Directives

Just as art projective assessments offer the clinician guidance for treatment planning, directives provide a framework for the therapeutic hour. Throughout the first part of this book the great majority of drawings resulted from directives. These directives were not offered haphazardly but were designed around the client's maturation process. Based upon Erikson's premise that emerging conflict must be mastered in order to prepare the individual for future growth and integrity, the use of directives allows the client to reveal unconscious material in a safe forum. Consequently, I cannot overemphasize the importance of directives in a process-oriented framework.

It is the therapist's responsibility not only to evaluate where the client is developmentally but to take into account the defense mechanisms that protect the individual and block communication. To this end, art therapy directives allow a freedom that purely verbal therapy deters. Directives can be designed to meet the client's changing needs and thus allow each individual to produce, share, and express on a multiplicity of levels.

As a result, if we return to Erikson's (1963) theory on psychosocial development and distinguish each period by the client's inner conflicts, we see that directives can be developed to enhance ego functioning, confront maladaptive patterns, identify similarities, and clarify life transitions.

Table 4.1 provides an example of how inner challenges to the basis of an identity can be delineated through directives. However, it is imperative that the clinician arrive at the client's developmental stage, regardless of chronological age, to assess the most effective directive in any category. Additionally, note that this list of directives is not intended to be all

Psychosocial Crisis

Sample Directives

Basic trust vs. mistrust: Constant testing of relationship due to need to define inside drives and outside experiences; literal and figurative biting (i.e., sarcasm), intense need to consume

Provision of soothing comfort and focused attention

• "Draw a picture showing what you want from ."

• "Select pictures of people and write down what they are thinking and then what they are saying."

Autonomy vs. shame and doubt: Gains power through stubborn control; destructive holding (control) or letting loose; obsessed by own repetition; feelings of being exposed

Firmness, outer control required

• "Select a picture that shows how you see yourself."

• "Make an animal. Discuss its characteristics."

• "Make the scariest animal you can."

• "Draw a person in the rain."

Initiative vs. guilt:

Jealous rage; desirous of favored positions; aggressive manipulation and intimidation

The need to learn and plan with others

• "Draw pictures of animals to symbolize each member of your family."

Industry vs. inferiority: Thoughts of inferior abilities produce withdrawal, isolation, or feelings of inadequacy; refuses to attempt new tasks

Recognition through task completion, skills

• "Choose 4-5 pictures that appeal to you and write why underneath."

• "Choose one color of clay and create a group sculpture."

Identity vs. role confusion:

Tests of trustworthiness, insistence on uniqueness, a search for belonging

Concern lies with how you are perceived

• "How do others perceive you? How do you perceive yourself?"

• "Draw your problem and solution."

Intimacy vs. isolation:

Avoidance of relationships produces self-

absorption and/or isolation

Empathy and mutuality toward others • "Draw a gift you would like to give to someone. Draw a gift you would like to receive."

Generativity vs. stagnation: Feelings of personal misery or impoverishment

Encouragement and direction required

• "Draw a picture of the past, present, future."

• "Draw something you would like to change."

Ego integrity vs. despair: Outward disgust hides internal hopelessness, fear of death

A return to the need for trust and reliability • "How do you feel when your needs are met? Unmet?"

inclusive; instead it is merely a sampling of how directives can be relevant when applied to developmental stage theory.

You will note in Table 4.1 that Erikson's psychosocial stages accentuate the polarity of conflict and integration. Therefore, many of the directives are offered as "polarities" (e.g., "Draw your problem and solution"). This type of directive translates well when looking toward personality formation that favors a hopeful outlook.

However, it is imperative that the clinician, when evaluating the developmental progression of a client, take into account a complete assessment of the individual and the artwork, lest an inaccurate picture of maturity emerge. As an example, see Figure 4.1.

Both drawings were completed by teenage females in separate group therapy sessions in response to the directive "Draw anything you wish." In each rendering, issues related to defecation figure prominently (this was a frequent drawing subject for both clients). For that reason, one may assume that both of these adolescents are fixated in Freud's anal stage of psycho-

Psycho Drawing

4.1 Letting Loose sexual development or Erikson's autonomy versus shame and doubt (to let go, to hold on). However, a review of the drawing style (see Table 3.1) imparts further information relating to developmental progression.

