The Experience of Grief: A Novice Art Therapist s Exploration. Nalini Iype. Graduate Centre for Applied Psychology. Final Project Letter of Intent

Transcription

1 The Experience 1 Running head: THE EXPERIENCE OF GRIEF The Experience of Grief: A Novice Art Therapist s Exploration Nalini Iype Graduate Centre for Applied Psychology Final Project Letter of Intent Supervisor: Dr. Ronna Jevne Monday, May 12, 2008

2 The Experience 2 The Experience of Grief: A Novice Art Therapist s Exploration Problem Statement In times of grief, which was borne from loss, or anticipated loss of any kind in my life, I have experienced a whole host of emotions. My grief was a natural human reaction and consisted of a complex interaction of thoughts, emotions, and behaviours (Hooyman & Kramer, 2006; Kübler-Ross, 1969; Servaty-Seib, 2004). This complex interaction may have been provoked by a variety of situations and experiences (Parkes, as cited in Reynolds, 1999). It has also manifested itself in many aspects of my life, including my relationships, my actions, and my ability to function normally (Worden, 2003). Not surprisingly, as an art therapist in training, my experience of grief is one that may profoundly affect my work. As I am currently experiencing personal grief, I may experience counter transference issues that arise during my practice (Schaverien, 1992). This is a possibility as counter transference is a common and expected result of working in art therapy (Robbins & Erismann, 1992; Schaverien, 1992). This may be due to the presence of a variety of triggers and emotions both within the therapeutic setting and also within my personal life (Lett, 1995; Rosenberger & Hayes, 2002). I may have to negotiate my own grief reactions concurrently with my counter transference reactions to my clients. In order to address some aspects of these elements, the intention of the inquiry will be to examine the following research questions: What is the experience of grief as expressed by an art therapist? How is that experience of grief related to my work as an art therapist? Rationale for the Project As an art therapist in training, I believe my self-awareness is a central component to maintaining an empathic relationship while monitoring my projections onto my clients. It allows

3 The Experience 3 me to acknowledge [my] own parallel experience and can [help me] keep this within the boundary of containment in a compassionate separateness and deep connectedness (Lett, 1995, p. 315). Self-awareness may also lead to a greater authentic presence and better ability to meet my clients needs (Camillieri, 2001). If I do not actively seek to explore my personal reactions to my clients and the world around me, the likelihood of affecting the therapeutic process in an unhealthy manner is enhanced (Singer & Luborsky, as cited in Hayes & Gelso, 1991). It has been suggested that art therapists actively explore their own experience, not only as a tool for personal growth, but as a means to understanding their total response to their clients (Robbins & Erismann, 1992). Through self-exploration, particularly through art-making, I may be able to investigate the unconscious, as well as conscious aspects of my counter transference reactions, to prevent the my retreat from the therapeutic process, a potential reaction to over identification with the presenting issues (Hayes & Gelso, 1991; Robbins & Erismann, 1992; Schaverien, 1992; Tobin & McCurdy, 2006). Self-awareness and the management of counter transference issues may be fundamental to the practice of art therapy. The purpose of this project is to explore my deeply personal experience of grief as an art therapist in training involved in practice. The project will comprise of a personal, qualitative, heuristic, and arts-based exploration of grief and counter transference issues that will eventually be expressed as a creative synthesis. This will be supported by an in depth literature review of the topics of grief, art therapy, self-awareness, and counter transference issues, which will serve as a basis and rationale for the exploration of the experience of grief. Supporting Literature

4 The Experience 4 Self-Awareness and Counter Transference Self-awareness has been denoted as one of the key characteristics in master therapists (Jennings & Skovholt, 1999). Higher self-awareness is associated with greater client satisfaction (Williams & Fauth, 2005). It has also shown to be effective in managing the effects of counter transference (Hayes & Gelso, 1991). This is of importance to art therapists as they may be confronted with new situations and emotions during their training and practice (Williams, Judge, Hill, & Hoffman, 1997). Self-awareness and management of counter transference have also been linked to the offset of vicarious victimization of the therapist (Neumann & Gamble, 1995). This may translate into a stronger therapeutic relationship and a decrease in burnout by the therapist (Barnett, Baker, Elman, & Schoner, 2007; Rosenberger & Hayes, 2002). Consequently, there are benefits of the exploration of the therapists self-awareness for both the client and therapist. Self-awareness and counter transference in art therapy. Some art therapists see selfawareness and counter transference as aesthetic processes, wherein the emotions and behaviours of the therapist may be translated into creative mediums, such as through symbolic images or poetry (Landy, 1992). Art therapists may explore their counter transference to their clients images through their own art-making (Ireland & Weismann, 1999). The art produced becomes a mediating object in which the process of self-awareness may be examined (Schaverien, 1992). The impression art therapists develop towards their clients artwork may be based in part on their own self-awareness and it is recommended that art therapists continue to integrate art-making into their practice (McNiff, 2000). For example, art therapists who are experiencing grief reactions developed through counter transference from their clients, may choose to express their

