ART EXHIBITIONS AS A THERAPEUTIC INTERVENTION FOR ADULTS WITH MENTAL ILLNESS by Melissa Diaz

A thesis submitted in partial fulfillment of the requirements for the degree of Masters of Professional Studies (Art Therapy and Creativity Development) School of Art and Design Pratt Institute

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ART EXHIBITIONS AS A THERAPEUTIC INTERVENTION FOR ADULTS WITH MENTAL ILLNESS by Melissa Diaz

Received and approved:

_________________________________________ Thesis Advisor ±Ann E. Smith, Ph.D., RDT-BCT

Date____________________

_________________________________________ Chairperson ± Jean Davis, MPS, ATR-BC, LCAT

Date____________________

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TABLE OF CONTENTS ACKNOWLEDGEMENTS«««««««««««««««««««««««..v LIST OF FIGURES««««««««««««««««««««««««««..vi ABSTRACT«««««««««««««««««««««««««««««.vii Chapter 1. INTRODUCTION««««««««««««««««««««««««1 Installation Artist as Art Therapist: Art Exhibitions Therapeutic Value Literature Review Mental Illness Art Therapy Art Product: Role of Art Object in Art Therapy Object Relations Theory Exhibition Space as Therapeutic Environment Holding Environment and Transitional Space Play Space within Transitional Space and Holding Environment Therapeutic Environment as Third Hand Art of the Mentally Ill Art Exhibitions in Art Therapy Exhibition Space within Treatment Facility Therapeutic Benefits of Artist Identity Therapeutic Elements in Organizing an Exhibition Brining the Art to the Public Conclusion 2. STATEMENT OF RESEARCH PROBLEM«««««««««««««..38 Research Question Definitions of Terms Limitations/delimitations 3. METHODOLOGY AND PROCEDURE««««««««««««««....45 Research Approach Research Methodology Research Procedures Setting Population

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Ethics

4. FINDINGS«««««««««««««««««««««««««««53 Open Coding Axial Coding Figure 1: Paradigm Model Description of Categories Community Art Making Process Identity Previous Forms of Treatment Outcome of Art Product Emotional Involvement toward Exhibiting Control Over Life 5. DISCUSSION««««««««««««......................................................60 Development of Mastery Intervening Conditions Long History of Art Making Community Art Making Process Identity Previous Forms of Treatment Outcome of Art Product Emotional Involvement toward Exhibiting Control Over Life Mastery Discussion of Implications Further Studies 6. CONCLUSION«««««««««««««««««««««««««94 REFERENCES««««««««««««««««««««««««««...96 Appendix«««««««««««««««««««««««««««««106

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List of Figures Figure 1. Paradigm Model, Axial Coding on p. 57.

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Abstract This study explored the therapeutic value of adults with mental illness participating in art exhibitions. The researcher interviewed participants of studio art and gallery programs that utilize the developmental model as a way to decrease stigma and encourage empowerment through use of artist identity. Grounded Theory methodology was employed as way to identify a central phenomenon, grounded in interview data. Based on five in-depth, open-ended interviews, Mastery emerged as the central phenomenon. This finding relates to use of creating and exhibiting art as a way to gain a sense of mastery of one¶s life. The researcher hopes this study can engender destigmatization while increasing the incorporation of the artist identity and art exhibitions in art therapy treatment.

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Art Exhibitions as a Therapeutic Intervention for Adults with Mental Illness Installation Artist As Art Therapist: Art Exhibitions Therapeutic Value During the formative stages of my thesis writing process, it became clear to me that I was in transition; feeling ambivalent towards the desire to create art and my need to continue writing. It was at this time I also felt torn about my thesis topic. Did I want to create an auto-ethnographic narrative related to my experience as an installation artist, or continue with my current topic of researching the impact of art exhibitions on artists with mental illness? I have often looked to my experience as an installation artist to support my efforts to become a therapist. During the toughest moments of my art therapy training, I found refuge in either creating an installation or reminding myself of the principles I use in art making to reiterate my role as an art therapist. I realized the true essence of my artistic expression is melding objects together in space. Why then could I not do the same for my thesis work? By describing my work as an installation artist I can further explain my journey to my thesis topic. When creating an installation I work on site, at the exhibition space, often times under a tight time constraint due to the soon pending opening. Fueled by the energetic adrenaline of these time confines, I find myself lifted into a realm of attunement with the space, constructing in a state of mindfulness, leading to acute awareness. I work in an improvisational, intuitive manner, incorporating time, space and energy. I grapple with boundaries and alternative realities; in essence I can create habitats that resemble real environments, yet do not actually exist in the tangible world.

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Constructing large scale visceral environments allows the viewer to enter into, and engage with the space. I see these environments as homes and safe spaces, acting as Winnicott¶s (1971) concept of transitional space, a realm existing between subjective and objective reality. I extend this concept of art space as transitional space to exhibition space as well, therefore proceeding with my original topic became more relevant to me and my own lived experience of exhibiting. I stumbled upon installation art through naiveté and frustration. I had never seen an installation nor studied this genre of art, but during the sophomore year of my BFA program, I began to yearn for a more embodied art experience. As a painting major, I was feeling confident about my progress with the medium; using art as a form of personal therapy, I created large self-portraits depicting spectrums of feeling states. However, I began to feel confined and stunted by the boundaries of the canvas. I moved from selfportraiture to images of birds as self metaphor. I painted birds in flight, amidst or tied in clumps of yarn, I draped bunches of yarn around the canvases, creating more of a threedimensional painting. I soon realized how trapped and stifled these birds appeared, representing a metaphor for how I felt about painting. The only element that felt truly satisfying was the clumps of yarn mounded on the canvases. I decided I needed a big change; I achieved this by transforming my painting studio cubicle into a three-dimensional painting. This cubby space, regularly used for storage and work space, became a sanctuary where I felt transported into another world. Before I even realized it, I was immersed in creating an ongoing installation piece. This medium allowed me to share my artwork and process in a new way; now others could

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literally step into my world of creation. I found an escape from the rigidity of the canvas, unlike painting and drawing, this art expression lied in the actual install of the piece. Installation art¶s site-specific nature required exhibitions in order to thrive; therefore exhibiting my art became a crucial component to creating my works. I used exhibitions to construct installations that formed a shared energy between art, artist, and viewer. Inviting the audience into the installation space incorporated the viewer as a part of the creation. Once within the space, the viewer becomes a co-creator; this is similar to elements of co-creating found in therapeutic space between patient and therapist. I began organizing group and solo exhibits at my university and in the community; this filled my final year of undergraduate studies with an extremely active exhibition schedule. After each exhibition, I began to feel more confident and empowered. Within the exhibition space, I sensed my true self emerging, allowing me to share intimate pieces of myself through artistic metaphor. The external validation I received during these exhibitions led to increased self-esteem and artist identity. I still look to my artist identity to find strength, by transforming external space, I transform inner space within myself. These early exhibition experiences further propelled my curiosity towards the relationship between art, artist identity, healing, and wellness. This interest continued throughout my art therapy training; having realized the therapeutic value exhibitions have had in my life, I wondered about the effects exhibitions could have on art therapy clients. At my second year internship, I was fortunate enough to experience the function of a permanent art gallery incorporated as a part of the art therapy program in an adult

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psychiatric hospital. At this internship site, I witnessed the transformative experiences that exhibiting in the gallery created for the clients. I also had the opportunity to give individual art therapy sessions to one of the continuing day treatment patients, 47 year old schizoaffective patient, Keith, had attended the program for the past 15 years. We worked together once a week for four months. Although this was his first experience with individual art therapy (mine as well), the client was also a regular to group art therapy. Our work together involved using an art as therapy approach, as coined by Kramer (1971), a therapeutic approach based in the idea that the art making in itself holds therapeutic value and opportunities for transformation. I approached these sessions from a non-interpretive stance in order to form a nonjudgmental and non-threatening environment. I worked in this framework for several reasons, I was aware that Keith was experiencing some mildly forceful, interpretive, and often impersonalized therapeutic approaches in his other therapies. His art and style was even being challenged for maladaptive qualities by therapists involved in his treatment, yet not involved with art therapy. I was also aware that Keith enjoyed making art; his dedication to art making was evident by his overflowing art studio folder. Therefore, I aimed to create a therapeutic opportunity that would not conflict with the team, yet offer a contrasting environment where Keith was free to form his own conclusions regarding his relationship with art making. Our work together was a delicate, slow moving process, which was primarily rooted in developing a trusting relationship. Our first sessions were filled up by Keith spending much of the time talking, almost laboriously, with a moderate nervous tone, about topics mostly related to more superficial surface layer material. These sessions

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were not only filled with talking, but also with constant drawing while talking. I aimed at conducting myself as a model; drawing alongside in sessions, I tried to form a grounded, cohesive environment free of hierarchical presence. As our work together progressed, and a bond of trust grew, I gently encouraged Keith to venture into new materials since he only worked in pencil and paper and we had a studio rich in a variety of materials. I sensed the time was right for more substantial art materials; I was curious if the shift in material could mirror a therapeutic shift. As Keith replaced paper for canvas, I noticed a shift in pride and confidence, expressed in his verbalizations about his works, a more relaxed use of the medium, and less superficial dialogue replaced by moments of concentrated art making. I witnessed Keith progress from a more nervous self-soothing use of material to a much more confident use of material. I began to hang Keith¶s canvases on one of the studio walls. I soon sensed his admiration, as he viewed them in the studio, and even brought others in to see these pieces. I understood this shift to be a development in his identity as an artist. Keith also started to take these pieces home to hang in his house and show family members. I saw this gesture as a development in confidence of his artist-self. His artwork mirrored our relationship; as I witnessed the art move from a less rigid, idiosyncratic mode, Keith became more comfortable and less rigid towards me in session. It was a slow process, and by no means a remedy for his mental illness, yet I witnessed subtle shifts due to empathic support and regard for his artist identity, working in a way to honor the healthy parts of Keith.

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Throughout our sessions a reoccurring topic was the pending annual art exhibit. Keith expressed his anxiety about the opening reception; however, the anxiety was juxtaposed with a sense of excitement and pride. This pride was demonstrated by regular check-ins to admire his framed piece for the show, followed by his proactive approach toward informing staff members of his participation in this exhibit. As we continued our work together, not only did Keith hone in on his artist identity, but also stated that he was feeling less anxious about the opening. We often spoke about strategies to manage his anxiety during the opening. However, this exhibition was taking place at an awkward time for the facility. The program had recently undergone many changes, involving splitting up the continuing day treatment program into two groups; this left many clients, including Keith, feeling a bit unsafe, unsure of their standing in the program, and saddened by the loss of certain friends. Shortly after this modification was the opening of the art exhibition, and the end of the academic year. This closing of the year meant several interns and externs involved in Keith¶s treatment were beginning to start the termination process with Keith. These changes and pending events culminated in much anxiety and nervousness for Keith. These feelings often became overwhelming for him, so overwhelming suicidal ideation would arise. Consequently, the week of the exhibition Keith was admitted to the inpatient unit. Although he seemed more stable than on his prior inpatient admission during our work together, I was concerned with the timing being so close to the opening of the exhibit and the end of our work together. I was distressed to learn about this hospitalization, yet I still felt we did powerful work together and that Keith¶s art aesthetics, confidence, and interpersonal skills had grown.

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Unfortunately Keith¶s admission coincided with my last week at the hospital. It was challenging to leave this internship after making such a powerful therapeutic connection with Keith. Parting ways was even more painful having to say good-bye on the inpatient unit, instead of the outpatient art studio. Two weeks after my internship ended, I was informed that Keith took his own life shortly upon discharge. I was devastated. Keith¶s death left me wondering whether or not the idea of exhibiting his artwork contributed to his choice to commit suicide. I questioned if an art exhibition could benefit this population, and if it was worth researching. I was not sure how to move on from losing a client to suicide. After much pausing, mourning, and finally regrouping from this loss, I revisited my enriching encounters exhibiting, created art, and remembered my experience being with the other day treatment clients at the art opening. At the opening reception I witnessed the therapeutic encounter that unfolded for these clients. I recalled the proud stances, the visual transformation of empowerment that filled the room, and the confident responses clients gave when questioned about their artworks. This also brought to mind many other exhibitions I have attended, the essence of a shared experience emanating throughout the space. I was then further fueled to continue with this topic. I realized my work with Keith was still valid and important and that I saw improvement and connection in our work together. I also felt, what better a research question than one I have not found the answers to. My combined experience as an exhibiting artist and my work with mentally ill exhibiting artists compelled me to share the stories of individuals with mental illness who have exhibited their artwork. In

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essence, I am interested in exploring the therapeutic value of exhibiting and exhibition space for adults with mental illness. Literature Review This literature review will cover key elements related to exhibiting art as a therapeutic intervention for adults with mental illness. The use of exhibiting art as a therapeutic intervention can act as a bridge between studio and exhibition space building upon the therapeutic process developed during artistic creation. Within the exhibition space, gallery, museum, or alternative showing space, the art is seen in a different context from its creative conception. Now brought into a realm where the art product created in art therapy can contribute to the fine art continuum, the exhibition space can act as holding space, mirroring back the works of art to the clients in an environment where the artwork can continue to thrive. This literature review will begin by defining mental illness, and then briefly touch on deinstitutionalization and normalization as treatment options for the mentally ill. I will then give a brief history of the spectrum of theoretical modes of practicing art therapy, with the concepts of art as therapy and art psychotherapy as the primary paradigms in art therapy. Particular attention will be paid to the lack of writing on art exhibits during the inception of art therapy and the emergence of studio art therapy as an art focused approach. I will then address the art object/product in relation to art therapy, and its relevance to object relations theory. This will be followed by a description of object relations theory, examining object relations used in art therapy, and its application to art exhibition space. Next I will discuss the therapeutic environment, addressing the concepts

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of transitional space and holding environment as they pertain to the art exhibition environment. Then, a brief historical account of art of the mentally ill will be given. Lastly, this literature review will examine pertinent research done in the field of art therapy directly related to exhibiting client artwork and mentally ill adults participating in art exhibitions. Mental Illness In an effort to explain the various modes of treatment of the mentally ill, I aim to first define mental illness, followed by treatment options specifically related to normalization, deinstitutionalization, and art therapy. Mental illnesses have many varying treatment options, however my main focus will be the method of normalization as it is related to art exhibitions as a therapeutic modality. This portion of the literature review will by no means cover all contributions in research on mental illness; instead this section will serve as platform for basic understanding of the population. According to the National Alliance of Mental Illness (2010), mental illness is described as a brain disorder that affects one¶s thinking, feeling, moods, and ability to relate to others. Rosenfield (1992) described the mentally ill population as a group that feels they have little control over their life circumstances and environments. Rosenfield (1992) suggested that successful psychosocial rehabilitation programs for the chronically mental ill are rooted in the normalization approach as a means to form practical help for living in the community (p. 301). Wolfensberger and Thomas (1983) described normalization as a way for socially marginalized individuals to obtain and maintain culturally normalized and valued activities. The normalization philosophy is rooted in the tenant that the mentally ill are not viewed as sick, but rather as socially

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marginalized (Vick and Sexton-Radek, 2008, p. 4). Rosenfield proposed that quality of life is linked to mastery and empowerment by normalization. Mastery is defined as a ³possession or display of great skill or technique´ (Merriam-Webster Dictionary Online, 2010). Successful programs promoting a higher quality of life acknowledge the strengths of patients over the illness, while minimizing differences and hierarchies between staff and patients (Rosenfield, 1992, p. 301). Rosenfield further stressed the importance of vocational rehabilitation where patients have an active role in their treatments, decision making, and opportunity to participate in socially valued activities and jobs. In essence, through a greater sense of mastery in life, one could increase feelings of empowerment and overall quality of life. Through the lens of the normalization approach, it is plausible that art exhibitions can be considered a valued activity aiding in the healing process by mastery of the art, empowerment through the exhibition experience and vocational experience as artist. Empowerment as a treatment approach for people with mental illness, can be defined as an approach that emphasizes the client having choice and control (Linhorst, Hamilton,Young, and Eckert, 2002, p.425). Goffman (1963) emphasized the empowerment approach as a way to de-stigmatize the mentally ill. There are many options for a person with mental illness to utilize an empowering activity, including a strong foundation in art as tool for personal growth and shift from stigmatize roles. Spaniol (as cited in Malchiodi, 2003) reiterated the concept of empowerment developed through artistic activity; she further postulated the use of artist identity as an empowering option to combat negative stereotype and stigma (p. 270). Linhorst, Hamilton, Young, and Eckert cited participation in treatment planning through collaborative decision