The upper drawing shows a cat endowed with human facial features and a stick figure with balloon hands (5-year-old style), while the lower image shows an attempt at perspective with a female's back turned from the viewer (teenaged style). It is evident that the upper drawing appears regressive (lack of proportion and detailing, repetitious schema for facial features) when compared with the bottom rendering's obvious statement of disdain (back to viewer while defecating).

If we now add the client's history to the evaluation, we learn that the upper drawing was done by a chronic schizophrenic who when decompensating tends to add fecal matter to her images just prior to destroying property or assaulting others. Thus, the upper rendering bespeaks of the anal stage of development or Erikson's shame and doubt with its concomitant destructive forces and residual rage, confusion, and mistrust of the environment. The bottom image was completed by a female who challenges the environment with her "uniqueness" of being; the intensity of her persona influences all of her interpersonal relationships, and she is cruel toward peers who are perceived as different from her. This drawing signifies the quest for identity— so important to an adolescent who is fearful of her own sense of self.

In the end, an assessment of these two females that incorporates the completed drawing, normative stages of art (Table 3.1), client history, and developmental stage theory (Tables 2.3 and 4.1) offers a progressively thorough appraisal of maturation. Although both of these clients were chronologically 16 years of age, only one was operating within the adolescent years of developmental stage theory. The other client, delayed by numerous years, would not benefit from a treatment plan that only took into account chronological age.

In this vein, if a directive (or intervention) is too advanced for the individual's developmental capabilities, then an already frustrating environment will further come to seem unsafe, confusing, and chaotic. Conversely, directives that are below the developmental age for any given client will seem infantile, and the client is likely to either manipulate or reject such directives out of hand.

The same consequences apply to the clinician's choice of media. As such, the use of pens or pencils with a child in the scribbling stage would be too advanced, while an offer of crayons for an adolescent is infantaliz-ing. Table 2.3 discussed select varieties of media as they applied to developmental stages and abilities. However, this list was not all-inclusive, and at this point I would like to introduce other materials into consideration.

The use of scrap materials and found objects is particularly helpful for clients who are navigating the stage of latency. It is within this phase of the developmental process that individuals move from parallel play to joint interactions. They can now understand another's point of view and are actively seeking competency through the completion of skills and tasks.

For this reason, not only is the tactile quality of cardboard, tissue paper, fabric, felt, and scrap paper appealing, but the act of creation from raw materials provides a feeling of accomplishment.

Figure 4.2 offers an example of a three-dimensional task created by a group of adolescent males (see disk to view in color). The project began as individualized designs (cardboard bases and toilet paper rolls) to which they added odds and ends until they were satisfied with the results. At this point they were instructed to combine the individual projects to form a single foundation. The final phase revolved around relating a story, and the group ultimately arrived at one that focused on power and the reward of female companionship.

Figure 4.3 (a detail of the finished directive) followed similar steps, yet this project was completed by a group of institutionalized adult males. The final theme paralleled their daily experience, with rivalries and scapegoat-ing taking precedence.

Art Therapy Directives

4.2 Power and Control: Adolescents 175

4.3 Power and Control: Adults

In both instances, although the chronological ages of the patients were separated by numerous years, their developmental skills were evenly balanced, and thus the use of mixed media provided an opportunity for recognition of individual skills through the completion of a hands-on group task.

The left side of Figure 4.4 was created by an adolescent male whose maternal grandmother had recently died and whose father was terminally ill (see disk to view in color). The family, as a whole, had never dealt with the feelings of loneliness or the associated anger and resentment of loss. Due to this situation, grief work based on a family systems approach was instituted. Utilizing a technique outlined in Maxine Junge's (1985) article "The Book About Daddy Dying," the client began to construct his own book based on events and recollections to aid in the mourning process.

