Researcher #ArtHeals
The research I've conducted reinforces the importance of art in healing, self-awareness and confidence-building. 
Alternative Possibilities in the Creative Art Therapies
Abstract: Art can take on various forms, whether it is through movement, music, or drawing. The creative arts in a therapeutic context have the ability to heal their patients in a secure and nurturing fashion. It is too often that the creative art therapies are overlooked or discredited as a true form therapy and, as a result, placed in the category of “recreational” activities. This paper intends to narrow in on three broad, yet critical, concepts in the field of psychology (imagination, self-actualization and empathy) as a means to explain what creative arts therapy is in relation to these concepts, as well as, its therapeutic values and goals as a legitimate form of therapy.
Alma (2008) states that imagination is “the cognitive capacity that permits us to give credence to alternative possibilities.” (p. 60) The word ‘alternative’ suggests that these presumed possibilities may be seen as either: (1) another or new, (2) a mutual exclusive from that which preceded the alternative, or (3) an avant-garde, unconventional way of thought. Regardless, the ‘alternative’ is always preceded by something else. Within the context of imagination, that ‘something else’ is the mere perception of what is. Imagination, in this case, is the alternative. It is the alternative way of perceiving or understanding that which allows one to see past the palpable and into the new and uncommon. In a sense, all three possibilities are possible in the realm of possibilities: imagination. In the realm of psychotherapy, however, imagination is needed for alternative understanding, or, empathic understanding, the “process of ‘feeling one’s way into’ another’s experience.” (Jenkins (2001), p.126) That, which precedes alternative understanding, or empathic understanding, is first self-understanding. In this paper, I will argue that the creative arts are a means to attaining self-realization, whereas, in the therapeutic context, the creative art therapies not only apply alternative understanding, or empathic understanding, in the context of imagination and therapeutic alliance, but also adhere to an unconventional, yet systematic, way of assessing artistic images in conjunction to more objective and observable measures. Since this paper will pertain to my personal experience with creative art therapies at Bellevue, the context of imagination and relationship, in this case, will be particularly art and movement.
Self-actualization and ‘Radical Intersubjectivity’
Self-realization is an integral part of human development. According to Maslow, the highest level in the hierarchy of needs is self-actualization. Self-actualization is the realization of one’s full potential, a need that is inherent in each and every one of us. In his “artistic theory of psychology,” Benjamin (2007) makes a point that, “the successful creative artist resonates with the highest levels of Maslow’s hierarchy of human potential.” (p. 66) He states that many people ‘labeled as mentally ill’ may be creative artists. He further suggests that providing a secure and sufficiently nurturing environment may be “conducive to enabling a mentally disturbed person with creative artistic potential to significantly develop and actualize this potential in life.” (p. 66) In a way, this all makes perfect sense. If a person is meant to be an artist in his life and he is neither provided with the proper environment or support, he will be unable to recognize his full potential. He may then become confused, disengaged and apathetic towards himself and others. He may even become majorly depressed. This argument shares irrefutable resemblance with Szasz’s (1960) “problems with living” stance. It is crucial to note that, in most cases, a hospital environment for the “mentally ill” is not constructed in a way to foster artistic potential. If anything, the medical approach used in most mental health environments only exacerbates mental illness through the provided environment alone. Szasz (1960) states that, “Since medical action is designed to correct only medical deviations, it seems logically absurd to expect that it will help solve problems whose very existence had been defined and established on nonmedical grounds.” (p.178) If not through creative art therapies to foster and nurture human potentials, is medication supposed to do a better job? If taken from Benjamin’s (2007) perspective, the pursuit for self-actualization, within the context of art and the application of one’s imagination, alternative routes may be taken to fix the problem. Szasz would agree that nonmedical issues should be treated in a nonmedical way. From personal experience, I would strongly agree on both accounts, seeing that the psychiatric ward of most hospitals do not cater to the higher needs of their patients.              
