Art Therapy Test 2 – Flashcards

- Art is a natural language for most children - Can reduce anxiety to express trauma / abuse - Can increase memory retrieval - Help children to organize their narratives

- Don't impose adult standards - Don't make assumptions about content and meaning - Look at art for variety of meanings, consider context, listen to the child's narrative about images > the child is the expert - Consider: Cognitive, Emotional, Interpersonal, Developmental aspects of art expression and the Therapeutic Relationship - Talking at end of session, 1. Helps child externalize thoughts, feelings, experiences; 2. Helps therapists gain understanding to provide best possible intervention / treatment

- Verbalizing feelings in storytelling is effective intervention > child is actively engaged and empowered > non-confrontational - Art Therapist provides Egg shape and initiates story: "Magic Egg" from which anything can come out of it - Egg represents internal world - Cave opening from the inside shape: "Not an egg" "What would you see outside?" > Cave represents fantasy related to conflict and conflict resolution (p. 159) - Not simply projective tests but drawing / stories to bridge gap between the child's fantasy and reality (p. 159)

- Struggle with common developmental and existential issues > Terrible Twos > Attachment and Separation confusion - Uncertainty / needing validation / peers / identity / body changes / worrying about future life choices - Adolescent engagement with art therapy can include: apathy, opposition, resistance, mood swings, power struggles - Adolescent communication can include: intense and exaggerated messages to shock or express strong emotions, raw, uncensored, superficial, amplified

- Sometimes long history of social service involvement due to family issues, trauma, placement > can result in reluctance to engage, uncooperativeness, suspicion - Guardedness and uncertainty > begin with building trust and rapport > fun / without asking too many questions - Build Terapeutic Relationship: Begin slowly > facilitate connection - Testing > "Firing" or rejecting therapist > countertransference - don't take it personally > prove that you are staying AND make safe boundaries - Nonthreatening art activities with some distance / allow for metaphoric selfidentity like magazine collage, symbolic images like Tarot, mask making

- Anger: Depicting angry monsters / mythic characters / cartoons -Friendship: Choosing animals to represent diferent social skills / mythic (archetypal) costuming > characters, heroes, historical fgures -Self-awareness by creating books: About Dad; About Me; Divorce; Old School/New School; Feelings - Mosaic: CBT = Stressor > Beliefs > Behaviors > Make new (positive) beliefs and behaviors and cut up old ones to create mosaic

- Neurologically based - afects both learning and behavior - Inattention / distractibility > Art Therapy focused on fnding ways to redirect the energy required to maintain attention > applied to listening, learning, and productively using learned information - Impulsivity = acting or talking without thinking of the consequences / high expectations and surprised when can't accomplish everything / lying or stealing - Hyperactivity = externally visible symptoms > motor activity, restlessness, nail biting, hair twirling, sleeplessness, talkativeness, overactive imagination, food of ideas > in art might fill up paper with random scribbles / inability to stop activity / intrusion on other's artworks

- 1. Art is "child-appropriate" activity; 2. Uses visual learning skills; 3. Provides structure to therapy; 4. Gives children a way to express themselves - Art provides an immediate and visual record of child's feelings or ideas / addresses ADHD difculty remembering / artwork can be a way to reencounter feelings & thoughts / making learning easier - Art expression is preverbal: does not rely solely on words > ADHD child's vocabulary may be inadequate to express what their feeling - Art Therapy is also useful when combined with individual and / or group therapy

- Activities require listening, focus, planning, organization - Create defned boundary (walls or room divider) - To stop too much stimulation: predictability, consistency, and structure - Several steps or short activities together address short attention span that results in impatience and restlessness.

