ATHABASCA UNIVERSITY THE EXPLORATION OF MINDFULNESS AND FLOW IN AN ART THERAPEUTIC CONTEXT RACHELA L. BUONINCONTRI. A Final Project submitted to the

Transcription

1 ATHABASCA UNIVERSITY THE EXPLORATION OF MINDFULNESS AND FLOW IN AN ART THERAPEUTIC CONTEXT BY RACHELA L. BUONINCONTRI A Final Project submitted to the Graduate Centre for Applied Psychology, Athabasca University in partial fulfillment of the requirements for the degree of MASTER OF COUNSELLING: ART THERAPY SPECIALIZATION Alberta April 2009 i

2 DEDICATION This project is dedicated to the profession of art therapy and to those individuals that believe in the power of creativity, imagination, and artistic expression to aid in healing and transformation toward subjective well-being. ii

3 COMMITTEE MEMBERS The members of this final project committee are: Name of Supervisor Dr. Paul Jerry Name of Second Reader Dr. Kenneth Barabash iii

4 ABSTRACT This project provides a comprehensive review of the literature on art therapy, mindfulness, and flow theory. An examination of the three topics in the area of philosophical, theoretical and applied basis is discussed. An art therapy manual for inducing mindfulness and flow is also included. The purpose of this project is two-fold including: (a) to examine the relationship between mindfulness and flow through a comprehensive literature review; and (b) to illustrate how such states of consciousness can be induced in an art therapeutic context. The literature review sets the foundation for the synthesis of mindfulness and flow, and also for the integration of inducing mindfulness and flow in an art therapeutic context. The manual is intended as a guideline for trained art therapists to induce states of mindfulness and flow with individual clients. iv

5 ACKNOWLEDGMENTS My academic endeavor was not only a journey into a new career but also an adventure of self-discovery, including the passage leading to self-growth, self-love, and selfacceptance. Thank you to my wonderful parents, brothers, and sister-in-laws for their faith in me to continue towards a goal and dream that has always been incredibly meaningful to me on a personal and academic level. Thank you to my beautiful nephews for always bringing a smile to my face, for making me laugh, and for giving me the opportunity to live joyfully in the moment! A special thank you goes out to all of my dear friends that have offered support and encouragement over the past few years. You have been a reliable pillar of strength. Thank you for believing in me and for believing in my dreams even at times when I gave up. To my art therapy colleagues and classmates, thank you for being an inspiration. I want to especially thank Laura Worrall for her guidance and supervision. Heather Dawson, no words can express how much you mean to me and how much I have learned from you thank you. To Carmen Richardson for your mentorship and genius creativity that is as beautiful to witness as it is to learn from. To Amy and Nalini, thank-you for being you! Your friendship means the world to me. To my practicum supervisor, Jim Haycock, thank you for believing in me and witnessing the magic in the profession of art therapy! To my supervisor, Dr. Paul Jerry, a heartfelt thanks for your wisdom, commitment, and dedication in assisting me to complete this project. v

6 TABLE OF CONTENTS DEDICATION. ABSTRACT ACKNOWLEDGEMENT ii iv v TABLE OF CONTENTS vi CHAPTER 1: INTRODUCTION... 1 Project Procedures... 4 CHAPTER 2: ART THERAPY.. 6 Philosophical Basis of Art Therapy. 6 Theoretical Basis of Art Therapy 10 Applied Basis of Art Therapy.. 20 CHAPTER 3: MINDFULNESS.. 25 Philosophical Basis of Mindfulness. 25 Theoretical Basis of Mindfulness. 28 Applied Basis of Mindfulness. 34 CHAPTER 4: FLOW 37 Philosophical Basis of Flow. 37 Theoretical Basis of Flow. 44 Applied Basis of Flow.. 55 CHAPTER 5: SYNTHESIS.. 58 References. 74 APPENDIX A: ART THERAPY PRACTICAL MANUAL 87 APPENDIX B: BETENSKY S (2001) PHENOMENOLOGICAL METHOD vi

7 CHAPTER 1: INTRODUCTION Art therapy, mindfulness, and flow have 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 a 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, and flow but little is known about these three subjects in relationship to one another. This paper proposes that flow and mindfulness are present in an art therapeutic context (Malchiodi). The profession of art therapy combines both art and therapy as a means towards healing, transformation, and change (Malchiodi, 2007). Although, the profession is in an early stage of development, it is strongly grounded in psychotherapeutic processes (Rubin, 1999). To approach therapy in this manner is to consider that healing includes the: (a) capacity for non-verbal means of expression; (b) cultivation of the mind-body connection; and (c) propensity toward self-healing. Art therapy encourages clients to look inward for answers to healing and to be open, honest, and accepting of what presents itself through creative expression (Allen, 1995). Mindfulness is a state of being and the focus is on awareness and acceptance of the present moment (Kabat-Zinn, 1990). Mindfulness is a process that supports inward introspection of the mind and body; and through practices such as meditation, a state of awakening may be attained (Kabat-Zinn). Awakening infers that there is an optimal state of consciousness that can be attained through mindfulness. To approach therapy from the mindfulness perspective proposes that awareness and acceptance of one s internal and 1

