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Using masks and video in group psychotherapy with bulimics
The Arts in Psychotherapy,
Vol. 17, pp. 259-261.
0 Pergamon Press plc, 1990. Printed in the U.S.A.
0197-4556&W $3.00 + .OO
BRIEF REPORT USING MASKS AND VIDEO IN GROUP PSYCHOTHERAPY
WITH BULIMICS
LISA D. HINZ, PhD and VICKI RAGSDELL*
White & White, 1987; Orbach, 1978). Thus, gender-role and real-ideal self conflict are central issues for bulimic women that potentially could be effectively addressed with masks and videotape in psychotherapy. The present investigation was considered a replication, with bulimic clients, of Fryrear and Stephens’ (1988) original work with adult outpatients. Art therapy previously has been demonstrated to be therapeutically effective with eating disordered clients (Levens, 1987; Schaverien, 1989; Wooley & Kearney-Cooke, 1986). Clients in the present eating disorders group previously had been successfully exposed to various art therapy techniques (e.g., clay, drawing, collage).
The history of the use of masks in psychotherapy was traced by Fryrear and Stephens (1988) who used masks and videotaped presentations of masks in group psychotherapy. Masks typically represent a part of the self that is not usually expressed overtly. Videotape was used to capture the masked self asking a series of questions to which the unmasked person later responded. As Fryrear and Stephens reported, “the result is a dialogue between clients and the facet of their personality that is represented symbolically by the mask” (p. 227). The authors hypothesized that interaction of client with masked self in group psychotherapy could facilitate awareness, acceptance, and integration of the part of the self represented by the mask. The present authors were struck by the potential therapeutic utility of masks and videotape with bulimic women who are perfectionistic “people pleasers’ ’ who rarely present their “real’ ’ selves in relationships with others. Instead, they present to others ideal, conforming selves and believe that if people knew the real persons within, they would surely be rejected (Boskind-White & White, 1987; Johnson & Connors, 1987; Orbach, 1978). The dichotomy between real and ideal self is expressed by eating little in public and at other times secretly engaging in binge eating and purging behavior. In addition, these bulimic women seem to be characterized by high levels of gender-role conflict such that they feel less masculine (i.e., assertive and independent) than women in general, and desire to be more feminine (Boskind-
Method Subjects
Subjects were nine female members of an ongoing psychotherapy group for bulimic women at a university counseling center; all were university students. The mean age of members was 22.4 years (range: 20-26 yrs); they had been bulimic for an average of 5.8 years. The mean height of members was 66 inches, and the average weight was 128 pounds. The women had been group members for an average of 11 months (range: 2 weeks-2 years) at the start of the mask project. Materials and Procedure
Following
Fryrear
and Stephens
(1988),
*Lisa Hinz is a lecturer in the Department of Psychology and staff psychologist at the Counseling Center, University of Louisville, KY. Vicki Ragsdell is a graduate student in clinical psychology at the University of Louisville.
259
group
Louisville,
HINZ AND RAGSDELL
260
members were provided with art materials including colored tissue paper, poster board, construction paper, gold and silver colored aluminum foil, yarn, feathers, ribbon, glitter, markers, scissors, and glue. They were then instructed to make a mask. If the members asked for more details they were told to begin and “just let the mask evolve.” All were finished making their masks in the first one-hour session. In the second group meeting, members were asked to read a series of questions (also from Fryrear & Stephens) into the video camera while holding their masks in front of their faces. The remaining group sessions were spent having members respond to the videotaped presentation of themselves, with other members and group leaders providing comments and/or sharing their own experiences. Results Of the nine members, eight constructed masks, five completed videotaping, and three responded to the taped questions in group meetings. Although attendance had been stable at 6-7 members per meeting for the previous year, introduction of this exercise was followed by a precipitous drop in attendance, to an average of two members per session. This drop was interpreted as reflecting resistance to the art therapy mask/video project. Resistance happened at two different times during the task: (a) during construction of the mask, and (b) during interaction with the mask on videotape. At mask construction, refusal came from a member with a history of attempts at sabotaging group art therapy projects. Four members experienced difficulty constructing their masks and were highly critical of the finished products. None of the four proceeded to the next level of interaction. During the videotaping session, members reported that they felt ill at ease and verbalized detailed criticisms of their videotaped appearance or voice; this was the last session that was well attended. Members neither informed leaders of their absences nor attempted to contact other group members. Three members continued to be enthusiastic about the project and discussed their frustration with the task noncompliance . Discussion The high level of resistance to interaction with the videotaped mask was puzzling to the authors. As
