Difficult Client Defined

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Drawing the Line: Art Therapy with the Difficult Client is intended for all who have felt frustration when faced with a resistant or difficult client. In my experience as a practicing therapist, supervisor, and lecturer I have had the opportunity to listen to a myriad of clinicians discuss this very topic. What defines the difficult client? Is there a set of criteria that can be applied to the whole of the population? One common definition that fits each individual?

In fourteen years of clinical practice that singular definition has remained elusive. Instead, what I have found is a common reaction or affect-laden response centered on the therapist's exasperation. A feeling of helplessness sometimes embedded in anger, at other times couched in pleas for assistance. A threat to the clinician's own confidence. At this point, we have become not only the transference object but also an object of countertransference: A response to the patient-therapist interaction based on emotional feelings.

So now the question takes on further complexity. How can we as clinicians provide opportunities of growth for both our clients and ourselves?

One answer is art psychotherapy.

As a psychodynamic therapist I believe development is epigenetic and take note of the unconscious processes that drive the individual as he or she maneuvers through his or her environment. As an art psychotherapist, I have learned to interpret these unconscious and repetitious symbols. Thus, the visual experience takes the place of language as a nonverbal means of communication. A picture always speaks the truth. Regardless of age or ability, art never lies. It may reveal only one side, one moment within the here and now, one facet, but that facet is the truth.

To that end I invite each reader to participate in a brief and very personal expression, for without looking within ourselves how are we to help others? Without understanding there can be no growth.

To begin you will need two sheets of white drawing paper preferably no smaller than 8" x 10", a set of markers, a sheet of lined paper, and at least 30 to 45 minutes of uninterrupted time. I now ask you to find a safe, quiet, and comfortable area where you can complete the following assignment.

1. On the first sheet of paper draw the best person that you can. Make certain that you draw the entire body, not just a floating head or a stick figure.

2. Once that is complete, name your person by writing the name on the paper.

3. On the second sheet of paper draw the best opposite-gendered person (i.e., if you drew a male, now draw a female) you can. Make certain that you draw the entire body, not just a floating head or a stick figure.

4. Once that is complete, name your person by writing the name on the paper.

5. On the lined paper answer the following questions about your drawings:

a. Describe each figure; be as specific as possible. Include their likes, dislikes, pet peeves, interests, goals, vocation. Imagine you were talking to a friend about these people—what would you say?

b. How did you feel while drawing? What were you thinking?

c. Write something else about each person.

d. Looking at the drawings, what do you think?

At this juncture, as awkward as it may seem, take your drawings and the lined sheet of paper and place them in a safe area. We will be discussing them in detail in Chapter 3, and you will retrieve them at that time. However, if you cannot wait, feel free to jump forward to Part 2 and join me in assessment procedures.

In this book I introduce the clinician to the power of art and its use with a difficult client. Consequently, I will focus on the theoretical constructs that form the basis of psychotherapy, practical solutions for assessment and treatment, and case history reviews (in all instances, identifying information has been changed to protect the clients). This book will offer the reader, regardless of your training or experience, a direction to take when verbal therapy has failed and will allow you to see through walls built over many years. I hope that it will also serve as an adjunct to your work with any number of clients, outside of those outlined in this book, and in so doing offer creative venues into the unconscious, where therapy can blossom.

In the end, how do I define the difficult client? The difficult client lies within each of us—our beliefs, morals, prejudices, fears, and worries—our self-concept.

Ultimately, the definition of a difficult client comes from a difficult source—from within each of us.

In the Beginning

Pictures, symbols, signs—that was the language of man. Long before words held meaning we communicated through art. On the walls of caves, images of animals were drawn one over the other. The Egyptians rendered living stories within their tombs and temples, while the Greeks depicted emotion on painted pottery. Even written language is based on the use of symbols. "Writing . .. was originally an independent language, as it has remained to this day in China. Writing seems to have consisted originally of pictures, which generally became conventionalized, coming in time to represent syllables, and finally letters" (Russell, 1921, words and meaning section, para. 5). On and on art symbolized an individual's thoughts, feelings, realities, and fantasies.