8 external surroundings are essential to conscious and healthy living. Essentially, mindfulness is focused on understanding the mechanisms of the mind and implies that attention must be given to thoughts, sensations, and feelings presented in any given moment (Kabat-Zinn). Flow has been described as a state of being while doing (Warren, 2006, p.103); it is a considered an optimal state of experience (Csikszentmihalyi, 1990). This state of optimal experience or flow is characterized by the complete absorption and focus of attention on the activity at hand (Schmidt, Shernoff, & Csikszentmihalyi, 2007). When individuals experience flow their perception of time becomes warped and they perceive the experience as pleasurable and enjoyable (Csikszentmihalyi). Proponents of flow theory state that by focusing one s attention on an activity for its own sake, subjective well-being and an expanded sense of self is obtained (Csikszentmihalyi). After a flow experience, individuals describe feeling a sense of accomplishment and increased selfesteem (Csikszentmihalyi). The concept of flow falls under the umbrella of positive psychology where the strength of human capacity is of focus and where research is centered on ascertaining what leads to happiness or subjective well-being (Nakamura & Csikszentmihalyi, 2002). There are currently several branches of research that describe the relationship between mindfulness and flow. One branch of research sees mindfulness and flow as conceptually similar states of consciousness (e.g., Budilovsky & Adamson, 2002). Another branch supports the notion that mindfulness and flow share some similar characteristics or elements but consider them to be distinctive processes (e.g., Gutman & Schindler, 2007). A third branch proposes that the two states are in symbiotic relationship 2

9 to one another whereby, the propensity to be in a mindfulness state also increases one s flow state (e.g., Germer, Siegel, & Fulton, 2005; Kee & Wang, 2008). Clearly our understanding of mindfulness and flow, and their relationship to one another in a psychotherapeutic context requires clarification. Researchers propose that interventions must be created in order to induce states of mindfulness and flow (Germer et al., 2005; Warren, 2006); art therapy may be a viable discipline (Malchiodi, 2007; Warren). Art therapy may serve as a bridge or a means for creating flow and mindfulness in a therapeutic setting (Malchiodi; Warren). For example, Warren (2006) proposed that art therapy is a natural approach to facilitating a flow experience. Art therapy offers the client the opportunity to be completely focused and absorbed in art-making. To understand the relationship between flow and mindfulness has important implications not only for art therapy, but for counselling in general and the profession of psychology as a whole. If such states of being and doing reflect healthy practices for living, then they require further examination and analysis. This paper investigates the processes of art therapy, mindfulness, and flow and synthesizes information regarding their interrelationship with one another. The goal of the paper is to increase understanding of the processes of art therapy, mindfulness, and flow, on their own, combined, and within the context of psychotherapeutic practice. The paper is oriented toward informing psychotherapeutic practice, specifically art therapy practice, and to facilitate future research in this area. In this paper, a chapter is devoted to each term art therapy, mindfulness, and flow. It is evident from the literature on art therapy, mindfulness, and flow that there are many similarities philosophically, theoretically, and within an applied context. Each 3

10 chapter begins with a thorough understanding of the philosophical basis of the term as it sets the foundation for comprehending: (a) the historical tone for which the term was intended; and (b) explaining the initial use and basis for the term in a psychological context. Second, the theoretical basis of each term will be reviewed, specifically, the psychological mechanisms, processes, or characteristics deemed important in effecting change. Third, the applied basis of each term will be evaluated such that an understanding on how to induce such a state can be attained. After a comprehensive review of each term, comparison and synthesis of the terms will be discussed in the fifth chapter of this paper. This paper ends with a manual (see Appendix A) on how to induce mindfulness and flow in an art therapeutic context. The manual includes a description of mindfulness states and flow. The manual is intended to assist art therapists to induce a state of mindfulness and flow with clients through specific art therapy interventions in order to increase subjective well-being. Project Procedures In development of the comprehensive review, current available information on art therapy, mindfulness, and flow was found through searching library collections and appropriate databases. Such databases included PsycINFO, PsycArticles, and MEDLINE via the Athabasca University Library and the University of Calgary Library. Various books were 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 included mindfulness, meditation, flow, optimal experience, art therapy, creativity, and psychotherapy. Further, 4

11 the reference lists of studies retrieved in the initial search were reviewed, and relevant publications were selected. In order to create the practical application component of this paper, the art therapy manual is based on information gathered from the comprehensive review. Underlying the manual is information outlining the theoretical and conceptual basis of mindfulness states and flow, and information on the importance of inducing such states of consciousness in an art therapeutic context. In addition, art therapy-based interventions for inducing mindfulness states and flow are suggested. 5