Self-actualization is often associated with spirituality. The spiritual realm is the level of consciousness where an individual may realize his or her own values in life that make if fulfilling and meaningful. Through his interpretation of Hegel’s Phenomenology of Spirit and Dostoyevsky’s Crime and Punishment, Mather (2008) utilizes the dichotomy “radical intersubjectivity” and “egological intersubjectivity.” ‘Radical intersubjectivity’ involves the individual seeking out a different perspective past his or her habitual frame of reference, in which, he or she “communes with alterity.” (p.34) Because its’ definition to spirituality is so similar, ‘radical intersubjectivity’ is also referred to as ‘spirit’ in Mather’s (2008) discourse, and is considered to be the “ground of all actual and possible human relationships.” (p.34) This leads into ‘egological intersubjectivity’ as an “empathic intentionality”, in which, the individual “experiences otherness” through imagination (p. 34) Mather (2008) suggests that spirituality, or ‘radical intersubjectivity,’ is necessary for empathy, or ‘egological intersubjectivity,’ because in order to be empathetic, one must be universally conscious. (p. 39) The aggregation of these two terms elucidates that self-actualization is interconnected with both spirituality and empathy, two components that are fostered through creative art therapies. Alma (2008) suggests that an individual is a “polyphonic character” because through the interactions and experiences the individual has with the arts and society, the internal dialogue is specified and developed. (p. 60) “Great artists give evidence of empathic and imaginative abilities. They invite us to look at the world from different perspectives and to articulate what is important to us.” (Alma (2008), p.62) In my mind, a creative art therapist is the great artist.  In fact, all therapists are artists in some sense. They are capable of both imagination and empathy. What makes a therapist an artist is his unconditional motivation to self-grow and self-understand through his experiences as a therapist. Being a therapist is becoming one at the same time, it is both an aspiration and a livelihood.
Empathy and Imagination
As a means of defining empathy, Bohart & Greenberg (1997) describe empathy in three ways. Empathy allows for one to see another individual as an idiosyncratic being through the appreciation of their experiences. Empathy also involves exploration or “immersing” into the  other’s experience. Lastly, through the empathic understanding of one individual into another’s experience, new meanings can arise by means of the “resonant grasping of the “edges” or implicit aspects of a client’s experience.” (p. 5) What is most important is: empathy can be expressed both verbally and nonverbally. In one study, the client’s perception of empathy from the therapist accounted for more variance in nonverbal behaviors than verbal behaviors of the therapist. (Bohart & Greenberg (1997), p. 22) Though this study was not shown to be generalizeable, the authors posited a question whether empathy is “primarily a relationship builder, or does it have specific effects.” (p. 23) In my mind, empathy is an engagement and act that involves two active players. It is an ongoing and always present component in therapy once a relationship has been established between the therapist and the patient.
The therapeutic relationship is a very important element in therapy. In Chambless et al’s (2006) chapter, “What should be validated?,” it is stated that within the therapeutic relationship, the therapist should act as a “nurturing parent with patients in the precontemplation stage, a Socratic teacher with patients in the contemplation stage, an experienced coach in the action stage, and a consultant during the maintenance stage.” (p. 215) It has been further argued against that, “those who advocate specific interventions for specific disorders do so without acknowledging the complexity of psychotherapy, therapists, and the human side of research.” (p. 208) As I will mention in this next section, there is another side to therapy that is not based on humanistic values.
Jenkins (2001) in his discourse on “Empathy as Dialectic Imagination” elaborates on the importance behind “therapeutic alliance” and empathy as an “outward movement” within the context of psychotherapy. (p. 130) He states that, “It seems reasonable to posit that the therapist’s empathic sensitivity toward the patient would be an important part of such an alliance.” (p.127) The other important part is the patient’s outlook and participation in therapy. Jenkins (2001) refers to two kinds of perspectives of the patients’ involvement in therapy: the “mechanistic” perspective and “humanistic perspective.” The mechanistic perspective describes the patient as a “passive reactor to the events impinging upon him/her.” This is the kind of scenario where the patient’s therapy is more directed in a systematic way towards achieving therapeutic gains. The patient has less control of the situation, thereby making him the “passive reactor.” The latter, on the other hand, is the “alternative” and humanistic perspective that describes the patient as an “already active agent who is seeking an environment in which s/he can solve the problems that are blocking more effective living.” (p. 127) This humanistic perspective seems to be most appropriate in addressing my argument – the ‘dialectical,’ therapeutic context that both the patient and the therapist actively engage in is the kind of environment that the creative arts offer. In Robbin’s (1986) book, “Expressive Therapy: A Creative Arts Approach to Depth-Oriented Treatment,” he states that the “countertransferential field of engagement is with introjects; our goal is the detanglement of self and object from the preverbal matrix.” (p. 31) The interaction that the therapist and patient have in expressive therapy is often not through any kind of verbal expression. The interaction creates a relationship between the therapist and patient within the context of an imaginative act. Through this, the patient-therapist relationship becomes the transference-countertransference relationship.