Art has always held a power over humans—the power to connect, to cleanse, and, lest we forget, to intensify. As an example, a drawing of a hand would be identified by all as a hand, even though the language might be different. Yet the spoken word can have numerous definitions. Chase (1956), using the above example, writes, "Take the word "hand." In 'his hand' it refers to a location on the human body, in 'hour hand' to a strikingly dissimilar object, in 'all hands on deck' to another reference, in 'a good hand at gardening' to another" (p. 260). Thus, over time language has become attached to what we have come to understand. It shifts, it changes, it's denied, it's distorted, and ultimately it can be exceedingly deceptive.

As we discuss the intellectualization of language, this is the point where art therapy flourishes. In a moment it breaks through our very human defenses and allows us to see within the recesses of our psyche. Let's take the phrase "A picture is worth a thousand words" and apply it to a self-portrait. Figure I.1 was rendered by a preteen who was instructed to paint a self-portrait using only shape and color (see disk to view in color).

One does not require words to feel this child's pain. A darkened, red figure, a floating headless body with open mouth, cries into the abyss. The

The Difficult Client
I.l Self-Portrait

symbol overwhelms in its intensity. The product is permanent. Reviewed without distortion it is a memory recorded for all to see and revisit, a painting that allows us to feel and experience another's reality. This rendering was the child's symbol for a sexual assault. It rose from her need to express a traumatic experience. These thoughts, so very difficult to communicate verbally, were symbolized safely through the art.

As a therapist, think of the times you have expected your clients to discuss intimate, embarrassing, or traumatic secrets. Would you be willing to share one of yours with a professional? A stranger? In detail? Yet that is exactly what we request of every new client. The beauty of art therapy lies in its ability to break through the verbal defenses acquired over a lifetime. Art, being a less customary form of communication, allows the unconscious to break forward. Thus, material in any expressive or evocative therapy that is important will repeat.

Symbols communicate inhibitions; they often evoke memories repressed in earlier life. At the same time they address a motif that points to the future. The symbol, as the focal point of psychic development, is the foundation of creative development in a therapeutic process. (Kast, 1989, p. 27)

In times past, man symbolized everything in order to make sense of the world. Lacking scientific knowledge, humans relied upon primeval beliefs. Fiske (1870) writes:

In the original conception the world is itself a gigantic tortoise swimming in a boundless ocean; the flat surface of the earth is the lower plate which covers the reptile's belly; the rounded shell which covers his back is the sky; and the human race lives and moves and has its being inside of the tortoise . .. they [Indians] regard the tortoise as the symbol of the world, and address it as the mother of mankind. (myths of the barbaric world section, para. 33)

These primeval beliefs stretched across continents and formed common legends in places where people had no contact with one another. Fiske has written extensively on this subject, and here I will outline one example. He notes that the legend of William Tell was found among those in Denmark, Norway, Finland, Russia, Persia, England, Iceland, and India. He further goes on to relate that the Turks and Mongolians, despite never having held a book, could recite the legend intact in relation to one of their own tribesmen. As though this were not enough, he outlines a poem of Farid-Uddin Attar, born in 1119, that revolves around a prince who shoots an apple from the head of his page. This phenomenon correlates to what Freud called "archaic remnants" and what Jung, taking one step further, identified with the term "archetypes" or "primordial images." In its most simplistic definition an archetype is made up of basic symbols or images without a known origin. These innate ideas may vary in content, but their basic pattern remains intact. Edward Carpenter (1920), in his book Pagan and Christian Creeds: Their Origin and Meaning, agrees wholeheartedly with Jung and states, "Deep, deep in the human mind there is that burning blazing light of the world-consciousness—so deep indeed that the vast majority of individuals are hardly aware of its existence" (rites of expiation and redemption section, para. 4).

The fundamental importance of these collective images will become all too clear when we discuss assessments and assessment procedures. However, at the present time suffice it to say that "symbols address our intellect much less than they do our universal perspective and our relatedness to the invisible reality that transcends us" (Kast, 1989, p. 13). They lie in our dreams and in our art. Symbolism is our guide to the truth.

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  • Luke
    What is a difficult client define?
    4 years ago

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