12 CHAPTER 2: ART THERAPY Philosophical Basis of Art Therapy Art Therapy There are many events, circumstances, and influential people that have set the foundation for the development of art therapy. Art therapy is an evolving field that has been influenced by: (a) related fields such as art, art history, psychology, psychiatry, and anthropology; (b) unique historical events in the twentieth century; and (c) pioneers that advanced the development and movement of the field (Malchiodi, 2007). The following section describes how art therapy advanced over time. Development of Art Therapy Throughout history humans have created art for several different reasons including as a form of communication, symbolic expression, healing ritual, worship, magic, to relieve physical and psychological pain, and as a form of protection to ward off evil (Edwards, 2004; Malchiodi, 2007). Art has been documented since about 20,000 B.C. or as early as the Stone Age period whereby art was considered a natural instinct such as language is today (Malchiodi, p. 23). Caves were marked with images and symbols believed to serve as a form of symbolic communication. There is proof through art that humanity has a strong bond through the language of visual art (Malchiodi). The view of art over centuries may be an indication of the purposefulness of art and why it is viewed as therapeutic (Malchiodi; McNiff, 1981). There are similarities in the way art was viewed in ancient times and how it is viewed today in contemporary cultures (Malchiodi; McNiff; Rubin, 1999; Wadeson, 1980). According to McNiff Today s art therapists are practicing one of the most ancient forms of healing (p. 5). 6

13 In the early twentieth century, art therapy advanced due to: (a) popularity gained by psychoanalysis; (b) interest in symbolic and spontaneous images; and (c) psychiatry s fascination with the art produced by those suffering from mental illnesses (Malchiodi, 2007). During this period there was movement toward understanding the human psyche, particularly the unconscious (Douglas, 2005). Psychoanalysis gained popularity as Sigmund Freud s and Carl Jung s work linking the psyche and visual expression progressed (Arlow, 2005; Douglas; Malchiodi). Freud (as cited in Edwards, 2004) posited that the unconscious played a significant role in neurosis, dreams, and the art work of his patients. He discovered early on with his patients that their communication was actually a description of visual images (as cited in Rubin, 1999). He recognized that dreams could be linked to the unconscious and further expressed visually by his clients but not verbally (as cited by Wadeson, 1980). In addition to his recognition of the unconscious and visual expression, Freud also proposed that individuals engaging in creative and imaginative processes were denouncing reality (as cited in Edwards). Although Freud inspired others to see the connection between art expression and the inner psyche, he favored reason and intellect over the intuitive, creative, imaginative, and artistic aspects of psychological life and was more interested in free association and verbal therapy (as cited in Rubin). Carl Jung (as cited in Edwards, 2004) on the other hand, believed that the arts were a way to reveal the unconscious. Jung encouraged his patients to express themselves through art analysis to gain awareness of their emotions thereby leading to well-being and positive change (as cited in Douglas, 2005). Jung was intrigued with the art expression of his patients and throughout his career he explored his own inner psyche 7

14 through artistic expression, especially during times of personal crisis (as cited in Edwards, 2001). Carl Jung s work influenced other professionals including Hanz Prinzhorn. Prinzhorn was a psychiatrist in the 1920s that was intrigued with the creative process and artistic expression of mentally ill patients (as cited in Hinz, 2006). He collected over five thousand art pieces from patients throughout Europe for his research. Prinzhorn (as cited in Malchiodi, 2007) believed that humans have a universal creative urge or drive towards personal expression and communication that is basic to all people, with or without mental illness and that art was a natural way to achieve psychological integration and wellness (p. 27). Art Therapy Pioneers Art expression developed as a therapeutic modality with the efforts of pioneers such as Edith Kramer and Margaret Naumburg (as cited in Wadeson, 1980). Both women predicate their theories based on psychoanalytical theory and the belief that art expression allows for unconscious material to be revealed (as cited in Rubin, 1999). By mid-century, when Naumburg s and Kramer s work flourished there was a rising belief that art making and the creative process could be a transformative and a rehabilitative force leading to change and growth in clients (as cited in Malchiodi, 2007). Art focused on the subjective reality and self-expression of the artists rather than on their external environment (as cited in Edwards, 2004). Margaret Naumburg was the founder of the Walden School in New York and has been credited with introducing art as a therapeutic modality in the 1940s (Peterson, 2006; Rubin, 1999). She was one of the first to delineate art therapy as a distinctive form of 8

15 psychotherapy (Malchiodi, 2007, p. 36), whereas, Kramer in the 1950s emphasized art as therapy rather than as a tool in psychotherapy (Malchiodi). Kramer (2002) emphasized the client s purpose to express inner truth through their art (p. 222). She encouraged her clients to express their authentic self and allow for genuine and truthful expression through the art work in moving toward an integrated and reconciled emotional state (Kramer, 2002). Naumburg (as cited in Rubin, 1999) emphasized psychoanalytical techniques like free association and transference in art therapy to obtain client change. In summary, Naumburg posited the use of art in therapy and Kramer advocated art as therapy. The distinction is significant in understanding the theoretical and practical use of art therapy today; art therapy has been developed along these two streams of thought (Waller, 1993). Art Therapy Today Art therapy is practiced all over the world in a variety of settings (Peterson, 2006; Stoll, 2005). It is being applied in mental health agencies, nursing homes, drug and alcohol addiction centers, prisons, schools, hospitals, private practice, open studios, halfway houses, wellness centers, corporate settings, outreach programs, and rehabilitative centers for developmentally and physically challenged individuals (Malchiodi, 2007; Peterson). Art therapists work with individuals, couples, families, groups, communities, and may also be found working in settings as part of a clinical team (Malchiodi; Peterson). Art therapy s use is not limited to specific populations or age groups (Malchiodi). Art therapists around the world have unique standards for practicing as a professional (Stoll, 2005). For example, art therapists may be found working as 9