- 2014 Diagnostic Statistic Manual 5 (DSMV) NO LONGER ASPERGERS >> Now Autism Spectrum for everyone - Core difculties in social understanding and communication / do not easily understand what others are needing or feeling and how to share interpersonal experiences - Modify or structure environment to minimize visual distractions and enhance comprehension of and cooperation with expectations (visual schedule, breaking down complex tasks into manageable steps / parts - Therapy as social learning container > embedding social interactions (hello, thank you) and natural rewards / consequences

- Sexually abused children are characteristically silent victims (by manipulative adults or situations beyond their comprehension) - Seven major psychological disturbances in most abused adolescents and adults (also common in young children): PTSD; cognitive distortions; altered emotionality; dissociation; impaired self-reference; disturbed relatedness; avoidance - Research > PTSD / anxiety, aggression, depression, sexually aggressive behaviors > Terapeutic focus for children > development of the self, attachment, effective and behavioral dis regulation/ specific issues for abused children > sleeping disorders / eating disorders / low self-esteem - Abuse impact: Greater when repeated and long term, multiple perpetrators, penetration/intercourse, physically forced, starts earlier age, concurrent physical abuse, perpetrator substantially older than victim / parent sexual abuse has greatest impact

- Children hesitant & guarded (have been questioned) > sometimes resistant - Non-directive assessment > Comfort and safety / symbolic communication - Play/Art stations = art, sand, puppets, toys > toys with symbolic potential > sand miniatures / puppets = dominance, vulnerability, aggression, docility, transformation (caterpillar) / police, medical, diversity, > nurturing station (dollhouse, cooking, bathtubs) > reparative station (symbols of healing, medical kit) > protection / hiding (capes, sunglasses, masks, nerf swords) - Materials + structure introduced, paying attention to "safety" needs - Drawing > therapist express interest > stories, symbols, metaphors > unconscious & conscious symbols with specif traits / attributes - Child > projection to distance / address difficult emotional material > distance buffers themselves "from perceptions, cognitions, or affects that feel uncomfortable, overwhelming, or threatening - Art Therapy assists sexually abused children: "create images that communicate their internal perceptions about self and the world" > also, paper creates boundaries / sense of control to "contain" overwhelming feelings to make them manageable - Express emotions that may be constricted due to anxiety, fear, confusion, loyalty

- Creative opportunities for skill generalization and learning by integrating cognitive, behavioral, and developmental therapy methods and techniques - Focus on common learning characteristics and patterns of behavior (visual-based learners) / specifc interests > cultivate these as foundation for (motivated) interaction and learning / concrete literal thinkers - Difficulty organizing and sequencing activities, controlling impulses, initiating activities > Art can provide variety of concrete visual cues / visual schedules / picture-word instructions / art-making steps - Sensory / tactile sensitivity (consult with caregiver or teacher) / repetitive sensory activities can be soothing (Is it appropriate? Or functional?)

- Research evidence: Structured trauma intervention (structured drawing activities / cognitive re-framing) reduces trauma-specifc reactions: 1. Re-experiencing; 2. Avoidance; 3. Arousal - PTSD - 1. Experienced, witnessed, or confronted with EVENT(S) that threaten harm/death/serious injury; 2. Person's response > intense fear/helplessness/ horror/ powerlessness - Relatedness / perceived relatedness with victim can also cause PTSD - Traumatized children: difficulty learning/problem-solving; cognitive and behavioral impairments

- Address themes of fear, terror, worry, hurt (emotional/physical), anger, revenge, accountability, and victim vs survivor thinking > don't focus on dysfunctional responses - Reexposure; trauma narrative; cognitive reframing - Trauma-specifc questions = related to trauma experience NOT necessarily the trauma incident > sensory (see, hear, feel) / details of experience gives sense of control > reframing narrative - Therapist structures slow and progressive detailed response to NOT promote overwhelming flooding of too much information

- Generally refers to traumatic stressors that are interpersonal, i.e., premeditated, planned, and caused by other humans, such as violating and/or exploitation of another person. Can include manipulation and betrayal of trust. http://www.giftfromwithin.org/html/cptsd-understanding-treatment.html ) - Interpersonal can be more severe reaction in victim than impersonal - Repeated / chronic interpersonal (in family) complex because creates insecure attachment relationships, lack of safety/trust, unmet emotional needs / betrayal - Cumulative adversities: ethno-cultural, religious, sexual, socio-economic (poverty, homelessness, human rights, displacement, prejudice...)

