Insights into Art Therapy

See art therapy in action! Learn how art therapists have been helping both hurricane victims in Puerto Rico and children with Autism Spectrum Disorder, while discovering the importance of activity and choice in working with these populations. The below articles are reprinted from the American Art Therapy Association’s Art Therapy Today Newsletter:

Puerto Rico and Florida AATA Chapters Offer Group Art Therapy in the Wake of Maria

By Anais Lugo-Axtmann, MA, LGPC, ATR | April 26, 2018

Experiencing hurricanes Irma and Maria was traumatic for most people living on the island of Puerto Rico. Seven months after Maria, Puerto Rico continues to experience prolonged losses of electricity, water, communications and infrastructure, limiting individuals’ ability to recover, keep their jobs and return to their routine (which is so vital for recovery). Many Puerto Ricans are reporting intense feelings of anxiety and depression which have been linked to the onset of mental health crises. While dealing with grief, they struggled to get their basic needs met; many of them had to permanently leave the island where they call home. From Washington DC, I heard how my family and friends had suffered and lost so much after the hurricane. Like many Puerto Ricans living on the mainland, this sensation of hopelessness and melancholy for what Puerto Rico used to be destroyed me inside. Puerto Rico was no longer the island that I grew up in and I could only hope that there was something positive that could come from the fierce transformation that Puerto Rico was going through.

From January 11 to January 15 of 2018, the Puerto Rico Art Therapy Association (PRATA) and the Florida Art Therapy Association (FATA) collaborated to volunteer in several shelters throughout the island and provide art therapy group services. I joined the four other PRATA chapter members (Maricel Ocasio PsyD, ATR-BC; Liani Vazquez, MA; Marta Rivera, MA; Urania Dominquez, MA), and four FATA chapter members (Joseph Scarce ATR-BC, MAAT, MFT; Stephanie A. Wray, ATR-P; Susan Joy Smellie, ATR; and Haley Haren), and two volunteer psychologists from Puerto Rico (Francis González, PsyD, and Manena González, MA, LPC) to provide art therapy services to those affected by Hurricane Maria. Joshua Garcia from Stars of Hope also participated in events and brought completed Stars of Hope from other tragedy sites to give to families in PR. Additionally Wayne Ramirez, ATR -R, PRATA HLM, sponsored art therapy student Haley Haren to join the trip.

The team provided art therapy to families at the Canovanas shelter, children from Comunidad La Cueva in Centro Tau, Loiza, and families at the Vega Alta Shelter. All or most of these families suffered loss of housing from Hurricane Maria. We used art therapy interventions focused on promoting self-expression, a sense of control, and discharge of acute stress, and worked with children, families and older adults. Through art therapy, participants practiced mindful awareness and told their stories.

why we used clay as the material of choice

Clay was one of the materials used to address the sensory and kinesthetic needs of the therapeutic process to offer participants the opportunity to create, reflect and reconstruct their piece. They were encouraged to create three bowls that represented the past, the present and the future respectively and were invited to reflect on what they wanted to contain in each of those moments in time. “Kinesthetic and sensory rich, [clay] allows for channeling much energy via aggressive movements that neurologically connect us to our non-verbal memories and experiences, exactly where trauma resides,” says PRATA President Maricel Ocasio.

Participants described their past, present and future through clay and expressed appreciation for the opportunity to create the tangible piece of art that they could keep. Using clay with children in Loiza, Puerto Rico provided not only sensory stimulation but also an opportunity to play a cathartic, rhythmic-beat with the pieces of clay.

Urania Dominguez, MA adds: “Clay allows the user to simply let go, to make and destroy over and over without judgement, without worrying if it is done well or not and this allows the energy to flow more freely, helping to alleviate stress, anger and sadness. Also, clay requires to knead and pinch, and it is also possible to punch and press with force. These actions help the user to channel energies that may be bottled up.”

creating a safe space for participants

Despite the number of families in the shelters and the limited space, we were able to create a safe environment for the participants for art therapy. At one point during the group, children exhibited hypervigilance from rain drops, but this was soon soothed by the presence of the group members and the art materials. Many participants created images of hope on beautiful wooden stars. The Stars of Hope program brought stars painted with images of hope made by other crisis survivors around the world to the shelters in Puerto Rico, offering the option for participants to take one and pay it forward with their own symbol of hope. Other participants took the opportunity to create a visual of their home, remembering what they had lost and envisioning a brighter future.