16 psychologists, social workers, educators, occupational therapists, and nurses (Stoll). There is a desire to establish universally recognized academic programs and professional standards of practice (Stoll). It is uncertain whether the profession will be restricted to licensed art therapists in the future (McNiff, 1997). As a result of the diversity in practice and in educational standards, art therapy has developed from one-nation to the next according to social, economic, and cultural circumstances (Stoll). Yet, the power of art therapy is undeniable throughout the world and for this reason continues to expand and grow as a profession (McNiff; Stoll). Theoretical Basis of Art Therapy Art Therapy Defined According to the Canadian Art Therapy Association (CATA, n.d.) and the American Art Therapy Association (AATA, 2009), art therapy is a mental health profession that combines the intentional use of art as a therapeutic intervention to enhance the well-being of individuals on a physical, emotional and mental level. 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, 2007). The creative expression helps individuals to increase self-awareness and autonomy, problem-solve, regulate emotions, expand interpersonal skills, and reduce stress (AATA). The art materials and application is the main form of communication, however, verbal and non-verbal means of expression are encouraged as well (Kahn, 1999). The art creation and expression are at the core of art therapy practice (Malchiodi). The above definition is not universally accepted (Stoll, 2005). Operationally defining art therapy has been a problem for a number of different reasons (Stoll; Ulman, 10

17 2001). One, art therapy is used in diverse practices such as rehabilitation, education, nursing, social work, and psychotherapy, and practice standards are based on the needs of the organization (Stoll; Ulman). Second, art therapists have differing views and theories on what art therapy is (Ulman). Third, the profession is young and evolving (Stoll). Possibly the only point of agreement in defining art therapy by professionals is that the visual arts are used in some attempt to assist integration or reintegration of personality (Ulman, para 2). Art therapy is a unique form of psychotherapy that is more than the sum of its parts (Betensky, 1995). Although many diverse practitioners are incorporating art in therapy, this is not art therapy. Art therapy requires specialized training in the art therapy process that is beyond the training required for counselors, psychologists, social workers, and nurses (Heywood, 2003; Rubin, 1999). There are two general categories by which art therapists define art therapy; one definition is based on the art making process, and the other on the art product (Malchiodi, 2007). Art as therapy emphasizes the importance of the art-making process and the inherent healing power of creative expression. This view proposes that art-making is healing and transformative on its own. McNiff (1992) writes about art making as medicine and refers to it as a form of depth psychology whereby the psyche is deeply explored. Such exploration and art creation leads to healing. There are several authors that have created art to heal from illness or life difficulties (e.g., Coupar, 1992; Swados, 2005). The second definition of art therapy is called art psychotherapy; it emphasizes the therapeutic process including the art product and its symbolic communication (Malchiodi, 2002; Rubin, 1999). The final art product becomes significant in not only enhancing communication between the client and therapist but also in allowing the client 11

18 to express her issues, concerns, conflicts, and emotions via the art product (Malchiodi, 2007). Some art therapists base their work on one or a combination of both of these definitions (Malchiodi, 2007). Efficacy of Art Therapy Despite the fact that art therapy has been evolving for several decades, the efficacy of art therapy has been largely unevaluated (Gabriel et al., 2001). Only very recently has the effectiveness of art therapy been investigated empirically through scientific study and quantitative research (Eaton, Doherty, & Widrick, 2007; Saunders & Saunders, 2007). Earlier studies reviewing the efficacy of art therapy were based on case studies and qualitative reports (Reynolds, Nabors, & Quinlan, 2000; Saunders & Saunders). The lack of empirical research in art therapy may be attributed to art therapists not receiving formal training in conducting experimental research (Tibbets, 1995). Another problem is in deciding what aspect art therapy should be studied (Gantt, 1998). The interest in research ranges from how, what, why and what effect (Gantt, para 4). Some questions that require further research include: How do people draw? Why do people draw? What effect does art making have on one s psychological or physical well-being? Where does symbolic content come from? (Gantt). Although there are difficulties in gaining empirical evidence for the efficacy of art therapy, research in this area is expanding (Eaton et al., 2007). Several pilot studies have been conducted to determine the usefulness of art therapy in improving psychological well-being in the treatment of patients suffering from depression (e.g., Bar-Sela et al., 2007); chemical dependency (e.g., Dickman, Dunn, & Wolf, 1996); grief and loss (e.g., Graham & Suntag, 2001); posttraumatic stress disorder 12

