CYC-Online 81 OCTOBER 2005
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Art therapy on a residential treatment team for troubled children

Anne Mills

Editor’s Note: Creativity represents the most authentic expression of the Self. In our adult world of structured language and formalized concepts, the confused world of the troubled child often struggles in helpless silence. Unfortunately, clinical psychologists have led many practitioners to believe that Art Therapy is only valuable to clinicians trained to interpret such expressions through intimidating theories and profound insights. In this article, Anne Mills minimizes the significance of theoretical underpinnings and liberates artistic expression as a process valuable in its own right.

With the use of interesting examples, Anne demonstrates how Art Therapists and Child Care Workers can collaborate to better understand the inner life of children. In a profession that often becomes tediously focussed upon observable behavior that must be changed through various forms of overt and covert manipulation, she offers exciting possibilities for the curious and creative practitioner.

What we really appreciate about this stimulating article is that the client is respected as the expert on his or her own inner experience while the practitioner is invited to assume the more humble position of learning something from the child “at least for some of the time.

A seven-year-old boy who was very articulate in many areas found it almost impossible to talk about his feelings. As a client in a residential treatment program, he may have been feeling lost among the other children, and a little lonely or angry at his family. He may have been confused about himself-he was intellectually gifted but couldn’t learn to read. Yet he carried this and other problems around inside him, “Like a little old man." as one child care worker put it.

Figure 1. Sob. 14" high. Construction paper, popsicle sticks, masking tape, oil pastel

In art therapy, this boy made the paper sculpture alien, whom he called “Sob" (see Figure 1). Sob’s body is almost cut off from his head; he has trouble standing up straight, his mouth has been “X-ed" out. Spontaneously, the little boy began to speak through Sob, to allow the art therapy product to express what he himself could not say. “I am running. There’s something in my eyes. It’s hard to live on Earth. I can’t breathe, I have no lungs. I am entirely made up of heart."

The boy continued to converse with the art therapist for some time using Sob as spokesman, When his sessions ended after six months of art therapy, he took this special product with him and gave it to his primary care worker as a gift. This may have been expressive of how she had, like Sob, helped him with his difficulties in communicating his emotions.

This example of how one particular child related to the experience of art therapy tells us much about his relationship to himself, to his primary care worker, and to the art therapist. However, the most striking element of this case is that the boy related to the art materials, in the context of the relationship with the therapist, as a means to create things which would then allow him to evoke hidden aspects of himself.

That the goals of child care and art therapy in this case paralleled each other attests to a common view of the child by each field, That different methods were used by child care workers and art therapists with this child (even toward the same goals) hints at potential misunderstandings between approaches which can arise when there is no avenue for communication between fields, or a lack of information about another’s field, and it suggests the need to address these issues. To that end, I would like to look at the question of “who are art therapists?"

Of the many definitions available, the one I would offer is that an art therapist is an artist trained to do psychotherapy, using art as the main tool. Normally, an art therapist has received a Master’s degree in Art Therapy after two years of specialized study following a Bachelor of Arts in Fine Art and Psychology.

The art therapist typically sees the client privately once a week for the fifty-minute hour common to psychotherapy. The art therapist will employ basic art materials (some kind of modelling material, tools for drawing and painting). If the client is a child, other materials an individual therapist finds helpful, such as sand play, water play, or dolls, may be used.

Art therapy is used with all kinds of populations: “normal" people seeking more insight into themselves, the elderly, people with psychiatric problems, families, and so on. Where there is a barrier to communication, as with mute, mentally retarded, or physically handicapped children, communicating through art can be a distinct advantage. Art is especially appropriate for children due to its playfulness and familiarity.

The value of art therapy to the children
The value of art as therapy for disturbed children rests on this fact, plus the remarkable tendency of each child to use the encounter with art therapy in his or her own personal way. Permission has been obtained to use the art work of children from a preadolescent treatment centre to illustrate some of the ways they related to the art therapy process in order to fulfill needs they could not verbalize. The particular examples show the use of art therapy for full emotional expression without fear; ventilation and containment; concreteness; nonverbal communication; and “as if" it is the real world.

