The Exploration of Mindfulness and Flow in an Art Therapeutic Context. GCAP Final Project Requirement. Rachela L. Buonincontri
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1 Letter of Intent 1 Running head: FINAL PROJECT The Exploration of Mindfulness and Flow in an Art Therapeutic Context GCAP Final Project Requirement Rachela L. Buonincontri Supervisor: Dr. Paul Jerry December 25, 2008
2 Letter of Intent 2 The Exploration of Mindfulness and Flow in an Art Therapeutic Context The understanding of art therapy, mindfulness meditation, and flow theory in a psychological context has been receiving increased attention from mental health practitioners, researchers, and the general public. According to some, art therapy, mindfulness, and flow are processes by which an alternative state of consciousness may be derived that leads to an increased propensity towards health and well being (Gutman & Schindler, 2007; Kabat-Zinn, 1990; Malchiodi, 2007). Research has been conducted in the areas of art therapy, mindfulness meditation, and flow theory but little is known about these three areas in relationship to one another. This project proposes that flow and mindfulness are present in an art therapeutic context (Malchiodi, 2007). The purpose of this project is three-fold including to: (a) understand the concepts of mindfulness and flow conceptually and theoretically; (b) explore the relationship or connection between mindfulness and flow; and (c) to determine how such states can be induced in an art therapeutic context. The practical application of this project is to compile a manual for art therapists to induce states of mindfulness and flow with their clients. Problem Statement There are currently several branches of research that describe the relationship between mindfulness and flow. Firstly, research suggests that mindfulness and flow are conceptually similar states of consciousness (e.g., Budilovsky & Adamson, 2002). Secondly, research supports the notion that mindfulness and flow share a few similar characteristics or elements (e.g., Gutman & Schindler, 2007) but are distinct processes. Thirdly, research proposes that the two states are in symbiotic relationship to one another whereby, the propensity to be in a mindfulness
3 Letter of Intent 3 state also increases one s flow state (e.g., Germer, Siegel, & Fulton, 2005; Kee & Wang, 2008). Our understanding of the concepts of mindfulness and flow, and their relationship to one another in a psychotherapeutic context is unclear. It is suggested that art therapy is a bridge or a means for creating flow and mindfulness in a therapeutic setting (Malchiodi, 2007). Researchers propose that interventions must be created in order to induce states of mindfulness and flow; art therapy may be a viable discipline. To understand the relationship between flow and mindfulness is important as it has implications for the professions of psychology, counselling, and art therapy. Art Therapy Art therapy is a profession that combines the intentional use of art as a therapeutic intervention to assist clients with their problems and concerns (Johnson, 1999; Malchiodi, 2007). Art therapy includes the utilization of images, symbols, and creativity to express one s self through visual means with the use of diverse art materials or media (Malchiodi). The art materials and art application is the main form of communication however, verbal and non-verbal means of expression are encouraged (Kahn, 1999). The art creation and expression is at the core of art therapy practice (Malchiodi). Mindfulness Mindfulness is a Buddhist philosophy that is centered on one s state of being (Kabat- Zinn, 1990). Only recently has mindfulness been operationally defined in the literature by clinicians and researchers (Bishop et al., 2004). Mindfulness has been defined by a model including: (a) the self-regulation of attention, and (b) acceptance of the present moment (Bishop et al., 2004). To be mindful, one must be aware of his/her thoughts, feelings, and sensations and accept them as they arise in the present moment (Bishop et al., 2004; Kabat-Zinn, 2005). The
4 Letter of Intent 4 intent or purpose for practicing mindfulness (i.e., mediation) is to increase self-awareness and to accept the reality in which one lives (Hall, 2003; Kabat-Zinn, 1990). Flow Theory Mihaly Csikszentmihalyi is a psychologist that has investigated the concept of flow for several decades. Flow is described as a state of mind that includes the involvement and absorption in an activity whereby, one loses sense of time and awareness of the external environment diminishes (Csikszentmihalyi, 1990; Gutman & Schindler, 2007). Flow is defined as the optimal state of one s inner experiences including the order of consciousness and attentive control of psychic energy (Csikszentmihalyi, 1990). Csikszentmihalyi s (1990) description of flow is the way people describe their state of mind when consciousness is harmoniously ordered, and they want to pursue whatever they are doing for its own sake (p. 6). Project Rationale The rationale for completing this project is to gain clarity and further understanding of the processes of art therapy, mindfulness, and flow theory and gather information about their interrelationship with one another. Such a project would also entail a greater understanding of the processes on their own, combined, and within the context of psychotherapeutic practice. The purpose of the project is to inform psychotherapeutic practice, specifically art therapy practice, and to clarify research for future exploration in the areas of mindfulness, flow, art therapy, psychology, and counselling. This project will review the concepts of mindfulness and flow; comparing the two processes within a psychotherapeutic context. Such information will form the basis of a manual on how to induce flow and mindfulness in an art therapy context. The manual is intended to