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making as an empowering approach. Spaniol further developed a concept of recovery, suggesting that the possibilities of recovery for the mentally ill are rooted in growing out of the boundaries of the illness by achieving a sense of self-hood through development of meaning and purpose in life. Concurrent with themes addressed in the normalization approach, Bachrach (1987) supported collaborative deinstitutionalization, suggesting that creating a sense of mastery should be a primary goal in psychotherapy for deinstitutionalized chronic mentally ill. Deinstitutionalization is a term that varies in meaning depending on context, for purposes of this study I refer to Lamb and Bachrach¶s (2001) definition of deinstitutionalization ³«as the replacement of long-stay psychiatric hospitals with smaller, less isolated community-based alternatives for the care of mentally ill people´ (p. 1039). Lamb and Bachrach further stressed that the term is often mistaken as merely a form of downsizing; while downsizing is a component, the essential element of deinstitutionalization is the development of alternative outpatient services for the mentally ill. Bachrach (1976) described the three components necessary for deinstitutionalization as: 1) transferring those hospitalized into the community 2) development of supportive services for noninstitutionalized mentally ill, and 3) to redirecting possible new admissions to alternative facilities. Bachrach (1987) also explained deinstitutionalization from a sociological perspective: he suggested institutions can impact how society views and cares for the mentally ill by setting an example of a ³set of social patterns´ (p. 2). Therefore, deinstitutionalization has the potential to impact social change, by restructuring the social system, highlighting potential to alter social control as determined by how the mentally ill

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are viewed and their status in society (Blachrach, 1987, p.7). Art exhibitions as a therapeutic modality have the potential to not only contribute to personal growth and sense of self, but also function as an impetus for social change and de-stigmatization of the mentally ill population. Mango (2005) asserted that public misconception about the mentally ill cannot be alleviated unless clients and people with mental illness are willing to share their stories. Keil (1992) suggested that once one accepts one¶s diagnosis of mental illness one is no longer a foreigner in the world of mental illness, and through acceptance one can move toward the road to rehabilitation. Robbins (as cited in Rubin, 2001) found that when working with clients who fell in the continuum of mental illness, ³therapy«cannot be in making the unconscious conscious´ (p. 59), rather the therapeutic approach should focus on building instead of revealing, aiding in integration and cohesion. Art exhibitions have the potential to aid in building and reinforcing the artistic experience conceived in studio/session. The concept of building can contribute to a sense of hope and healing. Pendelton (1999) described the use of art therapy with the mentally ill as a place to ³honor and nurture the health within´ (p.32). Spaniol (as cited in Malchiodi, 2003) described a useful way to work with the mentally ill was through treating them as fellow humans instead of ³mental patients´ (p. 269). I am postulating the possibility of art exhibitions as a therapeutic intervention, mirroring concepts of normalization and deinstitutionalization, while honoring the mentally ill client as a fellow participant in the realm of creativity.

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Art Therapy There are several ways in which to practice art therapy, I will be providing a brief explanation of three main art therapeutic ideologies, art psychotherapy (Naumburg, 1987), art as therapy (Kramer1971), and studio art therapy (Allen, 1995; Henley, 1995; McGraw, 1995; McNiff, 1995; Moon, 2002; Timm-Bottos, 1995; Wix, 1995) as an example of the slim use of art exhibitions as an art therapeutic intervention. Art therapy consists of a spectrum of approaches with art psychotherapy (Naumburg, 1987) on one end of the continuum and art as therapy (Kramer, 1971) on the other. Vick and Sexton Radek (2008) illustrates the origins and impact of these paradigm models: «the continuum stretching from ³dynamically oriented art therapy´ to ³art as therapy´ continues to be used as a dominant model in art therapy practice. Although serviceable and surprisingly adaptable, it is still a paradigm linked to the medical concepts of identifying and treating pathology. (p. 4) Naumburg (1987) developed dynamically oriented art therapy, which parallels psychoanalytic use of art as a means of free association. In this mode of art therapy, spontaneous images are created in session while the art therapist encourages free associations, so that the art is used as a vehicle to verbal articulation (p.6). Naumburg believed that the client gradually moves his cathexis with the therapist to a dependence on his own art (p. 3). This description of the client¶s cathexis to the art could be used as a powerful therapeutic tool if the art is revisited post-session, allowing for the possibility of the cathexis to continue outside of the moment of creation, lending itself as a supportive bond in the exhibition space. However dynamically oriented art therapy did not reference post-session revisiting of the art works. Naumburg refrained from using the term works

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of art, instead she described the art produced in session as ³symbolic speech´ (p. 6). This terminology not only negates the role of aesthetics but also decreases power of the art product in art therapy. In this explanation art therapy is seen as a means to move from symbolic to verbal. Kramer (1971) on the other end of the art therapy spectrum, conceived art as therapy. The act of creating itself is thought of as therapeutic; the art therapist provides conditions to nurture and support the creative process, including technical support and emotional support. In art as therapy the therapist acts as the auxiliary ego for the client, using Kramer¶s conception of the Third Hand, an un-intrusive way to support and help the creative process along for the client (Kramer, 1986). Art as therapy relies primarily on supporting the ego and identity formation. I am postulating that if identity formation was extended to the artist identity, exhibition space could possibly act as additional auxiliary ego; this concept will be discussed further in the environment section of the literature review. In a similar vein, Henley (1995) conceptualized the art studio as a therapeutic intervention, acting as the Third Hand. In the studio art therapy practice, ³the participants are viewed as artists over patients, and are seeking to use art making as a process for self-expression, exploration, and healing´ (Malchiodi, 2003, p. 211). From this perspective, the studio aims to create non-hierarchical environment, where the clear focus is dedicated time for art making. Allen (1998) emphasized a different set of rules for psychotherapy and art therapy, explaining that art loses its effective qualities when confined to the rules of psychotherapy. Allen (1995), co-founded the Open Studio Project (1995), one of the first open studio practices, where the focus was on deepening consciousness, through

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maximizing the art experience. Allen (as cited in Rubin, 2001) explained her concept of the open studio as a place where the therapist can make art alongside the participants, where the clients are seen as equal, and ³concepts such as diagnosis and treatment are given up´ (p. 182). Malchiodi (2003) cited The Creative Growth Center as the first studio in the United States that focused directly on exhibiting the artwork of disable people. This facility continues to inspire hope through exhibiting client art, demonstrating that ³art can reclaim many individuals who have been labeled hopeless cases´ (p. 217). Through the exhibition experience the client/artist is partaking in a community art experience. Vick and Sexton-Radek (2008) further highlighted a shift in art therapy towards more community, studio based programs, moving away from the medical model striving for redefinition of the field. Some art therapists believe more of an alliance should be formed between the art world and art therapy world, asserting that often in art therapy ³maker and audience are one´ (Lachman-Chapin, et al., 1998, p.237) and suggesting that art therapists make an effort to connect with art galleries. Allowing for a real audience to view the works has the potential to open up opportunity for further introspection of the art piece, and possible elongation of the therapeutic experience. Malchiodi (2003) declared that what was important was finding art activities that motivated the creative process, enriching the person¶s involvement in the work (p. 183). From this viewpoint, art exhibitions as an intervention can be considered to be part of the creative process. The Open Studio movement opened up the door to further exploration of art in art therapy. Timm-Bottos (1995) explores community focused art therapy. She proposed that through interaction and sharing, the community can be utilized as an agent of change and

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health. Timm-Bottos founded Art Street, originally an open studio created for the homeless population; she stressed the importance of a community element of the studio space as an external validation for creative abilities (p. 186). Vick and Sexton-Radek (2008) researched the divergence between community-based art studios in Europe and the United States, and found that European studies did not claim to be practicing art therapy, yet they still claimed to practice art therapeutic tenants; his findings displayed United State¶s studio¶s social service and sociological missions, in contrast with Europe¶s studios that lean more towards vocational based goals. My research will consider whether or not it is possible to develop an opportunity for the integration of the European and United States studio goals, creating a supportive holding experience for growth in social change, art and art aesthetics, job opportunities in the arts, alleviating stigma, and promoting self-esteem. From this perspective, each goal could perform in a cyclical, overlapping way, reinfusing one another. Exhibition space can be thought of as a reinforcement of art therapeutic benefits found in session or studio. Art Product: role of art object in art therapy The process of creating art inevitably results in an art product. In order to discuss exhibition space, which is the holding environment for the art product, the art product itself must be contemplated. Varying viewpoints on the art in art therapy will be examined in this section; particular attention will be paid to formed expression, the transitional object, and postmodern ideals. Kramer (1971) referred to the art product produced in art therapy sessions as formed expression, art in the full sense of the word, including sublimation and attention to the aesthetic product. Kramer defined sublimation as, ³a process where in drive energy is deflected from its original goal and displaced onto

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achievement´ (p. 68). She further explained sublimation as longer lasting than impulsive, direct gratification, made possible through a conducive, nurturing environment. Kramer believed that formed expression was unlike other forms of symbolic representation in that art was more than just a discharge of impulses moving beyond formless chaos, unique to stereotypical works, imbued with self-expression and communication (p. 63). It was through the use of formed expression that Kramer highlighted the product element with the process oriented ideas of art as therapy. There are varying views on the use of art object from therapeutic session or studio to exhibition space. The art product can also be thought of in a more postmodern sense, where art is aligned with conceptualism over formalism. Alter-Muri and Klein (2007) referred to postmodernism as a point of reference for the art therapy community to expand their view of artworks. They reiterate that in the postmodern view art exists on a continuum with multi-meaning, blurring the boundaries between fine art, arts and crafts, and outsider art. This view highlights the role of aesthetic in art therapy, questioning traditional notions of art therapy¶s process over product approach, where artworks created in art therapy are not viewed as art (p.84). In disagreement with the postmodernist view, Lentz (2008), director of the open studio, Project Moving Onward, art created for a therapeutic means has no business leaving the art studio. While Lentz accepts, and in fact promotes, people of all mental capacities exhibiting artwork, he differs in idea of intent for the creative object. Art viewed from a postmodern perspective can broaden the idea of acceptance of exhibitions of art of the mentally ill. Further, from this perspective, the art object can exist as a therapeutic tool for the client and the viewer.

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Spaniol (as cited in Malichiodi, 2003) stressed that not only do art activities build identity, but their concrete products can also furnish a form of self-identification. Winnicott (1969) elaborated on the idea of the object relations, extending it to a progressed development, he referred to as object usage. Winnicott explained object usage as distinct from object relatedness in its qualities of being a real actual object in the tangible world. Furthermore Winnicott stressed the importance of the analyst taking into account ³the nature of the object, not as a projection, but as a thing in itself´ (p.712). If the idea is extended within the realm of art object, a relationship between object and patient can also be made. Allen (as cited in Rubin, 2001) suggested that there is not only a relationship between client and art therapist but that the primary relationship experienced is between the individual and the creative process. In Arnheim¶s (1980) study of the art as therapy approach, he found that the art object can fill in as substitute for the absent ³real thing´ (p. 249). This study incorporated the idea of the art object standing in for absent objects. For art that lives within the exhibition space, possibilities for art object as transitional object arise, where the art object can function as other, yet not other-self, yet not self-transitional phenomena (Winnicott, 1971, p. 50). Winnicott (1953) conceived the transitional object as an object that is not part of the infant¶s body, yet the infant does not conceive it fully in external reality (p. 2). This object can be anything, such as a blanket or toy that the infant finds important and meaningful beyond the reality of what it is. Thompson (2009) reiterated this transitional experience as it unfolds in the art gallery, finding that ³the art object«in the gallery occupies this realized space in a physical sense and a temporal mode that permits revisiting the me and not me aspect of the self´ (p.11).

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Art as a transitional object holds potential to link therapeutic encounter from studio to gallery, thus offering the client a transition to the gallery for further opportunities of therapeutic engagement. The theory of transitional objects can also aid in understanding the fusion of phantasy and reality in works of art created by the mentally ill (Pickford, 1967, p. 11). The art object has the exclusive power to promote the uniqueness of the creator through exemplifying what is new in existence and will only exist in that form (Franklin, 1992, p. 80). In congruence with Franklin¶s view of the art object, Allen (as cited in Rubin, 2001) found that the art object itself can provide a sense of self- identity. According to Lejsted and Nielsen (2006) ³a piece of art undoubtedly reflects a particular patient¶s experiences, whether or not they are a part of the illness´ (p. 510). The art product is a crucial component in the process of creativity, holding possibilities for identity and self-worth. Alter-Muri (1994), wrote about her individual art therapy work with a mentally ill client who exhibited his art, described the finished art product in this context as providing a sense of self-worth, self-confidence, and identity as an artist (p.223). Henely (1992) described his work with an inpatient psychiatry client that involved care for the art therapeutic process, as well as the artistic integrity of the art work/object. This lead to the client¶s self-identification as an artist, which aided in increased self-esteem and self mastery (p. 157). The art object is a powerful component to be considered in its own right during the art therapeutic process, exhibiting art gives the art an incubator for further nourishment and growth of personal identity.

Object Relations Theory

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Object relations theory is based on the attachment concept that humans are object seeking beings, forming relationships as a means to develop personality. Melanie Klein was a prominent source in the development of this school of psychology. Klein branched off from Freud¶s developmental theories, creating a theory of phases, through use of direct observation and psychoanalysis of children. Klein (1931) expanded on Freud¶s concept of ³internalized objects,´ finding that a child initially views objects, such as the mother or breast, as part objects. By part objects Klein explained that the child splits objects into ³good´ and ³bad,´ based on levels of gratification and nurturing representing the ³good,´ and destruction or danger representing the ³bad´(Greenberg and Mitchell, 1983, p. 125). This experience of splitting is formed through projections and introjections, where the good is taken in during introjections, and the bad is projected outwards. Klein (1935) referred to this experience as the ³paranoid position,´ where the child wants to keep good and bad objects separated. Both internally and externally, the child attempts to protect good objects for fear of the bad objects tainting them. Klein (1935) suggested that after the third month of life, the child forms the capacity to integrate good and bad objects, resulting in a whole object and a real ³other.´ ³The other is no longer simply the vehicle for drive gratification but has become an ³other´ with whom the infant maintains intensely personal relations´ (Greenberg and Mitchell, 1983, p. 126). According to Corey (1996), early developmental object relations are the foundations that form current relationships in reality and fantasy. If there is a disruption in early development, and whole objects are not achieved, defenses such as splitting may maintain through adulthood, leading to forms of psychological impairment.

