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Introduction to the special issue on the creative arts therapies and the family
The Arts in Psychotherapy,
Vol. 18, pp. 187-189.
0 Pergamon
INTRODUCTION THE CREATIVE
Press plc, 1991. Printed in the U.S.A.
0197-4556/91
$3.00
+ .OO
TO THE SPECIAL ISSUE ON
ARTS THERAPIES
DAVID READ JOHNSON,
AND THE FAMILY
PhD, RDT, EDITOR-IN-CHIEF
ies. Some families take walks, some do sports together. Creating art, role-playing, singing, or dancing are less likely activities. Playing together may be the rare, if often most remembered, moments a family life can treasure. Creative arts therapists should be able to help the family to play: bring greater intimacy to a disengaged family, more freedom and spontaneity to the rigid or enmeshed family. Increasing the integrity and flexibility of the family is essential in maintaining it as a supportive environment for individuals’ growth, instead of as an incubator of psychopathology. Family therapists have discovered that to impact on the complex family system, powerful and often intrusive techniques are required. Given the fact that the creative arts therapies are successful at overcoming and circumventing strong defenses, bringing unconscious or covert ideas to the surface, their application to family therapy should hold a great deal of promise. Despite the fact that many family therapy practitioners utilize action-oriented techniques such as rituals, tasks, or sculpting, the creative arts therapies have not to date had a significant impact on the practice of family therapy. It is not clear if this is due to creative arts therapists’ lack of access to families or to inherent resistances of families to the arts media. The articles in this Special Issue describe the various ways in which the creative arts therapies have been applied to family treatment, and through them one can glean a vision of what we have to offer the families of the future: a re-assertion of family identity through creative and collective acts. The Special Issue begins with Helen Landgar-
The family, they say, is dying. The family has been blended, extended, enmeshed, disengaged, and torn apart. The nuclear family has had a meltdown. The average person’s sentient feelings are increasingly attached to images of products, processes, and news from their work setting or the mass media. The ongoing sagas of “Dallas” or “Thirtysomething” may have more immediacy to us than our own families, whose members often live far apart. We return to family gatherings fueled by warm hopes, only to find tension, worn out traditions, and disappointment. Perhaps we are experiencing the transition to a new form of human communion, and the family should cautiously be let go. Or perhaps we are witnessing the breakup of human bonding that will lead to an even larger increase in crime, drug abuse, perversion, alienation, and suicide. In response to these threats to its integrity, some families have retreated into rigidified systems with overlycontrolled interactions with the environment. The delicate balance between integrity and integration appears to be difficult to achieve. The death of the intergenerational transmission of family stories, myths, and images contributes to the death of the family as a powerful source of meaning in our lives. The interest recently in discovering our “roots,” in terms of genealogy, is a symptom of this alienation from our family. However, we also need to find our roots in the present, to find nourishment from our membership in our family now. The creative arts therapies may be an effective method for accomplishing this task. What do families do together? Most eat, share chores, drive each other to events, argue, talk about problems, worry about each other, and go to mov187
188
DAVID READ JOHNSON
ten’s Perspective, “Family Creative Arts Therapies: Past and Present,” that describes the development of arts therapists’ interest in families. Landgarten has pioneered a family therapy approach to art therapy that has defined a graduate program, and contributed greatly to the study of families among all creative arts therapists. She notes that creative arts therapists’ use of tasks in therapy predated their use by strategic family therapists. Pointing out that resistant families are the best candidates for creative arts therapies, Landgarten maintains a very positive stance regarding the potential contributions of the creative arts therapies to family therapy. Anthony Decuir, in “Trends in Music and Family Therapy, ” reviews the many ways music therapists have contributed to family therapy. He carefully discusses musical family therapy in terminal illness, pediatric trauma, adult psychiatry, autism, mental retardation, and aphasia. Comparing the family to a concerto, with the identified patient as the soloist amongst the orchestra, Decuir suggests that the therapist’s job is to hear the unsounded chords, that is, the background to the patient’s experience, often beclouded by the collusive family dynamic. He concludes that “facilitating communication among family members seems to be the most common use of music in family treatment.” Doris Arrington’s “Thinking Systems-Seeing Systems: An Integrative Model for Systemically Oriented Art Therapy,” presents a theoretical model of family art therapy that integrates historical, interactional, and existential models of family therapy. She describes symbolic and developmental modes of analysis, and then discusses applications of the genograrn, reframing, positive connotation, and ritual in terms of art therapy process and technique. A detailed case example of an art therapy assignment of an adolescent diagnosed with paranoid schizophrenia demonstrates the usefulness of an integrative approach. She suggests that art therapy’s major purpose, “to organize inner chaos into a coherent form,” is applicable to families in distress as well as individuals. In an important paper, “Creating a Family: An Integrated Expressive Approach to Adoption,” Steve Harvey describes a sophisticated creative arts therapy treatment in which “a network of intimate family relationships is being created through an ongoing expressive process. ” Harvey argues persuasively that the creative arts therapies have a particularly powerful effect on attachment behavior, especially important in adoptive families, but one could argue in-