5 Letter of Intent 5 assist art therapists to induce a state of flow and mindfulness with clients in order to increase health and well-being. The manual will include a description of flow and mindfulness states, as well as, integration of their similarities and differences. Art therapy interventions will be included in the manual as a way to induce a state of flow and mindfulness with clients. Supporting Literature It is evident from the literature on art therapy, mindfulness, and flow that there are many similarities conceptually, philosophically, and in the manner by which the properties and mechanisms are described. Mindfulness, art therapy, and flow are important in the field of psychology. Unfortunately, there is no literature that combines these three processes or disciplines; thereby, this literature review section will discuss each separately with the focus on understanding each within a psychotherapeutic context. Supporting Literature: Art Therapy There are two general categories for defining art therapy (Malchiodi, 2007). One, artmaking is a healing process, whereby the creative process of making art involves inherent healing power and allows one to express him/her self authentically, imaginatively, and spontaneously leading to personal fulfillment and transformation over time (Malchiodi). Second, the art product is a form of symbolic communication that guides and supports the therapeutic process (Malchiodi). The art product can facilitate new understanding to the problem, and bring new perceptions and insights leading to growth, healing, and positive changes (Malchiodi). Art therapy offers the field of psychology an alternative form of therapeutic treatment through non-verbal means (Malchiodi, 2007). The manipulation and use of art materials enhances the client s understanding of personal issues and concerns while allowing the client to
6 Letter of Intent 6 externally express internal processes (Betensky, 1995; Malchiodi). Art therapy empowers clients to gain self-awareness of their thoughts, feelings, sensations, and to understand their life circumstances through the art-making process (Malchiodi). Such understanding leads to the ability to self-support, self-regulate, self-sustain, and heal through awareness (Johnson, 1999). Art therapy can be used in individual, couple, family, or group counselling settings (Malchiodi, 2007). Its use is not limited to specific populations or age groups. Art therapy has been employed with individuals suffering from depression (e.g., Gussak, 2007), anxiety (e.g., Curry & Kasser, 2007), eating disorders (e.g., Frisch, Franko, & Herzog, 2006), and cancer treatment (Nainis, Paice, Ratner, Wirth, Lai, & Shott, 2006) to name a few. The use of art therapy with diverse populations and age groups allows it to be functional with most clients in the mental health field and within medical settings (Malchiodi). Supporting Literature: Mindfulness Mindfulness has historically been practiced within a spiritual context; however, its application in psychotherapeutic practice is relatively recent and is not affiliated with any particular philosophy or belief (Allen, Blashki, & Gullone, 2006; Kabat-Zinn, 2005). Mindfulness in the context of mental health has been adopted as a form of treatment employed to increase awareness and mental skills to cope with emotional, behavioural, and cognitive maladjustments associated with disorders (Bishop et al., 2004; Segal et al., 2002). In order to develop mindfulness one must practice focusing attention on the present moment (Kabat-Zinn, 2005). The goal of mindfulness is to passively observe thoughts and feelings simply as mental events with no inherent value of their own (Bishop, 2002, p. 72).
7 Letter of Intent 7 Some attitudinal characteristics of mindfulness include: non-attachment, acceptance, nonjudging, patience, beginner s mind, trust, non-striving, and letting go (Kabat-Zinn, 1990). Through the awareness that mindfulness creates, life becomes more manageable and meaningful, as well as, less stressful and chaotic (Kabat-Zinn, 2005). Some examples of mindfulness-based practices include a sitting meditation, yoga, walking or eating meditation, body scan, journal writing, and art making (Hall, 2003; Malchiodi, 2007). Mindfulness-based approaches have been used primarily in the treatment of stress reduction called Mindfulness Based Stress Reduction (Kabat-Zinn, 2005), and as a supporting form of cognitive treatment to combat the relapse/recurrence of depression called Mindfulness Based Cognitive Therapy (Segal et al., 2002; Teasdale et al., 2000). Mindfulness has also been linked to dialectical therapy (Linehan et al., 1991), acceptance and commitment therapy (Blackledge, 2007), positive psychology (Germer, Siegel, & Fulton, 2005), and has led to the creation of Mindfulness Based Art Therapy (Monti, 2004). Mindfulness has been applied in psychology and has been the focus of research with diverse populations (Kabat-Zinn, 2003, 2005). Some examples of the types of physical and psychological conditions treated with mindfulness include: chronic pain (e.g., Bonadonna, 2003; Kabat-Zinn, 1982), cancer (e.g., Carlson, Speca, Patal, & Goodey, 2003; Speca, Carlson, Goodey, & Angen, 2000), anxiety and panic disorders (e.g., Miller, Fletcher, & Kabat-Zinn, 1995), depression (Segal et al., 2002), and substance abuse (e.g., Leigh, Bowen, & Marlatt, 2005). Mindfulness has been exemplified as a successful form of treatment in many of these conditions (Kabat-Zinn, 2005).