Beyond the patient actively seeking out for help, the therapist is also often put into therapeutic situations where he or she does not share the same outlooks on life that the patient does, not to mention the potential differing cultural and gender components. This, in turn, demands a “heightening of imagination” from the therapist. Jenkins (2001) refers to this as “empathy as an ‘outward movement.’” (p. 130) Empathy, in these regards, goes beyond the therapist’s “self-experiential” understanding, and into a more “imaginative projection” understanding. In quoting Margulies (1989), “imaginative imitation empathy” is “imagining and imitating in fantasy an ad hoc model of the patient’s inner world.” (Jenkins (2001), p. 131) This returns back to the concept of imagination as a vital contribution to the process of empathy. The next section will cover more in depth on how the therapist’s empathy plays a role in emotional integration for the patient.
Emotional Integration
Greenberg (2002) states, “In many situations in therapy, arousing emotions seems to be important precondition to changing emotions. A safe collaborative relationship with a therapist as well as the therapist’s empathic attunement to clients’ feelings are important preconditions for working with emotion.” (p. 7) Schizophrenia in particular is a mental diagnosis that is strongly involved with emotion and cognitive disparities. For the Schizophrenic artist, due to the disparity between his primary process cognition and secondary process cognition, he streams his imagination into creating chaotic and two-dimensional images in representation of his own personal and separate understanding of the external world. Such a disparity between emotionality and conceptualization leads to three reoccurring characteristics found in Schizophrenic art: fusion, diffusion and misidentification. (Crespo (2003), p. 184) These artistic images speak for the patient, and as for the art therapist, in this case, he must also take on the role of being the art educator. (Crespo (2003), p.190) The reasoning behind this lies at the core of understanding Schizophrenia, a disorder that is far too complex to elaborate on within this paper. But what can be said is each creative approach is different depending on the mental diagnosis, which further supports Greenberg’s idea of ‘arousing emotions’ and ‘changing emotions’ stated at the beginning of this section.  The kind of emotions that are involved in therapy vary tremendously, and the therapist’s ‘empathic attunement’ is ironically both a rehearsed technique and a spontaneity factor.
Personal Experience
My personal creative art therapies experience allowed me to witness the artistic approach to therapy for both outpatients with substance abuse problems, as well as, inpatients with varying mental disorder diagnoses. As it turned out, the outpatient and inpatient programs were utterly different from one another. Each had its own distinct approach to treating the patients, with the former being more expressive and free than the latter.  In regards to the outpatient program, two experiences stood out to me that support the thesis for this paper. The first experience occurred during an open art studio when I was assigned by my supervisor to lead the art group for that day. The basic goal that my supervisor had in mind was for me to engage the patients in a creative process of drawing generic faces. With minimal experience prior to this, I found myself asking self-reflective questions on how art can be therapeutic in a group setting. I found myself stuck and wondering what the differences were between mere skill acquisition and art therapy. Before conducting any research, since time was limited, I decided to follow my gut instinct in that art is supposed to be free and expressive and projected that attitude in the project assigned to me. In showing the patients how to start drawing a generic face, I made sure to draw an example while explaining the process through body language. I touched my own face and asked the patients to do the same as well in order to integrate a sense of self into what will be drawn onto the piece of loose-leaf paper. I also tried to interact with the patient by asking questions such as: “What facial features are most striking to you? Which one do you think is most difficult to draw? Did you realize that our heads are shaped like an egg? We’re all so similar – we all have “egg-shaped” heads!” This, I believe, incorporated therapeutic elements of using one’s own imagination. Most importantly, at the end of the project, I was able to see through the artwork created by the patients their inner selves and self-expressions. It was a way of understanding them without having to verbally get it out of them. It aided in my understanding of who they were for the rest of my experience at Bellevue. I strongly believe that through art media, I was able to experience empathic understanding.
