Art Therapy. Cultivating self-awareness in children diagnosed with Autism Spectrum Disorder. By Janis Dochterman MA, LPCC, RYT

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1 Art Therapy Cultivating self-awareness in children diagnosed with Autism Spectrum Disorder By Janis Dochterman MA, LPCC, RYT

2 Topic How to cultivate self awareness in children coping with Autism Spectrum Disorder (ASD) using mindfulness based and developmentally informed treatment interventions focusing on breath, body, integration, and expression.

3 Origin of Interest Children diagnosed with Autism Spectrum Disorder: Ø Ø Ø Neurodevelopmental Disorder, Triad of impairment Constant stress from external and internal stimuli = Flight or Freeze Symptoms: easily triggered, impulsive emotional response, disconnection to present experience, lack of self-awareness Current work with 5-year-old Caucasian male, ASD Ø Ø Lack of self-regulation during transitions Stuggle with connecting to own breath, body, movement, expression of emotions

4 Definitions Art Therapy, Developmental Perspective, Transpersonal Approach

5 Art Therapy and ASD Art as Therapy, Relationship between client, therapist and art (Kramer, 2000) Developmental Art Therapy, Art as Assessment (Rubin, 2001) Ø Sensorimotor Phase (ages 0-2), Foster attachment, differentiation of self, other, object Ø Preoperational Phase (ages 2-7), Promote automony, expression, and symbolization Art as non-verbal means of communication (Malchiodi, 2012) Martin, 2009 Early childhood intervention, elastic brain Merge of Strengths (visual learners, sensory interests) and Deficits (imagination, need for sensory control) Art making as outlet for perseverative and self-stimulatory behaviors Art as rehabilitation

6 Developmental Perspective Neurosequential Model of Theraputics (NMT) by Bruce Perry (2008) Ø Neurobiological-informed, developmentally sensitive approach Order in which symptoms are addressed should replicate the normal sequential process of development Match the nature and timing of techniques with developmental stage, brain region, and neural networks causing the neuropsychiatric problem Organizes Bottom-to-Top (Perry, 2006): Ø Begin with brain stem, develops in first four years of life Ø Respiration, self-regulation, attention, arousal, and impulsivity Challenges shaped over a long period, with repetition Implement patterned, repetitive somatosensory sequence including breathing, movement, yoga, music, massage, and art Provide brain with neural activation necessary for re-organization.

7 Transpersonal Approach An evolving being, fellow seeker Whole being versus only behavioral perspective Intention guides treatment focus Mindfulness practice of therapist Mindfulness based interventions Expressive Arts Breath and Body awareness

8 Facilitation Breath Body Integration Feeling Tone Sessions #1-9

9 Sequence 50 minute therapy session, Begin session #9 Parent check in/ritual opening (5 Min) Free play (5 min) Breath Awareness (6 min) Body Awareness (6 min) Bibliotherapy: Mindful Monkey, Happy Panda (6 min) Feeling tone awareness (6 min) Art Intervention (11 min) Parent check-out/ritual closing (5 min)

10 Treatment Plan Eight individual sessions Segment of sequence paired with art therapy intervention Each session builds on previous session Ninth session and beyond facilitate sequence as whole Each session begins with parent check-in and opening ritual (i.e. play) Each session ends with parent check-out and closing ritual (i.e. pick jewels)

11 Breath Awareness Sessions #1-2 Session #1: Ø Listening to your breath Ø Symbol of breath Session #2: Ø Belly breathing with stuffed animal Ø Symbol of breath movement

12 Body Awareness Sessions #3-4 Session #3: Ø Finding connection with ground Ø Symbol of body/ground connection Session #4 Ø Union of movement and breath (yoga) Ø Symbol of movement and breath

13 Session #5 Integration Session #5-6 Ø Bibliotherapy: Mindful Monkey, Happy Panda by Lauren Alderfer Ø Art materials and the five senses Session #6 Ø Moving Meditation Ø Dyadic Drawing

14 Feeling Tone Awareness Session #7-8 Session #7 Ø Identifying a feeling following a external sensation Ø Symbol of feeling tone Session #8 Ø Identifying a feeling following a internal sensation Ø Symbol of bodily sensation

15 Sequence Session #9+ 50 minute therapy session Parent check in/ritual opening (5 Min) Free play (5 min) Breath Awareness (6 min) Body Awareness (6 min) Bibliotherapy: Mindful Monkey, Happy Panda (6 min) Feeling tone awareness (6 min) Art Intervention (11 min) Parent check-out/ritual closing (5 min)

16 Art Therapy Interventions Tailor to needs of child Facilitate symbol interventions from first eight sessions Or facilitate the following interventions (session #9+) Ø Ø Bi-lateral drawing: reintegration of hemispheres and assessment of development Feeling/Emotion Tracing on Mirror

