5A sense of individual identity incorporates successfully a variety of internal and external roles.
6Comfort with a changed body image frees the youth from obsessing about appearances.
7A sense of self strong enough to continue to mature with reduced outside assurance.
These stages are useful for the therapist to bear in mind as they consider long range goals for treatment. However, it is not helpful to intellectualize these processes and neglect how the socio-economic-cultural circumstances make the achievement of these goals difficult, even hazardous, for many teenagers.
Strand (1997) proposes a vastly different form of gauging the nature and development of the structures that guide development. He sees five levels of development that mark this progression. ‘Each successive order of consciousness represents a new position of meaning-making equilibrium, capable of organizing more aspects of possible experience than the previous order’ (p.327). He finds the adolescents developing at the third level of meaning-making. ‘This stage is referred to as cross-categorical thought, which signals the emergence of the capacity for abstraction and self-reflection, the development of values, and participation in mutual relationships. Egocentric management of one’s own desires gives way to concern about the feelings and impressions of others’ (p.330). Looking at adolescent development from a ‘developmental-constructivism’ viewpoint is significantly different from the psycho-sexual approach and one I believe will add substantially to successful adolescent treatment.
Rutter and Rutter (1993) take a broad perspective of the developmental process. They believe that:
there can no longer be a single theory which constitutes a final explanation of maturation; most theories pay lip service to the role of genetic factors; biological maturation; and the relevance of brain pathology. Rarely an attempt is made to provide any form of integration. In addition Freudians, Piagetians, and Ericsonians seem to ignore the social life of children. Psychosexual and operational changes have given way to a focus on attachments, on the way relationships influence others, on the development of social understanding, and on the way children make inferences about another person’s thoughts and beliefs. As a consequence of these neglects there has grown a need to create new concepts and a fresh approach. (p.3)
The incorporation of earlier observations of adolescent development with contemporary theories give today’s clinician a workable and realistic foundation for their approach to adolescent treatment. I believe that therapists should offer treatment that incorporates a knowledge of developmental stress points with an expressive mode of communication. Treatment that allows the adolescent to show where s/he is on their own personal scale of development.
Figure 1.2 Setting goals: ‘Stop screwing around. Stop fighting. Stop flaming up. Stop bugging people. Eat right. Go to school’
Environmental stressors and attention to context
Every person projects, in their artwork and their verbal communication, information that reflects their social, cultural, and familial context. Environmental influences emerge in a client’s artwork. Their concerns are embedded and expressed in the context of their world. Normally, the inner-city child selects images which reflect their daily life and traumas, or the dreams they have of a better world. For example, many of these children spend most of their time after school inside their homes; not because their parents are abusive or over-protective, but because it’s not safe on the streets. This situational stress may compound the reasons why the adolescent has been referred to the clinic. The teenager raised in a rural environment with comparable emotional problems, may convey a similar message but with dissimilar forms. Forced physical restriction to the home may not be their experience, perhaps they have to endure other limitations that are just as confining. Images may project the same distress, however they differ in form when created by kids from dissimilar environments. Therapists have misinterpreted the art when the client’s living conditions have been ignored. The key lies in looking for similarities and differences simultaneously. All art therapy expressions must be regarded in the context of the art maker’s world.
Poverty is endemic in many parts of the world and is equally debilitating no matter where the youngster suffers. Economic hardship cannot be disregarded when evaluating an adolescent’s traumatic situation. However, how the deprivation is experienced by the teen can vary tremendously. Poverty has a universal language of hopelessness, but the harm it inflicts is a matter of degree dependent on the personality structure and the support system for the individual. Some resilient adolescents combat poverty and are survivors, others are overwhelmed with deprivation and internalize it. These less resilient youths find ways to fill their lives with alternative means of stimulation; drugs, gangs and crime to combat the disillusion they feel with society. The countless factors that influence the child to make their choices are studied by sociologists and mental help workers, studies that are beyond the scope of this text.
What therapists have to be acutely aware of, is that surrounding circumstances impact the youth, and the youth impacts their environment. We, as art therapists, cannot feel secure that the image is understood until it has been explained fully in the context of how the client experienced his/her difficulties.
Issues of gender and culture
A therapist must wear different lenses when treating adolescent boys and girls. Male and female concerns are very much influenced by the cultural belief system in which they are lived. There are no absolute cultural guidelines. The therapist must do his/her own personal research depending on who they are seeing, where they are seeing them, and what specific external concerns are impacting the therapy. I live in a multi-cultured city. The Hispanic population is numerically about the same as the Caucasian. But who are these Hispanics? Who are the Caucasians? The Spanish speaking persons come from many countries and white skin does not represent a homogeneous group. Where do the other persons of color fit? We have Middle Easterners, Asians, Blacks, and bi-racial citizens in all parts of the city. How children reflect these complicated demographics, interact and develop, is one of the most challenging issues of our time.
In my opinion, the only sensible and practical way to approach this enigma, is to see each person in therapy as a member of an unfamiliar culture. Indeed, we all are strangers to one another. If we are genuinely curious and question with sensitivity, we can be open to the experience of the ‘other’. We must ask our clients to teach us about their culture and correct us when we make wrong assumptions. How each culture perceives the time of life that we have named adolescence differs greatly. A teenager may be expected in his/her culture to conduct him or herself quite differently from the general modes of behavior in Western society.
Theories that hold to a sequential pattern of adolescent development are most challenged when looking at therapy from the stance of gender and gender defined roles. Adolescent youths exert a powerful influence in society. They create the male/female image of tomorrow. A major difficulty lies in the confusion that the adolescent feels over the very roles that they are determined to modify. Since they are not clear about the distinctive traits and duties of men and women they will not be very perceptive when they strive to explain their views. Collage is useful when attempting to understand gender defined roles through the eyes of the youth in treatment. The client can cut, mix images, juxtapose shapes, and symbolically experiment with concepts that are vague. Drawing over or around the collage can add to the individuality of the art expression. If the adolescent is provided with flexible media, s/he can clarify what s/he is sure about and what s/he is not. However, if the magazine pictures are all taken from Cosmopolitan, the art will not be representative. It is the art therapist’s responsibility to buy or beg magazines that have illustrations which show persons of various cultures and color, a broad variety of ordinary people. Vogue will not do. Plasticine and marking pens come in a variety of skin tones. Art therapy must have the tools to facilitate reaching goals, not add to frustration. Many youths today are verbalizing equality for gender defined roles, but in fact are living according to the old double standard. The attitude of their ethnic group has much to do with this paradox. How the teen is influenced by the family’s belief system