Integration doesn’t happen overnight. Relying solely on time to heal a wound, however, inadequately bandages an untreated infection. Only through a concerted effort to confront the depths of our pain and the origins of its structure is it possible to feel the sun on our face. In C.S. Lewis’s (1961, pp.52–53) A Grief Observed he notes, there was no sudden transition from fear, anger, grief and pain to warmth and light. It was “like the warming of a room or the coming of daylight. When you first notice them, they have been already going on for some time.”
Art therapy and short-term treatment
If the work of integration is equivalent to reshaping our psychic puzzles to fit all the necessary pieces, then art therapy challenges us to create that puzzle in a tangible way. A theory may suggest a particular outcome based on an educated guess, but it is only through experimentation that an extraneous variable makes itself known, serving to validate, disprove and/or revise our original thinking. Through a willing suspension of disbelief, creative acts allow for this element of the unknown; we accept, for a moment, we don’t know everything, and are willing to try a new way of perceiving. This suspension allows us to watch a film, read a book, gaze at an abstract painting, or play a song and experience emotional resonance, which may be derived of fictional content, but nonetheless helps us solve real life quandaries.
In the context of art therapy, we might refer to these “extraneous variables” as sensations, metaphors, images and/or personal symbols that bubble up from the unconscious to deliver their own critiques of our conscious “self” theories. It is the responsibility of the art therapist to contain, assist, and mirror, in this fantastic “transitional space,” what reconciliation lies between the client’s inner and outer worlds (Winnicott, 1970). To meet this challenge, the art therapy student and working professional benefits from three things: knowledge of theory, an experiential understanding of its applications, and a mastery of implementation. Adhering to this philosophy, the content of this book was divided into three parts:
Part I: Examines grief and attachment, including definitions and key terms, existing change and recovery models, a developmental framework, a bio–psycho–social–spiritual perspective, and a discussion of directive and non-directive art therapy approaches.
Part II: Examines through the art-based self-studies of art therapists the intra-psychic journey of addressing the grieving process. Methods, procedures, and a discussion of themes are organized in an instructional manner for ease of replication.
Part III: Examines through the implementation of art therapy interventions with various populations the observable journey of integration in the grieving process. Methods, procedures, and a discussion of themes are organized in an instructional manner for ease of replication.
According to its website, the American Art Therapy Association (AATA) represents more than 5000 professional art therapists across the globe (and others who hold the belief that the creative process involved in art making is healing and life enhancing). A survey conducted of its members in 2013 revealed over two-fifths (41.9%) of respondents work with “Mood or Anxiety Disorders,” and “Posttraumatic Stress Disorder” was chosen by 30.7 percent of respondents. The American Psychological Association offers four “psychological effects” of mood disorders and PTSD: depression, generalized anxiety, survivor’s guilt, and grief and loss. Additionally, risk factors for complicated grief, which is a prolonged, dysfunctional experience of grief, include being a woman, a history of mood disorders, low social supports, insecure attachment style, positive care giving with the deceased, and pessimistic temperament and personality correlates—all of which “suggests common underlying vulnerability” (Shear et al., 2011). It is the argument of this author that the “underlying vulnerability” quite clearly relates to one’s fundamental attachment dynamics, and this has predictive and possibly protective implications for the experience of grief.
Much of the psychotherapeutic literature consists of studies and case examples that have been conducted over a long period of time, and in private practice. But many art therapists working in institutional settings engage their clients on a short-term basis, due to the terms of their employment (per diem work, volunteer positions, or internships are typically limited in their scope), the nature of the setting (such as in acute care, hospice, rehabilitation centers, foster care programs, or transitional programs and residencies), or because the clients are ambivalent about engagement and have no external incentive to participate (such as in community-based programs, outpatient programs, and harm reduction programs). A short-term treatment model was selected for this reason.
Studies of brief interventions and short-term treatment models have been conducted in a wide range of healthcare settings, from hospitals and primary healthcare locations (Babor et al., 1994; Chick, Lloyd, and Crombie, 1985; Fleming et al., 1997; Wallace, Cutler, and Haines 1988) to mental health clinics (Harris and Miller, 1990). Because they are timely, focused, and client centered, short-term treatment models can quickly enhance the overall working relationship with clients and can be useful for addressing specific behavior change issues in treatment settings. Interventions administered in short-term treatment are usually structured and focused. Its primary goals are to raise awareness of problems and then to recommend a specific change or activity that moves a client towards a new conception and/or experience of their problems (in the context of this text, the experience of grief and loss, and related attachment disturbances).
Additionally, while scholarly in nature, this book provides its readers with hands-on activities for working with grief. It is my fantasy that when the art therapist working in an institutional setting is asked to create a “billable” treatment plan, he or she will be able to pull out this book and feel up to the task, fearing the auditors and regulatory bodies who are ignorant to the benefits of art therapy no more.
How to read this book
If you have picked up this book and perused the introduction, grief has likely touched you or your clients in some fashion. My recommendations for considering its contents are as follows:
If you are a student in training, I ask you to consider your motives for exploring the topic of grief, and examine what unfinished business you may still harbor. I would encourage you to pay particular attention to Parts I and II, which will help frame your theoretical understanding and illuminate the processes of self-examination and discovery. This is essential to the teasing out of “what is ours and what was given to us,” allowing the professional in training to become a better facilitator of this process for his or her clients.
If you are a working professional, already you have a command of early developmental theory and have witnessed firsthand the effects of attachment disturbances in grief. I would invite you, however, to approach this book with a willingness to suspend pre-existing theoretical frameworks, and consider an integrated approach that expands upon them. Part II may be useful in processing any vicarious trauma or counter-transferential material, while Part III provides practical short-term treatment interventions.
If you are grieving and are interested in creative approaches to healing, this text is intended to be a useful addition to your toolbox. Whether your loss occurred in the distant past, recent past, or is anticipated to occur in the near future, it is never too late or too soon to engage in this work. In confronting the task of rebuilding your life story, I would encourage you to pay attention to Parts I and II, which provide a helpful frame of reference and examples of how others have navigated this path. Part III provides additional options for materials, methods, and procedures that may inspire. Please note, this book is intended to promote therapeutic practices but is not intended to replace therapy. I highly recommend seeking professional support as you embark on this journey.
References