- Re-exposure of core components > reorder > integrate into consciousness > self-regulate the intense fear / emotional reactions > healing IN THERAPEUTIC CONTAINER - Cognitive Reframing = narrative with reordered and manageable details - Drawing and the Trauma Narrative > Externalizing story into visual representation of the elements of that experience / sensorimotor / symbolic / translating memories / reintegration > to fnd relief from terror and to gain control - Internal (victim / powerless) > external (active / survivor) > therapist/witness - >>> Art Materials: Safety, Control, Contained

- Schizophrenia; Biopolar Illness; Major Depression - Hospitals; Psychiatric Hospitals; Day Programs; Prisons - Conditions for successful therapy: 1. Authenticity; 2. Creativity; 3. Recovery > therapeutic relationship / arts as empowerment / engagement / belief in recovery - Therapeutic Relationship = human connection / empathy / hope

- Standard Psychiatric Hospitalization = severe crisis > stabilization > discharge - Art Therapy in psych hospitals = groups (one time) / easy to control materials / structure / common themes / goal oriented / art as metaphor / action-based activity - Day Treatment: Assessment >Silver Drawing Test (Drawing from Imagination) / Coping Strategies > "stress" 1. Symptoms > visual analogue; 2. Triggers > depict; 3. Strategies > imagine peaceful scene / meditative; Strengthening Selfhood > rediscovering / reconstructing as mandala / tree - Studio Art: Creative transformation (Pat Allen > Way of Knowing) > Curiosity / artist quality materials / Phenomenological Approach

- Depression; Substance Abuse; PTSD / Head injuries > neurological, cognitive, emotional challenges / Interpersonal challenges with multiple deployments - "Veterans with traumatic combat injuries often fnd healing power in art" (Malchiodi, 2011, p.4) p. 321 - Combat Veterans developed their own art expression and rehab programs > VA Hospital > annual creative arts festival - Combat Paper Project (CPP): Shredded uniforms to make paper > create art on the paper

- Issues: Taking responsibility; Reconciling guilt; Confronting trauma of recurrent memories of combat. - VA Hospital: Creative Arts Therapy in "activity therapy departments" interface with music therapy, recreation therapy, horticultural therapy - PTSD = Anxiety disorder after experiencing / witnessing events that cause or threaten physical harm (to self or others) that involve feelings of fear, horror, helplessness - PTSD symptoms: reexperiencing events or memories, avoidance of reminders of traumatic experiences, hyperarousal or startle responses > fashbacks, nightmares, terrifying thoughts /sleeplessness / mood disorder or emotional numbness / exhibit behaviors that interfere with interpersonal relationships

- Research (1995): Only art therapy treatment reduced PTSD symptoms (p. 324) > distraction and way to address trauma memories thru visual narrative - Tx: Reduce hyperarousal; Create sense of emotional safety; Process traumatic events & associated memories / Enhance resilience & personal strengths to support self-efcacy & self-worth - Approaches: 1. Stress management & reduction techniques; 2. Cognitive restructuring & exposure or imaginal exposure therapy; 3. Resilience enhancement - Case Study pp 326-332

- Usually women (21-39% of women are victims of domestic violence) > 20% emergency room visits by women / 25% women homicide are battered women > more mental health disorders (including PTSD), substance abuse, anxiety, depression - Pattern of behavior: to gain power over partner through physical, sexual, emotional, economic, psychological actions or threats of actions to frighten, intimidate, terrorize, manipulate, hurt, humiliate, blame, injure, or wound another individual - Women in shelters / safe houses: Art as voice for survivors since talking / verbal disclosure is risky due to fears of retaliation by perpetrator > images help women express experiences - Clothesline Project > Women tell their stories of survival in words / artwork exhibited on a clotheslines

- Individual sessions or groups (counseling or support groups) and may include women and children in family treatment - Art Therapy can assist in emotional stabilization, validation of feelings, reduction of anxiety and fear, adjustment to shelter life & family changes, safety planning, prevention of future episodes. - Image making: separation, loss, socioeconomic concerns, single parenthood, gender roles, anger - Visual Metaphors help women express and contain stressful sensory experiences (quilting, book making, visual journaling)

- Forming, Storming, Norming, Performing, (Transforming, Reforming), Adjourning (Tuckman, 1965) > cohesiveness - Teams vs Therapy Groups - Relational Patterns / Roles / structured vs group decision-making > confict continuum > keeping up morale > therapist reinforces resiliency and celebrates therapeutic "work" - Balance: Gender, Diversity, Diagnoses