19 (e.g., Lyshak-Stetzler, Singer, St. John, et al., 2007); and trauma (e.g., Eaton et al., 2007). These studies found support for art therapy as an effective intervention. It is imperative that further empirical research be performed in examining the efficacy of art therapy. Art therapy is not only an enjoyable means for gaining therapeutic insight; also, many studies propose that art therapy is effective in improving health and well-being (Saunders & Saunders, 2007). Several quantitative studies in art therapy have investigated the behavioural or attitudinal changes of clients involved in art therapy (Brooke, 1995; Rosal, 1993; Saunders & Saunders). Most studies evaluated an outcome measure before and after the use of art therapy concluding that there were significant improvements in the outcome measure (e.g., Harvey, 1989; Saunders & Saunders). For example, Saunders and Saunders (2007) completed a quantitative study reviewing the effectiveness of an art therapy program with children struggling with behavioural and attitudinal concerns such as aggression, depression, alcohol/drug abuse, and self-esteem. The study found that the art therapy program had a significantly positive impact on all 94 children in the program. The behavioural ratings decreased significantly in severity and frequency after the art therapy intervention. For example, hyperactivity, poor concentration, poor motivation, fighting and other behaviours were found to decrease in severity and frequency as compared to the participants intake scores. The limitation of art therapy research is that the majority of studies lack a control group (Reynolds et al., 2000). Scholars recommend that additional studies in assessing the effectiveness of art therapy be conducted (Reynolds et al.). Art therapists are determining the best way to conduct empirical research on a field of study that bridges art and therapy, while taking into consideration the complexity of mind and body 13

20 proponents, such as creativity and artistic expression as personal and unique attributes of the individual. Mechanisms of Art Therapy Scholars are interested in understanding how and why art therapy works. What mechanisms, factors, or processes contribute to its effectiveness? What benefits and therapeutic value does art therapy provide? Art therapists recognize the transformative power of art therapy and subscribe to a number of different beliefs about how art therapy influences health and well being. Some art therapists argue for the importance of: (a) psychoanalytical processes (Rubin, 1999; Ulman, 2001); (b) creative and imaginative processes (London, 1989; McNiff, 1981; Csikszentmihalyi, 1996); (c) authentic expression or self-awareness gained from art making (Allen, 1995); and (d) phenomenological perspective (Betensky, 1995, 2001; Knill, Levine, & Levine, 2004). Aside from such diverse beliefs, since art therapy emerged directly from two movements: (a) psychoanalysis s belief that images are representations of the unconscious; and (b) belief that art-making and the creative process have therapeutic value, these primary mechanisms will be reviewed in this section (Malchiodi, 2007). Specifically, the unconscious, creativity, and imagination will be discussed in the context of art therapy practice. The unconscious. Psychoanalysis is based on the theory that the human psyche is composed of conscious and unconscious elements (Arlow, 2005; Edwards, 2004). Through psychoanalytical processes, the inner world or that which remains unconscious is revealed which leads to the integration of the psyche (Arlow; Edwards). 14

21 Psychoanalysis has played a role in the development of art therapy and offers both a theory and method for understanding the processes of art therapy (Edwards). From a psychoanalytical perspective, art therapy is concerned with gaining access into the inner world of the individual and relating such processes to the external world (Edwards, 2004). Self-understanding is gained by externalizing and exposing internal processes through art-making (Edwards; Malchiodi, 2007). According to psychoanalysis, the unconscious reveals itself in a number of different ways through art expression including by: (a) free association; (b) symbolic communication; and (c) metaphors (Malchiodi). Free association is the free flow of thoughts that are expressed without censorship, criticism, or disparagement; the client expresses his truth (Arlow, 2005). Freud developed this concept as a way of clinically working with his clients to uncover the unconscious process and understand human behaviour (Arlow; Malchiodi, 2007). Free association is seen in art therapy through spontaneous or free drawings (Malchiodi). It is believed that when a client expresses himself freely that the art expression is a manifestation of unconscious workings. The image or art creation increases selfunderstanding when explored through free association with an art therapist (Malchiodi). Through art making the unconscious reveals itself through symbolic communication (Malchiodi, 2002). It is believed that the unconscious is projected in visual form and expresses the client s fears, dreams, and fantasies (Malchiodi, 2002). The image becomes a form of symbolic communication from unconscious processes. Selfawareness increases when unconscious components of the psyche become available through creative work (Kramer, 2001). The final art product becomes significant in not 15

22 only enhancing communication between the client and therapist, but also in serving as an external object to allow the client to discuss his problems, feelings and thoughts via the art product (Malchiodi, 2007). A metaphor is a figure of speech used to imply that the properties or qualities possessed by one thing are like those belonging to something else (Edwards, 2004, p. 61). In art therapy a metaphor is used the same way as it is used verbally to evoke an idea or emotion beyond the specific object depicted (Edwards, p. 61). Metaphors assist in communicating a message that may be difficult to articulate. In addition, metaphors have the potential to expand expression and also create an opportunity for viewing something in a new and novel way. In art therapy a client draws a picture that is figuratively an expression of her state of mind and is depicted through the image metaphorically (Edwards). Art therapists pay attention to the client s expression and thoughts about the metaphorical image looking for opportunities to expand awareness (Edwards). Through psychoanalytical theory an understanding of the processes in art therapy are apparent. In addition to the benefits of exposing the unconscious through free association, symbolic communication, and metaphors, other secondary processes may also occur during art therapy such as: (a) cathartic release; (b) self-expression; and (c) positive physiological responses. Catharsis is the emotional release that comes from the expulsion and expression of strong emotions (Malchiodi, 2007). The art acts as a container for difficult emotions and sensations. The art-making process becomes a form of self expression whereby the art gives the emotions a cognitive-linguistic voice (Malchiodi, 2007). In addition, art therapy has an influence on the mind-body connection 16