mentioned above, group members previously had participated with emotion and enthusiasm in art therapy projects, reporting the experiences to be beneficial. Several possible explanations exist for the inability of most to interact with their masks. Prior art therapy exercises had focused on relationships with family members and food. They were not as directly focused as the mask exercise on the innermost self. Perhaps, when faced with mask construction, the bulimic women felt threatened by the risk of total exposure of their innermost selves, which usually remain hidden. It seemed as though they felt that gradual exposure over which they would have had control was not possible. One member even made a mask for her mask! In light of the conflict between real and false self, from which bulimic women seem to suffer, they seemed extremely afraid to present their real self in group, but derisive of anyone who responded to their masked or false selves. Throughout the course of the group, discussion often focused on the conflict between the real and the false self. Members frequently commented on the need to hide their real selves and to please others by presenting their false selves. In addition, they claimed that they resented the need to hide their real selves and negatively judged those people who “fell for the act” (i.e., who responded to their false selves). Thus, these group members probably negatively judged the members who responded to their “social self” masks, and obviously were too frightened to bring up these feelings within the context of the planned mask exercise. The three members who successfully interacted with the mask seemed to be at a stage in their therapy where they were struggling with issues of independence and personal responsibility. They seemed to be more able than other group members to deemphasize the opinions of other people and to realize that they alone were responsible for recovery from the disorder. Women who failed to interact with the masks were not yet so free of the influence of other people’s opinions in shaping their behavior. Perhaps videotaped presentations too immediately forced these women to confront the threatening possibilities of independently accepting their real selves and taking responsibility for rejecting their masked selves, neither of which they were ready to do at the time. Group cohesion certainly was lessened by the early resistance of group members. The drop in cohesion seemed to make a normally anxiety-provoking task even more so, resulting in decreased risk-taking
MASKS AND VIDEO WITH BULIMIC3 behavior and members leaving the group. It is suggested that such an art therapy project might work better if presented at the outset of a group and/or if everyone in the group firmly committed to complete the project. In fact, Fryrear and Stephens (1988) introduced the mask/videotaping project at the beginning of a new group.
References Boskind-White, M., & White, R.E. (1987). Bulimarexia: b~~ge~parge cycle (2nd ed.). New York: Norton.
The
Fryrear, J.L., & Stephens, B.C. (1988). Group psycho~erapy using masks and video to facilitate intm~rson~ co~unication The Arts in P~chotherupy, 1.5, 227-234. Johnson, C., & Connors, M.E. (1987). The etioiogy and treatment of bulimia nervosa: A biopsychological perspective. New York: Basic Books. Levens, M. (1987, Summer). Art therapy with eating disordered patients. Inscape, 2-7. Orbach, S. (1978). Fat is a feminist issue. New York: Berkley Books. Schaverien, J. (1989, Spring). Transference and the pictnre: Art therapy in the treatment of anorexia, Inscape, 14-17. Wooley, SC., & Kearney-Cooke, A. (1986). Intensive treatment of bulimia and body-image disturbance. In K. D. Brownell &J. P. Foreyt (Eds.), Handbook of eating disorders. New York Basic Books.
Vol. 17, pp. 259-261.
0 Pergamon Press plc, 1990. Printed in the U.S.A.
0197-4556&W $3.00 + .OO
BRIEF REPORT USING MASKS AND VIDEO IN GROUP PSYCHOTHERAPY
WITH BULIMICS
LISA D. HINZ, PhD and VICKI RAGSDELL*
White & White, 1987; Orbach, 1978). Thus, gender-role and real-ideal self conflict are central issues for bulimic women that potentially could be effectively addressed with masks and videotape in psychotherapy. The present investigation was considered a replication, with bulimic clients, of Fryrear and Stephens’ (1988) original work with adult outpatients. Art therapy previously has been demonstrated to be therapeutically effective with eating disordered clients (Levens, 1987; Schaverien, 1989; Wooley & Kearney-Cooke, 1986). Clients in the present eating disorders group previously had been successfully exposed to various art therapy techniques (e.g., clay, drawing, collage).
The history of the use of masks in psychotherapy was traced by Fryrear and Stephens (1988) who used masks and videotaped presentations of masks in group psychotherapy. Masks typically represent a part of the self that is not usually expressed overtly. Videotape was used to capture the masked self asking a series of questions to which the unmasked person later responded. As Fryrear and Stephens reported, “the result is a dialogue between clients and the facet of their personality that is represented symbolically by the mask” (p. 227). The authors hypothesized that interaction of client with masked self in group psychotherapy could facilitate awareness, acceptance, and integration of the part of the self represented by the mask. The present authors were struck by the potential therapeutic utility of masks and videotape with bulimic women who are perfectionistic “people pleasers’ ’ who rarely present their “real’ ’ selves in relationships with others. Instead, they present to others ideal, conforming selves and believe that if people knew the real persons within, they would surely be rejected (Boskind-White & White, 1987; Johnson & Connors, 1987; Orbach, 1978). The dichotomy between real and ideal self is expressed by eating little in public and at other times secretly engaging in binge eating and purging behavior. In addition, these bulimic women seem to be characterized by high levels of gender-role conflict such that they feel less masculine (i.e., assertive and independent) than women in general, and desire to be more feminine (Boskind-
Method Subjects
Subjects were nine female members of an ongoing psychotherapy group for bulimic women at a university counseling center; all were university students. The mean age of members was 22.4 years (range: 20-26 yrs); they had been bulimic for an average of 5.8 years. The mean height of members was 66 inches, and the average weight was 128 pounds. The women had been group members for an average of 11 months (range: 2 weeks-2 years) at the start of the mask project. Materials and Procedure
Following
Fryrear
and Stephens
(1988),
*Lisa Hinz is a lecturer in the Department of Psychology and staff psychologist at the Counseling Center, University of Louisville, KY. Vicki Ragsdell is a graduate student in clinical psychology at the University of Louisville.