This image illustrates a single page insert created out of fabric, tissue paper, and string (all media chosen by the client) that recalled comforting memories of his grandmother's favorite quilt. It is important to note that this was the only page of the completed project for which the client required mixed media. All other pages were drawn or utilized collage imaging.

Similarly, the right side of Figure 4.4 is an example of a memory box. This project, completed in stages, placed a variety of materials at the cli-

4.4 Grief Work

ent's disposal and ultimately provided a safe environment to communicate and explore issues related to self and others. In this session the client was instructed to incorporate the theme of family while "decorating the outside of the box." When this was completed, he was asked to "decorate the inside" and finally to create items for inclusion. The final objects (incorporating mixed media) represent his feelings of isolation surrounding missed holidays, birthdays, and events and his enduring need for a familial connection.

In each example (Figures 4.2, 4.3, and 4.4) these clients were served by the palpable quality of their mixed-media creations. With this in mind, the therapist should choose art materials carefully in order to take individual needs into account. These needs encompass everything from physical ability to environmental concerns to developmental requirements, as well as attendant emotional complications.

Directives as Interventions

Ultimately, the value of using directives lies in the flexibility it offers the clinician in individualized treatment planning. Their application in the therapeutic hour not only permits continued growth but can also provide a resolution of conflicts at any developmental stage.

As interventions, directives are as far-reaching as your imagination will allow. Whether in a group, family, or individual setting, they provide an integration of thought and feeling that in due course will heighten the interaction between the individual and his or her environment.

For the purposes of this section, directives are organized into five separate categories; however, I must state that this categorization is only for the purposes of illustration. Generally it is not possible to decide prior to a session whether to use specific directives during the therapeutic hour; instead, directives develop out of the unique requirements of the individual and his or her interaction in the here-and-now. For this reason, these categories should be utilized as a starting point for intervention rather than as a comprehensive guide.

The Introduction

Not unlike the stage theory of development, the phases of therapy can be distinguished by the progression of growth toward a mature identity. In this fashion, the initial encounter, with its need to join and build trust where mistrust often resides, is as important to the relationship as the stage of closure. For it is the introduction, the initial meetings that impart the tone for the relationship. In this stage, as Erikson (1963) noted in a discussion of the infant's social achievement goals, "the constant tasting and testing of the relationship between inside and outside meets its crucial test" (p. 248). Although Erikson's focus is infants, this statement easily applies to the client's first steps toward social relatedness regardless of age. Characterized by a struggle surrounding dependency (reliance upon another) and power (testing the environment), the initial stages of therapy seek an integration of inside and outside.

Art Therapy Directives

4.5 Hands of Love

For that reason, the individual requires a combination of comfort, control, and focused attention—the focused attention that directives and art tasks can provide.

The following illustrations typify directives that are useful in the early stages of therapy.

Figure 4.5 was completed by a group of adult males and entitled "Hands of Love." These gentlemen were instructed: "Trace your hand on your paper and draw a symbol inside the hand that represents something friendly about you. Once this is done, cut out the hand and glue it to the mural paper" (which was taped to the wall).

In this first meeting the task of forming connections was completed through not only the drawing phase but also the discussion that followed. Each group member explained the symbols that he had produced and how it related to the self. From verbal descriptions of faith (second from the left) and sobriety (fourth from the left) to the unconscious rendering of jagged lines framing the fingers of a male who the evening before had put his hand through a window (first on the left), these institutionalized men focused on the basics of their personality as they interacted beyond material needs.

In Figure 4.6 the same directive was given to a group of preadolescent females, yet the differences are profound. In this figure hands in one group

Art Therapy Hand Mural
4.6 Female Hand Mural

overlap and intrude upon their neighbors, while others languish on the outskirts or are placed upside down (the same individual created two hands—one for herself and another for her friend). Additionally, the group prominently labeled their hands with their names (digitally changed); rather than using their hands to symbolize the self, they preferred to affirm the connection physically with a name.