17 Purpose Segments of Sequence

18 Purpose of Sequence as Whole Mind-Body connection: Feel, Think, Act First three foundations of Mindfulness: Breath, Body, Feeling tone Threading mindfulness throughout session, touch and go Perry s NMT approach

19 Purpose: Breath Awareness Snel, 2013 First step in developing concentration Teaches to act rather than react Facilitates degree of control over inner experience without rejecting or repressing Breath as a way to inform client of how they are feeling, reflects internal and external experiences Perry, 2006 Rhythmic, repetitive tool Goldberg, 2013 Tool of self-regulation Stapert, 2008 and Rappaport, 2009 Drawing a symbol or handle of the breath allows the child to see it on paper and gain new perspective of their breath

20 Purpose: Body Awareness Murray, 2014 Tool to connect to ground, use when feel disconnected Goldberg, 2013 Synching breath with movement (yoga) improves vestibular system Rappaport, 2009 Breath and body awareness before art making help client feel more in touch with their body sense, bringing greater awareness and energy to body

21 Purpose: Bibliotherapy with Mindful Monkey, Happy Panda Murray, 2014 Children coping with ASD have a constant level of stress because they struggle with filtering out internal/external stimuli. Their mind/body may interpret a threat, resulting in range of symptoms Teaching mindfulness facilitates attention skills that increase ability to filter out other stresses. Reduce stress = reduce symptoms Example: Doing one thing while thinking about another thing may cause confusion and stress. Focusing on just one thing at a time may cause a calm mind and body.

22 Purpose: Feeling Tone Awareness Murray, 2014 Struggle recognizing emotions. Feel the energy but do not know how to access, control or communicate them. More effective to teach emotions from inside-out rather than outside-in Example: Pick a emotion, tell me why you are feeling it versus What are you feeling inside. What emotion does that look on the outside.

23 Therapist Role

Mirror for client Ø Establish rapport Ø Sense of safety Ø Non-verbal expression Dyadic Drawing Regulation/Modulation system and Companion Ø Be present and regulated Ø Naming experience and

24 Mirror for client Ø Establish rapport Ø Sense of safety Ø Non-verbal expression Dyadic Drawing Regulation/Modulation system and Companion Ø Be present and regulated Ø Naming experience and emotions for them until they can Ø Consistently bring awareness back their present experience Artistic reflection as empathetic understanding (Rappaport, 2009) Ø Partner drawings Ø Bi-lateral drawings

25 Limitations Other Considerations

26 Population Ø Developmental level Ø Perseverative symptoms, hyper focus Ø Age Sequence Ø Developmentally appropriate Ø Pace of segments Ø Tailor layout, Pair Bibliotherapy with all segments Ø Culture Ø Diagnoses Therapist s training Ø Ø Ø Yoga Mindfulness/ Meditation Art

27 Questions

28 References Alderfer, L. (2011) Mindful Monkey, Happy Panda. Somerville, MA: Wisdom Publications Chapman, L. (2014). Neurobiologically informed trauma therapy with children and adolescents: Understanding mechanisms of change. New York, NY: W.W. Norton & Company. Goldberg, L. (2013). Yoga Therapy for Children with Autism and Special Needs. W.W. Norton & Company, Inc. NY: New York Kramer, E. (2000). Art as Therapy. London, UK: Jessica Kingsley Publishers. Malchiodi, C. (2012). Handbook of art therapy. New York, NY: Guliford Press. Martin, N. (2009). Art as an early intervention tool for children with autism. London, UK: Jessica Kingsley Publishers. Murray, L. E. (2014). Connected Kids: Help kids with special needs (and autism) shine with mindful, heartfelt activities. Connected Kids Ltd.

29 References, cont. Perry, B. D. (2006) Chapter 3: Applying principles of neurodevelopment to clinical work withmaltreated and traumatized children: The neurosequential model of therapeutics. Working With Traumatized Youth In Child Welfare. The Guilford Press, NY: New York. Perry, B. and Hambrick, E. (2008) The Neurosequential Model of Therapeutics in ReclaimingChildren and Youth: Journal of Emotional and Behavioral Problems. Encyclopedia of Special Education, 17(3), Retrieved November 18, 2015, from Rubin, J. A. (2001) Approaches to Art Therapy: Theory & Technique. Abington, Great Britain: Taylor & Francis Group, LLC. Rubin, J. A. (2005). Child Art Therapy. Hoboken, NJ: John Wiley & Sons, Inc. Rappaport, L. (2009). Focusing-Oriented Art Therapy: accessing the body s wisdom and creative intelligence. London, UK: Jessica Kingsley Publishers. Stapert, M. & Verliefde, E. (2008). Focusing with Children: the art of communicating with children at school and at home. Monmouth, UK: PCCS Books Ltd.

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