creasingly at issue even in “normal” families. The adoptive family is faced with the need to “consciously produce a container around experience. ” He illustrates the diagnostic power of expressive activities by describing two case studies of adoptions and how his assessments predicted their success or failure. He then describes three stages of intervention: (a) establishing an interactive expressive activity with the entire family, (b) extending the action until repeatable patterns and salient themes are identified, and (c) helping the family understand these interactive episodes. Four cases are presented in which he uses artwork, family movies, dramas, ritual, storytelling, and movement games. Harvey’s interventions help an adoptive family discover its “myths” and “traditions,” formed in the session with the therapist’s guidance. The family emerges with an enhanced interpersonal bond among its members. Attachment issues are also addressed in Bonnie Meekum’s article, “Dance/Movement Therapy With Mothers and Young Children at Risk of Abuse.” Working with mother/child dyads, Meekums attempts to increase their interpersonal synchrony, echoing, molding, and access to body. The mother/child dyads who improved the most showed better communication, behavior control, and relationships with siblings, and more physical contact and feelings of intimacy. Dyads who did less well showed less intimacy and greater blocking of movement between mother and child. Meekums likens the interaction of the dyad to a dialogue, in which atunement (attachment) and differentiation (boundaries) are both required. Engaging mothers and children in an active, bodily oriented movement session allows this dialogue to develop. Lois Carey, in “Family Sandplay Therapy,” addresses the problem of helping families with rigid patterns of communication who have difficulty adjusting to changing circumstances. She asserts that sandplay uncovers the family’s boundaries, alliances, unconscious images, and “life force,” and gives room for reparative work by the children and “inner child” of the parents. Two cases illustrate beautifully how family patterns are played out, and how a resistant family can challenge the therapist’s best efforts. Carey concludes by pointing out how the sandbox can represent the family “story,” which accesses the inner child of the parents, who long for such contact. This process initiates a shift in attitude that can become a stepping stone to other
INTRODUCTION changes in the family system. Confronting resistant families is the subject of Eva Leveton’s paper, “The Use of Doubling to Counter Resistance in Family and Individual Treatment.” Doubling is a psychodramatic action technique in which the therapist sits next to the client and speaks his or her inner thoughts, like an alter ego. Doubling often helps the client to acknowledge suppressed thoughts. Leveton compares doubling to Minuchin’s concept of joining, or Bandler and Grinder’s concept of pacing. Noting that moving into action is often difficult in a private practice setting because it often seems to break the flow of the patient’s verbalizations, Leveton illustrates with two detailed case examples how doubling can be successfully integrated in a family therapy session. Her inclusion of actual dialogue is particularly helpful in communicating what she does. Her examples clearly illustrate how doubling helps the children give voice to perceptions suppressed by the family system. In this way, action methods help to give the children the edge in an otherwise hierarchical system that tells them to be quiet. The potential problems and timing issues involved are carefully discussed in the article. If communication and resistance have been the major topics of the papers in this issue, then Ellen Horovitz-Darby’s “Family Art Therapy Within a Deaf System” highlights these issues in bold relief. The special needs and issues raised in family therapy with a deaf child provide unique challenges for the family art therapist. Horovitz-Darby discusses the problems with language acquisition, the mouming process in the family regarding the diagnosis of deafness, and the role of the interpreter in the fam-
ily therapy sessions. She points out convincingly how art therapy can help the family cross sonic/linguisticlintimacy barriers by providing a visual context for communication. A case example of a family of a lo-year-old deaf boy illustrates this process, as well as the divided transference dynamics evoked by the presence of the interpreter. The child was able to “release his anger, accept limitations, and acknowledge his feelings of guilt and responsibility toward his family members.” The Special Issue on Families concludes with Reflections by Susan Sandel, entitled “Family Stories. ” Poignantly described are the frozen states of the families of chronic mental patients, whose lives have revolved around the illnesses of their children for decades. Through the spontaneous use of play, Sandel rediscovers the everpresent need in each of us to connect with our family stories, those myths that provide us a profound existential grounding. In a personal memory of the Seder, the family story of the Jews, she opens herself to her clients, who respond by opening themselves up to her. Life begins itself again. Sandel notes, “The family unit becomes disempowered when, due to the disruptive presence of mental illness, there is a paucity of intergenerational storytelling, myth-making, and play. ” Not only mental illness causes these troubles for families today. Many pressures - both internal and external to the family - are deadening family life. Creative arts therapists need to direct their energies, clinical talent, and scholarship toward the family. We have much to offer them in their search for inspiration - because through the creative arts therapies what appears to have died can come alive; what seems to have been lost is found again.