This example of closeness and distance contrasts with Figure 4.5's arrangements, which are evenly spaced and divided. There is neither closeness nor distance, only an equal sharing of space. This may be due in large part to the unspoken credo of the institutionalized that physical contact is always to be avoided, since in an institution even an innocent bump can create a dangerous situation.

Consequently, while the adolescent females seek a connection, often intrusively, the institutionalized male distances himself for protection and safety. Yet the objective of both groups remains the same: the provision of a safe haven where individuals can share, express, and build a foundation for improved trust that breaks down the division of internal wants and external needs.

In much the same way, a collage directive, with its prefabricated imagery, offers the individual a nonthreatening medium with which he or she can clarify interests and provide information in an atmosphere of support

Art Therapy Collaging

4.7 Collage of Me 180

and acceptance. The directive for Figure 4.7 was "Choose four to five collage images that tell me something about you, and write down why underneath." This completed collage not only presented interests related to the procurement of basic needs (the nurturance of food and joy of leisure) but also provided insight into this adolescent's relationship with the environment (a desire for knowledge and a generalized love).

In the early stages of therapy, the clinician is responsible for providing an environment of supportive safety as well as outer control. These conditions are necessary if the new client is to learn productive methods of communication within the environment. Yet for some clients the intensity of such a personal interaction creates a sense of fear and vulnerability, which is often juxtaposed with the use of defense mechanisms to protect from ensuing anxiety.

The client who completed Figure 4.8 relied upon the defense of undoing to resolve conflict and assuage the feelings of shame and guilt that threatened to overwhelm her fragile sense of self. For this reason I employed a dual scribble drawing. Not unlike collage work, this technique

Scribble Drawings

4.8 Help 181

offers a measure of safety as well as a manner of connecting. The process for this directive (although many adaptations can be utilized) was that I quickly scribbled random lines and asked the client to help me find a "picture" within the scribbles. She identified the bunny, and I colored in the disparate areas to flesh out the image. Understanding her issue with control and her frequent forays into destructiveness, I commented aloud, "he looks out of control," to which she responded, "turn it away, don't look at it." This metaphorical interaction continued with the client adding a "hammer" and bumps on the head as a means of discipline, while I commented that I didn't find the rabbit offensive, although others might, and symbolically toned it down with the use of color (rather than aggressive shaming techniques).

In Figure 4.8 the discomfort created by the client's conscious and unconscious guilt feelings drove her interactions within the environment. Along these lines, a directive that I make use of not only to facilitate trust but also to assess the level of identity formation is one I call the initial game. The procedure for this directive is to instruct the client to "draw your initials as large as you want on the drawing paper. Using the initials and the design they make, find ideas for pictures. Once you see a picture, color it in. Feel free to remain within or outside the lines, and use as much color as you desire."

4.9 The Flames of Anger

Figure 4.9 is an example of a completed initial directive (Landgarten, 1981, p. 25) drawn by an adolescent male. Instead of using his initials he used a combination of his first and last names (digitally changed). From an interpretive standpoint, the client's verbal explanation is as important as the visceral response of the viewer examining the drawn-form items. In the discussion phase he excitedly named his drawings as (from left to right) a video character, a fire pit, a flame, a man's face, a profile view of a woman, a woodpecker, and a polka-dot moon—fairly benign symbols as named verbally.

However, if we view our initials as emblematic representations of the self, then these details take on an increased significance. As reviewed in the last chapter, fire continues to stand for a duality of destruction and protection, a symbol that can both inhibit and shower hope. Unfortunately, the excessive use of fire and fire symbols in Figure 4.9, together with the renderings of male and female figures (accompanied with prominent genitalia on the woodpecker and female), appeared more destructive than encouraging. In this case the use of an expressive medium coupled with this client's past familial trauma (fire had destroyed his home) offered a process that was far too exciting.

Thus, not every introductory directive will create a safe and serene haven for feelings, thoughts, and emotions. An individual's past experiences will often find voice in unconscious expression, allowing the personal meaning to be brought forward—a personal meaning that has been formed from the cumulative experiences of his or her life.

Ultimately, the therapist must never forget that art has the power not only to bind but to intensify both existing and unconscious thoughts and memories.