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Mahler, Pine and Bergman¶s (1975) research further exemplified the understanding of development of the capacity to differentiate self and other. Mahler (1975) postulated three main phases of development that take place within the first three years of life, resulting in a sense of identity and object constancy. These developmental stages begin with normal autism, a blissful unity with the mother, which begins in utero, followed by symbiosis at about 3-4 months, a stage of nondifferentiated attachment, where the child feels he is one entity with the mother. At 5-6 months the child begins to move towards more independence and differentiation, going through the subphases of hatching, practicing and rapprochement, culminating in separation individuation. The process of separation individuation forms a sense of identity, autonomy and object constancy. For purposes of my research, I will focus primarily on the stages of symbiosis and separation individuation, comparing how these phases relate to studio and gallery space. Mahler (1967) described symbiosis as a metaphor for the biological term meaning two species living and sharing together. She defined symbiosis as an undifferentiated fusion state between the mother and child, ³in which inside and outside are only gradually coming to be sensed as different´ (p.741). In this symbiotic state, the child projects any unpleasurable experience onto the symbiotic relationship; the mother responds by providing a ³holding behavior´ or nurturance in the symbiotic experience (p. 741). Similarly, Robbins (as cited in Rubin, 2001) described the art in object relations art therapy as a container that holds, organizes and mirrors, while the relationship to the art allows for a safe forum to explore the world of objects (p. 59). The object relations approach can be particularly useful when working with mentally ill clients, due to a

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correlation found between pathology and deficient early object relations (Horner,1979). Horner explained that failing to differentiate during symbiosis can result in confusion regarding inner and outer reality. Robbins reiterated that every developmental problem offers a unique clinical experience, therefore the art therapist must be willing to differentiate and change art frames in order to ³transform pathological space into therapeutic space´ (p. 61). Harmonious with Robbins perception of the function of art, I am postulating that the process of creation, when one is immersed in art making in the studio, can act as a form of symbiosis. In this symbiotic state with the art, the artist is engaged in a sense of oneness with the art object. Different levels of reality can be experienced through the non-verbal process of art, in which the art organizes object relations and mirrors them to the patient (Robbins, as cited in Rubin, 2001, p.60). Therefore, I am suggesting that due to this symbiotic experience, there are possibilities for a sense of separation individuation to be formed in the exhibition space. Mahler explained separation individuation as a three part process taking place from 5-24 months. The first subphase experienced is hatching, where the child begins to differentiate, developing a sense of self-awareness (Malchiodi, 2003, p. 55). In this hatching period, the child begins to actually pull himself away from the mother to get a look at her, studying the mother, seeing her as separate. The child then moves into the practicing subphase, the child literally becomes mobile and explores the world around him. By utilizing the mother as secure home base, the child can now practice new experiences with the world, delighting in his new discoveries (Crain, 1992, p. 303). Rapprochment follows practicing, here the child becomes increasingly aware of the mother¶s presence, checking in to make sure the mother is there for protection, while at

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the same time feeling ambivalence toward further exploration and staying with the mother (Mahler, Pine and Bergman, 1975, p. 96). Checking in can also be experienced in a therapeutic realm. Thompson (2009) recognized checking in with the artwork in the gallery space as an opportunity for rediscovery of self. Separation individuation is fully realized when the child sees others as fully separate; the child has maintained an internalized image of the positive experience of the mother, that Mahler refers to as ³emotional object constancy´ (p. 109). Now, having gained a sense of autonomy, the child can extend her sense of self and identity. For purposes of my research, I am postulating the art exhibition experience as a form of separation individuation, where one can practice the role of artist, gaining a sense of autonomy and possible artist identity by utilizing the space and art as a holding environment. Similarly, therapists utilizing the object relations approach extend that they must participate as the holding environment, holding the client like a good mother would (Stark, 1999, p. 29). Winncott (1968) developed the concept of holding environment, which will be examined at length in the following section of this literature review. For purposes of this section, I am referencing the holding environment as a component to object relations theory. To elaborate on previously stated concepts, object relations art therapy employs art expression as a means to organize and integrate inner and out reality, repair early attachment deficits and promote autonomy for the client (Robbins, as cited in Rubin, 2001). Malchiodi (2003) also noted that ³art creates a setting in which individuation and separation can be witnessed, practiced, and mastered through creative experimentation and exploration´ (p. 54). While Henley (1995) actually specified the setting, suggesting

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studio space as a holding environment, operating as a secure home base, thus enabling practicing and exploration of the art space (p. 189). Therefore, I am suggesting the use of exhibition space as therapeutic intervention creates potential for the art to function as object; the client can then revisit the art object post-session, therefore, reiterating a sense of object constancy, increasing therapeutic continuity. Winnicott (1969) noted the ³development for capacity to use an object is made possible through a facilitating environment´ (p. 713). Exhibition Space as Therapeutic Environment The therapeutic environment and space are powerful components within the therapeutic process; this middle ground is often thought of as shared between therapist and client. I am suggesting the exhibition space could embody the holding environment, engaging as transitional space, and container, while utilizing Third Hand nuances, creating possibilities for continuation of therapeutic engagement beyond the art making. Moon (2002), studio art therapist, postulated the idea of conceptualizing the studio space as installation art; this concept requires examining space not merely by viewing it, but experiencing the space. My research aims to address how adults with mental illness experience and participate in the exhibition space. Mcniff (1997) directly referred to the effect the environment plays, expressing that authentic representation of self can be found when one engages with his or her environment. Holding Environment and Transitional Space Winnicott (1971) developed the concept of transitional space, referring to the space between objective and subjective reality, a space for play, development of creative self, and emergence of a true sense of self. Additionally, Winnicott (1953) noted that only

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the true self can be creative and feel real (p. 148). Malchiodi (2003) extended art making as transitional space because it is a way to ³bridge subjective and objective reality and practice attachment and relationship with the world around you´ (p.54). Winnicott (1953) formed the idea of a holding environment, describing it as a space where the infant is unknowingly protected by the mother. This holding environment must be present in order for the child to enter transitional space. In hopes to repair early object relationship shortcomings, holding environments are also created within the therapeutic encounter (Robbins, as cited in Rubin, 2001, p. 62). For the purposes of my research, I am examining art exhibition space as a possible holding environment, with potential to transform the art created in studio or session. I am further exploring potentials for this holding environment to create movement from inner and outer psychic and physical space uniting in exhibition space as transitional space. Winnicott (1969) asserted the use of holding environment to transitional phenomena, where the individual gradually begins to play and gain the capacity to independently move into the ³external world´ (p.711). Robbins (1987) referenced the therapeutic holding environment as an empathic, related space bridging communication between therapist and client (p. 28). In Deco¶s (1998) description of the acute inpatient open studio, she posited a flexible holding environment, allowing for the individual to engage and withdrawal as needed (p. 101). I am postulating that the exhibition space as therapeutic intervention can act as transitional space in that, the space and viewer could represent Winnicott¶s (1971) idea of external world, or outer space, while the process of art creating and actual art object as transitional object could parallel the inner world. If the viewer is valued as participant in the space, and if the exhibition space is effective as

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a secure holding environment, it may be possible for an extension of ego-relatedness to develop within the space via the viewer¶s involvement in the space (Alter-Muri and Klein, 2007). Winnicott (1958) described ego-relatedness as the capacity to be alone while others are present, so that the presence of the other is important to each person (p. 416). Robbins (as cited in Rubin, 2001) related the present other to the therapist, where the therapist engages in therapeutic play with the client, so that the play creates the holding environment (p. 62). Play space within transitional space and holding environment This section will focus on possibilities for therapeutic play engagement during art opening receptions. According to Winnicott (1971), play is a creative experience found in the space-time continuum. Winnicott further theorized playing as found within transitional space and a foundation for cultural experience. For purposes of my research, I am suggesting art exhibitions as a cultural experience not only create possibilities for therapeutic play, but also allow the mentally ill artist to become immersed in a culture outside of psychopathology. Exhibitions hold the transformative potential to shift into Winnicotian playspace through gallery opening as a part of exhibition participation. I am postulating a parallel between play within the transitional space and art opening within the exhibition space. Additionally, Winnicott affirmed that play in itself carries therapeutic value. It is play that is the universal, and that belongs to health: playing facilitates growth and therefore health; playing leads into group relationships; playing can be a form of a communication in psychotherapy; and, lastly, psychoanalysis has

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been developed as a highly specialized form of playing in service of communication with oneself and others. (Winnicott, 1971, p. 41). Exhibition space conceptualized as play space has the potential to act as a communicative intervention in the way Winnicott conceptualized play as a therapeutic intervention. Therapeutic Environment as Third Hand Henley (1995) extended the concept of therapeutic holding environment by exploring the concept of the art studio used as art therapeutic intervention, and posited that the studio space is a part of the therapeutic experience. Henley compared the studio to Kramer¶s (1986) Third Hand, finding that the studio functions as a nonverbal therapeutic intervention by facilitating the art expression in the client (p. 189). Henley postulated that studio space acting as Third Hand in its ability to set the stage for ³further intervention and therapeutic change´ (p. 190). Kramer (1986) described the Third Hand as a nonverbal, un-intrusive intervention through medium or technique, which is sensitive to clients¶ intentions, an alternative to verbal interventions for broaching clients¶ issues. Furthermore, the Third Hand technique does not impose unwanted preference to the client or distort intent or image of the art works. I am proposing that gallery/exhibition space can act much like Henley¶s perception of the studio space as a part of the therapeutic experience. The gallery space can be the non-verbal intervention, working as Third Hand intervention can aid in the holding experience of the exhibition participant. This can aid in the therapeutic experience of exhibiting artwork, enacting an extension of the therapeutic engagement from studio or art therapy session to exhibition space. Here the therapeutic process can continue to flourish outside of session.

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Art of the Mentally Ill Throughout history, art of the mentally ill has been a source of intrigue and curiosity for both art and psychology communities (Prinzhorn, 1972; Pickford, 1967; Foster, 2001). The Prinzhorn Collection, serves as a pivotal example of exhibiting art of the mentally ill dating as far back as the early 20th century. In 1919, Prinzhorn, art historian and psychiatrist, was appointed overseer of Heidelberg Psychiatric Clinic¶s collection of art of the mentally ill; here he established his collection of art works by the mentally ill (Foster, 2001, p. 4). Prinzhorn continued building his collection, gathering works from several European asylums, resulting in a collection with over 6,000 works of art (Spaniol, 1990a). Prinzhorn¶s collection along with his publication, Artistry of the Mentally Ill (1972) inspired many European modern artists, such as Paul Klee, Max Ernst, and Jean Dubuffet (Foster, p. 9). Inspired by the immediacy of the raw image, Dubuffet (1942) coined the term Art Brut, meaning raw art, or rough art, established to describe art created outside of the boundaries of the official culture, with attention to pure, and authentic artistic impulse, representing the depth of the artist. In 1949, Dubuffet hosted one of the first Art Brut exhibitions, Compagnie de l¶ Art Brut. In 1985 pieces from the Prinzhorn collection toured four American museums, awakening the American public to the visual potency and symbolic imagery of Art Brut. Following the Prinzhorn tour, art by people with mental illness has begun to enter mainstream American art in various supportive galleries and exhibitions. Paralleling European¶s Art Brut, the term outsider art was established in the United States by Roger Cardinal in 1972. Outsider Art encompasses art made by the

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mentally ill and people marginalized in society (Spaniol, 1990a, p. 72). Terminology such as ³outsider art/art brut/visionary art/folk´ is highly debated in the field of art of art therapy (Vick as cited in Malchiodi, 2003, p. 2). One such example is Spaniol¶s view of the term outsider art having the potential to increase social stigma of the mentally ill. While Lentz (2008) defended the use of the term outsider, proposing that the term outsider art as a term can actually ³harness the potential power of otherness´ (p. 14). Although the art community continues to debate on a universally accepted label for art of the untrained and mentally ill, it is clear a bridge between artist and psychopathology exists and has existed throughout history. Classic historical artists such as Vincent Van Gogh, Edward Munch, Paul Gauguin and Jackson Pollack all suffered from psychotic breaks and depression (Vernon and Baughman, 1972). Vernon and Baughman found that ³artistic expression is often a non-verbal manifestation of unconscious affects or feeling and a means for the artist to be better understood´ (p. 420). Cohen (1981) explained that people with mental illness can use art as a way to find a balance between fantasy and reality. Pickford (1967) suggested that psychotic fantasies can be brought to a secondary relationship with reality, by projections and realization in the art form. Vernon and Baughman (1972) further maintained, ³Communication between the artist and observer occurs at unconscious levels resulting in the deepest of human interaction´ (p. 420). The artist may test his dangerous thoughts and ungratified phantasies by exhibiting art expressive of them in public places, here phantasies are brought to exterior by projection, allowing the ego to realize even the most dangerous phantasies can be harmless (Pickford, p. 18).

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Art Exhibitions in Art Therapy The following section will examine art therapy literature regarding exhibiting art as a part of the art therapeutic process. Within recent years there has been more art therapy research and literature written on exhibiting client art, client¶s artist identity, empowerment via art product, and bridging the art and art therapy community. I am exploring the potential of exhibiting artwork as a way to elongate the therapeutic encounter and refuel the momentum begun in the process of creating. In Pendleton¶s (1997) writing she described her experience with art therapy in psychiatric day treatment, affirming that ³the artworks produced are reinforced when exhibited, contributing yet another cycle of therapeutic affirmations´ (p. 35). This section of the literature review will cover psychiatric hospitals with art programs, and the research of art therapists who believe exhibiting art is a useful component of art therapy with the mentally ill population. Exhibition Space Within Treatment Facility Although not directly employing art therapists, psychiatric facilities such as Brazil¶s Pedro II Psychiatric Hospital and America¶s Creedmoor Psychiatric Hospital serve as landmark examples of exhibiting art of the mentally ill as a therapeutic modality. Both of these facilities have not only welcomed art expression as a prominent therapeutic tool for their adult psychiatric programs, but also incorporated museums and gallery space in their psychiatric treatment facilities. The Museo de Imagens de Inconsciente (Museum of Images of the Unconscious) was established in 1952 in Brazil¶s Pedro II Psychiatric Hospital, by psychiatrist Dr. Nise de Silveira. As a part of the Art as Therapy program established in 1940, the museum

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provided regular exhibitions of patient work and a source of great art inspiration for Brazil. Acclaimed by Brazilian art critics, the artworks of Pedro II were recognized at an exhibition commemorating the Brazil¶s five-hundredth anniversary (Holston, 2004, p. 8). Some patients such as Isaac Liberato and Carlos Pertuis received world-renowned fame and recognition from both art critics and psychologists alike. For some of these patients Pedro II was a lifesaving experience aiding in mastery and a sense of pride through development of their artist identity (p. 12). The healing potential of this facility is still ever present, even more so with their incorporation of the Museo Vivo (Living Museum). Set apart from the museum¶s main gallery, this space, available for patrons to view, serves as an open studio where outpatients come and go, creating throughout the day (p. 13). Similar to Brazil¶s Pedro II art inclusion, The Living Museum of Creedmoor was formed from a 40,000 square foot, abandoned kitchen/dining building in Queen¶s Creedmoor Psychiatric Center, by Bolek Greczynki and Dr. Janos Marton. The museum has been running for the past 26 years, showcasing more than 800 patient/artist¶s work throughout the years. Marton (as cited in Goode, 2002) explained how the Living Museum provides a realistic framework to exhibit artwork, further substantiating the identity transformation from mental patients to artists. The Living Museum of Creedmoor is the first museum in the United States solely dedicated to exhibiting art by people with mental illness. Both Pedro II¶s Museo de Imagens de Inconsciente and Creedmoor¶s Living Museum, serve as landmark examples of ways to incorporate exhibiting art and artist identity into treatment procedures.