Full emotional expression without fear
Most troubled children have a need to express their emotions yet certain children in residential care may fear genuine self-disclosure, perhaps because of the turbulent feelings it releases, or because what is disclosed does not conform to the “role" they play in their everyday life.

Scribbling, painting, and modelling are, however, activities most children are not resistant to, for they are familiar with and interested in such “play." For these children, the rationalization of “it’s only art" allows them to ventilate their emotions in a spontaneous way.

Figure 2. Sound of Music. Finger paint.

An eleven-year-old boy on the brink of adolescence had a dramatic, performing ego (Figure 2). We can see by the composition, the finger strokes, etc., that he used the art therapy process to express the emotions and energy that sometimes overwhelmed him.

He could do this without the sullenness or the acting out that he often showed in family meetings. He seemed able to evade his fear of real emotion by denying that anything significant went on during his art therapy session. He threw himself “into battle" with the art materials in a way that seemed to characterize the battle within himself.

Ventilation and containment
Many people can sense at some deep level what they need most from art therapy, and without realizing it, will consciously use the therapist, the time, and the materials in order to achieve it. When one is too much in contact with one’s emotions or with more primitive ways of functioning, the “psychic balance" may generally need less regression and more control.

Figure 3. Colored paint in egg cartons. Cardboard and pipe cleaner product not discussed in text.

This latter need is illustrated by the artwork of an eight-year-old boy. On his arrival at the residential treatment centre, this child had many animal-like behaviors, despite his intellectual precocity. He sought for himself the containers, the boundaries, the self-control that would appropriately hold his primitive art products (Figure 3, Colored paint in egg cartons) which he referred to as blood, urine, and feces. (Notice the lack of distinction between primitive body product and primitive art product.) Torn between his need to regress and his need to grow, the art work may represent a desire for his primitive feelings, to be both accepted and contained.

This boy also made some very sophisticated art products which showed his ability to maintain control at times, as a sensual appreciation for materials and visual subtleties, A special benefit of the art therapy for him was the chance to discover art techniques on his own by exploring media. This art time, in addition to his school or treatment centre art time, may have aided the development both of his artistic gifts and his sense of self.

The ability to think abstractly is developed slowly by children as they mature. Some of the situations that have an impact on their entering residential treatment, for example, may be difficult for them to grasp. Children are more capable of understanding things stated in a concrete way, and are further aided by physical cues, sensations, etc. Memory, too, is reinforced by having a physical reminder of an event.

Like adults, children use metaphors or symbols naturally. They can find or create a concrete image that expresses one or many meanings for them.

Figure 4. Volcano / Rock from Mars. Self-hardening clay, red paint. 10" diameter.

Figure 4 was done by a ten-year-old boy from a background with a long history of family violence, who appeared to be perpetuating this family pattern. It looked as if he wanted to warn me off and address himself to his own aggressive tendencies. The product is a volcano fashioned with emotional vigor visible in its deeply textured surface. He said, “This is a rock from Mars. It could hurt you," with much threatening intensity. Rejection by his mother, having already been abandoned by his father, may have triggered his fear of death, in a child's irrational way, (Loss of parents” love, for example, is a common theme in fairy tales in which the child is left in the woods to die,) No child feels more helpless than when he or she has lost parental love and with it the expectation of protection from danger. This particular boy’s aggression and fear combined to create a morbid fascination with death, embodied in the concrete image of the volcano.

Nonverbal communication
The art therapist will elicit remarks from the child about what is going on in his or her picture. This helps the therapist learn the unique “visual language" of that child. Training in interpreting symbols in art, and familiarity with all developmental aspects of children's art will help the art therapist even when the creator has been unable to verbally share information about its content.

The ability to express concerns verbally is not completely developed in children who may neither be able to nor wish to talk about their problems. Sharing through art can be a great relief for troubled children who feel they have a secret they want to tell, but which is too “terrible" to reveal verbally.