23 whereby a relaxed physiological response can be experienced (Malchiodi, 2005). Art therapy can engage the body s relaxation response further encouraging emotional stability, reducing stress and anxiety, and improving the therapeutic alliance (Malchiodi, 2003). Studies show that art making may act as a form of meditation that also has a positive effect on reducing stress and anxiety (Malchiodi, 2007). Many studies have been conducted to support psychoanalytical processes in therapeutic practice (Arlow, 2005). Yet, little research has reviewed such processes in an art therapeutic context. From psychoanalysis, art therapy gains a theory and a model for practice (Edwards, 2004). Psychoanalytical mechanisms such as free association, symbolic communication, metaphors, self-expression, catharsis, and physiological response of the mind and body offer an understanding for how and why art therapy works. Many art therapists follow psychoanalytical theory to guide their art therapy practice, thereby recognizing the psychoanalytical mechanisms that play a role in its function (Edwards). Creativity. Creativity is defined as the ability to generate a novel idea or product into existence (Malchiodi, 2007). A creative individual has qualities and characteristics that may include: spontaneity, playfulness, imagination, motivation, originality, selfexpression, inventiveness, divergent thinking, and intuition (Malchiodi, p. 65). Researchers propose that a creative individual possess the ability to be autonomous, flexible, self-accepting, assertive, resourceful, persistent, and nonconforming (Ivcevic & Mayer, 2006). Self-expression plays a significant role in everyday creativity (Ivcevic & Mayer). Researchers propose that creativity and imagination have therapeutic value and lead to healthy approaches to living (London, 1989; Peterson & Seligman, 2004). An 17

24 important factor in art therapy is to allow a client to increase her creative potential and to enter into a state of using her imagination to improve health and well-being (Malchiodi). Art therapy cultivates an environment for creativity to occur. Allowing a client to focus her energy and attention on creativity enables her to tap into new ways of thinking and being in the world (Csikszentmihalyi, 1997; London). Art therapy honors creativity and encourages original thinking. The interest in creativity is growing within the field of psychology (Peterson & Seligman, 2004; Simington, 2000). Creativity is seen as a sign of positive mental health and optimal functioning (Simington). Cognitive, clinical, personality, and developmental psychologies are interested in understanding creativity in the context of their theoretical orientations (Peterson & Seligman). For example, personality psychologists are interested in understanding personal characteristics, morals, values, and traits related to creativity (Peterson & Seligman). In addition, clinical psychologists are moving towards understanding creativity as an intervention modality, such as applying art therapy in clinical treatments (Peterson & Seligman). According to Peterson and Seligman (2004), there are a number of character strengths and virtues that are important in the classification system of positive psychology. Such strengths are meaningful in leading a good life. One such character strength is creativity. Creativity falls under the following criteria in positive psychology s classification system noting that creativity is: (a) fulfilling, (b) morally valued, and (c) not diminishing of others (Peterson & Seligman). One, creativity is fulfilling and most people enjoy making art. The creative act itself is intrinsically motivating whereby the individual finds personal satisfaction in the act itself. Second, creativity is morally valued 18

25 whereby the art creation can elicit purpose, beauty, and expression into the world. People s creative expressions are encouraged, without creativity the development and expansion of civilization would cease. For example, lights, cars, computers, and airplanes are all creative accomplishments that have expanded our human existence. Third, creativity does not diminish others; in fact, it may inspire and encourage others to be creative as well. Creativity is seen as a positive sign of subjective well-being and mental health (Peterson & Seligman). Hence, creative therapies such as art and music therapy have emerged to promote psychological adjustment and growth through creative expression (Peterson & Seligman, p. 96). Art making as a creative process allows an individual to express himself imaginatively; over time transformation and reparation in personality formation occurs (Malchiodi, 2007). The art product can facilitate new understanding to the problem, and bring new perceptions and insights leading to growth, healing, and positive changes (Malchiodi). Imagination. Creativity allows individuals to access their greatest resource the imagination (Allen, 1995, p. 3). Imagination permits an individual to access opportunities, choice, and potential (Allen). Fostering a relationship with one s imagination is a chance to develop a relationship with our deepest self (Allen, p. 3). Art therapy provides access into the imagination, encouraging an individual to intimately know himself while doing so in a manner that enables him to see past patterns and problems that have held him back (Allen). According to Knill, Levine, and Levine (2004), de-centering is about moving away from the thought patterns or rigid thinking that emerges during problem solving; to 19