Another experience in the outpatient program that stood out to me as a supporting detail to this paper’s thesis is a ‘Meditation & Movement” group therapy led by my supervisor. The group was instructed to find a spot in the room that they felt comfortable in and to follow the leader into meditation of moving like a tree. We imagined our feet to be the roots going into the ground and our fingertips to the end of elongated branches. In the midst of meditating and moving freely with our instincts for about 45 minutes, we were asked what was either lacking, overabundant or ‘just about right’ in our ‘tree-like’ nourishment. The main question asked was: how rooted did we feel in the position that we were in? According to Nachmanovitch (1990), “play enables us to rearrange our capacities and our very identity so that they can be used in unforeseen ways.” (p. 43) This ‘free play’ that we engaged in during group therapy allowed the patients to metaphorically perceive themselves as trees that must be nourished, a concrete imagery task, in hopes of self-understanding through an ‘alternative possibility’ of being. At the end of this group, I found myself realizing that I couldn’t bear standing in one position for those mere 45 minutes that we were in session. I was not at all rooted, felt completely undernourished, and from those factors alone, was able to reevaluate my position in life in conjunction with my position in that room.
My brief experiences in inpatient were much different from that of outpatient. The atmosphere was far more restricted and hardly therapeutic. In the most blunt, matter-of-fact, way that I may possibly put this, the two separate times that I was there for art therapy, what I saw seemed to mark the epitome of what creative art therapies is far too often stigmatized with: recreation. But even that alone, it was hardly recreational. In reflection to the earlier section of this paper, the environment that was permitted in inpatient was exactly the kind of environment that did not facilitate the pursuit to both either self-understanding or the relatedness to the world, as well as, others. The ambiguous tasks that were instructed during the two times that I was upstairs in inpatient seemed to isolate and inspire fear into the patients more than it seemed to integrate and unite their sense of selves. None of the patients were allowed to have any sharp objects (including scissors and pencils) in their hands at any point in time. The assigned tasks, however, required the use of both scissors and pencils. The way that this issue was ‘handled’ was to have me hold the tools in my pocket, and use them for the patients when they needed them to be used for their projects. In my mind, this instills fear and distrust into the environment, leaving no room for imagination and empathy to take place. Though my own personal and very brief experience in inpatient is not at all representative of the whole inpatient experience, I strongly believe that the restrictions placed on safety issues affect the therapeutic value in creative art therapies. This is an issue that affects many, if not most, hospital environments. A possible way of resolving this issue is to have projects that do not require tools that patients are not allowed to use.
The Power of Imagery
As a means of integrating both theory and practice, this section of the paper will be based on research within the field of creative art therapies:
Art therapy is the distinct practice of creating artistic imagery as an alternative means of nonverbal communication and self-expression. It is both therapeutic for the patient, as well as, beneficial towards solidifying the patient-therapist alliance. As a means to creating images, Jung suggests that “images are the product of a collective unconscious, expressions of archetypal material or universal themes stored in a shared unconscious memory. Once emerged, they carry the quality of inner convictions.” (Robbins (1986), p. 97) According to “Personal Construct Psychology (PCP),” developed by George Kelly in the 1950’s, rather than the patient struggling to uncover his unconscious struggles, his struggles are merely constructs that are “preverbal” due to the fact that they have no yet been solidified into actual/tangible constructs within the psyche. It is stated that the “continual interplay between professional and personal construing” is something that therapists experience in the midst of engaging their clients in a “creative venture.” (Harter (2007), p. 172) Both set of authors convey that the concept of image is an integral part of our human psyche. It is something that is inherent and is expressed either way, whether that be through actual image-making or therapist-inspired “creative venture.” Either way, through expression of this image, or self-identity, the possibility for a therapeutic alliance arises. This adds to the therapeutic value of the artistic process because it is within the context of relationship that therapy can take place.
