Category: Interventions

Darren Daz Cox asks:

Hey Liz, what collage techniques do you use in your work?

When I think about collage, I usually think about a magazine photo collage where you cut out words or pictures from magazines and glue them onto a separate page. In art therapy, often times collage is used as a way to approach clients who may be resistant to art making or clients who may need some extra structure (due to their developmental level or perhaps due to an anxiety provoking subject matter that is the focus of the collage).

The art therapist may choose to add even more structure to the collage making experience by having pre-cut collage pics and words available to the client. Sometimes these pictures can be divided up into separate categories in their respective folders or containers. Some categories or themes may include people, food, words, animals, nature, fashion items, etc… The downside to this is that the art therapist may be intentionally or unintentionally censoring images or words, or may be overlooking certain images or symbols because of countertransference issues, personal value issues, personal comfort level, etc… In other instances, the art therapist may want to encourage autonomy and self-expression by allowing the clients to search through magazines themselves for pictures or words that may stand out to them. The downside to this is that many times the clients get involved in reading articles or looking at the magazine rather than focus on art making.

The art therapist may want to provide a directive for the client, which can help structure the session and guide the client with a theme or suggestion of what to base the collage on. Other times the art therapist may choose to refrain from giving a directive, allowing the client to make whatever he/she desires. This decision is based upon, for example, what the therapeutic goals may be, as well as the client’s resistance to art making.

Along with magazines and paper, other useful materials for collage include scissors, decoupage or matte medium, paint brushes and glue sticks.

Once the collage is completed I often like to ask the clients I work with to title their work before we begin processing the piece.

I hope this answers your question. Let me know if I could provide you with any more info.

I introduced mask making during the art therapy groups I run. This is an ongoing project that will probably take several weeks to complete, depending on the attention span of the client, how quickly they are able to work, and how often they are present for art therapy (since groups are voluntary).

Materials

– Lunch trays
– Plastic molds that look like faces (1 for every potential group attendee)
– Tissue paper of a variety of colors
– Vaseline/Petroleum jelly
– White glue
– Water
– Small plastic containers to hold the glue
– Large paint brushes.

Introduction

Depending on the cognitive level of functioning of the group members you are working with, you may decide to have a conversation about masks and their potential meaning. You may choose to discuss topics like Jung’s concept of the persona, and how the way we present on the outside may be very different than how we feel on the inside.

In the case of the clients I work with, many of whom are lower functioning, I decided to take a more art as therapy approach, where I focus on aiding the clients work through any difficulties they may have with the art making process in order to facilitate a successful art-making experience.

I am currently toying with the idea of asking each client to describe what their masks remind them of, after their masks are finished, and then encourage them to make a short story (in some cases that could be one sentence) about their mask. Many clients are unable to read or write, so I would ask other staff members to attend this group to help record the stories of each client who asks for help with writing.

Procedure

Before beginning the group, mix a small amount of water with white glue, making decoupage. Place the decoupage into small containers. If you would like to promote peer interaction and sharing, you may choose to have clients share these containers. However, in my experience with this directive, many clients have never made a mask before, and seem to find it overwhelming to have to interact with their peers and learn something new at the same time. Therefore, in order to promote socialization, I like to end group by each client showing the piece they worked on during the session.

Because many of the clients I work with have difficulty establishing boundaries with other people, or recognizing when they are becoming intrusive onto other people’s boundaries, I have introduced the use of lunch-trays as a work space for each client during art therapy group. Before the group begins place a mask is upon a lunch tray, and position the tray in front of each client.

Cover the mask with the Vaseline/petroleum jelly. This will help the paper to easily be removed from the plastic form without any ripping.

Explain to the group that this directive will take several weeks to complete, and that they will be gluing many layers of tissue paper onto the mask. The reason for this is that paper is very delicate, and the more layers you put, the stronger the mask will be.