5 The Experience 5 own grief through art-making as a way to examine the counter transference more closely (Landy). Grief Although grief is experienced universally throughout all cultures, it may not be expressed uniformly (Worden, 2003). Hooyman and Kramer (2006) defined grief as the physical, psychological, and social reaction to the loss of something or someone important to us (p. 16). For the purpose of this project, the definition of grief shall refer to the reactions experienced after any such loss or perceived loss. There exist several theories that serve to elucidate the experience of grief. Kübler-Ross s (1969) work on grief described five stages in which natural grief occurs. The stages will not always occur in the same order, and may at times occur simultaneously (Kübler-Ross). In recent years, however, there has been some criticism of Kübler-Ross s work in that grief cannot be divided into specific emotions and stages, but rather that grief may be viewed as tasks (Hooyman & Kramer, 2006). In what is termed the process perspective, grief is viewed as a complex interaction between emotion, thought, and behaviour. Rather than experiencing grief as five distinct stages, it is expected that individuals may complete a variety of tasks, such as accepting reality and adjusting to the separation (Worden, 1991). What does seem to be common among many of the theories of grief is the notion that there is an experience we call grief work. Certain tasks or activities appear to be completed before the mourning period is complete, or before an individual can return to a normal way of life. For example, Kirwin and Vanya (2005) noted in their study of children who lost a parent, that those who did not complete the tasks associated with grief were more likely to experience serious traumatic symptoms.

6 The Experience 6 In the absence of a normal trajectory of grief, an individual may become unable to function properly with daily living (Worden, 2003). At such times, it is thought that the individual is experiencing complicated grief (Hooyman & Kramer, 2006). What makes complicated grief distinguishable from normal grief, is not the presence of different emotional indicators, but rather the intensity and duration of them (Worden, 1991). It is noted in some studies that the percentage of those grieving who experience complicated grief can be anywhere from 10 to 20 percent (Bonanno, 2006; Hooyman & Kramer, 2001). Grief is comprised of a host of emotions that may or may not lead to complicated grief. Therapists may benefit from working through their emotions so that they are able to integrate loss and grief into their lives. One method that may help therapists to do so may be the use of art therapy. Art Therapy Art therapy is the use of arts to help individuals express themselves using mediums not available through other therapeutic methods (Kramer & Ulman, 1992; Ulman, 1992). It can include anything from the use of drawing and painting, to sculpture and journaling (Allen, 2005; Capacchione, 2002). For the purpose of this project, the definition of art therapy shall encompass the use of all visual and written arts as a means for attaining therapeutic goals. Art-making, and the process involved, can be seen as a tool to accomplish therapeutic goals. Davis (1988) considered art therapy to have four goals, including spontaneity and creativity. He believed that art was a medium through which feelings and emotions could be detected, explored, and experienced. Both Kwiatkowska (2001) and Filip (1994) also viewed spontaneity of free expression as the main goal of art therapy.

7 The Experience 7 The idea that therapeutic gains in art therapy are a result of the process of art-making and the opening of creative paths is gaining acceptance (Capacchione, 2002; McIntyre, 1990). McIntyre (1990) viewed the healing of art therapy as the creative transformation of pain (p. 16) and that the transformation occurs in the process of art making. She also saw the process of art-making to be a secure and comfortable place in which emotions may surface. Rationale for applying art therapy to grief exploration. The literature suggests several reasons that may account for the benefits of applying art therapy processes to the treatment and management of grief. First, the flexibility and creative openness allowed by art therapy can provide the means to access affect, which is at the core of grief (McIntyre, 1989). If these emotions are not explored or expressed, there exists a potential for more serious outcomes to occur (Hurd, 2004; Kübler-Ross, 1983). Art therapy can also serve as a protective container to hold those emotions (McIntyre, 1989) Art therapy is beneficial in the treatment of grief as it is a means for expressing more than one feeling at a time (McIntyre, 1989). Individuals may find their vocabulary limited when vocalizing their interconnected feelings, and may benefit from drawing or painting an image that explores all of the emotions at once (Goodman, 2002). Finally, grief may naturally incur a sense of loss of control (Hooyman & Kramer, 2006; Kübler-Ross, 1983) and art therapy is one way to achieve a sense of mastery and self-nurturance (Goodman, 2002; McIntyre, 1989). Rubin (2005) believed that the process of art making itself can instill a greater self-esteem in individuals and a belief that they are capable of handling the enormous changes associated with loss and grief. Methods and Procedures

