P A R T I I I
Clinical Applications with
Another feature of the phenomenological approach is the opportunity to ac-knowledge many different aspects of art expressions, including cognitive, emotional, interpersonal, and developmental. A therapist may also consider somatic (physical) and spiritual aspects, depending on one’s theoretical framework. Looking for a mul-tiplicity of meaning provides a therapist with information for developing and deepen-ing the therapeutic relationship as well as honordeepen-ing the uniqueness of the individual (For more detailed information on this approach, see Malchiodi, 1998.)
Many therapists who use art activities with children in therapy wonder: “Is talk-ing necessary?”, “If so, when is it appropriate to talk?”, and “How much should I talk with the child during an art activity?” The answers to these questions are de-pendent on the child, the relationship between therapist and client, and the context and course of therapy. Some children become extremely engrossed in art activities and find it disruptive to speak with the therapist while creating. Others, particularly adolescents, may be resistant to speaking about it directly and may require some en-couragement and a degree of patience on the part of the therapist. On the other hand, many children enjoy the therapist’s taking an interest in their art as they are working on it, especially when a sense of trust has been developed between therapist and child client. For some children, talking during drawing is helpful, especially if there has been trauma; talking can actually help diffuse some of the powerful and overwhelming feelings that arise during the process of drawing a traumatic event (Malchiodi, 2001; Steele & Raider, 2001).
Talking at the end of a session about finished art works is important and encour-aging the child to communicate is useful for two reasons: (1) it helps the child to ex-ternalize thoughts, feelings, and experiences through both art expression and story-telling; and (2) it helps the therapist to better understand the child and provide the best possible intervention on behalf of the child. With children who are resistant to talking, art expressions can be a way to facilitate conversation through storytelling, pretend, and play activities. In fact, most children do not know what their art expres-sions mean but can, with the help of the therapist, develop imaginative narratives about the elements of a drawing or painting that reveal a great deal about their feelings, perceptions, and world views.
The authors in this section demonstrate both the basic principles of art therapy with children and adolescents as well as the diversity in application of art therapy with a variety of child and adolescent populations. Tanaka, Kakuyama, and Urhausen (Chapter 10) illustrate how storytelling and art work hand in hand, result-ing in effective child therapy. The lead author based his innovative techniques on the seminal work of Donald Winnicott, a pediatrician, who created the “squiggle game,”
a simple method that involves both therapist and child in drawing and storytelling.
Winnicott’s work inspired Tanaka to develop the “Egg Drawing” and “Cave Draw-ing,” his own versions of drawing activities with children. Along with coauthors Kakuyama and Urhausen, he explores the value of drawing and personal narratives as both a creative assessment tool and a therapeutic intervention that engages the child’s imagination through metaphor and story.
Chapters 11 (Steele) and 12 (Gil) discuss ways that clinicians can use art and play activities to process trauma. Interventions using drawing have been successful in 120 Clinical Applications with Children and Adolescents
ameliorating posttraumatic stress disorder (PTSD) in children exposed to school shootings, family violence, abuse, and traumatic loss. During the completion of this book, therapists witnessed the value of drawing when terrorist attacks on the World Trade Center and the Pentagon created fear and anxiety in millions. Art interventions proved to be one of few ways to reach children’s fears, anxiety, and other sequelae of trauma created by subsequent terrorist alerts and biological threats to safety. Because of the prevalence of televised images of terrorist attacks, most children initially por-trayed airplanes crashing into buildings, the Twin Towers of the World Trade Center on fire, and rescue efforts by fire trucks and helicopters (see Figures III.1 and III.2).
Content of these images often reflected the more typical responses of children ex-posed to acute trauma—simple renderings and predominant use of red and black.
Children most exposed to the terrorist attacks continued to repeat these images for many months after the incidents of September 11, 2001, a response typical to severe trauma or loss. Trauma interventions such as those described by Steele (Chapter 11) have been successful in ameliorating PTSD in those who have witnessed violence, including school shootings and terrorism.
In addition to intervention, art expression is also used as a tool in forensic inves-tigations of children, particularly those traumatized by physical or sexual abuse.