A relationship between two human beings arises through communication and identification. In his article, “Aesthetic Properties of Pictorial Perception,” Shigeko Takahashi (1995) states that “what is expressed in a work of art is likely to remind the viewer of situations associated with particular moods.” (p. 672) The author proposes a “linkage between affective and cognitive processes” in perceiving the work of art created by another. Among some of the aesthetic properties found with pictorial perceptions are “seeing-in”, expressive perception and visual delight. (p. 672) These perceptual capacities entail a person-object relationship because the experience of emotional arousal allows for sympathetic identification to occur. The author states that, “among a variety of concepts describing this transaction are those of contemplation (Kant, 1952), aesthetic empathy (Lee, 1913; Lipps, 1965), psychic distance (Bullough, 1957), aesthetic sympathy (Lind, 1988), interpretation and understanding (Goodman, 1976), recentering (Benson), as well as the more psychoanalytic ideas of projection, introjection, and identification.” (p. 672)
Takahashi (1995) sets up a study to assess the congruence of feeling between the observer and the painter. In the context of this present argument, the role of the observer and the painter are not non-interchangeable. The observer may be the therapist, and the painter may be the patient. In any sense, the pertaining question is: which kinds of drawings elicit greater response from the viewer? Since Takahashi(1995) is arguing for the linkage between cognition and affective processes, a proposition arises that there is such a thing as “communicable” art. The drawings created by the participants in this particular study were nonrepresentational. The procedure involved line drawings based off particular emotions such as anger, femininity, sadness, illness, joy, etc. The results showed that viewers did in fact identify and sympathize with the art created by the participants, thereby yielding stronger substantiation for the “linkage” of cognitive and affective processes. As previously argued, emotional integration is an essential component to empathy. An image alone can elicit a response from the therapist, allowing them to communicate their understanding and emotional response back to the creator of the image, or in this case, the patient.
Images also have the power to act as “visual cues” for viewers. It is not only about creating images for the patient, but it is also about seeing and reflecting on images. Matto (2001) mentions that not only is art therapy beneficial in the emotional withdrawal process, where the individual experiences “direct intervention” with their drug-use habits through “visual cues,” but also beneficial in gathering clinical data in the “fast-paced hospital-based environment.” (p. 72)
In working with the methadone patients at Bellevue, there was a particular moment during the regular open art studio that a patient brought up a commercial she saw on television. This visual cue had made her think of struggle and she had expressed that she was terrified but could not understand why. In hopes of dealing with this issue, she expressed that she wanted to draw a picture that symbolized struggle to her. Instead of drawing about it, she began to talk about it. She had associated the commercial with her childhood war experiences and father’s aggressive tendencies. She was unsettled and conflicted in her descriptions until eventually she made a comment that, “All of us here, we’re very sensitive. I think that is why we are who we are, and which is why, we’ve ended up here.” Her ‘terrified’ struggle ended up translating into these words: “to struggle is to be strong.” She had said this just before the group was over, realizing her own strengths in the midst of communicating her visual interpretations.
Visual imagery strongly impacts the minds of its viewers and creators. The above discussion described how viewers are impacted tremendously by visual imagery that can be  daily basis. The creator, on the other hand, contributes to transferring both his emotion and inner psychology into the artwork that the viewer is witnessing. The transference of emotion is so evident in artwork that in fact research has yielded significant results in its direct correlation to mental health. In Gantt’s (2009) discourse on the formal elements art therapy scale, symptoms for disorders in the DSM are graphically equated with the stylistics elements found in drawing. Some examples of these stylistic features that are present on separate scales are: “depressed or elevated moods (Prominence of Color), decreased or excessive energy (Space, Implied Energy, Details of Objects and Environment), illogical thinking (Logic, Problem-Solving, Color Fit, Person, Integration), and cognitive deficits (Rotation, Perseveration, Line Quality, Realism.) (p. 126) The formal arts therapy scale is an systematic and objective way of evaluating artwork when in relation to mental health.
In overview of the important elements in therapy, the creative arts show great potential in fostering the emphatic and imaginative environment for the patient. Furthermore, the therapeutic relationship that arises between the therapist and the patient through both verbal and nonverbal representation seems to add more possibilities for the patient to communicate with the therapist. The creative art therapies certainly fit into the frameworks of humanistic psychology because the creative art therapist believes in the value of self-actualization and the idiosyncratic being. Through this, creative art therapy allows for self-expression – an element in human life that is far too often incarcerated either by the institutions of mental health or by our very own mind.

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