26 focus or move away from the problem at hand and move into a liminal space of the imagination. In art therapy the client is able to open up to an alternative experience of the world through art making and perhaps even play. By externalizing inner processes through art making, the client is able to gain distance from the problem or concern and detach from the experience and approach it from a novel view (Knill et al., 2004). Silence serves this function by replacing verbal expression with the act of doing and participating actively in life. The mechanisms associated with psychoanalysis, creativity and imagination are potential advocates for establishing how art therapy works and for extrapolating the essential therapeutic factors for its effectiveness. Art therapy utilizes internal sources of the psyche by revealing unconscious processes and increasing self-awareness (Allen, 1995; Arlow, 2005; Edwards, 2004; Malchiodi, 2002, 2007). Creativity and imagination foster new ways of thinking and being in the world allowing clients to think, feel, and participate in life fully (Csikszentmihalyi, 1996; Knill et al., 2004; London, 1989; Peterson & Seligman, 2004). Although there is limited research on the mechanisms of art therapy, the theories that researchers and art therapists propose are vast, and with further research will continue to establish the profession of art therapy. Applied Basis of Art Therapy Art Supplies The art therapist supplies art materials including paper, oil pastels, chalk pastels, pencils, felt markers, paint, scissors, glue, magazines or other collage materials, glitter, clay, notebook for writing, and other supplies as needed (Hogan, 2001; Malchiodi, 2007). The art materials range from being fluid to resistant; diverse materials elicit different 20

27 emotional responses (Peterson, 2006; Malchiodi). The materials are assorted to provide clients with an array of products to engage their senses and to encourage creative expression (Hogan). Directive versus Nondirective Approach Art therapy utilizes two main approaches to art-making: (a) directive; and (b) nondirective (Malchiodi, 2007). A directive approach includes instruction from the art therapist to create art according to a specific theme (Malchiodi). Some examples of directives include drawing: (a) your family as trees in the forest; (b) an emotional landscape; and (c) a self-portrait. A nondirective approach is also called a free or spontaneous drawing whereby the client receives no direction from the art therapist (Malchiodi). Although both types elicit personal expression, directives elicit a particular art outcome and goal from the client whereas free drawings are spontaneous. Art therapists will choose to be directive or nondirective based on the needs and responses of the client (Malchiodi). Attitudinal Characteristics In art therapy there are attitudinal characteristics in the client that must be nurtured in order to support the process. Characteristics that contribute to the effectiveness of art therapy include a permissive attitude, non-judgment, openness to new experiences, letting go of self-criticism, acceptance of the process and art work, and intention and commitment (Malchiodi, 2007). The art therapist is responsible for creating a therapeutic space and alliance conducive to including such attitudinal characteristics. Therapeutic Space 21

28 Edwards (2004) writes about the boundary or physical space required for art therapy. The art space serves a function and includes specific rules. It is a temporary space dedicated to the expression of the imaginative and creative inner world (Edwards, 2004; Knill et al., 2004). Further, the space serves to differentiate between external reality and internal symbolic expression (Edwards). The physical conditions that must be present include a clear and consistent approach to offering the client art materials, encouraging their use, facilitating selfexpression, and reflecting upon the final art product, if the client agrees to do so (Rubin, 1999). Safety in therapy means that the client has the option to discuss the meaning of her art product or sit with the image (Malchiodi, 2007; Rubin). The therapist is respectful of the client s decision and creates a space that allows the client to feel safe and secure (Rubin). Respecting the client s art is a means for respecting the client and allowing her to express her self authentically. In art therapy, the first step is to create the environment and then to focus on evoking expression (Rubin, 1999). The client is given the freedom to express her self creatively. The client is also given the opportunity to find catharsis in the process of art making as well as reflect on how it felt to create art and express ideas, feelings, concerns through the final art product (Rubin). The challenge that art therapists face is to find the best approach to help a client understand her self through the art in a way that is meaningful (Rubin, 1999). This can be done verbally or non-verbally through diverse means such as talking about what appears aesthetically in the image, creative writing, poetry, drama, using metaphors or symbolic speech, and free association discussing whatever the image evokes for the client (Rubin). 22

29 Meaning may also be evoked nonverbally by viewing the image and allowing its expression to be present; the art therapist acts as a witness to the art process and product (Rubin). Therapeutic Alliance The therapeutic process in art therapy involves a triangular relationship between the client, art therapist, and the artwork (Edwards, 2004). The therapist s presence is meaningful in art therapy as he serves as a witness to the art making process and to the final art product (Edwards). In verbal therapy, the client and therapist solely contribute to the therapeutic alliance; however, in art therapy the artwork adds a third component. The dynamic interaction requires that the art therapist play an active role in deciphering when to interact with the client and when to permit the art-making process to be the focal point in the therapeutic process (Edwards). To Process or Not to Process Art therapy contains several dimensions for learning and self-discovery which may include processing the final art product or solely witnessing the artwork (Malchiodi, 2007). Meaning can be found in processing the final art product with the therapist or through other means such as journal writing, poetry, drama or sharing with others. To process the final product further or to solely witness the final art product is the client s choice. The following are examples of questions an art therapist may ask a client in order to process the final art product: What was the art-making process like for you? What comes to mind when you look at the art piece? What stands out? Tell me about the art piece. List five words that come to mind when looking at the art piece. What title do you 23

30 give the art piece? Are there any changes you would make to the art piece? There are several ways an art therapist can process the art product with a client, but what is most important is to help the client find meaning through creative expression. Conclusion Positive attributes of art therapy include that it can be: (a) an enjoyable approach to therapy; (b) utilized with diverse individuals, couples, and group settings; and (c) used for different client concerns and issues (Malchiodi, 2007). Art therapy serves a number of different functions but has one primary goal. This goal is fostering a movement toward psychological well-being (Malchiodi). Art therapy empowers clients to gain selfawareness of their thoughts, feelings, sensations, and to understand their life circumstances through the art-making process (Malchiodi). Art therapy is a phenomenological approach to self-discovery (Betensky, 1995, 2001). Such personal understanding leads to the ability to self-support, self-regulate, self-sustain, and heal through awareness (Johnson, 1998). 24