Vol. 18, pp. 187-189.
0 Pergamon
INTRODUCTION THE CREATIVE
Press plc, 1991. Printed in the U.S.A.
0197-4556/91
$3.00
+ .OO
TO THE SPECIAL ISSUE ON
ARTS THERAPIES
DAVID READ JOHNSON,
AND THE FAMILY
PhD, RDT, EDITOR-IN-CHIEF
ies. Some families take walks, some do sports together. Creating art, role-playing, singing, or dancing are less likely activities. Playing together may be the rare, if often most remembered, moments a family life can treasure. Creative arts therapists should be able to help the family to play: bring greater intimacy to a disengaged family, more freedom and spontaneity to the rigid or enmeshed family. Increasing the integrity and flexibility of the family is essential in maintaining it as a supportive environment for individuals’ growth, instead of as an incubator of psychopathology. Family therapists have discovered that to impact on the complex family system, powerful and often intrusive techniques are required. Given the fact that the creative arts therapies are successful at overcoming and circumventing strong defenses, bringing unconscious or covert ideas to the surface, their application to family therapy should hold a great deal of promise. Despite the fact that many family therapy practitioners utilize action-oriented techniques such as rituals, tasks, or sculpting, the creative arts therapies have not to date had a significant impact on the practice of family therapy. It is not clear if this is due to creative arts therapists’ lack of access to families or to inherent resistances of families to the arts media. The articles in this Special Issue describe the various ways in which the creative arts therapies have been applied to family treatment, and through them one can glean a vision of what we have to offer the families of the future: a re-assertion of family identity through creative and collective acts. The Special Issue begins with Helen Landgar-
The family, they say, is dying. The family has been blended, extended, enmeshed, disengaged, and torn apart. The nuclear family has had a meltdown. The average person’s sentient feelings are increasingly attached to images of products, processes, and news from their work setting or the mass media. The ongoing sagas of “Dallas” or “Thirtysomething” may have more immediacy to us than our own families, whose members often live far apart. We return to family gatherings fueled by warm hopes, only to find tension, worn out traditions, and disappointment. Perhaps we are experiencing the transition to a new form of human communion, and the family should cautiously be let go. Or perhaps we are witnessing the breakup of human bonding that will lead to an even larger increase in crime, drug abuse, perversion, alienation, and suicide. In response to these threats to its integrity, some families have retreated into rigidified systems with overlycontrolled interactions with the environment. The delicate balance between integrity and integration appears to be difficult to achieve. The death of the intergenerational transmission of family stories, myths, and images contributes to the death of the family as a powerful source of meaning in our lives. The interest recently in discovering our “roots,” in terms of genealogy, is a symptom of this alienation from our family. However, we also need to find our roots in the present, to find nourishment from our membership in our family now. The creative arts therapies may be an effective method for accomplishing this task. What do families do together? Most eat, share chores, drive each other to events, argue, talk about problems, worry about each other, and go to mov187
188
DAVID READ JOHNSON
ten’s Perspective, “Family Creative Arts Therapies: Past and Present,” that describes the development of arts therapists’ interest in families. Landgarten has pioneered a family therapy approach to art therapy that has defined a graduate program, and contributed greatly to the study of families among all creative arts therapists. She notes that creative arts therapists’ use of tasks in therapy predated their use by strategic family therapists. Pointing out that resistant families are the best candidates for creative arts therapies, Landgarten maintains a very positive stance regarding the potential contributions of the creative arts therapies to family therapy. Anthony Decuir, in “Trends in Music and Family Therapy, ” reviews the many ways music therapists have contributed to family therapy. He carefully discusses musical family therapy in terminal illness, pediatric trauma, adult psychiatry, autism, mental retardation, and aphasia. Comparing the family to a concerto, with the identified patient as the soloist amongst the orchestra, Decuir suggests that the therapist’s job is to hear the unsounded chords, that is, the background to the patient’s experience, often beclouded by the collusive family dynamic. He concludes that “facilitating communication among family members seems to be the most common use of music in family treatment.” Doris Arrington’s “Thinking Systems-Seeing Systems: An Integrative Model for Systemically Oriented Art Therapy,” presents a theoretical model of family art therapy that integrates historical, interactional, and existential models of family therapy. She describes symbolic and developmental modes of analysis, and then discusses applications of the genograrn, reframing, positive connotation, and ritual in terms of art therapy process and technique. A detailed case example of an art therapy assignment of an adolescent diagnosed with paranoid schizophrenia demonstrates the usefulness of an integrative approach. She suggests that art therapy’s major purpose, “to organize inner chaos into a coherent form,” is applicable to families in distress as well as individuals. In an important paper, “Creating a Family: An Integrated Expressive Approach to Adoption,” Steve Harvey describes a sophisticated creative arts therapy treatment in which “a network of intimate family relationships is being created through an ongoing expressive process. ” Harvey argues persuasively that the creative arts therapies have a particularly powerful effect on attachment behavior, especially important in adoptive families, but one could argue in-