8 The Experience 8 The Literature Review As mentioned previously, part of the final project will consist of a literature review. In order to search for relevant sources for this literature review, several methods of information gathering will be utilized. The electronic databases that will be searched will include PsycINFO, Academic Search Complete, and Ebrary. The Internet search engine Google Scholar will also be used, along with the library catalogues of Athabasca University and the University of Toronto. Key terms that will be employed include grief, bereavement, art therapy, self-awareness, and counter transference. The years will be set as the parameters for the search, although preference will be given to more recent documents, peerreviewed journals, and to primary sources. Secondary sources will only be used when primary sources are unavailable or inaccessible. Reference sections of sources found will also be used to obtain further resources. In order to ensure a valid and accurate review, all books, journal articles, and websites will have to meet stringent criteria including the reliability of the sources, the strengths of the studies, and validity of the results, in order to be included in the review. However, an effort will be made to include those of a qualitative or phenomenological nature, and those by marginalized or oppressed sources. Rationale for the literature review. The reason for the literature review will be to explore the relationships between grief, art therapy, and the counter transference of art therapists. The ensuing review will serve as a foundation of the current knowledge of these topics and will highlight their possible interactions and relationships. It will also serve as a comprehensive introduction to my personal inquiry of being an art therapist in training who is experiencing grief while practicing art therapy.

9 The Experience 9 The Heuristic Inquiry The project will involve a heuristic self-inquiry where I, as the researcher, will serve as a participant. I will undergo an exploration of my experience as an art therapist who is dealing with personal grief as I practice art therapy. This will be done using the methodology developed by Moustakas (1990). He believed that heuristic research leads investigators to new images and meanings regarding human phenomena, but also to realizations relevant to their experiences and lives (p. 9). Heuristic research also follows a social constructivist approach in recognizing that truth and reality are based in socially constructed ideas and that they are equally as legitimate as more traditional fields such as science and mathematics (Etherington, 2004). It therefore offers a disciplined pursuit of essential meanings connected with everyday human experiences (Moustakas & Douglass, 1985, p. 39). For the purpose of this project, the exploration of the nature and experience of grief and how it impacts art therapists and the practice of art therapy will provide the greater social relevance. The heuristic methodology. Moustakas (1990) described the heuristic methodology as comprising of six phases: 1. Initial Engagement: a self-dialogue to discover an area of intense interest (Moustakas, 1990). 2. Immersion: a complete engrossment of the research question involving thought, debate, focus, and concentration (Moustakas, 1990). 3. Incubation: a retreat from the immersion that allows the inner workings of the tacit dimension and intuition to continue to clarify and extend understanding on levels outside the immediate awareness (Moustakas, 1990, p. 29).

10 The Experience Illumination: a natural occurrence where the researcher is open and receptive to tacit knowledge and intuition (Moustakas, 1990, p. 29). 5. Explication: a process of self-awareness and focusing to fully examine what has awakened in consciousness (Moustakas, 1990, p. 29). 6. Creative Synthesis: a comprehensive and intuitive depiction of the human experience expressed through a creative format, including but not limited to images, poetry, and stories (Moustakas, 1990). Several of the phases are already in progress due to the development of this proposal. The initial engagement and immersion stages were necessary as a precursor to determining the subject of my research. They will be re-examined before moving onto the completion of the remaining phases in order to adhere to consistency across all stages. All of the stages will be explored using a self-reflective and arts-based approach. Due to the spontaneous nature of creativity only a general description of the arts-based procedure can be described at this time (Naumburg, 2001). The procedure. The research process will consist of art-making approximately every two or three weeks to regularly process the experience of grief. In addition, art-making will also be done directly after a session in which I am involved as an art therapist or when it is deemed appropriate to explore the relationship between my grief and my counter transference reactions. Due to the open-ended nature of the creative process, art-making may also be completed outside of these prescribed times. This will be determined by both intuition and tacit knowledge of my current mood and need for processing the experience. Following the art-making, I will engage in reflective writing or a dialogue with the art, wherein I will be open and receptive to the tacit knowledge that may emerge, including noticing developing themes. Allowing for periods of rest