8 Letter of Intent 8 Supporting Literature: Flow The concept of flow has played an important role in psychology through understanding consciousness, awareness, attention, creativity, happiness, and optimal experience (Csikszentmihalyi, 1990). Flow has been compared to research on positive psychology, and emotional intelligence (Csikszentmihalyi). Daniel Goleman proposes that flow is emotional intelligence at its paramount (Malchiodi, 2007). It is believed that entering a state of flow leads to health and well-being and may have an impact on one s work experience and daily living (Gutman & Schindler, 2007). Csikszentmihalyi (1990) suggests that flow is a state of consciousness that involves: (a) a balance between a challenging task and the skills of the individual; (b) complete absorption in an activity that is rewarding; and (c) immersion in the present moment. Flow occasionally occurs spontaneously, however, it is more likely to occur when certain conditions are present and when particular (creative) activities are experienced (Csikszentmihalyi). Flow has been studied extensively with artists, musicians, writers, and athletes (Csikszentmihalyi). Flow has been associated with positive affect and reduced stress levels (Hull, 1991). Art therapy and flow have been connected by research on creativity. Specifically, flow theory explores the importance of creativity and artistic expression in everyday life (Csikszentmihalyi, 1996). Research on flow and mindfulness is linked by positive psychology and studies in the area of consciousness. Project Procedures In order to conduct a comprehensive review of the current available information on mindfulness, flow, and art therapy a search of library collections and appropriate databases will
9 Letter of Intent 9 be accessed. Such databases include PsycINFO, PsycArticles, and MEDLINE via the Athabasca University Library and the University of Calgary Library. Various books will be accessed from the following libraries: (a) the University of Calgary, (b) Athabasca University, (c) the Vancouver Art Therapy Institute, and (d) the City of Calgary Public Library. Keywords applied in the search include mindfulness, mindlessness, meditation, flow, optimal experience, art therapy, creativity, and psychotherapy. Further, the reference lists of studies retrieved in the initial search will be reviewed, and relevant publications will be selected. In order to create the practical application component of this project, the art therapy manual will be based on information gathered from the comprehensive review. Underlying the manual will be information outlining the theoretical and conceptual basis of flow and mindfulness states, and information on the importance of inducing such states of consciousness. In addition, art therapy-based interventions for inducing states of mindfulness and flow will be suggested. Potential Implications of the Project Understanding the connection between flow, mindfulness, and art therapy will have an impact on art therapy practice, such that techniques, interventions, and future research will be modified; further, client outcome will hopefully be improved. The culmination of this review could serve many functions. First, it could have an impact on the future of art therapy practice and assist in the progression of art therapy as a discipline in the mental health field. Second, it may devise a possible strategy for assisting clients to optimal health and well-being. Third, the research may introduce new techniques and interventions for art therapy practice. Fourth, the research may help promote mindful and flow states in psychotherapeutic practice. Fifth, the
10 Letter of Intent 10 research may initiate future studies in the areas of mindfulness, flow, and art therapy. Sixth, creative and artistic expression in psychotherapy may be further researched and explored.