- Interactive Groups vs Individuals in Groups - Projection / Scapegoating / Monopolizing / Splitting (Pitting) and Splitting (Good or Bad) - Borderline Personality Disorder / Narcissistic Personality Disorder / Histrionic Personality Disorder / - Behavior Management or Empowered Participation

- Supporting while letting go > Active participants - Open Studio? Themes? Who decides? - Terapist role-modeling: By doing artwork? Asking open-ended questions instead of making interpretations? Allowing group members to interact - Stages (Phases/tasks) of Development (as in children): Parallel play art (structured) to foster success and positive feelings / outcomes > Working together to make decisions - move from structure to less and celebrate successes

- Theme / Topic Groups: Grief Support; Sexual Abuse; Medical - Interactive Group Therapy creates opportunities for group members to re-enact interpersonal patterns in the group setting. Dysfunctional patterns can then be addressed through feedback. - Group Admission: Sign up (Open) or Referral or Interview - 8 members is the magic number

- Allows each member to somewhat personalize object by writing object's personal biography, hopes, dreams, needs, future goals - Objects are common but can be both silly and evocative - When each group member spends time alone with the object, they are bonding with it and creating a meaningful relationship - This can be one session (as parallel play) or part one with creating a shared environment

- In Interactive Groups, some conflict is a powerful force for individual and group meaning and transformation BUT low morale causes members to drop out - Too much conflict or poorly timed can blow the group apart - Metaphoric arts in structure, themes, and process can create a safe container in which the group can address confict in SMALL BITES - Skillful leadership / facilitation allows group members to explore interpersonal patterns of behavior that threaten cohesion and harmony

- To move to a controlled, structured interactive group with some investment (due to bonding through the object's biography but NOT original artwork) - Providing random materials for the groups to put together as a shared environment for their objects is not as serious as if they had to collaborate with their original art - Group members have an opportunity to enact interpersonal behavior patterns. Here is the opportunity for some confict, but within a silly context so it remains safer. - By answering the questions provided by the art therapist, each group member can reflect on interpersonal roles and patterns of behavior through the groups decision-making WITHOUT having to engage interactively / their experiences are validated through the questions

1) Affects effective impulses 2) Affects anger modulation 3) Causes self destructive tendencies 4) Personal methods for emotional regulation and self soothing (even paradoxical ones like self harm and smoking) 5) Affects attention and consciousness (-> amnesia's/dissociative episodes/depersonalization) A. Dissociative responses are different in CPTSD than the DSM criteria for PTSD b/c CPTSD incorporates findings that are related to severe interpersonal abuse in childhood B. Children are more prone to dissociation than adults 6) Affects self perception (predominantly negative) A. Predominantly negative B. Chronic Sense of guilt and responsibility C. Ongoing feelings of shame D. Predominantly children: Incorporate abuse messages and posttraumatic responses into their developing sense of self worth 7) Affects perception of the perpetrator A. Incorporation of his or her belief system -> addresses the complex relational attachment systems caused by complex trauma 8) Affects the persons relations with others A. Not being able to trust the motives of others B. Not being able to feel intimate with them C. Internalized "lesson of abuse" that other people are self serving and venal and out to get what they can abuse/whatever means necessary -> thinking no one can be benign, care giving and not dangerous 9) Affects Somatization and/or medical problems (no real cause) A. These may relate directly to the abuse and the abuse's physical damage B. Can involve any major body system, pain syndromes medical illnesses and somatic conditions 10) Affects systems of meaning/understanding of them. A. Feel hopeless about anyone understanding their suffering B. Feel hopeless that they can recover from their suffering

1) Stressors that are repetitive, prolonged or cumulative 2) Interpersonal stressors (direct harm/exploitation/maltreatment such as neglect, abandonment, antipathy by primary caregivers) 3) Occurring at developmentally vulnerable times (early childhood, adolescence, later in life in conditions of vulnerability associated with disability/ disempowerment/dependency/age/ infirmity)

1) Emotional, physical, sexual abuse and neglect 2) Social traumas (racism, sexism, classism, and religious persecution 3) Survival Insecurity trauma like poverty, homelessness, joblessness

Refers to a person's perception of the meaning of an event, as opposed to the event as it exists externally to (outside of) that person. The focus of phenomenological inquiry is what people experience in regard to some phenomenon or other and how they interpret those experiences.