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While the development of art therapy differs from the examples given above, many art therapists continue to seek and create new advancements in the field. Thompson (2009) cited the therapeutic value to his incorporation of a permanent gallery within an urban psychiatric facility. He found that the gallery promotes a more hopeful sense of identity through artistic sensibility and de-stigmatization (p. 162). Thompson described this mode of working as the gallery model; this term refers to the addition of an art gallery, serving as a modality for the art therapy program. Thompson proposed the gallery mode as a platform for showcasing the art product in its own right, therefore welcoming further introspection. From a humanistic perspective of art therapy, Betensky (1977) suggested that looking at the art product separates the object from the creator; this separation serves as a crucial element in exploring the relationship between an individual¶s objective and subjective reality. Furthermore, exhibiting in the gallery, unites process and product, promotes de-stigmatization of the mentally ill and empowers patients through artist identity (Thompson, 2009, p. 159). Therapeutic Benefits of Artist Identity Mango (2005) identified artist identity as a tool for increased sense of self-worth and self-esteem for the participants of the 1999 exhibit Art on My Mind, Achievements of Artists Living with Mental Illness (p. 217). According to Franklin (1992) self-esteem can be understood as a self evaluation of a core of personal worth and appreciation for self (p. 79). Exhibitions offer the opportunity for the client to test out the role of artist, fueling a sense of artist identity. This role is reiterated by placement of artworks outside of the studio and into museum or gallery space; here the artworks join the realm of the art world and art history continuum. Elevating the artwork to a more socially significant space,

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such as a museum, can aid in shifts in the client¶s perception of self. Rosenfield (1992) found that status serves as a crucial component for developing feelings of power, a key component in mental health services, which enhance quality of life (p. 309). In an effort to educate and promote de-stigmatization to the public, Art on the Mind took place at The Bronx Museum as a part of Mental Illness Awareness Week. Positive feedback from the community resulted in external validation for the exhibiting clients. This experience aided in a sense of empowerment and increased enthusiasm in the art therapy sessions that followed (Mango, 2005, p. 217). Focusing on empowerment through artist identity, Alter-Muri (1994) chronicled the implementation of art exhibitions in an individual art therapy treatment plan for a mentally ill client. She found that when her client, Mr. Q, felt his art was admired he gained a sense of importance through artist identity (p.221). Alter-Muri further posited her client¶s use of artist identity aided in decreased delusional thoughts of grandeur, indicating a sense of self of esteem, but also identity, that was now grounded in reality. Pendleton (1999) examined artist identity in art therapy participants of an outpatient day treatment facility; she concluded that artist identity increased clients¶ sense of accomplishments and allowed the clients to view themselves in new, more positive lights. It was Pendleton¶s hope that this sort of positive experience could permeate the entire treatment experience. In congruence with Pendleton, Vick (2000) suggested through the Creative Dialogue (1999) exhibition, which featured both client and intern artworks, that lines expert and helpless patient blurred and left room for new levels of empathic understanding. Vick found that exhibitions allow for ³an otherwise marginalized individual to share his or her art with others´ (p. 217).

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Schindler and Pletnik (2006) conducted a study in role development as an intervention with individuals diagnosed with schizophrenia; they found that despite complications regarding their mental illness, social life and economic status, participants were willing and able to develop skills and meaningful roles, including role of artist. Through use of individual art therapy sessions, Schindler and Pletnik found that art therapy increased a sense of role of artist, fueling an artist identity, which contributed to a more relatable role of family member. This case study found that the patient displayed increased self-esteem as a result of praise and acknowledgment of exhibited artworks. Schindler and Pletnick (2006) spoke to the empowerment enhanced through use of role development as a therapeutic intervention as a means to ³regaining roles and skills´ (p. 128). Lentz (2006), director of open studio program Project Moving On, firmly believes that an effective exhibition program for people with mental illness must promote role development that aids in vocational encouragement as well as self-esteem (p.14). Spaniol (1995) spoke to the concept of role development towards artist role as a way to form an achieving self, which aids in a positive self-identity. Additionally, Spaniol suggested strengthening of self-hood as a key component to the road to recovery for people with severe mental illness (p. 270). Through these examples, art therapists who incorporate exhibitions and artist identity in treatment found that ³for those who build art making into their lives, the positive social identity of artist often furnished an empowering alternative to the negative stereotype of the mental patient´ (Spaniol as cited in Malchiodi, 2003, p. 270)

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Therapeutic Elements in Organizing an Exhibition Spaniol¶s dedication to exhibitions for people with mental illness culminated in a Manual, Organizing Exhibitions of Art by People with Mental Illness (1990b); this resource explains useful steps and procedures for setting up these exhibitions. For example, the manual suggests group meetings for registration of artworks; this type of registration aids in participation by providing clear directions to the group. This group format alleviates the individual from a possibly overwhelming solo experience. In essence, this registration intervention reiterates a therapeutic stance throughout the entire exhibition process. In Henley¶s (2004) article regarding the use of art critique in art therapy, he explained the possibilities for anyone showing their artwork to experience feelings of anxiety and intimidation (p. 79). While these feelings should be acknowledged, if the gallery space is utilized as a continued therapeutic holding environment, it can help minimize the client¶s feelings of anxiety, rejection or loss. Spaniol (1990b) maintained that one of the vital components in exhibitions with individuals with mental illness is the idea of empowerment utilized throughout the entire process. Organizing Exhibitions of Art by People with Mental Illness (1990), documented the step-by-step process from conception to opening of the 1989 exhibition Art and Mental Illness: New Images. In Frostig¶s (1997) review of this manual, it is described as ³a pioneering effort to establish an ethical format that both celebrates the artistic accomplishment of people with mental illness and communicates the roles that art can play in healing process of one¶s life´ (p. 131). In keeping with the theme of empowerment throughout the exhibition process, the exhibition featured a running slide

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show of works contributed but denied for the actual exhibition. According to Spaniol (1990b) these exhibits must be handled with the utmost of delicacy, keeping in mind both stigma and bias of the mentally ill. In this way creating an exhibition featuring only works of current patients or ex-patient work becomes more complex than the duties involved in putting together exhibitions in general. Special awareness and precautions must be considered for such elements as, the title of the exhibit, the type of opening reception and sensitivity towards representation of those who may not be able to fully verbalize themselves clearly. Alter-Muri (1994) proposed that exhibiting art is not appropriate for all clients; the risk of unknown reactions to something as personal as one¶s artistic expression can be a major setback in treatment (p. 223). Bringing the Art to the Public Vick and Sexton-Radek (2008) identified that entering the gallery space holds the potential to offer altered perceptions by participants and viewers long after the exhibition (p .6). Further, Lentz (2008) maintained that outcomes for vocational empowerment and social role valorization are made possible when the artwork gets out of the studio and into the culture at large (p. 14). Bringing the art outside of the studio space allows it to exist in a new and unforeseen way; now the art can interact with others besides a therapist or fellow group member. Pendleton (1999) found that second level of self-esteem can be formed through experience artworks outside of the creation experience, and viewing them exhibited in publications, studio walls, or gallery space. The outcome of exhibitions for people with mental illness is two-fold; the artist can experience a new perception of self, while the viewer can experience a new perception of the artist or mental illness as a whole.

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Spaniol (1990b) explained that the Art and Mental Illness exhibition aimed to ³increase public awareness and understanding about those who experience mental illness, reduce stereotype and the resulting in social stigma´ (p. 22). Further, Spaniol (1990a) stressed one key mission for the exhibition was to highlight the art and artists and not just mental illness itself (p. 74). This idea holds potential for use of exhibition space as a therapeutic modality, and a humanizing experience in treatment. Conclusion In closing, while exhibiting art has the potential to engender therapeutic benefits, the uniqueness of the individual and their relationship with their artwork must not be forgotten. Treatment of mental illness is a vast topic in which many therapeutic modalities are applied. Normalization ties in with the de-stigmafying efforts of exhibits of art for the mentally. While a connection between mental illness and creativity appears to have a long history of correlation, the actual exhibiting of the art is another realm the creative process. It is within the exhibition space that possibilities for a different kind of therapeutic experience with the art can be made, via potential for holding environment, transitional space, play space, and external validation further opportunities for artist identity and empowerment can unfold. Therefore, art therapists can take the chance to focus not only on client¶s psychiatric disabilities but also on the creative strengths of the clients.

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Statement of Research Problem Art Therapists have written about their experiences witnessing, contributing, and aiding in art therapy related exhibitions with people with mental illness. They have demonstrated clinical vignettes of the effects of exhibitions and conducted case studies relating to exhibiting as a part of treatment. Despite this important research, the lived experience of the artists participating in these types of exhibitions had not been shared from their points of views. Spaniol (as cited in Malchiodi, 2003) emphasized the life and death seriousness in finding effective approaches to treating people with mental illness. She stressed the difficulty in creating ³hope-inspiring methods´ within the current climate of mental health in the United States. Spaniol is referring to the harsh realities in which treatment can be brief and limited in hospital settings. Art therapy offers a creative component to treatment by validating the use of non-verbal expression as a form of therapy. However, restrictions, and limitations within art therapy still exist. These limitations include, large groups held with people of not only varying diagnosis, but also vast differences in developmental stages, recovery stages, emotional states, and cognitive capabilities. How can art therapy further excel in aiding treatment for mental illness and can art exhibitions serve as an additional beneficial option to art therapy treatment for people with mental illness? Furthermore, Vick and Sexton-Radek¶s (2008) research on community-based art studios stressed the need for growth within the field of art therapy, ³Moving from a

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narrow medical model to services that address broader social, vocational, and rehabilitation dimensions demands a redefinition of the limits of the art therapy field´ (p. 10). There is a need for continued expansion and incorporation of new methods within the field of art therapy. Lachman-Chapin et al. (1998) stressed that the profession has been focusing on the mental health world for far too long, suggesting a shift toward the art world could add a source of enrichment for the profession (p. 234). Research Question How does participating in art exhibitions affect adults with mental illness? Definition of terms Medical Model: Psychotherapeutic approach that treats pathology or symptoms instead of the whole individual; a clinical way of viewing treatment. Normalization: Psychosocial rehabilitation model that emphasizes achieving and maintaining valuable social roles; full participant in the features of daily life. Empowerment: Factors that increase strength and power; a process to gain mastery over one¶s life. Empowerment Approach: Model of treatment that focuses on minimizing the differences and stigma between staff and clients; lessening the hierarchy to promote a collaborative form of treatment. A model in which staff focuses on clients¶ strengths over weakness and illness. Developmental model: Model of treatment grounded in a rehabilitation approach with vocational aspects. Art Exhibition: An exhibition of art objects (sculpture, painting, etc).

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Therapeutic Intervention: Intervening with intent to modify an outcome promoting healing and wellness. Art Therapy: Art therapy is a mental health profession that uses the creative process of art making to improve and enhance the physical, mental, and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and selfawareness, and achieve insight (American Art Therapy Association, 2009). Art as Therapy: The act of creating itself is thought of as therapeutic; the art therapist provides conditions to nurture and support the creative process, including technical support and emotional support. Open Studio Art Therapy: Approach to art therapy where participants are viewed as artists as opposed to clients or patients. The art therapist acts a facilitator, and fellow contributor to the space, often creating alongside the participants. Art therapists provide guidance and prevent overwhelming anxiety, yet they do not implement directives. Often more professional art materials are used in the open studio approach. Participants are encouraged to think of themselves as artists. Mastery: Possession or display of great skill or technique; knowledge that makes one master of a subject (Merriam-Webster Dictionary Online, 2010). Mental Illness: A brain disorder that affects one¶s thinking, feeling, moods, and ability to relate to others. Major Depression: Unlike normal emotional experiences of sadness, loss or passing mood states, major depression is persistent and can significantly interfere with an

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individual¶s thoughts, behavior, mood, activity, and physical health. This medical illness interferes with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major depression is also known as clinical depression or unipolar depression. Symptoms of depression may include loss of energy, prolonged sadness, decreased activity and energy, restlessness and irritability, inability to concentrate or make decisions, increased feelings of worry and anxiety, less interest or participation in, and less enjoyment of activities normally enjoyed, feelings of guilt and hopelessness, thoughts of suicide, change in appetite, and change in sleep patterns (National Alliance of Mental Illness, n.d.). Bipolar Disorder: Medical illness that causes extreme shifts in mood, energy, and functioning. Bipolar is characterized by the presence of an episode with manic features (manic, mixed, or hypomanic) in addition to a depressive episode. Bipolar Disorder is also referred to as Manic Depression. A Manic episode is described as an activated period of bipolar which may include either an elated, happy mood or an irritable, angry, unpleasant mood, increased physical and mental activity and energy, racing thoughts and flight of ideas, increased talking, more rapid speech than normal, ambitious, often grandiose plans, risk taking, impulsive activity (such as spending sprees, sexual indiscretion, and alcohol abuse), and decreased sleep without experiencing fatigue. A mixed state is when symptoms of mania and depression occur at the same time. During a mixed state depressed mood accompanies manic activation. Depressive episode described in symptoms of major depression (National Alliance of Mental Illness, n.d.). Schizoaffective Disorder: Related occurrence of both mood disorder episode (major depressive, manic or mixed) and symptoms of schizophrenia, such as delusions,

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hallucinations, disorganized speech, disorganized behavior for at least two weeks. There are two subtypes of schizoaffective disorder, bipolar subtype or depression subtype (National Alliance of Mental Illness, n.d.). Post-Traumatic Stress Disorder: Anxiety disorder, featuring a development of characteristics symptoms associated with exposure to an external traumatic stressor. Symptoms include, intense fear, horror, flashbacks or re-experiencing of the traumatic event, avoidance of associated stimuli, numbing such as dissociation or self-medicating, excessive emotions, overwhelmed feelings and increased arousal such as irritability (National Alliance of Mental Illness, n.d.). Limitations/delimitations Since the selection process was on a volunteer basis, only female participants were interviewed. This could have lead to a skewed sense of information. Further limitations were found in the inability to secure interviews with exhibiting artists with mental illness that are also part of an art therapy program. Recruitment for this study was conducted on a volunteer basis, five females volunteered. This study did not intend to conduct interviews with only female participants. According to the World Health Organization (WHO) (n.d.) Gender determines the differential power and control men and women have over the socioeconomic determinants of their mental health and lives, their social position, status and treatment in society and their susceptibility and exposure to specific mental health risks. Further WHO (n.d.) found that women are more likely to seek help for, and disclose their mental health problems to their primary care physician; while men are more

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likely to seek a specialist and are the primary inpatient care users. This finding offers insight into gender differences related to disclosing mental health information and could explain why only female participants volunteered for this study. Lastly, it was noted by WHO (2010) that when severe mental illness, such as schizophrenia or bi-polar, are involved, there are not distinct gender differences in the rates of those affected. This finding lessened the limitations of having all female participants, when each has a persistent and moderately to severe mental illnesses. The second limitation was due to time constraints and difficulty getting clearance into hospital facilities. I did not get to interview any adults with mental illness who exhibit their artworks and have participated in art therapy. My original intent for this thesis was to compare and contrast the responses from participants in art therapy and those that were not. However, the study was tailored and altered to fit the constraints, resulting in a different, yet beneficial viewpoint. If I conduct further research on this topic I would incorporate additional artists in art therapy programs. Delimitations were found in the open ended nature of the interviews with lead to rich, full bodied responses. Delimitations were also found in the willingness of the participants to share their stories and the ability to meet in a familiar atmosphere, gallery at Facility A. Due to my choice to conduct open ended interviews, the data was dense, yet rich in quality. However, the length of the recorded data between all five participants came to about just over 11 hours. Due to the transcription process and methodology of this research, I couldn¶t compile more data, or take on any more participants. In future studies I would aim to conduct similar research rooted in data analysis via scale based

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questionnaire and interviews done at exhibitions. These types of research tools would allow for more participants and a mixed, qualitative and quantitative study.

