are painting before and after you. 
Variation: Have participants work in pairs and create a painting together. Support them when needed in using skills in this process. 





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.