Figure 5. The Rose. 36" x 48". Red and orange markers. Joint drawing by client and therapist.

In Figure 5 we see the central motif is an “eye" shape, and that the flower, which is the picture’s subject, is so huge that it fills the page. A nine-year-old girl seems to be telling her secret-almost shouting her secret, given the size of the drawing (48" x 36") and her euphoria at doing it.

Art therapy researchers have noticed what seems to be a significant frequency of wedge or eye shapes, or of a red flower, in the drawings of women and girls who have been sexually abused (Spring, Abbenante, Silvercloud, & Meixner, (1984). Because of this and this child's case history, the therapist could perceive this picture as the girl talking about sexual abuse she had experienced. Creating and contemplating this and other drawings seemed to have a positive effect on this child. Creation of the art product externalized the child's inner world. The art’s content could then be explored with lessened emotional turmoil.

"As if" it is real life
At certain stages a child's thought is “magical “it is “as if" something is so because the child is supposing it to be so, The child's acting out of his or her fantasies in art therapy is not only a window on their desires, but is also a useful therapeutic tool in helping disturbed children “1ay to rest” wishful thinking that may preoccupy them, thus allowing them to move forward in their lives.

The rehearsal of new behaviors, which children seem to do in art therapy, may happen as a prelude to change in their behavior. In these situations, the art therapist plays a delicate role in keeping within the session (and not in the real world), acting out behaviors through symbolic art activities.

Figure 6. Broken string, broken popsicle. Sticks with drawings.

An eight-year-old boy depicted himself and his adoptive family in popsicle sticks. It seemed as if he were actually manipulating these individuals. After his tie to this adoptive family was severed, his hopes turned to aggressive feelings, which he began to work through by expressing a fantasy of power, breaking the objects symbolic of his family, and cutting strings (see Figure 6).

The relationship between child and art therapist
An art therapy product is quite a different thing in subtle ways from artwork made at other times. For instance, the protocols of the art therapist in limiting time or presenting materials is different from other art-making times the child experiences, Further, the therapeutic decisions made during the course of a session structure the experience so that it is felt to be containing and safe by the child, yet is moving toward difficult areas that need to be examined. The most important difference in setting apart the art therapy product from other artworks is that it was created in the context of the relationship between the child and the therapist.

It is more than the simple presence of the therapist which defines the time as therapy. It is the way the child acts in this relationship which is of great interest to the art therapist. Many art therapists working in the psychodynamic mode common today in Canada think that this may re-enact how the child behaved or felt in previous important relationships (Rubin, 1984). In re-enacting these behaviors without conscious awareness, the child projects certain mental or emotional constructs onto the therapist. The art therapist, to facilitate this, aims to remain neutral both to accept the projections (as does a screen) and not to react to the child's expectations. Many art therapists feel this “transference," as it is called, is like a river that carries the therapy forward.

Because of the protocols of this approach, a child's need to be hugged, for example, is probably not a need that would be gratified during a session. But when the session ends, the child goes back to the primary care worker and can have this particular need satisfied in a very positive and reinforcing fashion.

In considering an art therapy product, the therapist seeks to understand all the processes of its creation: the transference, mannerisms, hesitations, random remarks, choice of media, nonverbal behavior. The weighing of all these aspects to forma total picture of the child is based on the belief that all behavior, and hence all products such as art are meaningful.

Art made outside the formal “frame" of protocols, the transference relationship, etc., lacks this information for the art therapist. Hence, other art products cannot be assessed with as much sensitivity or accuracy.

The relationship between child care worker and art therapist
The main difference between a child care worker and an art therapist is the focus of their attention with a child. With the child care worker it might be the behavior of the child in terms of what is considered acceptable behavior in a reality-based approach, related to the socialization process. For the art therapist the behavior may be considered a form of communication, albeit a distorted message at times, which is available for analysis.