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Methodology Research Approach The qualitative research approach, grounded theory was chosen for this research, formulated by Glaser and Strauss (1967). Qualitative research is defined as: An inquiry process of understanding based on distinct methodological traditions of inquiry that explore a social or human problem. The researcher builds a complex, holistic picture, analyzes words, reports detailed views of informants, and conducts the study in a natural setting (Creswell, 1998, p. 99). Qualitative inquiry is rooted in understanding the nature of the participants lived experience and how they construct, understand and explain their experiences from a unique subjective view-point. The Grounded Theory approach is based in the idea of emergent research; therefore the theory is shaped by the data (Glaser, 1998). In the Grounded Theory approach the theory is developed out of the central phenomenon found in the data. This study aimed to develop a theory about the use of art exhibitions as a therapeutic modality for adults with mental illness, grounded in the interview data of 5 participants with mental illness that create and exhibit their artworks. I compared the data (interviews) to one another, culminating in an analysis of how the data leads up to a formulated theory. The data was analyzed through a system of coding; through this approach I found categories/themes across the interviews, this lead to emergence of a core category, evolving to the root of the formed theory regarding art exhibitions as a therapeutic intervention for mentally ill adults. The data was sequenced

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to form a path towards a theory. In this sense, as data interpretations accumulated, the theory was discovered. Data collection for Grounded Theory research consists of a process of notetaking, coding, memoing and sorting. The interviews were recorded for transcription purposes. The note-taking process took place post interview upon listening to and transcribing the interviews. Coding was the prime method of creating categories, memoing consisted of my own personal thoughts, beliefs, ideas, concepts, and feelings in response to the coding process; memoing aided in linking together the categories found in the coding process. Grounded Theory is rooted in a theory being formed from responses of the research participants, thus hypothesis testing does not occur, instead the hypothesis is formed based on data received. Data analysis for Ground Theory requires three types of coding procedures, open coding, axial coding and selective coding. The data is coded for each interview by reading each transcription several times, and searching for similarities and differences between the transcripts. In this way the findings of each interview are compared to one another. The coding process begins with open coding, this is how phenomena is found in the data, beginning with the first interview transcription, developing a core category. The second interview is compared to the first, and subsequent transcripts are coded using a ³comparative method´ that compared data set to data set (Glaser and Strauss, 1967). Similar experiences found throughout the transcripts are grouped together and given a conceptual label. These concepts are then grouped together into categories. Coding aims

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to break down the data and reform it in a new way, so that a coherent theory is formed (Strauss and Corbin, 1990, p.16). This process of reformation or axial coding makes connections between categories discovered during opening coding (Strauss and Corbin, 1990, p. 96). I coded with attention paid to inconsistencies within individual transcripts and across the transcripts. In essence, as the data was coded, core categories emerged; these categories were based on common themes found between the transcriptions. Axial coding makes connections between the categories; the central phenomenon emerges during axial coding, and its relationship to all categories is explored. The categories are then grouped together by relationship to one another, resulting in selective coding which is the process of integrating the categories to arrive at a core category, the basis for the theoretical framework of the research. According to Strauss and Corbin (1990), ³The process of selecting the core category, systematically relating it to other categories, validating those relationships, and filling in categories that need further refinement and development" (p. 116). By selective coding, a story is formed between the relationships of the categories. Therefore the core category is the category that has been mentioned frequently throughout all data, and validates other categories and subcategories. Lastly, the theory was formed as a result of sorting the data. Sorting provided a format for writing up the findings in the Results and Discussion sections of the thesis. Sorting involved grouping all memos, which had been taken throughout data analysis, as they relate to similar categories that validated the theory, thus a sequential map was created of how the theory was developed (Strauss and Corbin, 2008, p.279).

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Glaser (1998) explained that adequacy of the research can be tested by how the research and theory aids the participants and helps them gain a better understanding of their experience. I also extended this sentiment to the field of art therapy, suggesting that through Grounded Theory research it may be possible for the participants and the community to gain a better understanding of different art therapeutic interventions that do not necessarily include direct art making, but rather the lived experience of an event. Research Methodology I used the Grounded Theory approach because it is unlike other hypothesistesting methods; instead it is participant-based research rooted in uncovering the central phenomenon by understanding the research situation. Also this type of action research was particularly fitting for this study since participants were not tested against a preconceived hypothesis; this allowed for additional sensitivity to stigma against people with mental illness. Further, I found that Grounded Theory paralleled the emergence of art exhibitions to art therapy field. Research Procedures The central methods used in this study included interviewing the participants and recording their responses. I used a digital recording device to record the interviews and all dialogue during the interview sessions. I transcribed all of the recordings by playing the recordings and typing out all verbal communication. Four out of the five interviews were administered face to face; the goal of this type of interview was to create an atmosphere where I could explain the research procedures while creating a humanizing experience in which participants could speak more freely and ask questions. Interviewing in person was also utilized as a method to enhance accessing the theory

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found through viewing, listening and experiencing the story of the individual. However I made an exception to include the fifth participant; an opportunity arose during recruitment to interview a participant that lives abroad. I felt this participant¶s artistic background and active exhibiting career would be an asset to the research. The fifth interview was conducted via SkypeŒ with a participant affiliated with one of the recruitment facilities. SkypeŒ is a computer software program that enables free video and voice calls to be made internationally over the computer. Digital recording device was used to record the computer¶s output. I conducted semi-structured interviews, which entailed a questionnaire (see appendix A) of mostly open ended questions, which provided for the openness in sequence of questions and adjustment of questions according to the participants response (Steinar, 1996, p 124). The interview situation used in this qualitative method aimed to create a conversational atmosphere that helped clarify the experience of the participant and the participant¶s understanding of their experience (Soklaridis, 2009). I conducted interviews with a series of questions in order to create a structure sensitive to the participant¶s level of ability to speak freely, thus questions were used if prompting was needed. Semi-structured in-depth qualitative interviews were used to gain as sense of the social atmosphere of the eternal exhibition space as well as the internal experience of the participant. Both external and internal experiences were analyzed in relation to identity, empowerment and therapeutic significance. Setting Research participants were found through research facilities that specifically promote and partake in exhibiting art of the mentally ill. The participants were obtained

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from two facilities that work to decrease stigma of mental illness by use of artist identity. One facility is an art gallery affiliated under a larger umbrella facility that promotes vocation, work opportunities and education for people with mental illness; for protection of privacy this facility will be referred to as Facility A. The second facility in which participants were obtained will be referred to as Facility B. Facility A is a part of a psychosocial rehabilitation program that does not conduct therapy treatment onsite. Instead, the facility¶s goal is based in bettering the lives of the mentally ill by providing opportunities for working, learning and contributing to the community. The main goal is to find means of eliminating stigma against people with mental illness. The gallery is artist run and only showcases works by artists with mental illness. Further, Facility A provides an environment for artists with mental illness to partake in exhibitions at the gallery, take classes, volunteer in the gallery, and contribute their input to the community of artists affiliated. Lastly, this facility offers opportunities for artists to sell their artwork, expose their artwork to the local art community and participate in exhibitions and art fairs outside of the gallery. Facility B is a large art studio within a psychiatric hospital providing inpatient and outpatient services. This studio functions as a work space and museum for clients with mental illness. This studio program is directed and founded by a psychiatrist and is offered as a part of treatment, aiming to decrease stigma and promote artist identity for the psychiatric patients at the hospital. Long term members of the studio maintain their own studio spaces in which they can store and create artworks. Facility A hosted an exhibition for Facility B, I recruited participants via contact with Facility A; two participants were artists of Facility B and were showing in this

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particular exhibition. As mentioned previously, one of these two participants no longer attends the studio and currently lives abroad, yet remains affiliated with Facility B¶s exhibitions and the collective of artists associated. The other three participants were artists of the gallery, Facility A. Four participants were interviewed at Facility A and the fifth participant was interviewed via SkypeŒ, as mentioned above. The director of Facility A was aware of these interviews. One participant, an outpatient of Facility B, was a contributing artist to the group exhibit Facility A was hosting. This participant utilized Facility B for the studio space, exhibition space and a commissioned painting position. Population The research was conducted with 5 participants. Each participant was an adult 18+ with a mental illness and had exhibited their artworks in the past or is currently an exhibiting artist. Each participant is affiliated with a program that promotes mentally ill artists. Mental disorders among the participants included Schizoaffective, PTSD, Major Depression, and Bi-Polar. Ethics I received approval for research project by Pratt Institute Internal Review Board. I received proper, signed informed consent forms from each participant. I did not know or therapeutically work with any of the research participants prior to conducting the research. I began the recruitment process by contacting the director and staff of Facility A and the director/head psychiatrist at Facility B via email recruitment letter. I was informed by both to attend an Exhibition at Facility A which featured the artists of

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Facility B. I proceeded by attending two of Facility A¶s weekly information meetings, in order to explain the research project and recruit participants. I announced the study at the meeting and accepted interested volunteers that met the criteria, three from Facility A and two from Facility B. The participant living abroad from Facility B was contacted via email; contact information was obtained at Facility A¶s exhibition for Facility B. At the beginning of each interview meeting, I informed the participant about the use of the interview as a part of a graduate art therapy thesis requirement. I also asked the participants if they had any questions regarding the study, their involvement and the usage of data. Prior to recording, participants were informed that they are free to disclose as much or as little as they desire and that every level of their participation is completely voluntary. The recordings were heard and transcribed only by myself to insure privacy. Names and identity used in the research were changed for participant confidentiality protection. Participants received a consent form, and were allotted time to read over and decide if they wanted to be involved. I verbally reminded the participants that they have the right to withdrawal at any portion of the research. In order to minimize risks, four of the five interviews took place at the Facility A, where both members of Facility A and B had or were currently exhibiting their art. Location was chosen so that the participants would be comfortable, due to proximity and familiarity and support of staff and peers post interview.

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Findings The data for this study is based on five interviews of adult women with mental illness who create and exhibit artwork, ranging in mediums, such as painting, drawing, collage, assemblage, and performance. Four out of the five interviews took place at Facility A, a gallery affiliated under a larger psychosocial rehabilitation facility that aims to improve the life of individuals with mental illness. The gallery is a co-operative, artist run space, showcasing art by people living with mental illness. During the time of data collection for this research, Facility A was hosting a visiting artist exhibition, featuring the artists of Facility B. Facility B is a studio based program, operating as a museum and studio work space, located on a psychiatric hospital grounds. One interview was conducted electronically because the participant lived abroad, yet was a past member of Facility B and a contributing artist to this particular exhibition. Each participant had a diagnosed mental illness, diagnoses include: Schizoaffective Disorder, Post-Traumatic Stress Disorder, Bipolar Disorder, Major Depression, and Anxiety disorder. The participants ranged in age between 30¶s-60¶s and are all at varying levels of involvement in exhibiting their art. The interviews were semi-structured and open-ended in nature; this conversational method lead to varied interview lengths, from approximately 30 minutes to 2 hours in length. I aimed to create a conversational setting; thus, the participants were

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allotted as much time as they needed to share their stories. The disparity in interview times resulted in entirely unique accounts from each participant; each participant shared differing amounts of detail regarding history of mental illness and relationship to art. Each interview began with a debriefing about the use of this study, my role as a student, and an explanation of confidentiality. I also informed each participant what type of interview I was conducting and what to expect. I informed each participant that I had a questionnaire (see Appendix A for questionnaire) on hand as a guide if needed, but that the interview would be conducted conversationally, and that they could speak freely about what is most relevant for them to share. The questions from the questionnaire were utilized as a prompting tool to further engage in dialogue or reinitiate the dialogue, after allowing for a gap of silence. The questionnaire was also referenced when I felt a pertinent area regarding the impact of exhibiting art did not emerge during the openended discussion. In order to make sure criteria for participation was met, I began each interview by asking the participant their age and diagnosis. The interview proceeded with a more open question, ³Can you describe how you first became involved in creating art?´ This question began the dialogue for each interview; each participant described a rich account of her use of creativity and art starting at a young age. This similarity in life experience is where I began memoing and open coding, in search for thematic similarities. Open Coding Open coding began with finding core categories that stood out when comparing the interview transcriptions. The data is then named, and initial categories are developed and grouped together by similarities. These beginning stages of coding involved

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considering the data in minute detail, searching for linkages between each of the transcriptions. Since this was the first stage of the coding process and analysis of the data many concepts emerged before further narrowed down in the axial and selective coding stages. The categories that initially emerged included: 1) history of art background, 2) return to normalcy, 3) attachment feelings towards the artworks, to sell or not to, 4) impact of living with a mental illness: acceptance/integration, 5) sense of awareness of art as self treatment, 6) how the viewer perceives work/opportunities from exhibiting, 7) components necessary for personal, subjective process of art making: studio space/content of the art, 8) different roles and levels of involvement in exhibitions space and exhibits, 9) speaking to the viewer about your artwork, 10) feelings of pride during exhibitions, 11) past types of treatment programs: opinions on the mental health system, 12) community experience of exhibiting, 13) identity, 14) solitude, 15) giving back to community, 16) views on outsider art and quality of work, 17) art therapy, 18) cathartic discharge when creating, 19) seriousness about art. After this open coding phase, these preliminary categories were compared with the memoing notes that took place during the data collection period. These notes of my emerging thoughts and ideas throughout the study served as a helpful comparative reference point, contributing to the narrowing down of many, to fewer more saturated concepts. These concepts were formed by integrating categories; certain categories found during open coding served as an umbrella category, in which other categories could be condensed within, as a contributing element. The resulting categories were named: 1) attunement with art making throughout life, 2) sense of community, 3) art making

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process, 4) identity, 5) previous forms of treatment, 6) outcome of art product, 7) emotional involvement with exhibiting, 8) control over life. Axial Coding Once these eight core themes were identified, the next phase of coding, axial coding, was conducted. The process of axial coding involves creating connections between each category in order to arrive at the central phenomenon. The process of axial coding is best understood through forming a paradigm model (Strauss and Corbin, 1990). The paradigm model (see Figure 1) aids in the understanding of the relationship between the phenomenon and its causes, context, consequences, and strategies.

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Context & Intervening Conditions: Long term history with art making, previous forms of treatment, art as self-care

Causes:
Art creation, art exhibiting, gallery space, studio space, resiliency, art as apersonal coping mechanism, integration of mental illness long-term artist ID

Consequences:

Sense of Mastery

Possibilities for monetary gain, attachment to art product, new community, de-stigmatization, gains in control of life and treatment, more positive self identity, views on outsider art, return to a time of feeling normal

Strategies:
Level of involvement in art exhibitions, artist community, artist identity, mentoring, teaching

Figure 1. Paradigm Model, Axial Coding

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Description of Categories Attunement with art making throughout life The First category refers to each participant describing her history of art making throughout her life, beginning in childhood. This finding supports the long history of connections between art and mental illness. Community The second category represents two forms of community, the community gained when working in a studio, or participating in group exhibition and the art community. Art making process Each participant gave a unique description about her art making process and what that process meant to her. This category also refers to how the art making process can be used as a self-healing tool. Identity This category represents several themes mentioned throughout the interview; here identity conveys identity experiences with artist identity, mentally ill identity, and positive self identity. Previous forms of treatment Treatment modalities were common themes found during the interview process; participants described varying interventions, treatments, and treatment facilities that were beneficial, or not beneficial to their wellbeing. The discussion of previous treatments led to discussions about their current forms of treatment.

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Outcome of art product This category stands for feelings and experiences that occur once the art product is completed. Outcome is understood as what happens after the process of creating the piece, if it is exhibited or sold, and the feelings that surround the piece post-production. Emotional involvement toward exhibiting This category symbolizes feelings about opening receptions, feedback during exhibitions, and how involved one becomes in the actual process of putting together an exhibition. This category also speaks to the importance of exhibiting in general. Control over life Participants expressed common feelings surrounding control over their lives and treatment of their mental illness. Art was found as a source of control.