creasingly at issue even in “normal” families. The adoptive family is faced with the need to “consciously produce a container around experience. ” He illustrates the diagnostic power of expressive activities by describing two case studies of adoptions and how his assessments predicted their success or failure. He then describes three stages of intervention: (a) establishing an interactive expressive activity with the entire family, (b) extending the action until repeatable patterns and salient themes are identified, and (c) helping the family understand these interactive episodes. Four cases are presented in which he uses artwork, family movies, dramas, ritual, storytelling, and movement games. Harvey’s interventions help an adoptive family discover its “myths” and “traditions,” formed in the session with the therapist’s guidance. The family emerges with an enhanced interpersonal bond among its members. Attachment issues are also addressed in Bonnie Meekum’s article, “Dance/Movement Therapy With Mothers and Young Children at Risk of Abuse.” Working with mother/child dyads, Meekums attempts to increase their interpersonal synchrony, echoing, molding, and access to body. The mother/child dyads who improved the most showed better communication, behavior control, and relationships with siblings, and more physical contact and feelings of intimacy. Dyads who did less well showed less intimacy and greater blocking of movement between mother and child. Meekums likens the interaction of the dyad to a dialogue, in which atunement (attachment) and differentiation (boundaries) are both required. Engaging mothers and children in an active, bodily oriented movement session allows this dialogue to develop. Lois Carey, in “Family Sandplay Therapy,” addresses the problem of helping families with rigid patterns of communication who have difficulty adjusting to changing circumstances. She asserts that sandplay uncovers the family’s boundaries, alliances, unconscious images, and “life force,” and gives room for reparative work by the children and “inner child” of the parents. Two cases illustrate beautifully how family patterns are played out, and how a resistant family can challenge the therapist’s best efforts. Carey concludes by pointing out how the sandbox can represent the family “story,” which accesses the inner child of the parents, who long for such contact. This process initiates a shift in attitude that can become a stepping stone to other
INTRODUCTION changes in the family system. Confronting resistant families is the subject of Eva Leveton’s paper, “The Use of Doubling to Counter Resistance in Family and Individual Treatment.” Doubling is a psychodramatic action technique in which the therapist sits next to the client and speaks his or her inner thoughts, like an alter ego. Doubling often helps the client to acknowledge suppressed thoughts. Leveton compares doubling to Minuchin’s concept of joining, or Bandler and Grinder’s concept of pacing. Noting that moving into action is often difficult in a private practice setting because it often seems to break the flow of the patient’s verbalizations, Leveton illustrates with two detailed case examples how doubling can be successfully integrated in a family therapy session. Her inclusion of actual dialogue is particularly helpful in communicating what she does. Her examples clearly illustrate how doubling helps the children give voice to perceptions suppressed by the family system. In this way, action methods help to give the children the edge in an otherwise hierarchical system that tells them to be quiet. The potential problems and timing issues involved are carefully discussed in the article. If communication and resistance have been the major topics of the papers in this issue, then Ellen Horovitz-Darby’s “Family Art Therapy Within a Deaf System” highlights these issues in bold relief. The special needs and issues raised in family therapy with a deaf child provide unique challenges for the family art therapist. Horovitz-Darby discusses the problems with language acquisition, the mouming process in the family regarding the diagnosis of deafness, and the role of the interpreter in the fam-
ily therapy sessions. She points out convincingly how art therapy can help the family cross sonic/linguisticlintimacy barriers by providing a visual context for communication. A case example of a family of a lo-year-old deaf boy illustrates this process, as well as the divided transference dynamics evoked by the presence of the interpreter. The child was able to “release his anger, accept limitations, and acknowledge his feelings of guilt and responsibility toward his family members.” The Special Issue on Families concludes with Reflections by Susan Sandel, entitled “Family Stories. ” Poignantly described are the frozen states of the families of chronic mental patients, whose lives have revolved around the illnesses of their children for decades. Through the spontaneous use of play, Sandel rediscovers the everpresent need in each of us to connect with our family stories, those myths that provide us a profound existential grounding. In a personal memory of the Seder, the family story of the Jews, she opens herself to her clients, who respond by opening themselves up to her. Life begins itself again. Sandel notes, “The family unit becomes disempowered when, due to the disruptive presence of mental illness, there is a paucity of intergenerational storytelling, myth-making, and play. ” Not only mental illness causes these troubles for families today. Many pressures - both internal and external to the family - are deadening family life. Creative arts therapists need to direct their energies, clinical talent, and scholarship toward the family. We have much to offer them in their search for inspiration - because through the creative arts therapies what appears to have died can come alive; what seems to have been lost is found again.