31 CHAPTER 3: MINDFULNESS Philosophical Basis of Mindfulness Mindfulness Defined Mindfulness is a quality of presence that requires gentleness and acceptance (Bien & Bien, 2003). It entails the capacity to live life in the present moment with the ability to do so freely without attachment, judgment, reservation, or analysis and with a willingness and intention to accept life here and now (Bien & Bien; Bishop, 2002; Brown & Ryan, 2003; Kabat-Zinn, 1990). There are many misconceptions about what mindfulness is, to clarify, mindfulness is not a relaxation technique, positive thinking, a trance state, or an approach to avoiding difficulty (Brantley, 2007). The following section will explore the philosophical basis of mindfulness including: (a) the historical basis of the mindfulness in Buddhist philosophy, and (b) a philosophical description of the term. Historical Basis of Mindfulness Mindfulness originated 2,500 years ago from the teachings of the Eastern philosophy, Buddhism (Gowans, 2003). The story begins with a Prince named Siddhartha Gautama who lived in India; he later became known as Buddha, the enlightened one (Gowans). The literature states that Siddhartha was shielded from the outside world as he lived secluded within the palace gates. However, Siddhartha made his way out of the palace and into the real world; for the first time he witnessed sickness, old age, and death. Deeply disturbed by the suffering in the world, Siddhartha left his wife, son, and the comfort of the palace gates to search for understanding of and liberation from human suffering (Gowans). Undertaking several diverse practices and following various teachers, Siddhartha discovered that by quieting the mind, inner peace and enlightenment 25

32 could be attained (Gowans). Buddha spent much time meditating and spoke of such a state of mindfulness as being Awake (Kabat-Zinn, 2005). Awakening is considered an optimal state of experience that includes deep awareness of the present moment (Kabat- Zinn; Shapiro et al., 2006). Buddha was candidly an historical man that investigated his own mind and the mind s working in understanding human suffering (Kabat-Zinn). Buddha believed that suffering was an inevitable part of life. He educated people about his view of suffering and spoke of the cessation of suffering by focusing the mind through meditation and by awakening to life (Gowans, 2003; Kabat-Zinn, 2005). Buddha taught people that the potential for inner peace and well-being is linked to mindfulness and by approaching life with a compassionate heart (Gowans). At the centre of mindfulness teaching is an approach to being fully present in the world. Buddha s teachings are found in the Four Noble Truths and the Noble Eightfold Path (see Gowans). Mindfulness as a State of Being Mindfulness is a difficult term to comprehend because it describes not only a practice but a way of being (Kabat-Zinn, 1990). Mindfulness is not a state of achievement or a goal to be realized; it is a compassionate state of being that requires one to look inward towards his heart s intrinsic capacity. Intrinsic qualities such as affection, compassion, openness, and kindness are required (Kabat-Zinn, 1990). Mindfulness is not about changing who we are but about accepting and acknowledging who we are (Kabat- Zinn, 1990). In essence, mindfulness is not a prescription on how to live life, but on how to approach life and be fully engaged in life, as we are (Kabat-Zinn, 2005). Mindfulness is based on the belief that the wandering mind is the source of human suffering (Kabat-Zinn, 1990, 2005). According to Wallace and Shapiro (2007) all 26

33 individuals are prone to cognitive imbalances that stem from the wandering mind; such imbalances include: (a) cognitive deficit or absentmindedness; (b) cognitive hyperactivity, whereby the mind is overactive and prone to misconceptions and assumptions; and (c) cognitive dysfunction or misapprehension of circumstances. Central to mindfulness practice is to overcome cognitive imbalance (Wallace & Shapiro). Mindfulness is about attending to what the mind is doing, and through stillness one may lead her life with intention and awareness (Kabat-Zinn, 1990). According to Kabat-Zinn (2005) In awakening, we free ourselves from the suffering and anguish that come from mis-taking the nature of reality (p. 129). Awakening is about bringing awareness to the cognitive imbalances that shadow our daily life. Mindfulness has been described as psychological freedom and as emancipation from one s own habitual view of self and the world (Martin, 1997, p. 293). In short, mindfulness is about stepping back from the incessant workings of the mind and instead cultivating a conscious and objective approach to living that is focused on the here and now (Kabat- Zinn, 1990). Mindfulness Today Historically, mindfulness is based in Buddhist teachings and the experiences of the Buddha s understanding of human suffering. Today the term offers additional views as related to health and well-being and serves as a complement to treating illness (Kabat- Zinn, 1990, 2005). People today commonly suffer from stress, overexertion, depression, anxiety, and other physical and psychological illnesses that are prominent in our fastpaced world (Kabat-Zinn, 1990). Our thoughts are clouded, our lives are overrun with things to do; this is an unhealthy and unproductive approach to living (Kabat-Zinn, 27