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Discussion I began this research with an overall curiosity about the potential therapeutic powers exhibiting art can have on adults with mental illness. Centered in a qualitative approach, I entered the research with ideas for possible intervening elements such as: transitional space, holding environment, Kramerian third hand, and self-esteem through artist identity. While some of these factors were found to be contributing components, the research unfolded as a rich tapestry of interconnected responses, beyond what definitions and therapeutic terms can describe. My experience of the interview process is where the core foundation of this thesis lies. The shared spaces and holding environments experienced during the interviews highlighted the participants as exceedingly more than variables in a thesis study, rather real human beings willing and wanting to share in a dialogue about their lives. Each interview emphasized elements of art making, art exhibiting, and artist identity as a force for overcoming substantial obstacles and barriers, exemplifying resiliency and a testament to human survival. The single most cohesive similarity among all interviews was the thank you that took place at the end of each interview. Each participant conveyed gratitude towards me letting them openly share their stories. The participants showed a willingness to candidly tell me about their lives, and a dedication to meeting with me; this revealed how important it was for them to tell their stories. Each participant took their involvement seriously and expressed feeling honored in to participate in this research. In return I felt humbled and honored that all of the participants were willing to disclose intimate aspects

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of their lives to me. The sense of connection felt during these interviews cannot accurately be expressed by words or printed type. Manen (1990) expressed the sentiments of researching lived experience, stating that: ³Writing abstracts our experiences of the world, yet it also concretizes our understanding of the world´ (p. 128). The personal experiences of the interviews only remain in the memories of the participants and me. While these actual interview experiences are over, the data gathered remained to form a more universally conveyed message, the central phenomenon, and development of mastery. The phenomenon and themes found were based on five interviews with five different women, ages ranging from thirty years to fifties with one or more than the following diagnoses, Schizoaffective, Post Traumatic Stress Disorder, Major Depression, and Bi-Polar. Each participants name has been changed to a pseudonym for protection of privacy. Development of Mastery Mastery can be defined as ³skill or knowledge that makes one master of a subject´ (Merriam-Webster Dictionary Online, 2010). For purposes of this study, mastery referred to an individual having a skill or knowledge, which makes them the master of their own lives. Rosenfield (1989) found that an individual¶s sense of actual power contributes to a sense of mastery. Mastery emerged as the central phenomenon because each major theme found during data analysis related to the ways each participant used art to gain a sense of control over their own world. Rosenfield (1989) suggested mastery as a key element to a great life satisfaction.

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Intervening Conditions Strauss and Corbin (1990) described intervening conditions as conditions that either facilitate interventions or constrain them. The conditions found that facilitate art making and participation in art exhibitions are a long term history of art making, art making used as self-care and long-term feelings of possessing an artist identity. Since each participant described their long term relationship with art making, it was apparent that art making was a sustainable and essential piece of their identity. The relevance I found regarding a history of art making between all participants is related to their use of art as a way of being, knowing the world and knowing one¶s self. Based on the overall interview data, the process of art making was described as a way to communicate, feel a sense of recognition, escape from challenging moments, express and discharge emotions and make sense of feeling states. Long history of art making The first category, referred to each participant¶s life long history with art making. Each participant was asked how their relationship with art began. To my surprise, all respondents described early accounts of art making as a young child. Each interviewee recounted vivid and detailed examples of their first ever encounter with art making. I wrongfully assumed that due to my thesis topic the participants would begin speaking about art as a part of their current life or the inception of their exhibition history. All participants recounted their relationship with art before the onset of a psychotic break, or diagnosis; this demonstrated to me that creating art was engrained in their identity and served as a coping skill post diagnosis.

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These responses indicated that art making was a relevant process that impacted each participant¶s identity. Vernon and Baughman (1972) connected mental illness and creativity by referencing the biographies of Van Gogh, Gauguin and Pollack. They determined that, ³rather than having the defenses to repress or destructively sublimate primary process and affectivity, these persons were able to express this material´ (p. 420). All of the artists mentioned above were said to have had severe mental illness or experienced periods of psychopathology (p. 413). Vernon and Baughman suggested these artists were able to tap into primary process and expel it through the process of art making. This explanation implies that people with mental illness are inclined to utilize creativity as a way to cope with challenging primary process material and develop a relationship with art as a way to understand and vent such primitive material. Primary process thinking is developed in childhood, before the secondary process when speech and logic begin. This pre-verbal, pre-logical, dreamlike primitive form of cognition contains primitive impulses and drives expressed in symbols and images (McWilliams, 1994, p. 25). Spaniol (as cited in Malchiodi, 2003, p. 270) noted that some people with mental illness found their artistic nature to be a benefit of the illness. Further, Dubuffet (1989), creator of the term Art Brut, expressed that rather than a source of symptomology, psychopathology can be seen a pure and crucial component to the creation of art. Similarities in participant responses were also found within the description of art making as a way to communicate as a child, according to one participant, ³Art was all I could do.´ This individual described using art as her main mode of communication. Two other participants mentioned a sense of darkness that was released in artworks created

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during childhood; additionally two participants also referred to art making as a way to cope with challenging experiences as a child. Three participants referred to a strong connection to images of animals they created at a young age; I found this connection perhaps representing a sense of otherness, not quite human. Lentz (2008) spoke about this idea of otherness by interpreting the term outsider as a positive word that celebrates the idea of otherness instead of rejecting it (p. 14). Further, Lentz maintained that the term outsider, in relation to outsider art, communicates how artists with mental illness ³operate beyond the traditional norms and practice of visual art, devoted to producing artwork that has the capacity to communicate when language fails´ (p. 14). Each interviewee described their connection to art making as deeply rooted from early childhood, this finding validated much writing on the evidence of a connection between mental illness, art and creativity. MacGregor (1989) contributed to the wide spread correlation between art and psychology with his book, The Discover of the Art of the Insane. This book served as a historical account of the relationship between art and psychology spanning over the past 300 years. MacGregor wrote about the relationship between artists and madness, art as a treatment and use of artwork as a component to diagnoses. Each participant¶s long-term and basically lifelong connection to art making further substantiated the historical evidence of the connection between art, creativity and mental illness. While advocating for a middle ground between outsider and mainstream art, Prinzhorn (1972) found exhibiting art as a way for a person with mental illness to ³actualize the psyche and thereby build a bridge from the self to others´ (p. 12).

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Identity Identity refers to the way the participants see themselves and how they identify themselves. This theme relates to sense of self, stigma related to identity and artist identity. Jenny in particular discussed identity as it related to her artist identity and identifying with having a mental illness. Vick (2008) suggested that by entering the exhibition space as artist, the health care recipient can be seen in a different role to family, friends and staff (p. 218). This type of role shift can affect the identity of a person with mental illness and lead to de-stigmatization. Dawn adamantly spoke about the stigmatization of mental illness identity, asserting that people with a mental illness are the ³only people that can get yelled at for being sick.´ Previous to being diagnosed and treated for a mental illness Jenny had developed a long standing artist identity. Having created art ever since she could remember, being an artist characterized who she was. She also spoke about not really wanting to be a part of the ³ill scene;´ this is a term Jenny coined for exploited outsider art. She referenced how currently folk and outsider art created by people with a mental illness, is not seen for its artistic talent, but rather for its kitsch appeal. In essence, Jenny felt that the current fascination with art created by people with mental illness fuels a concept of rewarding the artists without artistic merit, but rather more simply because it is art created by an ill person. Similar to Jenny¶s opinion, Lachman-Chapin et al. (1998) wrote about the trend of romanticizing the painful lives of outsider artists, warning about the negative effects of highlighting mental instability (p. 237). Jenny explained this type of phenomenon, stating, ³a celebration of something that is not there«a celebration because someone said so.´ That statement seems to imply that there is a celebration or attention paid to

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stigmatized people being able to do something. Vick and Sexton-Radek (2008) suggested that a shift in art therapy practice towards a more studio based method would entail a shift from valuing all client art regardless of merit to dialogues about artistic aesthetics (p. 9). Jenny also explained this sentiment by stating, ³I don¶t want to be labeled or boxed in.´ This participant in particular emphasized her need to feel like a unique individual and not lumped in as another patient, or a set of symptoms. Jenny does not hide that she has a mental illness, yet does not want to be stamped as an outsider artist. Another participant, Alice, found that showing her work doesn¶t define who she is as an artist. Although Alice has participated in numerous exhibitions and plans to show more, she reiterated that exhibiting does not make you who you are. I surmised from our conversation that by these comments, Alice meant that one should not create artwork solely for exhibiting; art should be created as a personal therapeutic process as well, not just to put on display. Alice also mentioned her curiosity towards exhibiting at other galleries because she wanted to get feedback from additional viewers and artists. Thus, it was not that Alice did not believe in exhibiting her work, rather she felt just showing your artwork alone doesn¶t define your identity; it is in her creative process that artist identity is found. Additionally, Alice touched on how she identified with being an artist with a mental illness, she stated: It¶s wonderful if a show enforces your art, and doesn¶t define you, and being mentally ill, my mental illness is a part of me, I think I¶m very lucky to have it; I perceive and see things in a different way, sometimes I perceive wrong, sometimes it¶s good.

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Similar to Alice¶s response, Spaniol (as cited in Rubin, 2001) noted that some artists with mental illness find artistic creativity to be a benefit of the illness (p. 270). Barbara demonstrated a clear sense of pride in being an artist. Even her demeanor exuded a sense of putting her artist self to the forefront. Upon first meeting Barbara she was standing by her paintings, openly sharing about her works to entering viewers. Barbara¶s artist identity is also shown by the vocational effect exhibiting art has had on her life. Barbara not only has sold paintings and worked on music album covers, but she also is a part of a commissioned work program, in which she creates paintings for money. Barbara described her feelings about what it means to be an exhibiting artist, she stated, ³I feel confident, more not less than, its being established and I can be famous, I can teach other people. Someone¶s really interested, I can follow up on that too. After that I want to be more active.´ Visual art as a therapeutic tool can be used to strengthen a sense of self-hood; thus, the art product can aid in identity building (Spaniol as cited in Rubin, 2001, p. 274). Previous forms of treatment Various different treatment facilities and modalities, those which were helpful and those that were not, were mentioned from each participant. Receiving treatment, including pharmaceutical, psychotherapy both individual and group, inpatient hospital stays, day treatment and vocational services, are all forms of treatment that a person with mental illness will most likely experience throughout life. Three of the participants mentioned experiences in which their mental illness and disabilities were not validated or taken seriously. The lack of professional validation of their true experiences left these participants feeling blamed for their illness. One participant explained her feelings of loss

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and confusion when she couldn¶t ³just pick herself up by the bootstraps.´ Inevitably these experiences set up this participant for consistent failure in their well being. One participant, Jenny, spoke about her experience in an inpatient psychiatric state hospital, stating, ³People want to deal with you«all these strangers trying to make you a new person.´ She reflected on many challenging, hurtful and frightening experience she had during several different inpatient stays. She expressed that many of the modes of treatment within inpatient psych left her feeling disrespected, stripped of self-confidence and individuality. Jenny has identified herself as an artist for most of her life; it was during a prime period in her art career that she first was hospitalized. Due to this deep immersion in the arts, Jenny described the intense frustration and sadness that was felt from being away from her artwork, studio, and collective of artist friends. Jenny¶s description of these types of facilities brought attention to the dehumanizing practices that often occur within the mental health care system. Spaniol (as cited in Malchiodi, 2003, p. 268) affirmed that the state of health care in the United States discourages therapists from providing ³hope-inspiring approaches;´ this is due to brief treatment, sometimes limited to one or two sessions within the hospital and a few months in day treatment. Spaniol (as cited in Malchiodi, 2003) further stressed ³Individual art therapy is nearly obsolete, and people are often seen in large groups with various diagnoses, emotional states and cognitive abilities, and at widely different stages of their recovery´ (p. 268). Jenny explained the beneficial treatment experience she received at Facility B; she conveyed this treatment experience as a helpful due to the amount of space and time give for her to be alone in her art making process. As opposed to more prescribed groups

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or forms of treatment, just knowing the psychiatrist in charge was there if needed, yet having space for independent exploration allowed for development of a sense of security. At Facility B Jenny could work on art making at her own time and pace with her choice of materials. In this studio environment, Jenny found she was able to revisit her artist self, affirming that she felt like herself again. The shift in treatment was in tune with a person-centered, humanistic approach to creative arts therapy; according to Rogers (as cited in Rubin, 2001) this approach encourages ³the belief that every person has worth, dignity, the capacity for self-direction and an inherent impulse toward growth´ (p. 164). This return to a positive sense of self was in stark contrast to the effects she described from the treatment on the inpatient psychiatric unit, described as ³feeling you¶re not worthy because you lose your identity.´ Furthermore, Jenny summed up her grievances with the mental health care system, by stating: ³That¶s why people go crazy. There are systems for the aftermath, but there is no prevention in mental health, only treatment for after a breakdown, but not enough support system for people who might go crazy.´ This sentiment and her experience at Facility B, fueled Jenny to create an art space for people with mental illnesses in England; the space provides a refuge for artists, is equipped with occupational therapists and acts as an alternative to hospitalization. Another participant, Barbara, explained how the consistency, structure and stability of Facility B were helpful components to her overall treatment. She recounted her return to Facility B after a short hospitalization. She was concerned she would not be allowed to go back after her stay in the hospital. To her surprise, Barbara was welcomed back and able to pick up where she left off with her artwork. This dependability brought

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about the awareness that she had somewhere to come back to; a further sense of trust and belonging was developed by knowing that the professionals at Facility B would not turn their backs on her. Sandra mentioned various pharmaceutical treatments she endured, elaborating on the ill effects many of them have had on her health. She recounted one extreme occasion in which her medication induced a heat stroke; feeling faint, Sandra had to leave work early and stumbled upon Facility A, seeking a place to rest. Having no idea Facility A was a gallery for people with mental illness she was welcomed, given a glass of water and called a cab to the hospital. These kind gestures led Sandra to return to Facility A, this time discovering what it was and soon incorporating herself within the gallery. Here she was encouraged and empowered to begin exhibiting her artwork. Dawn met many friends through her treatment history. These friends too have mental illness. Having friends that also have a mental illness helps her gauge when she might be putting herself in a dangerous situation. Dawn described her experiences with manic feelings that lead her to solicit strangers via the internet for nude modeling. She proceeded, explaining these situations as dangerous and unpredictable. Dawn found that since friends have an understanding of mental illness themselves, they can better recognize when she seems to be going in a manic state. She expressed, ³My friends are also mentally ill and will call me on that stuff«so it¶s important to keep them in the loop.´ Kramer (1971) formed the term sublimation in art as therapy to illustrate the process of primitive urges transforming into socially acceptable behaviors that are insync with ego needs (p. 68). Dawn¶s check in with her friends mirrors this concept of sublimation.