We were honored to provide a sense of pride, dignity and ownership to our participants. While addressing their mental health needs, we were struck by how much they could create despite the difficult times.

truly a collaborative effort

FATA and PRATA worked closely together on logistics to implement this trip and make it successful. “Thanks to the Puerto Rico Art Therapy Association who despite facing challenge after challenge muster the courage to keep moving forward, serve others and be living examples of resiliency,” says FATA President Joseph Scarce.

Several factors helped in making this collaboration possible: the AATA Trauma Recovery Grant helped to pay for supplies; The Puerto Rico Chamber of Commerce assisted with air fare; Second Lady Karen Pence donated clay; The Puerto Rico Department of Housing provided security, transportation to and from shelters, and assisted in other logistics.

We even had surprise visits from some high profile figures. The First Lady of Puerto Rico Beatriz Isabel Rossello joined us at the start of our mission to wish us well, and Senator Elizabeth Warren visited us at the Canovanas shelter. Of Senator Warren’s visit, Dr. Ocasio says: “It’s been great to have the attention and stage for a brief moment and have major power players in American politics highlight to our mainland neighbors that we are US citizens being denied our basic civil rights by living in a colony, which is now clearer than ever due to the massive impact María has had on the island and the second class disaster response we’ve had to and continue to endure. I hope we continue to have a presence in their efforts, initiatives and future plans via sustainable projects.”

hear from PRATA members about how they are balancing self-care with being service providers post-Maria:

Urania Dominguez says:

On a personal level I am stressed because I have a lot going on in personal life (as usual) and work. In my personal life I have taken the difficult decision to go through a procedure that requires a lot of processes before and after, and the processes are becoming more and more complicated. Also, I am also in the process of becoming certified as a Child Life specialist which being in PR has made it next to impossible and the bureaucracy of the system does not help.

At work, due to the hurricane, there are many entities and foundations that have expressed their desire to help and donate. However organizing these visits, activities and donations takes time and energy and many have fallen upon me to do. Six months after the hurricane we are still getting a lot of requests to come visit, help and donate and we never say no, but this entails a lot of work and I am deterred from what I am supposed to be doing which is caring for patients in emotional distress, which also has its own set of emotional complications and cause burnout.

I am also being solicited by external entities to carry out presentations and art therapy workshops. I am happy that this is happening but also adds to my stress.

Maricel Ocasio says:

I’m doing well. Being of service to others was really therapeutic for me. I’m almost 5 months pregnant and with lots of work. Because life literally stopped for a couple of months after María, it feels like we are now making up for lost time. I am getting contacted about art therapy more than ever (aprox. 2-3 times a week) by different entities wanting to offer services due to high demand of mental health services, individuals interested in studying it or wanting me to tell them everything I know as an art therapist in an email so that they can “offer art therapy” or create programs.

The joint projects between PRATA and other organizations almost didn’t happen because I was overwhelmed, on the verge of burnout after going on full on solution-focused drive after María and being constantly sick during my first trimester. Grateful for Joe Scarce taking on much of the work on for getting the grant and bringing the materials needed. It was surreal to be the host for disaster relief art therapy efforts in PR. Incredibly grateful for the experience and being able to have some more art therapists to support our local efforts, but also to support us (PRATA members) as victims of María.

Individually we are each working on our different areas. I continue working with burned children and their families and offering clinical services at my individual practice. I developed a mommy and me art group for women at local shelter who’ve experienced domestic violence and their children. I’m consulting at local Special Education division of the PRDE to assure fidelity of implementation of trauma-informed PBIS at public school system that we made culturally appropriate by integrating the arts. And I developed a training for early childhood teachers on how to incorporate art therapy concepts with their visual arts projects so that they can appropriately manage post María emotional content that I will offer with Marta Rivera (PRATA) with the support of the Art Museum of Puerto Rico in Utuado, Humacao and Santurce.

Collectively, though, we have paused our efforts to take care of ourselves.

How Art Therapy Is Helping Children with Autism Express Themselves

By Casey Lesser

For individuals with Autism Spectrum Disorder (ASD), art can be an ideal means of expression. Researchers and leaders in the field of autism education, like Temple Grandin, have done well to explain that individuals with ASD tend to think visually.