Demonstrate how to glue the tissue paper onto the mask by dipping your paint brush into the decoupage, and putting some glue directly onto the mask itself. Next, place a piece of tissue paper over the glue and add more decoupage ontop, smoothing the tissue down. Instruct the group to continue layering the tissue paper until the whole mask has been covered. Remind the group that they will need to cover the mask with several layers, which will take a few group sessions, and they will not be able to finnish in one day.

Results

All the clients who have attended the art therapy groups over the past few weeks (presently approximately 15 clients) have been able to successfully begin and/or complete making a mask. My observation is that the clients seem to calm as they tear and glue the tissue paper. There is often very little talking while creating is going on.

I have found that some clients may need a 1:1 explanation of the gluing process in addition to the group introduction. It may also be helpful to have other staff present, who can help clients with reduced dexterity in their hands to maneuver the paint brushes, tissue paper and the mask.

A common counter-transference reaction to this population is to feel like one must help the client complete a task perfectly, or to our standard. Sometimes this means we can take control from the client, and essential do the task for them. Therefore, it may be necessary to remind staff before/after group that the artwork being produced is indeed that of the client, and that we do not want to complete the project for them. As staff, we are trying to help the client complete the mask to their satisfaction, rather than our satisfaction. Furthermore, the goal is to help each client create a successful piece of artwork. If one sees there are spots that need more layers, or places that need more glue, one must be sure to point this out to the client, letting the client find his/her own solutions to the potential problem or ask for help in implementing their solutions.

Overall, since many of these clients have never made a mask before, they seem proud that they were able to follow instructions and make something more complex and unique than a pre-made arts and crafts project. However, I have found that some clients need encouragement to attend art therapy and complete their masks. For some it seems that the idea of trying something new, something they may fail at, is so overwhelming that they choose to avoid finishing their masks. Many people with developmental disabilities have the experience of not being able to complete a directive to the standard that was set for them. This may lead to feelings of shame and/or guilt. It seems that a schema has developed that describes the self as incapable. With these clients, this is a chance to learn and challenge their self-concept. I have found it helpful to reassure these clients that they are capable of completing this project, and that however the mask turns out, thats okay because art therapy is about self-expression not how pretty a picture we can make.

My sketchbooks are like diaries…they capture the situation, mood, mental state, ideas, blind spots, fears, humor, defenses and subjects of importance that I may have be experiencing at the moment I chose to draw. I also sometimes use my sketchbooks for planning more than upcoming art projects. I use them to write to do lists, reminders to myself, thoughts and random phrases. My sketchbooks help me organize my life, while at the same time they are holding environments for private concepts that I may not be ready to release to the public.

I don’t think it is a coincidence that while completing my Masters degree, Drexel University’s Art Therapy Faculty encouraged their students to use sketchbooks as ways to capture the dynamics of discovery, which were inevitable throughout our academic and experiential learning.

The experience of using sketch books as a way of containing and reviewing emotions, ideas, learning, and probably way more than can be described in words, has allowed me to introduce the concept of a sketchbook/diary to the clients I work with.

Book Making

Because many of the clients I work with have difficulties with dexterity in their hands, and because many of them refuse to use scissors for fear they might hurt themselves, introducing traditional book binding techniques using a needle and floss did not seem appropriate. Instead, I opted for a simpler approach, stapling the spine in order to create a book.

Materials

– Stapler and staples. I purposefully made sure that there were only 3 staplers in my group of 10, in order to promote client interaction and sharing.
– Colored paper, 12″ x 18″
– White paper, 12″ x 18″
– Materials for decoration: markers, oil pastels, foam shapes, glitter glue, etc…

Pre-structuring

Before group begins, make an example of a sketchbook to show the group. This can help to structure the group and allow them to visualize what the outcome of the group may be. Pre-making a book can also allow you to know the limits of your stapler- how many pages it can staple through. This can help avoid client frustration with the directive- that is, if one of the group’s goals is success orientation, which is common when working with people with developmental disabilities. However, if the goal of the art therapy group is to increase frustration tolerance, you may want to allow the clients to discover the limits of the stapler for themselves.