Feelings Expression

If introductory directives can correspond to the first and second stages of developmental theory (basic trust versus mistrust and autonomy versus shame and doubt), then feelings expression can be said to correlate to the third stage of development (initiative versus guilt). It is imperative as clients leave infantile dependency needs behind that their emerging identity and ensuing efforts toward integration be tempered with acceptance and validation as they move in the direction of cooperation, increased self-sufficiency, and collaboration with others in the environment.

Because of this stage's thrust toward direction and purpose, the clinician needs to offer an atmosphere that allows for exploration of the emerging self as well as an opportunity to give vent to any associated negative ex pressions as the evolving individual seeks his or her course in an expanding world.

One way to provide for feelings expression in the use of directives is to allow the client to simply create, to experience the art materials without any instruction other than "Draw or create anything you wish."

The adult male who created Figure 4.10 recalled fond memories of feeding birds and the serenity of open space. Over the more than 20 years that he had been institutionalized, his hopes for release had turned to a fantasy that alternately produced depression and rage. His lack of freedom did not encompass the entire reason for his despair, however; much more important than his verbal protestations were the internal feelings of worthless-ness and a lack of accomplishment. With little purpose other than to sit and wait, his sense of isolation grew while initiative waned. Throughout numerous groups, this gentleman's art took on a similar appearance: With open expanses, rocky crags, and secluded surroundings, his images spoke of his failures to attain. However, each week he voluntarily returned to express his feelings and communicate the meanings of his experiences in a forum that offered recognition and validation.

In much the same way, a preteen explores her feelings of depression and loneliness as she both resists and reconciles herself to the dawning insight that family reunification will not occur (discussed in post-drawing inquiry).

Art Therapy Family
4.10 Rocky Mountain
Art Therapy Pitr Person The Rain
4.11 Clouds of Loneliness

In Figure 4.11 she has spontaneously drawn an image that expresses the anxiety of outer forces (rain, storm clouds) but also offers partial protection (umbrella) from these external pressures. Interestingly, this client has symbolically presented the problem (lack of parental support) and the solution (mastering the challenge by providing protection for the self), neither of which, at this point, requires conscious discussion. What she requires at this juncture is her own initiative to explore, absorb, and accept.

Along with an exploration of the self, the importance of negative expression cannot be underestimated. Whether it is in a group setting or individual session, this stage of the life cycle draws a parallel to the emerging personality as the individual tests not only his or her own limits but also the limits within the environment.

For this reason, in group therapy a client in this stage of development will often undertake challenges directed toward the group leader. Often a test of what will be acceptable and how the individual will be tolerated, these challenges are a necessary part of the developmental cycle as the client moves from an individual identity into a group identity.

In Figure 4.12 an adolescent completes a pass-around directive (Wade-son, 1980, p. 336) with a group of peers. In this directive the group was instructed to "draw anything you like on the front of your paper. When done, on the back list three things you want the group to complete. As we pass

4.12 Evil Child and Happiness

the drawings [to the right], each of you will draw one item in order. Once you have your original drawing, give it a title." This female wanted her peers to draw (1) an evil thing, (2) a happy thing, and (3) all evil and happy things.

In another pass-around directive, a group of adult males was instructed to "choose a collage image and draw one thing on your paper. After passing it to the right, add a second collage image; with each subsequent pass you will be told to add one thing. Once you have your original drawing, add anything you wish and give it a title."

This completed task (Figure 4.13) met with vocalized disdain from the original artist. During the discussion phase, he criticized nearly every aspect of what his peers had added while belittling the directive that I had chosen. In so doing, he, not unlike the female artist of Figure 4.12, was testing the environment's ability to withstand condemnation while employing early stages of learning in which working cooperatively with others aids the individual as he or she moves from "playful" expression to one focused on industry and competence.

Problem Solving

As the relationship matures and challenges related to power and control diminish, the client can benefit from directives that focus on problem solv-

Inferiority Drawing
4.13 It's G.O.D.

ing and the attainment of frustration tolerance. The sense of industry that develops during this stage is often coupled with skills acquisition arising from an increasing desire to expand the knowledge base through learning and responsibility.