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Although Dawn¶s friendships represent a positive gain from treatment, she also noted the stigmatization of people with a mental illness. She poignantly asserted that people with a mental illness are the ³only people who can get yelled at for being sick.´ This statement represents the type of injustice and stigma found in some treatment facilities. Spaniol (as cited in Rubin, 2001) suggested the benefit of being an authentic therapist that treats clients in a real and genuine way, treating them as fellow humans instead of mental patient (p. 269). This type of interaction leads to therapeutic alliance and encouragement for the client¶s growth. Alice was the first person that I interviewed. When analyzing the data, I realized that she did not specifically reflect on previous forms of treatment or current treatments for her mental illness. However, she did speak about several topics that paralleled a sense of treatment for her mental illness. Alice spoke at great length about several schooling experiences throughout her life. She initially expressed traumatizing times she had early on in school; teachers did not understand her learning disability and ridiculed her. Alice sees this time in life as partially responsible for her PTSD. Alice was then sent to a boarding school with a rigid structure. It was at this school that she had proper attention and concern given to her learning needs. She also spoke about the structure and the sense of boundaries aiding in her communication and understanding of tasks and procedures. This care seemed to develop a sense of an achieving self in Alice. One teacher in particular spent dedicated time working with Alice on her reading and writing. According to Vick ( 2008), ³Giving voice to individuals who might otherwise remain unheard is an act of political and personal empowerment´ (p. 216). She then went on to college; Alice characterized herself during this time as having a reputation for being the

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abstract artist amongst many realists. The development she experienced during boarding school appeared to serve as a molding device allowing Alice to create artwork with confidence in her own style. Community The theme of community refers to the effects of interpersonal interactions the participants have had with individuals and artists within either studio or exhibition space. This theme developed from the feedback each participant shared about their connections with others through the process of art making or exhibiting and the sense of belonging exemplified in some of the responses. Jenny described her experience getting to work in an art gallery as a part of her participation with Facility B. The return to a gallery space brought back a sense of returning to self for Jenny. Having been deeply immersed in the arts community before her admission, it was an important step in her treatment to feel that she could belong again after hospitalization. She recounted the reassurance gained by knowing once she was a part of Facility B, she is always a member; this long lasting membership mirrors a stable object that each client can always revisit, contact, or use as a way to refuel. This sense of acceptance can aid in mastery by acting as the Rapprochement phase in object relations theory; this phase is when the child checks in with the mother, seeing her as a source of protection. This ability to comfortably check-in can lead to healthy separation from the facility, while paving the way for individuation and recovery. Dawn gave quite a different perspective about how community affects her wellbeing and feedback. She explained the importance of exhibiting her work, and importance of having her friends and family see her work as a way to help her stray from

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dangerous situations that emerge during manic periods. Dawn detailed how she wants to be able to be able to share her artwork with her community of friends and family, and in order to do so, she knows the content level has to be appropriate enough for her loved ones to not show concern for her well being or fear of her art. Sandra recounted her first experiences as a part of a college level arts school; the theme of community arose from her description of this space as a ³home and haven.´ Not yet diagnosed, she spent her mid-twenties confused about her feelings and what was wrong with her. Sandra spoke about this art school serving as her only solace during that period of her life. Due to life circumstances, depression, and injuries from her work place, Sandra was making art less and less. Due to these injuries, she could not paint without feeling extreme pain and was devastated by the shift in art production. Sandra¶s return to art was brought about by her accidental run in with Facility A. Initially, when Sandra began to volunteer at Facility A, she did not tell anyone she was an artist. By the accepting and kind presence of the community at Facility A, Sandra became comfortable enough to share about her history with art making. This disclosure was met with great excitement and encouragement to continue. Soon after revealing herself as an artist, Sandra found herself exhibiting in an annual event for Facility A. Although art making continues to be a physical challenge for Sandra, the community of artists at Facility A encourage and support her to move forward with the arts. Schindler and Pletnick (2006) conducted a case study in role development, finding that the role of exhibiting artists helped their participant gain confidence to engage with the group by verbally sharing his thoughts and interests. By exhibiting his artworks, this participant gained positive feedback from his peers; it was this feedback that brought about confidence and thus a

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gain in interpersonal skills. Similarly, the support Sandra received from her peers at Facility A aided her in continuing to be a part of the group and to try new art mediums. Another form of community is the community gained when exhibiting your artwork, often a community of supportive peers. Barbara touched on the element of community when she spoke about attending art openings. She explained that she likes to see other artists¶ work and how they speak about their work. She went onto describe the pride she feels when receiving positive feedback from visitors of an exhibition. This exchange reflects the community at large, and the feelings felt from putting artwork out into the community. Spaniol (1990a) referenced the community building element she witnessed at the 1989 exhibit Art and Mental Illness: New Images. Spaniol found that for those who have not exhibited prior, ³it was the first awareness of belonging to a community of artists who shared similar issues and concerns´ (p. 76). Barbara spoke about her artist community and the enriching experience she has when attending openings; she felt a key component to these positive experiences is having the opportunity to talk to similar artists and receive feedback. Barbara also explained that art openings force her to speak about her artwork: I like to talk about it, it fills a void, the piece fills a void in my life. So, I wouldn¶t know what to say off the top of my head, but then I just did it, and it was not easy, but I challenge myself, because I challenge myself, to finish it and speak about it. This exchange between Barbara and the viewer adds an additional piece to the art making process; in a way the art piece is not even finished until seen and discussed. According to Spaniol (1990a), participants that exhibited in the past can utilize exhibiting and openings as an opportunity for networking and creating support systems (p. 76). In

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return for putting her work into the community and participating in that community, Barbara experienced pride, a boost in confidence and a sense of achievement. This network and experience of the community found through exhibiting, relates to the sense of play within transition space, discussed in the literature review of this study. Winnicott (1971) suggested transitional space as a place for practicing ³attachment and relationships to the world around them´ (p. 54). Community was also reflected in the participation within an artist studio or collective, but also the roles within these groups. Alice spoke with great pride about her position at Facility A. Having been one of the founding participants, Alice took on a great deal of leadership responsibility, even serving as a mentor to other members. As a part of Facility A, Alice taught several different art making workshops throughout the years. As an art teacher she was influenced by her experience in art school and took the position quite seriously. It was clear from the manner in which Alice spoke about teaching, that identity as a teacher brought her a sense of pride and accomplishment. She explained the reactions her students had after seeing a piece of artwork exhibited, ³There¶s great joy in all of a sudden discovering yourself. I can do something I never I expected.´ Although this statement was intended to describe the reaction of her students, it also mirrors the effects Alice experiences from teaching. Alice¶s longstanding bond with the gallery served as a comfortable community in which she understood and took pride in her role in the group. Her position as one of the heads of the directors of the gallery; this made her a familiar figure to everyone who attended the gallery. Art Making Process

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The method in which the participants created their artworks was an integral piece of each conversation. Although this research is geared towards the therapeutic benefits found after the art making process, the art product and related exhibitions would not be justified if personal process were not explained. One participant spoke at length about the importance of her art making process; she adamantly emphasized process over product. In reference to exhibiting her artwork, Alice stated, ³Feels good but doesn¶t define your work or who you are.´ This participant in particular spoke in detail about how she creates with discarded materials, finding beauty in transforming the ugly, thrown away and dirty. She described her method as a process that goes in waves, moments of creating, destroying, and conceptualizing (never giving up, trusting in the art process, and therefore trusting in self). Alice explained that she is not concerned when she is not technically producing, because even when thinking and synthesizing she is still in the process. Dawn reflected on a tumultuous time in her life that brought her back to art making after a long break from creating. A sense of deep turmoil brought her back to art; she used art making as a way to release intense feelings of anger and sadness; after creating this piece she explained feeling, ³a sense of feeling free, feeling right.´ Malchiodi (1999) found that the ³energy mobilized in the process, and the contemplative nature of art at once soothes, relaxes, energizes and lifts one up to a 'natural high'´ (p. 145). Dawn also mentioned her use of creating art on the train as way to curb her anxiety. She found that creating allows her to let go, thus putting her into a meditative state where she is more equipped to handle anxiety provoking situations.

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Sandra explained that being immersed in her figurative art classes as a way to gain peace and pleasure. The overall sense conveyed from the interviews was the element of art making used for self-care. Each participant expressed art making as a way to access a sense of peace and a cathartic release. They also conveyed an awareness of needing art making for their health and wellness. In Malchiodi¶s (1999) study of art therapy with chemical dependency treatment, she found that one art therapist interviewed felt that ³patients just want to do art so they don¶t have to think about all this other stuff´ (p. 145). This finding reflects sentiments expressed by the participants in this study, that art making can serve has a healthy escape and a way to be in control of your world. Jenny spoke about what art making feels like for her stating that the act of creating it is much more important her than exhibiting. She expressed she finds the enjoyment in working out the art making, and finding that once it is out, it is not hers anymore, it is out of her body and into the world. Jenny indicated that the most important elements of art making are getting the idea, working out the idea, and then letting it go. Outcome of art product All the participants spoke specifically about their relationship with the art object/product after the art making process. Each participant possessed a different sense of attachment to their art products. According to Lusebrink (1990) the art product is an important part of looking at the relationship between objective and subjective reality further in art therapy. From this perspective, the art object itself can help facilitate therapeutic goals. Bentensky (1973) explained the art product and its structure as a representation of the personality of the creator. When the artist then reflects on the

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structure and offers a description, an opportunity for integration between inner experience and artistic representation can arise (Lusebrink, 1990, p. 13). The actual art product is the key element to contributing to art exhibitions, and the basis of this study. My first interviewee, Alice, mentioned on several occasions that the product did not matter to her; she explained her main interest and reason for making art was the artistic process. She in fact repeated her sentiments regarding process and product so many times, that a strange paradox began to occur; Alice was reciting the motto of old and generic views of art therapy, process over product. However, the difference here was that Alice was an actively exhibiting artist. Although she described her passion for the process of creating over the actual outcome, she yearned to share the outcome or art product with people through exhibiting. Alice used art to convey personal and political messages, therefore she was able to separate or individuate from the product, allowing for the art to exist on its own. Dawn also uses her artwork to convey messages and social commentary. Therefore the outcomes of her art pieces are personally relevant, while conveying a universally understood commentary. She explained that she creates artwork that pushes the envelope and speaks about stereotypes and stigma portrayed by the media. Dawn was inspired by a book about stereotypes in the African American community; this book stated that in 1997 more young black men were in colleges than in jails. This particular fact moved Dawn to create a mixed medium series related the finding. Dawn expressed her motivation is to expose the negative stereotypes depicted in the media. She described these works as ³in your face, yet pretty.´ During the interview, I mentioned that it seemed

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Dawn was creating a visual metaphor for all stigmas; I sensed from our interview that she felt similarly about stigma against people with mental illnesses. Dawn replied, continuing the content of her paintings: There¶s a preconceived notion of how the world sees them and it¶s sad and in this country is this true? It¶s not the government fault, it¶s the media¶s fault, it¶s all pieces of this, it all comes down to, are you crazy when you think it¶s not the way everyone¶s telling you? If you believe you¶re just as capable as everyone else, just as worth it, I¶m just as smart, just as intelligent, just as resilience. Those are the truths. The truths that you are a gang banger that you belong in jail, just because everyone¶s telling you it is, doesn¶t make you crazy if you don¶t believe it! Dawn uses the art object as her voice, conveying personal feelings, and inviting others to think and question societal dilemmas. Jenny shared a similar view as Alice, exclaiming her need for artistic process over the actual make up of the product. As both a performance artist and painter, Jenny depicted her experience with these art forms as vastly distinct from one another. During her poetry readings, she cannot separate the process and product element, inherent in the work of performance, they are seamlessly integrated. However, she explained her paintings to be a means of releasing emotions while creating and receive money for the outcome. Jenny spoke about her painting as the business side of her craft. Another interviewee, Barbara also spoke about her relationship to her art product, but from a contrasting point of view. Barbara mentioned her art as filling a void in herself. Barbara spoke about her art process, but mainly spoke about how the finished art product affects her. She experiences not only the creating process by also the art piece as

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a piece of herself. Barbara expressed that it made her feel good when other artist from facility B would see her art pieces and compliment her good work, ³It made me feel so proud of myself that I accomplished that.´ Due to this feedback, her art piece served as a way to connect to others and receive external validation. The validation fuels Barbara to continue creating art as a way to gain a boost in self-esteem, motivation and happiness. Some of the interviewees also mentioned the relevance of selling their work, and their feelings about selling. Barbara mentioned selling artwork as a motivating factor. While Sandra found selling artwork to contribute to a sense of confidence that the art is ³worthy,´ yet felt like letting go of each piece was like letting go of a piece of her heart. Barbara too shared this sense of attachment to the art pieces, both participants finding them as an extension of themselves. Barbara stated that when she knows a buyer has hung up her art piece, she knows they ³didn¶t destroy her.´ This statement exemplifies how the art object itself can act an extension of the creator. Winnicott (1971) referred to this type of experience as a ³transitional phenomena´, the experience of ³self, yet not self´ (p. 50). In an effort to sell, Dawn marketed her artwork on a social networking website. She explained that the pieces sold at such a fast rate, she didn¶t have a chance to promote them further on an art website. Jenny also sells her artwork on the internet; she has her own website to showcase her works. These efforts to sell work reveal a sense of financial and vocational ownership. Rosenfield (1992) found that vocational services, such as work and employment, are important parts of treatment in regards to life satisfaction for people with mental illness. These responses confirm that selling artwork can serve as a vocational tool, leading to financial gain and a sense of empowerment.

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Emotional involvement toward exhibiting This category represents the participant¶s responses and reactions towards participating in art exhibitions. The category emerged because each participant spoke about art exhibitions in relation to what extent they are involved in the process and how exhibiting affects their feelings about their art work and their creative process. Rogers (as cited in Rubin, 2001) referenced the term creative connection to explain a creative process in which one art form unfolds into another; therefore using the arts in sequence can reveal inner truths with new depth and meaning (p. 165). In this way, the making of art unfolding into the exhibiting of art can be seen creative connection. While Alice spoke at great detail about the importance of exhibiting her work earlier on in her adulthood, she found that at this current time in her life that, ³exhibiting feels good but doesn¶t define the work and who you are.´ However, Alice shared some conflicting sentiments about exhibitions, while she explained that she doesn¶t care about showing her art work, that it is more about the process, she also stated in a later interview that she is interested in showing in galleries other than Facility A. During a second interview with Alice, she had decided to actually leave her position at facility A and instead work in another department of the umbrella facility. Alice explained this departure as a need to separate from Facility A in order to move forward and gain additional feedback by exhibiting at other venues. Alice confidently described her decision about the departure as a decision she had to make, that she was very happy about it and it was good for her art. She expressed that she needed to make this shift for herself, and that she wanted to continue showing her work at Facility A and also at other galleries. Alice¶s ability to execute this healthy separation mirrors the

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separation/individuation phase in object relations theory. Separation individuation represents a period when one has found confidence from healthy attachments and can separate from symbiosis to autonomously further their identity (Mahler, 1975). Alice¶s positive associations with exhibiting her artwork at Facility A and the community formed by exhibiting at the gallery, help Alice to separate and to make connections with other galleries. This situation also highlights the artwork functioning as a transitional object. In this sense, by exhibiting previously, the artwork is filled with meaning, and can serve as a source of support to move into a new phase of exhibiting. During Barbara¶s interview, she spoke about her exhibition experiences with beaming pride. She proudly mentioned she had participated in so many exhibitions, she could no longer remember how many. Barbara touched on many aspects of her involvement in exhibiting her artwork, and how they affect her emotions and motivation. Barbara has participated in several group and solo shows; she recounted her first exhibition with Facility B as a source of great accomplishment. These prideful feelings, boosted her confidence, and motivated Barbara to take part in several aspects of exhibiting, such as creating calendars, and artwork for a music CD. She discussed being at the openings as a part of her artistic process; she explained how talking about her art pieces can be a bit intimidating, but she overcomes that feelings and talks about her work as a way to finish the piece. This second part to her process exemplifies a bridge between subjective and objective space, found in the transitional space (Winnicott, 1971) of the exhibition. Sandra viewed exhibiting as sometimes anxiety provoking, but yet a way to boost self-esteem. She recalled her first curated exhibition with Facility A,

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It never meant much to me but seeing it through his eyes, started looking at it in a different way. It was an abstract, and I thought maybe I can do something abstract that I might like, different. These pieces were stored away, put away and never looked at. When I first heard the positive feedback, I thought these are not bad, started looking at work in a different way. I don¶t know why it took me so long to appreciate the work. The positive feedback Sandra received from her peers aided in shifts in feelings towards her own work, and therefore feelings about herself. This feedback encourages her to exhibit her artwork. Dawn¶s participation in exhibiting her work is layered, not only does she participate in group exhibits as a part of facility b, she always holds exhibiting in her home and exhibits her work on the internet. She discussed the use of social commentary in some of her works. Dawn described how she uses her artwork to speak to the prejudices in society. By creating social commentary art pieces, Dawn is already anticipating exhibiting, and thinking of sending a message to the viewer. Therefore her involvement in exhibiting begins during the art making process. Also, as mentioned previously, Dawn utilizes exhibitions as a way to stabilize her moods. When she feels manic, she finds it helpful to talk to people about her work and exhibiting, forces her to listen. When Dawn is feeling down, exhibiting brings her up, by offering encouragement found from positive feedback and interest in her artwork. This therapeutic element found through exhibitions, mirrors Kramer¶s (1986) concept of the Third Hand, as used by Henley¶s (1995) study, relating studio space to the Third Hand. This concept explains the environment acting as a therapeutic component.