Cohen-Liebman (Chapter 13) explains the concepts of “forensic art evaluation” as a method of evaluating child abuse and discusses how drawings are being used as novel scientific evidence in courts. Because children’s drawings may reveal physical Clinical Applications with Children and Adolescents 121
FIGURE III.1.A 5-year-old girl’s drawing of the World Trade Center attack.
or sexual abuse and can supplement verbal interviews of children suspected of abuse, they are an important method for all therapists who work with children subjected to possible violence or molestation. Liebmann addresses how drawings can help the therapist understand children who have been abused and how art expressions are an effective adjunct to verbal forensic interviews.
Art therapy is useful in the treatment of many disorders in children, and atten-tion-deficit/hyperactivity disorder (AD/HD) and autism are two that are particularly suited to creative expression in therapy. In Chapter 14, Safran explains how art ther-apy is effective with children with AD/HD, outlining its advantages in addressing impulsivity and inattentiveness in this population. Case material on working with in-dividual children and groups gives the reader a more complete understanding of how art therapy can be integrated within all phases of treatment. In Chapter 15, Gabriels offers a comprehensive overview of childhood autism and provides specific methods she has found helpful in intervention for a variety of issues. Both authors include valuable observations on the importance of family art therapy in the treatment of these children, underscoring the need to work with the child in the context of parents and siblings in order to achieve the greatest impact on behavioral change.
Councill (Chapter 16) provides a model with how art therapy is used with pedi-atric populations, particularly children with cancer. Medical art therapy is a growing area of application and has been used with children with cancer, HIV, asthma, juve-nile arthritis, severe burns, and other medical conditions (Malchiodi, 1999). It is used 122 Clinical Applications with Children and Adolescents
FIGURE III.2.A 9-year-old boy’s drawing of “what happened” when the World Trade Center was hit by airplanes.
not only to address trauma associated with illness, surgery, medication, and medical interventions but also as a form of psychosocial treatment and stress reduction. Art therapy with pediatric patients may minimize preoperative anxieties and fears, re-duce pain, and enhance a sense of self-empowerment in medical treatment. Council brings a wide range of techniques in both art-based assessment and art therapy, viv-idly illustrating how pediatric patients benefit from creative expression in hospital settings.
The final chapters of this section cover two contemporary issues clinicians face in work with adolescents: depression and violence. Riley (Chapter 17) provides guidelines for how art expression complements the treatment of adolescent depres-sion, underscoring how drawings can reveal unspoken indications of suicidal thoughts and depressed affect. Art for adolescents is one way to reach both those who are withdrawn as well as the resistant teenager; it provides a creative way to communicate without words that most adolescents find preferable to solely verbal in-terviews. Phillips (Chapter 18) tackles the topic of violent imagery in adolescents and discusses why both normal adolescents as well as teenagers with violent tendencies make violent images. Violence, whether in the form of school shootings and assaults, gang-related violence, or conduct disorders, is a serious concern to most therapists who work with adolescents. Events such as those at Columbine and other high schools have heightened interest in violence among those who work with youth and many therapists are interested in identifying those who have violence tendencies and effectively addressing the appearance of violent imagery in art expressions. Phillips explains ways the therapist can evaluate and work with these images in ways productive to the course of therapy.
All the applications described in this section underscore how therapists who work with children and adolescents can integrate art therapy in their work. Art can provide a window to children’s and adolescents’ problems, traumatic memories, de-velopment, and world views. Its primary purpose is to give these young clients an-other language with which to share feelings, ideas, perceptions, and observations about themselves, others, and the environment. Art therapy can serve as an impor-tant catalyst for increased interaction and exchange between therapist and child or adolescent, thus expanding and deepening the effectiveness of the relationship and its impact on young clients.
REFERENCES
Gross, J., & Haynes, H. (1998). Drawing facilitates children’s verbal reports of emotionally laden events. Journal of Experimental Psychology, 4, 163–179.
Malchiodi, C. A. (1997). Breaking the silence: Art therapy with children from violent homes. Phila-delphia: Brunner/Mazel.
Malchiodi, C. A. (1998). Understanding children’s drawings. New York: Guilford Press.
Malchiodi, C. A. (1999). Medical art therapy with children. London: Jessica Kingsley.
Malchiodi, C. A. (2001). Using drawing as intervention with traumatized children. Trauma and Loss: Research and Interventions, 1(1), 21–28.
Steele, W., & Raider, M. (2001). Structured sensory intervention for traumatized children, adoles-cents, and parents. Trauma and Loss: Research and Interventions, 1(1), 8–20.
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