Accordingly, directives that encourage a collaborative effort, centered on resolution and completion, provide an experience that counters feelings of inferiority with teamwork.

Regardless of the individual's cognitive ability or diagnosis, problemsolving directives shape the growing child's personality to prepare him or her for the increased intimacy involved in the sharing of him- or herself. Figures 4.14 and 4.15 provide an example of the use of a problem-solving directive with clients diagnosed within the pervasive developmental disorder spectrum. The project resulting from this directive (Figures 4.14 and 4.15) stretched over a period of 5 weeks and involved a group of boys with varying ability levels and communication skills.

Beethoven Hand Pencil Drawing
4.14 Beethoven and His Home

When you are working within this diagnostic category, teaching teamwork skills becomes exceedingly important in order to improve issues related to reciprocity, conflict resolution, and empathy. However, it is also important to recognize the high levels of anxiety that these clients experience when tasks outside of their normal routine are introduced. Therefore, it is beneficial to ease into the assignment by first creating individual projects and then combining these to form a larger whole.

The project began with the directive to each group member to "make an animal out of clay" (Figure 4.14 on left), and over the following 2 weeks group members were instructed to "choose a home for your animal and decorate it using any of the materials provided" (Figure 4.14 on right).

Once this was completed, the group was presented with a butcher paper-covered board, and a discussion followed that focused the group on pretend play. Each group member decided where their clay animal would

Whole Health Art Therapy Directives
4.15 Jungle of Illusion

live by placing their home and animal on the board; then they negotiated with one another when instructed: "As a group, title the project." The final step encompassed further negotiation and problem solving as group members worked as a team to complete the task by adding reality-based objects to the living environment. Figure 4.15 presents the assignment in its entirety (see disk to view in color). In keeping with the developmentally delayed child's symptomology, tissue paper not only predominates the project (fascination with tactile media), but six of the eight clay animals are hidden and in some cases sealed within the home, which symbolically points toward their preference for isolation over socialization.

In another directive, the same group of children used collage to explore facial expression as it pertains to the communication of feelings and emotions. The directive began with each group member choosing a series of collage images (two each, facial expressions only). I then introduced the group to the emotion pie on the wall which had four wedges. The wedges were labeled Serious, Hurt, Worried, and Happy. They were then instructed to "One at a time, glue your collage face where you think it belongs on the emotion pie." We then explored as a group the feelings as they applied to the task. In some instances the group did not agree with a particular placement. A situation such as this produced a spirited discussion about how feelings can confuse in their duality.

In the end, when you are working with a developmentally disabled population, "an essential component of these programmes [sic] is to describe and explore the event and comments that produce a particular feeling, both within the child and other people. . . . This is the start of acquiring empathy" (Attwood, 1998, p. 60).

Insight and Self-Disclosure

In keeping with developmental stage theory, the ability to understand and abide by rules is as critical to social competency as the attainment of a sense of self, empathy, and intimacy. The emerging personality possesses a rising motivation toward mutuality as well as self-exploration. However, in working with difficult clients I find that they have found much of their affirmation from self-absorption. In the avoidance of intimacy the individual has failed to master the ability to share his or her thoughts and feelings. Thus, the polarity exists whereby the client shows an intense need for social support at the same time that he or she prefers isolation, an isolation that is often motivated by the fear of a shared and intimate encounter.

Therefore, in this stage of therapy it is important that the clinician en courage a sense of responsibility and reciprocity, for the ability to compromise, share, respect dissenting opinions, and discuss frustrations is the foundation upon which genuine interpersonal relationships are built.

Figure 4.16 provides an example of a polarity directive that was given to a group of recovering substance abusers. These adolescent males were instructed to "draw what drugs or alcohol have done for you on one side of the page, and on the other side draw what drugs or alcohol have done to you."