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Jenny explained her multi-layered connection with exhibiting. She has been exhibiting for most of her life and enjoys being a part of the process from beginning to end, including creating her own events. Jenny spoke about how much she enjoys executing the events, finding the venue, creating the atmosphere, getting the acts together, showcasing in an alternative way in a sense. While she also shows in galleries and juried shows, Jenny described being most fond of aiding in producing the entire experience. This involvement reflects a sense of control and ownership in the exhibiting process. Jenny also expressed the differences she feels when performing live poetry compared to exhibiting paintings. She explained that when creating the painting it is hers, but when it is up on the wall at a show, she lets it go; the artwork then becomes a part of the viewer. Jenny emphasized the importance of having an artistic idea, working it out and then letting it go. She explained how her poetry performances differed because it was her reading in real time, not acting, but letting go and discharging the idea in real time. Jenny depicted her poetry performances by asserting, ³I don¶t detach, it¶s me, I don¶t perform it as an actor, it¶s me, I don¶t do actors. It¶s good because it challenges me not to be as shy as I am.´ Spaniol (1990a) regarded having an active role in the exhibition process as a great source of empowerment for the artist (p. 78). Control over life The Category describes the overall theme that was gathered from all interviews. After analyzing data grounded in the participants responses, it became clear, via comparison, that the one major component found within each response was the sense of control each participant gained by art making. Rotter (1966) explained control as life outcomes being rooted in the consequences of one¶s own actions. In essence this concept

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of control emphasizes life circumstances based on an internal locus of control, over external control. Spaniol (as cited in Rubin, 2001) noted loss of control as a one of the greatest losses that accompanies a mental illness. Although conveyed and felt in varying forms, art and art making prevailed as a source of control in each of these individuals lives. Rosenfield (1992) noted that ³Previous research found that low perceptions of control and personal control correlates with lower psychological well being´ (p. 300). This theme was used as the precursor to the formation of the central phenomenon of this study, Mastery. Further, Rosenfield linked low sense of self to lack of control over life circumstances. Perceived control was found as a key component in occupational therapy treatment for people with long term mental illness (Eklund, 2007, p. 535). Lastly, this section also reflects the control all participants have on their amount of involvement with creating and exhibiting their art. Both Facility A and B do not require exhibiting to participate in the program, therefore it is the client¶s choice; this ability to choose represents a degree of actual power these individuals have over their life. One contributing factor to a sense of mastery is an individual¶s actual power (Rosenfield, 1989). Sandra found that in very tumultuous times in her life creating art was her only solace. Sandra explained that during the most confusing times, pre-diagnosis, she could look to creating art as a constant in her life. Art was a stabilizing tool for Sandra, she could control her creation, and get lost in the process; this served as a grounding tool for times in her life when things seemed out of control. Sandra described a time before she was diagnosed and was not sure what was happening with herself. She was losing jobs

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and experiencing unexplained sadness, yet she could still find a peace during art making. She explained that when she had art in her life she found meaning. Jenny spoke at length about issues related to control over her life. One major theme that came up within our interview was control over her treatment. When Jenny was able to attend Facility B as a major component of her treatment plan, she was able to take control over the type of treatment she receives and thus regain feelings of being back to her old self. Feen-Calligan (as cited in Malchiodi, 1999) suggested the mastery over traumatic events when patient begins to take an active role. Jenny stated that the treatment she received at Facility B helped her gain back will power. She also reiterated throughout the interview how difficult it was to have ³people wanting to deal with you.´ Jenny explained how many of her encounters within the mental health system left her feeling helpless, because ³strangers were trying to make her a new person.´ This type of forced treatment can leave an individual having no control over their life circumstances. Jenny stressed how many inpatient admissions left her feeling stripped of confidence and uniqueness. When put in these situations, Jenny yearned to gain back autonomy over her life decisions. Facility B offered to Jenny a way to return to a way of living she knew, while also offering her more actual control over her treatment and in essence paved a road to her recovery. Jenny extended the sense of control she gained from Facility B, by giving back to the mental health care system and starting an art space for people with mental illness. This space serves as an alternative to hospitalization, offering music and arts; through this giving gesture Jenny offers opportunities for others to gain a sense of control in what can be out of control times.

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As mentioned previously, Barbara described the feelings she had around selling her artwork, and the confidence gained when she receives positive feedback about her artwork. She also explained how these elements of showing her work, fuel her to move forward and continue creating; this push forward demonstrates Barbara having control her life, control over money she earns and control over events she participates in. Dawn uses art exhibitions as a way to gain tangible control over manic periods. As noted earlier, Dawn explained how exhibiting her art aids her in making safer decisions as to creating her work. She also noted that when she exhibits her artwork she is put in a position where she has to speak to the viewers; this helps bring her up during times of depression. Choosing to exhibit for these reasons exemplifies how Dawn takes control over her life circumstance and makes decisions to be an acting agent in her own life. Alice touched on the theme of control by making choices about her roles within Facility A. Alice spoke great deal about the pride she takes in teaching a class at Facility A; and in the second interview conducted due to a recording failure, Alice had completely changed her role at Facility A. She decided to no longer work at Facility because she wanted opportunities to get distance from Facility A, offering more changes to exhibit her art in other venues. Alice also finds control through her art making process. Alice spoke about her creating process as ebbs and flow of actually creating and periods of synthesizing and thinking about the work. She works primarily with found object/trash, using this material as a way to represent transformation. She aims to continue to grow and change with her artwork, not to get stuck creating the same images. The way Alice describes her process shows a level of internal control related to her

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decision making during the creative process. Her process also speaks to a sense of metaphor for transforming self. Mastery Control over one¶s life is a pathway to mastery. Mastery is defined in several ways, for purposes of this study, I will be using two definitions in conjunction with one another. Mastery can be defined as possession of a great skill or retaining enough knowledge to be master of a subject (Merriam-Webster Dictionary Online, 2010). Rosenfield (1992) proposed that mental health programs should focus improvement of quality of life for treatment of the mentally ill. She suggested methods for vocational rehabilitation, financial support and empowerment result in a sense of actual power over one¶s life. This power culminates in gaining mastery or perceived control, infusing together as an increase of subjective quality of life. For purposes of this study, I am correlating vocational activities with exhibiting and creating art, financial support with selling artwork and empowerment with experiences exhibiting art, feedback received about art and positive feelings while creating art. Essentially, Rosenfield(1992) found that empowerment via actual power, and perceived power contribute to a sense of mastery, which then results in greater life satisfaction; therefore treatment for mental illness should involve tools to gain these elements. These findings were discovered through Rosenfield¶s study of the empowerment approach to treatment. Whether the empowerment is experienced from selling, sharing the artwork with a community, meeting new people, gaining new opportunities, gaining feedback or watching an art piece come to fruition, I found empowerment as a crucial component in exhibiting art. If art therapy utilizes this

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empowerment approach for art exhibition interventions, art exhibits can be seen as an effective therapeutic tool. Similar to Rosenfield¶s (1992) findings, Eklund (2007) found a strong relationship between self-mastery and satisfaction with daily occupations; the study defined occupations as daily occupations and activity level. The participant¶s accounts of their activities from creating the art, to participating in events speak to a sense of daily occupations. The participants also mentioned stigma and its damaging effects. Stigmatization places people with mental illnesses into a disadvantaged group, thus, selfmastery becomes increasingly important (Rosenfield, 1997, p. 665). According to Keyes (2002) ³positive functioning consists of six dimensions of psychological well-being: selfacceptance, positive relations with others, personal growth, purpose in life, environmental mastery, and autonomy´ (p. 208). The sense of mastery gained by art making and exhibiting is exemplified most poignantly by the resilience that was expressed by each participant. As the researcher, I was most astonished by the amount of recorded footage I received. Through the transcription process an undertone of resilience became clear to me. Resilience is defined as being able to rise above adversity, and not let the adversity to define you (Marano, 2003). Resilient people do not avoid struggle, rather the individual is able to struggle and continue to function. Each participant demonstrated resilience and the will to move forward. Akin to the concept of resilience is the concept of recovery. Recovery means to rise above afflictions and transcend the limits of the illness (Spaniol as cited in Rubin, 2001, p. 270). Recovery does not mean that mental illness disappears, rather it implies that one manages to build a meaningful life despite struggles due to mental illness. By

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this definition each participant¶s responses illustrated a stage of recovery closely associated with participation in art therapy. Art exhibitions are a part of a matrix of positive adaptive tool these participants have utilized. This study found that art exhibition is a beneficial therapeutic intervention, as it relates to community, identity, control over life, and an overall a sense of mastery. The additional themes, previous forms of treatment, art making process, and outcome of art product, exemplify tools for gauging control over one¶s life. Discussion of Implications This study found that exhibiting artwork had a positive impact on each of the participant¶s lives. Each participant spoke about the positive associations they had about exhibiting their art, and the motivating features of exhibiting. If art exhibitions aid in developing a sense of mastery, the implementation of art exhibitions in conjunction with art therapy may engender beneficial therapeutic effects for adults with mental illness. The art experiences of the adults with mental illness in this study have contributed to a sense of mastery and control in their lives. Mastery can be experienced in different ways, through mastering a work of art, conquering fears during an exhibition, feeling motivated to continue creating, or by receiving positive feedback from art peers and viewers. The findings indicate exhibiting artwork can act as a motivational feature for adults with mental illness. Exhibiting artwork is rooted in reality and seen as a culturally significant event. Art exhibitions offer opportunities for the outsiders to be insiders, and can be a reflective tool for testing out various pieces of self. Based on these findings, this study supports the usefulness of art exhibitions as a part of art therapy treatment for people with mental illness.

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Although exhibiting art had a different meaning for each participant, it was clear that all the participants were eager to exhibit their stories and help shed light on this topic. This demonstrated that exhibiting artwork in combination with encouraging treatment facilities, have led these participants to become advocates, for the arts, for people with mental illness, and for mentally ill artists. In a way they put themselves on exhibit, to share who they are and what they represent. Additionally, this study found that the participants emphasized the importance of treatment facilities that provided a humanizing and accepting environment. Furthermore, opportunities for decision-making, vocational activities (i.e.: open studios, exhibitions), and economic empowerment, are all factors in helpful treatment environments and in exhibiting. Finally, beyond the exhibitions themselves, it is crucial the client artists are taken seriously. Effectual treatment and incorporation of exhibitions should mirror the seriousness the artists feel about their work, by nurturing their artist identity and sense of dedication. Each participant expressed their positive feelings about exhibiting, with attention to the process of creating, and the impact creating art has on their lives. The findings also suggest art making itself gives purpose in these peoples¶ lives. The participants expressed that creating art served as a refuge, transformative experience, therapeutic escape, and a source of pride. Creating art holds a very important place in each participant¶s life. Further Studies Findings suggest that further studies should be conducted on the topic of art exhibitions as they relate to treatment for people with mental illness because they might help to further clarify the benefits of exhibiting. Further, it may be beneficial for the field

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of art therapy and for the populations involved for more studies to be conducted using qualitative grounded theory methodology, an approach in which a theory is grounded in the interview data. Grounded theory utilizes qualitative data analysis procedures to understand a process and interactions. The theory is then developed based on the phenomenon found in the data analysis. I found this methodology especially beneficial for this population because the theory is participant derived. I felt utilizing this type of method was less biased because it did not test against a hypothesis. I found the lessoned bias to be particularly important for an already stigmatized population. Essentially, these kinds of studies can give clients and patients a say in future treatment procedures. Additionally, the rich and in-depth amount of interview content I received could in no way be justified and utilized to its best and most helpful ability to the community via only graduate thesis. It is my goal to continue studies in this area and I aim to revisit the participants interviewed in this thesis to continue writing based on art identity and resiliency. Further, a comparative study between exhibiting artists with mental illness involved in art therapy programs and those who are not could bring forth important realizations about the incorporation of art exhibitions in art therapy treatment. This information could be helpful in expanding views of art therapy practice and bridging the gaps between the art world, art therapy world, and treatment facilities such as those in this study. Also, further studies regarding art therapy with artistic traditions, such as exhibitions, can bring art therapy out of its niche in the art world and the art in art therapy can be further acknowledged. That type of study could aid in Vick & Sexton-Radek¶s (2008) suggestion to amend outdated notions that art therapy only utilizes ³child like

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materials, lack of seriousness for the art, and interpreting all the art works´ (p. 8). The profession can be enriched by shifting some of the focus from the mental health world, to the art world (Lachman-Chapin et al., 1998, p. 234). Lastly, if I were to conduct this study again I would utilize mixed methodology, combining both qualitative and quantitative in an effort to produce statistical research for a more substantiated study while still sharing the direct experiences of the participants. Therefore, the lived experiences of the participants would be highlighted, allowing for a rich understanding of their life circumstances, while a scored questionnaire would be able to aid in finding more quantifiably measurable correlations.

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Conclusion Imagine a world where boundaries are flexible, where facilities such as those mentioned in this thesis and art therapy facilities are operating in unison. In this world, art therapy can further honor the art object to best suit the artist, offering opportunities for further creative exploration beyond the moment of creation. The participants in this study described the powerful affect art has had on their lives. Whether artwork is used for cathartic release, social commentary, exhibiting, monetary purposes, artist identity formation, or the empowering sensation of mastering a skill, each participant acknowledged the importance, seriousness and dedication they have to the arts. All the participants in this study participated in a developmental model, studio or gallery art program. This study brings to question the possibility for art therapy treatment, reaching across the continuum of art as therapy and art psychotherapy to function flexibly, as needed together with studio model programs. While the open studio approach to art therapy has recently become more prevalent, governing models in art therapy are still dynamically oriented art therapy (art psychotherapy) and art as therapy. However, these models inherently link to the medical model due to their use for treatment of pathology (Vick and Sexton-Radek, 2008, p. 4). This linkage perpetuates the identity of mental patient and illness, discouraging more positive identity associations. However, I am not suggesting elimination of the more traditional art therapy paradigms, because they not only hold historic value, but also still continue to engender therapeutic effects. I am suggesting that melding together developmental model studio/gallery programs with

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more traditional art therapy models, has the potential to highlight each modality¶s strength, creating a cooperative vehicle of healing. This type of merger would require increased attunement on the part of the therapist to the ebb and flow of therapeutic space, and actual environment. Therefore the art therapist would have to remain flexible and able to represent artist, studio facilitator, and art therapist, shape-shifting as needed. Principles in installation art, where creator can become observer and observer can become creator, serve as a poignant example for this type of healing sphere. Utilizing these principles offers opportunities to cross boundaries in a therapeutic way and to eliminate hierarchical forces. Therefore, room for shared creative expression can permeate the space; now the art, healing, viewer, artist, client, therapist, psychiatrist, director, are on a level playing field within the transitional space. Here one can remember to play, remember we are all human; one can acknowledge that the mutual experience of art-making, the transience of the human experience and the continuum traveled between mental illness and well-being. Artist, Joseph Beuys articulated embodiment in art as a powerful tool for change. He suggested the possibility of social organisms transforming into a work of art; thus, the entire process of this work of art combines production and consumption, forming quality (Beuys, 1974). Beuys, conceptualized the social sculpture, representing society as a large work of art, in which each person can creatively contribute to society. Through the lens of Beuys, artistic contributions allow individuals to share in the engagement of social change. I see this type of social change comparable to expansion within the canon of art therapy practice, with potential for innovative shifts in ideology, roles, and community engagement.

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Appendix A Interview Questionnaire

Age______

Mental Illness______

1) How did you begin your relationship to art? 2) How many exhibitions have you been a part of? a) Were they group or solo shows? 3) How long have you been showing your work 4) Describe some feelings about having your artwork displayed 5) Describe to the best of your ability an experience of an art opening you attended with your artwork displayed. 6) Describe to the best of your ability some feelings you had before the exhibit. 7) Describe to the best of your ability some feelings felt after the exhibit. 8) Describe what it was like to see you work displayed on the wall outside of the studio space. 9) Did your art look or feel different at the exhibit? 10) Did you receive feedback about your art work when it was exhibited and what was some of the feedback you received? 11) Did you talk about your art work to viewers, how did that feel? 12) How did you feel returning to your artwork after the exhibit, either in following art therapy sessions or in the studio at your own time? 13) Would you participate in more exhibitions? 14) Do you feel different after exhibiting? Do you view yourself differently after exhibiting?

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Exhibiting Artists with Mental Illnesss

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