259
group
Louisville,
HINZ AND RAGSDELL
260
members were provided with art materials including colored tissue paper, poster board, construction paper, gold and silver colored aluminum foil, yarn, feathers, ribbon, glitter, markers, scissors, and glue. They were then instructed to make a mask. If the members asked for more details they were told to begin and “just let the mask evolve.” All were finished making their masks in the first one-hour session. In the second group meeting, members were asked to read a series of questions (also from Fryrear & Stephens) into the video camera while holding their masks in front of their faces. The remaining group sessions were spent having members respond to the videotaped presentation of themselves, with other members and group leaders providing comments and/or sharing their own experiences. Results Of the nine members, eight constructed masks, five completed videotaping, and three responded to the taped questions in group meetings. Although attendance had been stable at 6-7 members per meeting for the previous year, introduction of this exercise was followed by a precipitous drop in attendance, to an average of two members per session. This drop was interpreted as reflecting resistance to the art therapy mask/video project. Resistance happened at two different times during the task: (a) during construction of the mask, and (b) during interaction with the mask on videotape. At mask construction, refusal came from a member with a history of attempts at sabotaging group art therapy projects. Four members experienced difficulty constructing their masks and were highly critical of the finished products. None of the four proceeded to the next level of interaction. During the videotaping session, members reported that they felt ill at ease and verbalized detailed criticisms of their videotaped appearance or voice; this was the last session that was well attended. Members neither informed leaders of their absences nor attempted to contact other group members. Three members continued to be enthusiastic about the project and discussed their frustration with the task noncompliance . Discussion The high level of resistance to interaction with the videotaped mask was puzzling to the authors. As
mentioned above, group members previously had participated with emotion and enthusiasm in art therapy projects, reporting the experiences to be beneficial. Several possible explanations exist for the inability of most to interact with their masks. Prior art therapy exercises had focused on relationships with family members and food. They were not as directly focused as the mask exercise on the innermost self. Perhaps, when faced with mask construction, the bulimic women felt threatened by the risk of total exposure of their innermost selves, which usually remain hidden. It seemed as though they felt that gradual exposure over which they would have had control was not possible. One member even made a mask for her mask! In light of the conflict between real and false self, from which bulimic women seem to suffer, they seemed extremely afraid to present their real self in group, but derisive of anyone who responded to their masked or false selves. Throughout the course of the group, discussion often focused on the conflict between the real and the false self. Members frequently commented on the need to hide their real selves and to please others by presenting their false selves. In addition, they claimed that they resented the need to hide their real selves and negatively judged those people who “fell for the act” (i.e., who responded to their false selves). Thus, these group members probably negatively judged the members who responded to their “social self” masks, and obviously were too frightened to bring up these feelings within the context of the planned mask exercise. The three members who successfully interacted with the mask seemed to be at a stage in their therapy where they were struggling with issues of independence and personal responsibility. They seemed to be more able than other group members to deemphasize the opinions of other people and to realize that they alone were responsible for recovery from the disorder. Women who failed to interact with the masks were not yet so free of the influence of other people’s opinions in shaping their behavior. Perhaps videotaped presentations too immediately forced these women to confront the threatening possibilities of independently accepting their real selves and taking responsibility for rejecting their masked selves, neither of which they were ready to do at the time. Group cohesion certainly was lessened by the early resistance of group members. The drop in cohesion seemed to make a normally anxiety-provoking task even more so, resulting in decreased risk-taking
MASKS AND VIDEO WITH BULIMIC3 behavior and members leaving the group. It is suggested that such an art therapy project might work better if presented at the outset of a group and/or if everyone in the group firmly committed to complete the project. In fact, Fryrear and Stephens (1988) introduced the mask/videotaping project at the beginning of a new group.
References Boskind-White, M., & White, R.E. (1987). Bulimarexia: b~~ge~parge cycle (2nd ed.). New York: Norton.
The
Fryrear, J.L., & Stephens, B.C. (1988). Group psycho~erapy using masks and video to facilitate intm~rson~ co~unication The Arts in P~chotherupy, 1.5, 227-234. Johnson, C., & Connors, M.E. (1987). The etioiogy and treatment of bulimia nervosa: A biopsychological perspective. New York: Basic Books. Levens, M. (1987, Summer). Art therapy with eating disordered patients. Inscape, 2-7. Orbach, S. (1978). Fat is a feminist issue. New York: Berkley Books. Schaverien, J. (1989, Spring). Transference and the pictnre: Art therapy in the treatment of anorexia, Inscape, 14-17. Wooley, SC., & Kearney-Cooke, A. (1986). Intensive treatment of bulimia and body-image disturbance. In K. D. Brownell &J. P. Foreyt (Eds.), Handbook of eating disorders. New York Basic Books.