Through the process of member-to-member interaction, the group initially chose to focus on their glorification and idealization of the past. Thus, at first their discussion focused on the right side of Figure 4.16 with its abundance of buxom girls, expensive cars, copious cash, and other accoutrements that defined their sense of self. However, as the dialogue turned to the left side of Figure 4.16, a more sobering discussion ensued. It was through this side of the polarity that the group stepped away from their fantastical recollections and processed the subsequent consequences. As a result, a range of emotions emerged that focused on the false sense of courage that substance abuse afforded, the physical ramifications (jaundice, weight loss, etc.), the legal implications, and the severed relationships with family and friends.

Although not every member of the group agreed with the feedback, the act of sharing, listening, exploring, and debating set in motion an intimate exchange.

In much the same way, a group of adult males redefines anger as not a driving emotion but one that is often driven. In Figure 4.17 the group was asked to "draw the feeling behind your anger and label each emotion that applies." This male, though initially focused on the theme of the stalled car, was ultimately able to process his feelings of sadness, betrayal, and isolation, which related less to automobile difficulties and more to familial problems. The helplessness and misery that this image illustrates is not only experienced viscerally by the viewer but was intuitively experienced by the creator as his discussion progressed.

When exploring feelings and emotional expression, the therapeutic hour, coupled with the therapeutic relationship, is often the first arena where the client not only practices the skills but feels safe enough to communicate and share them with others. Thus, this safe haven, whether it be in an individual or group setting, allows the growing individual to work at a pace that is comfortable while learning something about him- or herself.

4.17 The Feeling behind My Anger

Yet this situation can become dangerous if the skills learned remain only within the relationship and are not generalized. This type of dependency does not promote the continued growth that is necessary for future productivity in the larger world.

Therefore, it is imperative that any insights acquired are generalized outside of the protection of the treatment setting. One way to do this is to link directives so that they apply to both internal and external states. In Figure 4.18 an adult was instructed to "decorate the outside of the bag to represent how others see you. On the index cards provided, write down what you do not show the world and place them inside the bag."

When discussing Figure 4.18, the client stated that the stripes on the left denoted brightness while the inner circles symbolized calm. However, what he verbally focused on was the dark shading that surrounded the bag. This represented his darkness, which always encircled anything calm or

ZP cilvt* lei ■fif.üfle.^ jte ■fill fVv^ Lirfi ■

4.18 I Don't Let People See 192

bright and was how he believed others viewed him—sinister and threatening. Looking inside, he completed two index cards; the first said, "I don't let people's [sic] see how I fill [sic] about my life," while the second stated, "I don't let people's [sic] see the hurt I have in my heart." If we compare his drawing (how others viewed him as sinister and threatening) with his written word (how he doesn't show the world his hurt), these two states are polar opposites. Externally, he believes himself to be a representation of all that is ostracized, while internally he experiences the distress associated with isolation, apprehension, and secrecy.

This directive allowed him to explore his identity through symbolic expression while giving voice to internal fears and solitude. Once expressed, the secrets of his internal concerns were now available for discussion and offered the opportunity for change when treatment looked toward a future-oriented framework.

The same holds true when working with clients who not only are cut off from family relations but fail to acknowledge the role that family dynamics have played in fostering present-day issues. In the case of one male, his sense of isolation was profound, and he often voiced his feelings of loss through stoic verbal comments coupled with intellectualization as it applied to his and his family's propensity to substance abuse. Considering that secrecy and denial were this individual's personal tenets, I introduced a pictorial family genogram directive. As Holman (1983) defines it, a "genogram is a valuable assessment tool for learning about a family's history over a period of time" and "usually includes data about three or more generations of the family, which provides a longitudinal perspective" (p. 68).

Figure 4.19 not only offered more visual impact for the client than the traditional genogram circles and squares but also provided a factual response to a pervasive situation. Based upon the client's previous drawings, it combined his verbal statements to embellish his family history and consequently guided a discussion on multigenerational substance abuse through an empathic and respectful exchange of ideas.

Alone, the pictorial family genogram did not provide the change needed, but it offered the client a safe forum in which to discuss and explore the family system and their interactions, communication patterns, and structure.