Execution

After introducing the example sketchbook, ask the group if anyone can explain what a sketchbook is, what it can be used for. In addition to their responses, explain times when one may want to use their sketch book, for example when they are upset or sad, when they are having a feeling that they are having difficulty putting into words, when something good happens, etc. Also explain that what they are making is theirs. Emphasize that the contents of a sketchbook can be kept private, or they can share their books with people that they trust, like their therapist, a family member, etc. Encourage the clients to keep their books in a safe place.

Ask each client what color they would like to have on the outside of their sketchbooks. Once each client has what will be their cover, ask them to fold the paper in half. Then hand out approx 6 pieces of white paper (this may vary depending on the capability of your stapler), and ask the clients to fold those papers as well. Demonstrate placing the white papers inside the colored paper, fold-to-fold. Then, demonstrate stapling- how to hold the paper while you staple, trying to staple as close to the fold as possible. Some clients may need help with stapling. I like to encourage some of the higher functioning clients to help clients who ask.

Once the books have been assembled, place other art media on the table so that the clients can decorate the covers of their sketchbooks and make it their own. The purpose of introducing other art media at this point is to help avoid some clients from feeling overwhelmed with the amount of stimuli in the group. The art therapist can further structure the group by limiting the types of art media available to the clients.

In terms of closure, I find it useful to have each client take turns sharing their sketchbooks with the group. This helps to promote socialization, group interaction, and is often self-esteem building since clients often recieve positive feedback for their products.

Results

Every group member was able to construct and decorate their books, some independently and some with help.

Some clients seemed to be taken aback by the concept that these books were for them, and they had the choice whether to share its contents with anyone. One client in particular repeated this concept to every staff member present within the art therapy group. This made me wonder how little privacy some clients with developmental disabilities are afforded in their lives. Some clients need help dressing, toileting, showering and cleaning their rooms. What then is for them and them alone?

Since the books did not contain very many pages, I suggested that once their sketchbooks were filled up, they could request to make another one. Several clients have taken me up on this offer, as they have been consistently writing and drawing in their sketchbooks.

As the first art therapist to be working within the facility, it is very gratifying to introduce new ways of self-expression to the clients. As with all techniques for self-expression, some things work for some people but not for others. For this reason, I try to encourage each client to remain open minded to new experiences, while remebering that rigidity is common amongst adults in general, people who suffer from mental illness, and people who have been diagnosed with a developmental disability.

I’ve been at my new job for a little under 2 months. In that period of time I have begun introducing new ways of expressing oneself using structured media and directives. Here are some examples of the successes I’ve had over such a short period of time:

I decided to introduce collage in one of the artx groups. I pre-cut words and pictures (for added structure), keeping them in separate tupperware containers for easy pull-out and put away. Immediately the clients began searching through the tupperware, finding pictures and gluing them down onto colored paper. Some clients held up words and asked me to read the word to them, or explain its meaning. For one client in particular, the use of the pre-cut words seemed especially important to her. She appeared excited and began smiling as she completed her collage, periodically holding up her paper and saying “this all makes sense!”

It occurred to me that people with developmental disabilities often have deficits in their reading and writing abilities. Many of my clients describe thinking they are stupid and wonder how they appear to others. Perhaps having pre-cut words can help to lend a voice to these people, who may have difficulty finding words to say out loud what they think or how they feel.

Several clients have begun spontaneously drawing their feelings when they’re feeling anxious and/or upset. This is surprising to me because the clients I am speaking of rarely come to the artx groups. I had no idea of the developmental level in their artwork or that they even wanted to use artwork as a form of self expression/catharsis. In fact, many times when these clients are invited to attend artx group, they refuse.

Recently, one client went into the art supply cabinet after an incident with a peer and took out some collage words, pictures, paper and markers on her own, when the artx room was unoccupied. This client then came to my office with her drawing. She seemed to use it as a way to help both her and I understand how upset she was.

I think this vignette illustrates how important it is that all clients have access to art supplies at any given moment. This story also reminds me of the natural expressive and healing quality that art making has.