“I have noticed that children with autism think in pictures,” art therapist Theresa Van Lith told Artsy. “So it’s a natural progression, then, to use the visual arts to communicate what’s going on in their world.”

Van Lith is part of a broad group of art therapists who specialize in working with individuals with ASD. Verbal communication, she noted, “doesn’t allow them the flexibility that they need to show to us how they see things, which is different.” In contrast, communicating visually—be it through drawing with markers or sculpting with clay—offers opportunities to process the world in a more open-ended, flexible, and sensory way.

Over the past few years, art therapists have published research on how art therapy has been positively impacting children with ASD. A November 2017 study led by art therapist Celine Schweizer found that, broadly, “art therapy could have an effect on reducing behavioral problems of children with autism in specific problem areas, including social communicative behavior, flexibility, and self-image.” Indeed, art therapists are finding that regular art therapy sessions can help children with ASD both at school and at home, with things like regulating their emotions, interacting with peers and family members, and building self-confidence.

Van Lith notes that art therapy can begin for a child with ASD as early as age two or three. “It’s a way that they can problem-solve that suits their thinking style, in a world that’s otherwise kind of confusing and overwhelming much of the time,” she said.

Art therapist Jessica Stallings, who also specializes in clients with ASD, notes that many such art therapists take a client-directed approach. “I let them lead me to the most important thing they need to do,” she explained. For example, when working with a young boy who is struggling with recent diagnoses of both autism and epilepsy, she lets him make narrative drawings that spell out his own feelings and frustrations.

It’s also important to introduce some structure to the sessions. The art therapist might begin with a warm-up or an exercise; they’ll be sure to remind the child of how much time is left and what will happen next. Often, it’s necessary to limit the art supplies that are available: Too many options can be startling. And certain materials might not be appropriate for every child.

“Often, kids are introduced to painting through finger painting, but if you’re someone who’s sensory averse, that is a pretty threatening activity,” Stallings explained. “Instead, we might use Hot Wheels cars or tennis balls or a paintbrush with a very long handle—so they can interact with the paint, without having to touch it.”

Developing a familiarity with different art materials can help a child’s fine and gross motor skills, while letting them become more flexible in unfamiliar scenarios. Perhaps most importantly, art therapy can allow a child with ASD to express their feelings and impressions of the world. “They’re using the paintbrushes to gain control and achieve mastery, using lines to color the way they want to, using clay to mold their ideas into a visual form,” Van Lith explained.

For example, she notes that she was working with an 18-year-old client whom she’d encouraged to externalize how he saw the world. “What was really validating for him was that he was showing his artworks to his parents,” she said, “and his parents realized how much he observed and how perceptive he was.”

A lot of the work art therapists do to improve social skills among clients happens one-on-one, but it can also be facilitated in a group setting. Stallings said that, in these cases, she often provides a limited number of art supplies, giving children the opportunity to practice things like sharing and taking turns. “There are a lot of opportunities for focusing specifically on how to be in relationships with others,” she explained,  alluding to situations where children have to relinquish some control and respect the behaviors of others.

One commonly used round-robin exercise involves asking children to create a collaborative artwork. They’ll begin a drawing, then pass it on to the child next to them, and so on and so forth, until each child has added to the piece (a bit like Exquisite Corpse, a game that Surrealist artists were known to play). Van Lith recalled one instance where she did this with a group of eight children, all of whom were around five years old, and all non-verbal. “They began to realize that by making lines on the piece of paper, they were contributing to someone else’s art creation,” she said. “They started to look over at each other and acknowledge, ‘Okay, I see you, I realize that you’re here.’ That can be a validating process, to see that another person feels or sees the world in a similar way as you. They can realize that they’re not alone.”

Making art is an emotional experience. This means that therapy sessions allow children with ASD to practice recognizing and controlling their emotions in a controlled environment. “A lot of times, individuals with autism can be kind of impulsive, or when they have sensory overload, they have a hard time not becoming really upset,” Stallings explained, noting that much of her work deals with identifying emotionally upsetting situations and developing coping strategies, which often involve artmaking.

Over time, Van Lith notes, some individuals with ASD embrace art as part of their larger sense of self. “Later in adulthood, the art therapy process can help them to cultivate their artistic identity, to see themselves as an artist in their own right,” she explained. “Having autism is just one part of who they are.”