11 Letter of Intent 11 References Allen, N., Blashki, G., & Gullone, E. (2006). Mindfulness-based psychotherapies: A review of conceptual foundations, empirical evidence and practical considerations. Australian and New Zealand Journal of Psychiatry, 40, Retrieved October 3, 2006, from the PsycINFO database. Betensky, M. G. (1995). What do you see? Phenomenology of therapeutic art expression. London: Jessica Kingsley. Bishop, S. R. (2002). What do we really know about mindfulness-based stress reduction? Psychosomatic Medicine, 64, Retrieved July 4, 2008, from the PsycINFO database. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psycholoy: Science and Practice, 11(3), Retrieved September 30, 2006, from the PsycINFO database. Blackledge, J. T. (2007). Disrupting verbal processes: Cognitive defusion in acceptance and commitment therapy and other mindfulness-based psychotherapies. Psychological Record, 57(4), Bonadonna, R. (2003). Meditation s impact on chronic illness. Holistic Nursing Practice, 17(6) Retrieved October 4, 2006, from the MEDLINE database. Budilovsky, J., & Adamson, E. (2002). The complete idiot s guide to meditation (2 nd ed.). Indianapolis, IN: Alpha Books. Carlson, L., Speca, M., Patel, K., & Goodey, E. (2003). Mindfulness-based stress reduction in relation to the quality of life, mood, symptoms of stress, and immune parameters in breast
12 Letter of Intent 12 and prostate cancer outpatients. Psychosomatic Medicine, 65, Retrieved October 6, 2006, from Csikszentmihalyi, M. (1990). Flow. New York, NY: Harper Collins Publishers. Curry, N., & Kasser, T. (2005). Can coloring mandalas reduce anxiety? Art Therapy, 22(2), Frisch, M. J., Franko, D. L., & Herzog, D. B. (2006). Arts-based therapies in the treatment of eating disorders. Eating Disorders: The Journal of Treatment & Prevention, 14(2), Germer, C. K., Siegel, R. D., & Fulton, P. R. (2005). Mindfulness and psychotherapy. New York, NY: Guilford Press. Gussak, D. (2007). The effectiveness of art therapy in reducing depression in prison populations. International Journal of Offender Therapy and Comparative Criminology, 51(4), Gutman, S. A., & Schindler, V. P. (2007). The neurological basis of occupation. Occupational Therapy International, 14(2), Hall, D. (2003). Meditation. Seek serenity through self-knowledge. London: Anness Publishing Ltd. Hull, R. B. (1991). Mood as a product of leisure: Causes and consequences. In B. L. Driver, P. J. Brown, & G. L. Peterson (Eds.), Benefits of leisure (pp ). State College, PA: Venture Publishing. Johnson, D. R. (1999). Essays on the creative arts therapies: Imaging the birth of a profession. Springfield, Illinois: Charles C. Thomas Publisher.
13 Letter of Intent 13 Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. Journal of General Hospital Psychiatry, 4, Retrieved September 21, 2008, from MEDLINE database. Kabat-Zinn, J. (1990). Full catastrophe living. New York, NY: Bantam Dell. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), Retrieved October 10, 2008, from Kabat-Zinn, J. (2005). Coming to our senses. New York, NY: Hyperion. Kahn, B. B. (1999). Art therapy with adolescents: Making it work for school counselors. Professional School Counselling, 2, Retrieved November 12, 2008, from the Psychology and Behavioural Sciences Collection database. Kee, Y. H., & Wang, C. K. J. (2008). Relationships between mindfulness, flow dispositions, and mental skills adoption: A cluster analytic approach. Psychology of Sport and Exercise, 9, Leigh, J., Bowen, S., & Marlatt, G. (2005). Spirituality, mindfulness and substance abuse. Addictive Behaviors, 30(7), Retrieved October 7, 2006, from the MEDLINE database. Malchiodi, C. A. (2007). The art therapy sourcebook. New York, NY: McGraw Hill. Miller, J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow up and clinical implications of a mindfulness-based stress reduction intervention in the treatment of anxiety disorders.
14 Letter of Intent 14 General Hospital Psychiatry, 17(3), Retrieved October 1, 2006, from the MEDLINE database. Monti, D. A. (2004). Mindfulness-based art therapy: Results from a two-year study. Psychiatric Times, 63. Retrieved June 26, 2008, from PsycINFO database. Nainis, N., Paice, J. A., Ratner, J., Wirth, J. H., Lai, J., & Shott, S. (2006). Relieving symptoms in cancer: Innovative use of art therapy. Journal of Pain and Symptom Management, 31(2), Segal, Z., Williams, J., & Teasdale, J. (2002). Mindfulness-based cognitive therapy for depression. New York: The Guilford Press. Speca, M., Carlson, L., Goodey, E., & Angen, M. (2000). A randomized wait list controlled clinical trial: The effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine, 62, Retrieved October 4, 2008, from the MEDLINE database. Teasdale, J., Williams, J., Soulsby, J., Segal, Z., Ridgeway, V., & Lau, M. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), Retrieved October 1, 2006, from the PsycINFO database.
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