Working with developmental disabilities is a challenge — especially when the groups are not split up according to cognitive ability. I have some clients who are naming the scribble, while others are functioning on a schematic level in the same group. I find that art as therapy is a great approach with the lower functioning clients, however the higher functioning one’s seem to benefit from art psychotherapy as well.

In an effort to ballance the needs of the group, I’ve been trying to take a middle road approach (similar to Wadeson) when planning directives, but the fact remains that some of the clients do not have the ability to process abstract concepts due to their developmental level. Sometimes I wonder if my approach goes over their heads. At the same time, these clients don’t seem to notice any discrepancy between themselves and others while they are engaged in the process of art making, in a similar way that a 4 year old doing artwork alongside an 8 year old does not seem to notice the differences in cognitive ability between himself and the 8 year old. They seem to take pleasure in the art making process and don’t seem self conscious of others in the group.

What I have found very tricky, however, is introducing a particular directive in a way that everyone can understand so that the lower functioning people do not become agitated because the concepts are overly complex and so that the higher functioning people feel challenged and acknowledged. I guess that will come with time.

I discovered VICE magazine in my late teens. Lesley Arfin’s Dear Diary quickly became my favorite regular article…waaay better than the Gross Jar. Every month I looked forward to reading her old diary entries and her reactions to them in the present.

One day the articles stopped and in the back of my mind I always wondered what happened. I found my answer a few weeks ago when I picked up Lesley’s new book, Dear Diary. In her book, Lesley includes her “funniest” diary entries from the ages of 11-25, where she goes from self-conscious pre-teen to punk rocker to heroin addict to rehab. She includes follow up statements from both herself and the people who played a role in shaping her life…if she could track them down.

Lesley seems to use her writing as a way to make sense of the world. Through the careful review of her diary entries, as well as self-reflection, Lesley seems to discover and accept herself for who she was and who she is today. This process allowed Lesley to realize that there are numerous points of view to a single event. She is also able to connect with others in a way that seemed impossible at one time. I admire her honesty and her ability to confront herself and people from her past.

Here is a brief quote from the afterward section of the book:

“What was once written in a locked-up book on a plain sheet of pink paper had turned into something I could use to communicate with. This is how a girl who was so insecure once upon a time turned into someone who would let the entire world read her diary today…”(p. 230)

There are many ways one can keep a diary (see the post entitled Documentary Film Making). I most naturally use art in this way, but I also find writing during times of crisis extremely helpful in organizing my thoughts. While working with eating disordered patients, my supervisor Jeanette Pailas would often suggest keeping a visual and/or written diary as an intervention. Diary making was a common group directive, where the patients make books for the purpose of recording one’s thoughts throughout the treatment process and perhaps reviewing the entries at a later time.

Whether it be through pen and paper, the fine arts, film making, or even blogging, keeping a diary of sorts seems like the natural tendency for many people. Not only is it often experienced as non-threatening (because you don’t have to show it to anyone), but it can allow for self-reflection, self-confrontation and can be reviewed at a later date. As Lesley demonstrates, it can also be used to creatively inspire others to learn from their mistakes and to accept oneself.

So I’ve been waiting about a month to start a new job and I have been out of school for about three. I have always either been in school or working. There has never been such a long peroid of time (except when I have been sick in the hospital) where I was completely in charge of what to do with myself. Not that school and working weren’t my choice, but you know what I mean…

Structuring your time is probably one of the hardest things a person can do. I find myself on the verge of complete lethargy, which could easily turn into a depressive state if I had nothing to look forward to in the near future.

This brings me to the point of this post. When working with clients who for one reason or another have little to do with their days, it is important to discuss options for structuring one’s time. For example, are there organizations that could use a volunteer a few days a week? Are there inexpensive classes available through various community organizations? How about just getting out of the house for a few hours and reading in a coffee shop? Of course, lets not forget the idea of beginning an art project. Time flies when you are in a state of creation.