Closure

As the therapeutic relationship comes to an end, the expression and sharing of feelings become primary as the individual applies the accom-

Three Level Genogram
4.19 Pictorial Family Genogram

plishments of previous stages to present circumstances. With purpose, competency, and the ability to both give and take, the dependency of earlier years has transformed into a desire to produce. At this stage, the client benefits from both a review of progress made and a chance to express the myriad feelings that closure creates.

In Figure 4.20 the directive given was twofold so that the entire group

4.20 Accomplishment

had a chance to examine its feelings. The group was instructed to "draw something that you would like to give to [name of member leaving] to help him be successful." Conversely, the graduating client was instructed to "create something that symbolizes your feelings of leaving this group of people."

On the left side of Figure 4.20, one peer provided the graduating client with a signpost for success labeled "patience." On the right side, the graduating member correlated his accomplishments to a mission, an undertaking that was akin to a job. His bold statement "and I am out to do it" symbolizes his determination to continue to care for himself and to remain a productive member of the community. After the task concluded, the group presented the graduate with the completed projects, while his drawing was displayed in the group room on a wall designated for comings and goings.

Unfortunately, not all departures represent a sense of achievement. Figure 4.21 represents the departure of an elderly male who was diagnosed with terminal cancer and scheduled to leave to receive medical care. The group, faced with the news, responded with emotions that ranged from denial, fear, and sadness to attempts to "enliven" the situation through jokes and stories. It was apparent that the members were attempting to take care of their friend, yet the intensity of feelings overwhelmed their ability to provide comfort. Because of this, I presented the group with precut pictures and words, rather than drawing materials, to provide containment for the multitude of feelings that required expression. The directive was to "create an image that celebrates your spirituality in times of stress, something calm and reassuring," and as the focus shifted to the process of creating the group's emotional tone turned serene. This interval allowed the members to discuss the disparate pieces in a personal manner, focusing on themselves, their thoughts, and feelings.

After completing the individual pages, the group was instructed to "combine your illustrations on a larger board so they form one cohesive im-

Art Therapy For Identity Development
4.21 The Group Bids Farewell

age." The goal of this directive was to symbolically integrate each individual expression into a union with others, as a functioning member of a larger community where care and production provides support. In the end the group presented the poster to the departing member as a transitional object of hope, regard, and encouragement.

Art therapy directives provide a comprehensive approach to emergent issues, but the categorizing of directives as interventions can address the unique developmental needs of the individual to promote the development of a mature identity. With this in mind, Appendix F offers the clinician a list of sample directives divided into the five categories discussed in this chapter: introductory, feelings expression, problem solving, insight and self-disclosure, and closure.

Summary

The objective of this chapter was to introduce the clinician to a range of directives that focused on the maturing individual's ability to move beyond egocentricity toward social reciprocity. To this end, interventions were embedded within the framework of Erikson's psychosocial stages in order to illustrate the process of growth and maturity. However, I must stress that directives do not need to conform to these principles. In fact, art therapy interventions frequently arise from an individual's verbal statements during the session, and it is the therapist's responsibility to decide whether the use of directives will build upon the client's verbal statements or will be decided prior to the therapeutic hour to accommodate transitional stages.

Ultimately, the decisive factor when choosing a directive should be the comprehensive needs of the client. As a form of intervention, directives enhance the growth process as well as offering support where ego functioning is present but tenuous. This distinction is an important consideration for any clinician to understand, for it is the social trust formed and developed through the curative involvement of therapist and client that creates intimacy. And it is this intimacy that paves the way for insight as the ego is able to endure resultant environmental conflict.

As a basis for communication, art therapy directives encourage symbolic and creative representations, stimulate verbal expression, offer a controlled situation to explore and practice new modes of thinking, and provide an outlet for unconscious thoughts and feelings.

In short, art has the power to serve both expressive and interpretive functions of development. With an emphasis on integration and identity formation, directives can heighten the interaction between the individual and his or her environment as mature thinking develops.

Part III

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    How to do art therapy with adults who experienced abuse?
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