The benefit of a two-pronged approach for treating both the motivation and the outcome will be more effective in the long term than treating either factor in isolation, A constant interchange between child care worker and art therapist can give some way of coping with frustratingly incomprehensible behavior by understanding what lies behind it, and for testing out hypotheses about a child's dynamics by checking them against the realities of information from “the other 23 hours" of a child's life. It helps lead both kinds of workers away from a one-sided view of the child.

Most of the problems that may arise between the child care workers and art therapists may probably be traced to their different focuses on behavior and motivation, One difficulty was touched on in relation to the girl who drew “The Rose" (Figure 5). Because of the premium placed on behavior, primary care workers often hope to hear that a child in art therapy has been able to openly discuss a problem. They can feel somewhat disappointed if this does not occur. Here, the verbal self-disclosure is targeted as a short-term goal which is not necessarily shared by the art therapist. Thus, although the long-term goals are the same, the methods, protocols, and terminology differ at times.

The structure of working in the fifty-minute private session can set up a situation in which the art therapist is seen more as a consultant to the team, rather than a member of the team. Openness to the validity of each other’s views with the assumption that no one person has all the answers about a child, is the most productive and creative model in working treatment teams. Creating this structure in a multidisciplinary staff, plus the mechanisms for “touching base" between art therapist and child care worker, heighten the quality of treatment offered to the client.

Primary care workers sometimes evidence uncertainty about the value of art therapy for children but are interested in play therapy. In fact there are many important affinities between art and play therapy; they can resemble each other in materials used and procedures followed. Furthermore, most art therapists have some familiarity with dramatic play (plus music or movement as therapeutic modalities) in addition to art. This is so they feel comfortable following a child as he or she uses the therapy time to fulfill his or her needs. Often a child will move spontaneously, from painting a scene to acting it out, or incorporating puppets into a discussion of his or her artwork (Rubin, 1984).

However, the art therapist always comes back to the art, which remains the central focus. This specialization in art, with strong training in the process of therapy, is how the art therapist is different from other professionals who use art in their treatment.

The value of an art therapy program to an institution
Art therapy, as an effective modality for working with children, may be a valuable addition to the multidisciplinary team. There are, for instance, needs that cannot be met by traditional residential environments. A one-to-one therapeutic encounter centres on the individual child, and helps to identify those needs. The process of the therapy begins to respond to each child's differing needs, according to the client’s own pacing and priorities. The examples above are a few of the possible ways children can relate to the materials and the therapist.

Through art therapy, less censored, less conscious, more emotional material is easily reached, This is because doing art can provide a direct and rich encounter with the realm of dreams, imagery, and impulses in each one of us, This means the art therapist will have information to offer the team that may complement that of other staff. Information gained largely through nonverbal processes is likely to help us all reach a more complete and rounded view of the client.

Many adult institutions use art therapy in assessment or diagnosis, and it can be of benefit in the formulation of treatment plans for children as well. Whether in a one-time assessment interview or in continuing therapy, the art products can be used for their predictive and evaluative qualities. Certain signs may give early warning of more serious psychopathology, and clues may emerge to the source of past trauma.

In summary, by bringing a unique perspective to the understanding of the dynamics of a child's disturbance and by offering yet another tool for facilitating the resolution of that disturbance, art therapy contributes significantly to the quality and range of treatment the treatment team is able to supply.


Feder, B., & Feder, E. (1981). The expressive arts therapies. Englewood Cliffs, NJ: Prentice-Hall.

Kramer, E. (1979). Childhood and art therapy: Notes on theory and application. New York: Schocken.

Rubin, J ,A. (1984). The art of art therapy. New York: Brunner /Mazel.

Spring, D., Abbenante, J., silvercloud, B., & Meixner, D.L. (1984). The quiet trauma: Symbolic language of the sexually abused gives predictive clues. Paper presented at the American Art Therapy Association Conference, Washington, IX. Spring, D., Abbenante, J.

This feature: Mills, A. (1991) Art therapy on a residential treatment team for troubled children. Journal of Child and Youth Care, Vol.6 No.4 pp 49-59

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