11 The Experience 11 for incubation and illumination, I will also engage in explicating and elucidating my response to further angles and subtleties of the emerging themes through the process of responsive artmaking, focusing, and in-dwelling. For that reason, the creative means cannot be determined or scheduled in a consistent manner, as it is dependent on the developing experiences. The creative synthesis will [embody] an inclusive expression of the essences of what has been investigated (Sela-Smith, 2002, p. 68) and will consist of a creation that is beyond simply the amalgamation of the data. The creative synthesis will exemplify the phenomenon of experiencing personal grief and the relationship of practicing as an art therapist as a merging between tacit dimension, intuition, and self-searching (Moustakas, 1990, p.32). Finally, a summary of the results along with implications for further research will be provided. Validation. The validation of this heuristic inquiry will be derived from its meaning. If the experience of personal grief is explored, and deepened at every stage of the inquiry, and it represents an authentic representation of my experience, then it is valid by that fact that it does so. Its validity will be based in my personal transformation, and the transformation that others might experience by witnessing my story (Sela-Smith, 2002). Validity will also be qualitatively measured by the contribution of new knowledge and understanding to the topic of inquiry. (Etherington, 2004). Potential Implications The investigation of how personal grief affects an art therapist and the process of art therapy may have implications on several different levels. First, the literature review will hopefully serve to draw attention to present research regarding arts-based methods of selfawareness and grief processes. This is especially relevant to art therapists, who are likely to consider reflexivity through art as crucial to their practice (McNiff, 2000). The literature review

12 The Experience 12 may also benefit novice therapists who are exploring the particular issue of grief and how it affects their training and learning. Finally, the literature review may also serve to reveal areas in which further study of the stated topics is necessary. Since the heuristic inquiry will be a self-study, personal implications will exist as well. I anticipate I will learn and experience a great deal regarding my grief and counter transference issues as an art therapist. I will also undergo a time of self-awareness and self-growth as I explore many facets of the experience of grief. In fact, by following the notions of validity for this project, a personal transformation will hopefully occur. However, although the project will have a personal impact on me, I presume that my heuristic journey will also serve as an example to other art therapists who are interested in the experience of grief and arts-based exploration of their own self-awareness.

13 The Experience 13 References Allen, P. B. (2005). Art is a spiritual path. Boston, MA: Shambhala Publications. Barnett, J. E., Baker, E. K., Elman, N. S., & Schoener, G. R. (2007). In pursuit of wellness: The self-care imperative. Professional Psychology: Research and Practice, 38(6), Retrieved February 10, 2008 from the PsycINFO database. Bonanno, G. A. (2006). Is complicated grief a valid construct? Clinical Psychology: Science & Practice, 13(2), , Retrieved March 1, 2008, from the PsycINFO database. Camillieri, V. A. (2001). Therapist self-awareness: An essential tool in music therapy. The Arts in Psychotherapy, 28, Retrieved February 17, 2008 from the PsycINFO database. Capacchione, L. (2002). The creative journal (2 nd ed.). Franklin Lakes, NJ: The Career Press. Douglass, B., & Moustakas, C. (1985). Heuristic inquiry: The internal search to know. Journal of Humanistic Psychology, 25(3), Retrieved February 26, 2008 from the PsycINFO database. Etherington, K. (2004). Becoming a reflexive researcher: Using our selves in research. London: Jessica Kingsley Publishers. Fauth, J., & Williams, E. N. (2005). The in-session self-awareness of therapist-trainees: Hindering or helpful? Journal of Counseling Psychology, 52(3), Retrieved February 17, 2008 from the PsycINFO database. Filip, C. A. (1994). In focus: The value inherent in a single session of art therapy. American Journal of Art Therapy, 33(1), 4-6.

14 The Experience 14 Goodman, R. F. (2002). Art as a component of grief work with children. In N. B. Webb (Ed.), Helping bereaved children: A handbook for practitioners (2nd ed., pp ). New York, NY: Guilford Press. Hayes, J. A., & Gelso, C. J. (1991). Effects of therapist-trainees' anxiety and empathy on counter transference behavior. Journal of Clinical Psychology, 47(2), Retrieved February 17, 2008 from the PsycINFO database. Hooyman, N. R., & Kramer, B. J. (2006). Living through Loss. New York, NY: Columbia University Press. Hurd, R. C. (2004). A teenager revisits her father s death during childhood: A study in resilience and healthy mourning. Adolescence, 39(154), Ireland, M. S., & Weissman, M. A. (1999). Visions of transference and counter transference: The use of drawings in the clinical supervision of psychoanalytic practitioners. American Journal of Art Therapy, 37(2), Retrieved February 2, 2008 from Jennings, L., & Skovholt, T. M. (1999). The cognitive, emotional, and relational characteristics of master therapists. Journal of Counseling Psychology, 46(1), Retrieved February 12, 2008 from the PsycINFO database. Kirwin, K. M., & Hamrin, V. (2005). Decreasing the risk of complicated bereavement and future psychiatric disorders in children. Journal of Child and Adolescent Psychiatric Nursing, 18(2), Kramer, E., & Ulman, E. (1992). Art therapy: Further exploration of definitions. American Journal of Art therapy, 30(3), Retrieved March 1, 2008, from the PsycINFO database.

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